[Previous Months][Date Index][Thread Index][Join - Register][Login]
  [Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IPk] carb counting, basal bolus regimens

Pat wrote:

> > People are 'not much better off than mixtard' if they are told that they
> > _should_ inject so much of the bolus insulin and _should_ eat so many
> > grams CHO (or, worse, should eat 'a healthy diet').  True basal/bolus
> > regimes are trying to get the basal to cover the basal, and boluses to
> > cover only what's eaten.

In the UK and Ireland, very very few medical people use a true basal/bolus 
regime, and from what I've seen on other lists, it's only when people with 
diabetes do the work themselves that they end up with a true basal/bolus 
regime in this part of the world. The four shots a day regime medics 
subscribe to hear may be one of the reasons they're so negative about carb  
counting: as Abigail pointed out, you don't have an insulin/carb ratio if 
you're covering background need with shortacting injections during the day.

Perhaps the Italian regime of NPH+ short-acting at each meal was geared 
toward maintaining four shots a day while allowing people to carb count to 
get better results. Or it could just be that people avoided hypos related to 
long-acting insulin pools on the regime. That's speculation, and I don't 
have the study reference handy - I read about that study in 1998!

Mary responed to Pat:

>This is a key point, thanks Pat for emphasising it.  The majority of IDDMs
>can cope with the activity curves of injected long/moderately long "basal"
>insulins, and also rapidly acting ones.  However, these curves are
>artificial; most of us on this site have bodies which disagree and curves
>which differ significantly, which is why we're pumping.

It is possible to get a 'poor man's pump' out of long-acting insulin by 
injecting the insulin at a time of day that allows you to match the peaks 
and troughs of the insulin to your needs. It takes time, experimentation 
with injection schedules and different insulins, but it is possible for some 
people.  Medics in this part of the world are completely freaked by this 
sort of approach. It is this 'poor man's pump' that the book _Stop the 
Rollercoaster_ teaches. It is much more flexible than the regimes touted 
here and is a true basal bolus regime. That doesn't mean that the four shots 
a day we're given is wrong/bad in itself: it does mean that the four shots a 
day might not allow people as much flexibility.

Mary also wrote:

>Even the new
>"straight action" insulins won't suit those of us whose basals vary.

This is a very important point. It sounds like Lantus is an improvement on 
the four shots a day because of its more even curve, but people will still 
be covering basal need during the day with short acting insulin. So it's not 
a true basal-bolus regime. I haven't studied Lantus in depth, but it sounds 
to me like this is what it does. I will always advocate a basal-bolus regime 
over any other because it offers the most flexibility without pumping.


Grain is the enemy of the sedentary classes.

Surf the Web without missing calls! Get MSN Broadband. 
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml