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RE: [IPk] Re: High bgs 2 hours after meal



Hi Ivan


Unfortunately the UK do not seem to be very fond of diluting insulin.  In other
countries you can still get (or could until recently) insulin of different
strengths.  Its practically impossible to get any insulin of any other strength
here except 100U.  So that means diluting insulin.  I think you may be able to
get dilutent for Humalog, but if one uses Novorapid then the option seems to be
"water for injections" a saline solution.   Most diabetes health care
professionals here in the UK are not really very happy  (as far as I can see)
 about diluting insulin and some are not certain how to go about this without
the
risk of errors.

(Sodium Chloride 0.9% w/v Solution for Injection (PL 01502/0068) to Hameln
Pharmaceuticals Limited  The product is available as a prescription-only
medicine (POM). )


 We have parents with very young children on the UK CWD mailing list and the
 only option for one baby was this method. The baby is now at last on an insulin
pump.

Given that Anna isn't on an extremely tiny daily amount and there are parents
with children on pumps using smaller total daily doses Anna hopefully will be
able to get things right even without diluting the insulin.  Even the parents
 using pumps which cannot give a smaller basal increment than 0.05 units an hour
 have manage and have sometimes have 0.00 basal rates at certain times of the
day
with no problems.  Though obviously its an advantage to be able to have 0.25
increments if you have very low insulin needs.

I do understand about the advantages of being able to use diluted insulin
because very young children take such small amounts but the UK doesnt seem to
encourage this.  In most case an insulin pump will enable someone with very low
needs to manage


Jackie








> Hello Anna,
>
> Just one comment about your low basal rate and high insulin sensitivity:
> Unlike with long lasting insulin injected traditional way, basal rate
> supplied by the pump is non-continuous. Basal rate is basically high set
> of small equally distributed "boluses". My paradigm 722 uses shots of 0.05
> IU of insulin and I suppose it is similar with other pumps. So in your
> case basal rate of 0.30 IU/hour is turned into 6 shots of 0.05 IU every 10
> minutes (you should hear a click coming from your pump anytime this
> happens). My analysis shows that these shots are sometimes too high making
> fluctuation of interstitial glucose level with peaks +/- 1 mmol/l with
> frequency of couple of minutes. This results into poor overall diabetes
> control with measurable highs and lows and higher need of insulin.
> To reduce this fluctuation, you may think about mixing your insulin with
> injection solution (I am sorry this might not be the proper name in
> English) in rate 1:1 or even higher. This is normally done in case of
> small children. It requires a bit of calculation as your basal rate and
> boluses must be set twice higher, but it is not that big price for the
> results it brings. My overall insulin consumption dropped by 40% after I
> started mixing it in rate 1:1. And I also realized that less strong
> insulin is milder to the insertion site.
> I am just in the middle of experiments and analyses, I expect to provide
> better explanation with some graphs and advice on my page in around one
> month time.
>
> Best regards    Ivan
>
> >
> > Thank you Jackie.?
> >
> >  This is really useful. Yes, I do find that when I have better control
> > with
> > consistently lower blood sugars I am more sensitive to insulin. The
> > thought of
> > getting all levels under 7 mmol for a day would be a miracle though,
> > something I
> > have never yet achieved.  I'm already very sensitive to insulin with a
> > correction sensitivity of 6 mmol/L per unit insulin, and find that my
> > blood
> > sugars historically swing from high to low. I am on a low dose of insulin
> > with
> > one basal rate of 0.30 units/hour and a total daily dose of less than 20
> > units.
> > It doesn't take much to go hypo and most days I have at least one.
> > However,
> > following all three breakfasts since on the pump (started Monday) I have
> > had
> > these high blood sugars (as on MDI) which, Like Laura, return to the
> > normal
> > range before the next meal.  I have gone low before the next meal at
> > times, when
> > no active insulin is left, so maybe the basal needs reducing as well.
> >
> >  Thank goodness I am now on the pump and have the opportunity of sorting
> > all
> > this out.
> >
> >  Many thanks for your comments, if you can think of anything, else I will
> > be
> > very grateful.
> >
> > Anna
> .

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