Tips from FFL

[bev]

Bev im sorry i wasnt trying to cast doubt on what you were saying - only that we have a different experience which is VERY limited. Thank you for your advice re the two hypos (when I asked Dsn about both instances she just shruugged and didnt offer explanation) both are worth thinking about.

I have to say I have learnt far more on here than from Dsn and I want to thank everyone 🙂

Hi Carol,
No need to apologise - you didnt upset me at all. I do find that there seem to be huge differences in the way different teams are advising people all over the country and this just cant be right can it.....

Sorry to say that your DSN doesnt sound very helpful to me. The problem with treating a hypo and not knowing what the actual level is that it can be very hard to treat properly. If K was 2mmols for example she might need to have 2 lots of fast acting to bring levels up to range, whereas if she were 3.7 - this would obviously only need 1 treatment to bring up to range (unless it was already on its way down very quickly) and so needs to be re-checked after 15 minutes to make sure that levels are within range.

The 15/15 rule is to treat with 15 fast acting carbs and then re-test in 15 minutes. Often what happens is the people re-check after 5 minutes and then end up overtreating the hypo and then later have a high level.😱🙂Bev

 

[fruitloaf]

can someone explain how you know how much hypo treatment to give? I was told '4 glucose tablets' then test again in 15 minutes. I wasn't given any indication about treating with different amounts depending on the glucose reading.

 

[grandma]

well Iam going to go back to what Iwas doing before and having my injection before meals I was better controled then I am now😱

 

[bev]

can someone explain how you know how much hypo treatment to give? I was told '4 glucose tablets' then test again in 15 minutes. I wasn't given any indication about treating with different amounts depending on the glucose reading.

Hi Fruitloaf,
There isnt a hard and fast rule about this - its about trial and error. I know that for Alex if he is 4 - then he might need 2 glucotabs for example to stop him dropping. But, if he was 1.7 - he would need 1 x can of coke and then testing in 15 minutes - sometimes he would need to have another treatment and sometimes he wouldnt - so it would be very difficult to give you an exact answer. It might help you to log down all your hypo treatments from now on to see if there is a pattern to how much treatment you need to take and for what levels.🙂Bev

 

[bev]

well Iam going to go back to what Iwas doing before and having my injection before meals I was better controled then I am now😱

Hi Grandma,
If you feel that your control was better then I think you have made the right decision. Perhaps if you think you might forget to eat you could buy a little alarm clock or an egg timer to set for 15 minutes (or whatever times you choose) and set it as soon as you inject.🙂Bev

 

[grandma]

Hi Grandma,
If you feel that your control was better then I think you have made the right decision. Perhaps if you think you might forget to eat you could buy a little alarm clock or an egg timer to set for 15 minutes (or whatever times you choose) and set it as soon as you inject.🙂Bev

It isent that I forget to eat its that I get the grandkids sorted first and then its grandma I wasnt a drink grandma can I have saurse all that and I am up and down and then dinners cold so I dont want it. I have to think more about myself than them. they are getting to know now and do thing more for themselfs.

 

[grahams mum]

graham is about 26kg and half tablets is enough then i always follow with carb

 

[Pigeon]

After my last clinic appointment (where I was disappointed with my A1c) I started testing 2 hours after meals and found a typical post-lunch reading was 16! But by 5pm I'd be down to 5, so I think it's because I sit down at work all afternoon the Novorapid takes ages to work. So I've started injecting 30 mins before my lunch (when I'm confident I'll get lunch on tim) and this makes the 2 hr reading around 10. Hoping this will have an effect on my results in December when I next go to the clinic....

 

[randomange]

If you miss just 1 bolus for a meal - you increase your hba1c by 0.5%.

***

For fatty foods (people on pumps) - you should do your normal bolus 15 minutes before eating and then increase your temp basal to 150% for eight hours afterwards to help with the release of fat. The graphs to prove this point spoke for themselves.

Thanks for posting this Bev, I really like keeping on top of what the latest research is saying!

For me, I definitely find that I only need fast acting to treat a hypo, unless it's a weird one, and I've found that to be true both on the pump and MDI. I've also noticed that bolusing 15 minutes before eating seems to help with spike, particularly in the morning - I just need to be more organised!

I was curious about the missed bolus though - was that assuming you didn't correct, or that the meal was particularly carby?

Also, the advice on fatty foods was interesting. I've used an increase in temp basal for things like pizza before, with some success, but I've never been able to give the full bolus up front. Sometimes even giving 50% up front for something like pizza or chinese results in my blood sugar dropping considerably before rising - did they say anything about this?

Thanks again! 🙂

 

[shiv]

Gary Scheiner gave one example for pizza (and again, this isn't advice, just what he said). He said for pizza, give the bolus over 2 hours and then increase the basal by 50% for 8 hours. The fat in the food causes insulin resistance, which is why we see a big rise in numbers after something fatty like pizza. I think the 2 hours bolus/50% for 8 hours is a general guide and would need to be tweaked for individual needs, but works for a lot of people apparently!

 

[Adrienne]

Hi

I'll post more tomorrow as I can see Bev is answering everything here. There was so much said.

I've been saying for nearly two years now that no long acting carb is needed if on MDI (Daniela, our teams down here are very very wrong).

To treat a hypo you only need quick acting and start at 15 carbs (small can of coke and never juice) and test after 15 minutes, never before 15 minutes.

As Bev said this is for the hypo only. If there has been exercise beforehand or you are going to do exercise then you will need free carbs to cover the exercise.

As Bev said this is all on the US children with diabetes website.

There was stuff about bolusing all upfront for pasta, rice, pizza and then temp basal but it is each to their own at the end of the day. I used to do this for pasta but it stopped working and we have found a certainly dual wave works for Jessica just fine.

When basal testing no food at all, only water and sugar free jelly. The reason people say protein only meals for basal testing is for the young kids who can't go without but it will affect the levels as without carbs, some of the protein turns into glucose and stores itself.

Gosh there is loads and I could go on but I have to go to bed, am knackered.

🙂

 

[shiv]

Re the protein, Gary Scheiner said if you are eating a protein only meal then to treat 50% of the protein as if it were carbs - there is some physiological explanation behind it, but basically the body converts some of the protein into glucose if no other carbs are present. So a true basal test has to be a hungry one, lol.

 

[Twitchy]

Gosh, so many questions now!! 😱

Bev - What is Victoza, why where some T1s using it & what are the apparent benefits?

Adrienne - why not juice for a hypo? (do you mean pure oj type juice?)

Sorry to be asking more questions, but thanks - this is a really interesting thread!! 🙂

(Just got to start saving & get over crisis of conscience spending on myself so I can go next year lol!)

 

[everydayupsanddowns]

Re the protein, Gary Scheiner said if you are eating a protein only meal then to treat 50% of the protein as if it were carbs - there is some physiological explanation behind it, but basically the body converts some of the protein into glucose if no other carbs are present. So a true basal test has to be a hungry one, lol.

I came across this myself this year too. Fat is also converted (esp in the absence of carbs) but at a lower level again.

There's a graph that suggests levels of food-to-glucose conversion and timings here:
http://www.diabetes-support.org.uk/joomla/food-conversion-to-blood-glucose

 

[everydayupsanddowns]

I think what you touched on there Bev, about needing a shake up over here and what Grandma said about conflicting advice, shows that possibly the biggest area of investment should be in educating the professionals and keeping them updated.

They do seem to spend the bare minimum today and hope it'll be someone else's problem to sort. If nothing else, there should be clear guidelines for ALL health professionals to follow so that we are able to look after ourselves in the best possible way.

Sadly, lowest immediate cost is the criteria for NHS care. In the US they do at least look at the longer term and try to mitigate against future costs...

I completely agree with that Rob.

In some of the fishing about I did about the appalling lack of basic carb-counting education, essential information which is not given to tens of thousands of diabetics put on insulin every year I came across these interesting nuggets:

Cost to the NHS of one A&E admission due to a bad hypo: ?88
Cost of 3 afternoon carb counting introduction in local diabetes clinic: ?66

Cost of DAFNE (per person): ?545
Likely reduction in HbA1c: 0.9 - 1.1%
Likely reduction in development of complications: 30-40%

Even with it's hefty per person pricetag, it is expected that the reduction in cost of treating complications in areas that run DAFNE (or similar) will put them in profit.

Sadly it's down to the local PCT to allocate it's budget where it thinks it best serves the area. There does not seem to be any mechanism for spreading excellence in care, or ensuring that proper information is given to patients.

 

[bev]

Update,

Alex has bolused 15 minutes before each meal since last night and his post meal checks have given much better results than normal - he has been either 6 or 7 whereas he can sometimes be 11 or 12 at these times.🙂Bev

 

[Northerner]

Update,

Alex has bolused 15 minutes before each meal since last night and his post meal checks have given much better results than normal - he has been either 6 or 7 whereas he can sometimes be 11 or 12 at these times.🙂Bev

Goodness, who would have thought such a simple change could make such a difference? I must admit, I have been trying it (when I can remember), although nothing is proven in my case as I have so far forgotten to test! 🙄

 

[bigpurpleduck]

Update,

Alex has bolused 15 minutes before each meal since last night and his post meal checks have given much better results than normal - he has been either 6 or 7 whereas he can sometimes be 11 or 12 at these times.🙂Bev

Ditto for me! Last couple of days post-lunch has been around 14, today was 7. Thanks again Bev

 

[bev]

Ditto for me! Last couple of days post-lunch has been around 14, today was 7. Thanks again Bev

Glad you tried it and even better that its worked for you!🙂Bev

 

[bev]

Goodness, who would have thought such a simple change could make such a difference? I must admit, I have been trying it (when I can remember), although nothing is proven in my case as I have so far forgotten to test! 🙄

Hmm - not good Northey! You need to check otherwise we wont know if it works for you.🙂Bev