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Re: [IPk] Glargine / glucose sensing as a tool

Hello Abigail and all members ,
So far little work has been done comparing glargine use in multiple
injection regimes v pump therapy but we have some studies planned and will
use the cgms to compare the glycemic profiles .
Experts [ including  Prof. Tamborlane , Dr. Bode , Dr. Kerr etc ] believe
that pumps will still be necessary . Glargine will give a more reliable
overnight insulin release than current basal insulins via injection but long
acting analogues will never be able to manage varying insulin needs
overnight [ during pregnancy , post exercise  , after alcohol , reduction in
insulin needs around midnight , dawn phenomenens ] Only programmable insulin
pumps can do this .

The only certain way to avoid nocturnal hypos seen by the glucose sensor
 CGMS]  is to use an insulin pump and vary the basal rate as needed .
Pediatricians are starting to see the benefit of insulin pumps in young
children as many have been scared by the frequency of long periods of
nocturnal lows in toddlers and young children identified by the cgms . Even
the most conservative pediatricians are starting to consider pump therapy !

The cgms is a good tool and surely it is better to know that you are having
hypos and tackle them rather than not to know ! We also know from studies
that hypo awareness can be restored when an insulin pump is used and hypos
are avoided for a 2-3 week period .
I believe that tools are useful and we need as much info and help as we can
get  to avoid diabetic complications [ but that could also be because I work
for a company that manufactures tools !! ] I do also see the benefits that
pumps and sensors bring to families with diabetes and to my colleagues .
We are happy to send copies of pump and sensor articles to any IPUK members
Please just ask .

Enjoy the weekend .


----- Original Message -----
From: "Abigail King" <email @ redacted>
To: <email @ redacted>
Sent: Saturday, December 01, 2001 9:09 PM
Subject: [IPk] Continuous glucose monitoring: a point to consider

> I was speaking to one of the partners in the practice I now work in, who
> recently attended a conference re DM. Apparently ?Dr?Prof Kerr was there.
> seems that long acting analogues( glargine) are really going to be pushed.
> This is partly due to work with the CGMS which has revealed the full
> of nocturnal hypoglycaemia, even in those with really good control and
> daytime hypo awareness. Glargine apparently seems very effective in
> this problem.
> Apparently one man with IDDM was in a very responsible job involving night
> work. CGMS revealed unsuspected nocturnal hypos and he was advised to take
> time off work (?? or not given the choice to continue) until the problem
> ressolved. Fortunately glargine ressolved it. I was lead to believe that
> person involved was on a pump before( had A1c of 7% and daytime hypo
> awareness). This may have been a miscommunication although he could have
> been one of those people who don't benefit as much from pumps ( I still
> this a little hard to comprehend as even analogues have slight variability
> and surely can't be tuned as finely as pumps)
> Anyway, my main point is the implication for someone in whom CGMS reveals
> unsuspected and asymptomatic hypos , regarding fitness to drive and jobs.
> I would be very wary of trying it for this reason, and even before I heard
> of the above I would be cautious due to fitness to drive ie possible
> asymptomatic daytime hypos, although I think I have good awareness
> It seems that with many modern innovations there may be a price to pay and
> reason to proceed with caution ( could genetic testing and effect on life
> insurance be an analogy?)
> Of course, the  good thing is the guy's problems were solved so he has
> chance of loosing his daytime awareness, while retaining his good control,
> fitnss to drive and ability to do his job safely. Plus reduced the ?
> miniscule chance of a severe nocturnal episode resulting in him not waking
> up without some assistance ( ie glucagen)
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