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[IP] Insulin Absorption Test



Paul,
This is very interesting.  On the other hand, this information is
supplied for an average of 15 or so patients in the Humalog insert. 
Obviously, each individual will be somewhat unique.  I may try this
sometime, just to see???
Jay

<<<

Date: Fri, 26 Jun 1998 09:26:35 -0400
From: "Paula Berketo" <email @ redacted>
Subject: Re: [IP] Insulin Absorption Test

To Those Interested:

Simply put, the test used at McMaster University is conducted to
determine
how long it takes for Regular insulin to peak in an individual.  Once
you
determine this, the amount of time the insulin takes to react can then
be
applied to any other type of insulin based on the known peak rate.
Insulin
absorption is the amount of time it takes for insulin to reach its
maximum
strength in your body.  Apparently, in some boides, the insulin is
injected, crystalizes at the injection point, and then at some unknown
time, begins to work.  Because Lispro should not crystalize, there
should
be no delayed absorption problem.  If you inject, and then fell the
insulin
is not working when it should, delayed absorption may be the problem.

The information above and below is based on my best recollection of how
the
information was conveyed to me and the test was done.  The test is not
exceedingly complicated but may take up to 12 hours (or more) in some
individuals.

When it was first done on me, it was determined that my absorption was
12 -
14 hours.  The test was done (pre-pump) because I was going from very
high
to very low without explanation and going into reactions three to four
times a week (complete unconsciousness).  Needless to say, my quality
of
life was suffering.

The test is very similar to what any diabetic would do when their blood
sugars go very high.  Although this test is usually done by medical
staff,
I have done it at home, on a relatively low activity day.  I do not
believe
it is in any way dangerous to do - but you will have to judge for
yourself.

Incidentally, after I was on the pump for about eight months, I
believed my
absorption rate was beginning to return to normal.  Because I was very
busy, and the University hosiptal is an hour away from my home, I
thought I
would try the test myself.  Sure enough my rate had reduced to six
hours. 
Now, after seven years on the pump, insulin reacts in my body (peaks)
just
about when it should.

You will need your glucometer and enough test strips for one test every
one
half hour for at least 12 hours, one dextro tab per half hour, a chart
that
indicates every half hour and your BG reading every half hour, a
relaxing
atmosphere and maybe a good book.

The first time I had this test done at McMaster there was a man sitting
beside me who was going through the same test.  He was in a wheel chair
(poor ciorculation in legs due to poor control) and very heavy set.
This
was the third time the test was done and he requried at least three
units
of insulin for every number he wanted to drop.  He said he took over
250
units of insulin a day.  I believe this has a lot to do with insulin
resistance as well as absorption.

My test was started first thing in the morning and I was told that my
BG
had to be at least over 20.  In US terms I was told to multiply that by
18.
(360)  Write down your BG level before you begin and the time.  Do not
eat
anything other than dextro tabs during the test period.  Do not eat
breakfast.  You should disconnect from the pump, as you do not want any
insulin at all other that the insulin injected by syringe to be in your
system.  The tricky part is to determine when during the night before
to
disconnect.  It now only takes me about 4 hours without the pump to
have my
BG go very high.  Be careful and think about your disconnection time
carefully as you want to have your BG level over 360.  You do not want
to
be comatose! (That isn't supposed to be funny)

Next, take by syringe, in a place that is rarely used (arm), the number
of
units of insulin to bring your BG level down to something acceptable.
In
Canada, if my BG was 22 my goal would be to get it down to 6.  I was
told
to take one unit of Regular insulin (Toronto) for every number I wished
to
drop.  Therefore I would take 22 - 6 = 16 units of Toronto.  I believe
this
ratio is for someone of average size.  

When you take your injection also eat one dextro tab.  Now, go sit on
the
couch, or your deck or the patio, get out your book, and wait 30
minutes. 
This is not the time to add any extra physical activity.  After 30
minutes
test your BG, eat another dextro tab and record the results.

The dextro tab keeps you from dropping too quickly I think.

The goal is to watch your BG results every half hour.  They should drop
and
then begin to rise.  It is when they begin to rise that you have
reached
the insulins peak time.  If you have no absorption problem this should
occur according to the regular onset time of the regular insulin.  I
believe this is about 4 hours for Toronto.  I suppose this could be
done
with Humalog as well.  Humalog was not available when I first had the
test
done.

Once your sugar level begins to rise the test is over, hook up to the
pump
again and process your results.  I can only deduce that if your BG
level
never dropped to the required number (remember I wanted to get down to
a BG
level of 6 that would indicate a resistance  and I could then deduce
that I
required more that one unit of insulin to drop my BG one number.)

The process is simple and to recap:
1.      Disconnect from your pump some time during the night before the
test in
order to get your BG level over 360 (20 Canadian).

2.      Do a BG test and if your number is over 360 (20) begin.  Eat
one dextro
tab.

3.      Take by syringe, in a relatively virgin site, one unit of
Regular
(Toronto) insulin to reduce your BG level to about 108 (6).

4.      Wait 30 minutes.

5.      Test your BG, record the number beside the time and eat one
dextro tab,
wait 30 minutes.

6.      Repeat step 5 until your BG level begins to rise.  

7.      Continue the test for 90 minutes after your BG begins to rise
just to
make sure it is rising.

8.      Hook up again.

If you are an individual who used Humalog and must be careful not to
take
it too far before a meal because your BG will drop quickly, it is
unlikely
you have an absorption problem.

Anyone can have this "inconcenience" but it is more commom in those
individuals who have had diabetes for a long time (over ten years) or
those
of us who carry a bit of extra weight.

I am not in a medical profession so this information has been written
in
very simple terms.  I apologize for any trouble you may have had
contacting
me at my personal E-mail address - this computer communication is
sometimes
frustrating - especially for me as I usually do not have a clue as to
how
things work.

Keep me posted and feel free to write with any questions. 

PJB in Niagara Falls
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