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

Hello Jackie,

It is the same here in Czech Republic. The only insulins available are
with 100 IU.

This is the general problem with doctors and people from pharmaceutical
industry. They are very conservative and studied some universities we did
not. And many of them think that they know everything much better than us
I found several small software errors in my Paradigm 722 and reported them
to Medtronic helpdesk in US together with some technical questions. They
rearly replied them and treated me like an idiot. So I gave up and created
my web page.
I asked my doctor about possibility to dilute insulin. The reply was: I do
not see any reason. So I went to the pharmacy and asked a question: Do you
have something to dilute the insulin? And I got 250 ml of dilution for
intravenous infusion that I use (for less than one pound).

On one hand, I understand they do want to do things standard way as they
can be held liable if something goes wrong. On the other hand I live in my
body and I feel what makes me good and what not. And when I analyse my CGM
data and see something wrong, I try to find the reason and the solution.

If I cannot get help from official sources and I am convinced that it is a
right thing, I do it on my own risk. (It is my health, doctors are here to
help me to keep it. But keeping it is my responsibility). It is a game
that makes me sometimes tired. But time to time I get comments from my
doctor like: Wow, your HbA1c is lower than it was last time, keep it up...
And that is enough satisfaction for me.

Best regards   Ivan
> 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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