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Re: [IPk] Re: Matching bolus to food is difficult

In a message dated 12/13/2002 10:40:40 AM GMT Standard Time, 
email @ redacted writes:

> In the end I increased the bolus by 0.5 units every 2 days 
> until I got it right.  She now has her bolus 5 minutes before she eats her 
> breakfast and she needs 4.5 units for the 2 slices of toast.  At lunchtime 
> she eats much more than that and only needs 2.5 to 3.0 units for a perfect 
> result.

Have been catching up with the backlog, but this seemed the best bit in the 
discussion for a reply.

I don't disagree that bread can cause problems (although I don't seem to have 
any trouble, as long as I allow for the different carb contents).  But I 
think that the issue of different ratios for insulin bolus for food at 
different times of day (as opposed to different basal rates - although this 
is probably relative) is one that should be considered when there are 
problems, as well as in general pump practice.

Have others experienced sudden, substantial, long-term changes in basal and 
bolus insulin requirements for no apparent reason?  This happened to me 
pre-pump, but I thought it was related to factors such as site absorption.  
My requirements used to "reset" once a year or so and caused a lot of hassle! 
 I've just had the same experience with the pump. It's true that I've been 
under some stress at work, but that's been a regular feature of my working 
life for 20 years.  Otherwise, nothing has changed.  Suddenly my basals have 
totally altered (right in the middle of an important time, as chance would 
have it), I need far less at night (lots of hypos, but at least not at work) 
and a bit more during the morning (I can still think with a bg of 20+, but 
not the best time for decision making...).  (Fortunately a colleague with 
whom I work closely is always dashing to the loo in the middle of meetings - 
not diabetic! - I paid visits at the same time, so no disruption caused :-) ).

I'd appreciate thoughts/advice.

IDDM 30 yrs+, 508 2+
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