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Re: [IP] humalog and velosulin

On 18 Mar 98 at 11:19, Michael wrote:

> The mix ratio can probably be optimized to accomodate the average 
> digestion rate for the food you eat. For example:
> On straight regular, it is necessary to bolus about 45 min early so 
> there is not to sharp a post-prandial rise in bg's.  This is not 
> ideal, the bg's still rise some, in the range of 150 to 180. 
> Mixing H with R with a high proportion of H and bolusing immediately 
> before eating (basically at the same time) sometimes produces a 
> low/high reaction. Not too low but under 100. 
> A strategy of bolusing 1/2 at start of meal, plus 1/2 of additions 
> when grazing and the rest at the end of the meal (when grazing is 
> complete) produces the smoothest post-prandial bg's. However, even 
> this strategy can sometimes produce a low/high. Increasing the ratio 
> of R in the mix will eliminate the low/high and should produce a flat 
> bg for all but pizza-like foods or foods that are mostly highly 
> refined grains - you know the ones that go straight in like glucose.
> I would guess that a mix or 3/1 or 4/1 is closer to optimum, it 
> retains the initial quick response of the H but still covers the 4+ 
> hour digestion period for most foods and complex sugars.
> Anyone care to add their thoughts to this ??

There is a marked difference between time of onset for Humalog 
between people.   Lilly has some documentation on this and it 
shows the variation in time of onset as rather large.   When I take a 
bolus of Humalog my bg doesn't start dropping for almost 20 minutes, 
so it matches the digestion of most of the foods that I eat.  With R 
I had to watch it because I'd get a high/low action.  Humalog has 
reduced this effect but I still have to watch it.  If I take enough 
to get a decent post-prandial bg then I tend to crash an hour 
or two later.  We spent almost a month twiddling basal rates until I 
convinced my CDE that they were OK because of the evidence of my 
fasting days.  

I have to be careful with my evening bolus too, because without 
eating my bg stays nice and level, but if I underestimate the cho for 
the evening meal my bg will crash, usually around midnight.   When I 
first went onto Humalog I did a set of intensive monitoring tests to 
see how it affected my bg.  The curve was just slightly faster than 
regular but nowhere near the "instant onset" that some people have.  

It just goes to show that most of our treatment ideas are developed 
by trial and error, really mostly by error - finding out what doesn't 
work and trying something else.   We should change the YMMV (your 
milage may vary) to YMWV (your milage will vary)...

Randall Winchester

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Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/