# [IP] Fixing highs quick

```> In a message dated 03/09/2000 1:56:20 AM Eastern Standard Time,
> email @ redacted writes:
>
> << there is another way that is both fast and can cancel the above
>  message to the liver. Bolus for hbg + meal -- when bg's hit 150
>  -180, eat. You can bring a stubborn high down muy pronto and stop
>  the decline in it's tracks with a few minutes. The higher the
>  starting numbers, the higher the start-eating number. YMMV on this
>  technique, of course, but it rarely takes Lily more than 30 - >>
>
> Michael,
> I know you aren't a dr. but explain this step by step.

Sorry <vbg> It's the engineer in me talking about systems that comes
up with these things.

> What do you
> mean bolus for the high and meal --when bg hits 150 - 180 eat.  The
> higher the starting number the higher the start eating number?  Does
> that mean it has to get to 180?  Like if it is really high wait
> until 180 instead of 150?  Just curious,  trying to figure this
> stuff out.  That is what we have been doing bolusing for both,  but
> I was thinking about what she said about getting the high down first
> and that made sense too.
>
Perhaps an example would be a better explanation.

Lets say that bg's are 250 i.e. 150 above target and that one unit
brings you down 50 points. That would be a 3 unit hbg bolus and would
take a couple of hours to take effect. Now lets say that you are
hungry and it's lunch time. A big Mac and medium fry is 97 grams of
carb (round it off to 100), thats another 4 units worth of insulin.
If the hbg and food bolus go in together, the total is 7 units. This
will bring you from 250 to 180 in 30 minutes, to 150 in another ten
minutes -- better eat NOW.... <vbg>... cause it will take a few
minutes for those frys to take effect and bg's are comming down
farily rapidly at this point (23 points every 10 minutes). I've
seen the timing vary to an additional 15 - 20 minutes, while the drop
off (slope of the curve) remains constant once started.... I would
attribute this to absorbtion differences from day to day -- seems
that with a big bolus, sometimes it doesn't seem to "start" for a few
minutes, but once started absorbs at a the same known rate. YMMV

To extrapolate, say the high was 300, the hbg bolus would be 4 units
+ a little for insulin resistance then 4 more for food, total 8
units. The drop time to 180 would be about 45 minutes, comming down
at about 25 points every 10 minutes.

The rule of thumb we use at our house is 20% of insulin is absorbed
every 30 minutes for the first hour and a half or so, with the rest
spread over the remaining couple of hours. See the humalog absorbtion
curve at: