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Re: [IPk] Carbohydrate Counting

I have thought of some possibilities (only possibilities--the likelihood is 
that only one or two of the below will actually be true for Danielle right 
now) regarding Danielle's pattern of going low soon after lunchtime.

1) Her basal rate is too high around lunchtime. Even if she's on very little 
insulin, it might be that she needs to keep what she's on between like 6 
a.m. and noon just as it is, but perhaps she needs .1/hr less from 1 p.m. to 
dinner time.

2) Her carb:insulin ratio is different for lunch than it is for breakfast 
and/or dinner. Maybe she might need something like 12g carb : 1u. insulin at 
7 a.m., but her ratio could be 9g carb : 1u. insulin a few hours later. 
Personally, I have to bolus extra if I eat breakfast 'cos my dawn phenomenon 
is still on, even though my bg would be great if I didn't eat until lunch.

3) When Humalog came out in the US, the American Diabetes Association 
published an article in its magazine _Diabetes Forecast_ pretty much 
advocating that people should seriously consider taking their Humalog after 
a meal, so that it couldn't start working before the carbs were present in 
the body. Perhaps bolusing 15-20 minutes after a meal would be better for 
Danielle. For myself, I don't bolus in anticipation of food unless it's a 
correction bolus plus a couple of units for food I'm staring at already; if 
I eat more carbs during the meal, I bolus extra when I'm done or in the 
middle of the meal--whatever seems appropriate.

4) Fibre should not to be counted in total carbohydrate amounts because it 
can't be broken down by the body. If an apple has 15g total carb but 3g 
fibre, it should be treated as 12g carb, just as high-fibre bread needs to 
be counted minus the amount of fibre. Is total carb minus fibre what you 
meant by 'total' carbs?

Good luck,

IDDM 10 years; MiniMed pumper 6.5 years
Co-ordinator, Oxford University Student Union Diabetes Network

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