Lipids and Insulin



J

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
 
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
 
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
 
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
 
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
 
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
 
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
 
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
 
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
 
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.
 
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
 
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.
 
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
 
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,
 
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
 
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
 
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
 
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.
 
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
 
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
 
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