Everything you wanted to know about food & insulin *. Stephen W. Ponder MD, FAAP, CDE Scott & White Clinic Temple, Round Rock and College Station. * And a bunch of other important stuff. One goal of diabetes care is managing glucose…. FLUX. drift. Hint: It takes TIME and PATIENCE!.
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Everything you wanted to know about food & insulin*
Stephen W. Ponder MD, FAAP, CDE
Scott & White Clinic
Temple, Round Rock and College Station
*And a bunch of other important stuff
Hint: It takes TIME and PATIENCE!
Postmeal Blood sugars, A1c and CV Risk
Goal: improve post-meal control: BG < 180 mg/dl
This is T2, but forget about d-type for now.
Why do blood sugar levels shift all the time?
Actions are dependent on situation/circumstance
Flexible and adaptable
Outcomes influence subsequent actions
Training needed, plus ongoing reinforcement
More time intensive
Here is a picture of FLUX
“A well trained mind is the greatest weapon against diabetes”
“The good is the enemy of the perfect”
“Practice makes better”
Lower overnight insulin/add snack
Eat at home
“What are we doing for dinner, dear?”
Ok to me!
“Assuming a good working knowledge of the system, diabetes control is generally proportional to the time and attention directed towards it.”
…and it’s triggered by exercise
Kinetic: how fast insulin gets in and out
Dynamic: time that insulin lowers sugar
Glucose infusion rate
Time in hours
Early Insulin Pumps
Different tools for different jobs
Multi-dose insulin therapy
“Think of insulin as a tool”
Get my point?
The “3 dimensions” of insulin
What is the 4th dimension?
And the 4th dimension is: “consistency”
Note: Carbs estimated w/pre-meal insulin.
Carbs known with post-meal insulin.
Source: Clinical Therapeutics 2004; 26:1492-7.
That slowly turn to sugar in body
BG = 194
6 unit correction @ 7AM
BG = 115 in 3 hours
Fried food earlier in evening @ 8PM