Sudden increase in insulin requirements

Radioactive Man wrote in message ...

Quoted message said:

I am a 31 year old male with type 1 and I've been using insulin a little over 3 months now.
Until the last week, my doses have been fairly steady at about 1 unit of regular or fast-acting
per 30 g carbs
+ 6 or 8 units of lantus at bedtime. About a week ago, I started getting the flu (with a few days
of mild fevers and lethargy) and found that I had to keep increasing my insulin dose in order to
get the same results as before. At this point, my insulin dose is roughly double what it has
been. I'm still having the nasal congestion, coughing, runny nose, and other symptoms one
normally gets while recovering from the flu, but I believe the worst it over, but still needing
more insulin than before. Of all the following possible explanations for needing more insulin,
what is most likely?

(1) Increased secretion of counter-regulatory hormones due to infection?

(2) Sudden death of many residual beta cells triggered by infection?

(3) Insulin resistance?

(4) Insulin antibodies?

When I have a cold, flu bug, or undergo the stress of surgery, my insulin requirements just about
sky-rocket.

Some examples:

a. The last time I had a cold, I had to increase my insulin to an extent "calculated" to
compensate for the equivalent of about 180 gram of glucose during the daylight hours.

A dose of 180 gram of glucose is equivalent to 360 gram of table sugar, or about a lb of home-made
candy. IOW, a cold had the same effect as eating a lb of candy during daylight hours.

b. The last time I had surgery, I ended up doubling my insulin and halving my carb intake.
That let me cycle between about 130 and 180 mg/dL [whoopee :>( ] However that was a level
of control superior to anything the head nurse had seen before in an orthopedic T1
following surgery.

As to the reasons, the obvious one is (1). . .counter-regulatory hormones.

However, before the bug, you were using about half the amount of insulin a fully-developed adult-
onset T1 would be expected to use. The behavior of your immune system as it goes after your
remaining betas is more or less a [censored] shoot.

It took somewhere between 3 and 5 years to finish off mine. We have had posters who report 6-month
honeymoons (honeymoon: the period in which the 20% of their betas remaining after initial diagnosis
are finally destroyed). You could very well be experiencing a surge of destruction on top of the
counter-regulatory effect. You will find out in a week or so as the effects of the bug dwindle.

FWIW, you will probably end up somewhere around 0.5 units per day per kg body weight at the end of
the honeymoon.

AFAIK, the surge in T1 insulin requirements which accompany stress are not caused by surges in
Insulin Resistance (I.R. doesn't surge, it creeps), or surges in insulin antibodies. (AFAIK, another
"creep" phenomenon).

I also assume that your term "Insulin Antibodies" refers to antibodies which tie up insulin rather
than the antibodies which attack betas.

Regards
Old Al

you bg's probably increased due to the flu. that will subside. Another factor to consider is that
when you are first diagnosed, your insulin requirements may fluctuate (you may need more insulin as
your disease progresses over time).

I was diagnosed and put on insulin the very next day. I was given a "maintenance dose" of 7 units
per day--a combo of short and long acting. I got very hypo the first day, so obviously my insulin
requirements, starting out were quite low. Then, within 6 months, I got off insulin. I kept checking
for ketones while off insulin, as I was warned it was a temporary condition. Sure enough, after
about 3 months I started spilling ketones and went back on insulin. The dose needed was higher. As
time went on the dose went up, up, up.

Now, being on a pump, and not pigging out as much, my insulin intake is lower than on MDI. On some
days I've had as much as 110 units. Most of the time I take 33-37 units. If I go out for large meal,
add an extra 15 or more to cover the extra carbs and fat.

I don't get sick often, but when I do, my insulin requirements go up substantially. An infection
will cause your bg to raise, just as the flu will.

Don't be as concerned about knowing what the exact mechanism is, as in learning to anticipate the
rise and deal with it effectively.

dave

Radioactive Man said:

I am a 31 year old male with type 1 and I've been using insulin a little over 3 months now.
Until the last week, my doses have been fairly steady at about 1 unit of regular or fast-acting
per 30 g carbs
+ 6 or 8 units of lantus at bedtime. About a week ago, I started getting the flu (with a few days
of mild fevers and lethargy) and found that I had to keep increasing my insulin dose in order to
get the same results as before. At this point, my insulin dose is roughly double what it has
been. I'm still having the nasal congestion, coughing, runny nose, and other symptoms one
normally gets while recovering from the flu, but I believe the worst it over, but still needing
more insulin than before. Of all the following possible explanations for needing more insulin,
what is most likely?

(1) Increased secretion of counter-regulatory hormones due to infection?

(2) Sudden death of many residual beta cells triggered by infection?

(3) Insulin resistance?

(4) Insulin antibodies?

On Fri, 31 Oct 2003 07:46:18 -0500, "oldal4865" <[email hidden]>

Quoted message said:

Radioactive Man wrote in message ...

Quoted message said:

I am a 31 year old male with type 1 and I've been using insulin a little over 3 months now.
Until the last week, my doses have been fairly steady at about 1 unit of regular or fast-acting
per 30 g carbs
+ 6 or 8 units of lantus at bedtime. About a week ago, I started getting the flu (with a few days
of mild fevers and lethargy) and found that I had to keep increasing my insulin dose in order to
get the same results as before. At this point, my insulin dose is roughly double what it has
been. I'm still having the nasal congestion, coughing, runny nose, and other symptoms one
normally gets while recovering from the flu, but I believe the worst it over, but still needing
more insulin than before. Of all the following possible explanations for needing more insulin,
what is most likely?

(1) Increased secretion of counter-regulatory hormones due to infection?

(2) Sudden death of many residual beta cells triggered by infection?

(3) Insulin resistance?

(4) Insulin antibodies?

When I have a cold, flu bug, or undergo the stress of surgery, my insulin requirements just
about sky-rocket.

Some examples:

a. The last time I had a cold, I had to increase my insulin to an extent "calculated" to
compensate for the equivalent of about 180 gram of glucose during the daylight hours.

A dose of 180 gram of glucose is equivalent to 360 gram of table sugar, or about a lb of home-made
candy. IOW, a cold had the same effect as eating a lb of candy during daylight hours.

But were the increases more on the basal rate or with the pre-meal boluses?

Quoted message said:

b. The last time I had surgery, I ended up doubling my insulin and halving my carb intake. That
let me cycle between about 130 and 180 mg/dL [whoopee :>( ] However that was a level of
control superior to anything the head nurse had seen before in an orthopedic T1 following
surgery.

As to the reasons, the obvious one is (1). . .counter-regulatory hormones.

However, before the bug, you were using about half the amount of insulin a fully-developed adult-
onset T1 would be expected to use. The behavior of your immune system as it goes after your
remaining betas is more or less a [censored] shoot.

It took somewhere between 3 and 5 years to finish off mine. We have had posters who report 6-month
honeymoons (honeymoon: the period in which the 20% of their betas remaining after initial
diagnosis are finally destroyed). You could very well be experiencing a surge of destruction on
top of the counter-regulatory effect. You will find out in a week or so as the effects of the bug
dwindle.

About two weeks ago, when I went to be screened for a clinical trial, I ended up having to fast from
supper one evening until lunch the next day and also had skipped the evening's dose of lantus. I
believe my blood sugar was in the low 100's the evening before the test, 95 at 7 AM, 115 at 9:30 AM,
and then back to 95 at 11:30 AM. That means I was experiencing the dawn effect, but at the same
time, my pancreas was still making enough insulin to cover it. From what I've read, most type 1's
use 30 - 40% of their insulin as the basal dose, whether on pumps or multiple injections. If we
assume that all my remaining beta cells suddenly died a week ago, then my insulin requirements
should only have increased by 42 - 67%. Thus, beta cell death alone does not entirely account for
the change, but certainly could be contributing to a large proportion of it.

Last time I had a flu-like sickness was late July, which was the same time I discovered I had a
serious blood sugar problem - I had been having symptoms all day at work, came home, checked my
blood sugar for the first time and found it to be 306. I had physical results from several weeks
before showing 215, but I was very skeptical of the result at first. Thus, I would say that in my
case, the flu-like sickness actually caused the death of some beta cells.

Quoted message said:

FWIW, you will probably end up somewhere around 0.5 units per day per kg body weight at the end of
the honeymoon.

That would put me at about 42 units per day. Over the last few days, I've used about 31 units per
day, depending on activity level and carb intakes. As for the issue of insulin sensitivity /
resistence, I should theoretically fall on the low resistance / high sensitivity end of the spectrum
because I am highly active. At this time of year, I normally swim about 10,000 yds per week and run
about 20 miles per week when I am not sick. I always cut the insulin dose a bit for the meal
immediately after exercise, but that effect of increased sensitivity only lasts a few hours.

Quoted message said:

AFAIK, the surge in T1 insulin requirements which accompany stress are not caused by surges in
Insulin Resistance (I.R. doesn't surge, it creeps), or surges in insulin antibodies. (AFAIK,
another "creep" phenomenon).

I also assume that your term "Insulin Antibodies" refers to antibodies which tie up insulin rather
than the antibodies which attack betas.

Correct. That is what I meant. Do these antibodies actually destroy the insulin, or just tie it up
and delay its effect?

Quoted message said:

Regards
Old Al

Thanks for info. I've always appreciated the helpful responses I get here.

On Fri, 31 Oct 2003 14:44:03 GMT, Bay Area Dave <[email hidden]>

Quoted message said:

you bg's probably increased due to the flu. that will subside. Another factor to consider is that
when you are first diagnosed, your insulin requirements may fluctuate (you may need more insulin as
your disease progresses over time).

I was diagnosed and put on insulin the very next day. I was given a "maintenance dose" of 7 units
per day--a combo of short and long acting. I got very hypo the first day, so obviously my insulin
requirements, starting out were quite low. Then, within 6 months, I got off insulin. I kept
checking for ketones while off insulin, as I was warned it was a temporary condition. Sure enough,
after about 3 months I started spilling ketones and went back on insulin. The dose needed was
higher. As time went on the dose went up, up, up.

Ketones? Was this before they had portable blood sugar testers? I would expect most doctors now
would have their patients in that situation to check their blood sugar once a day, week, etc., or
whenever they start feeling crappy.

Quoted message said:

Now, being on a pump, and not pigging out as much, my insulin intake is lower than on MDI. On some
days I've had as much as 110 units. Most of the time I take 33-37 units. If I go out for large
meal, add an extra 15 or more to cover the extra carbs and fat.

Your normal dose is about what I've been using on MDI over the last few days.

The worst readings I've had have been with moderate to large mixed meals. Yesterday, I saw my blood
sugar go from low 100's 1 hour after lunch, 130's 2 hours after, and then 155 three hours
afterwards, using regular insulin, then eating pizza. In my case, the peak is normally at 2 hours,
so I injected 2 units of novolog to bring it down again. I think I also made the mistake of waiting
too long after injecting to eat and was feeling hypoglycemic symtoms while I ate. I think this may
have contributed to the counter-regulatory effect, thus wasting some of the insulin I had injected.

As a temporary solution to this problem, I've decided to try eating carbs and fat in separate meals
and snacks. That way, the food I'm eating digests and metabolizes more predictably. My reason for
this is that I've had good control in the mornings after eating a no-fat breakfast of whole wheat
pancakes and a low-carb whey protein shake and I've also done well with low carb meals of meat,
vegetables, and nuts.

Quoted message said:

I don't get sick often, but when I do, my insulin requirements go up substantially. An infection
will cause your bg to raise, just as the flu will.

Don't be as concerned about knowing what the exact mechanism is, as in learning to anticipate the
rise and deal with it effectively.

dave

Thanks for info.

Radioactive Man wrote in message ...

Quoted message said:

oldal4865 said:

. . .(snip). . .
. IOW, a cold had the same effect as eating a lb of candy during daylight hours.

But were the increases more on the basal rate or with the pre-meal boluses?

Quoted message said:

Quoted message said:

>(snip). . .

Last time I had a flu-like sickness was late July, which was the same time I discovered I had a
serious blood sugar problem - I had been having symptoms all day at work, came home, checked my
blood sugar for the first time and found it to be 306. I had physical results from several weeks
before showing 215, but I was very skeptical of the result at first. Thus, I would say that in my
case, the flu-like sickness actually caused the death of some beta cells.

(snip). . .Do these antibodies actually destroy the insulin, or just tie it up and delay
its effect?

Three areas I can comment on:

1. Most diabetics don't compensate by changing their bolus dose when encountering stress, or any
other temporary need for more insulin. Most of these factors don't affect our basal doses
anyway. We handle short term problems with added bolus.

Establishing a workable bolus regime is about the hardest part of T1 insulin therepy. Once we've got
one, we don't fiddle with it!

2. For a T1 with a flu-like sickness, a surprise 306 blood sugar is actually an expected event (I
hope you immediately shot some fast-acting insulin to knock that 306 down).

Also, for a T1, a reading of 215-when-not-afflicted-with-stress is entirely consistent with a
reading of 306 when-under-stress. IOW, the higher reading does not constitute evidence of death of
additional beta cells.

You're still making a lot of insulin and I would imagine your control is excellent. Fully-developed
T1 don't have the remnants of a suberb automatic regulation system helping out and thus experience
swings like that often.

An error of only two units, bounces us up by a 100 mg/dL. It's easy to string together a series of
small, almost trivial errors in technique or calculation and end up at 306 mg/dL. . .or 215 mg/dL.

3. Antibodies and insulin: It appears that most insulin-antibodies merely "tie it up", then slowly
release it.
e.g.:

Beef insulin is prized among many diabetics because it has a very slow
action, i.e. it makes the best basal. There is evidence that the beef
insulin, as a foreign protein, is acted on by antibodies which temporarily
hold it, then slowly release it, thus accounting for the very slow action.

Regards
Old Al

sounds familiar. like when I was on MDI. I'd wait 'til I was hypo to eat, thinking that was the
smart thing to do. I'd wolf down my food, overeat, feel like [censored], and then later on I'd get high
anyway. Sometimes I'd take a corrective shot (Regular) and then get low later! My timing was all
wrong. thank God for pumps (and MiniMed too...)

Radioactive Man wrote: snip

Quoted message said:

Ketones? Was this before they had portable blood sugar testers? I would expect most doctors now
would have their patients in that situation to check their blood sugar once a day, week, etc., or
whenever they start feeling crappy.

I didn't have a meter back then. All I had were those stupid Tes-Tapes (urine testing).

If you only went to 155 after pizza, I'd say you are remarkably well controlled! 🙂

dave

oldal4865 , who awoke from a deep sleep 30 minutes ago, and who yet may be sleeping, wrote in
message ...

Quoted message said:

Quoted message said:

Establishing a workable bolus regime is about the hardest part of T1 insulin therepy. Once we've
got one, we don't fiddle with it! Regards Old Al

when I actually meant to say:

Establishing a workable BASAL regime is about the hardest part of T1 insulin therepy. Once we've got
one, we don't fiddle with it!

Regards
Old Al

On Sat, 1 Nov 2003 06:51:54 -0500, "oldal4865" <[email hidden]>

Quoted message said:

Radioactive Man wrote in message ...

Quoted message said:

oldal4865 said:

. . .(snip). . .
. IOW, a cold had the same effect as eating a lb of candy during daylight hours.

But were the increases more on the basal rate or with the pre-meal boluses?

Quoted message said:

> >(snip). . .

Last time I had a flu-like sickness was late July, which was the same time I discovered I had a
serious blood sugar problem - I had been having symptoms all day at work, came home, checked my
blood sugar for the first time and found it to be 306. I had physical results from several weeks
before showing 215, but I was very skeptical of the result at first. Thus, I would say that in my
case, the flu-like sickness actually caused the death of some beta cells.

(snip). . .Do these antibodies actually destroy the insulin, or just tie it up and delay
its effect?

Three areas I can comment on:

1. Most diabetics don't compensate by changing their bolus dose when encountering stress, or any
other temporary need for more insulin. Most of these factors don't affect our basal doses
anyway. We handle short term problems with added bolus.

Establishing a workable bolus regime is about the hardest part of T1 insulin therepy. Once we've
got one, we don't fiddle with it!

2. For a T1 with a flu-like sickness, a surprise 306 blood sugar is actually an expected event (I
hope you immediately shot some fast-acting insulin to knock that 306 down).

That was actually the day I realized I had a problem and several weeks before I started on insulin.
I really didn't notice the flu-like symptoms until several days later. I actually brought that down
to the 140's by going out and running 3 miles very slowly and drinking lots of water, then cutting
most of the carbs out of my diet. I went to the ER that night, told them what had happened. They ran
a few tests, sent me home, just telling me I needed to watch what I eat.

Quoted message said:

Also, for a T1, a reading of 215-when-not-afflicted-with-stress is entirely consistent with a
reading of 306 when-under-stress. IOW, the higher reading does not constitute evidence of death of
additional beta cells.

You're still making a lot of insulin and I would imagine your control is excellent. Fully-developed
T1 don't have the remnants of a suberb automatic regulation system helping out and thus experience
swings like that often.

And that is the reason I'm trying to get into the Diapep277 clinical trial (it is supposed to
preserve remaining beta cells). The real [censored] about my situation is that I cannot yet buy the stuff
and I'm facing a 50% chance of getting a placebo, since it is only a phase 2 study (pretty much a
repeat of what was done in Israel several years ago). All I can do is control it as best I can on
insulin alone while the drug companies jump through all the hoops for the FDA.

Quoted message said:

An error of only two units, bounces us up by a 100 mg/dL. It's easy to string together a series of
small, almost trivial errors in technique or calculation and end up at 306 mg/dL. . .or 215 mg/dL.

3. Antibodies and insulin: It appears that most insulin-antibodies merely "tie it up", then slowly
release it.
e.g.:

Beef insulin is prized among many diabetics because it has a very slow
action, i.e. it makes the best basal. There is evidence that the beef
insulin, as a foreign protein, is acted on by antibodies which temporarily
hold it, then slowly release it, thus accounting for the very slow action.

Regards
Old Al

On Sat, 01 Nov 2003 16:25:18 GMT, Bay Area Dave <[email hidden]>

Quoted message said:

sounds familiar. like when I was on MDI. I'd wait 'til I was hypo to eat, thinking that was the
smart thing to do. I'd wolf down my food, overeat, feel like [censored], and then later on I'd get high
anyway. Sometimes I'd take a corrective shot (Regular) and then get low later! My timing was all
wrong. thank God for pumps (and MiniMed too...)

Radioactive Man wrote: snip

Quoted message said:

Ketones? Was this before they had portable blood sugar testers? I would expect most doctors now
would have their patients in that situation to check their blood sugar once a day, week, etc., or
whenever they start feeling crappy.

I didn't have a meter back then. All I had were those stupid Tes-Tapes (urine testing).

If you only went to 155 after pizza, I'd say you are remarkably well controlled! 🙂

The problem is that even at 155, I am frequently visiting the water fountains and bathrooms and
feeling a bit crappy - the same symptoms I used to get before I started using insulin and was having
numbers in the 200's. The thirst and frequent peeing can be a nuisence for me at work if I am
dressed out in protective clothing and working in a contaminated area. I am going to see if I can
cut back on the lunchtime carbs to solve the peeing problem. Hopefully, it won't impact my swimming
too much since I'll still be getting plenty of carbs in other meals and snacks.

Quoted message said:

dave

On Sat, 1 Nov 2003 06:51:54 -0500, "oldal4865" <[email hidden]>

Quoted message said:

You're still making a lot of insulin and I would imagine your control is excellent. Fully-developed
T1 don't have the remnants of a suberb automatic regulation system helping out and thus experience
swings like that often.

An error of only two units, bounces us up by a 100 mg/dL. It's easy to string together a series of
small, almost trivial errors in technique or calculation and end up at 306 mg/dL. . .or 215 mg/dL.

Quoted message said:

Regards
Old Al

I'm still making a fair amount of insulin, and understanding that is the main difference between my
new consultant and the old one. The old one was horrified at an HbA1c of 5.3, the new one looked at
the new number of 4.9 (and no big hypos!) and decided to see how much insulin I was still making -
over half of normal according to the test results.

Still waiting on the test results to tell me if I am type 1 and in honeymoon, or what else is going
on. I am so not looking forward to becoming a fully developed T1.

Sarah

PS Rosie is now trying diet and exercise, and has not needed insulin for 3 weeks - the vet is
astounded.

--
Cheshire, UK Type 1 dx 06/01/03 Humalog + Lantus (Rosie the chinchilla Type 2 dx 12/03/03
beef lente)

actually Al,

I'm kinda stressed beyond my max. I called my endo the other day to see what he wanted me to do,
since i'm pumping, he suggests to change to a new BASAL rate at a few different times, I think there
is a bit of a difference between not screwing with your basal on MDI as there is with pumping. iirc
Radioactive man is a pumper?

Which btw, the rates he told me to change to have worked, which was only .1u up.

rk

"oldal4865" <[email hidden]> wrote in message -"]news:[email hidden]-
berlin.de...

Quoted message said:

oldal4865 , who awoke from a deep sleep 30 minutes ago, and who yet may

be

Quoted message said:

sleeping, wrote in message ...

Quoted message said:

Quoted message said:

Establishing a workable bolus regime is about the hardest part of T1 insulin therepy. Once we've
got one, we don't fiddle with it! Regards Old Al

when I actually meant to say:

Establishing a workable BASAL regime is about the hardest part of T1 insulin therepy. Once we've
got one, we don't fiddle with it!

Regards
Old Al

Sarah said:

oldal4865 said:

You're still making a lot of insulin and I would imagine your control is excellent. Fully-
developed T1 don't have the remnants of a suberb automatic regulation system helping out and thus
experience swings like that often.

An error of only two units, bounces us up by a 100 mg/dL. It's easy to string together a series of
small, almost trivial errors in technique or calculation and end up at 306 mg/dL. . .or 215 mg/dL.

Quoted message said:

Regards
Old Al

I'm still making a fair amount of insulin, and understanding that is the main difference between my
new consultant and the old one. The old one was horrified at an HbA1c of 5.3, the new one looked at
the new number of 4.9 (and no big hypos!) and decided to see how much insulin I was still making -
over half of normal according to the test results.

Still waiting on the test results to tell me if I am type 1 and in honeymoon, or what else is going
on. I am so not looking forward to becoming a fully developed T1.

Do a google search on Diapep277 and interferon alpha - both of these are either being used in
clinical trials or have been, the purpose being to prevent destruction of remaining beta cells.

Quoted message said:

Sarah

PS Rosie is now trying diet and exercise, and has not needed insulin for 3 weeks - the vet is
astounded.

Sarah wrote in message <[email hidden]>...

Quoted message said:

I'm still making a fair amount of insulin, and understanding that is the main difference between my
new consultant and the old one. The old one was horrified at an HbA1c of 5.3, the new one looked at
the new number of 4.9 (and no big hypos!) and decided to see how much insulin I was still making -
over half of normal according to the test results.

Still waiting on the test results to tell me if I am type 1 and in honeymoon, or what else is going
on. I am so not looking forward to becoming a fully developed T1.

Sarah

For what it's worth:

a. The average T2 has about 50% of their insulin capacity remaining at the time of diagnosis.

b. The average T1 has about 20% of their insulin capacity remaining at the time of diagnosis.

c. If you are T2, remember that metformin is an anti-Diabetic Heart Attack med as well as a bG
med, and premature heart attack is the primary problem faced by most T2.

Regards
Old Al

RK wrote in message ...

Quoted message said:

actually Al,

I'm kinda stressed beyond my max. I called my endo the other day to see what he wanted me to do,
since i'm pumping, he suggests to change to a new BASAL rate at a few different times, I think
there is a bit of a difference between not screwing with your basal on MDI as there is with
pumping. iirc Radioactive man is a pumper?

Which btw, the rates he told me to change to have worked, which was only .1u up.

rk

You pumpers can pull off those basal adjustments a lot easier than we MDI'ers. I probably
make 0.1u/hour changes every couple of days or so just by changing injection sites, or not
clearing a bubble in the syringe. . .and I am probably more finicky with my basal than 90% of
the other shooters.

You bring up an interesting topic however. AFAIK, an MDI picks a basal which is high enough to avoid
the liver dump at the end of the absorbence period, but low enough to avoid a hypo or low at the
peak. That is a very broad range. We aren't really trying to optimize our basal, just stay out of
trouble. The pumpers are the first insulin users who can actually try to pick a basal which does
something useful for them instead of just avoiding trouble.

I've got a pumpers' book and am going to start looking into this. So far, I haven't seen any
references which help one pick a "useful" basal rather than a "stay out of trouble" basal.

Radioactive is on MDI (Regular(?) + Lantus )

Regards
Old Al

Radioactive Man said:

Sarah said:

I'm still making a fair amount of insulin, and understanding that is the main difference between
my new consultant and the old one. The old one was horrified at an HbA1c of 5.3, the new one
looked at the new number of 4.9 (and no big hypos!) and decided to see how much insulin I was
still making - over half of normal according to the test results.

Still waiting on the test results to tell me if I am type 1 and in honeymoon, or what else is
going on. I am so not looking forward to becoming a fully developed T1.

Do a google search on Diapep277 and interferon alpha - both of these are either being used in
clinical trials or have been, the purpose being to prevent destruction of remaining beta cells.

Diapep277 sounds great, but its only at the test stage, and seeing as the tests are Jerusalem and US
based I'm outa luck. I think I'd be unacceptable anyway, its nearly a year since dx, and they're
working on since-under-6-month people only.

Interferon alpha - I think my mother was in a test study for this (MS, not diabetes), and it was
useless for her so she chucked about a months worth of meds away. Looking at bits on the web, again,
its early days and they're only working on since-under-6-WEEKS dx'd people.

I think by the time either of these are ready for use in the UK, there'll be very little of my beta
cells left.

Sarah

--
Cheshire, UK Type 1 dx 06/01/03 Humalog + Lantus (Rosie the chinchilla Type 2 dx 12/03/03
beef lente)

"oldal4865" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

AFAIK, an MDI picks a basal which is high enough to avoid the liver dump

at the end of the absorbence period, but low enough to avoid a hypo or low at the peak. That is a
very broad range. We aren't really trying to optimize our basal, just stay out of trouble.

Quoted message said:

Hmmm. I wonder if this isn't the general approach I'm taking to my bg control. I'm on d&e. I know I
could do better on the "d", & I could add more (some?) weight-training work to the "e", but the
routine I have is livable, doable without too much trouble, reasonably non-deprivation & at times
enjoyable ('specially some of the running days). I hope to "stay out of trouble" (stave off
complications) even if my bg isn't always at the levels some here would like to be at (e.g. pp not
always optimal, but at least I don't have really *nasty* spikes, at least hardly ever). bj

On Sun, 2 Nov 2003 09:29:00 -0500, "oldal4865" <[email hidden]>

Quoted message said:

RK wrote in message ...

Quoted message said:

actually Al,

I'm kinda stressed beyond my max. I called my endo the other day to see what he wanted me to do,
since i'm pumping, he suggests to change to a new BASAL rate at a few different times, I think
there is a bit of a difference between not screwing with your basal on MDI as there is with
pumping. iirc Radioactive man is a pumper?

Which btw, the rates he told me to change to have worked, which was only .1u up.

rk

You pumpers can pull off those basal adjustments a lot easier than we MDI'ers. I probably make
0.1u/hour changes every couple of days or so just by changing injection sites, or not clearing
a bubble in the syringe. . .and I am probably more finicky with my basal than 90% of the other
shooters.

You bring up an interesting topic however. AFAIK, an MDI picks a basal which is high enough to
avoid the liver dump at the end of the absorbence period, but low enough to avoid a hypo or low at
the peak. That is a very broad range. We aren't really trying to optimize our basal, just stay out
of trouble. The pumpers are the first insulin users who can actually try to pick a basal which does
something useful for them instead of just avoiding trouble.

I've got a pumpers' book and am going to start looking into this. So far, I haven't seen any
references which help one pick a "useful" basal rather than a "stay out of trouble" basal.

Radioactive is on MDI (Regular(?) + Lantus )

Lantus, regular (Novolin R), and fast-acting (Novolog). I don't mix the regular and fast-acting, but
generally base the decision of which to use on the types of food I'm eating. If it is fast-absorbing
carbs, like the whole wheat pancakes I usually eat for breakfast, I use the novolog and it works
very well for that - I don't get the one hour lows and two hour highs like I would from using
novolog with slow carbs. If it is meat, vegetables, salad, eggs, tofu, etc., then I use the regular
insulin for a bolus.

As for the basal insulin (Lantus), I inject that in the evening and still have a fairly wide range I
can use without trouble. I've used as little as 6 units and as much as 12 without trouble. My doctor
initially started me on 8, but I dropped that to 6 for several months because I was still getting
good numbers in the mornings and able to minimize the occurrence of exercise-induced hypoglycemia
during the day. Only when I got sick, did I increase it to 12. I am back down to 8 now that I'm
mostly recovered.

Quoted message said:

Regards
Old Al