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Re: [IPk] hypers

In message <l03130300b72004926696@[]>, John Neale
<email @ redacted> writes
>>On an add occasion as
>>i'm sure it happens to alot of diabiteics we misjudge the insulin dosage
>>or the amount of carbs to eat,when we test later it could be high if this
>>is the case Emily usually give herself a little bolus to put her on track
>>and its usually perfect afterwards.The new doctor said that she should
>>stop doing this
>Hi Paul -
>If a doctor gave me advice like that, I would report the doctor to the
>relevant authorities. We pay doctors (directly or indirectly) to advise us,
>and if the doctor does not understand the basic principals of pump therapy
>- that you can correct a high bg with a precise amount of insulin - that
>doctor should not be advising a pump patient.
My guess is that what the doctor meant to say (but certainly didn't say
in a way that Emily understood) was
'I see that you are getting a fair number of highs, which you are, very
properly correcting with boluses.  However, I believe that a proportion
of these were preventable, not with hindsight, but at the time.  For
example, two weeks ago you had this dish, and it sent you higher than
you expected.  That's fine.  But you had it again last night, and
neither injected earlier, or more, and so had to correct afterwards.
What's going on here?'

This would have given Emily the chance to say, as she needs to, either
'But I don't see how I could have foreseen that' - and the doctor would
have explained how (or failed to, and admitted that he was wrong to say
it was preventable - even if he could have prevented it, Emily's brain
is wired in such a way that she couldn't see the pattern, and couldn't
prevent it).
Or she would have said 'well, I don't like to make adjustments on the
basis of one occurrence', or 'but the second time, I'd been exercising
and that usually means I take less insulin' or whatever reason it was
that she didn't make the right choice, even though she did see foresee

I don't think the doctor needs retraining in pump therapy, I think he
needs communication skills training.

Best wishes to all,

DM 30 years +, minimed 508 1month +
Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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