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Re: [IPk] one injection per day

I support what Jackie is saying here, this kind of situation is horrifying
and it is one where treating for the HbA1c alone is as useful as a
wickerwork chair in a nudist colony!

While the pump is certainly likely to improve things, Joanne, there are a
number of other things which might help and shouldn't be denied you.

First, change to mix 40 because as Jackie says, you can give the same dose
at breakfast and get more actrapid (where it is clearly needed) and less
insulatard (where it isn't)

Second, think about an analogue insulin mix such as novorapid mix 40,
because it doesn't have to be given before meals as the insulin works pretty
quickly. This is especially a relief when the child doesn't always eat what
and when he's supposed to! And that's all of them in my view.

Sure, these are not the 'complete' solution, but they are likely to help a
bit. As for the night-time hypos, again analogue mixes will reduce hypos
soon after bed, and changing the proportion will fix them in the early

Don't let anyone say no. Just show them your last e-mail!

----- Original Message -----
From: "Jackie Jacombs" <email @ redacted>
To: "Insulin Pump List" <email @ redacted>
Sent: Monday, June 03, 2002 10:07 AM
Subject: 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
> 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
> easy
> to use I feel that the diabetes teams seem to be taking the lazy way out
> not adjusting doses to suit the child or the situation (in honeymoon still
> example).  I have yet to meet anyone who is having problemsbeing shown how
> use a syringe but there is no reason why Miles couldn't try  a different
> of
> insulin.  Mixtard 40/60 has more short acting to  cover the breakfast meal
> less long acting so that Miles should not continue to drop in the
> If Miles has to go to be with levels of 18 mmols this is not right at all
> 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
> at the time.  Of course a lot depends on the age of your child and how
> 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
> the day.
> Did they give you a reason why they wont change things.  At one time our
> 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
> 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
> sure that you do always give the insulin 20 if not 30 minutes before the
> 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
> ahead but this is usually not the case.
> We really had the best, most predictable results when I separated the
> and gave separate Insulatard and Novorapid.  We did use Actrapid
> 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
> If your very unhappy, document why you are not happy go to see your GP and
> show
> him that you dont think he is receiving the best attention.  It doesn't
> if the A1c is good it not nice for Miles to feel unwell at times because
> blood sugar is too high and then too low.  Your GP may refer you to
> clinic.    It may be that you need to go to another clinic if you decide
> seriously go for pumping.
> Jackie
> 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
> > once he has breakfast its in the 20's, then no mid morning snack, small
> > 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
> > 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
> > 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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