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Re: [IPk] 4 vs 2 injections FAO ZOE



Zoe

Have just come on the computer for the first time in ages so apologies in
the length of time between your message and mine.

Before I was on a pump I was on two daily doses of insulatard (and later
Humulin I) morning and night.  A lot more at night than morning.  It
certainly improved things and you should talk it over with your diabetes
specialists to get your dose about right.  Definitely worth a go.

Gaye
----- Original Message -----
From: "Zoe" <email @ redacted>
To: <email @ redacted>
Sent: Monday, April 22, 2002 5:06 PM
Subject: Re: [IPk] 4 vs 2 injections


> Tony
> I quite agree - I won't be ruled by my HbA1c, there's more to life -
however
> long it is!
> It is possible to give an extra dose of insulatard in the morning as well
as
> nightime to stop bgs rising before meals - something my GP suggested to me
> but I never got round to trying.
> Does anyone do this?
> Zoe
>
> ----- Original Message -----
> From: "Tony O'Sullivan" <email @ redacted>
> To: <email @ redacted>
> Sent: Thursday, April 18, 2002 12:11 AM
> Subject: Re: [IPk] 4 vs 2 injections
>
>
> > Abigail is right, but there is another side to the 4 vs 2 injection
> > question.
> >
> > One of the big disadvantages of 4 injections a day, particularly if the
> > short-acting is an analogue, and the long-acting at night is a medium
> > insulin like insulatard, is that daytime gaps between meals are short of
> > insulin, and bg's can climb throughout the afternoon each day, even
though
> > everything else is right. This is less likely with twice daily, as there
> is
> > some longer-acting given twice a day.
> >
> > Secondly, children from the start of primary school to early secondary
> have
> > reasonably ordered lives, with mealtimes inevitably decided by a
> > parent/guardian. So the twice a day regime isn't too restrictive.
> >
> > Third, twice daily regimens give quite good control, certainly good
enough
> > for modern kids with diabetes who, and I don't mind repeating this, are
> NOT
> > facing a lifetime of diabetes. Studies show 2 injections to give better
> > control than 4 in this age group.
> >
> > Fourth, analogue insulins, and better mixes with subtle variations in
> > proportion have improved twice daily treatment too, so it isn't the
dreary
> > conservative approach it once was.
> >
> > But regardless of all this, what really worries me is the 'performance
> > anxiety' which seems to be fed to many parents to make the diabetes
> > disappear  by keeping blood glucose within the normal range at all
> > times....but at what cost?
> >
> > Professionals have a lot to answer for in raising the anxieties of
parents
> > about major complications age 12 if the child doesn't keep a bg below 7
at
> > all times. This is not how it is. Of course we should all try to keep
good
> > control etc, but this should be at an acceptable cost to quality of
life,
> > and to me that includes the quality of life of the parents! HbA1c's
above
> 7
> > give experienced expert patients such as Elizabeth the heeby jeebies,
but
> > for most of us, and that includes kids with diabetes, they shouldn't.
> >
> > Most of us have been weaned onto a pump after a period of multi-dose
> > injections, 4 or more times a day. It isn't written in stone that this
> > should be the way. Many US clinics use the pump as the default treatment
> > from day 1, and for someone who is enthusiastic, and wants to combine
> better
> > control with the freedom (eg to eat when and what you want), it can make
> > perfect sense to go straight from twice a day to the pump.
> >
> > Am I a cynic? When I hear someone say 'I'll be happy when I have really
> good
> > control', I sometimes wonder if they are saying 'I can't really accept
> that
> > I have diabetes'. I've experienced denial, but dealt with it in a
> differnet
> > way, by ignoring the diabetes. I suppose I'm basically offering a little
> > caution to the idea that more tech is the answer, or shaving 0.2% off my
> > HbA1c will improve my life. We should stop once in a while to ask a more
> > basic question. Can I accept this common, manageable condition for a few
> > more years until a cure is available, and in the meantime, which of us
> will
> > be in control of my life?
> >
> > Sorry, I should've saved it till Sunday!
> >
> > Tony O'Sullivan
> > 26 yr T1, pumping 6 months
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