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Re: [IPk] ketones- again

In a message dated 4/13/2003 10:47:11 AM GMT Daylight Time, email @ redacted 

> Hi Mary
> I understand your dilemma now. One thing in particular that has struck me 
> about what you have said is that you have to wait until ketones appear 
> before 
> you realize that you have an unsuccessful site. Surely you need to take 
> some 
> action before the appearance of ketones. Once you know that your bg is high 
> and you have taken a correction bolus, would it help to test your bg more 
> often (at least hourly?) when you first know that you have high bgs? 
> Perhaps 
> this could shorten the time that your bg is high. Another point to remember 
> is that it takes a higher correction bolus to bring down high bgs because 
> you 
> become more resistant to insulin, insulin is not as effective when you are 
> high. So the question you need to ask is whether you are taking enough 
> insulin to correct for your highs.
> Hope that you understand what I am saying.
Thanks Ken.

I understand and appreciate your advice but I know from experience (gained by 
testing every 15 minutes!) how long it takes for Humalog to work in me at 
normal bg levels (can take longer if high).  It's not useful for me to test 
within an hour after changing set and site, especially if I've had breakfast 
beforehand.  I am far too familiar with the problems of getting high bgs down 
(exponential effect - much worse if ketotic) and have waxed lyrical on this 
site before...:-)

At the risk of boring you to death, I'll give an example.
08.00     Change set and site.  Let's say no complicating breakfast today.
10.00     Check bg, say it's 15. (No point in checking bg before then - 
experience here - as insulin won't have had time to work). Give correction 
bolus.  Visit toilet (to minimise effect on possible subsequent ketone tests)
11.00 and 12.00     Check bg.  If OK at 11.00 I might have to correct for the 
bolus (in practice that's never happened.) If OK at 12.00 that's great.  If 
no significant effect by 12.00, ie drop more than 2 mmol, or increase, check 
ketones (no point in checking earlier, takes several hours).  If none, give 
larger bolus (and test again at 14.00).  If present, change set/site....and 
the whole thing starts again.

So you can see how the best part of a day can be shot.

But it's much better than MDI!

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