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Treating high BGs, was: Re: [IP] Exercise

Becky asked:

>Okay...I need some advice re: Barbara B.'s suggestion to NOT hit a high
>with more insulin followed by Bob seconding this...

Let me re state. I "cautioned" about bolusing to treat the high. I
suggested close observation and patience first. One thing I've learned
about pumping in the 3 years I've been doing it: It's very easy, actually,
*too easy* to bolus to try to correct something, then to discover later
there was actually another problem causing the high BG.

I don't like low BGs, but I dislike bouncing even more - it ain't fun.

>I changed my set this a.m. using my arm for the first time and a
>Sillouette for the second time...so was a 71 on getting up and still 70
>before breakfast an hour later. Bolused for breakfast with old set so
>when noon arrived I was 48...new set went in at 10 am....where DID this
>low come from?  I ate lunch and did NOT cover 12g of carb with bolus to
>cover the 48...but did cover the rest of lunch with bolus.

First question: Are your basal rates tested and validated properly? How
about your carbohydrate ratios?

If you changed your set mid morning, it's possible the new site absorbed
very well, probably better than you anticipated. I always change my set
*before* a meal - the bolus for the meal helps clear the end of the cannula
or needle, making sure I get good flow at the site. It's worked very well
for me.

The arm site was a new variable to factor in. The Silhouette (though your
second one) is also a new variable. 

The low at meal time is a challenge for me as well. The best thing for me
is to treat the low with glucose tabs - they work the fastest for me. My
meal carbs may metabolize more slowly than I need, and it complicates
things, so I don't use my meal carbs as treatment for low BG. If you're on
Humalog (I'm not), you probably want to delay the meal bolus till after you
eat, perhaps quite a bit longer than you usually might. This gives the
carbs a chance to "catch up" to the quick acting insulin.

>At 3:30 my bg was 348!
>So...I wonder IF new set and site is NOT working?   Or...is this a
>I have bolused for the high AND used 50% more insulin for potential
>resistance. At 4:30 a 30 drop to bg 317 and then at 5:30 a 51 point drop
>in bg to 265...new set is working.

I consider this a "suspect set / site" at best. Typical advice is to inject
via syringe, change the set, possibly the reservoir / cartridge, lastly the
bottle of insulin, if things do not come down. High BGs do take a bit
longer to drop to normal, but you're still above where you need to be.
Check for ketones at these levels, treat as advised by your health care team.

>Now what can I expect?  Do I need to NOT cover all of dinner carb's?
>I might add that at 3 a.m. I was 175 so did small regular bolus at 3
>a.m. I was 170 at midnight as well
>HELP!  I HATE low blood glucose reactions so much more than a high!
I would not eat dinner until my BG returned to a steady state of 150.
Adding carbs and boluses to this scenario is going to complicate things.

Bob Burnett

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