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Re: [IPk] mixtard ( high before bed, low in evening)

Pat wrote:

 I believe that mixed inslulins are the work of the devil, and any doctor
> prescribing them as the sole form of therapy for a type 1 should take a
> long hard look at the state of their soul. They are based on the idea
> that injections are the worst part of having diabetes, and that's so far
> from the truth that it's in a different country.

I have to agree that many countries with advance diabetes care do not use
mixed insulins because they do not believe it is best, because to the
restrictive nature of the regimen.  When I first joined a children support
group (US based) most have never come across mixed insulins.  Most drew up
their own cocktails or insulin on a sliding scale with guidance from their D
team.  Over the last year or so there are more children using insulin pens but
this is still less common than using syringes.  I had opposition when I wanted
to split the evening dose because I didnt want any more seizures overnight or
high levels that we couldn't correct.  I had to battle to get Actrapid even.
One of the arguments for not giving us any was because Sasha's HbA1c was below
7mmols.  Also I felt that they thought I was terrible to give more injections.
Never mind that she might be too high or hypo.  Sasha has no dawn rise so a
mixed regimen never seemed to work. After Sasha went on to a split evening
regimen at 7 years old they did suggest this to two others in my support group
both younger than Sasha and this has worked well for these kids too.   I didnt
tell them I was splitting the morning dose I just did it.  We had struggled
for most of the time to get reasonable lunchtime levels without the NPH
kicking in to early.  So now she has Novorapid with breakfast and no high
levels mid morning and the NPH (Insulatard) at 8.30 and it now kicks in when
they eat lunch instead of 11.30 am.  I know if I had asked the clinic they
wouldn't have liked it because they think its "bad" for a child to have "more"
injections despite the fact she was feeling unwell early in the morning at
time due to post meal highs then would suddenly start dropping at 11.00 and
spent some of the morning feeling crap because she was low.  Having said this
some mothers of older children were quite upset that the Dr had suggested they
split the evening doses.  Two of the teenagers, whose mother's come to my
support group say that their teenagers don't even take their meters to school
and would not like to have to have an injection at school.  I find it's such a
difficult balancing act to have NPH cover lunch that I hope that Sasha would
do a lunchtime injection but it seems that this is not the "done thing" here.
I hope that Sasha will not be so "shy" about looking after herself when she
starts secondary school as these boys.  They both have quite high HbA1cs.

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