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Re: [IPk] bad paeds care

Hi Pat - thanks for your help and advice.

My main concern with MDI is that Yasmeen it not really that tall for her age
and since being diagnosed she is developing fatty parts on her thighs and
tummy where she injects herself. As an adult there would be a greater
surface area to inject . She continually moves sites but the fatty tissue is
obviously also affecting the absorption rate of insulin. I feel that 1
needle every 2/3 days ( DSII ) would help rather than go on MDI which, I
feel, would make matters worse.

The HbA1 c issue is another and as you are aware does not take into account
the major fluctuations on a daily basis . To give you an example her bgs
would normally be around 15 - 20 at 7 am. After this we have reasonable
control until she returns from school. Even as a small child she has always
been hungry and always request food when she gets home. She will then eat
again around tea time and it is at this point that the problems continue as
her bgs is high ( typically around 20 ) due to the afternoon snack. Trying
to keep this down on mixtard without giving her too much is impossible. Even
after giving an evening snack before going to bed the bgs is typically
around 12. This does not seem 'high' enough as she will inevitably hypo
during the night if I cannot get to her first.

I am aware that her insulin/food requirements vary with exercise, health and
weather although I cannot ( and do not know how to) figure out the exact
basal requirements as she is on mixtard. Can you give me any guidelines in
anticipation of a pump ( or maybe MDI ) - or is that ' how long is a piece
of string'.

Thanks for the advice re pumps I now need to do more home work on the pump
we would like/need as most of my investigations have surrounded on what they
do rather than how they work exactly. I will be honest at this point and
admit that when I was initially told about them I assumed they would
register your bgs
and inject the correct amount of insulin as and when required. I now know
and understand that due to all the variables this would not be too easy to
achieve but I also believe that this will come in due time. ( Maybe they
could also install a small glucose tube which would also inject when sugar
levels became low - now that would be nice ) - I'd better get out to the
garage and see what I can 'knock up'.

Thanks again for your help and advice

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