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Bob's bad math, was: Re: [IP] morning insulin resistance

At 07:46 PM 6/26/98 -0400, Mary Jean wrote:

(Bob originally said this part)

><< 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. >>
(MJ said this part)

>Pardon me for stepping on your math, but, if somebody needs 1 unit for 12
>grams at breakfast and 1 unit for 15 grams the rest of the day, and they
>choose to manage the situation with a change in basal rate, then the morning
>basals would be set too LOW.  More insulin is required to counteract the same
>number of carbs. 
Don't apologize for stepping on my math. I don't have any math. I did not
inherit any math genes from my parents, I don't ever expect to win any math
in the lottery (requires picking numbers, and I can't do that ;-))

You are 100 % correct. I know that's right ;-)

I had the numbers reversed, and my logic got twisted to go with it. I was
confused by Sam's wording. He indicated "I also need to use a lower
carb/insulin ration for breakfast, than I do for the rest of my 
meals". He cites an actual ratio of 1 to 12 in the morning and 1 to 15 in
the afternoon. To me, the morning ratio is a "lower" carb to insulin ratio
(less grams CHO covered per unit of insulin) but a "higher" insulin to carb
ratio, since he requires more insulin per gram of CHO.

I flubbed it.

My basal rates can cover some of the variability in the boluses and vice
versa. I call this "masking", since the underlying cause of the different
insulin requirement can be any combination of factors: basal rates
combining with boluses, incorrect basal / bolus rates, "pooling of
insulin", etc. For a long time, we felt I needed a ratio of 1 unit insulin
to 15 g CHO in the morning, and 1 to 12 all other times. I was going too
low just before lunch. It turned out what I really needed was a less
aggressive basal rate during part of the morning, the same insulin / carb
ratio through the day, and the patience to endure some variation in morning

As another example of how I can be "math challenged", I computed my lunch
bolus today - 84 g CHO, required an 8.5 unit bolus. Cool, I can do that
simple math. Problem was I forgot to punch the buttons - you know, those
little buttons on the pump that tell it to bolus. (Where is that "clap on,
clap off, let's eat" Clapper pump option I'm looking for?). Many math
challenges the rest of the day, figuring out how to drag down the blasted
BG after that mistake.

Bob Burnett

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