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[IPk] Re: High sugars in early morning and after set change


in response to your problems, both of which I have experienced since 
beginning pumping four months ago -

The 13.6 BG value may have followed a night of high blood sugars, suggesting 
that either your basal rate needs to be higher during the night, or you may 
be eating too late and not giving a large enough bolus - (the latter I often 
used to do under MDI for fear of going hypo while asleep).

It really is worth testing on the hour through the night to see how your BG 
varies.  One of the leading pump-friendly dietitians in Bournemouth has 
written that a diabetic should not eat when there BG value is higher then 10 
mmol.  While this was impractical (and often impossible for me under MDI!!)I 
am finding that advice to be very good in stabilising my sugars, even though 
I become quite hungry at times.  Di is right - a high BG can be hard to 
bring down, and the bolus/correction method method will not work as 
scientifically as when you are calculating from a lower BG.

Are you using Humalog?? I find that the Humalog peaks in my body between 2 
and 4 hours, particularly in the fourth hour, when my blood sugar will 
return to pre-meal levels.  In this respect any testing within two hours of 
a substantial carbohydrate intake is not very useful to me.  The hospital 
agrees with this.

Other points to consider:

- insulin resistance (dawn phenomenon)can be highest when you are eating 
breakfast, so more insulin may be required.

- your carbohydrate/insulin level appears relatively low - perhaps you need 
more insulin to cover the cereals.

- I find Bran Flakes cereal raise my BG's considerably - certainly more than 
the figures you have given.  A different carbohydrate type or less of it may 

Regards set changing - I have found it stabilising to leave my old cannula 
in for four hours or so to prevent leakages, PROVIDING it is not irritating 
the skin, which it can with me after three days.  It is sound advice to 
change the set during the day, in order to allow monitoring of any change in 
BG.  I now bolus 1 unit through my Disetronic pump - 0.5 units more than 
recommended but I firmly believe it needs a little 'kick' into gear.  Also 
bear in mind the air bubbles in the cartridges if you use these.

Hope this helps.


(IDDM 10 years, Disetronic pumper since Feb 2002)


Subject: [IPk] High sugars in early morning and after set change

I finally started on a pump two weeks ago, and am currently in the
of trying to get Basal rates stabilised.  I have noticed two things
both affect me during mornings.

Firstly, my BMs shoot up when I get up/after breakfast (I haven't yet
determined what happens if I don't eat breakfast).  One morning I tried
testing regularly to see what happens and these were my results (My
BM at present is 10):
06:30	13.6
06:40  Breakfast (Bran flakes + semi-skimmed milk) 75g CHO, 5.0 unit
07:00	16.3
07:20	19.5
07:45	16.1
08:30	17.3
09:30	15.2
I wouldn't expect a meal like that to induce such a rapid rise in BM,
but it
is completely repeatable day after day.  Has anyone else had a similar

Secondly after a set change (9mm/43" Quickset) my sugars always go a lot
higher during that morning and will usually require a couple of
Boluses to get back into normal range.  I am confident that I am doing
set change correctly, priming the set, and giving a 0.5 unit prime bolus
fill the cannula after insertion.  Again has anyone seen anything
and have any constructive ideas?

The good news is that I have been fully funded for both Pump and
consumables.  This was all done for me by the Pump Clinic at Guy's, who
contacted my health authority (Sth Essex) and arranged funding.  This
all done before I could see Dr. Pickup for the first time (Which
back in January). I had initially been referred at about this time last
year.  Since January, Guy's have tried tweaking a few things with MDI
using a Glucowatch and Minimed CGMS to look in detail at what goes on,
before coming to conclusion that a pump would be appropriate.  This
was then made in May, which meant a new financial year and therefore
re-applying for funding.  Fortunately this came through fairly quickly
and I
started on Saline on 9 July, and on Insulin on 15 July.

	Colin - MM 508 2 weeks.

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