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Re: [IPk] temporary basal rate and walking

I'd always thought that the reason for Isabella's regularly changing basal
needs was to do with growth hormones, but maybe it's still her pancreas
producing insulin in fits and starts, is this possible? How long might this
go on for as it is really quite difficult dealing with changing insulin
needs every few weeks, sometimes from week to week. We find that we just get
her on a really stable profile and then hey presto we start to see climbing
or falling sugars at a particular time of day and it's all change again. Do
others with small children experience this? It was the same when she was
MDI, and the first point of the day to change is always the time between 7pm
and midnight for some reason.

Also, quite a few mentions on recent emails of the liver chucking out
glucose if there is too little insulin. I think we have experienced this a
number of times after she's been stable on 0.05 basal for several hours
suddenly her sugars will climb dramatically. Why does this happen? Is the
only way to prevent it to have a snack and a bolus every couple of hours on
a low basal? This would seem to defeat the idea of having a 'starvation'
basal rate.


On 10/04/2008, J <email @ redacted> wrote:
> I've no idea when insulin is likely to be produced if it's still
> being made. I think my son still has some insulin production judging
> by his dose compared to body weight and relatively easy to control
> BGs (though I think this may be tailing off now). As far as we can
> tell is seems to be released at a fairly consistent but low level, so
> he needs plenty of insulin with food but seems to need less basal
> insulin. But it is probably an individual thing. I've heard others
> who say that the insulin is produced sporadically, in fits and spurts
> and they found BGs easier to control when production stopped, so the
> opposite of our experience.
> It's possible that you would still have insulin on board from a lunch
> time bolus or the basal insulin before you need the low afternoon
> basal rate. The level of humalog (Novorapid is similar but lasts
> slightly longer I think) is quite high for 2 hours and then tails off
> during the third hour. This graph shows the level of Humalog in the
> blood over time, http://cgibin.rcn.com/johncm/images/HvsR.jpg. If you
> kept the low basal rate for 3-4 hours you might then see the glycagon
> caused increase mentioned before.
> I thought Emily needed very low basal rates in the afternoon, but
> after various problems we decided to start from scratch again and re-
> set basal rates to the recommended levels in the pump manual and
> adjusted from there. The basal rate total was quite a bit higher so
> we reduced bolus rates at the same time to balance this. We ended up
> with a similar basal pattern through most of the day though with
> fewer changes in basal rate and less of a difference between the
> highest and lowest rates. The daily basal total increased from 9
> units to 17.5 units. The afternoon basal rates are still the lowest
> during the day but are higher than they were (used to be 0.1 and 0.2
> but are now 0.6) and we are not getting afternoon hypos. Either her
> insulin needs have changed or we were always giving too much bolus
> insulin at lunch time which resulted in an artificially low afternoon
> basal rate.
> Best wishes,
> Jos
> On 10 Apr 2008 at 14:43, Tom Falconer wrote:
> > Is it possible to only be producing insulin for a few hours a day?  I
> > have a very low rate, 0.05, for two hours each afternoon, and still go
> > hypo if I am not careful.
> >
> > Regards,
> >
> > Tom
> >
> > J wrote:
> > > Is there any chance at all that you are still producing some of your
> > > own insulin? It seems amazing that you can be nearly completely
> > > without insulin (as you surely must be after about 3 hours at 0.05
> > > per hour) without seeing an increase in BG. Once insulin levels are
> > > that low there would be no way for glucose to enter your cells, your
> > > body would think it's starving and glucagon is released from the
> > > pancreas to convert glycogen to glucose in the liver.
> > >
> > > The Ragnor Hanas has a good chapter about exercise and type 1
> > > diabetes and it's available on Google books,
> > > http://books.google.co.uk/books?id=2lyIu4_5r4IC&pg=PP1&dq=type+1+diabe
> > > tes+ragnar+hanas&sig=AWgoiNjOxRsK92VmGbqRJLrqll4#PPA246,M1
> > >
> > > or mini link if the above wraps badly,
> > > http://lnk.nu/books.google.co.uk/jqs
> > >
> > > Jos
> > >
> > > On 10 Apr 2008 at 9:09, Fiona Hunt wrote:
> > >
> > >
> > >> Yes, we go walking for maybe 4- 7 hours and it can be quite tough and
> > >>  hilly. I
> > >> was in a blizzard last Sunday - so much for Spring! I use the same
> regime
> > >> when cycling (on road) also. Sometimes I wonder whether zero basal
> would
> > >> be better to save me eating so much but common sense prevails and I
> just
> > >> set the pump to the lowest basal rate of 0.05. As I write this
> though, I
> > >> realise I could set a profile with alternating 0.05 and 0 for each
> half
> > >> hour which would effectively half the basal - I might try that!
> > >>
> > > .
> > .
> >
> >
> >
> > --
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>   > Version: 7.5.519 / Virus Database: 269.22.11/1368 - Release Date:
> 09/04/2008
> 16:20
> .
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