Diabetes Talking

Question:

down to 340, but that’s it! The glucose level does not drop to an acceptable level (160-180) until around 10-11:00 a.m. BTW I am not eating or drinking anything during this time either.  My doctor says he

Just an addenda to all the other good advice posted: If you use sites for your pump that were previously very needle-scarred (very likely after your long time IDDM), it slows absorbtion, at least for me. If I use my two childhood favorite overused abdominal sites for a pump site, it will take an extra hour for the humalog to peak.  If I re-set to the side love handles or farther up on my abdomen, it peaks at 1.5 hrs as advertised. That might be a concern for you.  If there is any doubt I would use any "virgin" abdominal sites you have left after 45 years. Of course, others in my pump class went through exactly what you seem to be describing (H acting like R).  If it was me, I would fast for a day or two and chart exactly when my boluses are peaking in the absence of food or exercise. Even if the H is peaking later than expected, you can work with it with proper timing.  And to repeat what others have said, your dawn phenomenon may be masking your insulin action.  Check out the "Pumping Insulin" book for more details. Congrats on making it this long with IDDM.  I hope the pump works out for you, it has been great for me. Dave S.

Response:

Congrats on dealing with diabetes for so long.My daughter {11yr.old] will be going on the pump in july. In preparation she was given an insulin-to-carbo ratio that changes throughout the day and has a scale for high sugar adjustments.Her doctors were very concerned that the whole family understand this well before pump time arrives.Does your doctor have that info for you?You could also call your pump company.We have found Animas very helpful-but hey my daughter is not on it yet.Good luck. Let us know how it goes.

– Hide quoted text — Show quoted text – I have had T1 diabetes for 45 yrs and just recently went on the insulin pump.  Prior to the pump I took NPH and Humalin R. Since I’m on the pump I am on Humalog only. I have a strange problem with the Humalog though. My doctor has told me that Humalog should lower the blood sugar within 10 minutes and peak within the hour.  If my blood glucose is say for instance 350 at 7:00 a.m. and I take 3 units via the pump at 7:00a.m. to lower the glucose level,  my blood glucose does not go down for another 3-4 hours! If I test it, at say 9:00 a.m. it may have went down to 340, but that’s it! The glucose level does not drop to an acceptable level (160-180) until around 10-11:00 a.m. BTW I am not eating or drinking anything during this time either.  My doctor says he has never heard of anything like this. He’s going to have the Lilly rep call me about it. I was just wondering if anyone in this group has had anything like this happen to them?  I’d appreciate any comments. Skye

Response:

It sounds as though you need a tune up with your basil and bolus rates. it is very easy to chase blood glucose with Humalog (or not so easy in your case)..but the pump allows you to be much more pro-active in controlling diabetes. If you are waking up in the 300s your basil rates are too low, not your bolus levels…in addition 3 units will not bring down a glucose of 350 in most people.  The fact that you are not eating anything indicates your basil rates need to be increased. Are you working with a pump trainer…do you know you ISF (insulin sensitivity factor) and your CHO/insulin ratio??? Unless your Lilly rep is a CDE or a pump trainer, I would contact an educator or someone form your pump company (minimed has trainers). good luck! Alissa Heizler, RD, CDN, CDE, CPT Alissa and Jess http://hometown.aol.com/aljaim1/jessepagge.html

Response:

writes I have had T1 diabetes for 45 yrs and just recently went on the insulin pump.  Prior to the pump I took NPH and Humalin R. Since I’m on the pump I am on Humalog only. I have a strange problem with the Humalog though. My doctor has told me that Humalog should lower the blood sugar within 10 minutes and peak within the hour.  If my blood glucose is say for instance 350 at 7:00 a.m. and I take 3 units via the pump at 7:00a.m. to lower the glucose level,  my blood glucose does not go down for another 3-4 hours!  If I test it, at say 9:00 a.m. it may have went down to 340, but that’s it! The glucose level does not drop to an acceptable level (160-180) until around 10-11:00 a.m. BTW I am not eating or drinking anything during this time either.  My doctor says he has never heard of anything like this.

Your doctor must’ve spent a HELL of a lot of time not doing his job then. It’s a VERY common thing for small amounts of insulin NOT to bring down a morning high, particularly if you’ve not eaten anything. I’ve been in this position myself and the ONLY quick way to drop a high was to inject the Humalog (I’d inject around 10-12 units though for a 350) and eat a small (and I do mean SMALL) snack. Going about it this way, I KNOW my sugar will be where it should be in an hour or so. He’s going to have the Lilly rep call me about it.

Who will obviously not put the blame on the insulin, but who might say you need to take a long hard look at both of your insulin requirements. The basal AND the bolus, but look harder at your basal. I was just wondering if anyone in this group has had anything like this happen to them?  I’d appreciate any comments.

Beav

Response:

Happens all the time when your Bg’s are that high. 10 units will barely move the level at all. According to the pump coordinator for that amount of Bg you would need to use 15 units based upon a 1:10 ratio.  That should bring it down to 150-120 with NO food. Lilly won’t have an answer for you call your pump rep. Lurline – Hide quoted text — Show quoted text – I have had T1 diabetes for 45 yrs and just recently went on the insulin pump.  Prior to the pump I took NPH and Humalin R. Since I’m on the pump I am on Humalog only. I have a strange problem with the Humalog though. My doctor has told me that Humalog should lower the blood sugar within 10 minutes and peak within the hour.  If my blood glucose is say for instance 350 at 7:00 a.m. and I take 3 units via the pump at 7:00a.m. to lower the glucose level,  my blood glucose does not go down for another 3-4 hours!  If I test it, at say 9:00 a.m. it may have went down to 340, but that’s it! The glucose level does not drop to an acceptable level (160-180) until around 10-11:00 a.m. BTW I am not eating or drinking anything during this time either.  My doctor says he has never heard of anything like this. He’s going to have the Lilly rep call me about it. I was just wondering if anyone in this group has had anything like this happen to them?  I’d appreciate any comments. Skye

Response:

I am very sensitive to insulin and so do not have this problem.  But, what about your basals?  They can help as well to lower high numbers. Here is a link to the best possible book you could own fro learning how to bolus for high blood sugar, set basals, figure unused boluses, etc.  I use it as if my life depended on it (which it does)and have learned so much about personalizing boluses and basals.  Everyone will be different but this book helps you figure for yourself what it should be for your needs. http://www.insulin-pumpers.org/books.shtml Also, here is a page on the Insulin Pumpers’ site which might be helpful to you.  It is ‘How to measure blood sugar to insulin ratio’. http://www.insulin-pumpers.org/howto/bgi.html While there, you might look over the Insulin Pumpers’ site for all kinds of info about pumping.  Meantime, try to get the book.  You will be glad you did! I have been pumping for a full year now and find it is the best choice I could have made!  I wish success and good health with pumping to you as well. — Joanne Visit My Home Page http://www.geocities.com/Vienna/Strasse/6736/ All About  Insulin Pumps http://www.insulin-pumpers.org

– Hide quoted text — Show quoted text – I have had T1 diabetes for 45 yrs and just recently went on the insulin pump.  Prior to the pump I took NPH and Humalin R. Since I’m on the pump I am on Humalog only. I have a strange problem with the Humalog though. My doctor has told me that Humalog should lower the blood sugar within 10 minutes and peak within the hour.  If my blood glucose is say for instance 350 at 7:00 a.m. and I take 3 units via the pump at 7:00a.m. to lower the glucose level,  my blood glucose does not go down for another 3-4 hours! If I test it, at say 9:00 a.m. it may have went down to 340, but that’s it! The glucose level does not drop to an acceptable level (160-180) until around 10-11:00 a.m. BTW I am not eating or drinking anything during this time either.  My doctor says he has never heard of anything like this. He’s going to have the Lilly rep call me about it. I was just wondering if anyone in this group has had anything like this happen to them?  I’d appreciate any comments. Skye

Response:

– Hide quoted text — Show quoted text -I have had T1 diabetes for 45 yrs and just recently went on the insulin pump.  Prior to the pump I took NPH and Humalin R. Since I’m on the pump I am on Humalog only. I have a strange problem with the Humalog though. My doctor has told me that Humalog should lower the blood sugar within 10 minutes and peak within the hour.  If my blood glucose is say for instance 350 at 7:00 a.m. and I take 3 units via the pump at 7:00a.m. to lower the glucose level,  my blood glucose does not go down for another 3-4 hours!  If I test it, at say 9:00 a.m. it may have went down to 340, but that’s it! The glucose level does not drop to an acceptable level (160-180) until around 10-11:00 a.m. BTW I am not eating or drinking anything during this time either.  My doctor says he has never heard of anything like this. He’s going to have the Lilly rep call me about it. I was just wondering if anyone in this group has had anything like this happen to them?  I’d appreciate any comments. Skye

I do not know what your current sliding scale ratio is; but, I know it would take me more than 3 units to bring me down from a reading of 350, I wonder why your doctor does not suggest a lower ration exmaple a unit for every 50 clicks over 120. Ron Swain www.glucoweb.net

Response:

I have had T1 diabetes for 45 yrs and just recently went on the insulin pump.  Prior to the pump I took NPH and Humalin R. Since I’m on the pump I am on Humalog only. I have a strange problem with the Humalog though. My doctor has told me that Humalog should lower the blood sugar within 10 minutes and peak within the hour.  If my blood glucose is say for instance 350 at 7:00 a.m. and I take 3 units via the pump at 7:00a.m. to lower the glucose level,  my blood glucose does not go down for another 3-4 hours!  If I test it, at say 9:00 a.m. it may have went down to 340, but that’s it! The glucose level does not drop to an acceptable level (160-180) until around 10-11:00 a.m. BTW I am not eating or drinking anything during this time either.  My doctor says he has never heard of anything like this. He’s going to have the Lilly rep call me about it. I was just wondering if anyone in this group has had anything like this happen to them?  I’d appreciate any comments. Skye

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