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Re: [IPk] Newly diagnosed children

On 7/18/06, email @ redacted <email @ redacted> wrote:

> I'm a paediatric nurse and i work with children who have diabetes - as well
> as many other conditions.
> We can go months without seeing a newly diagnosed child, but in the last
>  week we have had 5 ages ranging from 2 - 15 (2 have been so poorly at
> diagnosis,
> that they have needed intnsive care).

My daughter was part of a similar diagnosis cluster in our area.  Fortunately,
she wasn't really ill at diagnosis, because my husband, being also type I, was
sensitive to the early symptoms.  When she'd had an unusual run of bedwetting,
he checked her bg with his meter, and we brought her in.

>  As someone who has been on a pump for 5  months, and seeing the benefits,
> i am saddened to say, all have gone on to twice daily Novomix or Mixtard. I,
 > personally have never used twice daily insulin. I went onto basal / bolus
 > after having my pancreas removed. With the experience i have now, i wonder if
 > people do manage to get good control on 2 injections? No children - or
 > at our local hospital are on pumps, even though it is a big teaching
hospital. Our
 > paeds endo seems to favour twice daily regimes. We don't see many children on
> basal / bolus regimes.

I suspect that some people with significant remaining insulin
production, and some people
who have really set schedules that fit the model, do very well on 2
injections.  But when my daughter was on a 2-injection, and then
3-injection, humalog/nph regimen, there were times of day when her
blood sugar was just entirely unpredictable, however we adjusted her
doses.  (I don't think premixed insulins are in anywhere near as wide
of use in the US as they are in the UK.)

The US hospital Isabel gets her care through supports and enourages
tight control and intensive regimens, including pumps (though the
targets they recommend for young children are significantly higher
than "normal", or than what is recommended for adults).  But even so,
they uniformly start kids on a 2-shot humalog/NPH regimen.  And for a
starting-point regimen, that may not be such a bad idea -- trading in
some adjustability for simplicity at a point when the patient and
their parents have a whole lot to assimilate in any case is likely
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