A tough Dilemma!

Suppose John's carb factor is 5 and his correction factor (insulin sensitivity) is 50 (Correction factor is high because he's honey mooning). He eats 30 carbs with a pre-meal BG of 100. With a bolus of 30/5=6 units. Suppose his 2 hour post prandial reading is 150 which is quite good as we're taught(20-50 more than pre-meal). At this point there is 1.8 units of active insulin (BOB) in his system (John Walsh: To calculate active insulin: 30% bolus 'consummed' every hour) equals: 6 x 30% = 1.8 units. So now he has 1.8 units of 'ready to hit' insulin in his system while almost all his meal carbs have already been converted to BGs and coverred by insulin. Now imagine what could a 1.8 unit excess insulin do to a person with a correction factor of 50. You guessed it: A 90 point drop in BG!! I want to argue that being in the '20-50 higher than pre-meal' range is kinda impossible without suffering from insulin excess (carb deficit). Maybe that's when dual/combo bolus comes to play. i kinda believed though that dual/combo is useless and by useless i meant logically impossible. My reason was that even though the 'curve' shown to us about dual bolus is seducingly similar to that of a real pancreas, but since even rapid acting insulin is way slower than real insulin, this 'fake similarity' shouldnt mis-lead us because a normal bolus would possibly match pancreas's secretion better than a dual one which is way slower.

 

We've struggled with this a lot!! And there's no easy answer.

The best that we've figured out is to make sure there is some fat and protein in the meals so that hopefully that extra IOB 2 hours post prandial will not cause that 90 point drop. But it's very hard to have a young child eat a perfectly balanced meal every time!

 

I agree with Brenda, there is no easy answer to this one. This is where diabetes goes from being an exact science to becoming an art form. To avoid a huge drop in a situation like this we always made sure that there was either enough fat or protien in the meal to slow things down. Usually we used drinkable yogurt as this is what works best for Abby.

 

I think things would be alot easier if you accept that D is Grey and Gray and not black and white. You can't explain it and can't predict it. You could do the exact same think tomorrow and get different results. You need to adapt and imporvise.

 

EVERY problem has a solution. Maybe i cant find it, but i do believe there is a solution. I'll never give up by assuming 'it's just the way it is', EVER.
This is a cause and effect world we're [doomed to be] livinig in, not a random-patterned one.

 

I respectfuly disagree with regards to D. Every problem has a different solution. So there isn't anyway to rationally assign each specific problem a definately solution that will always work. It just isn't like that. I think you would make yourself crazy trying.

 

I have to agree with Mrs. Badshoe. Although I'm just a newbie at this, I have found that D is far from an exact science -- my son can eat the same meal and get two totally different results. That is what makes this disease so challenging.

And I also have to add my two cents that I don't believe the rest of us are merely giving up.... Personally, I have to remember that my son is only 8 years old and he needs to have as normal a life as possible. I cannot get wrapped up in every # and he needs to be a kid.

Just my two cents.....

 

I also agree with Mrs. Badshoe and caspi. Insulin is a hormone, and it's "behavior" is directly and indirectly affected by a multitude of other hormones and metabolic processes. It is impossible for us to function as well as a pancreas, no matter how good our current technology is. Oftentimes, things happen in the body that are not obvious to us, and will result in strange blood glucose numbers. This is out of our control. We need to find formulas that work for our children, to be sure, but trying to make diabetes care an exact science is impossible and will make you insane. The "practice" of medicine in itself is almost as much art form as science, and this most definitely extends to diabetes care.

 

I agree with Mrs. Badshoe, caspi, and Twinklet.

Our 'model' of D is a hypersimplified version of what really is going on, like weather prediction models. Like weather prediction models, we're not going to be right all the time. We can't have a better model, there really is no understanding of all of the variables that is enough to model it perfectly. So we are part artists. The "I think that he'll go low because..." artists.

My kid isn't a robot. He's not going to sit unmoving forever, with the same exact portion of the same exact meal at the same exact time every day. He's gonna sleep in. Ride his bike. Eat an entire bag of popcorn. Skip dinner. etc... I'll keep him as close to 'normal' BG as possible. And I don't panic, get concerned, wring my hands, etc, when he's out of range. I correct him and we go on about our day. I get this feeling that there are folks that want to call CPS because we saw 400+ on the meter. Here's a secret: Every single T1 D is going to see 400+ on the meter. And not just once. It happens. Fixit and move on.

(rant off...)

 

Didn't you read the beginning of John Walsh's book? Where he said he has no answer for the T1D man who asked why he can have varying numbers even if he has the exact same meals, exercise, and insulin from day to day? Because it is diabetes.

There are too many factors that you CAN'T account for...emotions, hormones, stress, etc.

So just give up...or drive yourself crazy. Diabetes is a random disease.

 

alrighty then, sounds as if they need to find a cure and put us problem solvers out of business.

 

If at first you don't succeed try, try again!
Hang in there Payam 7777777.

 

Sounds like a plan...

 

Diabetes equations can't work because they never start at a set baseline - there are so many factors that happen before the pre- meal number of 100. Is that number still rising? falling? exercise coming into play? And how do you know that the correction factor of 50 is correct etc ? Too many variables to expect any scientific equation to work here
I prefer to stick with "Mothers Intuition" and tweak the bolus, lower the correction, put in a temporary rate or give a snack without a bolus etc

And I feel happy to be living in this world - NOT doomed

 

"Mankind has always feared what he doesnt understant"
- X-Men

 

i'm afraid my problem-solving attitude will eventually get me out of 'there', at least to a great extent. And YOU will be the one who'll be 'hung in there'.

Sorry.

 

Okaaaaayyyyy......

For most of us, this is a place of understanding, assistance and helpful information. We're not here to pick fights or be downright rude to others. I'm not sure what your intention is, and perhaps I'm misunderstanding it, but let's just say this will be my last response to this post.....

 

Wow, what a rude statement, Payam7777777. Maybe you're not familiar with the American phrase "Hang in there." It basically means, "keep trying and don't give up!".

I hope the problem here is a cultural misunderstanding and not intentional rudeness. Because none of that was shown to you in this thread. We are all trying to help one another here!

 

Confession, apologies and ...

i just hope margaret would kindly excuse me for the mistake i made. i'm sooooo sorry. i just didnt know the correct meaning of the phrase. it was 4:30 in the midnight and i was suffering from a 'sleep-deficit'.

I'm so soryy. How silly of me.

 

HEY payam7777777, No offense taken, lighten up and try to get some rest. I have been totally exhausted and overwhelmed too, so don't sweat it.
Margaret