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Re: [IP] Morning insulin resistance

Sam wrote:

><< I've finally figured out
> (duh!!) that I also need to use a lower carb/insulin ration for breakfast,
> than I do for the rest of my meals. As an example if I use 1 unit/15g for
> lunch and dinner I need to use about 1 unit/12g for breakfast (I'm still
> fine-tuning that one). I also have a slightly higher basal in the eary
> morning hours to compensate for a definite dawn effect. 
> So, am I the only one that has noticed this? (I always knew I was weird,
> but didn't thing that I was THAT weird...) >>

MJ responded:

>No, you aren't weird!  Michael refers to this as a "morning bolus" for Lily.
>He claims it is a set amount regardless of the number of carbs she eats for
>breakfast and is dependent on the time of day she gets up.  Other people on
>the list compensate, as you are, by using a different carb/insulin ratio.  I
>don't know which way is scientifically correct, but as long as you are
able to
>manage the situation, do whatever works!  I eat the same thing for breakfast
>most days of the week (Special K, toast, and OJ) and have always added an
>extra .2 units to my calculated bolus amount.  But now, it appears as if my
>insulin needs are changing, and I'm in the process of refiguring this.  
And Bob chips in with his .02 (oh, no, not again ;-))

And yet another theory says that "nothing is constant except change". My
dawn effect, though pronounced, sometimes "floats around". It may move an
hour or two one way or the other. Usually not significant, but these basal
rate changes, coupled with my breakfast bolus, can sometimes "mask" what is
really going on.

I used to drive myself nuts, trying to nail my basal rates firmly to my
dawn phenomenon. I'm on the pump, after all, and once I get my rates set,
everything else should fall into place nicely, right? Well, maybe,
sometimes, for some users, if all works as predicted, etc. .... You get the
picture ;-)

Sam indicates a need for using a ratio of 1 unit / 12 g CHO for breakfast,
yet less insulin / carb (1 unit to 15 g CHO) for lunch and dinner. This
might suggest that the morning basal rates are slightly higher than needed.
In essence the "excess" morning basal is also supplementing the breakfast
bolus, "masking" the true ratio required. The other factor, which is
referenced in a number of books, is that there is still some lingering
effect later in the day from boluses administered early in the day - even
with Humalog. Hence, less need for insulin later in the day. 

This morning thing baffled me for a long time. Once I realized what was
going on (and it did take a lot of testing and patience), my insulin / carb
ratios became much more consistent throughout the day and now have settled
in to a comfortable 1 unit / 10 g CHO ratio. Oh, they'll change again, I'm
sure, but this pump thing works out o.k. for stuff like this :-)

This shift may be a bit trickier to contend with using Humalog, due to the
short life span of the insulin. It doesn't seem to cover a "shifting dawn
effect" as well, since it is gone from your system so quickly. This is
where the "tail" from Regular or Velosulin is a real advantage. With
Humalog it's tempting to try to chase the shifting pattern with either
constantly revised basal adjustments in the a.m. or supplemental boluses.


Bob Burnett

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