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[IPk] carb counting, basal bolus regimens

I think a major issue here is that many people who are on what is known as "
basal bolus" are infact effectively not much better off than mixtard as they
just have the total dose split into 4 and their basal ie intermediate/ long
insulin only constitutes about one quarter of the dose. So it would not be
possible to work out how much of the premeal quick acting is substituting the
deficit in basal insulin as the previous nights NPH/ lente etc is running out/
and how much is actually for the carbs they eat. I believe that particularly
with short acting analogues BG can rise with the evening meal which means that
flexibility re eating later means sacrificing control. Elizabeth mentioned an
Italian article where NPH/ lispro were mixed with each meal
Before the pump my overnigh NPH was 12- 16 units. prebreakfast humalog was
about 6-. luch usually 4-6 and evening anything from 6 to 12. I was trying to
keep carb reasonably constant although was only guestimating.
Often BG would be 12  before evening meal and still high before bed.Sometimes
Sometimes however it would be within range at a much lower dose of humalog,
and I couldn't find a particular pattern with shifts. If I had not started
pumping I would have definitely commenced myself on 2 basal injections
although NHP absorption was so variable, I was trrified of more hypos and I
suspect would have got very little advice from clinic .( trying desparately to
be "compliant " at this stage and keep doses the same but this would have had
to have changed, whatever regimen)
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