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Re: [IPk] Intensive therapy

Simon, Morag, Di, Elizabeth, (everyone!)

I had a fascinating chat with my diabetes consultant last week. It was a
chat of equals, rather than doctor-patient. He was lecturing 4th year
medical students about diabetes, and had asked me to come along as a "live
specimen", which I readily agreed to - anything for an audience! :-) I had
to answer questions from the floor, and chat about my own experiences. I
felt it all went very well. There were 2 other lectures in the series, one
for conventionally treated type 1 diabetes (twice daily injection) and one
for type 2 diabetes. Before you all jump and down, these were just general
lectures for undergraduates.

In my private chat with Prof Reincke, what he explained to me was that many
of his conventionally treated patients do indeed have very stable bg's.
Twice daily injections do often work well, although sometimes they don't,
in which case intensive therapy is required (MDI), and if that doesn't
work, then pump therapy is required. The point he was putting to me is that
because someone is on twice daily injections does not imply they are
receiving sub-optimal care. Sometimes it simply works well.

For example, he explained that many people find that the dawn effect
disappears as they get older. There are much fewer anti-insulin hormones in
circulation. These things vary a lot from person to person.

Simon - I get the impression that your insulin sensitivity varies a great
deal. Di - you seem to suffer this as well, although to a lesser extent. I
also suffer variations in my insulin requirement. (Perhaps that's why I was
attracted to use a pump?) But it may not be valid to extrapolate that to
the rest of the diabetic population. Therein lies the skill of a doctor -
to help a patient decide what level of intervention will maximise the
quality of life, and ultimate outcome.

Having said this, I personally feel that an agressive approach should be
advocated when a patient needs it and is able to use it. I've had diabetes
for nearly 25 years. Thankfully I'm not yet showing any signs of wear and
tear. I earnestly hope that in 50 years time, when I am 85, I will continue
to be free of complications...


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