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Re: [IPk] Advice please



Hi Mary

The higher basals at mealtimes could be replaced with a more flexible
solution: dual-wave bolus. Because of the way insulin is absorbed into
the body and the way that your food is metabolized it is entirely
possible that you will benefit from more "background" insulin when you
bolus for a meal, but this does not necessarily have to be in the form
of a rate change in your basal profile. I am nervous about changing
basal profiles to accommodate meals because doing so can cause a hypo
if a meal is delayed - which is one of the things pumpers shouldn't
have to worry about so much.

The spikes you are seeing seem high, it's true. But sadly they are
probably pretty not unusual. In recent studies of children using
blinded continuous glucose monitoring devices, it has been shown that
a large percentage with an A1C in the mid-7% range go up as high as 15
mmol/L for at least half an hour after eating, before their bg starts
to drop quickly.
Abstract here: http://www.ncbi.nlm.nih.gov/pubmed/17705686

This situation is why we are advised to test glucose levels 2 hours
post-bolus rather than any sooner: seeing the very high numbers can
cause panic when if we just wait for the insulin to work we'll have a
good result by the time the insulin has finished working. Although
diabetes management has come along tremendously in the past 20 years
especially, the tools we have are still far from perfect, even insulin
analogues.

Melissa
Type 1 15+ years; MiniMed pumper 7.5 years; Animas pumper 4.5 years

 On Thu, Apr 24, 2008 at 8:28 AM, Mary Moody <email @ redacted>
wrote:
> I am still struggling with post-meal spikes. Ate only 20G carbs last night
>  at 5.30 p.m. (BG 6.8) and bolused for it. Went out to work and at 8 p.m. BG
>  was still 10.3. Went down to 7.6 by 10 p.m. This is a regular pattern across
>  the day, but sometimes the spikes are huge. 2 hours after lunch yesterday
>  reached 17.1 and an hour later was down to 6.8. This suggests to me that my
>  bolus is too low and basal too high, however, DSN has told me not to adjust
>  bolus on any account. I am still banned from making any changes and have
>  been told off yet again for having too many basals in (she was responsible
>  for 3 out of the 7 I currently have).
>
>  She has also told me to increase my basals at mealtimes (normal basals in
>  the 0.35 to 0.45 region). Now for 2 hours over mealtimes I run basals of
>  0.65.
>
>  I would just like confirmation that I should put my basals back to a normal
>  rate over mealtimes, increase my bolus, and if BG lowers 3-4 hours after
>  meals which was the pattern before, to cut my basals. She won't like it, but
>  at least it will get rid of the three extra basals she told me to put in.
>
>  Mary Moody
.
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