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Re: [IP] Newbie needs help

> It's Robin again, my daughter 10 pumping for 1 month.  This morning
> woke at 180 had usual breakfast with usual bolus two hour post meal
> was 398 so we did 2 unit high sugar bolus and it came down to 232 in
> 45 min.  My question is why did it get so high in first place?? Her
> pump did not give us any alarms as to no delivery and it's
> obvioulsly working since she responded to 2nd bolus.  This seems to
> happen alot.  I'm sure she did her am bolus because I watched her do
> it.  
This comes up now and then. I actually got a call from Lily (away on 
vacation at Lake Tahoe). She has had a metabolic shift (I guess) and 
is again experiencing this same thing (happened a few years ago too).

She wakes up, bg's are ok, eats anything at all and is 300+ in an 
hour. This has something to do with the level or degree of metabolic 
"rest" and a bunch of other things. The bottom line is that the act 
of eating primes the body to shift gears which requires a lot more 
insulin. If you fast, you don't see the spike. This is confusing and 
leads (incorrectly) to the conclusion that a different "ratio" is 
needed for breakfast. In fact, if you eat a breakfast that contains 
NO CARBOHYDRATE you will still see the spike. My instructions to Lily 
three days ago were to bolus about 2/3's of the insulin required for 
what she thought the spike would go to, then eat a breakfast with no 
carbs -- scrambled eggs and tea or crystal lite. Then check bg's 
every hour for 3 hours and adjust the bolus the following day for the 
error she measured and eat normally. This is the same procedure we 
used a couple of years ago, works fine. Lily's post-prandials are 100 
-150 the last few mornings with normal variable breakfasts of cereal, 
toast, whatever.....

In the past, we've noted that the expected "start up" spike is 
dependent on the amount of rest you get. If you rise earlier or later 
than usual, it may not even appear at all, so some care must be taken 
in using this technique. In Lily's case (two years ago, don't know 
about now yet). She only got the spike on days she got up before 
7:00am. If she slept in, it didn't happen. I don't think that is the 
case at the moment since she's on vacation at grandmothers place and 
I expect she gets up when she chooses -- usually late -- my kids are 
all sack rats.

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