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Re: [IP] Insulin on board



Sue Ann Wrote:
I ran into this repeatedly yesterdayhad one of those  days when I
couldnt get my blood glucose up.  I was in the 80s  (target 120) 2
hours after every meal and frankly shocky (65) 2 hours  after
breakfast.  I cant use the wizard with the snacks I take to  correct
these lows; what I do if the snack is larger than 15 or so  grams CHO
is set up the wizard and compare the recommended bolus with  the active
insulin (scroll down.)  Yesterday the recommended bolus  was below the
IOB in every case, so I simply backed out without  bolusing.  As to
whyI just lowered my basal rate in the 6 am-8 am  period but that
hardly seems a likely reason unless I was going low  without realizing
it while listening to the news before getting up.  Any suggestions on
why are welcome.

Ricardo Responds:
Sue Ann I occasionally have episodes where I bolus but my 2 hour post
prandials stay below my target. We are used to our boluses causing our
BG to decrease to our target but in these cases we have to increase to
our target. Anecdotally I have 2 possible theories (although there may
be others).

The first is where something in the meal has slowed my carbohydrate
metabolism. After bolusing the blood insulin levels rise as expected
but there is not enough blood glucose to react with the insulin. The
distinguishing factor I see here is that my BG hovers below target
without me becoming hypo and as the meal continues to digest and
additional glucose is metabolized my BG will rise at a later time. As
you say I feel shocky at first but better as the meal is fully
digested. My theory is I have bolused the proper amount of insulin for
the amount of carbs but the timing of the 2 are not matched at first
but eventually they catch up to each other.

Secondly placing the infusion set in a part of the body that will be
exercised can cause my post prandials to be below target. This happens
if I place the infusion set in my leg and have a heavy lower body
weight lifting or stair stepper workout.  Exercise in general can also
cause the same effect. Pumping Iron causes increased circulation to the
body part being exercised and in my case can increase the rate at which
blood insulin concentrations rise in the blood and / or insulin
sensitivity increases. I suspect that the increase in body temperature
during exercise may also catalyze the BG/ insulin reaction. Either way
I again have the scenario of too much insulin in the blood for the
amount of BG with the symptom of post prandials being below target. In
these cases I find I do go hypo because my insulin uptake and
sensitivity are now increased and my normal bolus will be too much for
any ingested carbs.

In summary my diagnostic tool is to see whether or not I hover just
above being hypo and then rise or do I hover and then truly become
hypo. Just my opinions. YMMV

Ricardo
Dx'd 1967, Pumping since 1/14/2004 w/ Animas IR1000 and since 7/2/2004
w/ the Animas IR1200
.
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