December 21, 2005

A very practical survey

Some hands-on, nuts-and-bolts inquiries for anyone who uses insulin or cares for someone who does. Feel free to answer only some questions if you prefer. (Some apply only to pumpers or their parents.) Also, I realize that these questions should be discussed with a CDE or endo, which I plan to do. But I’m most interested in the responses of people who are contending with these questions in everyday life.

1. When you disconnect your pump for ½ hour to 1 hour, e.g. for showering, do you adjust for the missed basal insulin? If so, how—by increasing the basal for the next hour? Or do you give yourself a bolus of the missed insulin? Or some other way?

2. What’s your favorite reference for carb counting? And/or what suggestions do you have for building on a basic carb counting education to improve accuracy, especially in a restaurant situation?

3. What are your guidelines for bedtime snacking? Do you always snack if below a certain BG? What’s the BG number, and what kind of snack do you eat? If you’re supposed to snack but aren’t hungry, do you snack anyway? Does anybody try lowering their nighttime basal in lieu of snacking?

4. If you drink alcohol, describe what you drink and your strategy for use of insulin & food to minimize BG chaos. For example, if your drink contains carbs, do you use your standard carb bolus or a reduced one?

5. If you are a woman who takes estrogen, do you see an effect on your insulin resistance? For example, I have different carb ratios (less insulin) for the week when my BC pill is a placebo, and this past month I’ve noted that I’m going to have start lowering my basals that week too.

6. Does your correction factor vary at different times of day? How can one figure this out, given the dozen or so variables at play? Surely I’m not supposed to cause myself to go high at 9 a.m., noon, 3 p.m. etc. on different days to test my correction ratio?

Thanks for your input, everyone!

19 comments:

  1. 1) I disconnect for 10 minutes max, so no, I don't bother to replace the basal. I probably would if disconnected that long.

    2) EzManager and the labels on the food.

    3) I'm working on the evening snacking thing. Unfortunately that's my worse time of day to control food.

    4) I don't drink, sorry.

    5) I take depo. MUCH easier, I don't even see much of a change when I get the depo shot. I've been on Depo for over 15 years now, so I may be different than someone just on it. Haven't had a period in over 10 years. I also don't have the blood sugar fluctations.

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  2. I forgot the correction factor -- that doesn't vary much, but what DOES vary a lot during the time of day is bolus rates.

    Also basal rate. It's definately based on activity level though.

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  3. Thanks Kathleen! What is EZ Manager?

    I'm intrigued by the depo idea. I've been afraid to even consider it because I'd thought it might cause huge fluctuations and I'd be stuck with a 3-month shot. Will investigate further.

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  4. 1. When you disconnect your pump for ½ hour to 1 hour, e.g. for showering, do you adjust for the missed basal insulin? If so, how—by increasing the basal for the next hour? Or do you give yourself a bolus of the missed insulin? Or some other way?

    I usually test pre-disconnect. If I'm planning to be disconnected for more than 10-20 minutes or my bloodsugar is higher than say 135 prior to disconnect, I might replace the basal by giving a bolus of whatever the amount I would have missed is. (ie: My morning basal between 7-8 (usual time I shower) is .75. If I am disconnected for 20 minutes and my bloodsugar is +135, then I give a bolus of .2 or .3 to replace the basal I've missed.

    2. What’s your favorite reference for carb counting? And/or what suggestions do you have for building on a basic carb counting education to improve accuracy, especially in a restaurant situation?

    The Calorie King. It's a great book -- contains a number of ethnic and special foods -- and has a list of restaurants and their appetizers, entrees,etc. in the back. I've gotten to a point where I look at not only carbs, but the amount of sugar and fat in foods, and I'm able to make fairly accurate estimates of carbs/sugar/fat, even if I don't have a lable to read. My best advice on this front is to find a good dietician. One who will sit with you and explain how the foods work and hwo to best handle insulin for those foods.

    3. What are your guidelines for bedtime snacking? Do you always snack if below a certain BG? What’s the BG number, and what kind of snack do you eat? If you’re supposed to snack but aren’t hungry, do you snack anyway? Does anybody try lowering their nighttime basal in lieu of snacking?

    I do not eat a bedtime snack -- ever. In fact, I try not to eat after 8pm. I do test before I go to sleep and I do adjust my basals slightly if I'm lower than 100. I also keep very close track of my overnight basals and my fasting glucose numbers -- looking at them closely once a week to figure out if I need adjustments. Of course, it doesn't always work. I sometimes end up way low or too high in the AM and most of the time there's no explanation for it. It's like my body stages a revolt while I'm asleep.

    4. If you drink alcohol, describe what you drink and your strategy for use of insulin & food to minimize BG chaos. For example, if your drink contains carbs, do you use your standard carb bolus or a reduced one?

    If I drink, I usually drink juice with some vodka. I try not to eat while I'm drinking, so I usually have a good meal or snack before I start drinking. I test every hour to two hours while drinking. I bolus for only 1/2 the carbs I'm drinking -- really, 1/2 the carbs in the juice. If my bloodsugar is higher than 180 or lower than 75 when the night starts, I skip drinking altogether.

    5. If you are a woman who takes estrogen, do you see an effect on your insulin resistance? For example, I have different carb ratios (less insulin) for the week when my BC pill is a placebo, and this past month I’ve noted that I’m going to have start lowering my basals that week too.

    Have no information on this topic -- sorry.

    6. Does your correction factor vary at different times of day? How can one figure this out, given the dozen or so variables at play? Surely I’m not supposed to cause myself to go high at 9 a.m., noon, 3 p.m. etc. on different days to test my correction ratio?

    The first answer is yes. I have four different correction factors. And the second answer is yes -- the only way to figure out exactly what you need is to experiment. If you start where you are now, you shouldn't have too much trouble. I find the best way to look for patterns is to enter everything in an Excel spreadsheet. Then once a week, I download everything and create line graphs for each time of day that I test. That way I can see large fluctuations and make necessary adjustments. Also, different times of month and different days of the week (specifically weekdays versus weekend days) call for varying basals and correction factors...

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  5. Nicole, my vocabulary is failing me.

    Wow.

    There, that was impressive, wasn't it?

    Thanks for all this information. Your thoroughness is at once inspiring and overwhelming. As I was already overwhelmed anyhow, I'll focus on the inspiration.

    I think I need to import you to Brooklyn for a crash course. What are you doing for all of 2006?

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  6. On lunch hour, I'll keep these pretty terse -
    1. I shower before breakfast, so I usually ignore the disconnect and then add in any correction I may need with my breakfast bolus. If I disconnect at night for exercise (ahem) I just ignore the missed basal, as it's pretty low then (and I still have problems dropping overnight).
    2. labels, Corinne Netzer's food counts book, trial and error...
    3. this is in a state of flux. Currently I snack if I'm below 130, we're trying new basal rates so hopefully I will stop dropping 40-150 pts overnight....
    4. ok, I'm going to sound like a real boozer, but keep in mind these are not everyday items ;) wine with dinner - ignore. Beer with food - regular carb bolus (guinness = 10g). mixed drinks (toasted almonds - yum) a very reduced carb bolus and a lot of checking later...
    5. No estrogen
    6. Correction definitely varies, trial and error to find out.

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  7. Thanks, Violet. I guess 25 years with the disease has probably taught me a couple of things. To be completely honest, I've really buckled down over the past three years with my diabetes care. I was tired of feeling like crap. I already had a lot of information, but what I didn't have -- I got. And I put it all to use. Before that time -- my bloodsugars were like a totally out of control yo-yo...

    And, this week, I have been completely uninspiring -- in my own head anyway. I had a day of lows -- all day on Monday. In fact, I woke up and got out of bed and fell flat on the floor -- I have an enormously understanding boyfriend. I had a hard time staying above 80 for the duration of the day. Since I was due to check them anyway, I took at look at my overnight basals -- and lowered them slightly. Yesterday, I started my day with a grand bloodsugar of 475 -- I haven't been that high in over a year. And my sugars just wouldn't come down -- all day. I called the docs office to basically say "What the fuck?" He had me fax over my bloodsugars and told me I'd done everything right... Ah, yeah, OK... Well, he must have been right, because my bloodsugar was 112 this morning, 122 post-breakfast, and is 127 now (pre-lunch...) Sometimes I feel trapped in an uncooperative and angry vessel that is my body.

    Now that you've all got me addicted to this writing forum, I think I'll be stuck at my computer for all or most of 2006. If I can be of assistance AT ALL, let me know.

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  8. 1. When you disconnect your pump for ½ hour to 1 hour, e.g. for showering, do you adjust for the missed basal insulin? If so, how—by increasing the basal for the next hour? Or do you give yourself a bolus of the missed insulin? Or some other way?

    I'm usually not disconnected long enough to have to worry about that. If I were to be disconnected for longer than say a half hour I would probably do something about it.

    2. What’s your favorite reference for carb counting? And/or what suggestions do you have for building on a basic carb counting education to improve accuracy, especially in a restaurant situation?

    I also love the calorieking.com stuff. They have, by far, the most complete and up to date database for foods that I have ever found. I still struggle in restaurant scenarios though. But the other thing that is tough with restaurants is that it's usually those tricky foods (high fat, etc) anyways, which are hard for me to do.

    3. What are your guidelines for bedtime snacking? Do you always snack if below a certain BG? What’s the BG number, and what kind of snack do you eat? If you’re supposed to snack but aren’t hungry, do you snack anyway? Does anybody try lowering their nighttime basal in lieu of snacking?

    I eat all the damn time. It's never a matter of whether I'm hungry or not. Shame on me.

    4. If you drink alcohol, describe what you drink and your strategy for use of insulin & food to minimize BG chaos. For example, if your drink contains carbs, do you use your standard carb bolus or a reduced one?

    I'm with Kathy on this one. I just don't drink. Not because I think it's bad or anything, just never had a desire to do it.

    5. If you are a woman who takes estrogen, do you see an effect on your insulin resistance? For example, I have different carb ratios (less insulin) for the week when my BC pill is a placebo, and this past month I’ve noted that I’m going to have start lowering my basals that week too.

    When I take my estrogen I notice a lot of strange things happening... :-)

    6. Does your correction factor vary at different times of day? How can one figure this out, given the dozen or so variables at play? Surely I’m not supposed to cause myself to go high at 9 a.m., noon, 3 p.m. etc. on different days to test my correction ratio?

    I have one correction factor all day. Maybe my control is just so sloppy that I don't notice any slight fluctuations at different times. I've also usually got some food & insulin mixing around (see #3). It is a very individual thing though, and will be a matter of trial and error to get it nailed down.

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  9. 1. When you disconnect your pump for ½ hour to 1 hour, e.g. for showering, do you adjust for the missed basal insulin? If so, how—by increasing the basal for the next hour? Or do you give yourself a bolus of the missed insulin? Or some other way?

    I don't change anything for showering because I'm usually not disconnected over 45 minutes. If I'm disconnected over an hour, I just take the basal that I missed, which is usually around 1u.

    2. What’s your favorite reference for carb counting? And/or what suggestions do you have for building on a basic carb counting education to improve accuracy, especially in a restaurant situation?

    Well, I had a carb book when I was younger that I rarely read. I think we mostly stuck to carb labels, and then we would just transfer those carbs over to other food items when we went to restaurants. If it was slightly bigger than what I normally had at home, well, you guesstimate as well as you can and then check a couple of hours later and bolus a correction. My suggestion is basically the same as Nicole's: go visit a dietician. Also, take a look at the food that you eat at home. Spend time measuring and finding out what things look like on your plate and how they affect your blood sugars. Then when you get to the restaurant, do your best with estimating.

    3. What are your guidelines for bedtime snacking? Do you always snack if below a certain BG? What’s the BG number, and what kind of snack do you eat? If you’re supposed to snack but aren’t hungry, do you snack anyway? Does anybody try lowering their nighttime basal in lieu of snacking?

    I'm on the pump, so who cares what my blood sugar is or if I'm hungry or not? I'm not "supposed" to ever snack, but that doesn't mean I can't. Well, I suppose that's not true. If I'm under 85, I usually will take a swig of juice just to pop me back up to 100 and then I'll head to bed. Usually I will have a bedtime snack if I'm in the mood or still hungry, but if I'm a normal number, I'll just hit the sack.

    4. If you drink alcohol, describe what you drink and your strategy for use of insulin & food to minimize BG chaos. For example, if your drink contains carbs, do you use your standard carb bolus or a reduced one?

    I don't really drink very much (because I'm 20 and haven't been given much opportunity... I'm not going to needs lots of help next summer when I turn the big 2-1). However, when I do drink, my CDE has told me to take my basal back to 60% of what it normally is. I test after each drink and an hour after my last one, just to see where the BG is tracking. I take insulin if I'm drinking alcohol with sugar (like a screwdriver), but that's it. The 60% basal rate really seems to help, and the monitoring to make sure you're not going up too high or down too low.

    5. If you are a woman who takes estrogen, do you see an effect on your insulin resistance? For example, I have different carb ratios (less insulin) for the week when my BC pill is a placebo, and this past month I’ve noted that I’m going to have start lowering my basals that week too.

    I'm not on birth control, so I can't help you.

    6. Does your correction factor vary at different times of day? How can one figure this out, given the dozen or so variables at play? Surely I’m not supposed to cause myself to go high at 9 a.m., noon, 3 p.m. etc. on different days to test my correction ratio?

    My correction factor doesn't change. You can figure out your correction factor based on your average total daily insulin. I can't remember the formula, though... Anyway, you're supposed to start with that and then if your correction factor is bringing you down too far or not bringing you down enough when you have highs at certain times of the day, then you can make adjustments.

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  10. Thanks, everyone, for all this great information. I really appreciate it.

    I think I was pretty unclear in how I phrased the snack question. Currently, per Dr. Patronize, I'm supposed to have a snack of 15 g without insulin if I'm below 120 at bedtime to prevent nighttime lows. But what that means is that I'm climbing high as I go to sleep and then eventually coming down over the course of the night. Doesn't seem all that healthy to me. I'd like to review my nighttime basals, which are still very low until 5 AM, and see if I can adjust for the drop.

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  11. V. I hope this helps.

    1. I disconnect for my long showers. If my bloodsugar is over 120 mg/dl, I bolus as little as 0.3 units or whatever the actual correction should be. I also disconnect for intimacy. The timeframe for that varies (grinning) but it is physical activity, so if I’m 175 mg/dl or less, I just disconnect. Anything above that gets a little bolus. I disconnect when I’m at the gym as well, as long as my level is less than 200 mg/dl and I have no ketones.

    2. The Calorie King is the man for me. That, and he wears his crown on a jaunty little angle that melts my heart. In restaurant situations, I usually opt for the lowest carb items (i.e. substituting all vegetables for any potatoey sides, that sort of thing.) On most menus, there is a lower carb section with a food breakdown. But for nights when I’m not sticking to the diet, I pretty much wing it. I’ve been carb counting for a number of years, so I’ve done a lot of trial and error. I find that measuring some of my food at home helps me eyeball the portion sizes when I’m at a restaurant. That, and I always ask the waitress if the food has any secret glazes or sugars to it. I’m sure I get on their nerves sometimes, but as soon as I say “I’m a diabetic,” they get all smiley, tell me about their cousin who has it, and then they trot off to the kitchen to get me the info.

    3. Bedtime snacks are easier now that I’m on a pump. I don’t eat anything unless I’m under 100 mg/dl, and most times it’s some cottage cheese, yogurt, or fruit. Nothing too intense. And I usually eat dinner around 8 o’clock so I’ve still got a decent amount of food in me before bed. Bedtime snacks are minimal. But I’ve got my nighttime basals figured out (finally), so I can go to bed at 125 mg/dl and wake up at almost exactly the same. I do, however, have a basal kick up between 4 and 10 in the morning (courtesy of the elusive dawn phenomenon), so I’m always a little wary of going to bed unless I’m at least 100 mg/dl. Nighttime lows are the main reason I went on the pump and they make me very nervous. I’d rather run a little higher than experience that cold, dead sweat.

    4. I don’t drink very often. But when I do, I get good and trashed. (You wanted me to be honest, right?) When I party, I drink pretty much the same drink every time: my beloved madras. Vodka, cranberry juice, and orange juice. The juice brings me up enough to combat the alcohol once it decides to bring me lower. I test constantly when I drink and I stop drinking once I crest over 250 mg/dl or anything even close to 80 mg/dl. I use the same carb ratio when I drink because it’s extremely infrequent that I’m drinking with a meal. And my “drinking buddies” know exactly what to do in case of an emergency. They all know how to test me, bolus me, feed me, and humor me, because I can get rather … chatty when inebriated.

    5. I have been on the pill since I was 18 (that’s 8 years now) and I have never noticed much of a fluctuation in resistance. My “off week” does reflect slightly lower bloodsugars, but that is a recent development (over the last 2 months). If that continues, I’ll let you know. But for the most part, the only bloodsugar strangeness I experience that is menstrual related are some wacky lows two days before I get my period, which is the first day on the placebo pill … hmmm… maybe I do notice something. I will have to take copious notes on this over the next few months and see if there are any direct correlations.

    6. My carb ratio is 1:10 for the most part. Thank god, because I am certainly not known for my math skills. But I have noticed that I sort of need a 1:9 in the very beginning of my work day, but my endo attributes this to work stress. To figure this out, I used the book “Smart Pumping” published by the ADA. Then I made efforts to review the patterns in my bloodsugars – and that was a true trial because I am not so good (read: terrible) at keeping records – and test new ratios based on those patterns. The software that came with my One Touch Ultra meter is a godsend.

    K.

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  12. Thanks, K. I think I need to get a One Touch. And drink slightly more. And make a date with Calorie King...

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  13. Sorry for the late post but I have some things that may be helpful.

    1. When I re-connect I check BG and do a normal correction if necessary.

    2. My favorite reference for carb counting is the USDA food database. There is a program that runs on PC and one that runs on a Palm PDA. I have both of them. The program is difficult (for me) to find. You go to www.nal.usda.gov/fnic. Click on FNIC Resource List then Food Composition Resource List for Professionals then (way down the page) under United States click the link next to Nutrient Data Laboratory. Wait for the page to redirect and you can access the programs for this page. There is probabally an easier way to get there.

    3. I always snack even if I am 400.

    4. Alcohol lowers blood glucose so you need to be very careful. I think the guideline is to take 15g of carb to counteract the effect of one serving alochol.

    6. Mine is always the same. One unit of insulin for every 50 points over 140.

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  14. I'll add my 2 cents here :)

    1. We don't correct unless he's been off for more than 1/2 hour. We either replace the basal amount he missed, or we test and correct from that number.

    2. Calorie King. We have about 5 copies of the book that we keep in the car, my purse, home, etc.

    3. If he's below 100, we give him some juice and we cut his basal back 50% until midnight when his basal is too low to cut back. Anything over 100 we just cut back as I said.

    4. N/A

    5. N/A

    6. We've set 2 correction factors (1/120 6am-7pm and 1/150 7pm-6am). We've based this on past corrections and the results we've gotten. He needs a lot more insulin in the morning and much less at night.


    I know kids are different than adults, but the principles seem to be similar. Good luck with stabilizing :)

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  15. Alcohol does not effect my sugar levels while drinking.I eat before I drink. I usually have (6) 1.5 OZ. shots of vodka or 1 bottle of wine. Thats about 600 calories which is bad for the waistline. If its gonna make me low its usually the next day or 2. I just make adjustments for any physical activity the few days after. I always mix with diet pop or drink straight.

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  16. 1. When you disconnect your pump for ½ hour to 1 hour, e.g. for showering, do you adjust for the missed basal insulin? If so, how—by increasing the basal for the next hour? Or do you give yourself a bolus of the missed insulin? Or some other way?

    Yikes! Some of y'all sure do take long showers. Hee! i don't worry about showers (mine are never more than 10-15 minutes, which would equal about 0.15 units at most of "lost" insulin) but for exercise i often disconnect for the entire time, depending on what my bG was to begin with. i definitely replace that insulin (because i work out in the morning, before breakfast, so i bolus based on my carb intake for brekkie plus the so-called lost hour or so).

    2. What’s your favorite reference for carb counting? And/or what suggestions do you have for building on a basic carb counting education to improve accuracy, especially in a restaurant situation?

    Labels. Experimentation. One of these days i'm going to get the EZ Manager system for my Animas pump but things seem to be working pretty well with my current semilackadaisical routine, so i'm not in a big hurry.

    3. What are your guidelines for bedtime snacking? Do you always snack if below a certain BG? What’s the BG number, and what kind of snack do you eat? If you’re supposed to snack but aren’t hungry, do you snack anyway? Does anybody try lowering their nighttime basal in lieu of snacking?

    i often fiddle with my overnight basals (much to my dear endoc Dr. P's chagrin), depending on what i've had for dinner, and how my bGs are running. Also certain meds that i might be on can have bG-lowering effects, so i'm cognizant of that as well, and will have a snack accordingly (often something like organic-no-sugar-added crunchy peanut butter, my fave), to keep me level throughout the night. A quick-acting carb is usually deadly for me before bed, unless of course i'm low to begin with. But more often than not, i'm likely to adjust my basal rather than have a snack. This is tricky, though, and requires some care. Even after 44 years of DM, i'm still fortunate enough to wake up with lows (thank God and knock on wood). i imagine hypoglycemic unawareness would make my bedtime and overnight regimen rather problematic.

    4. If you drink alcohol, describe what you drink and your strategy for use of insulin & food to minimize BG chaos. For example, if your drink contains carbs, do you use your standard carb bolus or a reduced one?

    i drink every night and i always have the same thing, and have for as many years as i can remember. 90 proof vodka and diet tonic water. i monitor my bGs carefully when out and drinking, but mostly i don't go low. i have never been able to tolerate mixed drinks that add sugar and in fact the extra carbs have always weirded things out much more than they have helped.

    5. If you are a woman who takes estrogen, do you see an effect on your insulin resistance? For example, I have different carb ratios (less insulin) for the week when my BC pill is a placebo, and this past month I’ve noted that I’m going to have start lowering my basals that week too.

    The only estrogen i take at this point is via transdermal HRT and it seems not to have an effect on bGs so far. i went menopausal at age 41, am 51 now, and on the lowest possible dose of HRT.

    6. Does your correction factor vary at different times of day? How can one figure this out, given the dozen or so variables at play? Surely I’m not supposed to cause myself to go high at 9 a.m., noon, 3 p.m. etc. on different days to test my correction ratio?

    Yes, i think i have three or four different correction factors. Four. Yeah, that's it. As i believe has been pointed out, it's the old Thomas Edison/Marie Curie/name your fave scientist thang: experiment!

    Jedi Vi, drop in at "Pins and Needles" sometime, willya? It sure has been quiet there of late. But we passed the 10,000-post mark sometime back so our original thread will be archived eventually and we've started a continuation thread called "More Pins and Needles." We've missed you!

    -tippy

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  17. Hey Vi. Late to the party, but here are my answers.

    1. I do not make up missed basals for my morning shower. My basal is much higher than yours (I range from 1.1 to 2.0 throughout the day). I test when I first wake up and will correct when needed. I have a natural rise after I get out of bed, too. I just don't think shower time is enough insulin to worry about. for other times of day, I just follow my regular testing and correcting routine--intimacy is awkward enough with the pump, so I don't make a point of testing right before or after.

    2. I use calorie king, too. I cook a lot and eat at restaurants that are not chains (and thus not in the book). I have an ok sense of portion size of raw ingredients, and what might be in a dish. I never ask special questions or announce I am diabetic at a restaurant--I am too self conscious. My theory--estimate as best you can, then correct later. I have worked closely with a dietician and I also have ratios to increase my boluses for fat and protein. It's the fat in restaurant meals that I am learning to always assume is there, and bolus accordingly.

    3. Bedtime snacking. I don't do it unless I am low enough to treat anyway. I have experimented with moderate success with lowering my basals when I am lower than I would like, depending on when I ate (dinner is late) when is bedtime, etc. I have an erratic schedule.

    4. Alcohol. I always eat when I drink, which has more to do with the effect of alcohol generally than on bGs. I will bolus for 50-75% of carbs, depending on my bg at the time. I try to drink martinis--no added sugar--or wine, but I drink beer and other stuff as well. If I have more than 2 glasses of wine, I am learning that my bg rises much more in the middle of the night. haven't figured out a solution yet. I keep to my regular testing schedule. If it's a party or some event where it is likely that I will be drinking more than my typical 1-2 glasses, I will definitely bolus less--would rather be high than low in that situation.

    5. don't take estrogen.

    6. my correction factor varies between day and nighttime. the nighttime factor is lower in part because of caution from my CDE and dietician--not wanting to cause an overnight low. it's trial and error and I can't say it's perfect now.

    Shelley B from TT

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  18. 1. I give myself a bolus right after the shower for the amount missed.

    2. I use this equation (which my pump does automatically): grams of carbs/15 = units of insulin needed.

    3. I don’t do nighttime snacking unless my blood sugar is actually low. I have set my basal rate so that my BS should not change during the night.

    4. I rarely drink.

    5. I am not a woman. :)

    6. I think that I need more insulin to correct in the morning. This is not always the case, though. I think it depends on the kinds of foods that I eat and what time I eat them. I have not found a simple solution.

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  19. 1. Showering: Before disconnecting, I estimate (on the low side) how much basal I'll miss, and I take that much as a Fixed Prime. Fixed prime doesn't show up on the total daily dose, so it keeps that in line. I then note the total daily dose, and compare when I reconnect, and if it's over the original reading + the amount I took by fixed prime (usually 0.3U), I take the additional amount.

    2. Carb reference: Since I accidentlly washed my PDA in the laundry a while back, and can't really afford to replace it, I refer everything back to things from nutritional labels I've memorized. A Ritz cracker is 2g. The ice cream I eat is 8.1 g / oz. (Mixed units because my scale is in oz, not g, sigh). A McDonald hamburger is 33 g. A slice of whole wheat bread is 19 g. etc.

    3. Bedtime snacking: My basals are set carefully for the overnight, and if I don't screw up, my glucose levels stay stable. So I project (based on when I last ate and bolus insulin on board) where I'll end up. If that's below 100 mg/dL, I'll snack or reduce basal. Usually snack, since I'm trying to maintain or gain weight, but tonight I cut 1/2 of basal.

    4. I don't drink.

    5. I'm a man who takes just about every steroid hormone besides estrogen. OK, that's an exageration -- but I replace cortisol (aka hydrocortisone), aldosterone (using fludrocortisone), DHEA (all adrenal steroids) and testosterone, not to mention vitamin D3, which is related. The effects of sex hormones is lost in the noise compared to the effects of hydrocortisone, which pushes my basal up from around 0.35 U/hr to 1.9 U/hr. I haven't noticed any insulin resistance from the testosterone.

    6. Correction factors: I used to keep a different correction factor (1 U : 100 mg/dL) for nighttime, but after I had to use it a few times, I eliminated it, and use 1 U : 80 mg/dL everywhere.

    However -- I find that if the correction is due to a basal rate that's too low -- as opposed to a miscalculated meal bolus -- that I have to allow for the missing bolus that hasn't had a chance to raise my BG yet. That is, it takes more to correct a basal problem than a bolus problem. If I need to correct by 0.3 U, and the problem has developped over the last 4 hours, that's about a 0.1 U/hr error, with about 1/2 of the problem over the last 2 hours not yet shown up. So I correct by 0.4 U, and (if the reason for the higher basal persists) adjust my basal rate up by 0.1 U/hr for a while.

    But you have to be sure you know it's a basal problem, and test often enough to know how long ago the basal problem begain. Often you can't tell whether it was the basal or the meal.

    If you need different corrections at different times of the day, you might consider that some of your corrections are due to basal problems. If you fix the basal problem, your corrections may behave more consistently.

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