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Re: [IP] Insulin on board

Unfortunately neither of these works for this case.  I remained low 
all day, and 80 gm of 240 gm of carbs were not bolused for, as I was 
using them to counter the low values.  All corrections were negative. 
I stayed low through the next meal each time in spite of the 
uncompensated carbs.  in fact my high for the day was a 129 (after an 
unbolused  snack) before  bedtime.  Exercise was exactly the same as 
I do every day--half an hour on the rowing machine--and I didn't do 
anything extra except some minor shopping.  I usually eat about 20-25 
gm carbohydrate without bolus before exercising; yesterday it took 38 
g to get me up to 123 and I had to keep breaking to let my blood 
sugar come up.  I changed sets a couple of hours ago, and with my 
brittleness I'm likely as not to stay high on this one.   If I don't, 
I guess it's time to try another basal change.

>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
>Dx'd 1967, Pumping since 1/14/2004 w/ Animas IR1000 and since 7/2/2004
>w/ the Animas IR1200
>for HELP or to subscribe/unsubscribe/change list versions,
>contact: HELP@insulin-pumpers.org

Sue Ann Bowling, North Pole, Alaska
http://mosquitonet.com/~sbowling (general)
http://bowlingsite.mcf.com/DogPage.html (dogs)
http://climate.gi.alaska.edu/Bowling/Bowling.html (professional--retired)
for HELP or to subscribe/unsubscribe/change list versions,
contact: HELP@insulin-pumpers.org