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Re: [IP] Re: Could use some advice please!!!!!

In a message dated 9/7/00 4:12:36 PM US Mountain Standard Time, 
email @ redacted writes:

<< I was looking for some help with highs after breakfast.I was wondering if 
 the carb bolus should be different or do I not change this till I know for 
 sure the basals are absolutely correct?It does not seem to matter what it is 
 Ryan eats for breakfast he goes high and he seems to stay high till lunch 
 time. I do not notice this with any other meal time it seems to be just 
 breakfast and have tried different foods and he still goes high? Any advice 
 would be great. Thank you.    >>

This has been my hardest adjustment to make too, both pumping and on MDI.  
I've been pumping 4 yrs now, dm for 20 yrs.  Please keep in mind that this is 
a great big YMMV (your milage may vary) item, but I'll tell you what works 
for me, and maybe between all our answers, you'll find a better solution for 

First of all, yes you need to be sure his basals are correct.  So you need to 
do a fasting morning and test often.  What works for a couple of months, can 
change. When I do a fasting test, I do mine hourly from lying in bed and 
awakening until I eat at lunch.  I have found that my bgs will rise most 
mornings about an hour after waking up, even without any food.  The less 
sleep I get, the worse this spike seems to be, but it is almost always there. 
 To correct for that I have been taking a small bolus upon waking, again, not 
everyone reacts this way, but it works for me.

Also, my ratio at breakfast has ranged anywhere from 1:7 to 1:10, my lunch is 
pretty stable at 1:12, and dinner at 1:15.  For the last year or so I've been 
taking a 20 minute fast walk BEFORE breakfast and after my wake up bolus.  
When I do this, my bgs are usually quite stable and I don't have the big 
spike.  Usually start out at 140 waking, do small bolus, walking, an hour 
later at 100, eat and bolus at 1:10, test again at 11am to see if I'm coming 
in good for lunch at 12:30 and usually its back to 120 by then.  I also have 
a higher basal in the am that I cut back at about 10:30.

This is what works for now.  When I first started insulin 20 years ago, the 
Dr had me taking 12 units of reg in the morning and I would spike up to 
250-300 mid morning, and crash down to 40 by noon.  Pumping is a lot of work 
to figure out, and we're each different and ever changing, but it is oh so 
wonderful to have this tool to work with.

Best wishes,
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