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Re: [IP] Someone Explain

Well here's another 2 cents worth of physiology from a physiologist.   The
BG is a balance of what goes in and what comes out.  If you do those
glucose tabs there's little doubt that the sugar all goes into the blood
within 15 min.  So a 4 g tab will raise BG by whatever your ratio is (for
me that's about a 12 mg/dl rise).  Don't know about chocolate cookies Sam,
but it may take an hour or more for all those nice CHO to raise BG. (And
lord knows what a "handful" of raisins will do!).  So if the sugar input
isn't raising the BG, then there must be something taking it away.  The two
main possibilities are 1.more insulin around than what you think there is,
and 2. the "post-heavy-exercise-phenomenon.
1) There may have been insulin pooling around the cannula, perhaps because
of  tunneling around the catheter, having the tip located in a very fibrous
area of skin with little blood supply,  or just some tissue repair walling
off the insulin.  Some pressure or motion may then free up this "bolus."
This process may also explain why sometimes we go high for unexplained
reasons--if the insulin is pooled too long it will start to denature.
This is one little studied disadvantage of the pump--its not an issue with
injections, unless you always shoot up in the same spot.
2) Up to 24 hours after heavy exercise the muscles may still be working
hard metabolically, repairing and rebuilding.  There are a number of
chemicals produced that greatly increase the cells ability to use glucose
without insulin.   In addition to directly lowering BG, these chemicals
also effectively lower the basal insulin requirements, so the normal basal
rate can then act like a steady bolus.

<<<<<<<<<What is the physiology behind this.
Woke Lily at 2:30 to check her bg's, she'd been a little low when she
went to bed but ate glucose to counteract.
At 2:30 her bg was 51. She ate 3 tabs, enough to raise her 70-75 points.
15 minutes later her bg's were 59. About this time she had a piece of toast,
12 grams of carbo and also ate 2 more tabs (another 50 pts worth).
15 minutes later, she felt better but bg's still only 70 so she got up
for a snack.
Bottom line, 5 glucose tablets, 12 grams (carbo) of toast and 30 minutes
later, bg has only come up about 20 points. I've seen this before, but
never really examined the underlying physiology. Anybody got a good
explaination. It seems to me kinda like walking on water. Her body is
somehow forstalling the crash until the last possible moment. I wake her
and within a few minutes she somehow uses up a lot of residual blood
glucose or something like that.
Curious about this.

<<<<<<<<<<This has happened to me a number of times... just the other day I
tested at
44. So I whipped out the glucose tabs (6 of them) and got a large handful
or raisins. 30 minutes later I tested at 41... hmmm. So back to the glucose
tabs and this time I reached into a handy box of chocolate-chip cookies...
seemed like a good excuse to me. An hour later I was still at only 64.... a
small glass of apple juice followed. At bed time, about 2 hours later I was
still just at only 105. So far so good... anyone want to guess what I was
at about 3am?? Close to 300 of course. Can't win for losing... bolused and
was OK by the morning. (sigh)

Explanation??  The great diabetic unknown! Just like you get those
unexplained highs, you also get those weird lows. As my doctor says... it's
just the nature of the beast.

(yeah, but those cookies were sure good...)

Wayne Mitzner
Department of Environmental Health Sciences
The Johns Hopkins University
615 N. Wolfe St.,  Baltimore, MD 21205
Tel. 410 614 5446,   Fax 410 955 0299

Insulin-Pumpers website http://www.insulin-pumpers.org/