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twodoor2
Last Activity:
Nov 7, 2015
Joined:
Oct 30, 2007
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Location:
Illinois
Occupation:
Programmer and designer of database transform and

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twodoor2

Approved members, from Illinois

twodoor2 was last seen:
Nov 7, 2015
    1. Omo2three
      Omo2three
      Marsha,
      Merry Christmas, hope you are all doing well!
      Sheryl
    2. Judy&Alli
      Judy&Alli
      How are the kids????
    3. Karenwith4
      Karenwith4
      Hi there
      Nice to see you around again. Hope all the kids are well.
      Karen
    4. Omo2three
      Omo2three
      Hi Marsha! Thanks for your posted information, I am signed up to take diabetes self management class. And your posts are very helpful! Trying to figure out BCR still, did you test at night So that she wouldn't miss a meal? Thanks for sharing the formulas with us! Anatomy and physics makes you appreciate how amazing one organ can be! Now if we could just figure out why the body attacks itself.....thyroid, diabetes, and ect.
      Have a great Day!
      enjoying your posts!
      Sheryl Ps I think your brilliant!
    5. twodoor2
      twodoor2
      How Lantus is supposed to work.

      Disclaimer: Not everyone will have this level of control, and therefore, they will need to pump, use a split dose of Lantus, or go on NPH or Levemir, but this is just meant to be a basic overview:

      Lesson 101:
      The Lantus dose is correct IF the sleep time blood sugar does not deviate +/- 40 points from the number that is taken 5 hours after the last bolus. Therefore, if you give your child his last bolus at 7:00 PM, and it's not sufficient, and at midnight he's 350 mg/dl, then he should optimally fluctuate anywhere from 310 to 390 mg/dl. Yes, he's high, but the Lantus is still correct!! If you give your child a bolus at 7:00 PM and it's too high, and he ends up being 80 at midnight, then he should fluctuate anywhere from 40 to 120 mg/dl through the night. These are extreme examples, but they're typical of what can happen if the last bolus of the day is not correct. Your child can potentially wake up either high or low (even if the basal is correct). Lantus does not work to bring you down, that's what boluses are for. The job of the Lantus is to keep you even keel after the bolus has done it's job and brought the blood sugar down. Once the bolus is out of the body, if you have the optimal dose of Lantus and a good dose of fast acting, the bg should remain stable, even with the +/- 40 point bg deviation.

      Lesson 102
      Sometimes growth hormones or a Lantus peak (if the Lantus is given before bedtime)can interfere with this deviation, but optimally, stable sleep time numbers are what you want to see.

      Lesson 103
      The ABSOLUTE MOST IMPORTANT THING to get right on a Lantus regimen (well any insulin regimen) is the basals. If you do not have correct basals, it's like the foundation of a house being faulty, and the house will crumble. Stable basals help to alleviate extreme highs, lows and the roller coaster ride. It is quite possible that you may never get the perfect +/- 40 point deviation on Lantus during the night, but you should attempt this before you make any further adjustments. If the Lantus never gets to that optimal dose, then you might want to consider another regimen, like a split dose of Lantus or pumping.
    6. twodoor2
      twodoor2
      How to determine the average Duration of Insulin Action (DIA).

      The basals must be correct before doing this test.

      Give a typical average size bolus with a low fat meal, check the blood sugar every hour after that bolus, and then in the third hour after the bolus, check every half hour until the blood sugar holds steady (assuming you have the correct dosage of basal). The time it takes for the blood sugar to stop dropping is the DIA. No exercise can be done during this period.

      Make sure you give a bolus of an average size that you normally give. If it's too small or too large, the DIA can be too short or too long, and not reflect the average DIA, which is what you want.

      See this link for for information as to how crucial it is to make sure you know the correct DIA for pump settings.

      http://www.diabetesnet.com/diabetes_technology/pump_durinslact_danger.php
    7. twodoor2
      twodoor2
      How to determine the BCR (Blood Glucose to Carb Ratio) - one of the greatest tools you will ever have in diabetes management


      The BCR can be used to avoid overcorrecting with carbs, and to determine the ISF's. It can also be used for calculating a "BG buffer" on days that you're afraid your child might go to low at night due to intense exercise during the day.

      The Basals must be correct before conducting this test.

      Test the BCR after all the bolus is completely out of the system and make sure the test subject is sedentary during the test. Depending on the type of fast acting, and how the body reacts to it, the DIA can be anywhere from 3 to 5 hours after the last bolus. My daughter has an average duration of bolus insulin time of around 4.5 to 5 hours (it also depends on the size of the bolus). Five hours is a good time to wait. Then take the BG at that time, and give an accurate carb amount. About 3 carbs should suffice or a glucose tab of 4 carbs which is very accurate (use a precise amount of glucose gel for a toddler or baby instead of a glucose tab), and then wait around 3 hours, take the BG again, and the BCR is equivalent to

      (Ending BG-Starting BG) divided by # grams of carbs

      Now, there are weight charts for average BCR's for people. The BCR is affected by weight more than anything else. The less you weigh, the higher the BCR. Toddlers usually have a BCR of 12, preschoolers 10, older kids can be anywhere from 8 to 4 (usually kids over 100 pounds are around 4). The average 150 pound adult has a BCR of 4.

      When conducting this test, there may be natural fluctuations due to hormones and imperfect basal. I do think the weight charts can provide a rough estimate, and I've done the BCR tests so many times becasue that's how I can judge how much she'll rise if I need to give her a buffer at bedtime. It may take a few times testing the BCR to get a good sense of what it truly is. It is very dependent on weight and accurate basals.
    8. hrtmom3
      hrtmom3
      What a great Idea! Paula is right, it's like going to the docs and getting some brochures. Actually this is probably more info than I have ever gotten at and endo apt.
    9. StillMamamia
      StillMamamia
      Hey Marsha, just checking in to see how you are doing? How's the family?
      BTW, love that you posted the info here on your visitor page. Kinda like going to the doc's and picking up brochures ;) Thanks.
    10. twodoor2
      twodoor2
      This is the list of things to get right when working on insulin dosages with a pump or Lantus/Levemir regimen. Get these things right in the following order as well.

      1) Basal. The ABSOLUTE MOST IMPORTANT THING TO GET RIGHT. If basals are not right, control will be seemingly impossible.
      2) Insulin to Carb Ratios (ICR)
      3) Average Duration of Insulin Action (DIA). If you do not know the TRUE AVERAGE Duration of Insulin Action, the ISF's will be more difficult to figure out, as well as the true ICR's
      4) Blood Glucose to Carb Ratio (BCR). How much 1 gram of carb will raise your fasting BG (one not currently affected by bolus) in either mg/dl or mmol points.
      5) Insulin Sensitivity Factor (ISF). When you know the true Average DIA, the BCR, and the ICR, the ISF is

      ISF= BCR x ICR

      for the time period in question.
    11. twodoor2
      twodoor2
    12. twodoor2
      twodoor2
      How to determine the correction dosage with the ISF on MDI.

      This dosage should only be given 3 to 4 hours from the last dose to avoid stacking of insulin. The basals need to be correct as well

      The formula is

      Correction dose = cBG -tBG divided by the ISF

      where

      cBG is the current blood glucose reading
      tBG is the target blood glucose you're trying to get to.
      and the ISF is the insulin sensitivity factor

      So for example, if your cBG is 300 and your tBG is 150 and your ISF is 200

      then 300 -150 = 150,

      therefore, 150/200 = .75

      Therefore, the appropriate correction dosage to give for getting 300 down to 150 is .75 units with an ISF of 200.

      This correction dosage is not to be confused with the food dosage that is done with the use of the Insulin to Carb Ratio (ICR).
    13. twodoor2
      twodoor2
      How to determine the BCR (Blood Glucose to Carb Ratio) - one of the greatest tools you will ever have in diabetes management


      The BCR can be used to avoid overcorrecting with carbs, and to determine the ISF's. It can also be used for calculating a "BG buffer" on days that you're afraid your child might go to low at night due to intense exercise during the day.

      The Basals must be correct before conducting this test.

      Test the BCR after all the bolus is completely out of the system and make sure the test subject is sedentary during the test. Depending on the type of fast acting, and how the body reacts to it, the DIA can be anywhere from 3 to 5 hours after the last bolus. My daughter has an average duration of bolus insulin time of around 4.5 to 5 hours (it also depends on the size of the bolus). Five hours is a good time to wait. Then take the BG at that time, and give an accurate carb amount. About 3 carbs should suffice or a glucose tab of 4 carbs which is very accurate (use a precise amount of glucose gel for a toddler or baby instead of a glucose tab), and then wait around 3 hours, take the BG again, and the BCR is equivalent to

      (Ending BG-Starting BG) divided by # grams of carbs

      Now, there are weight charts for average BCR's for people. The BCR is affected by weight more than anything else. The less you weigh, the higher the BCR. Toddlers usually have a BCR of 12, preschoolers 10, older kids can be anywhere from 8 to 4 (usually kids over 100 pounds are around 4). The average 150 pound adult has a BCR of 4.

      When conducting this test, there may be natural fluctuations due to hormones and imperfect basal. I do think the weight charts can provide a rough estimate, and I've done the BCR tests so many times becasue that's how I can judge how much she'll rise if I need to give her a buffer at bedtime. It may take a few times testing the BCR to get a good sense of what it truly is. It is very dependent on weight and accurate basals.
    14. twodoor2
      twodoor2
      How to determine the average Duration of Insulin Action (DIA).

      The basals must be correct before doing this test.

      Give a typical average size bolus with a low fat meal, check the blood sugar every hour after that bolus, and then in the third hour after the bolus, check every half hour until the blood sugar holds steady (assuming you have the correct dosage of basal). The time it takes for the blood sugar to stop dropping is the DIA. No exercise can be done during this period.

      Make sure you give a bolus of an average size that you normally give. If it's too small or too large, the DIA can be too short or too long, and not reflect the average DIA, which is what you want.

      See this link for for information as to how crucial it is to make sure you know the correct DIA for pump settings.

      http://www.diabetesnet.com/diabetes_technology/pump_durinslact_danger.php
    15. twodoor2
      twodoor2
      My favorite threads

      A very detailed one on how IOB works
      http://forums.childrenwithdiabetes.com/showthread.php?t=14581

      The ISF Proportionality Rule
      http://forums.childrenwithdiabetes.com/showthread.php?t=14829

      Mathematical Proof for the ISF Proportionality Rule
      http://forums.childrenwithdiabetes.com/showthread.php?t=24684

      How to go about having a good insulin adjustment plan
      http://forums.childrenwithdiabetes.com/showthread.php?t=19318

      The Artificial Pancreas
      http://forums.childrenwithdiabetes.com/showthread.php?t=16597&highlight=artificial+pancreas

      Standard Deviation and Glucose Fluctuations
      http://forums.childrenwithdiabetes.com/showthread.php?t=11621

      Daytime basal tests (more applicable to Huma/Novolog users with Lantus or pump)
      http://forums.childrenwithdiabetes.com/showthread.php?t=20679

      Lightbulb Moments in D management
      http://forums.childrenwithdiabetes.com/showthread.php?t=19233&highlight=good+point

      Half unit syringes
      http://forums.childrenwithdiabetes.com/showthread.php?p=223601#post223601

      Pros and Cons of each pump
      http://forums.childrenwithdiabetes.com/showthread.php?t=16503&highlight=curvilinear

      The problems with pumps performing too many negative corrections
      http://forums.childrenwithdiabetes.com/showthread.php?t=15800

      Correcting for highs (this thread has the MM Paradigm pump calculation methodology as well)
      http://forums.childrenwithdiabetes.com/showthread.php?t=11794&highlight=correcting+highs

      IOB while pumping (goes into the differences between linear and curvilinear IOB as well)
      http://forums.childrenwithdiabetes.com/showthread.php?t=11595&highlight=curvilinear

      Insulin Stacking
      http://forums.childrenwithdiabetes.com/showthread.php?t=11967&highlight=duration

      The mysterious surface area effect of insulin dosing on MDI (this can cause hypos if you space insulin dosages very closely together)
      http://forums.childrenwithdiabetes.com/showthread.php?t=12124&highlight=revelation

      Nutrition
      http://forums.childrenwithdiabetes.com/showthread.php?t=16091

      The Salter Scale
      http://forums.childrenwithdiabetes.com/showthread.php?t=8399

      Link to album of kids wearing their pumps
      http://forums.childrenwithdiabetes.com/album.php?albumid=10

      How Insulin Works
      http://forums.childrenwithdiabetes.com/showthread.php?t=20410&highlight=insulin+works

      Dual Wave Bolus
      http://forums.childrenwithdiabetes.com/showthread.php?t=14190&highlight=tabular
    16. twodoor2
      twodoor2
      This is the list of things to get right when working on insulin dosages with a pump or Lantus/Levemir regimen. Get these things right in the following order as well.

      1) Basal. The ABSOLUTE MOST IMPORTANT THING TO GET RIGHT. If basals are not right, control will be seemingly impossible.
      2) Insulin to Carb Ratios (ICR)
      3) Average Duration of Insulin Action (DIA). If you do not know the TRUE AVERAGE Duration of Insulin Action, the ISF's will be more difficult to figure out, as well as the true ICR's
      4) Blood Glucose to Carb Ratio (BCR). How much 1 gram of carb will raise your fasting BG (one not currently affected by bolus) in either mg/dl or mmol points.
      5) Insulin Sensitivity Factor (ISF). When you know the true Average DIA, the BCR, and the ICR, the ISF is

      ISF= BCR x ICR

      for the time period in question.
    17. buggle
      buggle
      Thanks for the friend request, my bug-loving friend. :)
    18. Judy&Alli
      Judy&Alli
      ;) Are you back yet?
    19. Lizzy731
      Lizzy731
      Thanks for the sweet messages about my pics!
    20. Lisa P.
      Lisa P.
      Last winter we found a preying mantis egg sac, kept it in a jar for months and had given up on it. Looked at it one day and thought something liquid was pouring out of it -- hundreds (thousands?) of babies! You have to watch out because apparently they start cannibalizing each other if left together too long, but it was amazing, the kids were thrilled.
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  • About

    Location:
    Illinois
    Occupation:
    Programmer and designer of database transform and
    Who has diabetes?:
    One child
    Does your family have celiac?:
    I'm not sure yet
    Working mom of three children

    Astrophysics, math, insects, English History, Renaissance Art, and now Type 1. ~B.S. Math~
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