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RE: [IPk] Pasta and Pizza

Hi Paul - Dietitian here... Yes you will go low after a huge
carbohydrate meal  - this is because the amount of carbohydrate is large
and can only be processed at about 50g at a time by digestion. This
means that if you give a once off bolus you will probably see this low
then large high in your BGL even though you gave yourself the correct
amount of calculated insulin.  Basically my understanding is that your
quick acting humalog (I am assuming the similar for novo rapid) acts
quickly to bring your blood sugar levels down (and with your calculated
insulin this does it too quickly because you have assumed the whole
amount of carbohydrate is digested at once when giving your bolus
insulin. BUT the problems lies with what happens to your sugars
afterwards. 1. your sugar level drops due to too much insulin for the
rate of digesting carbohydrate. Then after you do or don't treat the
hypo / assuming not much rebound hyperglycaemia, the rest of the
carbohydrate is still digesting and making your blood sugar levels rise.
Often leaving not enough insulin around to compensate.... The best way
to treat this type of high carbohydrate/associated high fat meal is to
either give a dual dose of humalog eg: calculate the amout needed using
your carbohydrate to insulin ratio, then give half at the start of your
meal and half after (or 70%/30%) - this should compensate for the dual
wave effect of the digesting carbohydrate. Alternatively with the new
508 mini-med pump you can supposedly do something that is called square
wave which I gather acts like a bolus but gives you enough insulin to
cover the meal - i get the impression it is like giving you a much
higher basal rate for the time of the meal rather than one  huge bolus.
Both techniques should work. It is a good idea and very timely as I am
hoping to study this in more detail in the next few weeks in terms of
what is best for high fat/high carb meals any volunteers please email me
direct. As it would prove very useful and there is no major lab evidence
to prove this except real-life experience. julette:)

> -----Original Message-----
> From:	email @ redacted [SMTP:email @ redacted]
> Sent:	24 February 2000 22:08
> To:	Insulin Pumpers
> Subject:	[IPk] Pasta and Pizza
> Hi there,
> I've jsut recently (three weeks ago) started on a Minimed insulin pump
> trial. Still working out the finer details, but things are looking
> good so
> far. Only three of us in N. Ireland are on it (including the Dr!) so
> feeling
> quite priveleged really. Feeling a lot better and getting better
> results.
> One thing ... when I have a meal mainly of pasta I seem to go low
> shortly
> after the meal, take some extra carbs and then go too high. Is this
> because
> the pasta is slow to be broken down in the body? If so, is it best to
> take a
> square wave bolus? Or maybe bolus half way through / after the meal?
> I've also heard that the dual bolus is also called the "pizza bolus" -
> the
> first intake of insulin for the carbs and then a square wave to sort
> out the
> fat. Has anyone tried this successfully? Should a dual be used for
> pasta
> meals as well? When else would a dual or square wave be used?
> Also I'd be interested to know peoples comments about the silhoette
> set
> compared to the sof set. I'm trying the sil. after some skin irration
> under
> the wings of the sof. I find it more comfortable so far and like the
> smaller
> patch.
> Paul Kennedy
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