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[IPk] Various: Square wave bolus; Sliding scale vs. pumps; Clocks back
> Just a comment from my own brief experience. I have used the square wave,
> not for certain types of food, but for a particular style of eating
> The usual ones are 'grazing' eg at a buffet or barbecue, and during a long
> drive when I often have some sweets or a packet of biscuits throughout the
> Tony O'Sullivan
> > I rarely if ever use the squarewave on my MiniMed 507. My main problem
> > what Di found - as soon as you've set the squarewave bolus going, you
> > decide to have some pudding - and have to cancel the whole damn thing! I
> > prefer to have a small bolus upfront, and then a small bolus later if
> > necessary. Also perhaps I don't have the confidence to think I know what
> > digestive system is going to do :-/
> > If the 508 allows you to add a normal bolus on top of a squarewave,
> > good news. But I'm not due for an upgrade :-)
> > But more often I will use a temp basal rate since it gives me more
> > John
I often use the square wave bolus, similarly to Tony. As giving it over
30 - 60 mins usually suits me, I've never had the problem that John
describes (I've never been a pudding person anyway...), but would be
interested to know if the 508 programme can cope with this - I've not tried
> > >I don't understand why they took me off my pump and put me on a sliding
> > scale for insulin, when the pump was more than capable of delivering the
> > required doses of insulin (6 units/hour initially).
> > You might have to ask them, Liz. It could be they did it because they're
> > more familiar with the drip and they'd be in more control. Any medical
> > opinions?
> I don't work in hospital, but it does sound funny. Certainly it makes
> for the ward staff to revert to the delivery method that is familiar to
> them, in some ways they are responsible for the success or not of the
> method, and they would be worried, even if you were well enough to control
> everything at the start, that maybe you might not be so well later, or
> during the night.
> What surprises me is that they chose to give insulin IV. This is done when
> someone is very hyper, and I'm not sure why you were in hospital. Other
> in that emergency situation, there's no benefit in giving insulin iv, we
> know how fast it works subcutaneously. If you were in hospital for
> besides diabetes, and were not on a diabetes ward, I'd blame inexperience.
> It is frightening how little many hospital staff know about diabetes, say
> surgical units and the like.
> One word of advice for anyone going to hospital. Even though we may have
> give in and let others dictate our delivery method in hospital, we can
> remain in partial control of the situation, by INSISTING that we are told
> every b.g. result and allowed to record it or view the staff's record, and
> we have some input into every insulin dose given or at least are told what
> the dose is, and have a chance to review the sliding scale daily with the
> responsible doctor.
> In my view, handing over completely means being blinded to something we
> all familiar with, and that is frightening, unacceptable, and completely
> unnecessary. What do you think?
> Tony O'Sullivan
The reason you were in hospital is important. A few years back (but not so
long ago that things might have changed...), I was in hospital for elective
surgery. At that time I was using multiple injection therapy, but the meals
for the day before had been carefully arranged to contain no CHO
whatsoever...("she's diabetic, she can't eat that"). I also had IV insulin
on the day of the op to control bgs - this used to be a standard practice,
and I doubt that things have changed with the possible exception of
hospitals with pump expertise. Even in the latter case, surgery does involve
a stress which would have to be allowed for in the pump programme, and this
might not be acceptable to the surgeon - IV insulin acts more quickly and so
is more readily controllable (if anyone checks the bg...).
Tony, I agree, and I think it's insulting to people who probably know a lot
more about their condition than those treating them when these attitudes
prevail. Unfortunately, few medics know much about diabetes, let alone
specialist subjects such as pumps - a few discreet surveys by the medics in
this family support this view...- doesn't make it better, I know.
> Twice a year I ponder this, and twice a year I reach no conclusion...
> Just because the government decrees that I put back the time on my watch,
> does that have any effect on my own biological body clock? ie if I needed
> higher basal rate from 6am to 8am on the old time, when I put the clock
> back on my pump, should I leave it at 6am to 8am on the new time, or
> the basal rate increase from 5am to 7am?
> Or after a few days of going to bed an hour later and getting up an hour
> later, will my body clock drift back an hour as well, so I shouldn't worry
> about changing the times for my basal rates?
> I think in practice my basal rates are fairly constant through the night
> and day, so any changes don't really show. But if anyone has any further
> insight, I'd love hear it :-)
If your daily basal rates change substantially from hour to hour, you might
need to take this into consideration - but as the change is only one hour
you could simply change your pump time, perhaps when you got up on Sunday
morning (there's no need for the change to occur at 2 am!), check and adjust
later if necessary. Your body clock will get used to things after a day or
two with a single hour's change. In practice, you probably don't need to do
anything at all (I haven't, although I admit my experience is limited to
this year's changes, but I do fly quite a bit and even then only need to
adjust if the change is more than three or four hours).
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