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Re: [IPk] bad paeds care

Hi Rob,

I'm absolutely gobsmacked at those figures.

MDI.  Now. Not after Christmas.  Now.  

The basal is calculated in one of two ways: the minimed way (although
you can do it with either pump) is to take total daily insulin at the
moment, halve it, knock a bit off because insulin needs on the pump are
less, divide by 24 hrs (rounding down) and set that as the basal rate
and watch what happens.

The disetronic way (and you can do it with either pump) is to take that
same amount of insulin, and look at how it would be distributed in a
'normal' diabetic, set that as the basal rate and watch what happens.

If you already know something about the basal rates you can take that
into account on the first guess setting (e.g. I knew I needed no insulin
in the late afternoon, and persuaded the nurse to let me set it that

Do try out the aida site (a search on aida, diabetes, insulin should get
it).  You can put in things like height and weight and insulin doses,
and see what happens.  It's labelled all over that it's not for trying
out personal care scenarios, but for finding out what different insulins
_could_ do in a 'typical' body.  It may give you some hints!  As well as
showing how Mixtard is the work of the devil.

With best wishes,


(dm 30+, 508 1+)

In message <002601c2986a$c7a79840$email @ redacted>, Rob Reznik
<email @ redacted> writes
>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
>for HELP or to subscribe/unsubscribe, contact:

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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