Achieving Good Control

Jorj Gaidin · #1 (**permalink**) 01-18-2005, 05:03 PM

I'm trying to adjust how I approach my bg control and am looking for a little help. I've heard conflicting things about post-meal bg when using an insulin pump. What bg levels do you aim for post-meal? How to you treat meals where you have used a square-wave (Minimed)? Do you test 2 hours after the end of the wave or from programming?

Any advice you can give me would be greatly appreciated... My last Ha1c was 9... so I've got to do something!

Thanks

dws · #2 (**permalink**) 01-18-2005, 06:14 PM

First!!! Don't rush to bolus, wait and test again at 3 hr. then 4 hr if needed. The 2 hr PP you hear and read about so much is the number that a 'normal' person will return to 'normal' fasting glucose after a meal . Some of us 'non-normal' folks have a slighly delayed emptying of the stomach , and a slower absorbing of the insulin . That kicks us right out of the 'normal' bracket. The only way to tell is to test.
don

Jorj Gaidin · #3 (**permalink**) 01-19-2005, 02:51 PM

What are your PP target levels? What would you recommend I aim for?

bel4_20 · #4 (**permalink**) 01-19-2005, 03:04 PM

Quote:

First!!! Don't rush to bolus, wait and test again at 3 hr. then 4 hr if needed.

He's right I to would jump the gun on testing 2hours after a meal and seeing it high and kept going low time after time(from taking more insulin), Then I read somewhere exactly that; wait another hour or 2 and low and behold BG readings were back to normal. This worked for me.

dws · #5 (**permalink**) 01-19-2005, 03:47 PM

I'm happy with a pp at 150, very seldom do I bolus if I'm 200 or less. I don't recomend anything, that is for you and your doctor to come up with. (that is what you pay him/her for

don

rzrbks · #6 (**permalink**) 01-19-2005, 04:10 PM

Quote:

dws
is the number that a 'normal' person will return to 'normal' fasting glucose after a meal

You DARE insinuate we aren't normal? Shame on you.

MarkMunday · #7 (**permalink**) 01-19-2005, 04:57 PM

My objective is for the blood sugar level to be back in the 90-130 target range within 4 hours. My blood sugar normally peaks about 1 hour after eating. And I don't let it go higher thatn 180. Because, if it exceeds this critical level (for me), it doesn't come down again. My body becomes more insulin resistant and I have to do a correction bolus.

You contain the height of the peaks by limiting carbs in your meals. The more carbs you eat, the higher the peaks become. And the harder you will have to work to keep your blood sugars on an even keel.

Cheers,

Mark.

dws · #8 (**permalink**) 01-19-2005, 05:24 PM

BUT, What is Normal??????
When I get too bored, I bring up the 'Normal' subject with my doctor........ drives him wild!!!!!! Think about it awhile, it will open all sorts of fun things to do when your doctor uses the word

don

MarkMunday · #9 (**permalink**) 01-19-2005, 06:55 PM

A "normal", non-diabetic 2 hour postprandial blood sugar would be in the 70-90 range. But that is of only academic interest to us T1s. We will never be able to achieve a normal pp blood sugar. And our reliance in injected insulin is only one of number of reasons for this.

So what number should we aim for? For obvious reasons, it needs to be a level that doesn't require you to do a correction bolus. For me that is 180, as I mentioned in a previous post. But we are all different. Find out what level you can comfortably tolerate and design a meal plan around it.

Cheers,

Mark

Jorj Gaidin · #10 (**permalink**) 01-19-2005, 08:13 PM

Quote:

Originally Posted by MarkMunday

My objective is for the blood sugar level to be back in the 90-130 target range within 4 hours. My blood sugar normally peaks about 1 hour after eating. And I don't let it go higher thatn 180.

It's interesting to me that you've figured to monitor the peak in your bg. How often to you monitor the rise? Regularly? Have you noticed a dependency with certain types of food? Finally, how do you deal with high fat meals (besides a square wave/dual wave bolus). Sorry for all the questions, I'm just very anxious to figure all this out.

JG
btw: I'm 23; dx '95; Paradigm 512

MarkMunday · #11 (**permalink**) 01-19-2005, 09:04 PM

Jorj,

The realisation that high post-meal blood sugar peaks are much harder to deal with than moderately raised peaks, has prompted me closely monitor and control them. After testing 1 hour after eating for a few months, I got a good feel for what causes spikes to penetrate that 180 threshhold. And I avoid the foods that do it - large helpings of rice, potatoes, pasta bread etc.

I normally test before meals. And I test about 2 hours after eating to make sure that the bsl is declining as expected. 2 hours after a meal, I would hope to see the bsl at around 130. At this point, about 1/3 of the pre-meal bolus should still be "on board". If I have a large or different type of meal, I may test after an hour. If the bsl is over 180, I will bolus immediately.

Relatively large amounts of fat and protein in a meal can result in high blood sugars after the Novolog action is finished. Unfortunately, I don't have a pump, so the square wave bolus isn't an option.

In the past, I have done another bolus shot after about 4 hours. But it is a bit of a hit-and-miss-affair. And I am going to experiment with using Actrapid before those types of meals, which are normally in the evening.

I am amazed that endos and CDEs don't suggest this approach. I find increasing insulin resistance with higher blood sugar levels to be a major issue. But then we are all different, I suppose.....

Cheers,

Mark

rzrbks · #12 (**permalink**) 01-20-2005, 08:20 AM

Quote:

I am amazed that endos and CDEs don't suggest this approach. I find increasing insulin resistance with higher blood sugar levels to be a major issue. But then we are all different, I suppose.....

The thing I've noticed, maybe it's just the people where I live, but most patients aren't........uh......well........exactly the type of people who stay on top of things........not so much that they don't, it's more that they can't.

I'm trying to be polite here.

Let's just say that many of them can't figure out, without a calculator, the change they're due back after a purchase.

Jorj Gaidin · #13 (**permalink**) 01-20-2005, 08:22 AM

Figuring out my insulin resistance has been a big challange for me. It seems to vary from day to day, week to week. I'm sure there must be a pattern, but no amount of analysis has been able to show me what it is. I think half my problem is poor carb counting. Maybe once I figure that out, the rest will reveal itself.

Have you noticed variation throughout the day in your insulin resistance?

JG