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Re: [IP] Brittle Diabetics


I'm going to have to agree with George regarding the term "brittle diabetic".
I think we could ALL be classified as brittle, at least at one point or
another.  Until we find what works best for us.  There may be seasons (some
longer than others) where it is "easier" to control our condition and where we
would be classified as "compliant" by our diabetes educators and counselors,
but there will inevitably be other times where we will have a more difficult
time in trying to maintain or attain reasonable control.  We need to watch out
for those "diabetes police" that infiltrate our lives.  'Nuf said on that

I have a couple of thoughts based on some things you have written in previous
posts.  First you mentioned (or was that in the letter you wrote to me?  I
don't remember now) that you tend to drop in the early afternoon.  Could be
that your basal is set too high, that your insulin to carb ratio is off, or
your thyroid med is peaking.  Depending on what thyroid med you take, this
could be an issue.  I know that synthyroid has a 14 day half-life, but if you
take something to stimulate T3, such as cytomel, this peaks 6-8 hours after
you take it.  I take both synthyroid and cytomel, and I also experience a drop
in bg between noon and 2 (I take my oral meds at 4:30 AM).  Just something to
think about.

Unlike many people on this list, my insulin to carb ratio changes after lunch,
from 1:20 to 1:15.  Couple of thoughts why:  to maintain reasonable coverage
for DP, my basal is 1.2/hr from 3AM-7AM (I get up at 3:45 AM, and this keeps
me in check until I get around to eating at 6:30 or so, after I get to work).
While I think my basal is working fine for me, I think it lowers my insulin
requirement for breakfast.  At 7AM, my basal drops quite a bit, and while my
bgs are stable, I need more insulin to cover my meals (my job is also pretty
sedentary).  Could be you need more than one ratio to cover your meals,
depending on your activity levels, etc.

Anyway, I strongly recommend you go through your basal checks again, as
described in Pumping Insulin, and see if maybe you need additional or other
rate changes somewhere along the line.  The changes should be made gradually,
as I'm sure you know, but with diligence, I bet you'll get it figure out.
Also, regarding where to put your sites, have you tried the top part of your
hiney?  I understand this is an excellent site for those slender persons among
us (I don't happen to be one of 'em!).  I've used my stomach exclusively for
over 18 years and have NEVER had a problem, but this is another one of those
YMMV things I guess.  (Tried using my thighs - once - and was in so much pain
I decided I didn't want to try that again.  Someone else wrote about the
problems with wearing Levi's and thigh insertions, and that fits me to a T).
In any case, good luck, and keep asking questions!  You'll get a lot of help

Kathy Fagan
dx T1 10/68, pumping 12/82
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