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Re: [IPk] carb counting, basal bolus regimens

In message <email @ redacted>, Elizabeth OShea
<email @ redacted> writes
>>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.

As far as I can make out, Lantus is a Good Thing for some people because
it has a fairly flat curve.  But so does Ultralente, and that's been
around for decades.  

No, the important thing about Lantus is the predictability of its onset
and curve.  It's easy to forget, after a few months on the pump, just
how unpredictable long and medium acting insulins were.  Personally, I
found that Insultard was the worst - with a peak that could be 2 hrs
earlier or later than.   So even if the basal need is for a steep curve,
covering the need up to the bottom of the curve with Lantus, and the
rest of the curve with Humalog or another short-acting seems to be a
great step forwards.  The problem comes for those with dawn effect, who
must take additional short-acting in the early morning (to prevent the
high), or with breakfast (to bring it down).  Doctors, of course, will
just see the morning high, and suggest another unit or two of Lantus
until it's within range - never, of course, to happen - the rebound from
the hypos during the night will ensure that!

Best wishes

(dm 30, 508 1+, now able to tell 'fast' sites from 'slow' ones - a
difference in humalog peak of mere minutes!)
Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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