Sunday, April 3, 2011

Pump Adjustments - Part 2 (Carb Ratios)

"Carb to Insulin Ratios"
First a quick update on the basals.  So I've decided to stay Pump Bound, with Mr Wizard Senior.  All is well thus far.  I set my basals as listed in the last post.

 Day one, my AM reading sucked, so it was a bust, day 2 much better.

Lots of testing, and documenting. Every little detail, Carbohydrate, fat, protein, activity, glucose levels.....I knew it would be a lot of work, but today I 'm already seeing stable before meal numbers.

Tonight I will have an early dinner (easy on the fat and protein) and fast until tomorrow to test my night-time rates which means a 0300 AM check. 

Next on my list to tweak are the carb ratios.

So to refer back to Dr Conway and Colleagues,  The Professionals Guide to Insulin Pump Therapy  as quoted below:

Adjusting The Meal Time Bolus:
The goal is for the blood glucose to rise not more then 2.8mmol/L 2 hours after a meal.  The meal bolus is based on the insulin to carbohydrate ratio: one unit of insulin to a determined number of grams of carbohydrate.
Raise or lower the number of grams of carbohydrate covered by 1 unit of insulin.  Make small adjustments: 1 to 2 grams of carbohydrate for each adjustment.
For example, if the insulin to carbohydrate ratio is 1:15 and the blood glucose two hours after is only 1 mmol/L above the pre-meal blood glucose, adjust the insulin to carbohydrate to 1:16 or 1:17.

Okay, so I have programed the 1:10 ratio into my pump for all meals. We shall await the outcome. As I have pumped for many years I know my variables roughly, but I am pretending to be a newbie.

I know that breakfast requires more then lunch and bedtime snack much less then supper, if you follow me. But I will do the trial and error thing and hopefully refine the regime. 

Better test since it's 2 hours post lunch as I type this.  One second.........

Okay, now. I am surprised it is high (Well technically in target, but I personally shoot for single digits) Based on the recommendation I was 7.4 mmol before lunch  and 10.4 (3 mmol raise) so I guess I am being too hard on my self.

I still ask myself;   Did I count properly? (Carbs that is) I did eat 2 strawberries on steroids, well, I am not changing the rate yet and  I plan to leave it for a couple of days.

If I get the same reading tomorrow post lunch then I will heed the advice above and change the ratio accordingly.  Work, work, work, think, think, think, tis diabetes!

I think I may hit Cosco tonight and get some CGM sensors, but man they are 210 dollars. Ouch.

Once again I know a lot of my readers are well versed in pump management. Hopefully someone finds this review useful, I know I am.