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Re: Basal rates (was Re: [IPk] low carbs/no carbs)

As others have pointed out, this is one of the areas where there can
be large difference between theory and practice.

For example both Di and I have written in the last 24 hours saying
that we need somewhat lower basals overnight after a day of eating low
carbs than a day of eating moderate carbs. And this may be part of
what accounts for what Joel reports from the Cambridge Artificial
Pancreas project - that most people do not have identical insulin
requirements every night - even though they are not eating anything
whatsoever during the night.

If I don't eat all day (and sometimes I too don't) then I need to
raise my basal for 2-3 hours in the morning (because it is
artificially low then to allow for the superbolus for normal days when
I eat breakfast) and then carry on as normal till early afternoon at
which point I have to lower the basal until I eat to avoid going hypo.

Furthermore the division between basal and bolus is not holy - it's a
useful concept (with a biological basis of course) to help one set up
a reasonable first approximation to a scheme of insulin delivery - but
one must remember that the cells of your body do not know whether
molecules of insulin they are using were injected as bolus or basal -
so it is not evil or being a 'bad diabetic' to have basal rates that
do not keep you in range but you keep in range at least at certain
times of the day, except by also using a too high carb ratio, if that
is what works for you - this is indeed exactly the principle of the
superbolus, recommended by John Walsh and others. It is the only way I
can have reasonable BG's within 1-2 hours after breakfast 90% of the
time instead of 0% of the time.

What all this emphasizes is that there are standard solutions - they
work for some of the people some of the time - if you are one of those
people for whom they work most of the time, that's great, but for the
rest of us, the challenge is to find solutions, often original
solutions not in the book nor in the diabetes course, nor in the
repertoire of the average DSN, that give you better BG's around the
clock. And personally I've received better advice and ideas over the
years from this list than from any book or DSN etc.


On 15 January 2014 15:04, Cathy Taylor <email @ redacted> wrote:
 > If i didn't eat all day (sometimes I don't ) I would stay between say 4 and
 > notwithstanding any other events eg unexpected exercise or illness. So
> not perfect control but good enough for the odd time this happens.
 > Incidentally if your basal rates won't keep you in range then you won't stay
> range even if you do eat, without correction, unless your basal rates are too
> low and your carb ratios too high in compensation ( if this was the case then
> you would see a hypo after a particularly carb high meal)
>> On 15 Jan 2014, at 13:00, "Joel Milner" <email @ redacted> wrote:
>> Cathy wrote:
 > >>>> In theory if your basal rates are set up correctly you should be able to
> go
>> without food all day if you wanted to!
 >> I know this is the theory, but it would be interesting to know how many of
 > > can actually achieve this in reality.? Even using CGM to fine-tune my
> my
 >> levels will still drift around even overnight when I have no IOB and have
 >> eaten for several hours. If I skip lunch and go all day without food,
>  > are I will have to make a small correction or eat a few carbs otherwise my
>> readings will drift out of target range.
 > > At the Diabetes Technology meeting in Manchester in November, somebody from
> the
>> Hovorka group in Cambridge presented data from their Artificial Pancreas
 >> project. Subjects had their overnight basals managed via a closed-loop
 > > using a CGM readout to control basal insulin delivery using a pump
> by
>> a laptop computer. Subjects achieved an amazing overnight stability in blood
 > > glucose levels, pretty much non-D levels! There were two interesting points
> of
 > > note: 1. How many small changes in basal levels the pump was having to
> 2:
>  > How much these levels differed over successive nights for individual
> subjects.
>  > If you bear in mind that the conditions for the study were carefully
> controlled
>> - subjects eating early and going to bed with no bolus IOB - this shows that
>  > basal requirements vary over quite a short time scale and that they can
> differ
>  > substantially from day to day. Maybe this explains why "Think like a
> pancreas"
>> notwithstanding, it can be difficult to maintain really flat BG levels.
>> Joel
>> .
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