# Re: [IP] evening highs?

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> Could her carb ratio be changing in the evening and night?  Mornings
> are 190pts/1u & 30C/unit.  When she was on MI the mornings were the
> insulin resistant time not the evenings.  Evenings were 100pts/1u
> now it appears that it may be greater than the morning ratio.
>
There are probably two interacting problems. When she gets that high,
she becomes insulin resistant so more insulin is necessary to bring
her down than would have been necessary initially to keep her stable.

The carb/insulin ratio is probably out of whack. Why don't you
measure it. It is a simple engineering problem. Some time when she
has fasted for a while, like before a meal. Have her eat a half a
glucose tab. Check before bg's and bg's 30 minutes downstream.
Calculate the ratio. It should be repeatable. You can also measure
her insulin sensitivity in this manner but it is a little more tricky
since you must be careful and you have to estimate the total
absorbtion at the 2 hour point which is not real accurate (I'm
assuming humalog). You must start with a bg of 150 to 180. Higher
will mess up the measurement since her nice healthy kidneys will be
busy disposing of excess glucose. A calculated bolus to move her 50
points can be measured after 2 hours and should have moved her about
70% of the way there. Look at the data sheet that comes with the
Humalog for the estimated insulin absorbtion. You have to integrate
the area under the curve at the two hour point with your eyeball, but
60% to 70% has worked pretty good for me hmmmm.... my daughter uses a
5/1 mix, so the estimate will have to be adjusted a little for you.
Read the HOWTO info on the web site for some background data on
technique and the relationships between the variables of interest.
The tools are for estimating only, use them with care.

Michael
> Is it typical to have a constant carb ratio or a varying carb to
> unit ratio? I have heard that there could be a diurnal pattern to
> insulin performance in dropping blood sugars. but it seem logical to
> have a constant carb to unit ratio.  Yes, this diabetes and perhaps
> I should stop trying to apply logic. I am an engineer I don't have
> many other tools.
>
> Curtis Lomax
> Staff Mechanical Engineer
> Molecular Dynamics
> 928 E Arques Ave
> Sunnyvale, Ca 94086
>
> 408-737-3095
>
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>
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