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[IP] Psot Prandial BGs and Bolus testing



Ok. I'm back after digging through the packed boxes to locate my resources. 
Here's what I found. (It might be long, so you are all forewarned.)

A. Post-prandial BG targets:

Source: ADA, MiniMed Pump Trainer's Manual (1998)

1.  Intensively treated healthy adults:

Pre-meal……………80- 120 (ADA)
2 hr post meal………<160 (*note that this may be higher for unhealthy adults, 
elderly adults, and children)
Bedtime…………….100 -140 (ADA)
3 am………………..>90

2.  Pregnant women:

Fasting…………..70-100 (ADA)
1 hr pp…………...110-120, (<140, ADA)
2 hr pp……………90-120  (<120, ADA)

3.  Hypoglycemia unawareness:

Pre-meal………….100-160
Bedtime…………..100-160 or higher
Some endo's place children in this category)

B.  From: Paul Davidson, MD, CDE, in The Insulin Pump Therapy Book: Insights 
>From The Experts, MiniMed, 1995, p.63:

1.  Verifying Boluses based on the Carbohydrate/Insulin ratio
(Do not test bolus if above or below pre-meal target)

30 min. before meal, test BG;
If in target range, take calculated bolus;
5 hr after meal, test BG;
within 30mg/dl of initial BG, CHO/Insulin ratio is correct; 
BG>30 above initial BG, decrease g of CHO per unit of insulin by 1( such as, 
1 unit per 12 g would be changed to 1 unit per 11 g);
BG< 30 below initial BG, increase g of CHO per unit of insulin by 1( such as, 
i unit per 12 would be changed to 1 unit per 13).


2.  According to John Walsh in Pumping Insulin, 1994, p67:

Start test at 80-120, but 70 to 150 is OK.
Calculate and give bolus.
2 hr pp, test BG. A 40 to 80 point rise at this point is OK.
If rise is less than 40, too much insulin bolus may have been given and you 
will need to test extra to avoid an insulin reaction. If >250, end the test 
and correct the high BG.
3 and 4 hr pp, test BG .
5 hr pp, (se Davidson's rules above) 
Therefore, one could be at 150 at 2hr pp, or higher, when you factor in all 
age groups and other variables.

If anyone else has additional or conflicting info on this, please add to this.
Barbara B.
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