Another piece of the puzzle

 The following is the rushes on my making sense out of my last experiences over the weekend.

 Dear Diabetic expert that is the age of my son.

MR. Footless did not respond well to the original parameters of the pump set up.  What could not have been taken into consideration was :

1)      MR. Footless is high blood sugar phobic.  He will not tolerate extended periods of blood sugars running over 180mg/dl

a)      His body responds to extended highs with nausea and vomiting so his refusing to tolerate them is entirely understandable.

b)      His lifetime manner of dealing with this is to refuse to eat, to take bolus insulin and wait until the blood sugar drops.  At present this is making him miserable.

c)     ( He is no bundle of joy to live with either.)

d)     I put the pieces together to figure this out about two weeks ago, and after twenty years of life together.

2)      MR. Foot less's insulin processing is very idiosyncratic. 

a)      This may be due to his extended life as an insulin dependent diabetic. After 70 years his body responses are what they are in part due to the long term and life long habits that have allowed him to survive and in part to thrive while injecting insulin.

b)        they aren’t normal.

c)      Apparently he has an extra long onset time, and a much extended active insulin period. It begins to make sense of the 4 am crash and burns and the wild variations over the years.

3)      The active Insulin period of Humalog is supposed to be four hours.  For MR. Footless it is ten hours.  This is the reason that he has the blood sugar crashes in the wee morning hours and the reason that the night time basal has been dropped to nonexistent.  With the pump calculating for four hours he has been inadvertently been stacking his dosages which all hit at somewhere around 4 AM (lucky Me)

a)      During the latest emergency I was able to get enough information to re-calibrate the information in the pump using the numbers that repeated testing over a ten hour period helped to confirm

4)      The following chart is the recalibration as Mr. Footless’s present numbers have indicated.  It has a much lower basal which may need raising and a much larger carb factor in line with both the blood glucose results and the crash and burn episodes in the early morning.  Todays  blood glucose results do not thrill Mr. White but they seem to be taking into account the long time that insulin is active in his system.  I have some questions.

1.      The pump does not have a ten hour insulin time. eight is as high as it goes.  While this is better than the stacking effect that four hours applied to Mr. Footless, is there shorter acting insulin?

2.      We are pretty sure that there is an hour delay before the insulin begins to show in the system, and we know that it begins to peak after four hours and continues to work for another four hours. How do you plan meals around that?