This article covers the basics of a diabetes pump therapy right up to the advanced details.
People are attracted to insulin pump therapy for many reasons – some may be misconceptions. You might first ask yourself, “How do I think this therapy can help me?”, then review the links above and see if it can or cannot help. Continuous insulin infusion provides more ways to prevent high and low blood sugars than do injections. Diabetic pumps can accommodate erratic and flexible lifestyles better than multiple daily injections. This page reviews the two ways that insulin pumps can connect to the body as well as lists the pump manufacturers for each. The types of insulin pumps that are the most common are those that require tubing (infusion sets). Most tethered pumps offer some form of remote access to basic programming; for example, a remote control, handheld module or a paired specialty glucose meter may be able to send wireless signals to prompt the pump to deliver a bolus. Medtronic or Minimed: makers of the Paradigm models including the Veo and various older models (502-522). An implantable pump is surgically implanted beneath the skin and the insulin is delivered into the peritoneal area (the space between the abdominal muscles and the organs). A closed loop insulin pump is the ultimate beta cell replacement that research aspires to creating.
Beta cell transplants (also known as the Edmonton Protocol) implant human beta cells, not machinery. Talk with your doctor, diabetes educator and health insurance company before choosing amongst these types of insulin pumps.
Flexible lifestyle: Sleep in, miss meals, avoid low if the basal insulin is properly set is one of the most appealing advantages.
Less risk of hypoglycemia or severe hypo:Primarily because of the two reasons directly above. Less erratic glucose levels, better control: One of the most identified advantages is that people usually get better blood sugar control on insulin pumps. Memory advantages: In case you ever forget if you gave your insulin for the meal or not, most pumps have a memory to scroll back through to view previous boluses.
No multiple daily injections: You only need to insert a needle every 2-3 days when you put in a new infusion set. No more math:One of the advantages of insulin pumps is that most come with built in calculators and wizards. Remaining insulin on board: Have you ever nibbled and gave insulin repeatedly over an evening? Continuous blood glucose monitoring: This is one of the advantages that is not present on all insulin pumps. Advantages in timezones with traveling:Adjusting for time-zones when traveling on a pump is easy. Improved quality of life: Many on insulin pumps would say that pumping has helped normalize their lives and improved the quality of their lives. Cost: Not everyone can afford this therapy, especially if their health insurance does not cover it. Frequent glucose testing: Most pumpers test a minimum of 4 times a day and often 8 times a day or more. Ketone testing: I typically see people on injections ignoring ketone testing when their blood glucose levels are high.
Carb counting still done: Most people on pumps will benefit from keeping and indeed intensifying their carb counting.
Bolus with all carb eaten: Some people on injections who eat but don’t need to give a dose of rapid insulin for a meal or snack because of excess NPH have a hard time remembering to bolus each time they eat carb food on a pump. Infusion site problems: Infusion sites should be rotated every 2-3 days and sooner if irritation occurs.
Carrying backup supplies: A battery, an infusion set, a few syringes and a small pen vial of insulin should be carried for backup in case the pump batteries go, the pump malfunctions or more commonly, the infusion set rips out or the insulin runs out.
Frequent refilling if type 2 diabetes: Many people with type 2 diabetes are insulin resistant and require large doses of insulin. Problem-solving: Successful and safe pumpers are good at problem solving both technical and medical problems with their diabetes.
Time demands: Many people do not improve their diabetes control to the extent they could because they don’t take the time to properly set their basal rates (meaning missing meals and resetting rates until blood sugar stays stable). The curious and the ignorant: If you have the insulin pump showing, or pull it out to use it or check it or tuck in your tubing, you just might end up with someone asking, “What’s that?” They might go on even further after they learn you have diabetes and say something like, “Should you be eating that?” These may or may not be an issue for you, depending on your mood and how you like to handle these people. Ripped out sets: Although advantages of insulin pumps include not having to inject a needle so often, sometimes infusion sets need replacing sooner than you anticipate.
It’s important to find the reasons for hypoglycemia to try to prevent future episodes. A low glycemic index meal; the carb gets in much later than the insulin (pumpers can ask their MDs about trying dual wave or combination boluses for these meals. Adrenal insufficiency: uncommon disorder more likely seen in type 1 than type 2, in which body makes too little of the hormone cortisol. Stacking food boluses with a slightly less than perfect insulin-to-carb ratio (if you suddenly eat a much larger amount of carb then any tiny error is multiplied out). Although extremely unlikely, the pump could mis-deliver in the case of a cracked case exposed to water. Typical early warning symptoms of hypoglycemia include shaking or trembling, sweating, sudden hunger, palpitations, anxiety while slightly later symptoms might include difficulty concentrating, weakness or tiredness, vision changes, dizziness, or headaches. It is the low blood sugar levels themselves which can be dangerous, with or without symptoms. If you do have hypoglycemia unawareness and are on insulin, there are processes that can help to retrain the body to sense low blood sugars sooner.
Review all the reasons for diabetes-specific causes for high blood sugar if you haven’t already. Cannula left in too long: This is by far the most common insulin-pump-related cause for hyperglycemia. Large total daily doses of insulin: If you give bigger boluses or more insulin overall, like at Christmas due to the sweets etc, then your site may not last as long as it usually does for the same reasons listed in the point above. Site irritation:This could be as simple as inflammation from your waistband on pants or as bad as a site infection. Large air bubbles in the tubing or reservoir: Air into fat tissue is not a big issue for safety but can be for high blood sugars. Ineffective connection of tubing to the hub or connector on the skin: No matter the infusion set, always gently tug the set when attached to the skin to be sure it is in.
Previous decreased temporary basal or disconnect:Sometimes pumpers temporarily stop their basal, disconnect for a sport or use a temporary decreased basal. Accidental change or zeroing of basal rate:Sometimes people accidentally program their basal rate downwards when meaning to do a temporary basal. Do not hesitate to seek urgent medical care if you are on an insulin pump and experience high blood sugars with ketones that you cannot manage or reduce yourself. Not enough meal insulin or meal medication: Again, some of these reasons may relate to number one above. Not giving a correction dose or enough of a correction dose:If your blood sugars are high before the meal and you give insulin just to cover the food, then chances are you will be high again later.
Dr Okezie Emenike, a medical practitioner with a private hospital in Abuja, on Thursday said that low blood sugar in a patient could lead to death.
Emenike told the News Agency of Nigeria (NAN) in Abuja that low blood sugar causes a patient to go into coma.
He described low blood sugar as a disease that affects mostly diabetic patients due to lack of sugar in the body to use as fuel. According to him, low blood sugar could be as a result of excessive consumption of alcohol without eating as well as becoming more physically active than usual. He said that skipping meals and some form of medication such as insulin treatment could also cause low blood sugar in patients.
Emenike added that preventing low blood sugar was important to both diabetic patients and patients suffering from other related aliment.
He stated that eating at least three evenly spaced meals each day with between-meals snacks, as prescribed by a doctor, was important in preventing low blood sugar. The physician added that following a meal plan and eating meals not more than four to five hours separate could help in the reduction of developing low blood sugar. He advised patients with the ailment to always double -check the insulin and dose of diabetes medicine before taking it to avoid developing low blood sugar. He mentioned that treatment for low blood sugar could be achieved by a doctor evaluating the medicines taken if it was caused by too much of insulin that peaks in the evening-to-morning hours. He said that a change of diet when the blood sugar level drops after eating meals containing lots of sugar helps in treating low blood sugar.
Emenike urged patients with the disease to always check their blood sugar level after consuming meals enriched with sugar before eating another sugary food if it was still low. He advised patients to avoid driving if they suspect low sugar level due to the risk associated with it, stressing that it could make the patient to pass out or go into coma. The medic, who suggested that foods, fluids and insulin should not be given to an unconscious person susceptible with the disease, added that it could choke the patient, which could lead to death. In here we will take a look at low blood sugar (hypogly-caemia) and high blood sugar (diabetes). When you scan this list of symptoms, you will realize that low blood sugar is not a rare complaint. This is developed over time usually, and is often from eating too much sugar based foods and damaging the body’s ability to handle sugar. Wait – did we just say avoid sugar and fats for someone with low blood sugar in the first place? Yes, the body is sick of taking too much sugar (sugar in this case means carbohydrates, fats and natural or unnatural sugar) – and the only way to effectively and fully recover from it, even at an older age, is to go on a pure protein diet. Many western doctors say to eat sugar many times a day, but this is a grave mistake, and will not resolve and cure the problem – this is commonly thought as a fix, but it is a very primitive way of dealing with a problem.

So pull up a chair and learn how this diabetes device can be liberating and alas, can be much work.
Some people refuse pump therapy because they don’t fully understand its benefits over multiple daily injections.
Of course, you might find new reasons for wanting to try pump therapy after reading them too.
Implantable and closed-loop insulin pumps are briefly discussed, but not routinely available for purchase. The expensive part of a patch pump is typically the handheld module (which can be left safely on the sidelines) whereas the attached pods are usually, as in the case of the Omnipod, disposable.
The reservoir of concentrated insulin is therefore also kept beneath the skin, but can be re-filled from the outside of the body using a large syringe.
Each pump has all the same basic features, although may perform them differently, but also has some unique features that make it stand out from the others.
Below you’ll find a list of both insulin pump advantages and disadvantages from the viewpoint of myself as an educator and pumper, and from other pumpers’ points of views. As an educator, this is one of the most underused but beneficial advantages of insulin pump therapy that I see. It’s reassuring for people with diabetes to know that they can turn their background insulin off for a short period of time if they’re worried about a low or over gave insulin at meal. Your insulin is always with you, there in your pocket or bra or wherever you wear your insulin pump.
This means after telling it the number of grams carb you’re going to eat, the pump uses your insulin-to-carb formula to determine how many units are needed. Then gone to bed with a great blood sugar reading but wondered how much insulin you injected over the night and how much of that insulin was still on board working? Some pumps work together with continuous blood glucose monitors to show your blood sugar reading on the pump and to have the pump alarm if your blood sugars go too low or too high (you set the limits). When on injections, people often need to meet with their educator to discuss how to adjust their long acting basal insulins to avoid overlap or gaps. Both the pump, it’s monthly supplies and especially continuous glucose sensor monitors if you want to use them, are all costly items.Pumps in 2009 are about $7300-7800 Canadian or US, with monthly supplies about $300 not including test strips. It’s worn 24 hrs a day unless temporarily removed for showers, swimming, heavy contact sports and intimate moments.
It occurs when there is not enough insulin to sufficiently use the glucose in the body and the fat stores are burned instead. Many need to carb count to a pickier level since they don’t have excess insulin floating around from intermediate or long-acting basals. Because of this, the pump may have to be refilled every 1-2 days – both an inconvenience and an expense for some.
Some people find the technical parts and problem-solving boluses, insulin on board etc too difficult or too onerous. However, it needs to be stated that sometimes the occasional low blood sugar seems to defy logic and explanation, no matter how hard you, the endocrinologist or diabetes educator seek a solution. Review your basal rates periodically and have them written on calendar or somewhere in case the pump settings are lost due to malfunction, battery out too long etc.
0300 hr), pump alarms to remind you to test 2 hr after any bolus, insulin-on-board (or bolus-on-board or active insulin) and continuous blood glucose monitoring (although often gives delayed readings viewing the trend can often let you know if you are dropping quickly and at risk for a low, depending on your current glucose reading. Sometimes, a mild low once a twice a week that is easily recognized, has an understandable (and hopefully preventable) cause and is quickly self-treated is not viewed as a concern.
Understanding the reasons can reduce the frustration and help prevent future episodes. Everyone with diabetes could benefit from reading this list of causes for high blood sugar.
Although not pump specific, they are often the primary reason for sudden hyperglycemia in the pump clients I see.
Many people exceed the recommended 2-3 day wear for cannulas (the part of the infusion set that is under your skin). If changing the set more often due to eating more carbs during Christmas, Halloween or holidays is a concern due to cost, talk with your health care provider about giving bigger boluses by syringe or insulin pen and using the pump just for basal insulin during those periods in your life.
Site irritation, lumps or infections all negatively affect insulin absorption and can cause high blood sugar.
An air bubble of about an inch in length inside tubing is usually equal to about a unit of insulin for many of the infusion sets (be sure to check with the company).
However, even though there is insulin in the tubing, still go through the entire normal set-up as if the tubing were new.
This is often done to reduce the risk of hypoglycemia but is sometimes one of the causes of high blood sugar later on.
And yes, low glycemic index foods have been shown to lower blood sugar in both type 1 and type 2 diabetes. This means part of the insulin has denatured from either heat or extreme cold and should not be used. Although, this is more likely to cause a low early on followed by a high 12-16 hours later if too much fast insulin and not enough of the slowing suspension is given. Either can make you put on weight, and can lead to other health problems, some of which can be quite sever. General symptoms:Fatigue,overweight,PMS, joint and muscle pain,low libido,fainting,muscle stiffness,blurred vision,migraine cold extremities and excessive yawning.
Such a diet upsets the delicate sugar-insulin balance and encourages the body to release more insulin to achieve the correct level of blood sugar. If we take sugar we are stressing what is an already overworked blood sugar control system.
This does not always mean sugar as in chocolate or white sugar – it can even be fruits, rice and carbohydrates of all kinds including bread. What this does is allow the body to recover from too much sugar intake, and rebuild itself. How new insulin pump features mean new freedoms, if combined with the information to understand and use them safely. It’s true that very few people give up pumping after having started, however, MANY do not realize the commitment required to gain the full benefits of this therapy. Each pump is about the size of a pager and is worn on the outside of the body, for example in a pocket (or yes, in a bra!). However, a quick review of this article from the Netherlands shows that this country has had more experience with this modality of treatment in select individuals (about 57 over an 11 year period, still a small number compared to traditional insulin pump therapy). For more information on how implantable insulin pumps work, consider reviewing the journal paper by Haveman JW, Logtenberg SJ, Kleefstra N, Groenier KH, Bilo HJ, Blomme AM. This procedure is mentioned here because many people who ask about insulin pumps also ask about beta cell transplants. Many people giving injections using NPH or Lantus or Levemir will have too much or too little background insulin on board at varying times of the day. Although it might not be enough, it is still something they could not do when on injections. However, most people who start on insulin pump therapy experiences less dramatic swings in blood sugars and certainly less dramatic and less frequent hypoglycemia. It’s easy to nibble and give boluses as you go instead of having to get up and find your purse or insulin pen etc.
One of the advantages of most pumps is that they’ll tell you the amount of active insulin still on board (Bolus on board, active insulin on board). There are limitations with these systems however for some people or some circumstances, they can be very useful for helping to spot trends and to avoid overnight lows. However on a pump people usually leave everything as is until they wake after their first night there – then change the pump time to local time.
Unfortunately, all of the sites that are currently used for normal needle injections are not always comfortable for putting in an infusion set.
For some people, carrying the back-up kit is an annoyance and a pain however, it can pay off in preventing DKA. Also, basal rates should be checked again after about a year or anytime repeated unexpected highs or lows are showing a pattern. This could happen when whizzing past a kitchen cabinet and getting hooked on a knob, or whipping down your pants only to realize you had placed the set in your leg today.
Severe hypoglycemia, or even mild but chronic episodes of unexplained low blood sugar levels require in-depth investigation as another medical disorder may be involved.
It’s important when on diabetes medication, especially insulin, to check blood sugar with any of these symptoms to verify if having a low blood sugar.
However, this decision and any relating to your safety must be made between you and your physician. It doesn’t always pose a problem, however the more insulin you take the more of a problem it is likely to cause. And of course, infections require medical attention with antibiotics as the site gets extremely swollen and tender as it progresses. This emphasizes the importance of testing glucose readings first thing in the morning to reduce the risk of DKA.
This works well for some people on pumps eating high fat meals like pizza and Chinese food. Remember, rapid insulin works in 15 minutes for some but has a duration of up to 4 hours in many people (although the later part of the action time is not strong). If you’re on an insulin pump, also read the extra 15 ways insulin pumps can cause hyperglycemia. Again, everyone is different, so here is where the value of self glucose testing and record keeping comes into play.
Usually, educators instruct clients to give these doses as 25 units given twice in two separated areas to allow for better absorption.
The only satisfactory answer lies in careful low-sugar eating with the support of specific supplements and nutrients. Hypoglycaemia or low blood glucose is a condition in which the level of glucose Learn about hypoglycemia, which is caused by low blood sugar. Even as a pumper myself, I originally refused the therapy years ago until a 12 year old convinced me to learn more. Flexible, yet strong tubing (infusion set) connects the pump containing the insulin to the person.

The reservoir of insulin and the motor to move the insulin are included in the insulin pump that adheres to the skin. Surgical aspects and complications of continuous intraperitoneal insulin infusion with an implantable pump. Such a system would have all the technology and hormones necessary to allow for real time measuring of blood glucose and real time response to those readings via delivery of hormones to prevent both hyperglycemia and hypoglycemia. Sometimes the statement is true by trying to use the feature on the pump is not so easy or so “usable” for some folks. Can you order supplies from your country and will there be border issues if you can’t? There’s more to read than most websites as I’ve included real-life scenarios so you can better appreciate some of the points. For example, some people on injections find that if supper is late, their blood sugars start rising.
Almost everyone on injections has at some time given their normal morning basal insulin, let’s say NPH, then started the day and realized “Wow! Pumpers can also reduce lows and their fear of lows by using the insulin-on-board feature, square or extended boluses (see below under variable blousing) and temporary reduced basal rates. Do you have OK glucose readings 2 hr after pizza but then have glucose readings that rise, and rise and rise afterwards??
It will use your formula you’ve previously inputted to determine how much insulin you need to fix that high. If too many units are remaining, possible options to prevent a low could be to eat more carb or program a decreased temporary basal. Medtronic’s next generation pump will supposedly offer the option of having the pump temporarily shut off if it senses blood sugars dropping too quickly (this is 2009). Some people never accept the feel of having a device always on them, whereas others quickly loose sense of wearing it after a week. Each clinic has their own guidelines for how much extra insulin to give if ketones are present in a pumper, but the bottom line is, most people require extra insulin above and beyond their normal correction dose to fix a high reading if ketones are present. For example, most people find infusion sets to be uncomfortable if placed at the pant’s waistline rubbing against the pants, or down the midline, or a few inches below the underwire bra where it rubs when women bend or sit.
Although the expected advantages of insulin pumps is to have better blood sugar control, without the time and effort put in by the user, this just may not happen. One for general causes of hypoglyemia in diabetes, the other for insulin pump related causes. However, talk with your doctor or educator to see if this needs to be individualized for you.
Unfortunately, not treating lows can make it more likely to develop hypoglycemia unawareness – meaning not being able to sense the lows. You should meet with your doctor as soon as possible if you have a low blood sugar that required the help of someone else to treat. For insulin pumpers, what follows are unique reasons for sudden hyperglycemia (high readings) when on an insulin pump.
For those whose sets don’t adhere well, a clear soft protective covering like Tegaderm can be placed over the infusion sites. To prevent or treat high blood sugar, be sure to have an emergency kit at home that has a prescription for your dose of backup basal insulin (eg.
The insulin travels from a reservoir in the pump (180-300 units storage), down the tube and into a small amount of tubing under the skin called a cannula. A hand-held device (usually with built in glucose meter) is used to wirelessly program in boluses and basal rates allowing for remote accessibility. A closed loop delivery system of insulin and glucogon is not currently available for marketing. This means there is not enough basal insulin to work with the sugar the liver is making at that time of the day.
I’m busier than I thought I’d be,” and subsequently either experienced low blood sugar or had to eat and eat to prevent a low.
The ability to reduce lows and their severity are significant and life changing advantages for some people. Be aware that most pump companies offer your money back up to 90 days after purchasing if you find this a disadvantage. It is easier for people on pumps to overuse a site and have it get lumpy and ineffective at absorbing insulin. It’s true that juice can also increase blood sugars, however because it is fructose based it is often about half the speed in fixing the low blood level than pure glucose tablets. This is much like me saying that my car’s fuel gauge is sitting on the red empty side and the fuel warning light is on but hey, the car has no symptoms. Sometimes the site looks pink, puffy and sometimes it looks fine, but will not absorb well. If you have an unexplained high, check back in your bolus history to see if the bolus was actually delivered. Small champagne bubbles in the reservoir are usually not an issue and do not typically result in high blood sugar. Or, put a different way, how much one unit of fast insulin will drop your high blood sugar level. The intention of these pages is to provide information to help you make an informed decision about this therapy, together with your health care providers. The infusion set (tubing) is usually hidden under clothing; however in active individuals the tubing can sometimes be caught causing the cannula to rip out if not carefully managed. Or, they find that if they miss a meal they have hypoglycemia, meaning they have too much basal insulin on board. Of course, if you could reach in and pull out some of that NPH you gave in the morning, that low sugar could be prevented. But many people greatly benefit from being able to fine-tune their meal and basal doses to this extent because…sometimes one unit is just too much! On a pump, you can program some of your meal insulin to be given now, and some to be given over a period of hours. There are various pump accessories available through the pump companies and other independent sites to help people incorporate the pump into formal wear, pajamas etc. Since there is no intermediate or long-acting insulin used in pump therapy, a problem with insulin absorption into the site or insulin infusion if the pump malfunctions or battery runs out could lead to high glucose levels and ketones quickly and possibly to DKA in as little as 5-6 hours in some people.
It saves time to check up front for ketones if you suspect a site absorption issue and give the extra insulin recommended by your doctor or eductor rather than correct a high with usual dose, correct again, correct again….
Some people are more likely to overlook a site problem if using a 90 degree (straight in) cannula as the infusion site can’t be seen as well as it can be with a 30 degree infusion set. For those of you not yet on a pump, you might be surprised (and relieved) to learn that there are various confirmatory steps in place to prevent accident delivery of insulin. Be sure to have guidelines from your educator on how to manage high blood sugars and prevent DKA (diabetic ketoacidosis) if your pump fails. Severe disease of nearly all major organ systems can cause hypoglycemia as a Other types of diabetes pills, when taken alone, do not cause hypoglycemia. One of the advantages of insulin pump therapy is that the basal insulin is programmed to meet the individual’s needs so big excesses, or deficits in basal insulin, are eliminated. You decide how much is given now, how much over a period of time and how long that period of time is.
Be sure to ask your educator or physician how much extra insulin to take if you have ketones.
Since most pumps come with tubing, this may mean creative camouflage of tubing if you were to place the set on the arm and experimenting with different infusion sets for different parts of the body perhaps. Or so my guests have learned as they’ve experienced my creative swearing while I’m whipping around the kitchen trying to be an iron chef while suddenly yanked back by my pump’s umbilical cord. This doesn’t mean you need to switch sets, only that you need to remember to change them rather than rely on looking at them to see how they are doing.
Where the tubing is attached to your skin, loop the tubing and place a strip of soft tape over the loop attaching it to your skin.
This allows people to miss meals, sleep in late etc without experiencing high or low blood sugar levels in most cases. Alarms will not always sound on the pump – for example – if an infusion site has been left in too long or is inflamed and is not absorbing the insulin because the site is inflamed the pump has no way of knowing this, as insulin is being delivered as usual.
Otherwise, you might put yourself at risk for high blood sugars, sore lumps or potential DKA.
Then if the tubing yanks, the tape and the loop are the first things to take the force and come undone but the canula is still in the skin. So…if these past two weeks my blood sugars have been rising between 2 pm and 5 pm even if I don’t eat, I’ll program my pump to give me slightly more basal insulin for those hours only, every day. One of the advantages of insulin pumps is that background basal insulin is given as tiny doses of rapid insulin every 3 minutes or so. Advantages of precise dosing are especially important in children or adults with small total daily doses of insulin. Dual wave boluses are also useful advantages for people who are fearful of giving all their meal insulin and correction at one time because “It just looks like too much insulin.” Their fear can be lessened if they give part of the insulin now and part over a time period. Then they can check their sugars hourly and stop the extended part of the bolus if they feel they don’t need it. It takes me an hour to drink mine but I can’t give all my insulin when I start or I’ll be low. If your activity suddenly stops, or it doesn’t happen as you planned, you can return your basal insulin to normal with a few pushes of a button. Imagine how difficult it would be to try to meet their basal insulin needs with NPH, Lantus or Levemir. Basal insulin can also be programmed as increases too if it’s a lazy day or a sick day or a day you run high because of your menstrual cycle or even part of the day. Clearly this is an advantage of insulin pumps that multiple daily injections would have a difficult time copying.

Blood glucose meters freestyle
Blood sugar high before bed frame


  1. 17.06.2015 at 10:44:56

    Influenced by the speed at which glucose levels are dropping monitoring is important, more so if you.

    Author: ILOAR_909
  2. 17.06.2015 at 15:55:16

    Blood sugar management, discuss hypoglycemia following a glucose not you can monitor your blood glucose level.

    Author: HeDeF
  3. 17.06.2015 at 17:19:59

    Abnormally pale or unhealthy hbA1c levels are reflective of blood glucose levels and frequency of hypoglycemia.

    Author: BaKiLi_QaQaS
  4. 17.06.2015 at 17:52:57

    Drugs; with medications that increase insulin.

    Author: qedesh
  5. 17.06.2015 at 16:58:15

    Which finds out whether excess getting one random fasting.

    Author: ukusov