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Re: [IPk] BDA Oxford conference

Replying to Julette Kentishes points:

Yes I am on a pump (for four years now, Humalog for nearly a year). I change
sites every day, I have regular eating, sleeping, exercising and testing
regime, and my insulin requirements vary by 20-30 per cent during a week,
which means in practice I have to watch my blood sugar levels closely,
despite the fact that there seem to be patterns which I think I recognise
from time to time.

My specialist in Brussels where I live has other patients like me  among the
fifty plus at this particular hospital when I started (pump therapy is far
more common here than in the UK,  but is primarily considered, since it is
fully financed by the health service, for "unstable diabetes").

 I cannot , of course, comment on what  practices work for others, but my
point is that for a certain category of patients (who hopefully are sanguine
enough to live without the illusion that their condition is not a problem)
many factors are crucial in deciding dosages, including awareness of that
strange day when you appear to need no boluses, followed by the day you have
to increase each one by a considerable amount. Such patients will be way off
track if they regard CHO counting as a basic management tool.
-----Message d'origine-----
De : Julette Kentish <email @ redacted>
 : 'email @ redacted' <email @ redacted>
Date : vendredi 24 septembre 1999 10:00
Objet : RE: [IPk] BDA Oxford conference

>Unfortunately people with diabetes can't lead normal lives - and you are
>right we keep telling patients 'control your diabetes rather than let it
>control you' This to a certain degree is rubbish. Everything you do is
>influenced by your injections, blood testing and what you eat. So much
>for the idea of freedom from diabetes.... But to try and have a positive
>approach to food and eating is still relatively important. The idea
>behind...you can eat whatever you like - has been replaced by  - as long
>as you calculate your carbohydrate and insulin accurately. Simon do you
>feel you are calculating carbohydrate conent and altering your insulin
>but with no benefit? Are you type 1? On a pump or injections? Changing
>your sites regularly? A few different avenues can be looked at before
>saying no matter what i do I can't predict my levels... I have a patient
>who finds great difficulty with this but he is producing residual
>insulin and at 75 has a bit of a problem ... his carbohydrate needs some
>work. That enough for now... any more information or you want another
>dietitian to add their 2 p's worth - just sing out :)
>> -----Original Message-----
>> From: Duckworth [SMTP:email @ redacted]
>> Sent: 23 September 1999 21:29
>> To: email @ redacted
>> Subject: Re: [IPk] BDA Oxford conference
>> I'm intrigued by the correspondence on this carbohydrate counting idea
>> which
>> I also think is a highly misleading thesis - part of the "diabetics
>> can lead
>> normal lives" myth. it reminds me of the 1970s when I was first
>> diagnosed.
>> The reality for me is that there are too many variables in my
>> condition to
>> pass up the chance of fixing within reasonably close tolerances one
>> parameter over which I can exercise easy control - what I eat and
>> when.
>> There is for me no fixed equation between insulin and carbohydrate,
>> something I have learned to my cost during a number of years of
>> multiple
>> injection regimes, when I was living under the illusion that because I
>> felt
>> OK and the tests were OK (with plenty of hypos to keep the HBA1C down)
>> everything was all right.
>> I would say beware of these easy solutions and check them out
>> thoroughly for
>> consistency before you put your faith in them.
>> ----------------------------------------------------------
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>for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
>help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml

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