They were. A number of the early studies comparing CSII and MDI focused on or included children, partly to gauge how receptive children and their parents were to pumps and whether the whole business had any future in that regard. Apparently children were often more enthusiastic about pumps than their parents (but of course the parents were the ones footing the bill).
One of the 1992 sources I accessed today indicated the pump study including children down to age 7.
I started with animal R insulin in my pump start on 507/8. A few years later the human R version was available and switched to that. Stopped NPH when moving to pump.
I had been with the same doctor for about 5 years, and had been treated for retinopathy on both eyes, so certainly a candidate for improved control. Yet was not taught carb counting until switch to pump, and pump had not even been mentioned during that 5 year period. I asked them about it after meeting other pumpers at support group.
I never understood why carb counting was only for pumpers.
Who needs it when you have Exchange Diets!
But seriously, most of us were taking N as well, and I donât think anyone had really worked out a way for adjusting doses specific to whatever you were going to eat that far out from the actual meal. I just tried to eat more or less the same thing at the same time every day and hope for the best.
And we all know that one bread exchange is equivalent to any other bread exchange serving, in terms of insulin dosing.
I wasnât particularly well controlled, partly because until the last year of high school I had a lousy family doctor and also because I didnât adhere that closely to the exchange system diet. In my last year of high school â and I canât remember why â I went to see a diabetes specialist for the first time, and he recommended a pump. I think at the time the concept of âcontinuous infusionâ was thought to be the abracadabra to good control. And after being locked in to the R/N regimen, there was a lot of appeal in the freedom to delay, skip or, with different-sized boluses, eat less or more at mealtimes. One wasnât tied so much to the exchange/calorie diet. I donât think carb counting had even been invented yet.
Given my lousy control beforehand, there was a good degree of âanythingâs an improvement.â Plus my dad was behind anything that promised to make my diabetes easier (or less fatal).
You say that almost like you supposed anyone did!
It amazes me how archaic everything was until the early 2000s. I donât even think Lantus came to Canada until 2005. I have a type 1 dad who started on 1 shot of Lente in the 70s and now pumps, but doesnât remember much about his treatment regimen in-between. Iâm curious, how did one shot a day of Lente work? Was it just a very high dose and you had to keep eating every few hours to feed it? Why did NPH become the standard when Lente was available? Couldnât R and Lente have been used sort of like how Lantus/Levemir/Tresiba and rapid are used now? What was ultralente and why was it not as popular as N?
I was started once per day Lente in 1965. It was considered a great convenience compared to when only Regular was available, and required multiple injections per day. We had no BG testing, only urine testing, which was useless to base insulin dose changes on. Every 4-6 months my ped doctor would review urine test logs and tell us to increase dose if required. (I rarely had negative urine tests, doc thought I was doing great, compared to other children having many lows or passing out.)
When NPH was available, it was thought better because there was mid day peak to cover a lunch time meal. But the timing for the meal was critical, and many would go low if meal was delayed, or kids were not eating their full meal. Regular was used to cover breakfast and dinner. I did a second injection of NPH before bedtime. But without BG testing it was like playing darts in the dark.
Some may have used Lente and Reg, but for young school aged kids, who would do lunch time injection?
NPH + Reg was recommended to me once BG testing was available, in mid 1980s. I would test before meal and add 1-2 units Regular based on BG. Syringes only, so no 1/2 unit pens or pump micro-bolusing.
The general belief was complications were caused by the same âthingâ that attacked the pancreas, and later doing damage to eyes, feet, and other organs. So wasnât that much concern about high BGs, more about avoiding lows. (At least in my case.)
For those that went to top notch diabetes centers, like Joslin, they were getting better treatments, sooner. Took me until early 1990s to have doctors that encouraged tighter control based on DCCT results and A1C tracking, while others were adopting improvements much earlier.
The perfect basal insulin matches the glucose output of the liver, nothing more, nothing less. In modern times with insulin pumps we know how hard it is to exactly match basal needs. You may get it right one day but the next day can be different.
I only used NPH for a few years but also briefly tried Ultralente. NPH basal, of course, was a compromise and it was intended to perform some bolus duty around its peak. I think the biggest drawback to these âbasal insulinsâ was that their action profile was not same from day to day.
Projected peak times often spanned several hours. In the case of Ultralente, clinicians thought of it as flat, but it did have a peak. And if that peak coincided with exercise or a delayed meal then it could often lead to a hypo. For me, basal hypos are worse than bolus hypos in that they are hard charging and sustained in duration. It takes a determined and sustained effort to raise glucose levels from hypoglycemia due to a basal mismatch.