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RE: [IPk] Constant basal requirement?



Hi Sarah


 We used to give the split dose of Insulatard by giving 13 units in the morning
and between 4-6 units at
 7.30 pm. We had to give it later than the Novorapid usually at 8.30am otherwise
it peaks much to
 early for lunch. The then we gave between 4 and 6.5 units of Insulatard in the
evening. Sasha has no
 dawn rise, or didn't appear to have one, until we used Lantus, now we have one
everyday! We only
 needed a small amount of NPH to cover the night in the summer months when she
is active playing outside
 until late, we only need 4 to 4.5 units of NPH to cover the night and during
the winter months when the
 twins are indoors after dark we have to increase the NPH to 6.5 units. Of
course this year she will be
bigger and would need more.

 We could switch back tomorrow morning without much problem, just give the
Insulatard instead of the
 Lantus, and doing extra checks, but I feel that as its supposed to work so well
and give a more steady
 basal we should try for at least a couple of months. If we give up too soon it
might also be held
 against us if one day we are lucky enough to find a hospital near enough who
would be able to supervise a
pump.

 The reason for trying Lantus in the first place is that Sasha has a very bad
hypo with no warning and
 despite the usual treatment and a glucagon injection I still had to call 999
because the fit went on so
 long. Her twin sister was very very shocked and frightened. Her gym training is
3 hours over lunchtime
 on Sundays and although we decreased the Novorapid at breakfast and she ate
regular snacks and ate a
 snack higher in carbs than she would at lunch and then came home from lunch and
ate that without any
 extra short acting insulin I think that the relentless action of the Insulatard
plus the increase
absorption sent her down so fast that she even notice she felt low.

 On NPH Sasha always had a good HbA1c usually around 6.5 to 6.9 but we had to do
many checks and
 frequently she would go low in the morning at school unpredictably but when we
reduced either of the
 insulins instead of her BG levels being slightly higher then are always then
very high over 16 mmols. So
 we see saw between good levels and low levels. We are not even getting steady
levels overnight with the
 Lantus despite her meals being a very similar carb fat and protein levels. The
clinic are not much help
 at present as Sasha is the only child of her age using Lantus, only a couple of
teenagers are using it at
the moment. So their experience is not much better than mine.

 The thing is with young children their activity levels are very unpredictable.
I want her to be able to
 behave like other children and her sister and be able to go out and play when
she wants to and other time
 maybe sit in a play computer games. I just don't think it can be done very
easily without a pump or a
 split dose. I don't see how a split dose of Lantus would work as it really
takes two or three days for
 any decrease or increase to work properly. Split doses of Lantus are sometimes
used when one shot does
 not last 24 hours. I least if I decrease the NPH I see a result that same
evening.

Jackie



> -----Original Message-----
> From: email @ redacted [mailto:email @ redacted]On
> Behalf Of Sarah
> Sent: 22 July 2003 07:45
> To: email @ redacted
> Subject: RE: [IPk] Constant basal requirement?
>
>
> Insulin Pumpers is made possible by your tax deductible contributions.
> Your donation of $10, $25, or more... just $1 or $2 per month is
> needed so that Insulin Pumpers can continue to serve you and the rest
> of the diabetes community. Please visit:
>
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>
> Your annual contribution will eliminate this header from your IP mail
>
> How did split dose insulatard work? My diabetes centre originally had this
> and not lantus as a requirement for doing the DAFNE course on the basis that
> it offered more flexibility becuase you can alter the doses of the morning
> and night insulatard. Have you spoken to Sasha's DSN/cons (I know they can
> be elusive...). Let them know about the holiday as they may suggest going
> back onto something you are more confortable with. I know of someone on a
> pump who went back onto MDI for his holiday just because he felt more
> confortable with it and didn't want the hastle of a pump on the beach.
> I hope you manage to get more sleep soon. I remember from going on a pump
> and know from nights when I've gone hypo several times in the night how
> miserable sleepless nights get - I can only offer my sympathy.
> Best wishes,
> Sarah
>
> -----Original Message-----
> From: email @ redacted [mailto:email @ redacted]On
> Behalf Of Jackie Jacombs
> Sent: 22 July 2003 18:26
> To: email @ redacted
> Subject: RE: [IPk] Constant basal requirement?
>
>
> Insulin Pumpers is made possible by your tax deductible contributions.
> Your donation of $10, $25, or more... just $1 or $2 per month is
> needed so that Insulin Pumpers can continue to serve you and the rest
> of the diabetes community. Please visit:
>
>     http://www.insulin-pumpers.org/donate.shtml
>
> Your annual contribution will eliminate this header from your IP mail
>
>  At the moment were are having worse BG readings than back when we were on
> Mixtard 30.
>
>  Most of the last 48 hours her blood sugar reading are bouncing around
> between 8
> and 12 mmols. When I
>  correct we do not have a predictable result. I have had to correct a high
> of 12
> mmols in the middle of
>  the morning. Which we hardly ever had to do before, but this resulted in a
> low
> BG later. The previous
>  day During the night if Sasha is over 12 mmols it takes much more insulin
> than
> it used to to take the
>  levels down, then on another night the usual one unit is too much. It
> actually
> seem less predictable
>  than NPH, plus I don't like to not be able to give less insulin if she
> suddenly
> decides to play hard
> outside for a couple of hours. I could do this with her split dose of NEPHI.
>
>   It must be something that I am not doing right but I am not sure what. I
> did
> expect to have to make
>  adjustments and get used to the way it works but I didn't know it would
> take so
> long with such poor
> results.
>
>  I have spent many nights now missing huge chunks of sleep checking
> correcting
> or just leaving things to
>  see what happens. Its not good at all. I am determined to carry on for
> longer
> and see if there is any
>  improvement. I really feel like going back to NPH because we are going away
> on
> holiday soon and had
>  hoped that we would have more flexibility with meal times but this is not
> proving to be the case. We are
> checking much more often at the moment but this is not really helping.
>
> Tried and frustrated
> Jackie Mum of Sasha
>
>
>
>
>
> > -----Original Message-----
> > From: email @ redacted [mailto:email @ redacted]On
> > Behalf Of email @ redacted
> > Sent: 22 July 2003 05:34
> > To: email @ redacted
> > Subject: RE: [IPk] Constant basal requirement?
> > When I first went on a pump I started on a constant basal and stayed on in
> > for about 1.5weeks and it sort of worked but a quite widely varying basal
> > works so much better for me. I can't help thinking that lantus is just
> more
> > predictable. Alternatively the people it works for have varying levels of
> > insulin provided by lantus (assuming it doesn't provide an absolutely rock
> > steady level in some people) and this just happens to fit well with their
> > insulin requirements over 24h.
> > I also split my insulatard in to 2 doses, morning and night, which does
> > improve flexibility, but certainally didn't solve the problem of 2am
> > hypoglycaemia and 7am hyperglycaemia. The pump works though :) just wish I
> > could persuade my PCT to fund me...
> > Sarah
> > DM 7years (yesterday!), pump 7months
> >
> >
> >
> > --On 22 July 2003 10:41 +0100 Jackie Jacombs <email @ redacted>
> > wrote:
> >
> > > Insulin Pumpers is made possible by your tax deductible contributions.
> > > Your donation of $10, $25, or more... just $1 or $2 per month is
> > > needed so that Insulin Pumpers can continue to serve you and the rest
> > > of the diabetes community. Please visit:
> > >
> > >     http://www.insulin-pumpers.org/donate.shtml
> > >
> > > Your annual contribution will eliminate this header from your IP mail
> > >
> > > Jos wrote:
> > >> Does anyone here have constant basal insulin requirements
> > >> or know of anyone that does? The impression gained from
> > >> reading this and other lists is that everyone has variable
> > >> insulin requirements so insulins like Glargine are only
> > >> useful in so far as we can more reliably predict when an
> > >> extra snack or extra insulin is needed each day.
> > >
> > >
> > >  I expect there might be a few somewhere who find a constant basal rate
> > > works" most" of the time but I
> > >  don't suppose there are many. We are still having loads of problems
> with
> > > the Lantus dose and getting
> > >  worse levels than on NPH. Plus, because Sasha's Insulatard was a split
> > > dose, morning and evening if she
> > >  was very active during the day and early evening we could lower the
> > > evening dose of NPH now we are using
> > >  once a day Lantus we are stuck with the same dose. Sasha is also waking
> > > up with higher levels than she
> > >  was on NPH. She is nearly always nearly 9.0 mmols by 7.30 where as on
> > > NPH she was more frequently around
> > > 4 to 7mmols.
> > >
> > > I did two hourly test the other night and these are the numbers
> > >
> > > 8.8 mmols at 10.15pm
> > >
> > > 6.2 mmols at  12.00
> > >
> > > 4.00 mmols at 2.30am (gave 5 carbs milk in case she was dropping too
> low.
> > >
> > > 5.7 mmols at  4.00am
> > >
> > > 8.9 mmols at 7.45
> > >
> > >
> > >  We give the Lantus in the morning. I am worried that if we increase the
> > > Lantus that Sasha would go too
> > >  low in the early hours. I think these are similar figures to those you
> > > got with Emily. Though this was a
> > >  good day getting only 8.8 mmols at 10.30 as we have had more days when
> > > she is more like 12 mmols at
> > > 11.00 pm!
> > >
> > >  The other thing is I think that we might be under dosing with the
> Lantus
> > > because we are seeing rises in
> > >  the evening towards our bedtime even when the meals appear to be
> covered
> > > correctly by the Novorapid but
> > >  the trouble is we are sometimes getting lows after meals and sometimes
> > > highs. Also yesterday we went to
> > >  the park for a hour or so and Sasha bg was only 4 mmols before setting
> > > off. So I gave a 8 carb ice cream
> > >  before we left and despite beginning moderately active (not as active
> > > because we had to shelter from the
> > >  rain for a while) when we got home her BG was over 15 mmols. But as we
> > > are sometimes seeing a drop to 4
> > >  mmols in the middle of the night I am concerned that increasing the
> > > Lantus will cause hypos which is one
> > >  of the reasons why we switched to lantus in the beginning. My life
> seems
> > > consumed at the moment with
> > > testing and trying to puzzle things out.
> > >
> > >  I think I might have to switch the Lantus to the early evening then if
> > > it has a six hour peak it will be
> > >  gone before the middle of the night. Also it is very hard to work out
> > > what is happening during the day
> > >  as we are obviously dosing with the Novorapid and if the Lantus dose is
> > > not spot on all these other
> > > boluses are not going to work out right.
> > >
> > >  Sasha was 8.8 at 7.45 this morning and we gave 4.5 units of NR at 8.00
> > > am now I have just checked her BG
> > > and it is 12.00 mmols!
> > >
> > > Jackie
> > > Mum of Sasha aged 9 weight 28 kl 62 lbs
> > >
> > > 11 units lantus at 8.30 AM
> > >
> > > average 11.5 of Novorapid during day
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