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

In message <001f01c272f8$d8bcc160$email @ redacted>, Diana Maynard
<email @ redacted> writes
>Hi Pat
>You completely missed my first point.
>Having a stable basal insulin (as MDI would give me if I had Lantus) isn't
>enough - I need to be able to set my basal insulin to give me differing
>rates at different times. That's pretty much impossible with MDI unless
>you're very lucky and can time the peaks and troughs appropriately.

I still don't get it. If you need different basal rates at different
times, and there is a long-acting insulin which gives you those
different rates, then you don't need a pump to give you those different

Say you needed to have 1 unit p/h from 5am to 10am, and then 0.7 ph
until 5m, and then 0.5 p/h until 5am.   It might be that Monotard (or
some other insulin) would give you that pattern.  Then the pump wuuld
have no advantage. But if you can't find a long-acting which matches the
pattern, then you need the pump.  Having 'different rates at different
times' isn't a problem which pumps solve.  Having 'different rates at
different times which cannot be matched by any long-acting insulin' is
the problem - but you seem to be ruling that out as your problem.

One extra advantage to the pump: basal patterns need to be delivered
with some regularity. On the pattern I gave as an example, the 1/unit h
rate needs to start at around 5am on virtually every day = i.e. not
starting the 1/unit at 5am on some days, but on others starting it at
2ma, sending you hypo, and on other days, not starting it until 8am,
making you high.

Best wishes,

dm 30 +, 508 1+, had a day thinking in Dutch, obviously ...
Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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