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RE: [IPk] people on non flexible regimes

From: Abigail King [mailto:email @ redacted]
Sent: Tuesday, October 17, 2000 7:18 PM
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

**** Abigail, there are no easy solutions, but your patient could try a
different mixed insulin eg: mix 25/mix 20/80 etc..but this will vary
with each meal so it is a difficult one, I am assuming he is on mixtard
30/70 or M3. Ideally if he needs to ajust his bolus at evening meal -
MDI or Pump is the way to go. There are no insulin pen techniques at the
moment that can deliver the same basal and varying bolus doses in one
injection...perhaps I have a calling as an inventor... if the patient
really hated the complexities of injecting too much during the day,
theoretically he could stick with the mixed injection at breakfast and
have a rapid at evening meal and a basal dose injection before bed. 3
injections but a bit more freedom - he may just not want the fuss at
work (???).
Hope you may find this useful....
Jules :) 
Ms Julette Kentish, BAppSC (NutSc) MND SRD
Diabetes Research & Specialist Dietitian
Royal Bournemouth Hospital
Castle Lane East
Bournemouth BH7 7DW
ph: 01202 704929
fx: 01202 704759
email: email @ redacted
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