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[IPk] my response to the DAFNE trial published in the BMJ

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> "adjusting carbohydrate and meal insulin only part of the problem"
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> <!-- article ID: 325/7367/746 -->
> <P>  I have struggled with type 1 diabetes for 16 years and for the last 2
> of these have greatly benefitted from a pump.I was encouraged to read that
> some far thinking professionals are now doing what should have been
> uniformly taught to those with type 1 diabetes who are capable of
> undertaking such a program, for at least the last decade since the advent
> of "basal bolus" insulin regimens and home blood glucose monitoring.
> However the DAFNE study fails to mention the vital need for physiological
> basal insulin substitution in order to give good control while minimising
> hypos and allowing freedom with food. I am doubtful and envious that once
> or twice daily NPH will meet this need in many of those with diabetes.
> Part of this problem could be overcome by substituting the new long acting
> analogue glargine but many of us have widely varying basal insulin
> requirements which can only be met by a pump which can be programmed to
> give different rates each hour. Without this there would still be a need
> to eat large snacks at certain times of the day when insulin sensitivites
> are greater, or conversely spend times when sensitivity is less,
> hyperglycaemic to the detriment of HBa1c and future health.
> I believe that for some of us the pump is the only way to achieve
> satisfactory control. Perhaps I am being unrealistic in my dismay that
> people who are willing to monitor and inject intensively achieve only an
> average A1C in the mid 8s, rather than the 6s or 7s. The pump has allowed
> me to improve gradually from 9.6 to 6.6 % while retaining hypo awareness
> I believe, as a diabetic or to be politically correct, a person with
> diabetes, that we deserve the best.
> If I could not afford to pay I may well have had to have settled for
> second best
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