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RE: [IPk] disappointing meeting with Sasha's consultant

Hi Mary

 Have just got a cable for the One Touch Ultra and we are busy making
graphs.  We have only had the One Touch for a short while and have other
meters in use but you can add other entries manually. We havent got much to
show at present.   Also we are told NOT to correct if bg are under 16 mmols,
but we do as otherwise, instead of one raised evening we would have a bad
evening and a bad day the next day as well. Plus a very miserable child.
Sasha feels unwell if her bgs are over much over 10mmols.

 We are using Novorapid and NPH.  Sasha is unable to give herself injections
yet, though she did have a go and was quite shocked how much it hurt her
when she doesn't mind injections usually when we give them.  She has two
separately injections in the morning.  Novorapid at breakfast and NPH half
an hour later at 8.30am as the NPH  peaks too soon if given at  breakfast.
We have struggled for 3 years with this.  She tends to drop down at 11.30.
If we give a bigger snack that doesn't seem to work much better as then
there is so little NPH working that Sasha can only eat a tiny lunch.  The
consultant was talking to our DSN and saying how much better it was when
children are older and they can spilt the evening dose, by older he meant 12
or 13.  But we have already been doing this for over a year!!!!!  He
forgets!!  I suppose we could ask to try true MDI and go up to school
everyday to give a shot until she is older.  She cant seem to grip a pen and
depress the plunger properly without jerking the needle.

The trouble is to show the problem I would have to not do any corrections
and that would mean letting Sasha run high an awful  lot and things spiral
out of control.   Anyway I will work on the graphs for now and see what they
show over  a month or two.


> -----Original Message-----
> From: email @ redacted [mailto:email @ redacted]On
> Behalf Of email @ redacted
> Sent: 29 November 2002 08:29
> To: email @ redacted
> Subject: Re: [IPk] disappointing meeting with Sasha's consultant
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> In a message dated 11/29/2002 7:52:46 PM GMT Standard Time,
> email @ redacted writes:
> > I have reservations about Glargine at the moment, for reasons
> that I don't
> > want to go into.There are children in the UK using it now
> though.    Maybe
> > another longer lasting insulin may be better than NPH.  But I don't
> > understand my consultant he is saying that he would only be
> happy if we were
> > at a hospital that had lots of experience with children but then said he
> > wouldn't be happy to take over Sasha's other care like doing the HbA1cs
> > even.
> Hi Jackie,
> As I said before, many diabetic specialists (including consultant
> diabetologists) - and note that I've taken the "I think" out of
> it, because
> I'm 100% certain now - have little knowledge of CSII and are only
> aware of
> the old studies carried out when the technique was far less
> reliable.  Even
> recent reviews, published in major medical journals which most
> medics would
> read, have focused on the early studies.  So they are scared of pumps.
> Or, as Abi rightly says, they (or the PCTs) just don't have
> enough money to
> fund them.
> If your consultant can't see beyond the "wonderful" HbA1c result, then
> perhaps you need to give him some evidence of what lies beneath
> the average
> result, ie the awful peaks and troughs - and I believe that
> graphs are great
> for a visual impact.  Maybe you've done this already, but if not,
> read on!
> I've held many clinics myself where numbers are crucial,
> including diabetic
> clinics, and a book full of numbers is unlikely to be appreciated by most
> docs who are running behind with the clinic whereas a couple of colourful
> sheets demonstrating ups and downs can be shown quickly with effect.
> You've tried MDI and it doesn't work.  If Sasha's basal rate is
> steady, then
> that would explain why she's had trouble with MDI.  It would also
> mean that
> glargine would be the next logical step, so you'd be likely to
> have problems
> obtaining a pump. If her basals are not stable, then you have the
> reason for
> a pump.
> Hope this is of some use,
> Mary
> IDDM 30+ yrs, 508 2 yrs, medic 20 yrs
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