Autor Thema: Stability of basic DM parameters  (Gelesen 7170 mal)

Offline Konstantin

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Stability of basic DM parameters
« 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,
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?

Offline Joerg Moeller

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Re: Stability of basic DM parameters
« Antwort #1 am: März 13, 2007, 11:28 »

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,


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

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


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.


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.


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

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


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).


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.


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?


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.
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Offline Konstantin

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Re: Stability of basic DM parameters
« Antwort #2 am: März 14, 2007, 13:36 »
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<0, i.e. almost hypo but we are still in SiDiary understanding, then we must raise BP to Hypoglycemic BP (HBP):
HBP=(TBG-ABG)*p1.

Here p1=p2/p3, p2=1/("your Korrektur x'er Regel") and p3="your BE-Faktoren". By the way p2 is better than its inverse as a manual multiplication is easier a manual division. In general p1, p2, p3 are here used as factors only.

Now all cases are in our vision field and p1 is useful.
Do you see?

I'm using mmol/l (= 18.02 mg/dl) as the only BG units in my glucometer "Elta Satellit"/Russia. In general "mol" is sometimes better than "g". For example, C-peptid is equimolar to insulin. My C-peptid was equal to 0.5 ng/ml in May 2005.

I see your p2 = 1 iu/(20 mg/dl) = (18.02/20) iu/(mmol/l) = 0.9 iu/bgu.

You are right the above-mentioned parameters aren't enough for a real good therapy, but it's already good for me, if only these ones are here sorted out. I have some intestinal problems and  I see the assimilability of meals is apparently changed by undergoing a treatment. In this case my p3 is changed from 1.7 iu/bu to 1 iu/bu for antibiotics treatment and to 2 iu/bu for bacteria bifidum treatment.

Thank you for your reply, Jörg.
That's all, good-bye, oder Auf Wiedersehen! :ichbaer:
Konstantin.
« Letzte Änderung: März 14, 2007, 21:10 von Konstantin »

Offline Joerg Moeller

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Re: Stability of basic DM parameters
« Antwort #3 am: März 15, 2007, 12:19 »

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.


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<0, i.e. almost hypo but we are still in SiDiary understanding, then we must raise BP to Hypoglycemic BP (HBP):
HBP=(TBG-ABG)*p1.


Why? You don't have to eat anything if you are not hypoglycaemic. And if so, then you should eat, not calculate.

Zitat
Here p1=p2/p3, p2=1/("your Korrektur x'er Regel") and p3="your BE-Faktoren". By the way p2 is better than its inverse as a manual multiplication is easier a manual division. In general p1, p2, p3 are here used as factors only.


Let's say my bg is 160, target is 100 and I know that 1 IU decreases my bg around 20. Of course I could calculate "60*0,05" but I can't see why this should be easier? It's simply another way.

Zitat
I see your p2 = 1 iu/(20 mg/dl) = (18.02/20) iu/(mmol/l) = 0.9 iu/bgu.


No, that's wrong. What you've calculated isn't the IU but the mmol/l
20 mg/dl = 0,9 mmol/l

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


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

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Re: Stability of basic DM parameters
« Antwort #4 am: März 15, 2007, 14:43 »

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


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

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

Offline Joerg Moeller

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Re: Stability of basic DM parameters
« Antwort #5 am: März 16, 2007, 13:06 »

Does any antibiotic have direct influence on the bg?


Some of them, for example Gatifloxacin (http://www.diabetes-deutschland.de/4822.htm Sorry, text is in german language).
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Offline Llarian

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Re: Stability of basic DM parameters
« Antwort #6 am: März 16, 2007, 14:26 »


Does any antibiotic have direct influence on the bg?


Some of them, for example Gatifloxacin (http://www.diabetes-deutschland.de/4822.htm Sorry, text is in german language).

The (english) abstract of the cited article is availabe at NEJM. I have access to the full text, PM me if interested.

Regarding the text:
  • why only patients of 66 or older?
  • I've taken fluoroquinolons myself several times and noticed bg influence only due to effects of the infection (increased bg) and since they found cases of hypo- AND hyperglycemia and fluoroquinolons are the most common prescribed antibiotics I'd still say, it is correlation due to change of behavior during infections


Konstantin, are you still reading this thread? Elsewise we could continue this in german...

Anja

Offline Joerg Moeller

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Re: Stability of basic DM parameters
« Antwort #7 am: März 17, 2007, 13:17 »
Sorry, but I don't have any answer to this. I just heard about it because I've searched the web several times for effects of antibiotics to diabetes. The most I've found were interactions to oral anti-diabetica.

So I surely agree to you, that most effects are related to the infections themselves.
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Offline Konstantin

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Re: Stability of basic DM parameters
« Antwort #8 am: März 17, 2007, 15:22 »

Konstantin, are you still reading this thread? Elsewise we could continue this in german...

Anja (and Jörg), german is possible.  :ja:
I'll understand by it somehow, but my replies will be in english ...

Konstantin

Offline Konstantin

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Re: Stability of basic DM parameters
« Antwort #9 am: März 17, 2007, 16:35 »

Sorry, but I don't have any answer to this. I just heard about it because I've searched the web several times for effects of antibiotics to diabetes. The most I've found were interactions to oral anti-diabetica.

So I surely agree to you, that most effects are related to the infections themselves.

My infection is Lamblia intestinalis,
but the influence on my DM parameters ("BE-Faktor") was felt by the treatment and repeated treatment only.

Konstantin
« Letzte Änderung: März 18, 2007, 07:26 von Konstantin »