Looking for a diabetes coach - any recommendations? Could you coach me?

[ollie1234]

Hello,

I've been trying to get on to a carb counting course for a few years (on and off), I'm tired of fighting with the NHS and would like to hire a diabetes coach for a while.

I'm looking for someone I can talk to on the phone about once a week with general questions and to 'check in' on how I'm doing, and who can look over my glucose, insulin dose and meal records to help me work out my ratios (I'm type 1 btw), think through what I'm eating and so on. I really need to learn to count carbs better, and my after meal spikes are scaring me a bit.

I don't mind paying for this, I figure that if I go without a couple of holidays in the next few years I'll get to go on a few more overall (I hope that doesn't come across too dramatic! It's a bit like buying gym membership I suppose!).

Some people here have been really helpful with getting me started on thinking about ratios and so on in this thread and some others I made a while ago. I'm extremely grateful for everyone who helped me get on the right track, but I have so many records and questions now it's more than I can expect people to answer voluntarily (here's my last post, I have another few weeks of records on top of that now). I have a referal to the local diabetic clinic but I've no idea when I'll see them (they didn't know when I called to ask) and I expect they will say there's no carb counting help available again.

If you've worked with a diabetes coach, could you recommend anyone or give me some tips on what to look for and how to find people?

If you know a bit about diabetes, can be patient and gentle with a somewhat-scared beginner* and would consider working with me for a while, please be in touch.

Thanks,

Ollie

* Type 1 for 20 years but am having a total review of my self-care, this is my first thread here where I start to reconsider things in a big way.

 

[ypauly]

My immediate thought is you shouldn't need to pay. My second thought is right here. Post up your resultsand queries and I am sure there will be some good responses, in fact it would probably be better to get a broad concencus than just one persons oppinion.

That is of course one persons oppinion though

 

[Northerner]

Hi Ollie, I appreciate what you are hoping to achieve, but bear in mind that most of the people here are not medically qualified and cannot offer advice, we can only make suggestions based on our own experiences. It might seem a subtle difference, but it is an important one. Have you tried the online carb-counting course at http://www.bdec-e-learning.com/ ? As Paul suggests, there is no problem posting your numbers and questions for discussion, so why not try that first? 🙂 Are there any particular problems you are having?

 

[ollie1234]

Hi ypauly,

In my heart I totally agree with you, all of us should get the help we need especially managing conditions like this. I think it's appalling that I can't even get on a carb counting course :-( That said, I've reached a point where I'm tired of fighting and just want the help. Any cost would be money well spent for me.

People have been really helpful here - I can't overstate this, I have got totally on track since visiting these forums and it has literally changed my life.

But I have worked as a personal tutor (face to face and on Skype) and know what a difference it makes to have a familiar person there every week dedicating an hour to helping you out. I could really do with that kind of consistent, ongoing attention and support right now. I feel I can ask a lot of things here but it seems too much to expect that level of personal attention in a forum.

 

[SacredHeart]

She might not be exactly who you're looking for, but if you're looking for someone to be extremely encouraging and who really knows her stuff, check out Ginger Vieira. She's a friend of mine, who does life coaching, but is also a T1. She's amazing, and has a wonderful book about taking control of your diabetes. She does consultations via Skype. Her website is http://www.living-in-progress.com

 

[ollie1234]

Hi Northener,

I appreciate that, I wouldn't be ask anyone to give formal, medical advice. Part of it is just feeling alone and finding it hard to make time to type things out and think them through - I'd like to find someone sympathetic and understanding, who could also make suggestions and help me out with all the thinking and analysing.

I posted my diary here a few weeks ago. I got some great feedback on it but I'd like to work through all the night time and meal records to review my lantus dose and meal insulin to carb ratios. There are so many records in there part of it is just wanting some help with all the work... we all get tired and lose enthusiasm sometimes. That's what I'd like a coach to help me with.

Ollie

 

[ollie1234]

Thanks SacredHeart, your friend seems like the kind of person I'm looking for 🙂

 

[everydayupsanddowns]

Whether you decide to investigate some sort of one-to-one coaching I hope you'll continue to share your questions and results with us too. Whenever anything is discussed around here it always seems to throw new light on old problems, and whether the thread is neatly answered or not seems not to matter. Sharing our own questions/successes/failures/conundrums makes us all more experienced and better able to cope somehow!

Mike

 

[ollie1234]

Thanks Mike 🙂

Funny enough I was just watching this video on Ginger Vieira's site about how we can't manage diabetes perfectly, just humanly. I think I have perfectionist tendencies!

I feel a bit frustrated that I'm still not very confident in my lantus dose despite doing all of these tests for a while. Partly this is because I seem to keep going to bed with some kind of unusual event happening, like a hypo earlier in the day or taking a little lucozade to prevent a hypo when my glucose is low.

I'm similarly frustrated to not have worked out my ratios. Some of this is also about not sitting down and combing through all of my records, which, honestly, I just find a boring prospect!

On the positive side I do have a lot more results to use now (here), but I'm also frustrated at feeling I'm not getting as much out of them as I'd like.

So - lots of frustration I'm trying to deal with!

Ollie

 

[Northerner]

That's quite an extensive diary Ollie, I'll peruse it and see if I have any comments that might help 🙂

 

[Ellie Jones]

Hi Ollie..

I would advise getting either one of these two books Using Insulin by John Walsh (I've got this one) or Think Like a Pancreas by Gary S... (can't spell the surname from memory😱)

Both of these books go through using basal/bolus (carb counting regimes) explaining how to use work out ratio's, corrections etc..

 

[everydayupsanddowns]

I feel a bit frustrated that I'm still not very confident in my lantus dose despite doing all of these tests for a while. Partly this is because I seem to keep going to bed with some kind of unusual event happening, like a hypo earlier in the day or taking a little lucozade to prevent a hypo when my glucose is low.

I'm similarly frustrated to not have worked out my ratios. Some of this is also about not sitting down and combing through all of my records...

I know just what you mean! Are you Lantus tests consistent in rise/fall? Not much you can do if you don't get repeatable results, but carry on observing and try to spot the overall trend...

As for ratios, as Ellie says there are methods in books that might give you a framework for that. Alternatively if there's a simple meal you usually get right you can use that to work backwards to give yourself a general idea. Or if not that, if there's a meal you can construct to be regular - 2 pieces of known-carb bread and a regular sized apple for lunch for a few days. Then divide the calculated carbs by the dose that works and Bob's your lobster.

Don't forget to assess carb ratio separate to insulin/food profiles too in that you can go 4.5 to 12.8 to 5.1 over 4 hours and because the 'before' and 'end of insulin activity' levels are pretty level it would suggest that the dose was right, but that the insulin was a bit late in getting going.

Hope that makes some kind of sense!

 

[ollie1234]

Thanks 🙂

I've been developing the habit of recording my thoughts when I test, eat and dose. I'm trying to get my thinking correct; it's interesting how far apart my thoughts and the theory can be.

I am doing a lot of thinking, an awful lot. Here's an example. Take last Thursday:

I start the day at 6.2 after going to bed at 7.3 - very happy to have had such a steady night.

I eat a croissant which I guess is 35g (is that right?) and intuitively don't really believe that needs 7u (based on my 1:5 ratio, which is very work in progress and I don't have much confidence in). I take 5u - a 1:7 ratio.

An hour later I'm at 10.8, I remember thinking I had possibly got the ratio wrong and maybe it was more like 1:6.

20 minutes later I test again (I probably felt a bit funny, I can't recall). 6.7, a drop of 3.9 in 20 minutes. I eat a bourbon biscuit (9g, I looked it up on the internet!) to reduce the rate of descent and prevent a hypo.

On reflection, was this a good course of action or not? I ate at 9.20, it's 11.29, about 2hrs 10mins after injecting so most of the insulin has done its work (75%? I forget the numbers but I recall seeing the effect over time charts). If there's 25% insulin left, and it lowers my glucose by x units, and the croissant is y units... then I can't figure out the math for how much further my glucose would have dropped if I'd not had that biscuit.

12.07, 40 mins after that bourbon, I'm at 5.1. The descent seems to have slowed and I've not hypo'd, great.

12.43, glucose 5.8. Why has it risen??? This has to be the bourbon, right? Still taking effect now? But it could be stress or perhaps a random fluctuation. Do we get random fluctuations or did I just imagine that? They seem random sometimes. Let me reframe that logically: how much can I reasonably expect to understand - will there always be unknown factors affecting my glucose levels, even if I were to have the best knowledge I could hope for?

So that was my morning. This is a lot of thinking and it feels like a lot of work for a croissant! Do you think things through to this extent too? How am I doing?

I feel like I have so many questions!

 

[everydayupsanddowns]

OK. First off I think you handled that brilliantly. No hypo, and while perhaps a smidge higher than you'd want at 10.x it didn't last more than a few minutes.

Some 'rules of thumb' for you to work out how much they *don't* apply to you...

1u : 10g cho
10g cho raises BG by 3mmol/L
1u lowers BG by 3 mmol/L

These seem to be the dafne 'default' values. Everyone starts with these and then tests to tweak them up/down for different times of day.

The other thing to ask is about the counting. Where did you get the croissant? If is was a supermarket, it most likely had a 'per croissant' figure on the wrapper. The ones we have are med sized and usually 20g. The fat in them slows absorption a little, but it's white flour. Sometimes I spike, sometimes I don't. If I wanted to test my breakfast ratio I'd choose Burgen toast. If I was really paranoid I'd weigh the slices of bread to double check (I've not needed to do this so far, though we do weigh most things at least to start with)

Keep us posted on how you get on 🙂

 

[HOBIE]

Good luck ollie the trouble is there is no perfect answers and everybod is different. I take it you have let your team know how you feel about a carb counting cource ? Have you been to a "Diabetes uk" meeting near you ? They are good for talking to other people in the same boat ! 🙂🙂

 

[ollie1234]

1u : 10g : 3mmol/L

...

that is absolutely priceless information, thank you. Going to keep that in mind as a starting point for future experiments.

I definitely need to get some slow acting, default meals together. I keep eating salads as they're very low carb and easy to think through, also eating a lot of Innocent veg pots and M&S salads. Partly because I love having the numbers in the nutritional information, also as I'm tired after work and don't enjoy cooking much. They seem fairly healthy and not too spiky.

 

[everydayupsanddowns]

1u : 10g : 3mmol/L...

that is absolutely priceless information, thank you. Going to keep that in mind as a starting point for future experiments.

As I said, it might be a useful starting point, but the results you posted suggest that your guess of 1:7 was not too far out.

You may well find you need more insulin in the mornings, less later on. And don;t forget that NovoRapid/Humalog will most likely last 4 hours (slightly more in some people, slightly less in others). Some seem to find the action is
onset--big peak--rapid fade

while others have
onset--gradual peak-- gradual fade

So you'll need to work out how much 'oomph' your bolus has left in it at, say 2 hours after injecting (has it done half its work or more like three quarters). Not easy to be sure about this without knowing the profile of the food, of course...

 

[imtrying]

Hi Ollie,

It's really great to be reading your posts and you seem to be in the same place I am with having been diabetic for nearly 20 years and now wanting to re-educate and do things properly. The main advantage I've got is that I have got a place on a DAFNE course (BERTIE at my hospital) and I am starting that on 7th October, doing one day a week for 4 weeks.

I will try and share what I learn after each week and maybe you can get something from that to help you.

Other than that, these guys on here are AMAZING and most of the time, their knowledge is invaluable.

Good luck 🙂

 

[Ellie Jones]

Before working too much on your carb/insulin ratio's you've got to ensure that your basal/ (background) insulin are correct or all your carb/insulin ratio's will be out... The basal is the kingpin as all your calculations will be off this profile..

If you did a fasting test with bg testing every hour and your lantus is correctly set then your BG's would be no more than +/- 2-3mmol/l of your mean line.. A big ask for one injection a day more so if you suffer Dawn Phanom where you BG has a big increase in the morning with this is can be better to split your background dose to 2 injections, so you inject at night to cover the morning needs, and inject in the morning to cover the rest of the day needs.. And don't forget that background insulin is a timed injections same time everyday...

When doing a fasting test it's wise to split them into 3 time periods, night, morning and afternoon... Arm yourself with plenty of test strips, hypo treatment and your quick insulin.. Ensure that you've not eaten a slow adsorbing meal or high fat meal piror to testing.. Then test every hour if you hypo or bg's become too high abort the fasting test and treat appropiately...

Do the testing on a quite day, so no heavy exercise or rushing around..

Night time testing, well we all love our kip so you can if you chose, do this over several nights.. So that you take a test every couple of hours if you'll doing it this way, ensure that the nights you do it on, the daytime was pretty similar and your starting BG pretty similar as well...

This will help to provide information, to whether your background is correct, whether you be better off spiltting your background insulin and/or whether you actually need to move the time you actually inject your background insulin make better use of it's profile..

To begin with yes it's pretty intense with recording everything weighing foods, noting down exercise, stress levels (did your manager pee you right off in work) then looking at your results to indentify patterns or connections between results achieved etc... But once you start pining it down, understanding where you've got to make an adjustment to dose to compensate for this or that activity or stress level etc.. It does become more easier not only to swiftly calcualte your needs but you can drop some of the data recording, and wieghing then just do a period of intense monitoring every now and again, either when routines change or for a periodic check in to ensure everything is ticking along nicely..

 

[Natalie123]

Hi Ollie, from looking at your diary I have a couple of suggestions:

Pizza is not ideal for you! I struggle with this one too, someone suggested taking some of the insulin before the pizza and some half an hour or so after eating ... might be worth experimenting.

Some of your meals - mainly breakfast are quite high GI I think - fruit, croissants etc, which could explain why your levels after eating are quite high or ok and then you drop very rapidly. I used to have this problem when I ate cereal or toast and jam. I switched to cooked breakfast (poached egg, seeded toast, tomatoes and mushrooms) which has helped hugely, and I feel much better too. The other suggestion, if you don't want to change your food, you could take your insulin earlier to try to match the peak of the insulin with the peak of your food, or see if there is an insulin with a quicker acting profile. I switched from novorapid (peaked in the first 20 - 30 mins and lasted 4 hours in me) to apidra which peaks earlier (10mins) and lasts less time (2 - 3 hours) - this stopped the spike followed by sudden drop after meals.