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  Back to Chat Chat with Dr. Stuart Brink
On February 16, 1999, Dr. Stuart Brink of the New England Diabetes and Endocrinology Center joined us for a special chat session on control in kids and teens. This transcript has been edited.

Tue Feb 16 1999 19:08:47 Eastern US
Jeff Hitchcock from 153.35.133.29
The special chat session with Dr. Brink begins at 8:00 pm Eastern Time (20:00:00).

Tue Feb 16 1999 19:50:20 Eastern US
Ellen from 205.188.193.33
Hi. Dr. Brink, when you get here, please type in hello :-).

Tue Feb 16 1999 19:54:15 Eastern US
Dr Brink from 152.163.206.208
Hello Ellen. I'm here!

Tue Feb 16 1999 19:54:36 Eastern US
Dennis Cardone from 24.128.70.72
Are you Ellen H. Ullman from KidsRPumping

Tue Feb 16 1999 19:55:55 Eastern US
Jeff Hitchcock from 153.35.133.29
Greetings Dr. Brink. Thanks again for joining us for this special chat.

Tue Feb 16 1999 19:56:00 Eastern US
Dennis Cardone from 24.128.70.72
Dr.Brink: How high does a childs glucose level get before they experience mood swings?

Tue Feb 16 1999 19:56:11 Eastern US
Brenda H. from 206.112.197.133
Hello Dr. Brink. Welcome to our website. People should start arriving soon and they will start bombarding you with questions.

Tue Feb 16 1999 19:57:23 Eastern US
Ellen from 205.188.193.33
Hi Dr. Brink, thank you for agreeing to answer our questions....

Tue Feb 16 1999 19:57:38 Eastern US
Jeff Hitchcock from 153.35.133.29
I'd like to try and set the tone for tonight's discussion. Ellen Ullman arranged this chat, and I'd like to give her a chance to provide some introductory comments. Ellen?

Tue Feb 16 1999 19:58:22 Eastern US
Barbara Towell from 205.188.200.47
What is the youngest age that a child may be considered for using the pump?

Tue Feb 16 1999 19:59:12 Eastern US
Dr Brink from 152.163.206.208
Ellen, I'll wait for your introductoriy remarks.

Tue Feb 16 1999 19:59:57 Eastern US
judy from la from 207.101.87.97
along the same line as how young, i would like to know what to do if your doc is not interested in the pump but you would like to try it?

Tue Feb 16 1999 20:00:04 Eastern US
Dennis Cardone from 24.128.70.72
Hello Dr. Brink

Tue Feb 16 1999 20:00:51 Eastern US
Kelly M from 12.68.100.137
Hi Dr. Brink, it's Kelly Melo (s/p Smith)

Tue Feb 16 1999 20:01:22 Eastern US
Ellen from 205.188.193.33
Dr. Brink wrote the most wonderful article on what has been learned about from the DCCT and how to apply it to children and adolescents with Diabetes. I was often mistakenly told that it didn't matter about high blood sugars while children were young...somehow they wouldn't have complications down the road from those early years... I've since been much better informed and wanted everyone to have the opportunity to learn the facts.

Tue Feb 16 1999 20:02:06 Eastern US
Dr Brink from 152.163.206.208
Hi Mr Cardone. Hi Kelly. (Know who Melo nee Smith is...!)

Tue Feb 16 1999 20:03:17 Eastern US
Jeff Hitchcock from 153.35.133.29
I guess with that as introduction, I would like to ask Dr. Brink to comment on the fact that many of us -- myself included -- were told that high blood sugars prior to puberty had little impact on long-term complications. What is the thinking today?

Tue Feb 16 1999 20:03:29 Eastern US
Mary from Ma. from 152.163.197.213
hello dr. brink, my two children see your associate.

Tue Feb 16 1999 20:03:43 Eastern US
Dennis Cardone from 24.128.70.72
Ellen that is a major issue with controling glucose levels in Children.

Tue Feb 16 1999 20:03:44 Eastern US
Brenda H. from 206.112.197.133
Along the lines of what Ellen said, we were told the same thing, but now try to keep our daughter, now 11.5, dx'd at 2, under 140 mg/dl. Could you please provide some guidance for parents as to what BS levels they should try to maintain for various age groups? for ex. children under 2, children 2-6, etc. Is this possible?

Tue Feb 16 1999 20:04:08 Eastern US
Dennis Cardone from 24.128.70.72
HI MAry

Tue Feb 16 1999 20:04:11 Eastern US
Barbara Towell from 205.188.200.47
Hi Dr. Brink I'm Barbara Towell, grandmother of a 7 year old who has tried the pump with saline for 2 days

Tue Feb 16 1999 20:04:28 Eastern US
garybfrom 209.154.103.173
What exactly are considered high bgs.Day to day no.s that stay high or an occasional high

Tue Feb 16 1999 20:04:38 Eastern US
Dennis Cardone from 24.128.70.72
Dr. Brink Melissa is here and says Hello

Tue Feb 16 1999 20:04:39 Eastern US
Ellen from 205.188.193.33
Melanie Richardson wishes she could be here, but was forced to go sailing in the Bahamas this week.

Tue Feb 16 1999 20:04:45 Eastern US
Mary from Ma. from 152.163.197.213
hi dennis..how's melissa?

Tue Feb 16 1999 20:05:38 Eastern US
Jeff Hitchcock from 153.35.133.29
Dr. Brink, the floor is yours.

Tue Feb 16 1999 20:05:44 Eastern US
Dennis Cardone from 24.128.70.72
Great! She has a good Dr. HA

Tue Feb 16 1999 20:06:37 Eastern US
Judy from NY from 24.92.54.96
Hi. Welcome, Dr. Brink

Tue Feb 16 1999 20:06:59 Eastern US
Dr Brink from 152.163.206.208
I guess I should let everone in the chat room know something about my background and training before starting to answer specific questions. Went to medical school at the University of southern California in Los Angeles and then did four years of pedaitric residenc training aLa County/USC MEdical Center. COncluded with a year as Chief Resident before specialized training in pediatric endocrinology at Children's Hospital in Boston. Then another year at the Joslin Clinice to complete my fellowship training. Joined the staff at Joslin and established a pedaitric diabetes team there. Before that, in 1978, only internists cared for the children at Joslin. I stayed at Joslin for 7 years and then opened my own private practice called NEDEC: New England Diabetes and Endocrinology Center in Chestnut Hill. NEDEC moved to Waltham to bigger quarters several years ago. I'm also on the faculty of Tufts University School of Medicine and Harvard Medical School and lecture frequently nationally and internationally about pediatric and adolescent diabetes issues.

Tue Feb 16 1999 20:08:10 Eastern US
Dr Brink from 152.163.206.208
Mr C: mood swings and BG levels - no set level. probably more likely with wide swings going in either direction. Younger kids often cannot explain what's going on but as they get older and more in tune with their bodies they can begin to associate the swinging BGs with not feeling wel.

Tue Feb 16 1999 20:08:26 Eastern US
Moira from 207.115.62.54
Hi Dr. Brink. My seven yr old, Lauren is treated at Children's in Boston. I am often interested in how much "looser" kids on Josllin's program are. Why the big difference?

Tue Feb 16 1999 20:08:33 Eastern US
Dorothy from 24.131.151.82
Dr. Brink then you were at Joslin when I went there as a kid in 1984

Tue Feb 16 1999 20:08:36 Eastern US
Dennis Cardone from 24.128.70.72
Beside complications, does the higher levels cause mood swings?

Tue Feb 16 1999 20:08:59 Eastern US
Dorothy from 24.131.151.82
It's a pleasure to "meet" you sir

Tue Feb 16 1999 20:10:26 Eastern US
Brenda H. from 206.112.197.133
Being the parent of an adolescent daughter I have heard that we should start to see higher BS readings and the need to increase insulin during puberty. Two questions: Is this also true of boys? (I know more about the hormonal changes in girls) and Once puberty ends, do the insulin levels reduce at all or just level out?

Tue Feb 16 1999 20:11:26 Eastern US
Ellen from 205.188.193.33
I'd also like to mention how forward thinking and proactive Dr. Brink is. He put Judy's (NY) then 3 year old daughter Elissa on the pump 14 years ago. That was very proactive back then.

Tue Feb 16 1999 20:12:05 Eastern US
Judith from 206.112.27.217
Hello, Dr. Brink. My son is 13, diagnosed at age 2 months. I wonder if isn't an oxymoron to mention "teen", and "control" in the same sentence?

Tue Feb 16 1999 20:12:11 Eastern US
Dr Brink from 152.163.206.208
Barbara: age for pump use is not as critical as maturity and self-care responsibility. We have treated children as young as 3-4 years of age when they and their parents were motivated and willing. In many instances multidose insulin treatment is equally good and doesn't burden one with wearing a pump. The biggest benefit of the insulin pump is the predictability of using regular insulin, and now Humalog insulin compared the unpredictability of all the other cloudy insulins. It requires more not less work, frequent monitoring and ability to analyze BG results and often is more expensive even if insurance companies pick up most of the costs. A common reason for insulinpump treatment at NEDEC is unpredictable hypoglycemia especially overnight hypo's. Also preconception/pregnancy for young adults.

Tue Feb 16 1999 20:13:16 Eastern US
joey in kentucky from 208.252.118.228
:-)

Tue Feb 16 1999 20:14:17 Eastern US
Judy from NY from 24.92.54.96
Dr

Tue Feb 16 1999 20:14:25 Eastern US
Dr Brink from 152.163.206.208
Brenda:

Adolescents often have a more difficult time with BG control because of the normal hormonal changes that occur. These interfere or "block" insulin action and so insulin doses must be increased very significantly. In those who are motivated, while these are legitimately more difficult few years, they do not have to be a disaster with good support, knowledge, frequent montioring and frequent office visits.

Tue Feb 16 1999 20:15:51 Eastern US
Joan from 152.163.205.54
Hello Dr. my 17 year old daughter..dxed at age 3..just went on pump in aug.

Tue Feb 16 1999 20:15:55 Eastern US
Mary from Ma. from 152.163.197.213
dr. brink.how often do you recommend that children in your offices practice visit??

Tue Feb 16 1999 20:16:46 Eastern US
Ellen from 205.188.193.33
Let's give Dr. Brink a chance to answer each question....

Tue Feb 16 1999 20:16:51 Eastern US
Joan from 152.163.205.54
she also has a history of hyper thyroid..how much impact does the thyroid usually have

Tue Feb 16 1999 20:16:58 Eastern US
Karla from 207.179.175.60
Dr. Brink, this is Karla. Just wondering if you have any guidance to offer in regards to spiking blood sugars during a basketball game (adreneline at work for sure!).We give a larger dose of insulin that am and often less Cho, but still often run in the 20's; 2-3 hrs later, we are back in range.This is an 8 yr old boy on Humalog/N in the am, Humalog ac supper, N at bedtime.

Tue Feb 16 1999 20:17:12 Eastern US
Dennis Cardone from 24.128.70.72
Since you deal with the pyschology of Diabetes.
How is it best for parents to deal with the stress
od caring for a child with Diabetes?

Tue Feb 16 1999 20:18:09 Eastern US
Dr Brink from 152.163.206.208
In LA, someone asked what to do about docs who aren't interested in pump tx. The best advice I can provide is to try to discuss the pros and cons nonemotionally. There are severeal excellent ped endo's in LA area who have lots of experience with pump patients. The other issue is whether it is the parent or the child who is interested in the pump. If it is not the child or mostly the parents, then pump treatment is likely to be unsuccessful. We spend a lot of time chatting with our patients and trying to determine why they want a pump, what they think it will do, making sure that there are no "magical" easy solutions. We ask everyone to read the Teen Pumping Book by Minimed before we do anything else and try to optimize multidose insulin treatment first.

Tue Feb 16 1999 20:18:20 Eastern US
Darlene from 209.57.212.170
Hi Dr. Brink, my son is 12 and has had diabetes for 2 years, with the hormonal changes- our biggest problem is the lack of consistency- highs one day, lows the next with the same activities and diet- is this something we just have to live with for the next few years??????

Tue Feb 16 1999 20:18:37 Eastern US
hom-hom from 207.86.100.205
Hello Dr. Brink, My son is 3.5 years old, diagnosed at age 18mo. We are thinking of switching him from pork to humulin insulin, not only to decrease the lipohypertrophy, but thinking that perhaps the antibodies to the pork insulin are, in the long run not good for him. We have very good control (recent A1c of 6.9), so on the other hand are afraid to "fix it if it ain't broken". What is your opinion?

Tue Feb 16 1999 20:19:24 Eastern US
Barbara Towell from 205.188.200.47
Which pump do you recommend for small children?

Tue Feb 16 1999 20:19:40 Eastern US
Dr Brink from 152.163.206.208
Dennis - the best way to deal with stress is the same for kids and families liviing with diabetes as for those without -openly, honestly, making sure that you/parents are unconsciously causing the stressful situations, setting realistic and reasonable goals and keeping discussions open with everyone in the family. Tx of diabetes is imprecise, unfortunately, so all we can do is keep trying to do a better job no matter how frustrating.

Tue Feb 16 1999 20:21:52 Eastern US
Jana (church@glinx.com) from 142.176.48.52
Hi My daughter is almost9 and been diabetic since 2.She also has celiac and no matter what we do, she is still brittle .After all these years, is this likely to continue as we have tried everything and specialist seems to have no answers either.She uses Humalin N and humolog which we love

Tue Feb 16 1999 20:24:05 Eastern US
Dr Brink from 152.163.206.208
Hom-Hom: we swithed our entire practice to Humalog from either Humulin, Novolin or pork insulin several years ago after participating in some of the earlier Humalog research studies. We found that Humalog is a much better insulin because it works faster, doesn't require waiting 30-60 minutes before food (which hardly anybody every sustains), peaks faster and therefore covers the immediate BG rise better, and goes away faster so causes less hypoglycemia. We have used Humalog with toddlers, school-age kids, teens and adults very successfully with clinic-wide A1c very close to that achieved in the adolescent group of the DCCT. However, the biggest reasono change from pork insulin may be the problems you may start to have after another year or so with its no longer being produced. Lilly has about a year or so left of pork supplies but will stop manufacturing pork inslin. We have not seen any problems since all of our patients are asked to use multidose insulin treatment and this works terrifically well with Humalog premeals. As always, you should talk with your doc and find out spefic recommendations.

Tue Feb 16 1999 20:26:31 Eastern US
Dr Brink from 152.163.206.208
Jana - the celiac disease, while adding great difficulties with food choices avoiding wheat/gluten, should not matter vis-a-vis BG control. I would look for other explanations, perhaps early pubertal changes. In general, we would suggest very frequent monitoring with pre and postmeal BG checks plus some throught the night very intensively for thre or four days. This should provide some clues as to when insulins are peaking and waning. If you have very high BG values at suppertime, then adding some NPH at lunch may work. An alternative is to stop the afternoon snack or to use some Humalog at afternoon snack, for instances. We frequently use overlapping doses of NPH three or four times each day if the BG pattern so suggests.

Tue Feb 16 1999 20:27:27 Eastern US
Alison from 149.130.195.249
We have been mixing Humalog, Regular and NPH in two injections per day for our nine year old daughter, with pretty good results. Why do you prefer not to use R with your patients?

Tue Feb 16 1999 20:28:12 Eastern US
Dr Brink from 152.163.206.208
Darlene: one fo the best systmes for such up and down patterns is to try to gain some consistency. Frequent small bursts/boluses of Humalog before meals will like help give more predicatabilty instead of relying mostly on big bursts of intermediate/long acting insulins. Have you tried this approach?

Tue Feb 16 1999 20:29:05 Eastern US
Dennis Cardone from 24.128.70.72
Dr. Brink do you feel tight control starting at a early age will lead to a habit during the teen years. And should a child have monthly endo visits?

Tue Feb 16 1999 20:29:47 Eastern US
Sandy D. from 209.44.47.175
Dr. Brink, you mentioned "early pubertal changes" in your response to Jana. My son is almost 12, dx'd at 4, and in the last couple of months his numbers have made a roller coaster look like a kiddie ride. We know he sneaks food sometimes, but not constantly or consistently. Are the early pubertal times more "rough and tumble" than the overtly adolescent times?

Tue Feb 16 1999 20:29:51 Eastern US
Dr Brink from 152.163.206.208
Alison:We find that regular insulin causes the need for more snacks and more calories because of its longer tail effect. This is te reason for more hypo as well especially prelunch, late afternoon and in the middle of the night. Regular inslin also automatically "misses" the BG rising effect after most food and therefore Humalog is more physiologic, closer to the action of the body's own insulin and, in our view, more preferable.

Tue Feb 16 1999 20:30:22 Eastern US
Judy from NY from 24.92.54.96
Dr. brink...what would be your answer to those who say teens will run high no matter what...and that it doesn't really matter....their age will protects them from developing complications?

Tue Feb 16 1999 20:30:44 Eastern US
Kelly M from 12.68.100.137
My daughter is 16 months old and a patient of Dr. Brink's...his "method" has been working great for our daughter. The overlapping NPH and Humalog at meal times. Her bld. sugars have been getting more consistent.

Tue Feb 16 1999 20:31:51 Eastern US
Dr Brink from 152.163.206.208
Sandy: early and mid-pubertal years all reflect increases in sex hormones but also adrenal hormones and growth hormone. All these contribute and start, chemically, around two to four years before you see any body changes. So, I would suspect that this is the chemical culprit you are seeking. Nevertheless, more small bursts of fast acting insulin and smaller overlapping doses of backgrund insulin should help. Do you use carb counting? Does it provide better flexibility for covering the intermitent food excesses?

Tue Feb 16 1999 20:32:10 Eastern US
Brenda H. from 206.112.197.133
Dr. Brink, do you have any advice to give parents whose teens may forego testing their blood sugars or their insulin shots? I have heard this can be a big prob. with some teens.

Tue Feb 16 1999 20:34:18 Eastern US
Dr Brink from 152.163.206.208
Hi Judy: The studies about the prepubertal years "not counting" towards the development of complications later on was done by good friends and colleageus at the University of Pittsburgh. However, more recent studies from Sydney Australia, Berlin and Brussels refute these earlier ones. The key problem is that complications generally take 10,15,20 andlonger years to develop. We believe that control counts all the time and therefore strive towards the best control possible - always with a caveat of minimizing or preventing severe episodes of hypoglycemia. Frequent testing matters. Learning how to use the BG data matters enormously.

Tue Feb 16 1999 20:35:25 Eastern US
joey in kentucky from 208.252.118.228
What range do you like to see in A1c's of children 8 - 10 years old?

Tue Feb 16 1999 20:36:06 Eastern US
Sandy D. from 209.44.47.175
Dr. Brink, yes, we use carb counting, and do extra Humalog when we know he will eat more or did eat more. I try to tell him that if he eats more than his carb allowance, he needs to tell us so we can adjust insulin. He HATES being diabetic, won't tell his friends, and feels it makes him different from all the other kids. It makes no difference to him that I've had type 1 for 30 years and will talk to anyone about it. He goes to diabetes camp every summer, but the good feelings don't continue throughout the school year.

Tue Feb 16 1999 20:36:50 Eastern US
Kelly Marshall from 205.188.192.176
Dr. Brink, I have a son, age 8, dx'd 3 years ago. He also has asthma and takes several meds daily for that. He is currently on Ultralente/humalog, but we have wild swings in BG's througout the day, due to the fact that his medication needs can change from day to day. One day he may have severe wheezing, the next he could be fine. We are currently discussing the pump with our doctor. Do you think this will help us with his situation? I'm worried about control, but the doctor feels we have time because of his age.

Tue Feb 16 1999 20:37:18 Eastern US
Brenda H. from 206.112.197.133
Speaking of A1C's: why is it that some endos compliment parents of toddlers/adolescents on their child's A1C when it's 10 or so? Should there be some agreement among ped. endos about this? Guess it might be difficult to get a big group of docs to agree on this one.

Tue Feb 16 1999 20:37:54 Eastern US
Dr Brink from 152.163.206.208
Omitting insulin can be a version of bulimia. We actually coined the term diabulimia. It causes high Blood sugars which then causes huge amounts of glucose losses in the urine - thus calorie loss and weight loss. It's a very dangerous eay to lose weight since the body burns muscle and fat. When carried to extremes, usually in very depressed youngsters, it can lead to ketoacidosis. The issue to address is how to helae sure that th insulin is really given. We don't think that giving kids total responsibility for their entire diabetes treatment makes sense just like we don't give kids the keys to the car when they are 10 or 12 or 14. They could likely drive from a physical and mechanical standpoint quite well but do not often have the emotional maturity all the time. Why do this when their health is at stake. We prefer shared responsibilities with continued involvement of both mothers and fathers. There are also several psychological studies that would support this approach.

Tue Feb 16 1999 20:38:00 Eastern US
hom-hom from 207.86.100.205
Dr. Brink, Thank you for your response. I get the sence from your answer to me, and from reading your other replies to other queries, that control is much improved and more like "Natures Own" regulatory mechanism, when humalog is used in lieu of the longer acting insulins. My question, then, is how is this achieved with a toddler, who is a "finicky" eater? If he eats 6 times a day, would that mean 6 shots a day? Or, if he isn't getting R and NPH, then he needn't eat 6 times a day? Is that the idea?

Tue Feb 16 1999 20:38:45 Eastern US
Judith from 206.112.27.217
I have been a firm believer in tight control since working at the Univ of MO with Dr. Robert Jackson in the early 60's. Problem is my SON doesn't believe in it!

Tue Feb 16 1999 20:39:46 Eastern US
Dr Brink from 152.163.206.208
Kelly - I would question whether the ultralente is contributing to the unpredictability you describe. You may also want to try overlapping smaller doses of NPH at breakfast, lunch, dinner and bedtime with Humalog giving by an adjustable scale we call algorithms. There is not much that you can about the asthma medications or the intermittent illnesses except work with your docs to get optimum asthma care. Here again, frequent BG testing will help immensely.

Tue Feb 16 1999 20:39:50 Eastern US
Darlene from 209.57.212.170
Could you explain your "method" of overlapping insulins that you recommend for your paients

Tue Feb 16 1999 20:41:15 Eastern US
Dr Brink from 152.163.206.208
Judith: Bob Jackson from Missouri was a pioneer in the belief of tight control. He and Dick Guthrie and their team were far ahead of their time in promoting the importance of control. Has your son read the book called In Control by Betschart and Thom. It may help persuade him.

Tue Feb 16 1999 20:42:16 Eastern US
Linda/So. Utah from 207.49.60.177
Hello

Tue Feb 16 1999 20:42:18 Eastern US
Marcia...WA from 209.17.80.33
Dr Brink.. How frequent is frequent for bg testing.. some parents talk about doing 10-12 tests a day every day... many just do tests before meals.. at bedtime and if there is an illness or unusual high or low.. is it possible to over do the control?

Tue Feb 16 1999 20:44:38 Eastern US
Judith from 206.112.27.217
Thank you, I will suggest that to him. Dick Guthrle was a resident when I was there...and Diana and I worked on the peds unit together. I saw them last September at the D Camping Assoc meeting. I work with Sam Wentworth at Happy Hollow camp.

Tue Feb 16 1999 20:45:25 Eastern US
Kelly Marshall from 205.188.192.176
Thank you for your answer, Dr. Brink. I've often observed the unpredictablity of the Ultralente when he gets an occasional "low day" ....sort of an Ultralente backlog. I will discuss this further with his endocrinologist. I appreciate your help.

Tue Feb 16 1999 20:46:22 Eastern US
Renee from 152.163.205.67
Dr. Brink...My 16 yr old has been pumping 3 yrs...We found that not only was it liberating for her, but also the entire family benefitted from NOT being tied to a clock,.

Tue Feb 16 1999 20:48:59 Eastern US
Renee from 152.163.205.67
Are you finding your colleagues any less reluctant to put younger kids on the pump with all the success stories you can relate???

Tue Feb 16 1999 20:49:05 Eastern US
Joan from 152.163.204.213
Dr Brink..any thoughts on best way to deal with thyroid problems in teens w/diabetes....medication vs surgery?

Tue Feb 16 1999 20:50:34 Eastern US
Dennis Cardone from 24.128.70.72


(:

Tue Feb 16 1999 20:50:51 Eastern US
Christine from 209.5.58.247
evening all.....

Tue Feb 16 1999 20:51:31 Eastern US
Dr Brink from 152.163.206.208
First option is analysis of BG levels. What we call a BG profile. Prebreakfsat and midmorning tell syou what's happenign withhe morning food and insulin doses. Prelunch gives you the beginninhg of the morning NPH and then mid-afernoon mostly the lucnhtime insulin needs. Predinner and bedtime gives you same info for supper food and insulins. Our routine testing would suggest that prebreakfsat, prelunch, mid-afternoon, predinner and bedtime are the key times to analyze. We prefer meters which download to our computers and promtote using thes ame systems at home. Doesn't matter, however, ifyou like to do this by color coding logbooks, making graphs as long as there is analysis ongoing. Kids grow, seasons change, illnesses interfere and all this shows up as BG levels flucutuating added to grwoth and hormonal changes.

Tue Feb 16 1999 20:53:37 Eastern US
Brenda H. from 206.112.197.133
We don't always get a mid-afternoon test because our daughter is in school, but we do try to test at all the other times you have mentioned, plus in the middle of the night, esp. after a late night low (i.e. 68 at 11 p.m.) or a period of exercise. What do you think of middle of the night testing?

Tue Feb 16 1999 20:55:07 Eastern US
Marcia...WA from 209.17.80.33
Thank you Dr. Brink!!! You can't imagine the kidding I use to get for my color coded log books!.. Now that Stephanie is 15..(dx'd at 2 1/2) we are lucky to get anything recorded.. thank goodness for those meters that have download capabilities.

Tue Feb 16 1999 20:55:21 Eastern US
Dr Brink from 152.163.206.208
Thyroid disease and diabetes are interlocked. Both are autoimmune disorders of the endocrine system and proabably share some underlying genetic predispositions. The thyroid gland can merely enlarge - called a goiter or the gland itself can become underacive or overactive. We routinely screen for thyroid problems at diagnosis and at least yearly since they are so common. Up to 25-40% of kids will have thyroid antiboides and about 2-5% will be hyperthyroid ile 10-15% will be hypothyroid. No surgery needed for any of this. Hyperthyroidism is more difficult to treat and may wax and wane like may other autoimmune diseases. Generaly we use medications like PTU and tapazol with good success and very little interference with BG control. Hypothyroidism is easier to treat, usually a single pill each morning, and also rarely interferes with BG levels. An underlying condition is called Hasimoto's thyroiditis. evelse

Tue Feb 16 1999 20:57:35 Eastern US
Dr Brink from 152.163.206.208
Marcia - color coding works - in the computers and diabetes talk that I sometimes give, I have a great slide of an old urine testing logbook color coded and beautifully demonstrating how insulin should be adjusted. BGs color coded force one to analyze what's happening and to think how the lows and highs could be prevented. Little kids often start to learn about such things as when and how insjulin works, activity works and food works in this fashion. It's a great teaching tool.

Tue Feb 16 1999 20:57:44 Eastern US
Brenda H. from 206.112.197.133
Dr. Brink, our daughter, 11, had her first thyroid test and first test for protein in her urine in the fall. How often do you recommend such tests be done? Is there a certain age at which our children should have these tests or is the length of time since diagnosis a factor in this determination?

Tue Feb 16 1999 20:58:26 Eastern US
mike from 152.163.207.54
my daughter was 370 for breakfast 380 for lunch and 360 for dinner. Very unusual--didn't seem like the insulin "worked" today? Brought her down at dinner with 2.5 Humalog/1 NPH. Very unusual day...her A1C was 7.2 last 2 times. Was wondering how this probably made her feel today. She is just 2.5yrs and can't express this yet. Was at daycare and acted fine.

Tue Feb 16 1999 20:58:45 Eastern US
Jeff Hitchcock from 153.35.133.29
Dr. Brink: Do you have a document that explains your color coding that you could share with everyone?

Tue Feb 16 1999 20:59:30 Eastern US
Dennis Cardone from 24.128.70.72
Is there a certain age a child should have a eye exam?

Tue Feb 16 1999 21:00:43 Eastern US
Joan from 152.163.204.213
Dr Brink...any way to test for Hasimotos?..other than normal thyroid testing?

Tue Feb 16 1999 21:01:18 Eastern US
jacob from 209.16.247.43
Dr. Brink, My son is 12 and has tested postive for both ICA & IAA autoantibodies. He is going to start into the DPT-1 trial on oral insulin. If you had a child, would this be the route you would take? If not what would you do?

Tue Feb 16 1999 21:02:20 Eastern US
Brenda H. from 206.112.197.133
Dennis, we have taken our dau. to the opthamologist twice in the past 2 yrs just to see how she was doing. We did learn that you cannot have the eyes examined if the BS's have been high within 24 hrs of the exam--something about the test results being inaccurate.

Tue Feb 16 1999 21:02:58 Eastern US
Ellen from 205.188.193.33
How often do you request your patients provide a 24 hour urine, and after how many years diagnosed?

Tue Feb 16 1999 21:03:25 Eastern US
JULIA from 24.231.2.129
Dr.Brink: Our 7 year-old has been on the pump since last April. He had 5 months of the most incredibly tight bg's 24 hrs per day. It was wonderful! Sometime during the summer, we noticed that he was waking up with lows. We were also aware of a growth spurt. Before we could isolate where he was dropping in the night (which he had NEVER done in the past) he had a seizure. Since that infamous night, he has been a living ping-pong ball. He was in the hospital two weeks ago due to HIGH ketones. The Endo was surprised to see his night charts which showed bgs that literally doubled up in number in one hour and doubled back down the next. They did hourly bg tests for 3-4 nights and it was always the same. They had hoped to see a 'pattern' so they could help us 'adjust' basal rates which have needed to be done for some time. They do not feel comfortable with us attempting this at home due to the seizure and his ping-ponging. We got nowhere that weekend and will go back and attempt it this weekend under 'h

Tue Feb 16 1999 21:03:33 Eastern US
Mary from Ma. from 152.163.197.213
dennis..we, too, take chris for regular eye exams..

Tue Feb 16 1999 21:03:43 Eastern US
Dennis Cardone from 24.128.70.72
Thanks Brenda, That is a complication that scares me the most!!!!!!!!!!!

Tue Feb 16 1999 21:04:58 Eastern US
alice from 209.156.79.20
we just started using Humalog last Friday....our daughter is in honeymoon and we have gotten conflicting opinions from the endo and the nurse practitioner on using Humalog during this time...the endo encouraged us to try it...what is your feeling about using humalog during this time?

Tue Feb 16 1999 21:05:57 Eastern US
Dr Brink from 152.163.206.208
We usualy recommend baseline testing for thyroid, lipid problems and kidney problems at diagnosis. We follow thyroid problems with thyroid antibody tests plus T4 and TSH levels at least annually, more often if positive family history of thyroid problems or other autoimmune disorders like celiac or Addison's. We published these results in the Journal of PEdiatric Endocrinlogy in the first or second issue about 7 or 8 years ago. Also was a chapter in my own textbook publsihed in 1987.

Tue Feb 16 1999 21:05:58 Eastern US
Brenda H. from 206.112.197.133
Perhaps we should let Dr. Brink catch up with all the questions.

Tue Feb 16 1999 21:06:59 Eastern US
Dr Brink from 152.163.206.208
Important to get yearly dilated eye exms by an ophthalmologistr who knows something about the retina and diabetes. We routinely check pateitns in a dark room twice a year.

Tue Feb 16 1999 21:09:47 Eastern US
joey in kentucky from 208.254.113.158
Could you comment on A1c's....My daughter is 10 and her endo wants us in the 7-8 range. Do you concur?

Tue Feb 16 1999 21:09:52 Eastern US
Dr Brink from 152.163.206.208
Kidney disease is best screened for via a test called microalbuminuria. We do it with an overnite timed sample but some do a random collection in the office. The gold standard is aq 24 hour urine collection but this is difficult to do correctly and a great hassle as well. We start after five years of diagnosis or the beginning of puberty. Leakagof protein, measured as a very sensitive microalbumin assay, is one of the earliest abnormalities that can be seen. Tied closely to long term complicatoins and to hypertension. It can be "fixed" with improved glucose control as we found in the DCCT. Also, decreasing total protein intake helps. If the microalbuminuria persists or worsens, then we consider ACE inhibitors like Zestril, lisinopril etc since they also offer good protection.

Tue Feb 16 1999 21:09:57 Eastern US
Jeff Hitchcock from 153.35.133.29
I would like to thank Dr. Brink for spending the past hour with us.

Tue Feb 16 1999 21:11:35 Eastern US
Sandy D. from 209.44.47.175
Thank you very much, Dr. Brink. I will discuss much of what you said with my son's pedi endo this Friday.

Tue Feb 16 1999 21:11:42 Eastern US
Jeff Hitchcock from 153.35.133.29
I'll have a transcript of this session posted within an hour for everyone to review. Again, thank you Dr. Brink. We all appreciate you taking the time to pass on your wisdom.

Tue Feb 16 1999 21:12:10 Eastern US
Renee from 152.163.205.67
thank you Dr. Brink..my daughter (age 16) takes 10 mgs of Vasotec daily for the past 18 months..decreased her protein form 2600 mgs at its worst to 288 mgs when last checked!

Tue Feb 16 1999 21:12:13 Eastern US
Dr Brink from 152.163.206.208
Joey: In our lab, normal A1c is 4.1-6.1%. Assuming that your doc's lab is similarly set up, would recommend aiming for high 6's or low 7's and always aim higher if recurrent or severe hypoglycemia cannot be avoidede. I would think that getting coser o the 8% range is getting too high and wil not offer the protection we learned about in the DCCT. Having been a co-investigator and one of the docs who helped write the DCCT protocol, I was and am now even more a firm believier that controlling the BGs matter. In all kids In all ages. Even if it's difficult work - and it is.

Tue Feb 16 1999 21:12:17 Eastern US
Ellen from 205.188.193.33
Thank you so very much Dr. Brink. When will the next set of ISPAD articles be available?

Tue Feb 16 1999 21:12:24 Eastern US
hom-hom from 207.86.100.205
Jeff, if you can get some info. on the color coding of the charts to post , that would be great. Thank you, Dr Brink!

Tue Feb 16 1999 21:12:48 Eastern US
Wendy - PEI from 142.194.204.216
Thank you Dr. Brink - I only lurked but found your responses informative and helpful

Tue Feb 16 1999 21:12:56 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
Dr. Brink, our ped endo has reservations about placing a younger child on the pump he brought up possible psychological damage of having something attached to him all the tims and greater dependancy on me. What do you think? My son wants the pump.

Tue Feb 16 1999 21:13:08 Eastern US
Jeff Hitchcock from 153.35.133.29
Dr. Brink, if you can share the color coding technique, I will be happy to share it with everyone.

Tue Feb 16 1999 21:13:53 Eastern US
Wendy - PEI from 142.194.204.216
Thanks Jeff - I was copying and pasting like made to save it all and would also love to have the colour coding technique as well

Tue Feb 16 1999 21:14:01 Eastern US
Renee from 152.163.205.67
We all appreciate your time & caring, Dr. Brink.

Tue Feb 16 1999 21:14:26 Eastern US
Dr Brink from 152.163.206.208
Renee- the protein spillage of 2.6 grams is very high so 288 is significantly improved. Is she also cutting back on total protein? We have found that Vasotec works quite well but often nees to be given twice a day. Our preference has been for Zestril or Prinavil since it is longer lasting and has the same type effect. Also would be very important to have her eyes followed closely since kidney disease and eye problems often show up around the same time.

Tue Feb 16 1999 21:15:09 Eastern US
Mary from Ma. from 152.163.197.213
thank you Dr. Brink...and good night!

Tue Feb 16 1999 21:15:32 Eastern US
Dr Brink from 152.163.206.208
Hello Wendy from PEI. Is Charlene W still the nurse up there? I used to travel to PEI every few years to give lectures and was very impressed with the work that Charlene and others on PEI were doing. If you know her, give her my best wishes.

Tue Feb 16 1999 21:15:42 Eastern US
joey in kentucky from 208.254.113.158
Thanks Dr. Brink....Thanks Jeff, this is a great service you put together...

Tue Feb 16 1999 21:16:21 Eastern US
Renee from 152.163.205.67
her eyes are checked & are fine..she does take it 2xs per day..had a kidney biopsy 15 months ago by a ped. nephro , Dr. Susan Conley, formerly of Stanford, now in Phila.

Tue Feb 16 1999 21:16:46 Eastern US
Wendy - PEI from 142.194.204.216
Yes Dr. Brink she is still there and is still a bit help to all of us. I will pass on your best wishes

Tue Feb 16 1999 21:19:19 Eastern US
Mary from Ma. from 152.163.197.213
jeff...you use red highligters on the low bg's in your logbook, and blue on the high bg's and then look for the patterns..its an awesome visual...

Tue Feb 16 1999 21:19:52 Eastern US
Renee from 152.163.205.67
I thnk Siskel & Ebert would rate this "show" TWO THUMBS UP!!! An excellent, enlightening forum!!

Tue Feb 16 1999 21:19:53 Eastern US
Dennis Cardone from 24.128.70.72
Great discussion tonight.
The color code technique is taking three different colored highlight markers. You your log book you use one color for highs one for lows and one for in range. At a quick glance you can see a pattern.

Tue Feb 16 1999 21:19:54 Eastern US
Jeff Hitchcock from 153.35.133.29
Again, thank you Dr. Brink, and Ellen for arranging this special chat session. I'll leave this room open for a while longer.

Tue Feb 16 1999 21:20:32 Eastern US
Jeff Hitchcock from 153.35.133.29
Thanks Mary: our computer software kind of does that: green is good, yellow marginal, red high/low.

Tue Feb 16 1999 21:20:42 Eastern US
Renee from 152.163.205.67
and thank you Jeff for all YOU do too!

Tue Feb 16 1999 21:21:11 Eastern US
Judith from 206.112.27.217
Ah...and Marcia used GREEN on the "in range" ones! VERY colorful!!

Tue Feb 16 1999 21:21:53 Eastern US
Sandy D. from 209.44.47.175
Jeff, thank you very much.

Tue Feb 16 1999 21:22:25 Eastern US
Mary from Ma. from 152.163.197.213
hopefully there's always lots of green in marcia's book!!

Tue Feb 16 1999 21:22:28 Eastern US
Judith from 206.112.27.217
Thanks Jeff, Ellen and Dr. Brink!

Tue Feb 16 1999 21:22:59 Eastern US
Jeff Hitchcock from 153.35.133.29
I'm signing off now. Thanks again to Dr. Brink and Ellen, and for everyone for coming.

Tue Feb 16 1999 21:23:20 Eastern US
Dr Brink from 152.163.206.208
For those of you interested in the NEDEC color coding scheme, it's similar to what we sugted and was adopted by the Medisense computer program. Red is a danger color and so highlights for the low values. We usually suggest less than 65 but you can obviously pick any vlaues you'd like to focus on. Green, like a green lite, is thenthe vs in the 65-70 up to 140 range. Black is 141-179 and over 180 is blue, makes me sad. These are the colors of most 4-color pens that are inexpensive and readily available. The second part of the color coding is the comments that should be made to try to explain all the reds and blues. After about 1-2 weeks, most of our patients who continue get very good at doing this and begin to make their own inslin adjutmstnes between vistis. We usually reocmmend visits every month just like we did in the DCCT. It works for us in the DCCT so why should we not use the same model that worked...?

Tue Feb 16 1999 21:23:21 Eastern US
Jeff Hitchcock from 153.35.133.29
And special thanks to Brenda for manning the fort at home while I'm out of town on business travel.

Tue Feb 16 1999 21:23:28 Eastern US
Wendy - PEI from 142.194.204.216
bye Jeff - thank you

Tue Feb 16 1999 21:23:34 Eastern US
Mary from Ma. from 152.163.197.213
goodnight jeff..and thank you!!

Tue Feb 16 1999 21:23:34 Eastern US
Dennis Cardone from 24.128.70.72
THank you Jeff, Ellen and Dr. Brink. I must go and
do a blood test and eve NPH shot. Our work is never done.
Good night All!!!!!!!!!!!!!

Tue Feb 16 1999 21:23:35 Eastern US
Sandy D. from 209.44.47.175
Ellen, sounds like you helped arrange this - thank you.

Tue Feb 16 1999 21:25:23 Eastern US
Brenda H. from 206.112.197.133
By the way, anyone who has a child under the age of 10 with Type 2 diabetes and willing to participate in an interview for a magazine, please e-mail us your phone number and name and we'll pass it along.

Tue Feb 16 1999 21:25:25 Eastern US
hom-hom from 207.86.100.205
Since Dr. Brink had an E-mail address on screen, could one interpret that to imply that we can E-mail him, or would that be pesting him...

Tue Feb 16 1999 21:25:51 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
oops guess i was too late, i'll just have to read the archives. Thanks for providing this CWD

Tue Feb 16 1999 21:26:17 Eastern US
Ellen from 205.188.193.33
Dr. Brink do you think Diabetes will ever be cured soon?

Tue Feb 16 1999 21:26:48 Eastern US
Jeff Hitchcock from 153.35.133.29
If anyone has additional questions, please use our "Ask the Diabetes Team" section to submit questions. Dr. Brink is one of our "Occasional Experts."

Tue Feb 16 1999 21:26:54 Eastern US
Brenda H. from 206.112.197.133
Leann, we'll have to talk about your endo some other time (like does he allow older kids on the pump or is he/she just from the old school and anti-pump, etc.) Gotta get my kids in bed....

Tue Feb 16 1999 21:27:13 Eastern US
Wendy - PEI from 142.194.204.216
Great session - thanks to all who made it happen and time to head on out - take care all

Tue Feb 16 1999 21:28:14 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
he does allow older teenagers on the pump. I am not sure if he is considering Alex and just warning us of all the dangers or if he is totally trying to deter us?

Tue Feb 16 1999 21:28:18 Eastern US
Kelly Marshall from 205.188.192.172
Thank you Ellen, Jeff & Dr. Brink. This was so informative. I'll surely be looking forward to reviewing the transcript. Have a nice night, all!

Tue Feb 16 1999 21:28:46 Eastern US
Dr Brink from 152.163.206.208
Ellen: You ask hard questions! I suspect that it would depend upon how you define cure. (Sorry, Mr President...). I suspect that there will be better treatments and more automatic treatments with some automatic ability to detect BG or its equivalent tied to a mechanical device to deliver the insulin. This would be a version of a mechnical pancreas. I never predict time lines since we first started talking and hearing about this when I was a fellow in 1977...

Tue Feb 16 1999 21:31:13 Eastern US
Ellen from 205.188.193.33
It plagues me...I hope for some genetic manipulation...

Tue Feb 16 1999 21:32:03 Eastern US
Dr Brink from 152.163.206.208
The other option involves transplants either of beta cells or of partial pancreases. These remain extremely difficult to do but there is great progress in many centers around the world. But this clearly still needs immune suppressions which has its own perils attached.

A most promising research endeavor is learning how a cell becomes a beta cell. If we could learn this genetic trick, then we could take the same gene, splice it into a skin fibroblast and transplant these converted fibroblasts/now beta cells with much greater success. This is still science fiction but the work of the learning about the genetics of the cell and its differentiation is a key.

Tue Feb 16 1999 21:33:37 Eastern US
Sandy D. from 209.44.47.175
What about encapsulation of islets? That would negate the need for immunosuppressants. Could you share your opinions on that?

Tue Feb 16 1999 21:34:02 Eastern US
Ellen from 205.188.193.33
Todah rabah! Thank you again...I hope to meet you someday.

Tue Feb 16 1999 21:35:16 Eastern US
Debbie-La. from 209.142.177.89
Does the blood glucose count ever level off, somewhat? My daughter,16, was diagnosed 3 weeks ago, Type I. All this is very overwhelming.

Tue Feb 16 1999 21:36:38 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
Dr. Brink, our ped endo has reservations about placing a younger child on the pump he brought up
possible psychological damage of having something attached to him all the tims and greater
dependancy on me. What do you think? My son wants the pump.

Tue Feb 16 1999 21:37:23 Eastern US
Mary from Ma. from 152.163.197.213
well..goodnight all...dr brink..thanks again and say hello to Dr. M from chris and Angela!!

Tue Feb 16 1999 21:40:26 Eastern US
Jeff Hitchcock from 153.35.133.29
Goodnight everyone. I'll have the transcript up soon.

Tue Feb 16 1999 21:41:01 Eastern US
Ellen from 205.188.193.33
There is going to be a forum on the JDF Children's Congress at Melissa's Room at 10:00 P.M. - Please welcome Sandra Silvestri there at that time.

Tue Feb 16 1999 21:41:40 Eastern US
Judy from NY (pmpmom@yahoo.com) from 24.92.54.96
Leann.....my daughter-almost 18- has been on the pump since she was 3. I don't notice any "damage." In fact, because the pump has given her more flexibility, I think it has helped rather than hurt

Tue Feb 16 1999 21:41:46 Eastern US
Dr Brink from 205.188.197.159
Nobody has yet made a polymer that works well in the body. When this is finally done it eliminates the need for immunosuppression, as least theoretically. More work, more research money and more directed efforts needed.

Another option is figuring out what makes the cell identifiable as foreign. If this could be learned and manipulated, then the cell could be "turned off", therefore "cloaking" it to attafck by the immune system. Then transplanted cells wouldn't get destroyed and we also wouldn't need immunosuppression. But also still science fiction right now.

Tue Feb 16 1999 21:41:47 Eastern US
Jeff Hitchcock from 153.35.133.29
Melissa's room is at:
http://virtualnurse.com/Chat/Diabetes/

Tue Feb 16 1999 21:42:45 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
Judy, I think he was just trying to make us think and make sure this is what we want but, i would have liked to have gotten a psychological opinion from dr. brink.

Tue Feb 16 1999 21:43:17 Eastern US
Jeff Hitchcock from 153.35.133.29
Thank you again Dr. Brink.

Tue Feb 16 1999 21:44:04 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
i don't see how the pump could be any more psych. damaging than MIT or 'd' in general

Tue Feb 16 1999 21:44:19 Eastern US
Judy from NY (pmpmom@yahoo.com) from 24.92.54.96
I think it is a very individual decision, Leann. Not everyone is suited for the pump and the person/families who do not get proper education & training are the most likely to fail

Tue Feb 16 1999 21:45:03 Eastern US
Judy from NY (pmpmom@yahoo.com) from 24.92.54.96
Leann - I assume you've been to the KidsRPumping website?

Tue Feb 16 1999 21:45:12 Eastern US
lisa (green nhp) from 152.163.213.192
ellen, is there a way to be e mailed about these forums?

Tue Feb 16 1999 21:45:41 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
oh yes, i have done much research already, i just wish i could have total support from our dr.

Tue Feb 16 1999 21:46:02 Eastern US
JESSICA from 208.237.209.32
Hi,I am 10,I got "D"on Oct.12,'98.
No one is in the onther chatrooms.
May I talk with you women and men?

Tue Feb 16 1999 21:46:06 Eastern US
Dennis from 24.128.70.72
Leann/IN: If your sound wants the pump get the pump.

Tue Feb 16 1999 21:46:28 Eastern US
Dennis from 24.128.70.72
If your son. Sorry

Tue Feb 16 1999 21:46:45 Eastern US
Judy from NY (pmpmom@yahoo.com) from 24.92.54.96
well, I must go. Leanne, if you feel very strongly about this, perhaps you need to find a different endo

Tue Feb 16 1999 21:46:49 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
It's not that simple Dennis, we want someone who is with us on this to back us up and support us.

Tue Feb 16 1999 21:47:02 Eastern US
JESSICA from 208.237.209.32
When I get back from eating?

Tue Feb 16 1999 21:47:19 Eastern US
Dr Brink from 205.188.197.159
Leann-I'm still here but lost my connection to the web temporarily. A big question is what does Alex think about the pump, why does he want it. Making sure that he has no magical thoughts and therefore won't be too disappointed when there are still lots of ups and downs of sugar levels. I would spend a lot of time talking with him about all of this - and also with you as his parents. I suspect this is what your doc is trying to do. You should be able to discus this quite directly perhaps with a special consultation visit just with the parents and doc to make sure everyone is on the same wavelength. There is no reason to think that wearing an insulin pump would harm anybody psychologically but lots of reason to worry about surreptitious coercion from docs, nurses and parents. This almost always produces no glucose control improvement and lots of angst. There are some excellent studies about even younger kids started on pumps from some friends of mine, almost 10-12 years ago. Lead author of one was Claire LEvy-Marchal and the other was Carine de Beaufort. Both had good success with very young children started soon or at diagnosis.

Tue Feb 16 1999 21:47:28 Eastern US
Jeff Hitchcock from 153.35.133.29
Jessica: This room will be closing soon. People will start heading back to the other rooms.

Tue Feb 16 1999 21:47:33 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
Judy, the problem is i know of no other endos in our area that support younger children on the pump and believe me i have asked around.

Tue Feb 16 1999 21:47:41 Eastern US
Judy from NY (pmpmom@yahoo.com) from 24.92.54.96
you folks might want to switch to another chat room so this conversation doesn't end up in the archives!

Tue Feb 16 1999 21:48:00 Eastern US
Mary from Ma. from 152.163.197.213
leann..judy's right..our son started on a pump last summer..it really is an individual choice that you need to make with your eyes wide open..its better than mdi, but its not going to solve all the bg problems..

Tue Feb 16 1999 21:48:21 Eastern US
Judy from NY (pmpmom@yahoo.com) from 24.92.54.96
Leann - how far are you willing to travel? We used to drive 3 hours to see Dr. brink - well worth the effort

Tue Feb 16 1999 21:48:38 Eastern US
Judy from NY (pmpmom@yahoo.com) from 24.92.54.96
good night

Tue Feb 16 1999 21:48:57 Eastern US
Dr Brink from 205.188.197.159
Ciao

Tue Feb 16 1999 21:49:03 Eastern US
JESSICA from 208.237.209.32
All right by then!!
Thanx anway!:-)
Goodnight!

Tue Feb 16 1999 21:49:09 Eastern US
Judith from 206.112.27.217
Dr. Brink, I've found NO research studies of kids on pumps done in this country. What little I saw was done in France. Why is that?

Tue Feb 16 1999 21:49:40 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
Thank you Dr. Brink. Yes Alex wants the pump, we have viewed all the information and will make a final decision with our dr. in June and I told Alex if he doesn't want to go with the pump after a trial weekend with saline then we will stay with multiple injections. goodnight all

Tue Feb 16 1999 21:49:40 Eastern US
Judith from 206.112.27.217
Oops...looks like the party is REALLY over now!

Tue Feb 16 1999 21:50:49 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
Indianapolis is 2 1/2 hours away, now we go to chicago about an hour away willing to travel to either but still noone there who supports young pumpers.

Tue Feb 16 1999 21:53:23 Eastern US
Leann/IN (son Alex 9 1/2 dx'd 11/94) from 205.217.28.87
*poof* gone to parents room

Tue Feb 16 1999 21:55:54 Eastern US
Jeff Hitchcock from 153.35.133.29
This room will close in five minutes. Please move on to another room if you wish to continue chatting.



                 
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