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Does this look like Somogyi?

Discussion in 'Parents of Children with Type 1' started by Theo's dad Joe, Jan 21, 2016.

  1. mmgirls

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    here is some infomation, they actually call it COB = carbs on board http://www.nightscout.info/wiki/labs/the-nightscout-iob-cob-website

    and look over here too http://diyps.org/2014/05/29/determining-your-carbohydrate-absorption-rate-diyps-lessons-learned/

    I will be on no help on this stuff, but if you are on Facebook you can join the CGM in the cloud group and post questions and meet people using it.
     
  2. Theo's dad Joe

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    these are interesting. I will look deeper into them though I read the second article. I will mention a couple of things though.

    1) They actually DO assume that your correction factor should equal the rise in blood sugar that you should get from the carbs COVERED by 1 unit of insuln, back to that question I had earlier.

    I was wondering why my son's correction factor is about 100 which is considered to be normal, and he rises about 8-9 points per gram of carbs, which is also normal for a kid his size, but his 12:1 carb ratio is considered to be really low. Using the methodology in the second article, if your correction factor is 100:1 and you gain say 8.5 points per gram then you SHOULD have a carb ratio of basically 12:1 8.5 x 12=102! Again just using their methodology, if a kid has a correction factor of 100:1 and sensitivity of 8.5, both of which are considered to be typical, they SHOULD have a carb ratio of 12:1, but I am told that 12:1 is atypical.

    2) I will mention that their assumptions about carb absorption may be true, but they may be making some false assumptions. First off, blood sugar rises after consumming glucose in two phases. Most people without diabetes will absorb the fast carbs into the liver and muscles within 1 hour and may often be back down to a fasting blood sugar at 1 hour, BUT then the liver gets a signal from glucagon to release some of that glucose and it comes out in the second hour, and insulin has to be there again to hold it in the liver or put it back in. In other words, fast carbs usually enter the bloodstream twice. I've attached an image showing the usual pattern, glucose entering the bloodstream, being put away by insulin and then the liver releasing some and the second insulin response. I always assumed that this was why humalog is often shown to have two peaks. Type II diabetics also are known to have a peak at 2 hours when the liver releases the glucose that got put away by the first response.

    Also glucose and starch are both absorbed faster in larger amounts, and we know that low GI starches are not completely absorbed within 2 hours and carbs mixed with fat often slow down absorption to the point where a meal with starch may not be completely absorbed within 4-5 hours, so a test done with something simple like rice or glucose tablets is not going to give someone any idea how many carbs are still on board. I know you didn't promise to help with this, but I wanted to just mention that. I think I will look at the facebook group.
     

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    Last edited: Jan 27, 2016
  3. forHisglory

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    We discussed this at point, but can you tell me again...I've heard insulin causes weight gain. How does it cause weight gain vs just pure calorie consumption? In other words, is the insulin by itself causing the weight gain? Would a higher carb diet cause more weight gain because more is available for the insulin to mobilize/pack away? Also, is fatty liver an issue in a high fat diet? My son is a teeny guy, thin now but I want to set up good habits for the future.
     
  4. Theo's dad Joe

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    (Non alcoholic) Fatty liver is not caused by a higher fat diet, it is most common when people eat a high sugar diet because sucrose is half fructose and the liver only turns about 25 grams of fructose a day into glycogen (more with exercise). After that fructose often gets turned into fat in the liver and triglycerides. So a high sugar diet basically promotes fatty liver and high blood triglycerides because the liver doesn't have any more room to turn fructose into glycogen and it has to dispose of it some other way (fructose can be eaten and transformed into one of those other things, but the body does not store fructose "as is" because it damages tissues and organs. Fructose in the blood is 10x more powerful at causing glycation of molecules than glucose.

    Insulin holds fatty acids in fat cells so the body can not access them for fuel. This is a problem for diabetes because burning of fat from adipose is very hard during exercise when insulin sensitivity is high. When someone eats less than about 30% carbs though, they start to store the fatty acids in their muscles and adjacent to muscle cells rather than in adipose cells. The fat can be accessed by muscles during exercise even if insulin levels are high because it doesn't have to escape from adipose cells (with insulin holding the door shut) and get to the muslce, it is already in the muscle cell, or right outside the cell membrane. It SEEMS though that having this fat around the muscle makes one less sensitive to insulin. Adipose is built largely on excess carbs getting turned into fat and moved into fat cells with insulin. There is a fundamental physiological change that occurs when carbs go below about 150 grams and fat goes up.

    Sorry I'll try to get back tomorrow.
     
    Last edited: Jan 27, 2016
  5. forHisglory

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    Thanks Joe! This is what I was trying to explain to someone. That answers it! :welcoming:

    Edit: I am keeping your family in prayer.
     
    Last edited: Jan 27, 2016
  6. Theo's dad Joe

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    I am going to try later boluses today. Yesterday was the most bizarre. He was 75 an HOUR after breakfast before coming up. He was also under 80 an hour after lunch even though they gave him 5 grams fast before his shot, and he was under 100 for 3.5 hours after dinner but then went up to 160 in bed and he is not correcting that anymore-he drifted up to 175 (f.s. checked) at 3:30 so I gave him half a unit when he was asleep and he came right down to 100 within just 2 hours but stayed there, 101 for breakfast, so for some reason corrections clear out blood sugar fast, but meals are just agonizingly drawn out.

    I think that maybe there is something to his body not liking to be 75 for an hour after a meal, and so maybe his liver is just cranking up to give him some blood sugar and when the insulin is gone it comes out. We may even be wasting insulin against his own body trying to stay higher at certain times of the day. So I am bolusing WITH breakfast instead of -20, and I think I will bolus right after lunch and dinner. Maybe he's wasting bolus working against his own body trying to get up a little. Maybe it is slow absorption too, or still having a first response. Also I will use the leg or abdomen whenever possible. I may just go to school and do it myself.

    Anyway I guess it can't hurt. We may lose a few hours a day under 100, but I'll take the flexibility. I was afraid to go on a walk with him for 90 minutes after dinner because that has been his low point and afraid to give him carbs then because I knew he has tended to be a little high at 4 hours.
     
    Last edited: Jan 28, 2016

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