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Re: [IPk] bad paeds care

In message <001701c297ed$91259d80$email @ redacted>, Rob Reznik
<email @ redacted> writes
>On the point of MDI's I agree that this would only be a stepping stone and
>my current philosophy is ' if you are going to do something then do it
>properly first time'. Whilst I understand that I will come unstuck at some
>stage there is always the expert advice available from sites such as this -
>thank you again.

MDI may be 'properly' for Yasmeen - there's no point in spending all
that money if it's not needed - so give it a go.  It suits many people.
>Yasmeen's HbA1c's have ranged between 7.2 to 11.4 earlier on this year when
>the Paed Specialist doctor prescribed the wrong insulin!!!
>I have been waking up at around 2-3 am and 5-6 am as she has had Hypo's and
>I now fear that she is becoming less aware of the Hypo symptoms during the

Yes - that's common.  Hypo unawareness comes from having hypos.  So
avoid hypos: run the bgs higher (e.g. instead of aiming for 4-8, and up
to 10 after meals, run 6-10 and up to 12) for a week or so.  A week free
of hypos usually brings symptoms back.  
>Whilst I appreciate without the 'support' of anyone else I am letting myself
>in for a tough few weeks but having discussed this at great length with my
>daughter I feel this is the only way to go.
>I would however like to ask a couple of questions.
>Having received and read a number of brochures on various pumps - which one
>would anyone here recommend and why.

The main differences are ones you will only know how they affect your
daughter when you have been using the pump for some time.  For example,
do you know how your daughter's basal pattern varies between active and
inactive days?  (If at this point you are going 'what basal pattern???'
it shows how difficult it is to differentiate between the pumps).

You can pre-programme the medtronic with three basal patterns - which is
great if you have up to three wildly different patterns (e.g. school
days is a steady 0.3 p/h, weekends is 0.3 during the night and 0.2
during the day, and hiking which is 0.1 during the hike, and then 0.6
for the following night).  The disetronic doesn't have the different
patterns, just one, which you can shift up or down by a percentage: so
if 'normal is 0.6 during the night and 0.4 during the day, you can
increase it by, say, 50% and get 0.9 during the night and 0.6 during the
day, or you can reduce it by, say, 30% and get 0.4 during the night and
0.3 during the day.

There are similar differences in the delivery mechanism (the disetronic
being near-continuous, the medtronic by impulses.  I don't think that
makes much difference unless your daughter is having a very small amount
of insulin (?under 10 units basal a day?).

What you might want to look at is the level of support promised by the
company: can they supply a back-up pump, should you be going out of
reach of telephone for a fortnight?  If you arrive in Cornwall at 10pm,
to find that your supplies are still in Wolverhampton, how soon will
they get a new box of supplies to you?  If your pump fails completely at
3am on Sunday morning, when will the new one arrive?  How will supplies
arrive usually?

It might be wise to get those answers in writing: of the two companies,
one has attracted much more criticism than the other for not
understanding the urgency of the situation and for not understanding
that diabetics are not invalids who stay at home all day.

>Which makes of insulin prove to be more stable/reliable than others.

The makes (wellcome, lilley, etc) are all equally reliable.

Of the medium and long acting insulins, the new glargine is most
reliable (i.e. if injected at the same time each day, it peaks at the
same time each day, and stops working at the same time each day).
Insulatard (NPH) has a bad name for unreliability - but I've not seen
the data for a long time.  The best long acting insulin is a compromise
between reliability and getting an activity curve which matches the
basal needs.

Of the short acting insulins, they all seem about the same in
reliability stakes.  Where they differ is in their action curves:
actrapid (regular) is the longest, humalog (lispro) is the shortest.
The best one is the one that matches most closely the digestion curve,
and that, of course, is different for everyone, and for every meal.

Best wishes,


(dm 30+, 508 1+)
Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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