[Previous Months][Date Index][Thread Index][Join - Register][Login]   Help@Insulin-Pumpers.org
  [Message Prev][Message Next][Thread Prev][Thread Next]   for subscribe/unsubscribe assistance

[IPk] Long one: glucagon, exercise, hypos and pumps

Hi y'all (putting on my American hat for a moment--but just a moment),

In the US it seems to be standard or at least general practice to tell 
people that glucagon needs to be intramuscular--the only instructions 
enclosed in any US-issue glucagon kit I had (though never used; I've never 
had a severe enough hypo, touch wood) indicated that it needed to go in a 
large muscle. Sorry for my 
one-track-greatest-nation-in-the-world-mindedness. I do think it's awful to 
have had so many experiences with glucagon that one has a preference 
regarding its administration...[idealist mode ON] would that we lived in a 
world in which no one ever needed it....[idealist mode OFF].

Re hypos and exercise, the nit-pickiest advice I can give is:

A) test about 30 mins. before, every 30 mins. during (if you aren't sure 
what's happening, but many of us will, in time, figure out at what sort of 
rate our bgs will do what things under certain conditions and be fine for an 
hour or even longer between tests), and about 15 mins. post-exercise. Make 
sure bg is at about 10 pre-workout if you don't know what's going to happen 
when you get exercising. [NB. As a list, we have had a few go-rounds on 
whether that advice is bulletproof. We seemed to conclude that it isn't. If 
you know your bg will do something particular, you should get it to the 
level that works best for you, which is another good ol' 'YMMV; no, this 
advice is not universal; yes, we are all individuals' point...have I now dug 
myself out of the hole I just made?]

B) test 6 to 10 hours after exercise (try testing at various intervals for a 
while until you get a sense for when it's most crucial; each of us will 
figure out at what point we will likely have a delayed hypo, if we have one, 
which many of us will). I am lucky to get a psychological charge out of 
exercising between 4 and 6 p.m. as I nearly always go low 7-9 hours later 
(sometimes even spot-on 8 hours later), which is roughly when I have just 
gone to sleep. I leave my bg a bit high (c. 10-12), when I go to bed (at 
about midnight) and tend to wake up (at 7.30 to 8 a.m.) between 3 and 5 if 
I've had a good session at the gym any given afternoon.

The explanation I have been given for that delayed hypo phenomenon is 
'glucose going back into muscles'. Makes some sense to me, so I have not 
researched it. Much like I can't be bothered with which enzymes do what in 
the digestive process, sometimes I deal with the causes and effects of 
bodily processes rather than with their mechanics. If anyone has a better 
explanation for 'glucose going back into muscles' several hours 
post-workout, bring it on!!!

Moving on: yes, of course, a pump could be just the thing for Sasha. The 
only point I wanted to make by saying that one can still get a severe hypo 
on a pump is that a pump does not--cannot--actively prevent hypos by 
releasing sugar or reducing insulin of its own accord. The user or the 
user's carers must be aware of the combinations of exercise, carbs and 
insulin and must make adjustments. Whether a lower temporary basal rate is 
necessary once on a random day (which we might call a one-off) or three 
times in four days (which we might call a pattern), the pump doesn't know, 
but action must be taken by someone or a hypo is the most likely outcome.

If I see that my bg reaches 2.0 and I have a fit because I've set a basal 
rate of 2u per hour when I might need 1.2u/hr (or whatever, this is my 
hypothetical scenario and I am making it up), my pump could, by some people, 
be considered the cause of the hypo (remember the poor guy who died of a 
hypo on a pump back in 19-early-80-something, and how that one BMJ author 
whom we all decided was an idiot concluded *last year* that the pump could 
be deadly?). However, anyone who has a pump would say, "No, that's not 
necessarily the pump's fault, as such, that's probably what computer people 
call a 'user error'".

We spot a big problem with intermediate and long-acting insulins and see the 
benefits of variable basal rates when we meet people like our beloved Pat 
Reynolds (sorry to pick on you again, Pat!), who have strikingly different 
basal rates morning v. afternoon. If Pat kept her basal the same at teatime 
as she has it just after breakfast, she would get badly low in the 
afternoons, as she used to on injections. Yet these days Pat can set her 
basal rates however she chooses; if she went low every day because of a 
too-high basal rate, the pump itself clearly wouldn't have prevented that 

User errors abound: I probably make at least one every day--but I tend to 
catch it, correct it, and try to make a new one the next time. With 
isophane, one might fiddle with the dosage a whole lot and still get weird 
bgs because the insulin works funny (now how's *that* for scientific 
language?! ;> ). And yep, some people respond more predictably to Humalog 
and others to Novorapid--for the sake of all that is holy, use what works 
for you. Lest I forget, we must also detect if we have different 
carbohydrate:insulin ratios at different times of day and remember to take 
those into account. (Have I covered enough bases? Hope so, 'cause it's about 
time for bed).

No one ever said diabetes management was easy or straightforward, which is a 
good thing or I'd have to call him/her a liar and locate a BIG stick!

Hoping not to have stepped in it yet again,

IDDM 10 years; MiniMed pumper 7 years
Co-ordinator, Oxford University Student Union Diabetes Network

Get Hotmail on your mobile phone http://www.msn.co.uk/msnmobile
for HELP or to subscribe/unsubscribe, contact: