Sorry for the derail. I was diagnosed around the same time as you (1986). My memory is pretty fuzzy. I spent about 3 weeks in the hospital. I was put on a regime of 1 shot a day (N+R mixture), and taught to weigh food and follow an exchange program. I kept the same routine, just increasing the dosage, until switching to 2 shots / day about 5 years later. Never aware of the basal + bolus method or the effects of carbohydrates until I discovered them independently, much later.
I have never heard of a Dr. monitoring you throughout the day to set your basal. I was monitored for several hours BG + EKG when I was a test patient in an insulin inhaler study. When my BG got too low, I was told to go home and come back another day with a higher fasting BG. That's about the it.
When I started the pump, my trainer calculated my basal based on my body weight. A few months ago, a Diabetes Educator adjusted my basal, and other settings to change several times throughout the day to compensate for highs and lows, based on the graph of my pump's stored BG levels. The new settings did not work well.
I am particularly interested in this thread, because I'm also trying to figure out my basal. I've been testing 12x/day and tweaking it, along with other settings. Also constantly checking for ketones, which show up sometimes even with normal BG. I'm making progress. I never knew that there was a standard procedure for this.
I don't fast for basal testing, I use fasting bg (before eating) as the gauge of my basal and postprandial as the measure of my ratios. It usually works ok for me. Most of the time, fasting would be a disruption that I can manage without.
WOW I did that same study on inhaled insulin about 8 years ago, It was called exhubera I think. It was awful. The study people were trying to get me to lower my basal rates and increase my inhaled insulin.
My a1cs went up and I could never master it.
The inhaled insulin came in packets of 3 or 5. And there were in fact double the strength of regular U100.
That meant I could not bolus less than 6 units at a time.
Also if you coughed you had no Idea you what actually made it in.
I think they took it off the market, I have not heard about it in years.
Actually, it was a different study, but around the same time. It was for the MannKind inhaler. I actually did pretty well with it. My A1C went down a little. I believe 7.5 - 7.2. But then Exhubera beat it to market and bombed, so it never made it. I think it had similar dosage issues, though. And it looked like a crack pipe. I noticed they're still trying with a different inhaler. The insulin is called afrezza.
I follow your logic here Holger, but I think a couple of things need to be clarified.
I don't think you mean to say that the liver releases glycogen at all. Glycogen is just the storage form of glucose and doesn't circulate in the blood to affect BG at all.
Insulin, of course, causes the reverese to happen. BG is lowered because one of the effects of insulin is to convert glucose back into glycogen in the liver and muscles where it can be stored, but insulin is fighting against the presence of glucagon and adrenaline to keep BG in balance.
That's why we have to fast and have no other IOB in order to establish the correct dose of basal insulin in the first place. We are trying to isolate the rate at which the liver is converting glycogen to glucose and releasing that glucose into the bloodstream in order to determing the amount of insulin necessary to counter and keep your BG stable.
I replied to Holger regarding this point in more detail, but you hit the nail on the head.
The whole point of basal testing is to determine the correct does of basal insulin to counter the conversion of glycogen to glucose in the lvere and subsequent release into your bloodstream. Your liver does this continuously.
I was told this by a MD. I don't know if it is accurate, but I think it sounds logical.
Dr. B. mentions the "Chinese Restaurant Effect." i.e. when a big mass of anything; rocks, lettuce in large amount passes through the small intestine, enlarging it, it triggers the alpha gland to produce glucagon, triggering the liver to release glycogen, raising the BG, fine tuning it, specifically because insulin is present.
What I am describing (if it's real) is essentially the "reverse chinese restaurant effect." I can't find anything about it, but it seems if it works one way, it should work the other. I've never really had a stable fasting BG, until now, so never much of a chance (or reason) to test it out.
So far, I've worked out twice since cutting my daily insulin total by about 50%, and my carb intake by about 70%.
I elevate my BG to about 155. Then, unhook my pump for 30 minutes. Work out for an hour and reattach. My BG is about the same after, and I haven't experienced any radical drops, like I used to.
To me the Chinese Restaurant Effect is just about hidden carbs (lots of them). Why converting glucagon to glucose when the digested food will deliver glucose? With the presence of bolus insulin the liver is starting to refuel its glycogen stores not releasing them.
Thanks for the clarification. So Glycagon is the storage form and its long chains can be broken down to simple glucose. The glucagon is the hormone that will trigger the liver to start this conversion process. With the presence of insulin the liver will refuel its glucagon stores by creating long chains of glucagon from glucose.
In contrast: fatty cells seem to use the energy of glucose to create long fatty chains. In need these chains can be released. By breaking down the chain the energy that bound the chain can be utilized again. It is still a different metabolic process from the direct use of glucose. Much more dirty or wasteful - thus the high risk of DKA.
However, under normal conditions, the use of fatty acids to produce energy is not an inherently more wasteful process. In fact, much more energy can be produced from fat. Both glucose and fatty acids are oxidized (stripped of electrons and protons) to produce energy. The metabolic processes are basically the same.
The problem with diabetes is that our metabolism is broken which causes the amount of acteyl-COA (a key intermediate that enters the Kreb's Cycle from both the initial breakdown of glucose and from fatty acid degradation) to be thrown out of balance. Too much acetyl-COA gets produced from the increased fatty acid degradation that occurs in response to our inability to produce insulin.
Again, this is an imbalance between the action of insulin which causes the storage of glucose as fatty acids and the actions of glucagon which causes the breakdown of fatty acids to acetyl-COA.
Instead of being completely oxidized to Carbon dioxide during the Kreb's Cycle, the excess acetyl-COA gets shuttled into an altenative pathway that produces ketones and diabetic ketoacidosis.
I understand how to correct the Lantus dosage to dial in on what I need to get the best coverage; but can someone please help me with my Novolog?
I've been using a 15 to 1 Carb to Insulin ratio; this doesn't seem to be enough coverage in a 2 hour period (this is when my doctor told me to check my sugar, 2 hours after eating....) But it does seem like enough after 3 hours. I've gone from 199 at the 2nd hour to 70 at the third with no correction insulin at the 2nd hour... (this was after eating a bowl of veggie soup, no potatoes and no crackers. (When I eat a corn product, my Insulin stands no chance at the 15 to 1 ratio..)
I am probably just running on and on and not making any sense. I am terrible at the terminology and if I had health insurance I'd see an educator but I don't...
Also, does anyone know of an affordable Pin Needle? I went to wal-greens without a prescription tonight to get needles for my Lantus Solarstar and Novolog pens, and it cost me 48 bucks...
Hmmm, I'm not sure about the needles but, if you think 15-1 isn't quite enough, maybe nudging it 10% 13-1, 12-1 or something like that would be a way to test and see how it plays out?
The premise (mostly paraphrasing Bernstein). Is that human insulin is extremely potent. The stuff we inject is diluted by about 90%. So, the liver releases glycogen after we eat to fine tune our BG, as the non-diabetics beta gland ODs with insulin. Basically, insulin is a chainsaw, glycogen is sandpaper.
I got a pump last year. With that you have a basal “drip rate” you can vary up or down that works for me. If my current basal rate is .75 an hour I reduce it by half for 1.5 times the length oh the exercise. For running an hour this would mean reducing the basal to .35 for 1.5 hours.
After winging it for 20 years the pump is the answer for me
