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Re: [IPk] Bolusing problems

Hi Helen,

I think you are being let down by your nurse: she is giving you
difficult sums which show she is still thinking about old-style carb
counting (when we had to have a number of 'lines' or 'exchanges' at each
meal) and about injections (when we moved in numbers like '1 unit').  On
a pump, the maths is much easier!

While some of us _do_ find that the fat and protein (not to mention
alcohol) which comes along with carbohydrate do have an impact on blood
glucose (both in total rise, and in timing of that rise), I don't think
it necessary to think too much about them at first: they are fine tuning
things, not basics.  Alcohol, on the other hand, is definitely best
avoided until you've got basals sorted and know what your boluses should

I would try not to eat meals which are _too_ different in calorific
balance (e.g. not having fish and chips with mayonnaise one night and
steamed vegetables and rice the next!).  

So ... all you have to worry about is the carbohydrate.  The difference
between 1.0 per 15 and 0.5 per 15g CHO is huge!  Also, I would try and
think of it in terms of 'per 10g CHO', because it is very easy to divide
something by 10 to get your units of insulin, whereas dividing by 15 is
quite difficult.

I would only move by 0.1 or 0.2 units per 10g at a time.

On timing: if you go hypo, that means that the insulin is too early.
Try injecting it later.  If you simply go hypo later, the insulin is
peaking too strongly.  You could either look at cutting down the fat and
protein (which will make your blood glucose peak more strongly), or you
could think about using a dual or square bolus so the insulin is not
peaking so strongly.

As 1.0 units per 15g was too much and 0.5 per 15g is too little, I would
start experimenting at 0.5 units per 10g.  This has the advantage that
the maths is really easy!  Say your meal has got 68g CHO in it.
Dividing by 10 gives you 6.8, and halving it gives you 3.4.

You can print out a little table which gives you the amount of insulin
you need to inject.  I do this for my evening meal, because I need 0.8
per 10g, but of that I need about 2/3 'now', and 1/3 on an extended
bolus.  So once I've counted the cho, I don't work out the maths, but
just look on the chart to see what it tells me to bolus.

Don't worry about the grazing, but do make sure you are weighing things
and know _exactly_ how much CHO you are having.  'A very small piece' of
a dense French bread can have 25g CHO.  'some melon' (especially a sweet
one) could have another 15g CH0, salad leaves would have none.  40g CHO,
if you need 0.5 units per 10g is a 4 unit bolus, not a 0.5 one!  

Best wishes,

(dm 30+, 508 2+)

In message <email @ redacted>, email @ redacted writes
>Thanks for the advice on the first few days of being on the pump. 
>Now on day 5. My basals have been changed and I'm now on 1.7 8am-10pm and 1.4 
>The problems I seem to be having are down to the actual bolusing for carbo 
> intake. The guidelines I was given said to bolus 1 unit per 15g CHO. This
>to make me hypo soon after, so told to drop this to 0.5 units per 15g. 
 > Trouble is, whatever I do seems not to work. I can't seem to get my head
>whole issue right now and am finding this side of it a lot harder than I 
> anticipated! Partly, I think, due to the fact I've learned that not only CHO
>has to
>be counted, but protein and fat content, too. Even using the CHO contents on 
 >packets seems to make things go awry. I either hypo after or shoot sky-high. I
>am hopeless at maths (maths dyslexia)! Seriously, I have a major problem with 
>maths and find it hard to calculate percentages of CHO to bolus, etc. Am I 
 > trying too hard? I don't know. I always unconsciously counted carbs as that
 > the way things were when I was dx 29 yrs ago. But as far as working out how
>protein/fat affects things is beyond me! Another problem is that I don't eat 
>a great deal when stressed and with the break-in and everything I am stressed 
>right now! I tend to graze and eat little and often. 
>For example, I didn't feel like anything early on (I'm not a breakfast person 
>at all) but was peckish at 11am. So, I had a small amount of melon, some 
 > salad leaves, and some french bread...a very small piece. Bolused .5 and was
>hour later! Argh!
>It doesn't make sense! 
>PS, just a question...the pump I'm using 507C seems to click once every 15 
>mins or so...working fine as far as i can tell, no alarms, etc., Should it do 
>this? Has done it since it was set up.
>for HELP or to subscribe/unsubscribe/change list versions,
>contact: HELP@insulin-pumpers.org

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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