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Subject: [IP] evening highs?

Hi Curtis,
There is actually some physiology involved that doesn't defy engineering
logic in the changing Insulin:carbohydrate levels.    Insulin receptors on
cell membranes are affected by a number of things that make them more or
less sensitive to the effects of insulin - fluctuation of cortisol levels,
growth hormones, epinephrine, exercise amount, acidity of the intercellular
fluid  - so the cell membrane is far from a static structure around the
clock.  Unfortunately, there is little way to monitor the cell's
environment, so we "guess" at what works best.

That said, a lot of kids on the list have more than one carb insulin ratio
depending on time of day, also day of the week.  Usually, when we see a
"shoot" instead of a "creep" upwards, I figure that's a bolus problem -
basal problems change more slowly.  Best way of testing the system is with a
late lunch, then a very late supper, and monitor the sugars every 2 hours
during the troublesome period.  If they're level, then it's a bolus problem.
If they creep up, work on your basals.

Happy engineering.  Don't forget the thousand variables that affect the
working of the "machine".  And the magic that happens according to the
phases of the moon and the position of the mouth....

Nancy Morgan, sometimes MD, sometimes mom of Jenna, age 10, pumping for 11
Date: Fri, 30 Jul 1999 13:31:50 -0700
From: Curtis Lomax <>
Subject: [IP] evening highs?

<<We are very new to the pump (Emily 7). . .
Could her carb ratio be changing in the evening and night?  ...
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.>>

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