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RE: [IPk] lots of questions from a newbie!

Hi Louise,
I have no personal experience of diabetes in pregnancy, but the attitude of
your diabetes team to a 'good' HbA1c is quite typical of many! I had similar
problems until I reached medical school when my HbA1c rose to 8-9% as I
could afford hypos anymore so ran myself high (although I still had night
time hypos). I have now been on a pump for 10months and my HbA1c has fallen
I can't answer a lot of your questions, but I have tried lowish carb diets
on both a pump and humalog injections. I achieved really similar post-meal
results to you on injections and was more stable with a 'normal' amount of
carb (not huge!). It might be worth just trying. Results with a pump are
better but I feel better with a normal amount of carb in my diet. It does
seem a bit extreme not to be able to eat any at lunch or dinner time (unless
that's what you want!). Novorapid may help as it has a longer tail-off of
action in most people - again there's probably no harm in trying it. The
other thing I found really helps BGs in exercise. During revision I tend to
slack off until I feel lousy because of swinging BGs and realise it would be
good to do some exercise! It doesn't seem to matter what it is or what time
of day and doesn't seem to need to be regular, just there!
As far as funding goes it isn't easy in a lot of places. I bought my pump
and am still paying for supplies whilst my PCT (Cambridge) faff about
sorting out some local guidelines (hopefully this month!). My consultant is
quite positive that i'll get funding, althought the main basis for this is
the small number of users in this area! Should this happen, the PCT (or
someone!) will pay for the supplies but I won't get anything I've already
spent reimbursed. I also don't perfectly meet the NICE guidelines (as you
don't with an HbA1c <7%) and my consultant was fairly unkeen as even HbA1c's
of 8-9% aren't considered horrendous! Fingers crossed! Certainly in my
region, it seems easier to get funding for a pump if you are or are planning
to become pregnant. However, at least some people are then forced to come
off the pump at the end of their pregnancy (although I think there are now a
couple of people funded in my area who started pumping under there
I don't know about diesetronic, but Minimed have a 1month free-trial. If you
don't like your pump at the end of the month you can send it back to them
and get your money back. They also have pump nurses (I was trained by one of
them who was excellent and has supported my DSN) who can come to your local
hospital. It doesn't quite solve all problems, as the support is not great
with a team who aren't experienced in pumps, but actually most practical
advice can be obtained from this list.
Also, try to change your DSN - they really don't sound very helpful and
there should be some others in Newcastle.
Good luck
DM7+y 508 11months

-----Original Message-----
From: email @ redacted [mailto:email @ redacted]On
Behalf Of Louise Kempton
Sent: 03 November 2003 14:53
To: email @ redacted
Subject: [IPk] lots of questions from a newbie!

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Hi all - I'm Louise, new member.  I'm 32 and was diagnosed in January 2003
with Type 1 (after initially being diagnosed with gestational diabetes in
July 2002 and then IGT - going into DKA finally helped the medics to figure
it out!)  After terrible results with Insulatard/Mixtard I was fairly
quickly put onto MDI (humalog and lantus).

My hba1c is currently 6.7% which my diabetes team seem to think is enormous
cause for celebration.  However this is just a midpoint between the frequent
highs and lows.  To get this kind of control I can expect about 2 hypos per
day.  Also I have had to pretty much cut out  bread, potatoes, pasta, rice,
fruit etc.

I couldn't get the Lantus to work for 24 hours.  Taking it at night meant
morning hypos but creeping up from mid afternoon.  Taking it in the morning
meant I was waking with high BG (so feeling crummy) and hypos in late
morning.  I now take it twice a day (14 units in the morning and 2 at night)
which works as long as I don't eat any carb for lunch or dinner!  My team
would not give any advice or support on this so I took the decision and set
the dose myself.  Does anyone else have experience of splitting Lantus?

My carb to insulin ratio seems to be about 1 unit to 5 g.  This seems really
high.  Most of the literature talks about it being 1:10 or 15.  Does this
mean I have reduced insulin sensitivity??  (I'm not overweight).  I unit of
humalog seems to lower my BG by 2.5 - 3 which seems pretty typical.

The other reason I am eating low carb is because of problems with humalog -
I get decent BG results 1.5-2 hours after a meal but it then climbs up 3-4
hours later.  If I take more humalog then I go hypo, need to eat and then go
high from the snack.  Does anyone else have this problem?  Would Novorapid
be better or splitting the humalog?

(By the way I have stopped calling my DSN as her reaction to any of the
above is "that's diabetes for you" ....)

I am really keen to try a pump.  There are some people at my clinic using
them, but the consultant seems to only use it as a complete last resort.  I
am afraid that I am being discriminated against because of my perceived
'good control' - which is only achieved by testing 8-10 times per day,
giving correction doses, rigorous carb counting and carb restriction etc.

Any tips on how to persuade my team would be appreciated!  I am keen to try
for another baby next year but would not dream of it with my current BG
levels and am terrified of the effect that pregnancy hormones will have on
what already feels like a roller coaster at the best of times.  Therefore I
will pay (re-mortgage the house, whatever ...) for one myself.  Does anyone
have experience of dealing with the pump manufacturers directly?  Is it
possible to get a trial of a pump before committing to buying one?  If I buy
the pump privately is there any chance of getting consumables on
prescription or will I have burnt my bridges?

I am going back to clinic in a couple of weeks time and will again try to
put some pressure on the consultant to recommend me for pump trial, but I'm
not very hopeful.  (I am under Newcastle NHS - would love to hear from
anyone else in the area who has local experience).

Thanks to anyone who has taken the time to read this long message, and
special thanks to anyone who replies to any of my questions.

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