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[IPk] consultants etc

if you think about it, its a miracle so many people ith DM survive as long as
they do. Even some one having clearly suboptimal control often only attends
clinic/ sees DSN every 6 months or yearly or even less frequently if
appointments get cancelled. Some of these do not and are not encouraged to
make meaningful dose or regimen changes and get told to increase the evening
dose by or 4 units or reduce the morning one etc, and then surprise surprise
the A1c is no better 6 months on. Usually no mention of doing a BG at  am to
rule out symogi effect or to take insulatard later in order to counteract dan
phenomenon more effectively. My insulin requirement seem to be constantly
changing and I just deal ith it from day to day. partly in a reactive manner
and partly pattern recognition and analysing previous day's results.I
 don't seem to ever be on my standard basal profile at the moment. I'm alays
running at 80 percent in the morning or110 percent in the evening etc. This
gets a bit frustrating at times but at leeast I'm dealing ith it as
effectively as I can. If I attended a non pump clinic they proabley ould not
be able to keep up ith me (probably  not even understand the basics of people
needing different amounts at different times of day etc) I think the compliant
patient( horrible term) is someone keeping things exactly the same or making
very little changes so the medic doesn't have to ork to hard/ think too hard.
After all it's purely a lack of self discipline isn't it, not being able to
maintain an environment ith a constant temperature, stop having a menstrual
cycle, stay in a sterile cabin to avoid ever having an infection, not ork in
case one day is busier than the next,either never go shopping, clean the
house, excercise or alays do it for exactly the same amount of time...vbg
seriously I think certain professionalsare in denial about the reality of DM,
blood glucose control etc and also the definition of " normal life" and if
they ould be happy to do the things they expect patients to do, in the name of
glycaemic control

I met a professional person-labels herself as a " brittle diabetic", on
novorapid 3x day and insulatard x1. She only gets through 50 strips per month.
If I had time I could have had a long discussion. The reality is her diabetes
is proabley no more brittle than many people here leading a normallife and
having good control. I bet she doesn't carb count or try adjusting the
insulatard timing/ splitting dose etc. And I am sure no one has ever mntioned
the pump to her. I should have. She is proabley like many of us requirements
change frequently but can still achieve control given the right regimen
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