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Re: [IPk] Re: Pump Holiday, and an idea

Hi Nanette,

The 'textbook' answer to your basal rates appearing to be different when 
you're fasting could involve your carbohydrate : insulin ratios and levels 
of insulin resistance varying at different hours of the day. Theoretically, 
basal insulin should keep your bg steady, with only marginal fluctuation, 
without correction, for 24 hours if you were not to eat in that period. I 
have found lately that my basal rate from 7 a.m. to noon has to be a lot 
higher than any of my other basals _and_ I need to take 1 u. Humalog for 
every 8g carbs...seems I'm getting more after-waking insulin resistance than 
I used to and my old 1 u. : 13g carbs formula for breakfast is just not 
cutting it. If you find that you risk a hypo when you bolus but your bg goes 
up when you skip breakfast, the textbook answer would be that your basal 
rate is too low and your breakfast bolus effectively (sometimes 
over-)corrects for the too-low basal. On the other hand, it could be that a 
dual (normal + square-wave) bolus would work better with how your body 
metabolizes food and uses insulin than overlaying a normal bolus on top of a 
regular basal rate...you might be going hypo when you bolus because your 
body doesn't deal so well with lot of insulin at once....

[Personal whinge mode ON]
The past week has been one in which I've been torn between wanting to test 
10 times per day and not wanting to know...things have been so weird. Last 
night after dinner (hall food: 2 broccoli and cheese croissants, a mountain 
of Brussels sprouts, and half a piece of bread + butter pudding) I wanted to 
go to the gym. My bg was 8.3 40 minutes after my last bolus (whoo-hoo, I 
thought). So I reduced my basal rate by half because the last time I went to 
the gym and reduced my basal further, my bg went up by a couple of mmol/Ls 
during my workout. Thought I was turning into Bev for a moment! After 15 
minutes on the cross-trainer last night, my bg was 4 (that was fas, I 
thought!). So I put pump on 'suspend', got off the cross-trainer, stretched, 
and did some stomach crunches. Bg was up to 5.4 20 mins. after hitting 
'suspend'. Sorted! Went back to full basal right then. But at 11 by bg was 
11. Took 2 u. Humalog for correction, ate some cinnamon ice cream anyway, 
taking 3 u. Humalog for that. Bg about 10 at 12 a.m. Corrected with 1.2 u., 
expecting a bit of glucose to go back into muscles and didn't want to be 
totally hypo as a result. Woke up with bg of 9.5 at 9.30 a.m. Maybe when I 
woke up at 7 to go to the loo I was hypo and should have tested: perhaps 
that 9.5 was a rebound/Smogyi effect?

No rhymes or reasons I can figure. Just my basals seem suddenly too low for 
no reason I can identify. I don't think it's normal hormonal 
fluctuations--I've been on Dianette for over a year now and my last 'week 
off' it was 2 weeks ago. To have a CGMS right now! But of course my 
'specialist centre' doesn't have one yet. I spoke to Hannah at Medtronic 
about how I might use a CGMS otherwise, and the amount of paperwork/red tape 
means I sure wouldn't have one within a couple of days of asking. Bah!
[Personal whinge mode OFF]

Really should get dressed for work now. At least soap and shampoo will take 
my mind off of hormones and glucose for a little while :[ .

Type 1 10+ years; MiniMed pumper 7+ years; part-time shop assistant at Lush 
9 months
Co-ordinator, Oxford University Student Union Diabetes Network
Oxford area contact, INPUT

----Original Message Follows----
From: Nanette Chana Freedman <email @ redacted>
Reply-To: email @ redacted
To: email @ redacted
Subject: [IPk] Re: Pump Holiday, and an idea
Date: Mon, 24 Nov 2003 10:37:21 +0000 (GMT)


On a slightly different tack, Melissa wrote suggesting the need for
more checking of basal rates by fasting. I have come to despair
somewhat of this method of testing. My basal requirements are almost
never the same when fasting. A prime example is when I eat a late
breakfast (for example if fasting for an early morning blood test), my
blood glucose always, without fail, rises during that fasting time,
unless I agressively up the basal rate by at least 30% - it continues
to rise at least until 11 or 12 o'clock (after that if I continue
fasting, basal requirements decrease until I have to decrease the basal
rate by 30%). If I do eat breakfast as usual at 7.15, and bolus
appropriately, I have to watch carefully that I do not go hypo around
10 or 11 - i.e. after the effect of a 7 am pre-breakfast bolus should
have worn off - so it seems like a difference in basal requirement in
the fasting vs the non-fasting state. This is not a problem for me - I
can make the necessary adjustments, but it has made me very sceptical
indeed about the 'traditional' recommendation for fixing basal rates
according to fasting requirements. Has anyone else found this sort of


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