350 to like 75 in 25-30 minutes is nothing to sneeze at. Although, of course, if you don't stick the landing, you're up the creek without a paddle...
Well, Afrezza has got me wondering about that "stick the landing" thing.
LOL, that's hilarious, AR
That's bizarre. I mean, smaller dose = more surface area per unit, but I've never heard of Lantus lasting 12 hours in anyone, and I took small doses and it certainly didn't in me. If you really have such different nighttime and daytime requirements, a 12-hour insulin is great, I would have thought Levemir would have been a better fit.
The pump pulses for a given dose all get delivered within about a minute. I doubt much absorption is happening within a minute. I think you're conflating bolus insulin with basal insulin, where the pump substitutes pulses of fast-acting insulin for one or two doses of injected long-acting insulin that crystallize and only gradually dissolve under the skin.
Confirms what I knew from other reliable sources. Corroboration is a good thing.
There have been occasions (infrequent ones) when I would have really liked to have the IV method in my toolkit. I'm just a wee bit too paranoid to go there. (It isn't hypos I'm worried about but something else entirely.)
Bernstein says that injections greater than 7u tend to behave more inconsistently. Consequently he advocates breaking up large boluses into smaller ones. I believe him for two reasons:
- His data is exclusively empirical, not theoretical. He has observed the results of hundreds of thousands more injections than I ever will, both in himself and his patients.
- He hasn't misled me once, not ever. Everything I have done based on his advice has worked precisely as he says. No exceptions.
Is his reasoning regarding due to absorption? That's how people explained it to me...
Two 6 units injections at two different sites will absolutely absorb quicker than one 12 units injection at one site, because of greater surface area per dose.
Dozens of pulses from a pump over a few minutes infusing 12 units into one site doesn't seem meaningfully different to me than an injection delivery those 12 units into one site within seconds instead of minutes.
Ultimately, all that matters is how Lantus is behaving in your body. Trust your empirics over others' opinions any day.
I'm insulin-sensitive and eat a moderate carb diet, so I've never given a 12 unit bolus. I suppose it takes a few minutes. I don't see how that's meaningfully different than having it happen within a few seconds, though.
It makes perfect sense that breaking up larger injections into smaller ones, at separate sites, is helpful, due to the surface area/dose relationship.
Breaking up a multi-second injection into one site into a multi-minute set of pulses into one site, from a pump, doesn't seem like much of a difference to me.
"Well, the guys lectured me about it a lot, so I quit doing it."
You quit doing what? Splitting big doses? Why would you do that? Splitting big doses *will* make them absorb faster.
I'm skeptical pump pulse delivery into a single site, with minutes instead of seconds timelines versus injection, makes any difference. I'm not at all skeptical that splitting injection doses over different sites makes a big difference.
Or maybe you meant you've quite doing massive single injections? That would be good.
Niccolo, sorry. I see your confusion. The big problem was that I have higher basal requirements during the day than at night. So, if I set the basal to stabilize overnight, then the day time numbers totally self destruct. If I set the basal to stabilize during the day, then the night time numbers were completely unmanageable. Damned wherever I set the basal. Mike suggested splitting the lantus basal so that both were set appropriately. It was a simple solution, but I had never heard of it before. The data is flat line, just like that. There's some fine adjustments to do, but that will be easy. Comprendo?
Yep, at some point this became hard to follow, in part because at a certain point direct replies are no longer feasible.
Splitting Lantus doses is a no-brainer, glad it's working for you!
Yea, Ill delete a bunch of my posts when I'm back on my Pc, so as not to mess up his post.
Well, all I can contribute to the discussion is that none of these approaches differs from the other in terms of pharmacokinetics for my body. As T2 with fairly typical IR, I take some big doses (IC 1:4, a 40g carb burger is 10U).
If I split a dose into 2-3 injection sites, no difference. When I started pumping, no difference.
I know many other people have site absorption problems, so it's a real issue, to be sure.
One suggestion: Keep in mind that all that liquid goes somewhere. It doesn't form a vesicle -- a bubble of fluid in the tissue. If injected gradually enough, the fluid disperses in the underlying tissue fairly quickly. What I mean here is it distributes interstitially among the thousands upon thousands of cells in the small area where the injection is taking place.
Remember that every single cell in your body has direct contact with a capillary. As such, the tissue where this injected fluid is sitting is literally infested with capillaries. Pressure differential at the injection site causes the fluid to spread an equalize within minutes.
So, the capillary density exposed to the injected liquid is relatively constant after a few minutes, regardless of the size of the injection.
I suppose this is why there are no insistent rules about splitting up large injections -- it just isn't much of an issue.
Whatcha up to there, mohe? :-)
I only find stuff like this online. Are you working on a medical degree?
BTW, interesting stuff... thanks for the pointer!