Friday, December 19, 2008
As a pediatric diabetologist, I am confronted daily with complex issues related to day-to-day management of diabetes. Recent blogs have tackled major research studies targeted to finding a cure for type 1 diabetes mellitus. But what about dealing with the simple tasks of daily living in the meantime?...
My son uses several techniques to improve post prandial meal control.
He uses rapid acting insulin for correction doses and fast acting carbs eg sugars and starches but uses regular insulin for covering protein and meals that have slow digesting carbs such as salad vegetables and carbs plus a lot of fat in them.
In addition he gives extra insulin if he eats more than 40g of carb at one sitting.
Say we are in a restaurant and he is not sure how much he will be eating. He will inject 7 units of rapid insulin and 7 units of regular insulin after orders are taken. We then calculate how much insulin is needed to cover any correction doses/food as it is served/eaten and see how much more insulin is needed or how much is still "in the bank". The sums can be concluded with dessert.
Grazers may do well by using a regular insulin bolus.
You can learn more about these techniques at www.dsolve.com
Thanks for your much appreciated comments. Your strategy is also commensurate with using the dual wave/extended bolus/ combination bolus features of the various insulin pumps. I totally agree that using regular insulin along with rapid acting insulin (mixed together) works well especially in the circumstances described above as well as buffet and restaurant meals, parties, weddings etc in which the meal is somewhat protracted. The most difficult part for me is to figure out exactly the percentage of regular vs. rapid acting insulin that is applicable for each situation. Sometimes 50%/50% works, and in other situations 30%/70% etc. It seems that the percentage is also different depending on the individual and activities. I am totally looking forward to the marriage of the insulin pump and continuous glucose sensor that will hopefully do most of the work for us.
Happy New Year,
DrCogen
Thank you for getting back to me on this Fran, especially today, Christmas day!
You are exactly right regarding the pump comparison. Pumpers are taught sophisticated techniques for precision meal/insulin matching but why are pen / vial injectors not taught the same?
The course at www.dsolve.com aims to get them the same results as pumpers can get. I am in the UK, where pumps are less available than in the USA. Also, many people just cannot afford pumps, if their insurance provision is not adequate.
I would say that precision meal /insulin matching has three elements:
1. Learn the science. What is the carb/protein count? What is your carb/insulin ratio for that meal of the day?
2. Learn the art. What sort of meals respond best to rapid insulin, mixed insulins and regular insulins? Do you need to split your boluses over a length of time? (Here is a hint, you certainly need to do this even with regular insulin when you are covering pizza and lasange.)
3. Learn from experience. What works for you? I have heard that the average person only regularly eats about 20 different meals, and many people are more restricted than this. If you learn how to "profile your meals" you can learn the insulin adjustments that will work for you.
Katharine: Thanks for further educating all of us! I will pass on this website for my patients who remain (often by choice) on basal/bolus with multiple daily injections.
DrC