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[IPk] Re: ip-uk-digest V2 #584



Re Honeymoon period,

thanks Pat for your response. I think I mislead you when I said
he had dropped 1 unit off for breakfast etc. He takes 75 grammes
carbohydrate for breakfast and when he left hospital, his insulin
requirements were set as follows for the 75g- 
BG below 5,  6 units,
BG 5-10, 7 units,
BG 11-20, 8 units

Now for 75g with  a BG below 5 he takes 5 units and so on.

Jamie has insulin tables like this for all meals, related to his
weight and Carbohydrate intake. We see that he has to take
slightly less insulin for the 85g evening meal than the 85g
lunchtime meal for each BG range. (half a unit less).

He knows how to adjust boluses but we are not supposed to do
this without consulting the hospital.      

Jamie spent 11 days in hospital, 7 of those on the pump so they
spent a lot of time getting his boluses "right" although did warn
us that this would need regular changing.

I think what I was trying to find out if there was some kind of
measure that linked insulin taken to weight that would tell us he
was definately in honeymoon. I guess things arn't as clear-cut as
that.

Thanks anyway for taking time to respond

regards

Maggie (mum Jamie dx 22.9.03 and pumping ever since)

>>> ip-uk-digest <email @ redacted> Wednesday, 17.
December 2003 09:47:31 am >>>

ip-uk-digest       Wednesday, December 17 2003       Volume 02 :
Number 584



PLEASE edit the subject line of your reply messages.
####################################################
This issue of the digest contains:
[IPk] Belly To Leg agghhh
[IPk] changing insulin needs
Re: [IPk] changing insulin needs
[IPk] Dave: using leg
[IPk] Honeymoon Period
Re: [IPk] Dave: using leg
[IPk] Naming your pump (was sleeping with the pump)
[IPk] chemo update
RE: [IPk] chemo update
Re: [IPk] Dave: using leg
Re: [IPk] Honeymoon Period
Re: [IPk] changing insulin needs
RE: [IPk] lack of knowledge was chemo update
RE: [IPk] lack of knowledge was chemo update

----------------------------------------------------------------------

Date: Mon, 15 Dec 2003 21:03:40 -0000
From: "dave.sayer20" <email @ redacted>
Subject: [IPk] Belly To Leg agghhh

     Hi all just another really rotten day, i have developed 2
large rotten
abcesses one each side of my tum so I have been putting the
canulars into my
leg.
     I thought i would have to reduce my basels due to the leg
being more
active but, and I know I have a serious infection but my bg's
are impossibly
high I am testing every hour and bolusing accordingly.
     The thing is I know people have used different sites and I
use to inject
in my leg but is it just you can't use the leg whilst pumping,
as I've found I
actually like using my leg.
     In the meantime the hospital won't drain them as they are
too big and
hard so they have given me a higher than average dose of
antibiotics (already
been on antib's for 10 days) and some lovely Magnesium Sulpahte
to draw it
out.
     I cant have penicillin as I have a bad reaction to it, and
I have had one
of these evry December for the last 4 years the same time I have
been pumping
I am sure its seasonal stress, does anyone else get these?, I
follow all the
basic cleanliness things but I know i have a very low immune
system.
Some advice would be welcomed.

A very depressed Diabetic Dave
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------------------------------

Date: Tue, 16 Dec 2003 08:47:09 -0000
From: "Fiona Stoate" <email @ redacted>
Subject: [IPk] changing insulin needs

Hi

I ve just had three months of stable, feeling I ve cracked
it pumping!
However, I do find my basal needs vary but I realise working
shifts and
dashing all over the place don t make for static needs!  My
insulin
sensitivity seems very high at the moment when I m sleeping as
I ve
needed to reduce the basal to 0.1u/hr for a few hours to prevent
hypos,
but when I wake I have to run it at 0.7u/hr for a couple of
hours as I
find without eating, just getting up bs will increase by 2 -3
mmol.
Does anyone set the pump to deliver 0u/hr for any of the time
they are
asleep?  I don t think it would be possible for long for me. 
I just had
a real shock two days ago when having got over confident with
everything
I left changing a brilliant Quick set site as I was busy in the
morning.
I changed it before supper and thought hey why not try under my
arm.
Crackers   I was going to work in an intensive and special
care baby
unit.  I checked just before I left, only an hour after eating
and bs
was 12mmol.  That was high but food not long in.  Drove to work
had
report and checked again, well over 20mmol!  Yikkes  puts one in
such a
difficult situation as I had drugs to sort out and give but I
knew I
couldn t ignore myself as I think I would develop ketosis very
quickly.
Fortunately I had kept my now 4 day old very good site in so I
quickly
swapped it over and bolused.  After I sorted out  a few things I
checked
bs and still above 20mmol which I realised was the insulin
resistance
now present  but  thought I had better inject a couple of units
as I
couldn t afford to have too much time trying to get sorted. 
With a
vastly increased basal rate as well it gradually got knocked
back into
shape over about 4 hours but did end up dropping to 1.4mmol
quite
suddenly but didn t feel too bad and enjoyed eating some
Quality Streets
as well as glucose tabs.  The Quick Set on my arm was bent at
right
angles but hadn t alarmed with a bolus of over 3 units so I
don t know
where that insulin went.   I found I was dying to discuss my
predicament
at work but I feel that people would rather not know what I m
up to and
I think the pump scares them and they are health professionals! 
So
anyway I m telling you to get it off my chest!  Managed to
resite
successfully yesterday back on my abdomen..

Bye for now

Fiona
Pumping 5 months DM Type 1 36yrs
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------------------------------

Date: Tue, 16 Dec 2003 10:48:49 -0000
From: "Abigail King" <email @ redacted>
Subject: Re: [IPk] changing insulin needs

 I've had exactley the same thing happen to me when I put a set
in my loin last
summer. I certainly can become ketotic in a matter of
 hours so I treat a BG over about 14 or 15 almost as urgently as
a hypo with
ketone test if possible and appropriate action
following. must be difficult in your job though


 ----- Original Message --> as well as glucose tabs. The Quick
Set on my arm was
bent at right
> angles but hadn t alarmed with a bolus of over 3 units so I
don t know
> where that insulin went.
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------------------------------

Date: Tue, 16 Dec 2003 10:52:42 -0000
From: "Abigail King" <email @ redacted>
Subject: [IPk] Dave: using leg

 I don't think there is a problem as such, using the thigh.
Probabley a good
thing to give your tum a rest every so often. I find I
 can only do this if I am waring skirt and no tights ( long
skirt or summer!) or
a very light baggy pair of cotton trousers rather
 than jeans, as I seem to catch every thing else on the cannula
and dislodge
it.!
Hope things heal soon !
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------------------------------

Date: Tue, 16 Dec 2003 11:47:20 +0100
From: "Margaret Reid" <email @ redacted>
Subject: [IPk] Honeymoon Period

Dear IP group,
I've heard a lot about the honeymoon period but don't know
whether Jamie has been through it or not. Can someone help
advise
us?
He was diagnosed the 22nd September and has been pumping since
the 26th September. He is 11 years old.
When he left hospital he weighed 36kg and was taking 32units
approx humulog. 3 months later he weighs 42kg and takes about
30
units but with more frequent hypos.
Fortunately he has good hypo awareness - spots them at a BG of
about 4.2  and we have reduced basals by about 0.5 a day in
total
and dropped 1 unit off breakfast and 0.5 unit off lunch (in
discussion with the hospital).
He is becoming increasingly worried that he is going to have
more hypos because of the honeymoon period but we don't know
whether he is in it or not or has gone through it. Help!

regards
Maggie mum to Jamie dx 22/9/03, pumping ever since (D-Tron
plus)
- ----------------------------------------------------------
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contact: HELP@insulin-pumpers.org 

------------------------------

Date: Tue, 16 Dec 2003 11:31:15 +0000
From: Diana Maynard <email @ redacted>
Subject: Re: [IPk] Dave: using leg

I've tried the leg 3 or 4 times and every time my BGs have
soared withitn 
hours. I'm a bit scared to try again now, but would really like
to use my 
legs occasionally. I know other people have managed with no
problem.
Di

On Tuesday 16 Dec 2003 10:52 am, you wrote:
>  I don't think there is a problem as such, using the thigh.
Probabley a
> good thing to give your tum a rest every so often. I find I
>  can only do this if I am waring skirt and no tights ( long
skirt or
> summer!) or a very light baggy pair of cotton trousers rather
>  than jeans, as I seem to catch every thing else on the
cannula and
> dislodge it.!
> Hope things heal soon !
> ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe/change list versions,
> contact: HELP@insulin-pumpers.org 
- ----------------------------------------------------------
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contact: HELP@insulin-pumpers.org 

------------------------------

Date: Tue, 16 Dec 2003 12:56:12 -0000
From: Lesley <email @ redacted>
Subject: [IPk] Naming your pump (was sleeping with the pump)

 Now there's a thought! When I read this message, I thought
about it briefly,
and decided not to name my pump. I tend to think of it as part
of me, now, and
giving it a name would make it separate from me....

Deep stuff!  Hope there aren't any psychologists on this
list...

Best wishes

Lesley
IDDM 35 years, D-Tron 1+ year

- ----------
From:  Diana Maynard [SMTP:email @ redacted] 


My boyfriend tells me I should give my pump a name, since it's
attached to me 
24hours a day. He currently refers to it as my "portable
pancreas" in the 
absence of a name. I always thought that was a bit sad (like
naming your car) 
but maybe I should (I know some people do name their pumps).
What do other 
people call their pumps? I think my pump would definitely have
to be male....
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------------------------------

Date: Tue, 16 Dec 2003 15:42:55 +0000 (GMT)
From: =?iso-8859-1?q?Claire=20Barrett?=
<email @ redacted>
Subject: [IPk] chemo update

thank you to everyone for their support got a call
from the doctor yesterday and will start chemo on
friday (how fun 5 days before christmas) at least i
get to go to the christmas parties before i start. I
will see another doctor on friday so will ask again
what i should expect with my diabetes.

I did not realise till last week how little health
care professionals know about the iinsulin pump. I am
a nurse myself and got fed up explaining to everyone
how the pump works i got comments like you must have
very servere diabetes i managed to cope with using it
apart from when i went for my op and they had to put
me on a sliding scale.


thanks for all your support

love claire

aged 21 iddm since 1996 pumping since june diagnosed
with hodgkins last week

________________________________________________________________________
 BT Yahoo! Broadband - Save #80 when you order online today.
Hurry! Offer ends
21st December 2003. The way the internet was meant to be.
http://uk.rd.yahoo.com/evt=21064/*http://btyahoo.yahoo.co.uk 
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------------------------------

Date: Tue, 16 Dec 2003 18:38:01 -0000
From: "Jackie Jacombs" <email @ redacted>
Subject: RE: [IPk] chemo update

 You might still have lots of explaining to do even if you were
on injections.
In my experience many
 doctors and nurses have scant knowledge about injection
regimens either. When
Sasha went to Oxford for a
 biopsy we had a right old time! One nurse thought that insulin
was given to
correct LOW blood sugar.

 Sorry to hear about the Hodgkin's and I hope the chemo goes
alright and doesn't
cause too many probs with
the BGs levels.


Jackie


> -----Original Message-----
> From: email @ redacted
[mailto:email @ redacted]On 
> Behalf Of Claire Barrett
> Sent: 16 December 2003 03:43
> To: email @ redacted 
> Subject: [IPk] chemo update
>
>
> thank you to everyone for their support got a call
> from the doctor yesterday and will start chemo on
> friday (how fun 5 days before christmas) at least i
> get to go to the christmas parties before i start. I
> will see another doctor on friday so will ask again
> what i should expect with my diabetes.
>
> I did not realise till last week how little health
> care professionals know about the iinsulin pump. I am
> a nurse myself and got fed up explaining to everyone
> how the pump works i got comments like you must have
> very servere diabetes i managed to cope with using it
> apart from when i went for my op and they had to put
> me on a sliding scale.
>
>
> thanks for all your support
>
> love claire
>
> aged 21 iddm since 1996 pumping since june diagnosed
> with hodgkins last week
>
>
________________________________________________________________________
 > BT Yahoo! Broadband - Save #80 when you order online today.
Hurry! Offer ends
> 21st December 2003. The way the internet was meant to be.
> http://uk.rd.yahoo.com/evt=21064/*http://btyahoo.yahoo.co.uk 
> ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe/change list versions,
> contact: HELP@insulin-pumpers.org 
- ----------------------------------------------------------
for HELP or to subscribe/unsubscribe/change list versions,
contact: HELP@insulin-pumpers.org 

------------------------------

Date: Tue, 16 Dec 2003 19:17:39 -0000
From: "Abigail King" <email @ redacted>
Subject: Re: [IPk] Dave: using leg

 Had you used legs a lot with MDI, prepump? could be lots of
gristly bits there,
I used mainly arms and thighs pre pump and only went
 on to tum and bum about 7 months before pumping as erratic
absorption from
other sites was postulated as a cause of my poor control


> I've tried the leg 3 or 4 times and every time my BGs have
soared withitn
> hours. I'm a bit scared to try again now, but would really
like to use my
> legs occasionally. I know other people have managed with no
problem.
> Di
>
> On Tuesday 16 Dec 2003 10:52 am, you wrote:
> >  I don't think there is a problem as such, using the thigh.
Probabley a
> > good thing to give your tum a rest every so often. I find I
> >  can only do this if I am waring skirt and no tights ( long
skirt or
> > summer!) or a very light baggy pair of cotton trousers
rather
> >  than jeans, as I seem to catch every thing else on the
cannula and
> > dislodge it.!
> > Hope things heal soon !
> > ----------------------------------------------------------
> > for HELP or to subscribe/unsubscribe/change list versions,
> > contact: HELP@insulin-pumpers.org 
> ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe/change list versions,
> contact: HELP@insulin-pumpers.org 
- ----------------------------------------------------------
for HELP or to subscribe/unsubscribe/change list versions,
contact: HELP@insulin-pumpers.org 

------------------------------

Date: Tue, 16 Dec 2003 19:14:34 +0000
From: Pat Reynolds <email @ redacted>
Subject: Re: [IPk] Honeymoon Period

In message <email @ redacted>, Margaret Reid
<email @ redacted
coe.org> writes
>Dear IP group,
>I've heard a lot about the honeymoon period but don't know
>whether Jamie has been through it or not. Can someone help
advise
>us?
>He was diagnosed the 22nd September and has been pumping since
>the 26th September. He is 11 years old.
>When he left hospital he weighed 36kg and was taking 32units
>approx humulog. 3 months later he weighs 42kg and takes about
30
>units but with more frequent hypos.
>Fortunately he has good hypo awareness - spots them at a BG of
>about 4.2  and we have reduced basals by about 0.5 a day in
total
>and dropped 1 unit off breakfast and 0.5 unit off lunch (in
>discussion with the hospital).
>He is becoming increasingly worried that he is going to have
>more hypos because of the honeymoon period but we don't know
>whether he is in it or not or has gone through it. Help!

He should cope with honeymoon by reducing basals and changing
the
insulin-to-CHO ratio.  Your saying '
>dropped 1 unit off breakfast and 0.5 unit off lunch (in
>discussion with the hospital).'
is very worrying.  You should be assessing how much carbohydrate
is in
the meal, and working out how much insulin to give, not giving a
set
amount of insulin, and hoping that it won't send him hypo. 
Also, your
hospital should have taught you how to change the basal and
bolus.

What will happen with honeymoon (it may be that he's started
it), is
that he will need less insulin, so you will reduce it.  Then
he'll need
more, and you'll increase it.  This kind of change is going to
happen
throughout his life (short term with things like going on an
active
holiday/not doing much exercise during exams, infections, etc,
and long
term with hormonal changes, etc.  So it's a key skill which he
and you
should acquire asap.  If your hospital doesn't teach diabetes
management, I think you should change to one that does.

Best wishes,

Pat
dm 30+, 508 2+

>
>regards
>Maggie mum to Jamie dx 22/9/03, pumping ever since (D-Tron
plus)
>----------------------------------------------------------
>for HELP or to subscribe/unsubscribe/change list versions,
>contact: HELP@insulin-pumpers.org 

- -- 
Pat Reynolds
email @ redacted 
   "It might look a bit messy now, 
                    but just you come back in 500 years time" 
   (T. Pratchett)
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------------------------------

Date: Tue, 16 Dec 2003 19:35:54 +0000
From: "Melissa Ford" <email @ redacted>
Subject: Re: [IPk] changing insulin needs

Hi,

Remember that it can take 4 units (or so) not getting delivered
for a 
MiniMed 50-whatever model pump to tell you there's a problem.
With my basals 
fluctuating between .9 and 1.2, I usually have not gotten any
insulin for 
3-4 hours by the time I get the alarm, with the accompanying
high bg for 
want of basal insulin. If I get a no-delivery alarm in the
middle of a 
bolus, that'll mean there wasn't any basal getting in for a
while before the 
bolus. Sucks!!!

Melissa, who had a ripe ol' 14.7 this afternoon a couple of
hours after 
lunch thanks to a kink in tubing she didn't know about when she
bolused 4.5 
u. for the meal. (The no-delivery alarm didn't go off until 1.5
hrs after 
the meal, when pump should have been giving me .1 u. of basal)

- ----Original Message Follows----
From: "Abigail King" <email @ redacted>
Reply-To: email @ redacted 
To: <email @ redacted>
Subject: Re: [IPk] changing insulin needs
Date: Tue, 16 Dec 2003 10:48:49 -0000

  ----- Original Message --> as well as glucose tabs. The Quick
Set on my 
arm was
bent at right
 > angles but hadn t alarmed with a bolus of over 3 units so I
don t know
 > where that insulin went.
- ----------------------------------------------------------

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------------------------------

Date: Tue, 16 Dec 2003 22:40:31 -0000
From: "Adrian Miller" <email @ redacted>
Subject: RE: [IPk] lack of knowledge was chemo update

> You might still have lots of explaining to do even if you were
on
injections.
In my experience many doctors and nurses have scant knowledge
about
injection regimens either.

Unfortunately I experienced this when taken to an A&E Department
after a
Hypo episode - my girl friend had given me coffee with loads of
sugar but
unfortunately 2 hours later I still couldn't communicate
properly - this is
a common problem for me after bad Hypos - can take me up to 12
hours to
properly recover (longer if I have been Hypo for a while) The
A&E Department
tested my blood sugar and it was 10mmol. Great I though I would
be
discharged and left to recover in my own time. How wrong could I
be! I was
presented with a pile of sandwiches and a sugar free jelly
(don't know what
good they thought the jelly would do!) . Because I still
couldn't talk (can
think of the words - just can't say them) I got up and walked
out of the
hospital. The Hospital called the police, had me arrested and
brought back
to them and their pile of sandwiches which the A&E Doctor said I
had to eat.
When I refused - he called one of the Junior Hospital
Psychologists, who
interviewed me then called a more senior Psychologist who also
then
interviewed me and then called the Duty Psychologist together
with someone
from Social Services. In effect they were trying to get me
sectioned!
Fortunately as the time went on I became more and more
communicative and
they finally agreed that I could be discharged! This whole
process took
about 12 hours during which time I was accompanied by two police
officers
and my girlfriend wasn't allowed anywhere near me!

What a waste of public resource due to the lack of knowledge of
A&E staff
(and also the less co-operative side of me which comes out
during and after
Hypos!) Its an incident that I can laugh about now but was
pretty terrifying
at the time - I felt I came so close to being hospitalised for
life.

Adrian
DM 20+ Years (Lantus + Humalog for not much longer!)

> http://uk.rd.yahoo.com/evt=21064/*http://btyahoo.yahoo.co.uk 
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------------------------------

Date: Wed, 17 Dec 2003 08:49:59 +0000
From: "Ingrid Morrow" <email @ redacted>
Subject: RE: [IPk] lack of knowledge was chemo update

How ridiculous, I always thought we had a right to refuse
medical treatment, 
but we don't have a right to refuse food?  I imagine if you had
eaten all 
the sandwiches your bg would have soared, potentially leading to

ketoacidosis, and guess who would have got the blame for not
taking care of 
themselves!


Ingrid

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------------------------------

End of ip-uk-digest V2 #584
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