The problem is that even though she is taking less, it's still too much,
by definition of the problem.  cut back more.

Dave

How long has your mom been a Type 1?  I ask that because if she's had
it for awhile certainly she would understand the delicate balance
between insulin and food intake.  If she's new she might be
experiencing a little of what's called "the honeymoon effect" where the
beta cells that produce insulin still work a little and start kicking
out insulin again because the pancreas gets a break from being more in
control.  This doesn't last too long.  What you describe seems to be an
easy thing to figure out...she's injecting more fast acting insulin
than is needed for the carbs she is eating.  Also, what is her activity
level right after eating?  Does she go for long walks or workout at the
gym? It is scary when the bgs dips down to 47 and even scarier if it
goes further.  If this is continuing every night then she needs to
notify her doctor immediately and discuss these details with him or
her.  If she doesn't know how to calculate insulin/carbs she needs to
learn how to do that pronto.

Also, is she taking Lantus or some other kind of basal insulin.  A
friend of mine just started taking Lantus and didn't make the
adjustments on the fast acting.  The basal insulin is a background
insulin, but it will mean that less fast acting insulin is needed.

Like most Type 1's I learned a long time ago how to calculate how much
insulin I need to cover how much food I eat.  But like most Type 1's,
there are still those rare times when even my learned calculations
don't work and I either go too high or too low.  It is frustrating, so
I work to try and keep it as stable as possible.  Most of the time it
is.

Best,
Kurt

P.S. What's with all the websites listed at the end of your post?

You didn't tell us what kind of insulin regimen she is on. Is she on a
basal insulin like Lantus, plus boluses of short-acting insulin to
cover her meals? And if so, does she adjust her boluses based on the
carbs in the meal?

Assuming that the above is the case, the only significant carbs in the
above-mentioned meal would be from the baked potato. The key question
is this: What did she put *on* her baked potato? If she's like me, she
might have put butter and/or sour cream on the potato. This fat slows
the absorption of the carbs, so that it doesn't match the action of
the short-acting insulin. After eating a meal like that, I've
experienced exactly the same thing: going low soon after the meal and
then rebounding high. I've found that the solution in a situation like
that (and pizza seems to be the worst offender for me!) is to delay
taking the short-acting insulin until half an hour after eating. This
gives the carb absorption a chance to get a "head start" on the
insulin.

The "sliding scale" CAN BE part of a solution. If the overall dose is
too high then the bedtime numbers will be too low as well, but are
they? Often the goal for before-bedtime numbers for a Type 1 are set a
little on the high side to help prevent hypoglycemia overnight, what
number is she aiming for and what is she hitting before bedtime?

The issue is more likely related to insulin type and absorption rates.
Does she take R or Humalog? How long before dinner? What injection
site? If her bedtime numbers were OK to begin with, then maybe just
shifting before-dinner injection time or choosing a slower-absorbing
site could be a different or even better solution.

I know that she's been told to rotate injection sites, but some sites
really do absorb faster than others. The belly in particular is a lot
faster absorbing than others. Exercise shortly before or after dinner
can also do a lot for speeding absorption. These facts are part of
fine-tuning dosage but a lot of doctors and books kind of gloss over
these details.

47 is not "Crazy and SOOOO Scary...", it's just part of the overall mix
of things to deal with. Measuring an hour or two after a meal provides
valuable data points: never regard the additional data as scary! You
use it to help.

As a Type 1, I know all too well that having the insulin get absorbed
too quick, then eating to take care of the hypo, can easily end up with
your numbers 4 or 6 hours later being too high.

Tim.

On Mon, 20 Mar 2006 20:18:23 -0800, "taterbug"
<taterbug66spamout@comcast.net> Huffed and Puffed the following into
the madness of usenet:

not enough info to help.

only thing we could guess is that her insulin to carb ratio and
insulin to premeal BG ratio is still wrong.

she should read through the how to section at www.insulin-pumpers.org
and focus on the parts discussing these 2 specific ratios, print them
out and go over them with her doctor.  they apply to all type 1s even
if they do not pump.

But she should not make changes without her doctors help and approval.

Thank you for all of your replies.....Mom cut her insulin Humalog down 2
units last night and that seemed to work....for now, she talked to the Dr.
and said that was the best starting point....

Thank you again...