bolus 'capping'?

[Northerner]

I must admit I'm very surprised that people seem to think there should be some kind of upper limit onwhat insulin dose people require. Surely, it's whatever the person requires to cover a healthy diet? If it's 4 units for a normal-sized evening meal, then all well and good, but if it's 40 then that's what that person needs? People come in all shapes and sizes, and there are quite extreme differences in the way our major organs behave, so I don't see how you can set a range. I understand what aymes says about absorption though, it's logical that a large amount of insulin in one place is going to be less 'normal' than a small amount, as a functioning pancreas is ptting the 'right' amount into the bloodstream - under the skin is very crude in comparison.

For info, I have (usually) 5-8 units with breakfast, 10-14 units with lunch and 12-16 units with evening meal + 9 lantus. I was higher than this until recently.

 

[sasha1]

Hi sue
I have a type 1 diabetic friend who was diagnosed at 8mths old she is 36 now.
Like you in her words was subjected to a horrendous regime to which she rebeled in teenage years, eventually leading to 2 strokes at 17.
Now however she does not carb restrict, eats sensibly and healthy as we all should do regardless of being diabetic or not. Adjusts doses according to how much food 'by eye' and experience she has on her plate.
She has way more better control than she did back then and has a more relaxed approach to food and diabetes.
I would like to point out that although nathan doesnt have capping or on that system his following hb readings, starting from diagnosis to feb07 are...6.8, 7.8,7.5,7.6,7.7,7.4,7.2,6.9,7.9 and 13.1..to me that is good control..
This is growing children here..we know as you say 'Pancreas has kicked the bucket'..
We are all trying to do our best for our children and there health/well being.
I have to agree with bev. I would prefer nathan to have a healthy relationship with food and his diabetes....not an unhealthy one that leads to various eating disorders and added complications
Heidi
🙂

 

[aymes]

I must admit I'm very surprised that people seem to think there should be some kind of upper limit onwhat insulin dose people require. Surely, it's whatever the person requires to cover a healthy diet? If it's 4 units for a normal-sized evening meal, then all well and good, but if it's 40 then that's what that person needs? People come in all shapes and sizes, and there are quite extreme differences in the way our major organs behave, so I don't see how you can set a range. I understand what aymes says about absorption though, it's logical that a large amount of insulin in one place is going to be less 'normal' than a small amount, as a functioning pancreas is ptting the 'right' amount into the bloodstream - under the skin is very crude in comparison.

For info, I have (usually) 5-8 units with breakfast, 10-14 units with lunch and 12-16 units with evening meal + 9 lantus. I was higher than this until recently.

I agree. I don't limit myself if it is a higher amount of insulin I do two injections! My requirements for evening meals can vary from nothing to 20+ (evenings I'm on a 1.5 units to 1CP ratio (I CP = 10g)

 

[bev]

Sue,
Whilst i appreciate that you have 44 years experience of diabetes, things have moved on incredibily since the 60/70's!
It is only fairly recently that blood checks became as accurate as they are now. I believe that testing bloods even up to 20 years ago was inefficient and innacurate - holding stick up to the light to see what colour it had changed etc. As we have the facility to check bloods so accurately now - we can check blood glucose levels and react to them - so if high after 2 hours of a meal then we can correct. In the days when it took more time - nobody stood a chance trying to 'guess' what level they were and therefore corrections must have been worse than difficult. New technology/research has enabled children/people to live near 'normal' lives and cope with diabetes.
MDI wasnt popular when it first came out - but now its offered as the first medical intervention as its so compatable with living a normal life.

A doctor told one family 5 years ago that pumps are dangerous and could lead to their child dying! But that was because of ignorance rather than fact - and the fact that people dont like change (medical profession included).
A senior doctor at the DUK weekend we were on said he doubts whether there will be any people hospitalised due to diabetic complications in the future as we have testing and can correct. He was about 50 and can remember a time when there were diabetics in hospital having amputations etc. But he hasnt seen people (other than those from the 60's who have been abusing their diabetes) in hospital with complications for a number of years now! He was also diabetic and uses MDI. The main reason people were admitted with complications was because they would often be running in the 20's and not realising because testing was so inefficient.
I realise that MDI isnt in a league with the pancreas - but its pretty close. The pump is probably the closest bit of technology at the moment that closely resembles the function of a pancreas - but i believe that will change in the future due to stem cell research. So the future for diabetics is rosy!🙂Bev

 

[diagonall]

I have no idea where people get the idea that setting a limit on carbs leads to unhealthy relationships with food
I love food I have used MDI for at least 30 years. It was a bit hit and miss before blood testing but hey it was done by many people.
Personally I eat a great verity of food and am a normal weight and hight.
I have never had DKA or ever been admited to hospital due to my diabetes except at diagnoses.

Bev if you honestly think a pump is going to allow Alex to eat what he wants and when he wants you are sadly misguided.
I am also aware things have moved on from the 60/70's. If you did some research you will find that the more informed do know that carb restriction/moderation is the best way to control diabetes be it type 1 or 2.
There have been many news articles and medical notes published on this aspect of controling diabetes.

Personally I am sick to death of every time I make a point you throw it back in my face in a derogatory way.
Best wishes to you and young alex for his future I doubt I shall bother post here any more.

 

[bev]

Sue, it was never my intention to make you think your opinions are not valid! Of course they are! But i think it is worth remembering that i/we can only go on what a Consultant is telling us! I think it may be worth remembering that mothers/fathers/carers are trying their utmost to deal with the effects of diabetes - losing sleep and constantly worrying about the person they are looking after, never a second goes by that i dont worry about Alex - even in my sleep i dream about diabetes! So, it does hit a nerve when someone tells us/me that everything that i am doing is wrong - or i am allowing Alex to eat far too much etc - i am sorry if you feel that i disregard your opinions - i dont - i value most of what you say as you have some brilliant advice. I just think that we are coming from two different perspectives - that of a carer - and that of a diabetic - and i think there will always be some subjects that create a divide. Children do need different requirements than adults - both nutritionally and phsycologically. I think we should agree to differ - a bit like politics and religion - there are some subjects that will be a flashpoint! Please dont leave the forum - your opinions are very much needed! 🙂Bev

 

[tracey w]

nikki, do you only need a bit of insulin? i have a psycological thing about doses over 20, the most ive done is 26. I wish i only needed 6 units at most

before dafne, i was scared of giving more than 9 units so would split the dose over a couple of hours if i needed more. Now i give for whatever im eating, most ive given so far is 16, and it seems to be working. I did ask them about splitting doses and would it be more effective etc, and they said no, dose to match your food. we all have to do what we are comfotable with i suppose. 🙂

 

[Northerner]

...Personally I am sick to death of every time I make a point you throw it back in my face in a derogatory way.
Best wishes to you and young alex for his future I doubt I shall bother post here any more.

Sue, your help and advice here is invaluable, you have so much experience of so many aspects of diabetes that you offer help to so many at different stages of diagnosis. You must concede, however, that you are sometimes a little blunt with your responses so I'm surprised that you would get upset if the reaction is blunt in response! Please don't take offence, and continue to give us your perspective.

 

[tracey w]

Sue, your help and advice here is invaluable, you have so much experience of so many aspects of diabetes that you offer help to so many at different stages of diagnosis. You must concede, however, that you are sometimes a little blunt with your responses so I'm surprised that you would get upset if the reaction is blunt in response! Please don't take offence, and continue to give us your perspective.

I have to agree here,

would just like to add that the dafne approach to eating is that YOU CAN EAT WHAT AND WHEN YOU WANT, it is not unhealthy it is brilliant and i dont want other diabetics, thinking for one moment that they have to be restricted to what and when they eat. It does not matter if you are on mdi or pump either. Im sure others who follow the dafne principles will agree with me here. Sorry but just had to say that.

 

[aymes]

Im sure others who follow the dafne principles will agree with me here. Sorry but just had to say that.

Absolutely, I am such an advocate of dafne, one of the best things I have ever done!

 

[Patricia]

I seem to have missed quite a lot on a thread I started in the last day...!

All I can say is I'm sure that different methods work differently for different people. It's a compromise and perhaps too diplomatic, but I do know several people who have lived with diabetes, like Type1Sue, for 40 years, and are extraordinarily healthy and suffer no complications. In part I'm sure this is due to an incredible discipline around eating. Some may feel this is unhealthy (one such person with diabetes I know feels it did lead her to developing such a relationship with food); others may feel this is quite usual and only sensible, and not at all too controlling. Which is fair enough.

I think too that we can't forget there is now a lot of research being done on the genetic indications of the possibility of developing complications. It seems clear that genes play a part, though what we don't know yet.

The other thing we do know, when it comes to raising children, is that if insulin does not match carb, then the risk of stunting our children's growth is very high. Stunted growth from diabetes is now quite rare -- but it didn't used to be.

I guess I would fall in the middle. I'm taking pride is seeing my son eat and grow alongside his friends, and this is being achieved through him eating all the carbs he wants -- though he doesn't tend to have junky ones. Carbs are the body's building blocks in nutrition, and good brain food. I would expect, though, for him to cultivate a lower carb diet later in his life, when his growing is done. Somehow this seems natural to me.

I've said before and I'll say again that our team say growing children can require 1.2 - 2 units of insulin per kilogram. This is completely different from what adults tend to need on average, apparently. Much of this is because of the raging hormones, all of which interfere quite profoundly with insulin, apparently....