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Re: [IPk] one injection per day

Hi Joanne

I do feel for you and know several mothers at my clinic where this is
happening to their child too.  I just dont understand why they cannot do
something about it.  In most other countries they dont use mixed (pre mixed
that is) for children or adults.  They special use a dose for that child
drawing it up in  a syringe.  By using pen devices which are convenient and
to use I feel that the diabetes teams seem to be taking the lazy way out and
not adjusting doses to suit the child or the situation (in honeymoon still for
example).  I have yet to meet anyone who is having problemsbeing shown how to
use a syringe but there is no reason why Miles couldn't try  a different mix
insulin.  Mixtard 40/60 has more short acting to  cover the breakfast meal and
less long acting so that Miles should not continue to drop in the afternoon.
If Miles has to go to be with levels of 18 mmols this is not right at all in
my opinion.  (only a lay person)  It means that he has high levels for too
long unnecessarily.  There is also mixtard 50/50 which has even more short
acting.  Only by trying different ones can you see which  may be right.

We did have a good year on Mixtard 30 but then changed to 40 which was better
at the time.  Of course a lot depends on the age of your child and how well
they eat.  If they are young and picky eaters then more long acting is
probably the reason for them using mix 10 as it will cover the grazing through
the day.

Did they give you a reason why they wont change things.  At one time our pead
was reluctant to change things as Sasha HbA1c was 7.2  so he thought thats
fine, which it is but what he couldnt see and didnt have to live with was the
huge highs post meals and the huge drops at night and the fact that if you
increase the insulin you end up with more of both sorts when you only want
more short or long acting.

One thing you can do to see if you can get better post meal levels is to make
sure that you do always give the insulin 20 if not 30 minutes before the meal.
If the sugars are higher than about 6.5 we used to have to give Sasha the
insulin much earlier than that.  Occasionally some children are very
sensitive to Mixtard or Actrapid and you may not have to give them it so far
ahead but this is usually not the case.

We really had the best, most predictable results when I separated the insulin
and gave separate Insulatard and Novorapid.  We did use Actrapid separately
too, before we got Novorapid.  Insulatard is the longer lasting element of
mixtard.  So Mixtard is just Actrapid and Insulatard mixed together in
different proportions like Mixtard 10, 30 ,40 ,50

Good luck with your quest for a pump.  I forget how long Miles has had D for.
If your very unhappy, document why you are not happy go to see your GP and
him that you dont think he is receiving the best attention.  It doesn't matter
if the A1c is good it not nice for Miles to feel unwell at times because his
blood sugar is too high and then too low.  Your GP may refer you to another
clinic.    It may be that you need to go to another clinic if you decide to
seriously go for pumping.


The only thing
----- Original Message -----
From: "JOANNE CHALLIS-BAILEY" <email @ redacted>
To: <email @ redacted>
Sent: 03 June 2002 09:10
Subject: Re: [IPk] one injection per day

> Barbara,
> Miles is on the 30/70 mix and his reading are exactly the same as Danielle,
> once he has breakfast its in the 20's, then no mid morning snack, small amt
> of lunch but then in the afternoon he either has a hypo or sugars go low
> enough that i have to feed him. Im sure this is contributing to Miles being
> a big child, i  seem to be feeding the lows in the afternoon.
> I know that he only eats low fat high in carbohydrate food but i think it is
> the quantity of food.
> i cannot let Miles go to bed with suagrs any less that 18 otherwise he will
> hypo, this cant be right but they wont change anything, I am contacting
> Minimed today so they can send me the video.
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