Is MDI the right way to treat newly diagnosed T1 diabetes given the current educational model?

[GrantGam]

On diagnosis I was given a choice of insulin regimes to choose from which I thought would be best suited to my lifestyle. Although the thought of two injections per day was a lot more appealing than 5 or more with my current MDI regime; I liked the idea of being able to alter my carb intake at my own free will, rather than being stuck to a fixed daily carb intake.

The idea of counting carbs wasn't really focused on it great detail until a couple weeks of getting to grips with everything. I was encouraged to make sense of the nutritional labels and adjust my dosage this way, and also pointed in the direction of carbs and cals for instances where I wasn't cooking or able to see the food packaging. I guess I was lucky that I had such a good diabetes team who were only a text message away in terms or advice for meal dosages, etc. I was also feeding back on a weekly basis my BGL's and then having my background insulin increased until things started coming back into line.

The idea of a fixed regime would be better for a lot of diabetics out there, especially ones who are in denial/uninterested in getting in control. The idea of being able to adjust your insulin around your food (instead of food around your insulin) often makes many think they can eat whatever they like. Often overindulging in the evils: refined carbs and sugars...

My input anyhow. Insulin regimes are suited to a personality. Having the options are great for many but can be complicated or a bit of an escape for others.

 

[RuthW]

That's interesting @RuthW

I remember being taught in carbohydrate exchanges on diagnosis but would have to say things are much better now with the education courses on offer,also I think now Consultants/DSN's & Dietitians are beginning to realise that its not just carbs that impact on bg levels in type 1's.

Things are massively improved. It's really incomparable. The only thing that worries me is that 'old-school' diabetics have been left to their own devices for far too long. They are simultaneously 'non-compliant', uncomplaining, and don't know what they don't know so they are being 'missed' in this new wave of diabetes education.

 

[noblehead]

Things are massively improved. It's really incomparable. The only thing that worries me is that 'old-school' diabetics have been left to their own devices for far too long. They are simultaneously 'non-compliant', uncomplaining, and don't know what they don't know so they are being 'missed' in this new wave of diabetes education.

Right Ruth, yes I can see the point your making.

 

[RuthW]

On diagnosis I was given a choice of insulin regimes to choose from which I thought would be best suited to my lifestyle. Although the thought of two injections per day was a lot more appealing than 5 or more with my current MDI regime; I liked the idea of being able to alter my carb intake at my own free will, rather than being stuck to a fixed daily carb intake.

The idea of counting carbs wasn't really focused on it great detail until a couple weeks of getting to grips with everything. I was encouraged to make sense of the nutritional labels and adjust my dosage this way, and also pointed in the direction of carbs and cals for instances where I wasn't cooking or able to see the food packaging. I guess I was lucky that I had such a good diabetes team who were only a text message away in terms or advice for meal dosages, etc. I was also feeding back on a weekly basis my BGL's and then having my background insulin increased until things started coming back into line.

The idea of a fixed regime would be better for a lot of diabetics out there, especially ones who are in denial/uninterested in getting in control. The idea of being able to adjust your insulin around your food (instead of food around your insulin) often makes many think they can eat whatever they like. Often overindulging in the evils: refined carbs and sugars...

My input anyhow. Insulin regimes are suited to a personality. Having the options are great for many but can be complicated or a bit of an escape for others.

Yes, I think there is both a motivation factor and, frankly, an intelligence factor. I think medics regularly encounter people who are unable to absorb information, whether for emotional or intellectual reasons. Learning also takes time and patience. Whenever I witness or take part in a conversation with a 'brittle diabetic', I always see someone who finds complex cause-effect relationships too difficult to follow (or sometimes even acknowledge as possible) and who has been handed a 'label' by an exasperated medic. Their biology is no different from the next diabetic's, but they lack the capacity to deal with it. I do think 'brittle diabetics' are probably best on a very rigid schedule.