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Re: [IPk] carb counting, basal bolus regimens

In a message dated 10/30/2002 7:14:09 PM GMT Standard Time, 
email @ redacted writes:

> 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. 

Hi Pat, and all,

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. Even the new 
"straight action" insulins won't suit those of us whose basals vary. A 
diabetic can also experience absorption problems, which may be exacerbated by 
injected insulin, so that they need an option which minimises these.  

There is therefore a need for an insulin therapy which can be based on 
tailored basal rates and boluses, together with the capacity to enable a 
pretty accurate ratio between carbohydrate content eaten and units 
(fractions, if possible) of insulin given to be calculated, to be provided - 
the pump can do this. Getting the basal rates right is crucial to good 
control, but these can change so may need to be checked every so often 
especially if you're getting unexpected readings.  They can also change 
significantly between work/non work days, so many of us have tailored 
schedules. With the pump, it's possible to get the dose delivered down to 0.1 
unit per hour or per bolus with Minimed pumps (I believe less with Disetronic 
- would appreciate more info here from users).  With injected insulin you are 
obviously limited to much larger doses. The availability of small doses is 
great if you need little insulin - as a personal example, I usually need a 
fraction between 0.5 and 3 units as a bolus and 0.1 to 0.9 as basal rate, and 
0.1 unit drops my bg by 1 mmol on average - you can imagine how inaccurate my 
pre-pump insulin regime was!  :((

Mary IDDM 30+, coming up to second pump birthday, pump aficianado these days 
after great results...
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