When I saw a media alert recently about a new book on the “functional use of insulin,” I jumped at the chance to order a review copy. I’m sure I’m not using the stuff as well as I could be, and this little 190-page volume looked like a great way to brush up on 
my skills.
Turns out the book is designed as an introduction to, and supplementary part of, a diabetes education course in something called “Functional Insulin Treatment,” designed by Dr. Kinga Howorka and his team in Vienna, Austria.
Initially this was a disappointment, because the authors specially state that they don’t recommend anyone trying to implement the program on their own just by reading this book. You’re supposed to work with a trained healthcare professional, and there are only a few people in this country offering anything similar — arrrrgghh!
But fortunately I took some time to look the book over anyway. On first glance, it appears like a mini-text book, with tiny print and many complex graphs. How engaging can that be to read?
BUT the closer I looked, I realized that between the detailed descriptions of FIT therapy*, the book is packed with some of the best diabetes Q&A I have ever seen — addressing everything from insulin algorithms to when to see an obstetrician. There are also a number of quizzes in the book that are very informative. I nearly flunked out on Dr. H’s “basic diabetes training,” so clearly there’s a lot to be learned here.
Although the whole concept of FIT therapy confused me a bit…
The core idea is a “new approach” to insulin delivery described as “separate replacement” of:
You are tasked to “adjust the insulin supply you need with 4 to 6 daily insulin injections, using numerous injections of short-acting and long-acting insulin or with an insulin pump.”
Despite a fancy chart showing how this differs from “conventional” and “intensified” insulin therapy, I’m not sure it’s really that new; it just appears to be a very proactive, assertive approach to managing your BG levels by understanding the various types of insulin well, and testing and dosing VERY FREQUENTLY. Which is a good idea, I am sure — but also kind of hard to keep up, as we all know.
There’s a lot of talk about “insulin kinetics” — understanding the curves of when certain insulins peak in your body. And quite a few example scenarios are offered, encouraging the reader to figure out what went wrong or right with post-meal BG levels. All useful stuff.
The trouble with intensive therapy is that it’s … intensive. That is, difficult to master (Dr. H recommends 30-40 hours of initial training!), and difficult to maintain over time (he recommends a refresher course every two years). What a dream to imagine that the US healthcare system would invest in empowering, training and educating people with diabetes this way, instead of just reluctantly covering the “co-morbidities” including blindness, amputations, kidney and heart failure. Grrr.
If you are ambitious about perfecting your insulin adjustments — and curious about best practices from other countries — then the Functional Use of Insulin would be a good read for you.
{Springer press; not cheap at $24 for the paperback on Amazon.com}
The DMBooks Giveaway
Once again, we’re offering readers a chance to win a free copy of a book reviewed here at the ‘Mine.
Entering for your chance to win this book, Diabetes? Insulin Dependent? Functional Use of Insulin, is as easy as leaving a comment!
Here’s what to do:
1. Post your comment below and include the codeword “DMBooks” somewhere in the comment (beginning, end, in parenthesis, in bold, whatever). That will let us know that you would like to be entered in the giveaway. You can still leave a comment without entering, but if you want to be considered to win the book, please remember to include “DMBooks.”
2. This week, you have until Sunday, June 26, at noon PST to enter. A valid email address is required to win.
3. The winner will be chosen using Random.org.
4. The winner will be announced on Facebook and Twitter on Tuesday, June 28, so make sure you’re following us! We like to feature our winners in upcoming blog posts, too.
The contest is open to anyone, anywhere. Viel Gluck, Alle! (That’s Good Luck in German)
This sounds so interesting! Only when I studied the functional aspect of the insulins I take did I begin to really understand how to intensively manage my blood sugars safely (without too many swings in blood sugar). I think it’s FUNDAMENTAL and I think too many people are trying for very close glucose management without a full understanding of how their insulin works and as a result live through unfortunate frustrations as their tremendous efforts are not met with desired results.
We should be teaching everyone diagnosed with diabetes all about the ins and outs of insulin-we NEED that info. I resent having to learn it on my own with sometimes risky trial and error methods.
“DMBooks” – I’m very interested in this book!
Definitely DMBooks. This book would be very valuable to me.
DMBooks
I don’t know if I’ll have the time to read it, but it sounds fascinating. I always appreciate an Austrian outlook!
Looks a great book. I’ll bet there’s info in there about bolusing rapid-acting insulin 15-20 min. BEFORE meals. This is an old idea (matching the insulin curve to the arrival of food) many of us used when we were shooting Regular insulin 15 or more years ago. I’m using this technique now with Apidra in my pump and my Dexcom shows my blood sugar staying FLAT after breakfast. When I say FLAT, I mean never rising above 140 after eating a carb heavy breakfast. I honestly wouldn’t have believed it to be possible if I didn’t see it on my own Dexcom receiver.
DMBooks
Hmm, could be very useful to me. Thanks for pointing it out. DMBooks.
Ok, you’ve got my interest, too, Amy and Allison! Sounds like it could be a good one for many of us who use insulin. DMBooks!
Sounds fascinating. As a UK-based PWD with only MDI at my disposal this sounds like a really interesting concept, and good to see something which can be used by pumpers and non-pumpers alike. DMBooks!
DMBOOKS
This looks so interesting!! I am a pumper and I”d love to read it!
DMBooks! Trying to fathom the big picture and all the parts. Gracias for your continuous additions to my knowlege bank. Still working on lowering my A1C. Diagnosed with type 1 in 2005 at age 53.
DMBOOKS! Sounds like a good in-depth read.
[quote]“Functional Insulin Treatment,” designed by Dr. Kinga Howorka and his team in Vienna, Austria.[/quote]
Correction:
She and her team, and she developed fit in the 1980ies
My husband is Type 1 and we were fortunate enough to go through FIT training by Kinga and HER team in Vienna Austria in the late 1990′s, along with a group of about 14 other patients from the US. Before it was vogue in the US Dr. Howorka trained patients to be empowered members of their own health care team and to use all available information to control their diabetes. The subtle tools that are part of FIT are priceless and we witnessed many patients, including my husband, who were liberated from restrictive insulin and food regimens of the past. Practicing FIT has been a major reason why my husband has lived with Type 1 for 27 years without complications and without depriving himself of participating fully in life. Kinga Howorka is a pioneer in diabetes self management and in understanding the concept of patient centered care. DM Books!
DMBooks! This would be a great read for our family. My 42 year old husband was just diagnosed with Type 1 last Wednesday. This is on the slightly delayed heels of our 11 year old son’s diagnoses in July 2009…yes we are doing things somewhat backward…They are the only 2 Type 1′s on either side of our family tree to our knowledge…
DM Books
Sounds like an interesting read, always looking for any information to help control type 1 diabetes better.
A bit daunting, but I’m intrigued by this offering of DMBooks
DMBooks Looks interesting. I would love to read a copy.
this looks like it could be super useful- DMBooks!
Sounds like it would be a very helpful book to have in your library. DM Books.
I am really interested in this book too. Seems to have a lot of useful information.
DMBooks. Definitely looks interesting.
DMBooks Looks very interesting for helping me with type 1
DMBooks; I love to read the book first, then but for a continued reference, if is seems helpful.
I was pretty sure I added DMBooks in my comment above!
Really sounds like a quantum leap to anything out there…I am just realizing after almost four years of managing my son’s diabetes how much I still don’t know!
DMBooks Looks interesting!
I´m an insulin dependent for a little while, let’s say, fifthy (50!!!) years.
Yes, He must have lost my file once I’m still very alive.
For severl years i’ve being using the several daily shots (4-6) to cntrol the blood sugar. Tonight I,ve took the same before sleep shot and heaten the usual milk and salt and water cookies and unexpectally it occurs a huge hipo without a reason. with this intense treatment may arms, legs and baley began to have no places untouched. could be the case that the night shot reached a “virgin” leg spot? it will be possible that my musclus are preventing the insukin to reach the rest of the body? i never repeat a shot on the same spots, lest’s say weeakly. Thnaks in advance for yr coments.