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Re: [IPk] reply to Rhoda - more creaking bits

Hi June,

In message <000c01c51775$632d68e0$email @ redacted>, June Searle
<email @ redacted> writes
>Pat I read you do a dual bolus over 7 hours so your problems sound similar 
>but is this so every day and how do you know if it will be 7 hours or not? 
A dual bolus is a think one can do with more modern pumps (i.e. those
from the past five years or so).  You tell the pump 'so much now' and
'so much over so many hours' (that is, a normal bolus, plus a square
bolus).  The seven hours is when the insulin stops being delivered, not
when it stops working.  My pump (the 508) allows one to do a square or
dual bolus for up to 8 hours.

>I can't do corrections when it's just over 7 as so often the insulin will 
>still be working and there may be some basal there which may also work at a 
>different rate.  
Why can't you do a correction at 7.2?  If you would be happy to see your
bg at 5, or 4.5 at that time, that is.  If your bg _has_ to be 7 at that
time, then, correct to 7 at that time, rather than correcting to 5 (so
for 0.2 over correct bg, you are right, it probably isn't worth the
hassle .. but for a 7.3 when I wanted 7.0, yes, I'd correct.

>You say the results are not reliable in the first 2 hours 
>after meals so how can you correct?  
I have found they do seem to be reliable.  Many people simply avoid
measuring during those two hours, unless they feel hypo/are about to
drive, or feel high.  A 20 an hour after eating needs _some_ treatment,
even if it isn't accurate.

>How is it your bgs don't rise after 
Because the insulin coming into action matches, more or less, the
glucose coming into the blood stream.  I find this much easier in the
evening, when I have slower digestion.  I find this easier to do with
meals (meals, note, not foods) with low GI for me.

>The figures you quote are so beautifully low I envy you and I could 
>correct in the way you do if mine were near that but ....  
I was not quoting my figures!  I am not like this.  But I still correct
in this way.

>As you say, if I 
>were 10 no way would I try to get to 5 or I might miss it and go hypo. 
That sounds as if you haven't got your insulin/exess bg ratios worked
out.  One thing that they often don't mention is that for 12 hrs after
drinking alcohol, a different number is needed - if I took the normal
correction this morning, I'd be hypo - is that what's messing you up?

It sounds as if putting some effort into getting your corrections sorted
would be a great help to you.

Doing this while running, at say, 8 - 11, would give you the confidence
that 'missing' the bottom would disrupt your day.  After correcting,
measure your bgs each half hour.  Find out what the typical pattern for
dropping bgs is, for you - where the bulk of the drop comes.  If you try
this five or six times, you will finds some consistency (I think).  Then
you can see how long after the bolus you should check to see where you
are (e.g. if 10, correcting to 5, you might expect to be at 7 after 90
minutes - if you check and find you are only 9, you need more insulin
(or might want to wait a bit and measure again, if you think it might
just be slow), if you are 5 you need to keep an eye on your bgs as you
could be heading to a hypo.

Hope that helps,

Pat Reynolds
email @ redacted
   "It might look a bit messy now, 
                    but just you come back in 500 years time" 
   (T. Pratchett)
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