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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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!
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? the bloodstream
present the bloodstream
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
“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 control is generally proportional to the time and attention directed towards it.”
Different tools for different jobs
Multi-dose insulin therapyCurrent insulin pump therapy…
“Think of insulin as a tool”
Get my point?
The “3 dimensions” of insulin control is generally proportional to the time and attention directed towards it.”
What is the 4th dimension?
And the 4 control is generally proportional to the time and attention directed towards it.”th 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