# Re: [IP] Breakfast meal & other weird bg responses

• To: Insulin Pumpers <email @ redacted>
• Subject: Re: [IP] Breakfast meal & other weird bg responses
• From: Michael <email @ redacted>
• Date: Sun, 16 Nov 1997 11:16:25 -0800 (PST)

```>   Wow!  Thanks for that explanation.  Our daughter (8) does something
> similar.  We just thought it was random BG fluctuations.  Now I'll have to
> watch more carefully to try and characterize it.      You kind of lost me on
> this part.
>
> << If high, she does a hbs bolus, boluses the next hour's basal rate and then
> spreads the remaining total basal until 1:00am over the time until 1:00 am.
>  This gets her down considerably faster but does not cause a low. >>
>
>   I assume hbs = High Blood Sugar. Please tell me if I have this right.
That is correct.

>   In your example, Lily's sleeping basal is 1.0.  If she is high, you
> calculate an adjustment then add 1.0 (one hour's worth of basal).  Say she
> was going to bed at 10:00pm.  The remaining basal insulin is 2.0 units (three
> hours at 1.0 = 3.0 minus the 1.0 for the hour's basal done with the bolus,
> leaving 2.0.)  You split the 2.0 over three hours, doing a temp basal rate of
> .7 for three hours. (?)
That is correct.

>   How low does she get before she eats some carbs, and does she eat short or
> long term carbs?
Well.....  Normally, if she catches it the number should be 70 or so,
however, usually she feels crummy and tests and finds out she is in the
30's somewhere.  Then 3 glucose tabs will pull her up to 100.

However, (again) both the high and the low blood sugars must be corrected
with additional insulin or carbo according to the 'UNUSED INSULIN' rule
or the corrallary -- "UNDIGESTED FOOD" rule.

>  If she has to eat carbs, do you try to adjust her to 100,
> then just run the 1.0 temp basal?
No, see original answer, if low she subtracts 0.1 for each 10 points as a
static adjustment for unused insulin or extra exercise/ whatever ... over

Where this does not work is on a serious zig zag from pizza or a large
piece of cake.

The pizza has lots of cheese and fat. The fat slows down the digestion
and the cheese contains enough protein that converts to glucose in the
long term to produce a large bg rise 6 - 8 hours after eating.

The cake is another story.  The flour is highly refined and goes in
quick. The frosting, which if made from powedered sugar, contains GOBS of
carbo but is a complex sugar that take ages to digest, especially when
combined with fat.  It is tough to get an accurate bolus for this large
amount of carbo (60 - 90 grams) but usually you can get within a few
percent. Leaving only a 30 - 50 bg point error (I assume a meal was eaten
as well).

Under the example conditions there is almost always a big low with a 50 -
100 poing correction, followed by a bounce up an hour or so later
of the same magnitude.  Hard to predict, just test and fix.
- ---------------------to continue------------------

for example let us assume that a basal rate of 2u/hr is running and about
to stop.  You discover that your blood sugar is 50 so you eat 2 glucose
tabs to bring it up to 100.

Problem, there is still insulin in that will bring you down.

Because it is a basal, figure that at 2u/hr, there is still 1/2 of it
left to bring you down over the next hour or so (Humalog of course other
wise double the times).  So figure at 60points/ unit that you will come
down another 60 points so eat another glucose tab and have a small snack
(like a couple of crackers).

The reverse is true for highs but can be fixed with a small bolus.

Hope this helps

email @ redacted

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