Diabetesfragen > ICT - Basis/Bolus

Stability of basic DM parameters

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Konstantin:
I want to discuss the stability/changeability of three
basic parameters used by diabetics:
1) nutrition-sugar-per-blood-sugar parameter:
    p1 = n1 bu/bgu,
2) bolus-insulin-per-blood-sugar parameter:
    p2 = n2 iu/bgu,
3) bolus-insulin-per-nutrition-sugar parameter:   
    p3 = p2/p1 = n3 iu/bu.
The last parameter is choosed by unchanged blood
glucose (BG) before and 1.5 hour after taking
the nutrition.

n1, n2, n3 here are  undimension numbers and
dimension units are
iu = insulin unit (of bolus),
bu = bread unit = 12 g of sugar,
bgu = blood glucose unit = mmol/l.

We have useful relation: p3*p1=p2. For example,
my real parameters in the relation are

(1.3 iu/bu)*(0.62 bu/bgu)=(0.81 iu/bgu).

What do you think of stability/changeability of this
parameters?
For example, my practice shows that my p3 is lower
after taking intibiotics and higher after taking
Bacteria bifidum. My p3 don't usually depend on daily
time.

In SiDiary the p1 isn't used in coming up window and
advice for BG below normal level is absent. Why?

Joerg Moeller:

--- Zitat von: Konstantin am März 12, 2007, 19:36 ---
I want to discuss the stability/changeability of three
basic parameters used by diabetics:
1) nutrition-sugar-per-blood-sugar parameter:
    p1 = n1 bu/bgu,

--- Ende Zitat ---


That's what we would call "correction BU" (german: Korrektur-BE).


--- Zitat ---2) bolus-insulin-per-blood-sugar parameter:
    p2 = n2 iu/bgu,
--- Ende Zitat ---


And that is the correction rule (Korrektur-Regel). For example: my rule is always 20 which means, that 1 IU (german: IE) Insulin decreases my BG about 20 mg/dl. If I want to calculate it I measure my BG and then: (actual BG - target BG)/correction rule = necessary insulin dose


--- Zitat ---
3) bolus-insulin-per-nutrition-sugar parameter:   
    p3 = p2/p1 = n3 iu/bu.
--- Ende Zitat ---


And that's our BU factor (BE-Faktor) which means 1 BU takes n IU (IE) to equalize it.


--- Zitat ---bgu = blood glucose unit = mmol/l.
--- Ende Zitat ---


Be careful: some diabetics measure their BG in mg/dl


--- Zitat ---We have useful relation: p3*p1=p2.
--- Ende Zitat ---


And we calculate: (actual bg - target bg)/correction rule + (BU * BU factor) = necessary insulin dose before meal.


--- Zitat ---
For example,
my real parameters in the relation are

(1.3 iu/bu)*(0.62 bu/bgu)=(0.81 iu/bgu).

--- Ende Zitat ---


Sorry, but I can't see any sense in this calculation. Why should I calculate how much I have to eat? I want to eat 'till i'm not hungry anymore. And if I'm not hungry I shouldn't be forced to eat something.


--- Zitat ---What do you think of stability/changeability of this
parameters?
For example, my practice shows that my p3 is lower
after taking intibiotics and higher after taking
Bacteria bifidum. My p3 don't usually depend on daily
time.
--- Ende Zitat ---


I think for a real good therapy these parameters are not enough. You still need a injection-meal-distance, because the subcutaneous resorption isn't in the same time as the way of the carbs through stomach to the small instestine. (and from there to the blood). And this IMD (German: SEA/DEA) depends on many factors like glycaemic index, fat in your meal, volume of your meal, outside temperature (-> blood circulation) and bg before meal.


--- Zitat ---In SiDiary the p1 isn't used in coming up window and
advice for BG below normal level is absent. Why?

--- Ende Zitat ---


Because it's not required to eat something if your bg is below your target bg. For example: I have a target bg of 100 mg/dl. And sometimes my bg is about 60 mg/dl and I'm not hungry nor hypoglycaemic. So why should I have to eat something?
Sometimes I plan a meal and my bg is 65 (without any hypoglycaemia). Why should I have to eat more, if I also could decrease my insulin dose to reach my target bg?

Please don't missunderstood my words: if your calculation works for you and you like it, please keep it. But we couldn't change the sidiary calculation way (which is absolutely medical correct) for you.

Konstantin:
OK, Jörg,
let's try to see once more.

We thus take initial data: Actual BG (ABG), Target BG (TBG), Bread Portion (BP> or =0), and firstly calculate Insulin Dose (ID), i.e.
ID=(ABG-TBG)*p2+BP*p3.

Now if ID> or =0 then OK, but if ID

Joerg Moeller:

--- Zitat von: Konstantin am März 14, 2007, 13:36 ---
We thus take initial data: Actual BG (ABG), Target BG (TBG), Bread Portion (BP> or =0), and firstly calculate Insulin Dose (ID), i.e.
ID=(ABG-TBG)*p2+BP*p3.

--- Ende Zitat ---


No, thats wrong. If you say "1 IU is needed to decrease my bg around x mmol/l (or mg/dl), then you can't multiply p2, you have do divide it: ID=(ABG-TBG)/p2+BP*p3.


--- Zitat ---Now if ID> or =0 then OK, but if ID

Llarian:

--- Zitat von: Jörg Möller am März 15, 2007, 12:19 ---

--- Zitat ---In this case my p3 is changed from 1.7 iu/bu to 1 iu/bu for antibiotics treatment
--- Ende Zitat ---


Be careful: not all antibiotics are the same in their relationship to the bg! Some has an effect, some not.

--- Ende Zitat ---

Does any antibiotic have direct influence on the bg? Or is it the infection that causes the body to start countermeasure and increase cortisol? And since antibiotics often have an gastrointestinal effect, many people eat less or do so because of feeling sick, which would leed to receptor-up-regulation and reduced factors.

Grüße
Anja

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