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Re: [IP] Article for Lisa

> MIchael,
> Your answers make sense.   Is this somehting we should be doing on a REGULAR
> basis or just on occasion to check a situation and see if we are on the right
> track.  Obviously it can't be done at school but after supper is certainly a
> viable option for us.  
> Let me know.     Sherri

Hard to answer as a 'should be'. Even at age 11, Lily was very 
pro-testing. She quickly realized that she could eat what and when 
she wanted if her blood sugars were OK. I provide her with these 

Eating an physical activity are not permitted with bg's over 160.
She has to wait until her bg's come down. For food, she will bolus 
her HBS plus meal plus basal for 1 hour and suspend her pump for 1 
hour. This usually results in a 30 45 minute wait. Physical activity 
is permitted if bg's are over 80 and care has been taken that they do 
not fall lower. Except for swimming and skindiving where bg's must be 
at LEAST 100. Here the window narrows because we have found her bg's 
drop rapidly without supplemental carbo when exposed to cool water. 
For skindiving (snorkeling) she likes to be in the 120 - 150 range 
with a powerbar or something like that eaten.

The end result is that Lily test about 7 to 9 times a day. The only 
time she constantly needs reminding, is to test at least 1/2 to 1 
hour before meals so if she is high, she can bolus down in time to 
eat wih the rest of the family. She is forgetful and would like to 
test when she sits down to eat. The post prandial test is not a 
necessity, but allows you to establish a pattern for response to 
known foodstuffs from which you can adjust accordingly the timing of 
your bolus and/or a square wave. For example, milled cereals have a 
high glycemic index. Some are converted to glucose so rapidly that 
even with Humalog, it is necessary to bolus in advance of eating. 
Whereas, chocolate cake with frosting (lots of fat) digests very 
slowly, as does pizza, macaroni and cheese, etc.... The chocolate 
cake can usually be done OK if you use an H/V mix and have no 
digestion difficulties (gastro problems), it is easy to overbolus for 
this treat, I suspect that the fat load in the frosting actually 
prevents some of the sugar from being digested. Pizza and mac+cheese 
will extend for 5 - 7 hours. The initial bolus needs to be smaller, 
and a square wave or temp basal rate must be set to extend the 
insulin delivery to within about 3 hours from the end of the 
digestion cycle. You will have to document this for your child and 
watch it change as age and size increase (slowly, don't worry). Once 
you know these things, it is only necessary to spot check once and a 
while. Unfortunatly, I've found that all pizza is not the same.

I tried mightly to teach all this to Lily with the result that after 
2 years pumping, she only asks me about basal rate adjustments and 
sleep time temp basal rates (occasionally). She tests often enough to 
have a pretty good picture of her bg pattern every day and what to 
expect and when. There are still problems, but overall her A1c's are 
good and she is pretty free to do what she wants like the rest of us.

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