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Annual Review Today

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newbs

newbs

Well-Known Member
Relationship to Diabetes
Type 1
I have my annual review this afternoon at the hospital. My levels are all over the place, in October I?ve had over 50 highs and 20 odd hypos, not many at the correct level at all. Not sure what to do about it as I am carbohydrate counting but it is just not working, e.g. I had vegetable moussaka for lunch, 380g pot contained 36.9g carbs ? based on 2/10 ratio injected 7.5 units NR ? now BS 3.1. Obviously ratio too high but at other times less insulin means highs and there is no pattern i.e. lunch needing a higher ratio etc. There just seems to rhyme or reason to my BS levels. :confused: Had protein in my urine last time so am hoping that will be clear this time. Also hoping appointment won't be running too late as I?m last one in at 4.45pm!
 
I hope things go well. Might be worth asking if they have a CGMS you can use for a few days to see if you can work out what's happening. Also wondering if it is your basal insulin that needs looking at, as having this at the wrong levels can mess with your meal bolus ratios something rotten.

Good luck! 🙂
 
I haven't basal tested for a while but my first morning BS is generally ok, this wouldn't be the case if the basal was the problem, would it?
 
newbs said:
I haven't basal tested for a while but my first morning BS is generally ok, this wouldn't be the case if the basal was the problem, would it?
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It's awkward with MDI as you can't make too many adjustments, but it may be that as the day progresses your basal is either too high or too low and might benefit from a split injection.
 
It needs to be 'as right as it can be' 24/24 .......
 
Saw the consultant who is very concerned about the amount of hypos I have, especially how low they are, so wants me to have a target HbA1c of 7-7.5% (currently 6.6%). Not sure how I feel about this, have always tried hard to get my HbA1c down, not up! I can see what he is saying, and didn't realise how detrimental lots of hypos can be, thought they only caused temporary problems, so educated there. Have to reduce my insulin for breakfast and lunch. Tea and Basal stays the same for now. Just concerned about the highs, he didn't seem bothered about them at all, just kept going on about the lows. I suggested CGM and he laughed! Said he wouldn't even considerate it with someone as well controlled as me. I'm not well controlled at all, it's just the swings mean my HbA1c is lower. Also asked about the protein and he said "you didn't bring a urine sample." I told him I had and he said nobody had tested it so to get a sample sent away before I return to see him in 4 months. Feel like I'm stuck between a rock and a hard place.
 
Doesn't sound particularly helpful, and I think it's very rude to laugh at the idea of a CGMS - I think it's a perfectly reasonable suggestion if you are having problems, which clearly you are. Also, I don't think that some HCPs realise that it's really difficult to run your levels a bit higher when you have had it drilled into you what the consequences of higher levels are. I also think they miss the point that aiming to have your levels a little bit higher, but still not too high is just as difficult (if not more so) than trying to avoid hypos - it's not like we aim to have hypos is it?

I hope that the adjustments he has suggested work for you, but it seems he didn't accord you proper respect and concern. Just my opinion, of course! 😉
 
OK fine - if you want to, but only if you do (cos he's only giving you advice!) do what he says.

BUT

Test your basal anyway. It's essential for all T1's to do it - if BERTIE can put it in their carb-counting course I see no reason why every hospital in the land don't teach it. If you don't get your basal right you are basing your carb ratios and correction rates on complete guesswork.

Don't worry aiming for 7/7.5 for a couple of months. In that time your hypo warning system will reset itself and you'll know a bit sooner and thereby be able to sort yourself out before the hypo gets too deep.

Have they also checked you for lipo's? - only just thought of that one .....
 
Sorry for being a bit daft, but what do you mean by lipo's? 😱
 
newbs said:
Sorry for being a bit daft, but what do you mean by lipo's? 😱
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I think she means lipohypertrophy, which is when you get fatty lumps at injection sites that can affect insulin absorbtion 🙂
 
Northerner said:
I think she means lipohypertrophy, which is when you get fatty lumps at injection sites that can affect insulin absorbtion 🙂
Click to expand...

Oh right, thanks. I don't think this is a problem, have had with my legs in the past but seem ok at the moment.
 
Hyperlipotrophy.

I have em all over, and you can't see any of them.

Trouble is, insulin injected in em doesn't disperse properly. (ever had that I may just as well be injecting water, feeling?)
 
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