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[IPk] injections for correction and Bernstein

John (Neale),

> Richard - if you want fast absorbtion, I'm told an intravenous injection -
> into the vein on your arm say - is about as fast as you can get.

Sounds interesting, I'll let you try it first, though :-)

> I'm not surprised that Berstein suggests muscle for fast absorbtion... he
> recommends no injection of long acting insulin more than 7 units. So a
> bedtime injection of 20 units should be broken into 3: 7, 7 and 6. This
> guarantees a more regular absorbtion.

Indeed he does, and for any insulin not just for long-acting. I found this
to be one of the most useful pieces of advice in the whole book actually. It
noticeably decreased the number of inexplicable swings in blood sugar I
experienced from one day to the next when I started splitting up my larger
doses (when I was on MDI).

The other most useful piece of advice (sorry, I AM a Bernstein fan, his book
gave me more insight into diabetes than other single source before or since)
was to lower the amount of carbohydrate you take at one go, and so lower the
amount of insulin you take to cater for it which then means that your margin
of error in matching insulin to carbohydrate is smaller. I don't go as low
in carbs as he recommends though. But this advice is just as relevant to
pumping as to MDI: say you're pretty damn good at estimating/measuring carbs
on your plate (and I'm going to ignore glycemic indexes for simplicity) and
you always get within 5% of the actual number of carbs. For breakfast one
day you have just cereal and estimate 30g CHO. Using your e.g. 1:10 carb
ratio you bolus 3.0 units. The maximum your BS could differ mfrom the norm
at the end is by the rise/fall in BS caused by 1.5g of CHO (lets assume this
is 0.3 mmol/l). This means that your BS would be in a range of 0.6 mmol/l,
lets say 4.9 - 5.5 mmol/l. This sounds pretty good. Next day you decide you
need some extra sustenance at breakfast, and have a fry-up with sausage and
baked beans and several rounds of bread followed by a jam doughnut, and this
comes to 300g CHO. You accordingly bolus 30 units. Now, your 300g estimate
could be 15g CHO out, which equates to (using same ratio as before) a 3
mmol/l uncertainty in your resulting BS level, i.e. your BS level will end
up anywhere in the range 2.2 - 8.2 mmol/l. This isn't so good!

Well I'm just off for my jam doughnut now.... what the heck :-)

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