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Re: [IP] bg's after bolusing (was eating out)

Kasey, I don't think you can ever get it perfect.  The problem as many have
already stated is that there are two delays that need to be matched, the
delay in insulin absorption and the delay in food absorption.  Both can
vary because of independent causes that we have little contol over.   What
works one day may not work the same way the next.
 This is the reason they are so very far from closing the feedback loop to
make a self contained artificial pancreas.   In designing a control system,
engineers normally go to great lengths to avoid any delays in the loop,
because it is known that such delays can lead to great instabilities.  With
our manual pancreases, we've got two delays, so there is no way we can ever
get it as perfect as the real pancreas, which senses BG directly and
responds with insulin directly into the blood.  So you might be able to get
a post meal BG a little better than 200 (maybe by injecting 10 min prior,
instead of 1/2 h), but don't be disappointed if you don't get it perfect.
YMMV even on a day to day basis.

<<<<<<<<<From: Kasey Sikes <email @ redacted>
Subject: Re: [IP] bg's after bolusing (was eating out)

Michael wrote:
> > Good advice,  Ruth.
> >  Another rule of thumb I was taught was 1 hour after eating you bg should
> > never be above 180, Two hours after eating should never be above 150.
> This rule of thumb is for regular insulin. For Humalog, the bg's
> should be relatively flat. If bg's are 50 points high after 1 hour,
> you must bolus for the 50 points plus that much again for the next
> hour. Always calculate the 'unused insulin' or 'unused carb' and
> compensate accordingly.
> Michael

Hopefully someone can help me with this.  Kayla's bg is NEVER less than
>180 one hour after eating.  (She uses Humalog, so by Michael's post, she
>should be about where she was before eating - doesn't happen.)  However,
>within four hours she is back in the normal range.  But she's usually in
>the 200's one hour after eating and slowly comes back down over the next
>three hours.  If I compensated at one hour with more insulin, or even if
>I gave a bigger carb bolus, she'd be going low four hours later.  I
>can't seem to grasp "the big picture" of what is going on here.  Any

>email @ redacted


>Thanks, Ruth for the advice.  Her endo seems to think that Humalog works
>longer for Kayla than it should.  It's still working six hours later and
>seems to peak at four instead of two.  We once tried bolusing 1/2 hour
>before eating, like with Regular, but then she dropped too low too
>fast.  So, the Humalog starts working quickly (as it is supposed to) but
>doesn't seem to get into high gear soon enough.

T>onight was a perfect example.  At 5:30 her bg was 121.  Perfect.  I
>decided to try giving the bolus early another shot.  I gave her 2.9u for
>her meal bolus and by 5:50 she had dropped to 25.  Yikes!!!  A 96 point
>drop in twenty minutes!!  Yet if I had waited and bolused her just
>before she ate, her postprandial would have been over 200.  Argh!


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

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