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[IP] Correcting High Blood Sugars

Correcting highs is something that should be done, as prolonged high
blood sugars lead to a phenomenon called "glucose toxicity" where your
cells become more insensitive to insulin the longer you stay high. This
causes you to require more and more insulin making it very difficulty
and somewhat complicated to try to lower your glucose with a basal rate.
Bringing it back within range is best accomplished with a bolus. Once
you bring your blood sugar back within range, you have a better chance
of avoiding highs and lows after meals because the carb-to-insulin ratio
will be constant and not affected by "glucose toxicity."

Everyone has a unit-reduction ratio that they need to figure out when
they use the pump. This is the number of points that your glucose will
fall when you give one unit of insulin. It is a number dependent on your
insulin sensitivity and total daily insulin consumption. For me it's
about 40.

For me personally, I found that HUMALOG was a godsend when it came to
correcting highs because it is metabolized so rapidly. The problem with
using Velosulin or regular to correct highs is that it can linger for up
to 4-6 hours after you give it, which can lead to a lot of unexpected
ups and downs. With Humalog, if you find a high, just give the
appropriate dose of insulin, wait 1 hour and check your sugar. If you
gave the appropriate dose it should be down approximately half way to
where it's eventually going. After 2-3 hours the humalog that you gave
is completely gone and you should be back to baseline.

As far as how high is acceptable for a postmeal blood sugar before you
consider bolusing, that also depends on whether you are pumping
Velosulin or Humalog. With Velosulin, you may get glucoses over 200
after meals especially if you are taking in a lot of starchy foods. You
may have to bolus a little early to compensate. 

With Humalog it's a whole new ballgame. Humalog is strong enough to
handle even concentrated carbohydrates in most people because it's so
fast acting. I wouldn't expect a postmeal blood sugar over 170 with an
appropriate dose of Humalog. It is that good. I honestly believe that
Humalog has changed the face of type 1 diabetes by enabling diabetics to
consume foods that were once taboo - orange juice, rice, mashed
potatoes, and even table sugar. These are foods with a high glycemic
index which regular insulin cannot handle but Humalog can handle.
Humalog is like high octane gasoline for the insulin pump - why drive
your car with regular when you can go premium!

By the way, my name's Guru and I've been a type 1 diabetic for 13 years.
I'm an internal medicine resident at UCSD medical center in San Diego. I
have been pumping for about 3 months now and using humalog for about 2
years. If you've got any questions feel free to ask.


Swaminatha "Guru" Gurudevan, MD
email @ redacted
Insulin-Pumpers website http://www.insulin-pumpers.org/