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[IP] High Blood Sugar Bolus



Here's an issue for the list:

My endo vehemently believes that high BGs should NOT be brought down
with extra boluses.  He always yells at me for doing this and repeatedly
points out that "chasing" highs with extra insulin leads to lows and
rebounds and more highs etc . . .   He says now that I am on the pump it is
even more important NOT to chase highs.

Here is the protocol.  If I have a high:

1)  Figure out why (too low food bolus, error in delivery, bubbles, wrong
basal rate etc . . .) and fix it so it won't happen again.

2)  Do not bring the high down with a bolus.  Use basals.

3)    If  the BG is > 240,  temporarily increase Basal rate by 50%  and test
every hour (when the temp basal alarm goes off) untill the low drops to 20
points above target.  Then, discontinue the temporary basal increase.

4)    If the BG is > 200, temporarily increase basal by 20% and test every
hour (when the temp basal alarm goes off) untill the low drops to 20 points
above target.   Then, discontinue the temporary basal increase.

5)    If a high above 240 persists to the next meal, increase pre-meal bolus
10% or 20% if ketones are present.

My doctor does not agree with the Walsh and Roberts Pumping Insulin book
directions to bolus for high BGs.   He says bolusing for highs causes more
lows and
drastic drops that are in themselves harmful.   He says gradual drops are
preferable.

I have been fighting him for years about this.  It is just so hard to not
bolus to bring down a 250.  Since I went on the pump last month, however, I
made a deal to follow his directions and IT IS WORKING.  240s drop gradually
to target over 3 hours and I have none of the rollercoaster lows following
highs that I used to get all the time when "chasing" highs with extra shots
of H.

Does anyone else do this/have any comments?

Neal


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