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- Gary Scheiner MS, CDE
- Integrated Diabetes Services
- 333 E. Lancaster Ave., Suite 204
- Wynnewood, PA 19096
- (877) 735-3648
- (610) 642-6055
- www.integrateddiabetes.com
- gary@integrateddiabetes.com
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- Basal Insulin Regulation
- Bolus Regulation
- Physical Activity Adjustment
- DKA Prevention
- Temporary Basal Rates
- Prolonged Boluses
- Alternate Basal Patterns
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- Basal Insulin’s One And Only Job Is To Hold Blood Glucose Levels Steady
In the Absence of Confounding Influences*
- * Food, Exercise, Bolus Insulin, Unusual Hormonal Conditions (illness,
rebounds, menstruation)
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- Conditions for Testing Basal Rates:
- No food or bolus for at least 4 hrs prior
- Last meal/snack low in fat
- No food or bolus during test phase (water/diet drinks OK)
- BG above 80, below 250 throughout
- No lows for previous 12 hrs
- Stay connected, no stopping/suspending
- Exercise OK up until test phase (if usually performed)
- No heavy activity during test phase
- Do not run test if sick or just prior to/start of period
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- Currently:
- .30 3am-9am,
- .25 9am-3am
- Skipped Breakfast
- BG results:
- 6am 109
- 8am 201
- 10am 230
- 12pm 224
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- I:C Ratios:
- The correct ratio should match pre-meal BG 3-4 hours (not 2!) after
eating
- I:C Ratio often varies from meal to meal
- (bkfst dose > lunch & dinner)
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- Correction Boluses:
- 1500-Rule (aggressive)
- (Total Daily Ins.)/1500
- 1800-Rule (conservative)
- (Total Daily Ins.)/1800
- May vary day vs. night
- (nighttime often 50% more than day)
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- Meal Bolus
- Adjustment*
- Low Intensity Cardio ę 25%
- Mod. Intensity Cardio ę 33%
- High Intensity Cardio ę 50%
- Competitive/Anaerobic ???
- * If activity is after meal
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- Snacking to prevent low (examples)
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- Watch Out for D’OH!
- (Delayed Onset Hypoglycemia)
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- OK To Disconnect Up To 1 Hour w/ Activity
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- Alternatives to Disconnection:
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- Normal Cellular Metabolism
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- Metabolism
- With
- Insulin
- Deficiency
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- Causes of insulin deficiency in Pump Therapy
- Malabsorption (site problems)
- Insulin Spoilage
- Tubing or infusion set clogs
- Leaks where the cartridge connects to the tubing
- “Tunneling”/Leakage at the infusion site
- Air pockets in the tubing
- Dislodgement of the canula from beneath the skin
- Improper or insufficient priming
- Extended pump suspension or disconnection
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- Basal Insulin Should Hold BG Steady Under Normal Conditions.
- How Often Is Life Under “Normal Conditions”?
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- Prevention of D’OH!
(Delayed-Onset Hypoglycemia)
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- Offsetting
- Bedtime
- Insulin-On-Board
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- Description
- Normal/Standard Boluses are delivered within a few minutes; peak is
approx. 1 hr, duration approx. 4 hours
- Prolonged boluses are delivered over a period of a couple of hours; peak
is delayed/blunted and duration is extended.
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- Purpose
- To do a better job of matching the blood sugar rise caused by
slow-digesting foods.
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- Applications
- Very Large Portions
- Low-Glycemic-Index Foods
- Meals/Snacks that take a long time to consume
- Gastroparesis
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- Options for slow-digesting food:
- Normal Bolus
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- Options for slow-digesting food:
- Square/Extended Bolus
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- Options for slow-digesting food:
- Dual/Combination Bolus
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- Called Pattern A/B (Medtronic), Prog 2-4 (Animas), Pattern 1-4 (Deltec)
- Useful when basal changes are needed for several days (or more) in
succession
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- Menstrual cycle phases
- Extended illness
- Recovery from surgery
- Periodic use of steroid medications
- Seasonal sports
- Off-day vs. work/school-day
- Extended travel
- Climate changes
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