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Re: [IPk] Carb boluses and post meal levels HELP NEEDED



Jackie this may be irrelevant but I found that insulatard was very
unreliable. I was stunned pumping first ,that numbers were way more
predictable. But as absorption is notoriously unreliable might it not be
that, that is the varying factor. Kids are notoriously unreliable too and
the team poopoohed me when I expected that the same meal etc would end up
with the same numbers. Also I  find the gluten free bit makes quite a
difference in picture . Might it not be the dietician has limited experience
of that rather than you and Carbs. Sure the meter could be out by 2-3mmols
on a bad day. Muggins here would challenge them to test me rather than take
that rubbish. You have enough to be negotiating.
Sorry, cross tone cos I feel frustrated with their nonsense... so you must
be at hair pulling stage!
Mir
----- Original Message -----
From: "Jackie Jacombs" <email @ redacted>
To: "Insulin Pump List" <email @ redacted>
Sent: 23 February 2005 15:37
Subject: [IPk] Carb boluses and post meal levels HELP NEEDED


> After having the CGMS we and the other parents doing carb counting
education
> classes are keeping food diaries and checking post meal levels 2 hours
after
> meals to work out the insulin to carb ratio.  This is part of the review
> before we can have a pump.  Other parents are using Lantus.  We use NPH in
a
> split dose 12 hours apart. Tried Lantus last and had the worse results
> ever!!  Prolonged highs, sudden lows and Insulin action running out!
>
>
> Getting a bit depressed here because prior to the CGMS we seemed to have
> better and more stable levels.  We are still getting huge post breakfast
> peaks 2 hours after meals when we check especially breakfast.  The only
time
> we don't get huge peaks is if the blood sugar level before breakfast is
low
> from 3.8 to 4.5 mmol but then we also risk low BGL towards 12.15
lunchtime.
> If Sasha's BG is higher then the Novorapid doesn't work fast enough with
the
> meal digestion, even if we add extra units of NR.  Sasha cant have stuff
> like Weetabix, Shredded Wheat of a lower glycaemic value because of
coeliac.
> She has no sugar or even  sweeteners on cereals and we do give GF brown
> grain bread, but this is still not like giving wholemeal ordinary bread.
I
> feel under pressure all the time because this seems to be what the Glos
DSN
> interpreted as not being able to carb count properly.  I did suggest
giving
> the NR prior to the meal but the dieticians and another DSN didn't seem to
> think that this was a good idea.   Sasha has a breakfast very similar each
> day of about 60 grams of carb.  If her BG is low to normal we give about 5
> units.  If she is higher we increase to 6.5 units.  However if she's
higher,
> its often been higher for a long time and then she has increased insulin
> resistance.
> So we usually give one unit to about 12 grams  when Sasha wakes with
normal
> levels.  Of course we don't know how long she has had raised levels.  One
> night the CGMS showed elevated levels all night and another night the same
> morning level but the levels had only been raised for a short time. Which
> surely makes a difference to the insulin sensitivity?!?
>
>
> Does anyone else have a child who weight roughly 31 -32 kilos and if so
what
> ratio of insulin to carb do they use in the morning? How much do you have
to
> vary the dose if the morning blood glucose target range is out?
>
> Now we come to the evening meal Tuesday night we had roughly the same BGLs
> before the evening meal as we did on Monday night.  The twins had homemade
> Leek and Potato Soup which I carb counted the ingredients for and worked
out
> the carb count as 20 carbs per bowlful. Terry checked with me.  Sasha also
> had half a small GF baguette which we also weighed and calculated.  So the
> carb count for the evening meal was the same both days and the starting
BGL
> similar.  On Monday night we had great levels two hours after the meal.
6.2
> mmols and the bedtime level at 11.30 was a bit on the low side and then
> continued to be low through the night and we had to feed her.  Tuesday
> evening exactly the same meal again and same insulin but 2 hours late this
> time Sasha was 9 mmol and by 9.15 she was saying she felt dizzy (which
could
> be high or low) and she was 18 mmol!!!!
>
> I don't understand how the same insulin and meal can give such vastly
> different results (same exercise or rather, lack of it, both evenings)
and
> I fear that instead of looking at the results and thinking "this is why
this
> child needs a pump" that the Glos DSNs will say we aren't carb counting
> properly!!!
>
> We also found that when we get the insulin to carb ratio correct, to get
the
> evening post meal levels under 8 mmol then Sasha is then lowish by 11.30
pm
> and for several nights we have had to give milk or lucozade at 11.30pm
2.30
> am and 7.15 am.  So we concluded that we couldn't go on like this and
> reduced the overnight basal insulin which is Insulatard.  Now this effects
> the morning BGL and we are getting worse levels again in the morning until
> lunch time.
>
> Do any of you give the Novorapid or Humalog 10 minutes before Breakfast??
>
>
> Any suggestions welcome for getting better results post meal.
>
>
> Jackie
> Mum of Sasha aged 10 dx 1999, twin sister Rebecca, both coeliac 2001
> Mum also to Danni and Nicola, wife to Terry
> .
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