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[IPk] people on non flexible regimes

I've been seeing a patient who has had DM for 30 years, and has background
retinopathy and cataracts but is otherwise "quite well". He's on bd mixtard
and A1cs have been around 8.5 to 10. When they've been on the higher side
the GP seeing him at the time has entered " need for better control- usual
warning given" When going through a particularly brittle phase he was
advised to test twice a day. I've seen his results and bgs have soared in
the evenings but he's on mixtard so if he increases his evening dose he is
at greater risk of nocturnal hypo- so effectively he has to make an
appointment with his GP to adjust his dose
I don't believe he is particularly neglectful of himself but tends to follow
the advice given. Yet the above warning suggests that people tend to think a
large proportion of his problems can be attributed to him directly
Surely the problem lies in the fact that a great number of healthcare
professionals have an over simplistic view of the condition and believe that
"correct" dose at "correct" time and atention to diet = good control and
they don't understand the complexities of metabolism ( not that I usually do
Another colleague mentioned that "brittle diabetics are often young females
with psychological problems"
I like to believe that they tend to be young women with lots of progestagens
and oestrogens floating around which affect glucose metabolism making it
difficult and unpredictable, which in turn perhaps leads to psychological
distress and perhaps denial and even worse control

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