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Re: [IPk] carbohydrate counting

----- Original Message -----
From: KRISTINA ROBINSON <email @ redacted>
To: <email @ redacted>
Sent: Wednesday, March 19, 2003 7:26 PM
Subject: [IPk] carbohydrate counting

> today i went with my 9 year old daughter to the hospital to ask for a
> pump for her.  this is something that we have been considering for a
> while.  he wanted her to try mdi first but as i pointed out this is
> totally impractical as she does not do her own injections at present.

If she is unable to do her own injections she will need help inserting a
set. If this is not working properly eg occluded then either she will need
to do the above on her own, or an injection to tide her over or you will
have to be available fairly quickly ( not longer than one hour)
Does she do her own blood tests? The sooner one gets self sufficient with
the practical aspects of care the better although making decisions about
doseage etc would obviously need more maturity

Your consultant doesn't sound bad. Many are reluctant to switch children to
MDI let alone a pump. MDI together with regular testing and carb counting
can often work wonders ie difference between bad and good control and is
less expensive than a pump ( NICE criteria recommend pumping only if MDI has
Could she get used to doing injections? Is there a physical problem with her
using a pen ( some can be a bit awkward in small hands)It's a lot for a nine
year old to have to take on board. Perhaps I am being a little unfair, being
almost 13 at time of diagnosis myself

I can see the attraction of a pump vs MDI but MDI often is very effective re
control and lifestyle flexibility. And getting a pump may take a long time

> with a bit of persuasion he is going to try and get her a pump although
> we will need to go to another hospital initially as our consultant has no
> experience of pump therapy as yet.  her hba1c today was 9.2 they have
> suggested that whilst we wait we try and reduce her morning and evening
> insulin doses to see if this helps as she is having fairly frequent

makes sense if she is getting highs due to rebounds from hypos. One of the
attractions of MDI is that if hypos occur mostly at one specific time you do
not have to run high/ eat less to avoid this, for half the day if dose is
reduced to avoid the hypo: ie 4 points of control rather than 2

 the dietician wants her to start to learn more about the effects
> that different foods have on the blood sugar and how carbohydrates, fats
> ,fibre etc  affect this.  they were both saying that it is really hard to
> estimate the carbohydrate content of a meal and seemed to be trying to
> put us off the idea of! a pump.

At least she is being encouraged to experiment and learn rather than be told
to eat a high carb healthy diet and avoid excessive suger and fat and to
avoid certain foods. Glycaemic index and protien and fat are important
although the most important thing to learn for flexible eating ( not just
pump but proper control on injections), is carb counting. It's a myth that
it is really complicated but it has  fallen out of fashion and people are
reluctant to teach it. There are various books available such as colin's gem
which have contents of most foodstuffs. Packets often have the information.
With some meals esp if eating out it can be guesswork. I find it incredible
that people with diabetes have not been taught basic nutrition info such as
a small apple = 10 carb, av slice of bread = 15 g etc etc
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