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Things your doctor may not have told you . . . In English . . .

      1 gram of carbohydrate will raise blood sugar by about

o       3 points (mg/dL) in people who weigh ~200 lb

o       4 points in people who weigh ~150 lb

o       5 points in people who weigh ~100 lb

o       So, to treat a low, you may think of it this way:

§         [120 – (your value)] ÷ #points appropriate for weight = # grams glucose to treat with

§         Translated:

·        figure how much your blood sugar needs to rise to get to the “normal” value of 120 = 120 – “your value”

·        divide that by # points your blood sugar will go up per unit of glucose (from the chart above)

·        answer = # grams glucose necessary

      Test your blood sugars often

o       There is a positive relationship between the frequency of blood tests and the level of control a person has over his/her diabetes.  This means that the more tests that a person does, the better his/her control tends to be.

      Keep good records of your blood sugars, insulin, and activity…but why?

o       There is a catch, however:  keeping good records of blood sugars, insulin, activity, and food results in even better control.

§         Personally, I really only keep track of my blood sugar consistently, but occasionally will keep a food/insulin/activity diary for 3 days or so.  The food/insulin/activity diary can be useful to see how the different components affect blood sugar, but it can be somewhat time consuming to keep, that is why I usually do 3 days to 1 week occasionally.  Otherwise, it only takes a moment to write do blood sugar results, and doing so can help make a big difference in the level of control (from an A1c of 8.0 to 7.0, for instance).

o       The reason is because a record allows you to see patterns, provided you look at it every so often.  If your blood sugars are frequently high or low at a certain time, then you may need to change your insulin.

§         A free, downloadable, daily journal is available from MiniMed that you can print out and use; guidelines are available on the site as well: http://www.minimed.com/help/pumptips/recordkeeping.html

§         Click Here for (two versions of) one example of a spreadsheet for recording Blood Glucose and Insulin/Medication (one is shaded and the other is not, just for aesthetics)

      For Pumpers

      TDD = Total Daily Dose…how is this useful?

o       Helps to set basal rates, carb factors (how much insulin per X grams carbs), and correction factor

o       Basal insulin should account for 50-60% TDD

o       Carb boluses should account for 40-50% TDD

o       The TDD form day-to-day should be pretty consistent

      Insulin stacking, or “insulin on board”

o       When several boluses are given in a short period of time

o       The insulin’s active time overlaps, which may cause hypoglycemia

o       Approx. 20-25% of a Humalog/Novalog bolus is used per hour after it is given

§         Example: for a 10 unit bolus with 25% used per hour, 2.5 units will be used per hour.  At 1 hour post-bolus, 7.5 units will be left unused; at 2 hours post-bolus, 5 units will be left, etc.

      The Dawn Phenomenon

o       The rise, often rapid, of blood glucose in the early morning hours (starting around 3am, but varies)

o       Causes? 

§         Not enough insulin

·        basal rate too low for pumpers

·        long-acting starts to wear off for injectors

§         Body goes into fasting state

·        Hormones that elevate blood sugar, such as cortisol, start to rise

·        “Glyconeogenesis” begins to occur; the formation of glucose from amino acids (from protein…muscle)

§         Insulin resistance is slightly greater in the morning

      Basal rate changes are small and should be made several hours before the effect will be seen

      500 Rule for Carb factor→ gives an estimate of how many carbs 1 unit of insulin will cover

o       500 ÷ (your ave. TDD) = grams of carbs covered by 1 unit of Humalog or Novalog insulin

§         Does not necessarily work if you require different carb factors at different times of day

o       Blood sugar should be somewhat elevated 2 hours after the meal and then decrease to about the pre-meal value at about 3.5 to 4 hours after the meal

      1800 Rule for Correction factor→ amount blood sugar will fall per unit insulin

o       1800 ÷ (TDD) = # mg/dL blood sugar will fall per unit insulin

§         1800 is an average; 1600, 2000, or 2200 may be used (divided by the TDD) as well.  The 1600 rule will give more insulin; using a 2000 or 2200 rule will give less insulin

§         I would guess that body size may also affect how much insulin you need

§         As with any of this info, talk to your doctor before making any adjustments!

o       A high blood sugar should return to normal in about 4 hours

§         How fast your blood sugar returns to normal will tell if you have the proper correction factor

      All of this info was retrieved from:

o       “Insulin Pumps: the Latest Advances” an online slide show

by John Walsh, P.A., C.D.E.

of the North Country Endocrine and Diabetes Mall

San Diego, CA

o       Found at this website http://www.diabetesnet.com/diabetes_technology/insulin-pumps-advanced.html

o       Also linked to from the Diabetes Mall website http://www.diabetesnet.com/diabetes_technology/insulinpumps.php