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Re: [IP] Re: pizza and other high fat foods

Michael wrote :
   The insulin must be matched to this throughput. It is tough to 
figure this out, but can be estimated more easily if you approach from a 
"maximum bolus" standpoint. That is, the bolus size after which you are 
guaranteed to force a low. Once you know that bolus size you can 
calculate the food it represents, and anything else must be spread out 
over the remaining hours to process the rest of the food.

This is an excellent point you make Michael. There have been quite a few
times, either due to high fat meals, high bgs, or site changes, that we have
had to make decisions about where to "cut it off", so to speak, in the amount
of insulin Amy takes. No matter what, Amy will not (I'll never say never,
because you just don't know!) bolus over 10 units. I know this will make her
go low! It was hard for her to understand at first why she couldn't bolus all
she had figured. But, I know she has it now!!! Wed. a.m. she woke up very high
(392), with high ketones. She should have changed her site the day before, but
had enough insulin to last until breakfast, so we thought. So, with her
breakfast carbs, cannula prime, adjustment for high bgs, and extra for the
ketones, she would have theoretically needed to bolus 18.2 units!!! Not this
little gal!!! She didn't like that number, so refigured it on her own, and
consulted with us about only doing a bolus of 9.2 with a square wave of 9 over
the next 1 1/2 hour. Told her to go for it. Tested each hour for 4 hours - 1st
hour - bg was 291, small ketones, 161, neg ketones, 123 and 127. Now, I'm not
sure if she was lucky and guessed good, but I sure was proud of her for taking
it on and going with her gut feeling! Could she have bolused more? Maybe. But,
knowing Amy's response to H, I don't think so. She would have probably gone

Just our experience....
Sue Tappendorf
Mom of Amy, 12, pumping since June '98
Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org