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Re: [IPk] Post-Lunch highs



Hi Fiona and Di

Along the lines of increasing the basal, if it is the basal that needs to be 
increased (Fiona, you can check this yourself by delaying lunch by 3 hours 
past your normal lunchtime and testing every 30-45 mins. between when you 
*usually* check your bg before lunch and when you actually sit down to eat 
lunch), perhaps increasing the Lantus isn't the ideal solution but changing 
to Levemir might be.

I would be hesitant about upping the dose of Lantus for a couple of reasons. 
First, doing so might result in slightly better midday bgs but hypos in the 
afternoon and evening. Second, and I can't fathom why I seem to be the only 
person who tells people this, if you look at the graph for the time-action 
profile of Lantus it is very clear that the stuff needs 6 hours from the 
point of injection to reach full operating strength. The 'observation 
period' shown on the graph ends at 24 hours with the insulin still working 
full strength. Thus we may conclude that the way to represent the ideal 
nature of Lantus' basal coverage in a line drawing might be:
/IIIIIIIIIIIXIIIIIIIIIIIXIIIIIIIIIIII &etc. D'you notice the X represents a 
period of time when one dose is wearing off and the next one is just getting 
up its strength? That period of time is supposed to be of little consequence 
to the average person with type 1, but what if, for YOU, even if you were to 
up the dose, Lantus lasts 18 hours?

If Lantus does not last a full 24 hours (or more) for YOU, your line drawing 
might look like this:
/IIIIIIIIIVIIIIIIIIIVIIIIIIIII with the Vs representing periods of time when 
you have little to no active basal insulin on board because you have 
metabolised all the Lantus already. If the insulin is effectively wearing 
off 20 hours after injection but you take it every 24 hours, you've got a 
few hours of insufficient basal insulin to contend with.

Does that help, or does it even make sense?

I'd be more willing to try Levemir than to up the Lantus if it is indeed the 
basal that needs adjusting. The other good thing about Levemir, imho, is 
that if you need a larger dose to meet your daytime needs and a smaller dose 
for night time, you can have it that way because Levemir is optimized for 2x 
daily injection. [I really don't work for Novo Nordisk!!!! I even use 
Humalog in my pump, honest]

As for correction dose: you can check out a way to figure your insulin 
sensitivity factor (aka correction factor) at 
http://www.insulin-pumpers.org/howto/bgi.html

Melissa
Type 1 12+ years; MiniMed pumper 7.5 years; Animas pumper 2 years 1 month

----Original Message Follows----
From: Diana Maynard <email @ redacted>
Reply-To: email @ redacted
To: email @ redacted
Subject: Re: [IPk] Post-Lunch highs

Hi Fiona
It might be that you need more Lantus in the morning to cover the afternoon 
highs. I mean, it might not be the bolus for lunch that is causing the 
highs, but a lack of basal insulin.
If you don't eat lunch, or you eat lunch late, does your BG go up?
If so then you have your answer.

I've always had problems keeping my post-lunch BG in control when I'm at 
work and sat down at a desk all afternoon. I do find that a short walk 
immediately after lunch helps in that respect, though it may not be feasible 
for you.

Another alternative might be to eat less carbs at lunch and then have a 
snack before you exercise....
Good luck, I know how frustrating it is trying to get it right!
Di

email @ redacted wrote:

 > Hi everyone. I joined the mailing list a couple of weeks ago and although 
not
a
 > pumper, have found your comments and tips very interesting  Ive learnt 
lots
of
>stuff that my diabetes team have never mentioned!
>  I am desperately trying to sort out my control on MDI (Novorapid/Lantus)
>regime. A ratio of 20g CHO to 1unit of insulin seems to work pretty well 
>for
 > breakfast and evening meal (using a correction dose of 1 unit for 4 
mmols/l
when
 > necessary). However at lunchtime even using at least twice this (10g to 1
unit)
>results in a very high BG in the afternoon (16 or higher is typical, 2 
>hours
 > after lunch). Any suggestions as to why this should be and what 
correction
dose
>I should use? I often exercise in the late afternoon after work and want to
>avoid a hypo before dinner.
 > I think if I can get these highs sorted this would really improve my 
overall
BG
 > averages and SD. I have a meeting with my care team on Feb 15 and want to
show
>that Ive tried my best on MDI. One of the things they wanted me to do was 
>to
 > avod hypos but by tightening my control Im averaging about 1 hypo per 
day.
I'd
>like to sort out the post-lunch high though. Thanks for any suggestions.
>.
.
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