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Re: [IPk] Forgetting injections

Hi Mary

Yes, that's all 'true' enough (not necessarily stone-hard facts, but
not necessarily false either). As most people with type 2 diabetes
don't feel much better or worse if they skip one injection every so
often and a large number of type 2s take just 1 injection per 24 hours
plus pills, type 2s may mismanage their diabetes through forgetfulness
or conscious decisions. Meanwhile, a small set of non-compliant type
1s are more likely to be conscious in their decisions not to take
insulin and then to *say* they "forgot" when challenged by a
healthcare professional about their behaviour.

If you google this phrase:
"type 1 diabetes" malingering
you will get over 3000 results. Many of them are case
studies/psychological reports of type 1 diabetes patients who
mismanaged their diabetes - whether by intentionally making themselves
ill or through negligence - as a result of a mental health problem or
because they were in denial of their situation and chose to ignore it.
It is upsetting when the behaviour of a small percentage of diabetes
patients who may be mentally ill affects how a healthcare provider
views all patients with diabetes.

Some patients have indeed been put on pumps because the risk of going
into DKA can be higher versus injections and they have to manage their
diabetes or else they will go into a coma. That's a very small number
of patients, though. By and large the rule of thumb remains that
patients who are already making a sincere effort to control their
diabetes will benefit most from pump therapy. If the A1C goes from 13%
to 10%, someone's less likely to die soon, but still may not have much
quality of life and is still highly susceptible to complications;
meanwhile, if the A1C goes from 10% to 7% someone's more likely to see
significant benefits in physical health and overall well-being,
productivity, etc.

Does that help at all?

Type 1 15+ years; MiniMed pumper 7.5 years; Animas pumper 4.5+ years

 On Tue, Jul 29, 2008 at 6:33 PM, Mary Moody <email @ redacted>
> Heard some interesting stuff today about why some diabetes teams like to
> keep absolute control over what their patients do.
> Apparently there is a very fast growing groups of diabetics who miss
> injections regularly and generally don't manage their condition that well.
> The consultants apparently deal with this by exerting total control over
> dosages. I was even told that some of the patients who mismanage their
> condition have been put on pumps as this has been considered the only way to
> save their lives. I have noticed my own personal situation has improved
> since I challenged my DSN to let me get on with things myself as I knew my
> body and its signals better than she ever would. I wondered if this was one
> of the reason for all the control freakishness I was experiencing with my
> diabetes team.
> The information came from a very authoritative source and I just wondered if
> anyone had heard of anything similar.
> Mary Moody
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