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Re: [IPk] Re: long-acting insulin discussion

>I stared using a pump one and a half weeks ago, but until then, I was on the
>same regime as you, with exactly the same problem as you with my night time
>BG. The only way I could control it was to give myself some extra Actrapaid
>sometime between 4 - 6 am every day.  I was expecting my pump bazal rate to
>reflect this, i.e increase druing the night , but it has not been necessary,
>it has completely rectified the problem, I now have really good control
>thoughout the night.  I hope you can get your problem sotred out.

Lydia -

Glad things are going well!

I never cease to be amazed by the curious things that go on with insulin
and bg levels - certainly in me! It is all far more complex than you think
once you get a grip on things...

My wife has a work colleague whose husband has Type 1 diabetes. The woman
was terribly anxious the other day because her husband had been in hospital
yet again with DKA. This time they told him that if he didn't take his
diabetes seriously, he would end up having his legs chopped off. Fair
enough. I don't know the full story; my wife, Julia, met the guy once and
formed the opinion that he was very pleasant but essentially rather stupid.
He's probably mid-30's and has had diabetes for years. I would guess he is
on 2 injections a day, when he can be bothered to take them. I suspect that
if he doesn't feel hungry, he skips the injection. Hence the DKA.

What can you do? If a patient will not or is not capable of taking control
of the situation, and just muddles along from day to day, what is the
doctor meant to do?

I compare him with a girl my wife met at birth preparation classes. She has
had diabetes for 3 or 4 years, is on MDI, and is absolutely meticulous with
her control. I gave Stephanie moral support during her pregnancy. It was
all fairly straight forward, except at the end when her insulin requirement
dropped almost to zero. Turned out that the baby was producing enough
insulin for the mother as well. After the birth, the Stephanie's insulin
requirement returned to pre-pregnancy levels, while the baby suffered
continuous hypoglycaemia. They put the baby on a glucose solution drip, and
things stablilised after a week or so.


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