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RE: [IPk] changes in basal rates



Your carbohydrate meal bolus should be based on your insulin sensitivity,
BGL and food intake (specifically carbohydrate). How you give that bolus
(normal bolus, at the end of your meal, split bolus or
dual-wave/extended-square-wave (functions on some of the newer pumps)
depends on what type of meal it is (high fat, high fibre, high carbohydrate
etc..).

1 u for 15g carb works in many people - but not everyone.  1u/15g
carbohydrate is useful at the start. Your sensitivity to insulin can change
year to year (and possibly season variation too) so it is worth you and/or
clinic revising these doses, ie: if you are having to do lots of
corrections... 

Julette :-)

Julette Kentish
Diabetes Research Dietitian
Bournemouth Diabetes & Endocrine Centre
Royal Bournemouth Hospital
Castle Lane East
Bournemouth
BH7 7DW DORSET UK
Ph: 01202 704929
Fax: 01202 704759

		-----Original Message-----
		From:	Zoe [mailto:email @ redacted]
		Sent:	25 April 2001 23:12
		To:	email @ redacted
		Subject:	Re: [IPk] changes in basal rates

		Thankyou for clearing this up! I have been struggling to get
my boluses
		right before meals. My rep at Disetronic insists that I
should always bolus
		1 unit for every 15g of CHO and won't accept when I tell her
it doesn't
		work - I too seem to need a larger bolus at lunchtime for
the same amount
		(eg 2 slices of bread) that I had for breakfast and it has
been puzzling me,
		I assumed that my basal rates were wrong.

		Zok
		----- Original Message -----
		From: "paulleonard" <email @ redacted>
		To: <email @ redacted>
		Sent: Wednesday, April 25, 2001 8:55 PM
		Subject: [IPk] changes in basal rates


		> I mailed the group several months ago about the apparent
changes in
		insulin
		> requirements at different times of the day.  There was no
response, so I
		> assumed that you knew it all already - but that doesn't
seem to be the
		case
		> (or you wouldn't have asked!). As a pumper who's also a
medic (and yes,
		there
		> are some good guys out there who understand), I feel
reasonably qualified
		to
		> respond to those queries.
		>
		> Each of us has an individually tailored circadian rhythm,
and our
		requirement
		> for various hormones differs according to our lifesyles
and sleep
		patterns.
		> In general this means that each person will need more
insulin at certain
		times
		> of day and less at others.  Your basal rates should
reflect this, but you
		are
		> unique and only you can determine what's right for you, by
carrying out
		> experiments where you don't eat, don't exercise and aren't
stressed.  You
		then
		> have to add in the various factors affecting life, and
personally I agree
		that
		> it's learning that counts, not loads of graphs (but each
to his/her own).
		What
		> doesn't seem to be common knowledge is that your bolus
insulin:carb ratio
		may
		> differ according to the time of day.  For example, you may
have 50g C at
		> breakfast with 2 IU insulin, but for the same amount of
carb you may need
		more
		> (or less) insulin at lunch-time.  I personally need almost
double the
		ratio
		> used at breakfast for midday meals - the stress factor
seems to come into
		play
		> here!  Shift work also messes up the body clock; I used to
and my husband
		> still does work shifts, so our bodies are seldom attuned
to a set pattern.
		It
		> takes about a week to adjust properly from a night shift
to a day shift,
		much
		> the same as adjusting to jet lag, and I have to set my
basal rates to cope
		> with this.  Fortunately, the Minimed 508 which I use
allows up to three
		basal
		> rate patterns to be set in advance.
		>
		> Hope this helps more than puzzles!
		>
		> Mary
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