ning 10 the end of any of these periods call for a change in the amount of insulin infused. The fact that Lhese infusion rates can be changed, and In micro-amounts, is one of the benefits of pump therapy that are not available to those using syringes to administer insulin.
The pre-meal to post-mea] change in blood sugar level should be approximately 50 mg/dl. If the change is greater, an error has been made either in calculating the amount of insulin needed for the meal or in quantification of the meal's carbohydrate content. Most patients can determine the amount of insulin they need to take to balance the amount of food they are going to ingest by practicing carbohydrate counting and assessing how much insulin is necessary to maintain a normal blood sugar. Use of this technique in the DCCT to determine insulin requirements for meals resulted in a reduction in HbA,c of 0.75 (20). The range for this number is large and can vary with each individual, the time of day, and the type of carbohydrate eaten, and with what. Most patients learn by trial and error or-—as it is scientifically called—experimentation and observation. An approximate amount of insulin necessary to balance the grams of carbohydrate eaten can be determined initially by calculating the total daily dosage (TDD) of insulin and dividing the number 500 by that amount. The result is the number of grams of carbohydrate that one unit of insulin will be able to balance (e.g., a total daily insulin dosage of 50 units divided into 500 means that every 10 grams of carbohydrate eaten requires one unit of insulin). This number, as in all calculations for insulin requirements, is arbitrary, and adjustments are the rule and not the exception. To make successful adjustments, patients need to frequently monitor glucose levels and other variables and have the skills and training to make changes on an ongoing basis. This "empowerment" of the patient is an essential component for success whatever the method of insulin delivery. For patients who cannot count carbohydrates, remembering the amount of insulin necessary for given foods and amounts is equally adequate and often very successful.
Corrective action is also needed when blood sugars taken other than at mealtimes are out of the predetermined target range. When the blood sugar is too high, the action required is called a correction bolus. The amount of insulin to be taken can be calculated by using the familiar rule of 1500 (21). This aids in determining the insulin sensitivity factor or the estimated drop in blood glucose per unit of insulin. The starting point—the TDD—is divided into 1500 and the result is how much glucose should empirically be lowered following the administration of one unit of insulin (e.g., A TDD of 50 units of insulin divided into 1500 is 30: in this case, one unit of insulin will lower blood sugar by 30 mg/dl. !f a patient's blood sugar is 220 and his target is 130, he needs to take 3 additional units to reach that level. The results of some studies using rapid-acting insulin analogs suggest that this rule of 1500 should be corrected to the rule of 1800 or even 2000. Only individual assessment will determine which of these will bring about the correct adjustment for an individual patient.
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.