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Re: [IPk] happy pumping and the area under the curve

Diana Maynard wrote:
> Well, I got it a bit wrong last night and got home at 11pm to find I
> had a BG of 17! oops.
> See, I'm not perfect :-)

Congratulations nonetheless Di!

Now go a step further and make _all_ your readings available for public
scrutiny... download them to a text file and pop them up once a month on
your website... I know you do good websites, so there's no excuse. It's
a bold step, but once you've done it there's no going back :-)

Mine are all available for inspection and comment at
http://www.webshowcase.net/diabetes. June numbers have not yet been
posted. I think what it shows is that I'm not perfect, but I'm getting
bg's I'm happy with. HbA1c of 5.9% (or 6.4% depending on the scale -
just within "normal"), and no problem with hypos. My highs generally
reflect reckless facing-filling, snacking, drinking and casual bolusing.
But at the end of the day my health is great (bar a slightly raised
blood pressure - 140/90), my overall figures good, and my quality of
life superb.

> I had had a pint of beer and forgotten to bolus for it though, which I
> definitely need to do. Also I seem to find that drinking after eating
> has more of an effect on my Bg (ie it raises it more). I know that's
> weird, but you know me.....

I do indeed know you. Yes, you are weird. But no more so than the rest
of us I suspect.

> By this morning I was back to a nice 5.6 though.

I often find that my morngin bg's are more stable than I should
otherwise deserve.

> What do people think about the whole "area under the curve" scenario?
> Is it better to be high for a short period of time or less high (but
> still high) for a longer period of time. Assuming the area under the
> curve is identical?

Pass. Area under curve, weighted-average, HbA1c... I'm sure it varies
between each of us. And we can't know until it's too late. I believe
DCCT just established a correlation between HbA1c and complications,
rather than a causation. But it's all clouded in the mists of incomplete
data and unknown (and unknowable) facts.

Certainly normal bg's is not the whole story for diabetes and
complications. In the non-diabetic, insulin is made in the pancreas and
50% immediately used up by the liver. The other 50% then enters general
circulation, and is used by the muscles and other organs. For us, we
inject or infuse it directly to general circulation, meaning the liver
gets far less than it usually wants, and the muscles and arteries far
more. That's why exercise can make you rapidly hypo. Horribly complex I
know. This excess of insulin is believed by some to be responsible for
macro-vascular complications, since the insulin also promotes the laying
down of "bad" cholesterol on your arteries. That's why it's also good to
generally keep your cholestrerol low, and also keep your insulin low
(but not at the expense of a high bg).

Disetronic have, I believe, developed a permanentally fixed tube that
goes from the surface of your abdomen to your liver, giving much more
stable control. The problem is that an infected infusion site, such as
we get sometimes, becomes an infected liver in this case. Not nice, and
much work still to be done.

At a tangent, I was at a JDF conference in London at the weekend, and
met some researchers who are developing a hepatic insulin - that is, an
insulin that can only be used by the liver. It's a genetically modified
insulin, with a large piece of "stuff" hanging off the insulin molecule,
even in its monomeric form as it floats round in the blood circulation.
Enlarging the insulin molecule prevents it passing though the muscle
membrane, but allows it to pass into the liver. So, no matter how much
insulin is in your blood, only the liver can use it and not the muscles.
This gives you much more stable control.

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