Friday, March 25, 2011

Peak & Trough: A Lesson From Nursing School

Disclaimer: I'm not a doctor, a nurse, or even play one on tv. So don't take any of this as medical fact..YDMV,consult with your own Health Care Guru.

You can go ahead & say it. How does this not look like the action of fast acting insulin(only more of the "peak" part)

And because much of my thinking is colored by diabetes,immeadiatly my mind starts drawing parallels in the D-World.

What you're actually looking at is the action of a medication. There's the time it "starts working" (T1) the time it's peaking (T2,etc) and the time it tapers off.(T3) A "peak" is the time when it's most effective but there is this not so small matter of ensuring that that peak stays inside the minimum effective concentration and the minimum toxic concentration lines as well. And let me tell you something,trying to keep the drug onset,side effects,peak times, minimum toxic concentrations straight (x 20 or so meds per pt) is not exactly easy. Drugs also like to clash with other drugs & are absorbed differently. Anyway,insulin is the easiest example of this because generally there is only one side effect (hypoglycemia) and that's like the minimum toxic concentration. Bad,bad, BAD to have enough insulin in your bloodstream to cause that.(although it's not that difficult to get into that situation)

A "Trough" is a blood level drawn right before the next medication dose. It tells you if you are at the minimum effective dose and if not,that you need to do something about it.(I do troughs with my mag levels too only I don't take the dose until I get the's like a "fasting" result) People with diabetes do alot of troughs only there is always some insulin involved and one can never be quite sure that the dose you are taking is too much/just right/not enough because we can't see how our bgs will respond. But in my observations,blood sugars(postmeal) do not go as high when there is a certain amount of mealtime insulin still floating around, 3-4 hours later.(this also applies to snacks) Maybe because my basal is so low(I have to have insulin above & beyond that,where food is involved). Prebolusing also helps.But with diabetes,the line between keeping a little extra IOB and spiraling down into hypoglycemic horror is a very thin one. (am I an expert on this,nope, but understanding how Apidra works in my body is a step toward more consistent bgs)
And of course there are a hundred other factors involved(exercise,etc) which makes D a constant science experiment. Nursing school is not entirely detrimental to one's health. (it's rekindled the "gotta sync this right" flame)

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