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Re: [IPk] high BGs, ketones etc very long

In a message dated 6/20/2003 8:19:10 PM GMT Daylight Time, 
email @ redacted writes:

> Do you use insulatard of glargi ne or just inject at v. short intervals
> vvith humalog. and ho long are the "pump breaks"

Hi Abi,

I use lispro and isophane (I've not tried glargine, and hope not to have to 
because I can't see any correlation between its activity and my very variable 
basal rates!), i.e. back to MDI, but I use old thigh sites, now rested for a 
few years but still not good.  Poor control for a while but better that than 
poor control for ever (I am not prepared to consider the alternatives at 
 present...but that's one of my soapbox subjects, won't bore you now!). I only
do this
when I'm getting reproducibly poor results from more than one site, and 
stopping the pump for a couple of weeks seems to do the trick if I catch the 
 problem early. Resting each site for at least a month between pumping is of
advised, and I do this but some of mine seem to need a lot more than that.  I 
 also just don't have enough useful sites to stop using the iffy ones in my site
rotation, hence the rests!

In my opinion: There are lots of possible causes for your difficulties which 
you should obviously have explored in depth (sorry if I'm being condescending, 
not intended, but simple overlooked solutions crop up so frequently - for 
 everyone - that I have to say this). Once those are excluded there are several
options.  Taking a "pump rest" might be useful for reasons similar to mine. It 
would also be valuable if you feel frustrated/upset etc about the problems 
 you've been having (nothing like experiencing good ol' MDI again to get you
on track! - or to make you have another think).  Pumping may not be the right 
option for you, especially if you're having good results with glargine.  
 Insulin resistance is an issue, and I would love to get to the bottom of what
to be a common problem in this group (research topic? - will take this up in 
2/52 when I see consultant if nobody has any answers.).  Also consider the 
possibility of insulin antibodies, but only when you've excluded others.

Oh dear, just looked at the length of my response, I just can't resist!  Hope 
some of it is useful.

Best wishes,

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