Tips from old timers

Yeah, I can sort of sympathize. You get in a certain groove with your treatment and you don’t want to change because that requires giving your disease a whole lot more mindshare for a while. I was that way about pump therapy for a long time because Lantus-Novolog MDI was so life changing after R/N, and most of the time I could coast along without having to think about it too much, whereas pumping looked like it was going to be rubbing my nose in “You’re a Type One!!!” for a while until I got it down. And in fact it did do that for a couple of months, though in the long run it was worth it.

OTOH I had to fight to get onto analog-insulin MDI, which made things so much easier right from the start. Took me a week or so to figure out carb-counting, getting my ratios dialed in and whatnot, but that was relatively easy and the benefit of the change was apparent right from day one. Worst thing about NPH is that it is not a “basal” as most of us understand the term. It has a very distinct peak that can really sneak up on you, and in combination with R for meals–or even, in this case, Humalog–it can set you up for some really scary lows. Of course a CGM might help with that, but the first step would be to switch to Lantus or one of the other analog basals, particularly if he’s gadget averse and doesn’t want to spend a lot of time learning a new system. The thing about the analogs, that I can swear to with great vehemence, is that they make your life so much easier right from the moment you start. (I can still remember sitting at my desk the first week I was on it, the day I decided to try letting the clock tick past my Eat Now! time, until over an hour had gone by and I was still ok. I literally had to close the door to my office because I started weeping with the relief and newfound freedom.

Ah, he’s not gadget averse, he just has a lot going on, and doesn’t prioritize his T1D, which overall is a good thing, but means that he postpones this kind of stuff. I think a visit to an up to date endo would help him a lot.

EDIT: And what you write about NPH vs. analogs … read this outrageos nonsense: High-Tech Insulin Is More Problem Than Solution - Bloomberg

I particularly “like” this part:

The advanced formulations are meant to work faster or longer, but they’ve been shown to offer little or no advantage over the basic alternatives.

I think we can agree that this is complete and utter BS.

I keep running into this and have even discussed it with my endo, who is familiar with this strain of thought. The problem is the focus on “outcomes” to the exclusion of all other factors, like, y’know, quality of life!!! Which isn’t just a mushy euphemism for “convenience,” it means not living in fear (at least not as much) of crashing into a low and losing your sight while driving, or being able to function at work, etc etc. As opposed to things it’s easier to put a number on, like longevity, incidence of complications and the like. Frustrating.

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