Lipids and Insulin

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

  1. Alan

    Alan Guest

    On Thu, 18 Mar 2004 20:42:56 -0600, willbill <[email protected]> wrote:

    >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?

    I'm checking them out over here. The local agents only stock
    the top-of -the-range CardioCheck PA, saying that the
    BioScanner is outdated and the cheaper CardioCheck needs
    seperate tests to do HDL, TGs and Total Cholesterol; so they
    don't stock or support it. I'm getting details at the
    moment, but phone advice is that the CardioCheck PA is about
    AU$770, lipid strips are about AU$8 each. No insurance
    support at this time.

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


  2. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

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

    Why? Give me a good reason why I shouldn't.
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  3. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    >> 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)

    Insulin moves triglycerides into fat cells, that's a fact.
    So we should be able to monitor this causal relationship.
    More importantly, we should be able to dose insulin for
    this effect as well. Just because nobody else is doing it,
    doesn't mean it can't (or shouldn't) be done. Just look
    back to the early BG meter days and slow medical acceptance
    of this new technology. That should shake your complaisant
    tree alittle.

    > 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?

    Yes. It has more functionality. It will do the lipid panels
    of Total Cholesterol/HDL/Triglycerides in one test strip
    then calculate LDL and display it for you. It will also test
    single assay Bioscanner test strips so you have more
    flexibility too. But the batteries don't seem to last as
    long in the CardioChek versus the Bioscanner.

    From what I can tell, the two CardioChek meters are
    identical and just have a removable plastic face plate
    overlay that says either CardioChek or CardioChek PA (as in
    Physician's Assistant). The latter is to be sold to
    professionals only but I have two. One of my Bioscanners
    sh*t the bed and it was replaced with the patient CardioChek
    by the factory. So the two are identical in menus and
    functionality. Buy the cheaper of the two CardioCheks, as
    they are the same unit.

    I plan to write a little paper for my Doc detailing the use
    of bedtime and morning triglycerides to dose basal insulin.
    Then present it to the poor guy and ask for an Rx for
    Bioscanner TG strips. Then fight with Humana HMO over CHD
    prevention via basal insulinemia. They seem to accept
    anything the PCP signs off on. So I just have to get his
    approval. The last time I saw him he said: "Slow down! I
    don't know what you're talking about!" I was telling him
    about the A1cNow that I pushed under his nose with a
    flashing 6.6% on it. So this should be a piece of cake to
    get TG strips.

    I had the poor guy writing scrips til the cows came home. He
    was mumbling to himself, "This is the second one and I have
    3 more..." When I got out of the exam room, I noticed he
    wrote my Humalog 1.5 ml cartridges for Novolog 3.0 ml and I
    had to complain to the nurse that it was wrong. She took it
    back to him and he sent it back to me saying "Write what you
    want and he will sign it." So I wrote the script for my
    Humalog 1.5s. When I went to Walgreens, they had never seen
    the Humalog 1.5s and ordered the wrong ones, disposable
    3.0s. So I had to give them the Lilly part number to make
    sure they ordered it correctly.

    In any case, if you plan to measure lipids, how will you
    modify your therapy to use the data? That is to say, once
    you measure TGs, for example, what will you do with this
    data? If you don't plan to act on the results, then why
    bother to measure the data?

    One inquiring mind wants to know,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  4. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    > geez louise jim. :(

    I don't know her. But here's today's lipids:

    Ate tacos & beer at 5:30 pm without exercise (exercise every
    other day) bedtime 12am: Total Chol 239, HDL 31, TGs 389, BG
    170 all mg/dl

    basal dose = 18N + (389-100)/60 = 24U NPH added 6U NPH with
    50% relative (to R) potency factor for BG uptake so must
    subtract 3U R from mixed R+NPH bedtime dose to prevent
    nocturnal hypoglycemia. Final bedtime dose 9R+24N with AUCs
    of action profiles.

    No Nocturnal Hypoglycemia and 9 hours later (14h fast) in
    the morning: Total Chol 199, HDL 41, TGs 150, calc LDL 128,
    BG 131 all mg/dl.

    Helsinki Heart Study LDL/HDL=3.12 (<5 good) and TGs<200mg/dl
    good! so CHD risk=1, normal! CHD is a major problem for T1s
    per Clinical DM text.

    The problem with TotalChol/HDL is Total Chol=HDL+LDL+VLDL is
    not pure ratio of BAD/GOOD so not a good number to use. But
    LDL/HDL is a pure BAD/GOOD ratio and therefore much better
    "figure of merit" to use.

    Next, from the ADA's "Red Book," Medical Management of Insulin-
    Dependent (Type 1) Diabetes, 2nd ed., 1994, p 144 in
    Macrovascular Disease section with Table 6.9: Lipid Levels
    for Adults:

    Total Cholesterol <200 mg/dl
    LDL <130 mg/dl TGs <200 mg/dl

    So I'm golden on Mexican food days.

    And BTW, variable basal NPH dosing is more physiological,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  5. Willbill

    Willbill Guest

    Jim Dumas wrote:

    > willbill wrote:

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

    > Why? Give me a good reason why I shouldn't.

    you clearly have not done your homework on your basal-
    insulin needs

    even with a pump it will take you more than 2 years

    without a pump it will take longer

    bill t1 since '57, ex 8-yr pumper
     
  6. Willbill

    Willbill Guest

    Jim Dumas wrote:

    > willbill wrote:

    >> geez louise jim. :(

    > I don't know her. But here's today's lipids:
    >
    > Ate tacos & beer at 5:30 pm without exercise (exercise
    > every other day) bedtime 12am: Total Chol 239, HDL 31, TGs
    > 389, BG 170 all mg/dl

    239/31 = 7.71, which is still very high. :(

    >
    > basal dose = 18N + (389-100)/60 = 24U NPH added 6U NPH
    > with 50% relative (to R) potency factor for BG uptake so
    > must subtract 3U R from mixed R+NPH bedtime dose to
    > prevent nocturnal hypoglycemia. Final bedtime dose 9R+24N
    > with AUCs of action profiles.
    >
    > No Nocturnal Hypoglycemia and 9 hours later (14h fast) in
    > the morning: Total Chol 199, HDL 41, TGs 150, calc LDL
    > 128, BG 131 all mg/dl.
    >
    > Helsinki Heart Study LDL/HDL=3.12 (<5 good) and
    > TGs<200mg/dl good! so CHD risk=1, normal! CHD is a major
    > problem for T1s per Clinical DM text.
    >
    > The problem with TotalChol/HDL is Total Chol=HDL+LDL+VLDL
    > is not pure ratio of BAD/GOOD so not a good number to use.
    > But LDL/HDL is a pure BAD/GOOD ratio and therefore much
    > better "figure of merit" to use.
    >
    > Next, from the ADA's "Red Book," Medical Management of Insulin-
    > Dependent (Type 1) Diabetes, 2nd ed., 1994, p 144 in
    > Macrovascular Disease section with Table 6.9: Lipid Levels
    > for Adults:
    >
    > Total Cholesterol <200 mg/dl
    > LDL <130 mg/dl TGs <200 mg/dl
    >
    > So I'm golden on Mexican food days.
    >
    > And BTW, variable basal NPH dosing is more physiological,

    only if it is beef-NPH

    bill t1 since '57
     
  7. Willbill

    Willbill Guest

    Jim Dumas wrote:

    > willbill wrote:

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

    > Why? Give me a good reason why I shouldn't.

    above all else, you NEED to establish a baseline for your
    basal needs

    even if you have stable day-to-day basal needs, it will take
    you a MINIMUM of 2+ years to get a clue, PROVIDING you are
    using an insulin pump!

    it's MUCH more difficult if you are not using an
    insulin pump

    that is my experience

    and with regard to the issue of triglycerice levels possibly
    providing insight for basal needs, that remains a very open
    issue (imo)

    bill t1 since '57, ex 8-yr pumper
     
  8. Willbill

    Willbill Guest

    Jim Dumas wrote:

    > willbill wrote:

    >> is there any reason i should get a cardiochek?

    > Yes. It has more functionality.
    <snip>

    thank you for the response

    bill
     
  9. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    >> And BTW, variable basal NPH dosing is more physiological,
    >
    > only if it is beef-NPH

    Dear Dude,

    I want a fast basal if I'm vary it daily. Beef NPH will
    be too slow.

    So IMO, the faster human NPH is a better variable basal,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  10. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    > even with a pump it will take you more than 2 years
    >
    > without a pump it will take longer

    I used blood ketones to establish the minimum basal insulin
    requirements. This is better than your pumping method. So I
    have a baseline basal insulinemia that just barely prevents
    ketones. This is the lowest insulin dosing possible for my
    metabolism: 16U ultralente at 0700h and 18U NPH at 0000h.
    That barely keeps ketones to a minimum and therefore is the
    lowest basal dosing my metabolism will tolerate.

    Now I'll move basal insulinemia higher for triglyceride
    disposal. That's what happens in normals with high fat
    diets, as an example. So why can't we T1s mimic the true
    physiology?

    I any case, I don't need a pump to determine my basal.

    Because ketones are a better measure of optimum basal
    insulinemia.
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  11. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    > Jim Dumas wrote:
    >
    >> willbill wrote:
    >
    >>> you do NOT want to be making BIG variance to your daily
    >>> background insulin amounts!!!!!
    >
    >> Why? Give me a good reason why I shouldn't.
    >
    > above all else, you NEED to establish a baseline for your
    > basal needs
    >
    > even if you have stable day-to-day basal needs, it will
    > take you a MINIMUM of 2+ years to get a clue, PROVIDING
    > you are using an insulin pump!
    >
    > it's MUCH more difficult if you are not using an
    > insulin pump
    >
    > that is my experience

    That's the problem. I have a different experience and think
    that using blood ketones, (extremely sensitive assay to low
    basal insulin levels), is a far better method to determine
    minimum basal insulin requirements.

    > and with regard to the issue of triglycerice levels
    > possibly providing insight for basal needs, that remains a
    > very open issue (imo)

    I have some more experiments to do. One will use my typical
    18U NPH bedtime dose after my half fat-laden pizza meal per
    the wife's tastes. If TGs remain high (say HIGH at bedtime
    and 400 mg/dl at breakfast) then the variable NPH basal is
    clearly having a good therapeutic effect, based on the TG
    211 mg/dl the other pizza day with 7U extra NPH.

    There is the possibility of a TG NPH basal producing too
    much of an hypoglycemic effect. Lets say my BG is 50 mg/dl
    and TGs are 450 mg/dl, as an example. Then I could OD on
    the NPH dose as BG is too low to begin with. So there is
    some danger in trying to satisfy both BG and TG
    requirements simultaneously. But I haven't seen this gross
    difference yet in my personal BG/TG data. But that doesn't
    mean it can't happen.

    But for me, it's a no brainer: insulin impacts TGs.
    Now use it,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  12. Willbill

    Willbill Guest

    Jim Dumas wrote:

    > willbill wrote:

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

    >>> Why? Give me a good reason why I shouldn't.

    >> above all else, you NEED to establish a baseline for your
    >> basal needs
    >>
    >> even if you have stable day-to-day basal needs, it will
    >> take you a MINIMUM of 2+ years to get a clue, PROVIDING
    >> you are using an insulin pump!
    >>
    >> it's MUCH more difficult if you are not using an
    >> insulin pump
    >>
    >> that is my experience

    > That's the problem. I have a different experience and
    > think that using blood ketones, (extremely sensitive assay
    > to low basal insulin levels), is a far better method to
    > determine minimum basal insulin requirements.

    the bottom line is that when you have your background
    insulin right, you can skip 2 or 3 meals and your blood
    glucose values stay stable

    i'm betting that you can't skip 3 meals with your current
    background insulins without going either skyhigh or into a
    serious hypo

    >> and with regard to the issue of triglycerice levels
    >> possibly providing insight for basal needs, that remains
    >> a very open issue (imo)

    > I have some more experiments to do. One will use my
    > typical 18U NPH bedtime dose after my half fat-laden pizza
    > meal per the wife's tastes. If TGs remain high (say HIGH
    > at bedtime and 400 mg/dl at breakfast) then the variable
    > NPH basal is clearly having a good therapeutic effect,
    > based on the TG 211 mg/dl the other pizza day with 7U
    > extra NPH.
    >
    > There is the possibility of a TG NPH basal producing too
    > much of an hypoglycemic effect. Lets say my BG is 50 mg/dl
    > and TGs are 450 mg/dl, as an example. Then I could OD on
    > the NPH dose as BG is too low to begin with. So there is
    > some danger in trying to satisfy both BG and TG
    > requirements simultaneously. But I haven't seen this gross
    > difference yet in my personal BG/TG data. But that doesn't
    > mean it can't happen.
    >
    > But for me, it's a no brainer: insulin impacts TGs.
    > Now use it,

    i've got an open mind. chances are that i'll get a meter and
    strips. thank you for the info and ideas

    on the subject of pumps, trust me: use a pump for two years.
    what you'll learn about your basal needs is invaluable and
    unlikely to be gained from tracking TG levels

    on the subject of your ratios, you're doing a lousy job

    bill t1 since '57
     
  13. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    > i'm betting that you can't skip 3 meals with your current
    > background insulins without going either skyhigh or into a
    > serious hypo

    You bet wrong. I usually have just one meal a day and snack
    once in the morning to arrest a Humalog-induced BG free fall
    (breaking the fast) with 40 calories of dried fruit. This
    single large meal per day tends to elevate lipids/ketones
    and increase fat storage for the long fasting periods. But
    it also slows the metabolism down. 99% of my hypoglycemic
    events are nocturnal and related to the R+NPH bedtime dose.
    Now with the TGs included, the bedtime dose will be the most
    important dose of the day.

    As one of my exercise days demonstrated, once I achieve my
    quiescent BG (QBG) of 90 mg/dl (also my target BG) in the
    morning, I have glucose homeostasis and can stay there
    fasting all day. In discussions with other T1s, they have
    also noticed this ~90 mg/dl (5 mmol/L) set point where the
    liver tends to hold BG in equilibrium for a wide range of
    basal insulinemia. This is what I call the quiescent BG
    where a balance is struck between glucose demand by
    peripheral tissues and liver supply. By the use of blood
    ketones assays, I've determined my minimum basal insulin
    requirements to maintain this QBG in the fasting state.

    Next, by adding up my minimum daily basal insulin of 16U
    ultralente at 0700h
    + 18U NPH at 0000h, I have my basal requirements nailed down
    at 34U/day as a minimum. I can easily integrate (find
    areas under the curve of) this basal insulin action
    profile to estimate needs in the afternoon or nocturnally,
    as examples. So with calculus, I don't need a pump. I use
    a simple computer model and integrate from X to Y hours,
    for all active doses, to estimate intraday insulin needs.
    More importantly, with the glucose transform results, my
    areas under the insulin action profile are far more
    accurate than the pump calculations for dose remaining, as
    an example.

    So with some math, I can derive the info needed to adjust
    basal insulin. Also note that my basal is not flat
    throughtout the day. I need a large basal insulinemia to
    counter my dawn phenomenon. Finally, if I use my relative
    (to R) potency factors on the basal, I get an equivalent
    endogenous basal insulin requirement of:

    16U * 0.56 + 18N * .45 = 17.06 effective basal units per
    day.

    I weigh 186 lbs or 84 kg so this basal is 17.06/84 =
    0.2U/day as a minimum starting point. This assumes no losses
    for R of course.

    So I don't need a pump to find my basal insulinemia.
    But you do,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  14. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

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

    Let's talk lipids. I did eat a snack (without dosing
    insulin) of two broccoli heads with Paul Newman's Olive Oil
    dressing (about half the large bottle, I love that stuff) to
    get rid of some old broccoli at bedtime. Then I measured
    lipids to get:

    Total Chol 224 mg/dl HDL 37 " TGs 243 " BG 305 "

    Dosed 17R+21N without exercise this day. The N was 19U +
    143/60=21. The 19U was determined by a computer model to
    achieve basal insulinemia when I want to get the next day
    started with insulin. This is the minimum basal rate in U/h
    necessary to maintain BG homeostasis when I expect to check
    BG and dose the next morning. So the computer model iterates
    (on the HP48GX calculator) to find the correct bedtime NPH
    dose to achieve my usual basal rate when I take my morning
    ultralente dose. This was 19U in this case. The R bumper for
    the 305 was 19.5R - 3*0.45=17U R. Bedtime dose 17R+21N.

    And you can't use Chol/HDL here because I just ate
    (not fasting).

    No nocturnal hypoglycemia.

    10 hour fast (so you can't use Chol/HDL as it needs a
    12h fast):

    Total Chol 241 mg/dl HDL 41 " TGs 112 " BG 100 "

    What a lovely day. BG target is 90 mg/dl and TG target is
    100 mg/dl.

    I think I'll have a beer,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  15. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    > and with regard to the issue of triglycerice levels
    > possibly providing insight for basal needs, that remains a
    > very open issue (imo)

    Chapter 21 in Joslin's DM 13th ed., "The Pathophysiology and
    Treatment of Lipid Disorders in Diabetes Mellitus," has good
    information. For one thing, HDL is increased as
    triglycerides are lowered due to VLDL conversion to HDL. See
    p 374, "As VLDL become progressively depleted of
    triglyceride, a portion of the surface, including
    apolipoproteins C and E and phospholipids, is transferred to
    HDL." So if I lower my triglycerides, I can raise the good
    HDL cholesterol. That's interesting.

    Next, p.379 under "Lipoproteins in IDDM" states: "It is now
    well established that elevations in VLDL triglycerides in
    IDDM are often correlated with the degree of diabetic
    control [73,74]." This means that as BG control increases,
    lipids get better. (You have to read the whole section to
    get the drift.)

    Next, p.380 under "Triglycerides" states: "For patients with
    diabetes, unlike the general population,
    hypertriglyceridemia has been implicated as an important
    contributor to ASCVD [102,103]. Both the WHO Multi-National
    Trial [102] and the Paris Prospective Study [103] have shown
    that hypertriglyceridemia is a significant predictor of
    subsequent cardiovascular mortality in persons with
    diabetes."

    Next, p.379 under IDDM again states: "Institution of
    continuous subcutaneous insulin infusion resulted in a
    significant fall in the rates of VLDL triglyceride
    production to levels below those observed in the nondiabetic
    subjects." This suggests that a proper basal insulin for
    pumpers probably produces this lower triglyceride effect. So
    I'll try to do the same thing with MDI using a variable
    basal insulin. This section also mentions liver VLDL
    production is under control of insulin via liver lipoprotein
    lipase production.

    In any case, I don't think lower TGs via basal insulin is an
    open issue.
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  16. Willbill

    Willbill Guest

    Jim Dumas wrote:

    > willbill wrote:
    >
    >> i'm betting that you can't skip 3 meals with your current
    >> background insulins without going either skyhigh or into
    >> a serious hypo

    > You bet wrong.

    ok

    > I usually have just one meal a day and snack once in the
    > morning to arrest a Humalog-induced BG free fall (breaking
    > the fast) with 40 calories of dried fruit. This single
    > large meal per day tends to elevate lipids/ketones and
    > increase fat storage for the long fasting periods. But it
    > also slows the metabolism down. 99% of my hypoglycemic
    > events are nocturnal and related to the R+NPH bedtime
    > dose. Now with the TGs included, the bedtime dose will be
    > the most important dose of the day.
    ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^-
    ^^^^^^^^^^^^^^^^^

    ack!

    i finally wised up 6 years ago on diet, and minimized my
    dinner meal. i suggest you do something similar

    anyhow, i could never get consistent and *low* rising b/g
    values without having occasional unconscious hypos while
    asleep at night. so my goal was only to be under 200 (!)
    upon rising. once i started posting on m.h.d. it didn't take
    a genius to understand that that was going to cause me major
    health problems at some point in the future; but hey,
    anything to avoid anymore of those nasty/dangerous hypos

    >
    > As one of my exercise days demonstrated, once I achieve my
    > quiescent BG (QBG) of 90 mg/dl (also my target BG) in the
    > morning, I have glucose homeostasis and can stay there
    > fasting all day. In discussions with other T1s, they have
    > also noticed this ~90 mg/dl (5 mmol/L) set point where the
    > liver tends to hold BG in equilibrium for a wide range of
    > basal insulinemia. This is what I call the quiescent BG
    > where a balance is struck between glucose demand by
    > peripheral tissues and liver supply. By the use of blood
    > ketones assays, I've determined my minimum basal insulin
    > requirements to maintain this QBG in the fasting state.
    >
    > Next, by adding up my minimum daily basal insulin of 16U
    > ultralente at 0700h
    > + 18U NPH at 0000h, I have my basal requirements nailed
    > down at 34U/day as a minimum. I can easily integrate
    > (find areas under the curve of) this basal insulin
    > action profile to estimate needs in the afternoon or
    > nocturnally, as examples. So with calculus, I don't need
    > a pump. I use a simple computer model and integrate from
    > X to Y hours, for all active doses, to estimate intraday
    > insulin needs. More importantly, with the glucose
    > transform results, my areas under the insulin action
    > profile are far more accurate than the pump calculations
    > for dose remaining, as an example.
    >
    > So with some math, I can derive the info needed to adjust
    > basal insulin. Also note that my basal is not flat
    > throughtout the day. I need a large basal insulinemia to
    > counter my dawn phenomenon. Finally, if I use my relative
    > (to R) potency factors on the basal, I get an equivalent
    > endogenous basal insulin requirement of:
    >
    > 16U * 0.56 + 18N * .45 = 17.06 effective basal units
    > per day.
    >
    > I weigh 186 lbs or 84 kg so this basal is 17.06/84 =
    > 0.2U/day as a minimum starting point. This assumes no
    > losses for R of course.
    >
    > So I don't need a pump to find my basal insulinemia.
    > But you do,
    ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^-
    ^^^^^^^^^^

    you're getting defensive, so maybe it's time to end
    this thread

    with regard to improving your cholesterol levels, i suggest
    you look into niacin therapy. buy/read the book:

    Cholesterol Control Without Diet!: The Niacin Solution by
    William B. Parsons (Hardcover - October 1998)

    www.amazon.com shows it as "Out of Print"
    w/Limited Availability = "Used & new from $11.00"

    best, bill
     
  17. Jim Dumas

    Jim Dumas Guest

    willbill wrote:

    > with regard to improving your cholesterol levels, i
    > suggest you look into niacin therapy.

    That's a good suggestion. Joslin's DM, 13th ed., p.386,
    mentions >= 1 gm/day of nicotinic acid is necessary to see
    "profound lipid-lowering effects." Unfortunately, I have
    rosacea and the "flushing" effect of niacin will increase
    the facial vasodilation and make the condition worst. So
    niacin is not good for me.

    But oat bran is on my list. Started it today.

    Also digging into the Joslin lipid disorder chapter in more
    detail. Maybe something will jump out on a second pass.
    There are some interesting statements that I need to study.
    One such comment is free cholesterol can be bound to HDL and
    transferred to VLDL triglycerides that are remnants from the
    digestive process. These remnants with attached cholesterol
    are removed from the circulation by the liver and excreted
    to the GI tract. Hopefully, I can enhance this effect by
    lowering TGs with variable basal NPH. (Then oat bran is
    necessary to bind to this cholesterol so it's not reabsorbed
    by the GI tract.)

    Will know if it's working in a few months,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
  18. Willbill

    Willbill Guest

    Jim Dumas wrote:

    > willbill wrote:
    >
    >
    >>with regard to improving your cholesterol levels, i
    >>suggest you look into niacin therapy.
    >
    >
    > That's a good suggestion. Joslin's DM, 13th ed., p.386,
    > mentions >= 1 gm/day of nicotinic acid is necessary to see
    > "profound lipid-lowering effects." Unfortunately, I have
    > rosacea and the "flushing" effect of niacin will increase
    > the facial vasodilation and make the condition worst. So
    > niacin is not good for me.
    >
    > But oat bran is on my list. Started it today.
    >
    > Also digging into the Joslin lipid disorder chapter in
    > more detail. Maybe something will jump out on a second
    > pass. There are some interesting statements that I need to
    > study. One such comment is free cholesterol can be bound
    > to HDL and transferred to VLDL triglycerides that are
    > remnants from the digestive process. These remnants with
    > attached cholesterol are removed from the circulation by
    > the liver and excreted to the GI tract. Hopefully, I can
    > enhance this effect by lowering TGs with variable basal
    > NPH. (Then oat bran is necessary to bind to this
    > cholesterol so it's not reabsorbed by the GI tract.)
    >
    > Will know if it's working in a few months,

    if you've never looked at that book by Parsons, it's worth
    looking at coz it gives detailed info on how to possibly
    work around "flushing"

    also, drink dry red wine. :)

    bill

    www.cnn.com/2004/HEALTH/conditions/03/22/alcohol.hypertensi-
    on.ap/index.html

    <"In the study, men with high blood pressure who reported
    having about one or two drinks a day were 44 percent less
    likely to die of cardiovascular causes such as heart attacks
    than men with hypertension who rarely or never drank.

    Alcohol is known to increase levels of good cholesterol
    ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
    and can thin the blood, warding off artery-clogging clots
    that can cause heart attacks.

    A drink or two a day has been linked with reduced
    cardiovascular risks in healthy men and women. But many
    doctors are wary about alcohol use among people with
    hypertension because heavy drinking can increase blood
    pressure. For that reason, the American Heart Association
    generally advises patients with high blood pressure to
    avoid alcohol.

    The latest findings suggest that moderate alcohol
    consumption offers the same benefits to hypertensive
    patients as it does to healthy people."
     
  19. Alan

    Alan Guest

    On Mon, 22 Mar 2004 17:14:20 -0600, willbill <[email protected]> wrote:

    >
    >if you've never looked at that book by Parsons, it's worth
    >looking at coz it gives detailed info on how to possibly
    >work around "flushing"
    >
    >also, drink dry red wine. :)
    >
    >bill
    >
    >
    >
    >
    >www.cnn.com/2004/HEALTH/conditions/03/22/alcohol.hypertens-
    >ion.ap/index.html
    >
    >
    ><"In the study, men with high blood pressure who
    >reported having about one or two drinks a day were 44
    >percent less likely to die of cardiovascular causes such
    >as heart attacks than men with hypertension who rarely
    >or never drank.
    >
    > Alcohol is known to increase levels of good cholesterol
    > ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^-
    > ^^ and can thin the blood, warding off artery-clogging
    > clots that can cause heart attacks.
    >
    > A drink or two a day has been linked with reduced
    > cardiovascular risks in healthy men and women. But many
    > doctors are wary about alcohol use among people with
    > hypertension because heavy drinking can increase blood
    > pressure. For that reason, the American Heart
    > Association generally advises patients with high blood
    > pressure to avoid alcohol.
    >
    > The latest findings suggest that moderate alcohol
    > consumption offers the same benefits to hypertensive
    > patients as it does to healthy people.">

    I'm with you there, but I think I'll stop recommending it.
    It's going to put the prices up :)

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

    Jim Dumas Guest

    willbill wrote:

    > if you've never looked at that book by Parsons, it's worth
    > looking at coz it gives detailed info on how to possibly
    > work around "flushing"
    >
    > also, drink dry red wine. :)

    Hi Bill,

    I may try niacin if I can't lower total cholesterol with my
    current approach. I used to drink half a 750 ml bottle of
    California Merlot or Cabernet each day at dinner. But my
    metabolism changed and I found that it dehydrated me too
    much. So I now drink alcohol only on special occasions. The
    problem with using wine medicinally is the potential for
    excessive use. So I find I'm better off not to tempt myself.

    On the basal NPH front: I added a 6U NPH bumper dose to my
    morning 16U ultralente (separate injections) to see if it
    will lower my high morning triglycerides. These were left
    over from a HIGH (off scale) bedtime reading so I could not
    accurately dose for them. The cause was too much cheese at
    dinner. So I'm now testing the hypothesis that NPH is better
    than ultralente, as a variable basal, because of its shorter
    tail. The objective is to minimize hypoglycemia and
    triglycerides during the day. The method corrected a morning
    Humalog dose for the NPH taken, as done in the bedtime
    examples in this thread. So it should be interesting today.

    In any case, thanks for the suggestions,
    --
    Jim Dumas T1 4/86, background retinopathy, rarely
    hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
    exercise, typically <6% HbA1c
     
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