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Re: [IPk] RE: ip-uk-digest V2 #780 nelh - diabetes



Hi Abi,

The concerns that Prof Amiel voiced did not have to do with cell 
proliferation. Her point of view is that while were still learning how to 
use analogues, doctors should be careful about prescribing them. She wants 
to see how new drugs act in a population for which they are specifically 
indicated before prescribing them to people who may or may not get any 
specific benefit from them.

This would mean not switching over to analogues anyone who is getting decent 
HbA1cs on conventional insulins. Prof Amiel did not say whether she would 
switch someone from Actrapid to Novorapid or Humalog in order to improve 
flexibility in mealtimes and lower post-prandial glucose levels even if the 
HbA1c were okay. Personally, if changing therapy might improve quality of 
life by letting someone eat when hungry and allowing him/her to eat the 
dinner he/she wanted and have a chance of euglycaemia at bedtime, I'd 
suggest it even if the HbA1c were all right. I can understand not wanting to 
rock the boat if it looks like a regimen is working, but I am sceptical 
because a lot of people don't tell their doctors when something isn't 
working, they just plod along. Alas, I am not a doctor so I don't get to 
decide anything.


Melissa
Type 1 11+ years; MiniMed pumper 7.5 years; Animas pumper 7.5 months

----Original Message Follows----
From: email @ redacted
Reply-To: email @ redacted
To: email @ redacted
Subject: Re: [IPk] RE: ip-uk-digest V2 #780 nelh - diabetes
Date: Sat, 31 Jul 2004 04:54:39 EDT

re Prof Amiel's stance on analogues: is" knowing" the older insulins merely 
a
euphamism for not having a ( however slight) concern re long term safety/
effects on cell proliferation etc. I have heard some people do well on an 
MDI
  regimen with short acting insulatard and NPH/ lente if the latter is 
optimised
ie given twice daily or three times daily or whatever and wonder of glargine 
is
being pushed more in the UK than in countires like Geramany where twice 
daily
intrmediate or long acting were used anyway, so less of an advantage with
lantus
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