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Re: [IPk] Advice please

Hi Mary,

We may not be doing it by the book but the only way we have found to avoid
post meal spikes is a combination of pre-bolus of usually 30 minutes and
increased basal effect for the 2 hours after eating (i.e. the hour before
and hour after in reality) followed by a low basal later when a sharp drop
would otherwise occur, i think this is sometimes referred to as a super
bolus. After breakfast she would probably still rise 4 -5 mmol even doing
this. Whilst it would be inconvenient If a meal were missed or delayed, in
fact this occurs quite rarely for Isabella and if it does we use a temp
basal. We can't really do a fasting test very easily for a 4 year old, and
we too find that her basal needs are different when she has or hasn't eaten,
so we set the pattern according to what usually happens and adjust it if it
doesn't. I guess this would be more difficult if we had less of a routine.


2008/4/24 Mary Moody <email @ redacted>:

> 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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