Lipids and Insulin

Discussion in 'Health and medical' started by Jim Dumas, Mar 4, 2004.

  1. Jim Dumas

    Jim Dumas Guest

    About 2 years ago I posted that I was using blood ketones to establish basal insulin requirements.
    This has worked well but I gained weight (my diet changed to that of the new wife's shopping). So
    now I'm looking at lipids with the Bioscanner 2000 meter and noticed they are high. Since insulin
    causes triglycerides to be moved into adipocytes, I thought I'd increase my basal insulin alittle
    more and see if my lipids come down without increasing rates of hypoglycemia (hopefully).

    Has anybody else tried to use lipid assays with a home meter to adjust basal insulin? I know pumpers
    adjust basal for pizza days. But have you specifically used lipid data to adjust basal insulin
    requirements?

    Thanks,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo. lispro+R+U+NPH daily,
    moderate exercise, typically <6% HbA1c
     
    Tags:


  2. Jim Dumas

    Jim Dumas Guest

    Jim Dumas wrote:

    > About 2 years ago I posted that I was using blood ketones
    > to establish basal insulin requirements. This has worked
    > well but I gained weight (my diet changed to that of the
    > new wife's shopping). So now I'm looking at lipids with
    > the Bioscanner 2000 meter and noticed they are high. Since
    > insulin causes triglycerides to be moved into adipocytes,
    > I thought I'd increase my basal insulin alittle more and
    > see if my lipids come down without increasing rates of
    > hypoglycemia (hopefully).
    >
    > Has anybody else tried to use lipid assays with a home
    > meter to adjust basal insulin? I know pumpers adjust basal
    > for pizza days. But have you specifically used lipid data
    > to adjust basal insulin requirements?

    I just want to mention that I'm in the process of adding a
    bedtime triglyceride assay and resulting basal NPH insulin
    dose. I've found this to be important in bringing down my
    trigs for a fasting lab measurement for the Doc. So my basal
    insulin changes with trigs and BG. The basic idea is to dose
    for trigs then add R for hyperglycemia adjusted for the
    changing basal NPH in a computer model.

    I've also found that total cholesterol falls slightly when
    the basal insulin is adjusted properly on a daily basis. HDL
    has no change. LDL was calculated so only good in the
    fasting state data.

    In any case, if anybody else has done work with
    insulin dosing for triglycerides+BG, I'd be interested
    in your results.

    Thanks,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  3. Frank Roy

    Frank Roy Guest

    Jim Dumas wrote:

    > I just want to mention that I'm in the process of adding a
    > bedtime triglyceride assay and resulting basal NPH insulin
    > dose. I've found this to be important in bringing down my
    > trigs for a fasting lab measurement for the Doc. So my
    > basal insulin changes with trigs and BG. The basic idea is
    > to dose for trigs then add R for hyperglycemia adjusted
    > for the changing basal NPH in a computer model.
    >
    > I've also found that total cholesterol falls slightly when
    > the basal insulin is adjusted properly on a daily basis.
    > HDL has no change. LDL was calculated so only good in the
    > fasting state data.
    >
    > In any case, if anybody else has done work with insulin
    > dosing for triglycerides+BG, I'd be interested in your
    > results.

    Could you fill us in on some of the biochemistry:
    glycolysis, pyruvate dehydrogenase complex, citric acid
    cycle (also known as Kreb's cycle or TCA) involved as you
    perceive it where this all fits in. Information on the home
    testing meter you are using to do your assessments would
    also be helpful. It would help us to get on the same page.

    Frank
     
  4. Jim Dumas

    Jim Dumas Guest

    Frank Roy wrote:

    > Could you fill us in on some of the biochemistry:
    > glycolysis, pyruvate dehydrogenase complex, citric acid
    > cycle (also known as Kreb's cycle or TCA) involved as you
    > perceive it where this all fits in. Information on the
    > home testing meter you are using to do your assessments
    > would also be helpful. It would help us to get on the
    > same page.

    Hi Frank,

    I shouldn't get into the biochemistry because I've never
    studied it formally. But on a macro scale, insulin causes
    free fatty acids (aka triglycerides) to be pulled from teh
    bloodstream and stored in fat cells. I would recommend
    reading Guyton's Textbook of Medical Physiology, chapter 68,
    Lipid Metabolism, pp 754-763 in my 8th ed. copy.

    I'm measuring lipids with the PTS Lipid Panel test strip
    using the professional version of the CardioChek PA meter (I
    think I paid $250 for the meter). This gives three assays
    with one 35-40 uL pipepette filled from one fingerstick. The
    three assays are total cholesterol, HDL and triglycerides.
    Then the meter displays calculated LDL using:

    LDL = Total Chol - HDL - Triglycerides/5

    This meter and strips are not cleared for patient use but
    you can still buy them with alittle fast talking. The strips
    are expensive at $8.00 each. The 40 uL pipepettes come with
    each package of strips.

    The cheaper approach is to buy the PTS Bioscanner 2000 for
    $179 or so (I paid $100 each for two units two years ago in
    a sale). Then buy the strips for each assay of interest:
    blood ketones, total chol, HDL or triglycerides. The strips
    are about $3 each. The ketone measurement is very sensitive
    to blood volume so you should also buy 15 uL pipepettes with
    the strips to make sure the test sample size is correct. The
    lipid assays are not that sensitive to sample size and a
    "hanging drop" of blood is good enough.

    So when I finish experimenting, I'll drop back to a
    Bioscanner 2000 with a single bedtime triglyceride assay
    for $3/day.

    HTH,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  5. Frank Roy

    Frank Roy Guest

    Jim:
    >
    > Frank Roy wrote:
    >
    > > Could you fill us in on some of the biochemistry:
    > > glycolysis, pyruvate dehydrogenase complex, citric acid
    > > cycle (also known as Kreb's cycle or TCA) involved as
    > > you perceive it where this all fits in. Information on
    > > the home testing meter you are using to do your
    > > assessments would also be helpful. It would help us to
    > > get on the same page.
    >
    > Hi Frank,
    >
    > I shouldn't get into the biochemistry because I've never
    > studied it formally. But on a macro scale, insulin causes
    > free fatty acids (aka triglycerides) to be pulled from teh
    > bloodstream and stored in fat cells.

    You have probably picked up some biochemistry here and
    there. Maybe you only need to fill in the gaps.

    > I would recommend reading Guyton's Textbook of Medical
    > Physiology, chapter 68, Lipid Metabolism, pp 754-763 in my
    > 8th ed. copy.

    Fatty Acid Synthesis - http://web.indstate.edu/thcme/mwking/lipid-
    synthesis.html. "Regulation of Fatty Acid Metabolism One
    must consider the global organismal energy requirements in
    order to effectively understand how the synthesis and
    degradation of fats (and also carbohydrates) needs to be
    exquisitely regulated. The blood is the carrier of
    triacylglycerols in the form of VLDLs and chylomicrons,
    fatty acids bound to albumin, amino acids, lactate, ketone
    bodies and glucose. The pancreas is the primary organ
    involved in sensing the organisms dietary and energetic
    states via glucose concentrations in the blood. In response
    to low blood glucose, glucagon is secreted, whereas, in
    response to elevated blood glucose insulin is secreted." I
    tried to use the find feature on the browser and entered the
    term insulin and found it about 5 times in the article.

    There is also a table of contents for biochemistry in
    general at The Medical Biochemistry page -
    http://web.indstate.edu/thcme/mwking/.

    >
    > I'm measuring lipids with the PTS Lipid Panel test strip
    > using the professional version of the CardioChek PA
    > meter (I think I paid $250 for the meter). This gives
    > three assays with one 35-40 uL pipepette filled from one
    > fingerstick. The three assays are total cholesterol, HDL
    > and triglycerides. Then the meter displays calculated
    > LDL using:
    (snipped)
    >
    I suppose you are not going to get many takers for your
    question from the original post. Nevertheless, I would be
    interested in any report/analysis that you come up with.
    Most of us only only know fasting lipid measurements about
    once a year. Postprandial responses is an other story.

    Frank
     
  6. Frank Roy

    Frank Roy Guest

    Jim:
    >
    > Frank Roy wrote:
    >
    > > Could you fill us in on some of the biochemistry:
    > > glycolysis, pyruvate dehydrogenase complex, citric acid
    > > cycle (also known as Kreb's cycle or TCA) involved as
    > > you perceive it where this all fits in. Information on
    > > the home testing meter you are using to do your
    > > assessments would also be helpful. It would help us to
    > > get on the same page.
    >
    > Hi Frank,
    >
    > I shouldn't get into the biochemistry because I've never
    > studied it formally. But on a macro scale, insulin causes
    > free fatty acids (aka triglycerides) to be pulled from teh
    > bloodstream and stored in fat cells.

    You have probably picked up some biochemistry here and
    there. Maybe you only need to fill in the gaps.

    > I would recommend reading Guyton's Textbook of Medical
    > Physiology, chapter 68, Lipid Metabolism, pp 754-763 in my
    > 8th ed. copy.

    Fatty Acid Synthesis - http://web.indstate.edu/thcme/mwking/lipid-
    synthesis.html. "Regulation of Fatty Acid Metabolism One
    must consider the global organismal energy requirements in
    order to effectively understand how the synthesis and
    degradation of fats (and also carbohydrates) needs to be
    exquisitely regulated. The blood is the carrier of
    triacylglycerols in the form of VLDLs and chylomicrons,
    fatty acids bound to albumin, amino acids, lactate, ketone
    bodies and glucose. The pancreas is the primary organ
    involved in sensing the organisms dietary and energetic
    states via glucose concentrations in the blood. In response
    to low blood glucose, glucagon is secreted, whereas, in
    response to elevated blood glucose insulin is secreted." I
    tried to use the find feature on the browser and entered the
    term insulin and found it about 5 times in the article.

    There is also a table of contents for biochemistry in
    general at The Medical Biochemistry page -
    http://web.indstate.edu/thcme/mwking/.

    >
    > I'm measuring lipids with the PTS Lipid Panel test strip
    > using the professional version of the CardioChek PA
    > meter (I think I paid $250 for the meter). This gives
    > three assays with one 35-40 uL pipepette filled from one
    > fingerstick. The three assays are total cholesterol, HDL
    > and triglycerides. Then the meter displays calculated
    > LDL using:
    (snipped)
    >
    I suppose you are not going to get many takers for your
    question from the original post. Nevertheless, I would be
    interested in any report/analysis that you come up with.
    Most of us only only know fasting lipid measurements about
    once a year. Postprandial responses is an other story.

    Frank
     
  7. Frank Roy

    Frank Roy Guest

    Frank Roy wrote:
    >

    > Fatty Acid Synthesis - http://web.indstate.edu/thcme/mwking/lipid-
    > synthesis.html. "Regulation of Fatty Acid Metabolism One
    > must consider the global organismal energy requirements in
    > order to effectively understand how the synthesis and
    > degradation of fats (and also carbohydrates) needs to be
    > exquisitely regulated. The blood is the carrier of
    > triacylglycerols in the form of VLDLs and chylomicrons,
    > fatty acids bound to albumin, amino acids, lactate, ketone
    > bodies and glucose. The pancreas is the primary organ
    > involved in sensing the organisms dietary and energetic
    > states via glucose concentrations in the blood. In
    > response to low blood glucose, glucagon is secreted,
    > whereas, in response to elevated blood glucose insulin is
    > secreted." I tried to use the find feature on the browser
    > and entered the term insulin and found it about 5 times in
    > the article.
    >
    > There is also a table of contents for biochemistry in
    > general at The Medical Biochemistry page -
    > http://web.indstate.edu/thcme/mwking/.
    >
    There were 27 finds in the above series that linked to
    different pages. http://searchisu.indstate.edu/cgi-
    bin/htsearch

    Frank
     
  8. Frank Roy

    Frank Roy Guest

    Frank Roy wrote:
    >

    > Fatty Acid Synthesis - http://web.indstate.edu/thcme/mwking/lipid-
    > synthesis.html. "Regulation of Fatty Acid Metabolism One
    > must consider the global organismal energy requirements in
    > order to effectively understand how the synthesis and
    > degradation of fats (and also carbohydrates) needs to be
    > exquisitely regulated. The blood is the carrier of
    > triacylglycerols in the form of VLDLs and chylomicrons,
    > fatty acids bound to albumin, amino acids, lactate, ketone
    > bodies and glucose. The pancreas is the primary organ
    > involved in sensing the organisms dietary and energetic
    > states via glucose concentrations in the blood. In
    > response to low blood glucose, glucagon is secreted,
    > whereas, in response to elevated blood glucose insulin is
    > secreted." I tried to use the find feature on the browser
    > and entered the term insulin and found it about 5 times in
    > the article.
    >
    > There is also a table of contents for biochemistry in
    > general at The Medical Biochemistry page -
    > http://web.indstate.edu/thcme/mwking/.
    >
    There were 27 finds in the above series that linked to
    different pages. http://searchisu.indstate.edu/cgi-
    bin/htsearch

    Frank
     
  9. Jim Dumas

    Jim Dumas Guest

    Jim Dumas wrote:

    > So now I'm looking at lipids
    >> with the Bioscanner 2000 meter and noticed they are high.
    >> Since insulin causes triglycerides to be moved into
    >> adipocytes, I thought I'd increase my basal insulin
    >> alittle more and see if my lipids come down without
    >> increasing rates of hypoglycemia (hopefully).

    Here's an interesting example this morning.

    I rode my road racer bicycle for 70 minutes from 4-5:10 pm
    then ate chinese that's often high in fat. My BG before
    exercise was 298 mg/dl so I took 8U Humalog 40 minutes
    before starting exercise. The distance travelled was 15
    miles in the warm Florida sun so I drank much water along
    the way. My BG was 81 mg/dl at 5:30 pm after the exercise
    period. Then we had the chinese food about 6 pm.

    At bedtime (12 am) lipids and BG were:

    Total Chol 240 mg/dl HDL 41 mg/dl Triglycerides 349 mg/dl BG
    378 mg/dl (underdosed dinner for exercise effects)

    I had a triglyceride target of 100 mg/dl and have determined
    trigs fall at 75 mg/dl/NPH Unit above my typical 18U NPH
    bedtime dose. So I dosed 21U NPH + 14U R mixed at bedtime. I
    underdosed R by 5U for exercise effects to prevent nocturnal
    hypoglycemia.

    12 hour fasting results:

    Total Chol 219 mg/dl HDL 39 mg/dl Triglycerides 67 mg/dl
    BG 319 mg/dl Blood Ketones 7.0 mg/dl ( <6.0 is good, <3.0
    is normal)

    If blood ketones were >10.0 then basal insulin is low. So
    basal NPH is good. Triglycerides are perfect at <100 mg/dl.
    The feared exercise effects did not show so the BG is high
    at 319 mg/dl but I had no nocturnal hypoglycemia.

    The only medication I use is insulin. No ACE inhibitors,
    cholesterol lowering meds, etc. The Doc is letting my try to
    lower cholesterol with exercise before we consider meds the
    next time I see him.

    The reason triglycerides are so important for CVD is they
    theoretically become oxidized thereby triggering white blood
    cells to engulf and digest them. The macrophages eat so many
    of them that they get trapped under the cells that line the
    arteries and become plaque after they die. So triglycerides
    are the major contributor to CVD and insulin has a major
    impact on triglyceride uptake. This suggests iatrogenic CVD
    could be the result of an improper basal insulin regimen.

    Also note that I'm one of those DMs that has a low HbA1c
    with high mean BG. So I thumb my nose at all the charts and
    graphs for HbA1c to estimated mean BG that are published in
    the medical literature.

    Food for thought: triglyceride+BG management without
    hypoglycemia,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  10. Alan

    Alan Guest

    On Mon, 15 Mar 2004 17:00:53 GMT, Jim Dumas
    <[email protected]!mindspring.com> wrote:

    >Jim Dumas wrote:
    >
    >> So now I'm looking at lipids
    >>> with the Bioscanner 2000 meter and noticed they are
    >>> high. Since insulin causes triglycerides to be moved
    >>> into adipocytes, I thought I'd increase my basal insulin
    >>> alittle more and see if my lipids come down without
    >>> increasing rates of hypoglycemia (hopefully).
    >
    >Here's an interesting example this morning.
    >
    >I rode my road racer bicycle for 70 minutes from 4-5:10 pm
    >then ate chinese that's often high in fat. My BG before
    >exercise was 298 mg/dl so I took 8U Humalog 40 minutes
    >before starting exercise. The distance travelled was 15
    >miles in the warm Florida sun so I drank much water along
    >the way. My BG was 81 mg/dl at 5:30 pm after the exercise
    >period. Then we had the chinese food about 6 pm.
    >
    >At bedtime (12 am) lipids and BG were:
    >
    >Total Chol 240 mg/dl HDL 41 mg/dl Triglycerides 349 mg/dl
    >BG 378 mg/dl (underdosed dinner for exercise effects)
    >
    >I had a triglyceride target of 100 mg/dl and have
    >determined trigs fall at 75 mg/dl/NPH Unit above my typical
    >18U NPH bedtime dose. So I dosed 21U NPH + 14U R mixed at
    >bedtime. I underdosed R by 5U for exercise effects to
    >prevent nocturnal hypoglycemia.
    >
    >12 hour fasting results:
    >
    >Total Chol 219 mg/dl HDL 39 mg/dl Triglycerides 67 mg/dl
    >BG 319 mg/dl Blood Ketones 7.0 mg/dl ( <6.0 is good, <3.0
    >is normal)
    >
    >If blood ketones were >10.0 then basal insulin is low. So
    >basal NPH is good. Triglycerides are perfect at <100 mg/dl.
    >The feared exercise effects did not show so the BG is high
    >at 319 mg/dl but I had no nocturnal hypoglycemia.
    >
    >The only medication I use is insulin. No ACE inhibitors,
    >cholesterol lowering meds, etc. The Doc is letting my try
    >to lower cholesterol with exercise before we consider meds
    >the next time I see him.
    >
    >The reason triglycerides are so important for CVD is they
    >theoretically become oxidized thereby triggering white
    >blood cells to engulf and digest them. The macrophages eat
    >so many of them that they get trapped under the cells that
    >line the arteries and become plaque after they die. So
    >triglycerides are the major contributor to CVD and insulin
    >has a major impact on triglyceride uptake. This suggests
    >iatrogenic CVD could be the result of an improper basal
    >insulin regimen.
    >
    >Also note that I'm one of those DMs that has a low HbA1c
    >with high mean BG. So I thumb my nose at all the charts and
    >graphs for HbA1c to estimated mean BG that are published in
    >the medical literature.
    >
    >Food for thought: triglyceride+BG management without
    >hypoglycemia,

    Hi Jim

    Excuse my ignorance, but I wasn't aware of a mrthod of home
    testing for TGs and other lipids. What do you use for that?

    Cheers, Alan, T2 d&e, Australia.
    --
    Everything in Moderation - Except Laughter.
     
  11. Jim Dumas

    Jim Dumas Guest

    Alan wrote:

    > Hi Jim
    >
    > Excuse my ignorance, but I wasn't aware of a mrthod of
    > home testing for TGs and other lipids. What do you use
    > for that?

    Hi Alan,

    See Polymer Technology Systems at http://www.ptspanels.com
    for home testing of lipids, ketones and glucose with a
    single meter using a fingerstick whole blood sample. The
    meters are the Cardiochek and Bioscanner 2000.

    So yes, you can test lipids at home. HTH,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  12. Alan

    Alan Guest

    On Tue, 16 Mar 2004 05:41:10 GMT, Jim Dumas
    <[email protected]!mindspring.com> wrote:

    >Alan wrote:
    >
    >> Hi Jim
    >>
    >> Excuse my ignorance, but I wasn't aware of a mrthod of
    >> home testing for TGs and other lipids. What do you use
    >> for that?
    >
    >Hi Alan,
    >
    >See Polymer Technology Systems at http://www.ptspanels.com
    >for home testing of lipids, ketones and glucose with a
    >single meter using a fingerstick whole blood sample. The
    >meters are the Cardiochek and Bioscanner 2000.
    >
    >So yes, you can test lipids at home. HTH,

    Thanks Jim. Off to check price, availability and insurance
    aspects. Do you need both meters for HDL, LDL, TGS? At the
    moment I don't need ketones home-tested and I already have
    the Accu-chek for glucose.

    Cheers, Alan, T2 d&e, Australia.
    --
    Everything in Moderation - Except Laughter.
     
  13. Jim Dumas

    Jim Dumas Guest

    Alan wrote:

    > On Tue, 16 Mar 2004 05:41:10 GMT, Jim Dumas <j-
    > [email protected]!mindspring.com> wrote:
    >
    >>Alan wrote:
    >>
    >>> Hi Jim
    >>>
    >>> Excuse my ignorance, but I wasn't aware of a mrthod of
    >>> home testing for TGs and other lipids. What do you use
    >>> for that?
    >>
    >>Hi Alan,
    >>
    >>See Polymer Technology Systems at http://www.ptspanels.com
    >>for home testing of lipids, ketones and glucose with a
    >>single meter using a fingerstick whole blood sample. The
    >>meters are the Cardiochek and Bioscanner 2000.
    >>
    >>So yes, you can test lipids at home. HTH,
    >
    > Thanks Jim. Off to check price, availability and insurance
    > aspects. Do you need both meters for HDL, LDL, TGS? At the
    > moment I don't need ketones home-tested and I already have
    > the Accu-chek for glucose.

    You only need the Bioscanner 2000 for all test types. The
    Cardiochek meters can assay three tests at once so the lipid
    panel strips have three reflectance holes for Total
    Cholesterol, HDL and Triglycerides. But the Cardiochek
    meters and panels are more expensive. The Bioscanner does a
    single test on each strip so you have to use three
    fingersticks for the equivalent lipid panel measurement.

    There is no LDL assay available. It is estimated using LDL=Chol-HDL-
    TG/5 when TGS <=400 mg/dl. The assay range for TGS is 50-500
    mg/dl (0.57-5.65 mmol/L) but I've been off the scale after
    pizza. So I'd like to see a higher range to say 600 mg/dl.

    I still use the AccuChek Complete with Comfort Curve strips
    for my BG too. They are less expensive then the PTS BG
    strips and easier to use.

    But for lipids and ketones, the Bioscanner is great. HTH,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  14. Willbill

    Willbill Guest

    Jim Dumas wrote:

    > Jim Dumas wrote:
    >
    >
    >> So now I'm looking at lipids
    >>
    >>>with the Bioscanner 2000 meter and noticed they are high.
    >>>Since insulin causes triglycerides to be moved into
    >>>adipocytes, I thought I'd increase my basal insulin
    >>>alittle more and see if my lipids come down without
    >>>increasing rates of hypoglycemia (hopefully).
    >
    >
    > Here's an interesting example this morning.
    >
    > I rode my road racer bicycle for 70 minutes from 4-5:10 pm
    > then ate chinese that's often high in fat. My BG before
    > exercise was 298 mg/dl so I took 8U Humalog 40 minutes
    > before starting exercise. The distance travelled was 15
    > miles in the warm Florida sun so I drank much water along
    > the way. My BG was 81 mg/dl at 5:30 pm after the exercise
    > period. Then we had the chinese food about 6 pm.

    hmmm... you took the 8U Humalog at 3:20pm with a 298 (at
    about the same time?)

    so... 81 two hours later... assuming you've got your
    background insulin close to your normal basal needs (a BIG
    assumption given your wild BG swings), the very recent
    exercise) would mean your normal basal insulin is now too
    high and then you took extra NPH which is still active, so
    at 5:30pm you've got at least 3+ units of FAST insulin
    active (above your basal needs) and excessive basal
    insulin also

    did you eat anything at 5:30pm?

    >
    > At bedtime (12 am) lipids and BG were:
    >
    > Total Chol 240 mg/dl HDL 41 mg/dl Triglycerides 349 mg/dl
    > BG 378 mg/dl (underdosed dinner for exercise effects)
    >
    > I had a triglyceride target of 100 mg/dl and have
    > determined trigs fall at 75 mg/dl/NPH Unit
    ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
    > above my typical 18U NPH bedtime dose.
    ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
    > So I dosed 21U NPH + 14U R mixed at bedtime.
    ^^^^^^^^^^^^^^^^^^^^
    > I underdosed R by 5U for exercise effects
    ^^^^^^^^^^^^^^^^^^^^^^^^^???
    > to prevent nocturnal hypoglycemia.

    i wouldn't call a bedtime BG of 378 good. i hope it's an
    exception for this example

    >
    > 12 hour fasting results:
    >
    > Total Chol 219 mg/dl HDL 39 mg/dl Triglycerides 67 mg/dl
    > BG 319 mg/dl Blood Ketones 7.0 mg/dl ( <6.0 is good, <3.0
    > is normal)
    >
    > If blood ketones were >10.0 then basal insulin is low. So
    > basal NPH
    ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
    > is good. Triglycerides are perfect at <100 mg/dl. The
    > feared exercise effects did not show so the BG is high at
    > 319 mg/dl but I had no nocturnal hypoglycemia.

    some friendly comments/questions:

    1. i wasn't aware that triglycerides can jump around like
    your above example

    if you have any refs on this, would you kindly
    provide them

    and how often do you see this kind of triglyceride
    variation? (for yourself of course)

    with what kind of frequency?

    and/or are triglyceride jumps like this specific to high
    levels of exercise?

    2. where did you come up with this? i.e.:

    <"If blood ketones were >10.0 then basal insulin is
    low.">

    3. given the amounts of insulin (that you mentioned above),
    i find it hard to believe that another 5U of "human"-R at
    midnight would have gotten that 319 rising BG down to 100

    4. i personally think you should use an insulin pump for the
    next 2 years. that way you'll get a real clue about what
    your basal needs really are (and how much yours really do
    or don't fluctuate)

    5. i also suspect that you've got a lot of room for
    improvement of your BG management. which is why i
    suggested that you give serious thought to using an
    insulin pump. trust me, you'll be in pig heaven (given
    your love of high tech gadgets)

    6. oh, and one other thing... what little i know about
    cholesterol/HDL/LDL is that the ratios are what's
    important. 240:41 = 5.85, and
    7:39 = 5.6

    assuming your home meter numbers are accurate, both
    ratios are high and might merit attention

    bill t1 since '57, ex 8-yr pumper, pork/beef-L 2x,
    simple MDI/DAFNE

    >
    > The only medication I use is insulin. No ACE inhibitors,
    > cholesterol lowering meds, etc. The Doc is letting my try
    > to lower cholesterol with exercise before we consider meds
    > the next time I see him.
    >
    > The reason triglycerides are so important for CVD is they
    > theoretically become oxidized thereby triggering white
    > blood cells to engulf and digest them. The macrophages eat
    > so many of them that they get trapped under the cells that
    > line the arteries and become plaque after they die. So
    > triglycerides are the major contributor to CVD and insulin
    > has a major impact on triglyceride uptake. This suggests
    > iatrogenic CVD could be the result of an improper basal
    > insulin regimen.
    >
    > Also note that I'm one of those DMs that has a low HbA1c
    > with high mean BG. So I thumb my nose at all the charts
    > and graphs for HbA1c to estimated mean BG that are
    > published in the medical literature.
    >
    > Food for thought: triglyceride+BG management without
    > hypoglycemia,
     
  15. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    > Jim Dumas wrote:
    >
    >> Jim Dumas wrote:
    >>
    >>
    >>> So now I'm looking at lipids
    >>>
    >>>>with the Bioscanner 2000 meter and noticed they are
    >>>>high. Since insulin causes triglycerides to be moved
    >>>>into adipocytes, I thought I'd increase my basal insulin
    >>>>alittle more and see if my lipids come down without
    >>>>increasing rates of hypoglycemia (hopefully).
    >>
    >>
    >> Here's an interesting example this morning.
    >>
    >> I rode my road racer bicycle for 70 minutes from 4-5:10
    >> pm then ate chinese that's often high in fat. My BG
    >> before exercise was 298 mg/dl so I took 8U Humalog 40
    >> minutes before starting exercise. The distance
    >> travelled was 15 miles in the warm Florida sun so I
    >> drank much water along the way. My BG was 81 mg/dl at
    >> 5:30 pm after the exercise period. Then we had the
    >> chinese food about 6 pm.
    >
    >
    > hmmm... you took the 8U Humalog at 3:20pm with a 298 (at
    > about the same time?)
    >
    > so... 81 two hours later... assuming you've got your
    > background insulin close to your normal basal needs (a BIG
    > assumption given your wild BG swings), the very recent
    > exercise) would mean your normal basal insulin is now too
    > high and then you took extra NPH which is still active, so
    > at 5:30pm you've got at least 3+ units of FAST insulin
    > active (above your basal needs) and excessive basal
    > insulin also
    >
    > did you eat anything at 5:30pm?
    >
    >
    >>
    >> At bedtime (12 am) lipids and BG were:
    >>
    >> Total Chol 240 mg/dl HDL 41 mg/dl Triglycerides 349 mg/dl
    >> BG 378 mg/dl (underdosed dinner for exercise effects)
    >>
    >> I had a triglyceride target of 100 mg/dl and have
    >> determined trigs fall at 75 mg/dl/NPH Unit
    > ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
    >> above my typical 18U NPH bedtime dose.
    > ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
    >> So I dosed 21U NPH + 14U R mixed at bedtime.
    > ^^^^^^^^^^^^^^^^^^^^
    >> I underdosed R by 5U for exercise effects
    > ^^^^^^^^^^^^^^^^^^^^^^^^^???
    >> to prevent nocturnal hypoglycemia.
    >
    >
    > i wouldn't call a bedtime BG of 378 good. i hope it's an
    > exception for this example

    Hi Bill,

    Just want to mention that catecholamines (adrenaline,
    noradrenaline) and cortisol (stress hormone) were still high
    post exercise as I couldn't get to sleep at bedtime. These
    tend to keep BG high and you have to suffer through their
    effects since you could go low abruptly if they end
    abruptly. So the exercise training effect keeps my BG high
    for about 12 hours. This is why the German MD Van Aiken
    could get less sleep as an avid runner, for example. He
    claimed 4 hours of sleep is all a runner needs. The training
    effect kept him "hyped-up." I try to get 6-7 hours of sleep
    no matter what. But sometimes the training effect keeps me
    awake and the BG high. That's my metabolism. These
    catecholamines also control blood pressure and I'm hoping I
    can lower my BP with exercise. The idea is to get my
    metabolism to right itself by using exercise medicinally.
    This data is an early "snap-shot" of blood chemistry in this
    rectification process.

    >> 12 hour fasting results:
    >>
    >> Total Chol 219 mg/dl HDL 39 mg/dl Triglycerides 67 mg/dl
    >> BG 319 mg/dl Blood Ketones 7.0 mg/dl ( <6.0 is good, <3.0
    >> is normal)
    >>
    >> If blood ketones were >10.0 then basal insulin is low. So
    >> basal NPH
    > ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
    >> is good. Triglycerides are perfect at <100 mg/dl. The
    >> feared exercise effects did not show so the BG is high at
    >> 319 mg/dl but I had no nocturnal hypoglycemia.
    >
    >
    > some friendly comments/questions:
    >
    > 1. i wasn't aware that triglycerides can jump around like
    > your above example
    >
    > if you have any refs on this, would you kindly provide
    > them

    There are two energy substrates in the body: glucose and
    triglycerides. When the body burns fats it's the
    triglycerides, aka free fatty acids. My data shows
    triglycerides can have extreme moves but much more slowly
    than blood glucose. Muscles can burn triglycerides directly
    but the brain can't, as an example. Ketones result when
    triglycerides are burned. So high ketones do not necessarily
    mean basal insulin is low. People on the Atkins diet could
    have high ketones and normal insulinemia, as an example. The
    only refs I have are basic physiology for a 12 hour fasting
    measurement and not sports medicine related for more samples
    over 24 hours.

    > and how often do you see this kind of triglyceride
    > variation? (for yourself of course)
    >
    > with what kind of frequency?
    >
    > and/or are triglyceride jumps like this specific to
    > high levels of exercise?

    If I eat pizza and look at trigs 5-6 hours post meal, they
    are off the scale and I get HIGH on the meter (500 mg/dl max
    assay range). If I fast for more than 12 hours,
    triglycerides are low because the muscles are burning them.
    There is an ebb and flow of fats (trigs) from the fat cells
    to muscle and liver just like we see with glucose from the
    liver to the muscles and brain. So there is no "frequency"
    per se, since it depends on diet and exercise. Cortisol
    causes the fats to be released from the fat cells into the
    blood and when you get your "second wind" your muscles have
    switched over from burning glucose to burning triglycerides.

    > 2. where did you come up with this? i.e.:
    >
    > <"If blood ketones were >10.0 then basal insulin is
    > low.">

    This is my observation where the fasting state maximum
    ketones, with no basal insulinemia, are about ~17-20 mg/dl
    on the Bioscanner 2000. If I'm burning triglycerides, a 12
    mg/dl is not unusual but high nonetheless. A 6-7 mg/dl is
    typical for me in the fasting state. A 3 mg/dl is typical as
    Humalog peaks (1-2 hours post dose) in the fasting state. I
    never see the low end of the ketone assay range of 2 mg/dl
    (all time best is 2.6 mg/dl).

    > 3. given the amounts of insulin (that you mentioned
    > above), i find it hard to believe that another 5U of
    > "human"-R at midnight would have gotten that 319 rising
    > BG down to 100

    I depends on the training effect, glycogen rebuilding,
    stress like my wife bugging me, etc. So a broad brush stroke
    of "I find it hard to believe" just tells me that you've
    never experienced the training effect. You should exercise
    alittle more and see what happens.

    > 4. i personally think you should use an insulin pump for
    > the next 2 years. that way you'll get a real clue about
    > what your basal needs really are (and how much yours
    > really do or don't fluctuate)

    I'm not willing to use a pump. My last HbA1c was 6.6% with
    the A1cNow about a month ago so I'm a happy camper. I
    currently have to go to the lab before my next vist with the
    Doc (I haven't made an appointment yet) and this is why I'm
    looking at lipids in detail.

    > 5. i also suspect that you've got a lot of room for
    > improvement of your BG management. which is why i
    > suggested that you give serious thought to using an
    > insulin pump. trust me, you'll be in pig heaven (given
    > your love of high tech gadgets)

    I'm sure I'll like the technology of the pump. But I'm a
    happy camper with my current low tech method. If my HbA1c
    was >8% (ref <6.1% normal), I'd consider it.

    > 6. oh, and one other thing... what little i know about
    > cholesterol/HDL/LDL is that the ratios are what's
    > important. 240:41 = 5.85, and
    > 219:39 = 5.6
    >
    > assuming your home meter numbers are accurate, both
    > ratios are high and might merit attention

    Agreed. But exercise should move HDL up to 55-60 mg/dl. I
    had these kind of numbers before I hurt my knee running a
    decade ago. My Total Cholesterol target is <200 mg/dl and
    HDL is >55 mg/dl with training. This will give me a
    200/55=3.6 CVD risk factor (<5 is good for males, looking
    for ref on this). Training should also lower LDL thereby
    moving total cholesterol lower. The lowest total cholestrol
    I've measured is 185 mg/dl. Calculated LDL averages ~140
    mg/dl. So if I control trigs to 100 mg/dl I should see:

    Total cholesterol ~= HDL+LDL+trig/5 = 40+140+20 = 200 mg/dl
    !

    And the Doc is a happy camper just by insulin control of
    triglycerides alone. But exercise should help even more.

    The trick is correctly dosing basal insulin to control trigs
    but not have an impact on the liver to cause a drop in BG.
    This permits some independence between basal insulin dosing
    for triglycerides and the resultant impact on BG. The data
    above, with high BG and low triglycerides, demonstrates that
    this hypothesis is correct, i.e., I can dose basally for
    triglycerides then add R to correct hyperglycemia. This is
    the primary message in this data.

    And I'll know in 2-3 months of training if I'm right
    about lipids,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  16. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    > and/or are triglyceride jumps like this
    > specific to high levels of exercise?

    From the ADA's "The Health Professional's Guide to Diabetes
    and Exercise," first ed., 1995, p. 128 under
    "Hyperlipidemia" states:

    "The most consistent effect of regular exercise is a
    decrease in plasma triglyceride levels. Decreases in plasma
    triglyceride levels of as much as 20-30% are often, but not
    always, noted. Changes in total low-density lipoprotein
    (LDL) cholesterol have not been consistently demonstrated,
    but exercise does appear to diminish the concentration of a
    small dense subclass of LDL that may be more closely
    associated with atherosclerotic vascular disease."
    ---

    So if my trig target was 100 mg/dl with my bedtime NPH basal
    dose of 21U, the increased uptake from exercise of 30% would
    place it at ~70 mg/dl. I measured 67 mg/dl the next day
    after the exercise period. So that's consistent with the
    literature.

    In any case, I still think basal insulinemia is the key to
    DM dyslipidemia.

    Food for thought,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  17. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    > about cholesterol/HDL/LDL is that the ratios are what's
    > important. 240:41 = 5.85, and
    > 219:39 = 5.6

    Note that the 240 total cholesterol was not from a 12 hour
    fast. It was a bedtime assay. So that ratio of 5.85 is
    meaningless.

    Next, it looks like LDL/HDL<5 with TGs<200 is very good. My
    current LDL/HDL is 3.5 before exercise. TGs are controlled
    by basal insulin to 100 mg/dl. So my CHD risk is already
    pretty good.

    This is from: (n = 4,081) of the Helsinki Heart Study, a 5-
    year randomized coronary primary prevention trial among
    dyslipidemic middle-aged men.

    See:

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&-
    db=PubMed&list_uids=1728471&dopt=Abstract

    "Joint effects of serum triglyceride and LDL cholesterol and
    HDL cholesterol concentrations on coronary heart disease
    risk in the Helsinki Heart Study. Implications for
    treatment."

    The Total Chol/HDL<4.5 is good but not as useful as the
    LDL/HDL & TGs,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  18. Alan

    Alan Guest

    On Tue, 16 Mar 2004 06:51:52 GMT, Jim Dumas
    <[email protected]!mindspring.com> wrote:

    >Alan wrote:
    >
    >> On Tue, 16 Mar 2004 05:41:10 GMT, Jim Dumas <j-
    >> [email protected]!mindspring.com> wrote:
    >>
    >>>Alan wrote:
    >>>
    >>>> Hi Jim
    >>>>
    >>>> Excuse my ignorance, but I wasn't aware of a mrthod of
    >>>> home testing for TGs and other lipids. What do you use
    >>>> for that?
    >>>
    >>>Hi Alan,
    >>>
    >>>See Polymer Technology Systems at
    >>>http://www.ptspanels.com for home testing of lipids,
    >>>ketones and glucose with a single meter using a
    >>>fingerstick whole blood sample. The meters are the
    >>>Cardiochek and Bioscanner 2000.
    >>>
    >>>So yes, you can test lipids at home. HTH,
    >>
    >> Thanks Jim. Off to check price, availability and
    >> insurance aspects. Do you need both meters for HDL, LDL,
    >> TGS? At the moment I don't need ketones home-tested and I
    >> already have the Accu-chek for glucose.
    >
    >You only need the Bioscanner 2000 for all test types. The
    >Cardiochek meters can assay three tests at once so the
    >lipid panel strips have three reflectance holes for Total
    >Cholesterol, HDL and Triglycerides. But the Cardiochek
    >meters and panels are more expensive. The Bioscanner does a
    >single test on each strip so you have to use three
    >fingersticks for the equivalent lipid panel measurement.
    >
    >There is no LDL assay available. It is estimated using
    >LDL=Chol-HDL-TG/5 when TGS <=400 mg/dl. The assay range
    >for TGS is 50-500 mg/dl (0.57-5.65 mmol/L) but I've been
    >off the scale after pizza. So I'd like to see a higher
    >range to say 600 mg/dl.
    >
    >I still use the AccuChek Complete with Comfort Curve strips
    >for my BG too. They are less expensive then the PTS BG
    >strips and easier to use.
    >
    >But for lipids and ketones, the Bioscanner is great. HTH,

    Thx. Off to check it out, girding my loins to fight the
    insurance company :)

    Cheers, Alan, T2 d&e, Australia.
    --
    Everything in Moderation - Except Laughter.
     
  19. Jim Dumas

    Jim Dumas Guest

    Jim Dumas wrote:

    >> So now I'm looking at lipids
    >>> with the Bioscanner 2000 meter and noticed they
    >>> are high.

    Decided to feed the willbill parking meter:

    Another example from the last 24h. Yeasterday from 3:35 to
    4:37 pm, 15.7 miles in 62 minutes with 6 stop lights on the
    route. Course is flat with winds. Before and after ketones
    of 4.1 mg/dl. BG was 88 mg/dl before and 92 mg/dl after with
    about 100 calories of sucrose at the start. Before and after
    triglycerides were 258 and 218 mg/dl. Only basal ultralente
    working with 19U morning dose (added 3U more for 409 mg/dl
    triglyceride assay). Wife decided to make pizza (large like
    Red Barron cheese only) with solid sheet of pepperoni on top
    of the cheese layer. (I don't have the heart to push her
    into DM diets.) Ate 1/2 the pizza and salad at 5:15 pm with
    26U R dose and no delay. Salad had make-it-yourself dressing
    with Wesson vegetable oil: I want olive oil but she doesn't
    like the flavor. No hypoglycemia occurred postprandially.

    12am bedtime data was BG: 154 mg/dl, total Chol: 246 mg/dl,
    HDL: 36 mg/dl and TGs: HIGH! (>500 mg/dl). I decided to add
    7U NPH to my usual bedtime 18U NPH dose so basal dose was
    25U NPH. I added 9U R to control the 154 BG. The 7U NPH
    suggests a 60 mg/dl/NPH unit is really better for
    triglyceride disposal. I was using 75 mg/dl/NPH unit. I have
    a very strong dawn phenomenon that wipes out exercise
    effects. So again, bedtime dose was 9R+25N with the tail of
    the morning 19U ultralente working too.

    No nocturnal hypoglycemia.

    8am morning data was BG: 120 mg/dl, total Chol: 231 mg/dl,
    HDL: 33 mg/dl, TGs: 211 mg/dl, calculated LDL: 156 mg/dl.

    Not too bad but added a 1U ultralente bumper to the morning
    basal for the 211 mg/dl TGs since my TG target is 100 mg/dl.

    The assumption in the bedtime dosing is the NPH impacts BG
    and TGs. But the bedtime R only has a major impact on BG. So
    I calculate bedtime NPH using only TGs then use a variable R
    dose with the area under the NPH dose action profile
    subtracted out of this R dose. The math model is now using
    relative potency factors, (to properly scale different
    insulins before addition to form a composite action
    profile), for BG and another set for TGs! Yeah! More
    complexity.

    A few weeks ago I decided to try a pseudo-sham experiment to
    see if the extra bedtime NPH was really doing anything. My
    bedtime TGs were 170 mg/dl and I took 4U extra NPH for a 22U
    dose (3U too much). I suffered nocturnal hypoglycemia and
    became an instant believer that the 3U was really doing
    something. I did not start my exercise program yet. So no
    exercise effects to worry about in this data.

    In any case, TGs appear to be respond well to variable
    basal insulin.

    Food for thought,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  20. Willbill

    Willbill Guest

    Jim Dumas wrote:

    > Jim Dumas wrote:

    >>> So now I'm looking at lipids with the Bioscanner 2000
    >>> meter and noticed they are high.

    > Decided to feed the willbill parking meter:

    :)))))

    i'm not ignoring your posts. yesterday i asked a local
    pharmacy about bioscanner and cardiochek and only got refs
    to bigger/specialized medical companies. today i checked
    with a local Wal-Mart and got zero

    a google check on the web later today
    (http://www.healthchecksystems.com/bioscanner.htm) shows
    that this bioscanner and strips are not cheap ($140 for the
    meter and 3.5 bucks/strip for each of the total-
    cholesterol/HDL/triglyceride)

    have you used the cardiocheck meter?

    >
    > Another example from the last 24h. Yeasterday from 3:35 to
    > 4:37 pm,
    > 15.7 miles in 62 minutes with 6 stop lights on the route.
    > Course is flat with winds. Before and after ketones of
    > 4.1 mg/dl. BG was 88 mg/dl before and 92 mg/dl after
    > with about 100 calories of sucrose at the start. Before
    > and after triglycerides were 258 and 218 mg/dl. Only
    > basal ultralente working
    ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

    false

    i've yet to see anything substantive on the residual of any
    of the NPH insulins

    and trust me, i've been actively looking for the last 5+
    years

    afaik, beef-NPH has residual that goes well beyond 24 hours.
    fwiw, i wouldn't be surprised if "human"-NPH has some
    (lesser) residual beyond 24 hours

    > with 19U morning dose (added 3U more for 409 mg/dl
    > triglyceride assay).

    geez louise jim. :(

    you want to keep your day-to-day background insulin
    constant!

    using an insulin pump is the primary thing that you could do
    that will drive this home

    if you really do have day-to-day variability of your basal
    needs, using an insulin pump is the one thing that you can
    do to identify it

    > Wife decided to make pizza (large like Red Barron cheese
    > only) with solid sheet of pepperoni on top of the cheese
    > layer. (I don't have the heart to push her into DM diets.)
    > Ate 1/2 the pizza and salad at 5:15 pm with 26U R dose and
    > no delay. Salad had make-it-yourself dressing with Wesson
    > vegetable oil: I want olive oil but she doesn't like the
    > flavor. No hypoglycemia occurred postprandially.

    jeez, Wesson vegetable oil will kill you in the long
    run. problem is that it takes time and still isn't
    understood (imo)

    in addition to avoiding "vegetable oil", the main fat to be
    avoiding is trans fat

    >
    > 12am bedtime data was BG: 154 mg/dl, total Chol: 246
    > mg/dl, HDL: 36 mg/dl and TGs: HIGH! (>500 mg/dl).

    246/36 = 6.8

    even worse than your last 2 ratios. :(

    > I decided to add 7U NPH to my usual bedtime 18U NPH dose
    > so basal dose was 25U NPH.

    you do NOT want to be making BIG variance to your daily
    background insulin amounts!!!!!

    > I added 9U R to control the 154 BG. The 7U NPH suggests a
    > 60 mg/dl/NPH unit is really better for triglyceride
    > disposal. I was using 75 mg/dl/NPH unit. I have a very
    > strong dawn phenomenon that wipes out exercise effects. So
    > again, bedtime dose was 9R+25N with the tail of the
    > morning 19U ultralente working too.
    >
    > No nocturnal hypoglycemia.
    >
    > 8am morning data was BG: 120 mg/dl, total Chol: 231 mg/dl,
    > HDL: 33 mg/dl, TGs: 211 mg/dl, calculated LDL: 156 mg/dl.

    247/33 = 7.0, the worst of all your ratios. :(

    >
    > Not too bad

    see immediately above

    > but added a 1U ultralente bumper to the morning basal for
    > the 211 mg/dl TGs since my TG target is 100 mg/dl.
    >
    > The assumption in the bedtime dosing is the NPH impacts BG
    > and TGs. But the bedtime R only has a major impact on BG.
    > So I calculate bedtime NPH using only TGs then use a
    > variable R dose with the area under the NPH dose action
    > profile subtracted out of this R dose. The math model is
    > now using relative potency factors, (to properly scale
    > different insulins before addition to form a composite
    > action profile), for BG and another set for TGs! Yeah!
    > More complexity.
    >
    > A few weeks ago I decided to try a pseudo-sham experiment
    > to see if the extra bedtime NPH was really doing
    > anything. My bedtime TGs were 170 mg/dl and I took 4U
    > extra NPH for a 22U dose (3U too much). I suffered
    > nocturnal hypoglycemia and became an instant believer
    > that the 3U was really doing something. I did not start
    > my exercise program yet. So no exercise effects to worry
    > about in this data.
    >
    > In any case, TGs appear to be respond well to variable
    > basal insulin.

    i don't believe that coz you are the only one saying that
    (that i've seen)

    i'll grant that it has my attention. :)))))

    when i get some money, i'll give some serious though to
    getting a bioscanner 2000 and the strips that it uses

    is there any reason i should get a cardiochek?

    bill t1 since '57
     
Loading...