Re: insulin - Barb

[Guest guest]

Barb, I posted the following 2 months ago, now with a few amendments.

Maybe there is something you will find usefull. If any questions, please mail

me.

My therapy:

ICT, i.e. Intensive Conventional Insulin Therapy, which is the same

for pumpers in CSII, i.e. Continuous Subcutaneous Insulin Infusion.

Its my impression that any DM type-1/type-2, not only those of us,

who are insulin dependent, would benefit from these principles and

techniques (a.o. evaluating carbs) with better BG-control with only

minor restrictions and a higher quality of life. It has a price though:

Lots of learning, training, training and BG-tests, documentation (diery).

Its also my impression that many of us here who are in more

”extensive” therapy a. o. with diets, in-between meals and

fix-combination insulins could benefit from ICT to the same

extent as well.

The aim of ICT/CSII is to get a BG-profile as close to normal as

possible to be able to live as good as, and possibly as long as

any non-diabetic.

To do this, we, who are / have become insulin dependent,

must remember that our Pancreas is now situated in another place:

In our brain.

My ICT:

I test BG 4-8 times/day, depending on, how I do, and what I am

planning to do. MediSense Pen Sensor (and just to please me:

Pricision-Link hard- and software to keep record on the PC.)

I use 2 pens, NovoPen3 (3 ml ~ 300 IE, 100 U)

Target BG fasting (~4 hours after the last meal): 100-120 mg/dl (~5,5-6,6

mmol/l)

Corrections: +/- 1 IE per 40 mg/dl (~2,2 mmol/l) from target daytime,

and +/- 1 IE per 80 mg/dl (~4,4 mmol/l) from target during the night.

One rule: Only go to sleep at night with BG readings of minimum 120 mg/dl

(~6,6 mmol/l) to minimize the risks of going hypo asleep around 2-3 am, where

insulin resistance is at it lowest(~insulin sensitivity is at its highest).

Basic insulin (prolongued acting) at bedside, to cover my fasting needs:

7 a.m. test and injection of Protaphan HM NovoNordisk 10 IE and again

at 11 p.m. test and injection of 2 IE,

~ Basic-I : 10 - 0 - 0 - 2

Normal insulin to cover my meals: Actrapid HM, NovoNordisk. Before

every meal I test BG, evaluate the carbs I'm going to eat. The carbs

are evaluated as " CarbUnits " (CU). 1 CU ~10 - 12 g carbohydrates ~ 1 IU

normal insulin.

So " converted " into IUs, I multiply the CUs to be eaten with a certain,

individually set factor depending on time of day (as insulin resistance

varies over a 24-hour period), and inject the needed amount of normal

insulin before eating.

~ Factors at present: breakfast – lunch – dinner,

IUs x 1,25 - IUs x 1,0 - IUs x 2,0

Carbs:

It has been shown that roughly only the following carbs have a

significant impact on BG, hence to be accounted for in the ICT/CSII

in terms of insulin units to be taken at meals:

Sugar, fruit, pure fruit-juice, milk any fat%, yoghurt, potatoes,

rice, pasta any kind, and bread any kind.

Roughly what fits into a hollowed palm (or corresponding spoon)

is approx. 1 CU. Especially to begin with you have to weigh a lot

to train your eyes to evaluate, what’s 1 CU.

Of course the glycaemic index (GI) of the carbs play a role in the speed

by which BG will rise, and so may be used to ”fine-tune” BG-profile.

The index is of minor practical value though, and its changing dramatically,

for instance of " mashed potatoes " , ready to cook powder/flakes. In that form,

the starch of the original potatoe is already split into minor chains of

glucose,

hence this form of of potatoes cooked, is turned into glucose very quickly

and cause rapid rise of BG-readings, almost as quick as after ingestion

of grape sugar.

One of the major difficulties of evaluating carbs in ready-to-cook products

are due to the possible changes of GI due to the " pre-fabrication " of

the original vegetable etc. Besides that, often the information on

the packs is not correct or easy to judge.

A rule of thumb, which I learned, was that you are pretty well off

just taking the first 3 mentioned carbs on the declaration into consideration,

as any later mentioned mostly will be of only little significance in your

counting.

It may look at bit confusing at first hand, but in fact its manageable and you

can learn it, though pizza and lasagne for instance may be difficult to

evaluate right on carb content. Mostly there are more carbs in these meals,

as one thinks.

So in ICT there are only few restrictions and NO DIET, unless

necessary for calory-reasons, no in-between meals needed.

I was recommended to take my shot normal Insulin immediately

before eating. And everything is documented in my diary-book.

I was at the hospital, diabetic center on a 2 week training in this.

Learned a lot! – And you get a ”Diabetes-Passport” with lab-status,

current dosage, physical status etc. to be checked and registered

quarterly. Eye- and kidney check 1 time per year min..

My HbA1c, when diagnosed, Oct.-98: 11,6%, 4 weeks ago it was 6,4%.

(Norm of HbA1c is 3-6%), but the target of my diabetic clinic is below 7%.

I'm attempting a target-BG fasting of 100 mg/dl (~5,5 mmol/l). Average 118 mg/dl

off all tests last month according to my computer's statistics.

Lately the specialists are loosening a bit up on fasting BG and HbA1c readings,

as you can see. By that the risk of getting hypo, especially at night is

considerably

reduced. This has no detectable effects on HBA1c nor on late diabetic

complication

rate.

If you are interested, I could give you some simple recommandations how you

yourself

can check, if your basic insulin dosage day/night maybe should be changed after

discussion with your doc.

I'm a " late starter " in DM Type-1, I'm 52, Dxd Oct.-98.

Good Luck!

Oluf

[Guest guest]

Oluf nson writes:

<< ... It has been shown that roughly only the following carbs have a

significant impact on BG, hence to be accounted for in the ICT/CSII in terms

of insulin units to be taken at meals: Sugar, fruit, pure fruit-juice, milk

any fat%, yoghurt, potatoes, rice, pasta any kind, and bread any kind. >>

The American Diabetes Association maintains that, basically, " a carb is a

carb. " All food sold in the US is supposed to contain nutritional labels,

including the manufacturer's *estimate* of the carbohydrate content.

<< A rule of thumb, which I learned, was that you are pretty well off just

taking the first 3 mentioned carbs on the declaration into consideration, as

any later mentioned mostly will be of only little significance in your

counting. >>

YMMV, Oluf ... perhaps because of your late diagnosis, combined with your

lack of insulin resistance. My biggest problem is with pasta. And baked

potatoes have a higher GI than does sugar.

<< Lately the specialists are loosening a bit up on fasting BG and HbA1c

readings, as you can see. By that the risk of getting hypo, especially at

night is considerably reduced. This has no detectable effects on HBA1c nor

on late diabetic complication rate. >>

They have been loosening up because atetmpts at tight control have been

killing diabetics. But as far as I know, the consensus is still that HbA1c's

at 7 and above result in complications. And increasing our average bg's does

result in higher HbA1c's. It's a tradeoff, for those who are at risk for

life-threatening hypos - namely, type 1's as well as type 2's who are still

taking sulfonylureas.

Susie