Re: misc. insulin stuff; was: Liver dumps?
- From: Jackie Patti <jpatti@xxxxxxxx>
- Date: Sat, 15 Dec 2007 10:09:17 -0500
that took keeping a written daily log
what an accurate understanding of your basal
provides is the ability to avoid serious hypos
re the log, forget those preprinted dumb logs
that you get (free) when you buy a new b/g meter.
i take high quality 8.5"x11" paper (25% cotton),
cut it in half (8.5x5.5), take 5 sheets and
fold it 3 ways (so it'll fit in my shirt pocket),
attach ball point pens (black and red), abbreviate.
the cotton content helps to avoid ball pen skipping
Yeah, I make my own logs in Excel.
I can get a week's worth of data on a sheet which makes it a lot easier to see what is going on.
I also have my carb and protein ratios, correction ratios, and Sweetart ratios printed right on the top of it as well as my daily meds and supplements.
I have columns for time, temp, bp, preprandial bg, insulin/symlin/sweetart doses, carb/protein/calories, and 1 and 2 hr postprandials. And I have a "notes" column so I can type in whatever random stuff ends up relevant.
I don't do any kind of data analysis really, I find just looking at a week's worth of data at once lets me see what is going on.
going left to right, then down, i can generally
manage to cram 5 days info on one sheet.
red line separates days; b/g #s underlined with red;
insulin amounts preceded by red asterisk
Yeah, I can see how graphing it out would be very useful.
I'm a T2 on MDI, and do take my Lantus in two shots for *some* basal adjustment, but it seems to me that the ability to change basal rates around the clock is a *big* advantage of the pump.
you can do the same thing by adding a few
units of an R insulin
Or possibly Novolog to "adjust" the high basal I need in the mornings; the problem is, if I sleep in, I miss cutting off the bg rise until it's begun a bit.
e.g. if i get up in the morning with a 130 b/g,
i'll take a few units of R coz my 2x of background
insulin is my basal insulin and it is very slightly
under my morning basal needs. if i didn't take
a few units of R insulin, my b/g would slowly climb
to 180/200, and i'd feel poor throughout the
I suspect that's a big difference between us as T1 vs. T2. If I do nothing all morning, I rise to maybe 150-160 or so and then stops rising. Or maybe I have a less efficient liver than you.
I'm just not sure if it's the ability to be very precise about what I do and micromanage the heck out of it is part of the attraction (cause I'm that sort of control-freak) or if I'll really get better control overall.
i don't like bad hypos, so i micromanage
I don't generally have much experience with bad hypos. My most serious hypo incident was a few weeks after I began insulin when the doses they originally gave me suddenly became way too large, presumably because my IR improved. In spite of panic, it was handled easily with glucose gel.
That being said, I have a propensity to micromanage myself anyways, so a pump seems like a kind of kewl toy to me. A geeky "reward" for being on insulin. I wonder if I'd really get better control or just enjoy changing my basal a bazillion times a day. ;)
in my morning experience (after waking,
whether that's 4AM or 11AM) liver dumps
in the several hours after getting up,
are real. but typically if i'm 60 upon
getting up, at worst it'll only go up
to 150/170 4/5 hours later
I see a big difference depending on how long I've slept. If I wake up after 6-7 hours and test, I get good fasting numbers, and if I take my Lantus and Novolog and eat right away, I keep good numbers.
But if I sleep 9 or 10 hours, or postpone breakfast for a couple hours, I have drifted up to 120-150 or so.
So it *seems* as if my evening Lantus shot only works for 8 hours or so,
spoken like a true t2
I chose my words carefully! I said it *seems* to do that. I suspect what is really going on is the Lantus dose that works overnight is insufficient in the morning; enough Lantus to control me in the morning would send me hypo overnight. I on't increase my evening Lantus without testing during sleep as I don't think you can *just* aim the dose at fbg.
I add an extra bit of Novolog to my breakfast bolus to "correct" my higher basal needs cause that's all I can do on MDI.
out of curiosity, how long do you think
your Novolog lasts for?
Novolog starts at about 10 minutes, peaks at 60-90 minutes and is gone in 3 1/2 - 4 hours. Though personally, I don't see a bg difference from 2 hrs postprandial to the next meal's preprandial, so functionally, it *seems* to be done at the 2 hour mark. Again, I'm choosing my words carefully here!
It *is* very different for a T2, both wrt to insulin resistance and wrt to some endogenous insulin production still occuring. I can't make direct comparisons of I took x amount of insulin and y amount of carbs and it had z effect - I have to test for a while and watch what happens over time to figure out what works.
For instance, I'm still gathering data on Symlin, and I cut my bolus in half as they suggest when I began. At first, my postprandials were very wild, nearly unpredictable, but they're starting to settle down now. I suspect whatever my pancreas still does takes some time to adjust to a change.
How so? Higher fat intake keeps your fastings down or raises them?
what you've eaten, yesterday, has an affect
on what your basal needs are today, especially
in the morning
In which direction though?
And are you saying you find this is independent of the bg effect? Like... if I eat and get a high postprandial, but have good numbers at bedtime, that will still effect my basal needs the next day?
I know if I'm high, it can take a while to come back down again, but I haven't noticed if I get my bg back down, that it tends to run high the next day.
But I can look in my data sheets to see if it's there or not as I have piles of the things! A tendency to micromanage can be useful sometimes. ;)
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