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RE: [IP] call for help from those up late tonight



 Paula, the first question I'd ask is if you've been given any steroids
(prednisone, prednisolone,
 hydrocortisone) for inflamation. If you have, then the particulars of what will
happen to your blood
sugars will depend on the characteristics of the specific steroid.

 I'm guessing they don't give steroids for this procedure, in which case it's
your body that's making
 them, and it's hydrocortisone that your body makes. (Also known as cortisol).
The good news is this
 will have less lasting effect on your blood sugars. The bad news is that the
half-life in your blood
 stream is around 90 minutes, and the half-life of its affect on your blood
sugar is on the order of
 4-5 hours, so it's possible to change quite rapidly. Be alert and test often.
Setting your alarm for
 every two hours is right on -- actually, I've done every hour, but that was a
more extreme
 circumstance -- my basal rate was about 5x normal, due to higher doses of
stronger steroids.

 You can change your basal rates, so the temp basal (200%) will be higher, but
simpler, and a bit
 safer from lows, is to do frequent correction boluses. Correction boluses for
incorrect basals are a
 bit different than correcting for getting your mealtimes wrong. Basal errors
continue to accumulate
 -- so if your basal was 0.5 U/hr too low for 3 hours, you might see half of
that difference at the
 end of the three hours, perhaps a rise of 60 mg/dl. So you bolus a correction,
say 0.8 U. But you
 were actually missing 1.5 U over that 3 hours, and over the next few hours the
deficit grows again,
so your blood sugar continues to rise!

 So what you have to do is ramp things up, looking for the amount that will hold
your glucose levels
 steady. When you get there, that's your basal -- if basal + corrections average
to 3 U/hr, then your
basal is 3 U/hr.

 So now you have to start correcting. The problem is, your data is still
imprecise -- it's not as
 good as doing a real basal test -- and your body's changing, anyway. So while
continuing to give the
 additional insulin to replace the missing basals, you have to add in small
correction boluses --
 maybe correct 1/3 of the way, wait 3 hours, and see what happens. (If you rise,
you didn't really
find the right basal amount).

 The problem is on the other end, when your body starts going back to normal --
you WILL overshoot.
 Being alert, you can reduce insulin and take carbs at the first sign of a
change, but don't get
carried away and overcorrect there, either.

 At the end, you may find that your old, original basal is temporarily too high,
as the liver has
 been depleted of glycogen (or at least that's my armchair theory for the
phenomenon).

 You won't get it completely right, but if you're cautious and persistent,
learn, and watch, you can
 keep things under moderate control, and still avoid hypos. I've gone from 25-30
U/day up to 90 U/day
 (with all the increase being basal, so this is about a 6x increase in basal).
The first day, I did
 spend a few hours above 200 as I worked out the amount of basal that was
needed. You have to work
 out what is a SAFE increase to try -- and from the results of that, what a safe
increment above that
is, etc.

 Caution is absolutely warrented -- 90 U/day would be enough to kill me on a
normal day. So you have
 to be patient enough to wait and learn, and be vigilent. Your first priority is
to avoid lows.

Good luck!
.
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