In the case of Type 1 diabetes, the body does not produce any insulin, thereby leaving the body unable to break down and use or store glucose properly. Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. View the Winnipeg Health Region's current approximate Emergency Department and Urgent Care wait times. The Winnipeg Health Region has a variety of career opportunities to suit your unique goals and needs.
Note: insulin pumps do not measure blood glucose levels, but some pumps can read the signal from a separate glucose sensor.
A “tethered” pump uses a fine tube to connect the pump to the cannula; the pump is worn in a pocket or clipped to a belt (as shown above).
A patch pump or micro pump has no tubing or a very short tube, and the pump is usually stuck on to the skin. Because the pump delivers insulin continuously day and night, only rapid-acting insulin is necessary at rates designed to meet basal insulin requirements: this means that you don’t need meals at specific times. Injected long-acting insulin can be absorbed differently every day-sometimes too quickly, sometimes too slowly, and sometimes only in part.
Most experts and users agree that the advantages of pumping far outweigh the disadvantages. If you are struggling with highs and lows despite your best efforts on MDI, or you have frequent hypos that affect your day-to-day choices, then a pump may help you.
The national Insulin Pump Audit published in May 2013 suggests that just over 18,000 of us in the UK are using an insulin pump. Although glucose is the major fuel whose oxidation leads to energy-coupled insulin secretion there are other means for stimulated insulin secretion.
The pyruvate is oxidized by the PDHc and the resulting acetyl-CoA is oxidized in the TCA cycle. The major advantage of carb counting is that it gives flexibility to eat a meal or snack when ever you wish and gives a freedom to choose any food you like. The carbohydrate content of a meal is quantitatively a determining factor of the mealtime insulin doses.
Initially carbohydrate counting and insulin dose calculation may sound like a difficult task. The good news is that the technology for the management of type 1 diabetes is moving fast and is making living with type 1 diabetes a lot easier. At ACE diets we can help you to learn the differences between carbohydrate counting and general diabetes control.


As the illustrations below show, a person without diabetes is able to use insulin to break down glucose which is then used or stored by organs in the body.
In Type 2 diabetes, the body does not produce enough insulin or respond effectively to the insulin it does produce. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books. Studies such as the Diabetes Control and Complications Trial (DCCT 1993) have shown this is the best way to prevent or delay complications of type 1 diabetes such as blindness, amputation, heart disease, and kidney failure. Pump users can easily adjust their insulin dose according to their own changing needs, thus minimising high and low glucose swings and the resulting long- term complications. Basal rates are adjustable down to lower than a tenth of a unit per hour, depending on the make of pump. One important process is referred to as the pyruvate cycle and involves coupling of amino acid metabolism to insulin secretion. Within β-cells of the pancreas, this process, driven by mitochondrial malic enzyme serves as an important means for the use of amino acid carbon oxidation for the stimulated secretion of insulin.
For people with Type 1 Diabetes, blood glucose control is best achieved by matching rapid acting insulin dose directly to the amount of carbohydrate consumed; this method is called Carbohydrate Counting.
Find your individual “correction factor” – extra units of insulin to correct a high blood glucose level that is above your personal targets. However, you will gradually become more familiar with the process and it will eventually become second nature. If you are using insulin pump therapy, you are probably already using the bolus calculators built into most pumps. The randomized and non-randomized studies have shown the efficiency of Insulin Pump Therapy across all age groups.
We are experts in advising people with multiple daily injection therapy (MDI) as well as those on insulin pump therapy (CSII). As a result, glucose levels in the blood can increase unchecked, causing permanent changes in the structure and function of the body's organs. You can also exercise without risking high or low blood glucose levels promoting better health and well-being.
The tiny doses of Insulin from a pump are more consistently absorbed than a larger amount from an injection where it is sometimes not absorbed properly causing glucose levels to run low or high for several hours. With a pump and rapid acting insulin continuously delivering in tiny drops, absorption is much more reliable and your diabetes more stable and predictable. The insulin secreting β-cells, in contrast to the liver, do not express the gluconeogenic enzyme phosphoenolpyruvate carboxykinase (PEPCK) but do express robust levels of the gluconeogenic enzyme pyruvate carboxylase (PC).


Indeed, this process is energetically equal to glucose-stimulated insulin secretion (GSIS).
If you are on  MDI therapy there are now several blood glucose meters available with a built in mealtime (bolus) insulin calculator for calculating suggested insulin doses which means that it eliminates the need for you to make any mathematical calculations when estimating your mealtime insulin dose. However, to make most of the technology, you also need to know about carbohydrates, how to monitor your blood glucose regularly, how to re-address insulin to carb ratios and about correction factors, how to re-address the adequacy of your background basal rate and use correct strategies for high and low blood glucose. A pump used well is an effective tool for maintaining blood glucose levels within the normal range and helping to keep pumpers healthier and in work. Coupled with the activity of PC is the activity of malic enzyme which together, is the only means for pyruvate cycling in β-cells.
For example, 1 unit of rapid acting insulin may be appropriate for every 10g of carbohydrate in a meal. Once you have worked out and programmed the information into the meter along with your insulin-to-carbohydrate ratio and correction factors, the rest is then calculated by the meter.
Using fasting tests help you learn about your individual background insulin requirements over 24-hour period and allow programming of your pump to your individual needs. Cytoplasmic malic enzyme plays an important role in acetyl-CoA transport from the mitochondria to the cytosol for its use in lipid biosynthesis. This ratio is individualized from patient to patient, and it may even vary for the same patient at different times of the day. It is also important to make full use of the extra features available on your pump, such as temporary basal rates and multi wave and square wave boluses.
The role of the mitochondrial malic enzyme is principally to provide the cell with an alternate source of pyruvate under conditions where glycolytic flux in reduced.
Patients will also have to take into account pre-meal blood glucose level and give a correction dose if blood glucose is above the target range.
In these circumstances, the pyruvate generated by the actions of mitochondrial malic enzyme comes from fumarate precursors such as glutamine.
The correction factor is again individualized to each patient and it may vary at different times of the day. When glutamine is de-aminated by glutaminase the resulting glutamate can also be de-aminated by glutamate dehydrogenase yielding 2-oxoglutarate (α-ketoglutarate) which can then be shunted to malate synthesis in the TCA cycle.



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