basal bolus ruling my life !! should it be ??

[uselesspancreas]

surely its not supposed to be like this
ive been diabetic for 20 yrs but changed to basal regime in september now i feel like it rules my life.
i wake for breakfast and cant eat it til ive carb counted it and blood tested ( some mornings its low so have pre brekkie of jelly babies as machine wont tell me what to inject till im above 4.
then i have to make sure ive got a snack with me mid morning
dinner is a bind before sept i used to sometimes miss this now im starving and want to eat so have to remember carry sandwiches everywhere as i cant carb count anything unless its packaged.
and by teatime im hungry same procedure as breakfast.
then cant got to bed early as i have to stay up till the same time to take my long acting.
this week i went out christmas shopping 😡 and got home too late for my lunch as i was having to have an early tea so went hungry.
and as this will be my first christmas im already fed up loking at the carbs of things im going to have to rule out.
am i getting my knickers in a twist over nothing or am i doing something wrong ??

 

[Robster65]

HI

What regime were you on before ?

WHen you say basal bolus, is it 4 injections a day (MDI) and what insulins ?

You shouldn't need to snack in between meals. It means you're either over-injecting or your basal is too high.

Once you have a good idea of the carbs in food, you should be able to just work out your dose and inject for it. It's easier than other regimes.

And surely you needed to work out carbs of meals before ? You still needed to match carbs to insulin for the previous 20 years ?

Rob

 

[uselesspancreas]

reply

HI
yes its four injections a day novarapid and levemir.
before Sept i used novomix twice a day then i ate regular-ish and just got on with it i was never shown carb counting just told to make sure every meal contained bread rice pasta or potatoes ( things have changed a lot in 20 yrs).
i certainly wasn't constantly thinking about food and clock watching this i hate the most
when i saw the dietitian she also said there was no need to snack! but im starving and always was a grazer before this. only good point is Ive lost a stone ( i wasn't overweight for my height)

the only foods i know without checking are bread per slice/eggs everything else i have to check as i cant remember and then doubt myself all of which i find an inconvenience.
Ive carb counted for a meal then not wanted to finish it ive had to eat it whether i want to as ive injected for it. also when eating a packed lunch i have to decide before i eat anything exactly what im going to eat - its taking over !!

What regime were you on before ?

WHen you say basal bolus, is it 4 injections a day (MDI) and what insulins ?

You shouldn't need to snack in between meals. It means you're either over-injecting or your basal is too high.

Once you have a good idea of the carbs in food, you should be able to just work out your dose and inject for it. It's easier than other regimes.

And surely you needed to work out carbs of meals before ? You still needed to match carbs to insulin for the previous 20 years ?

Rob

confused yeah me too

 

[Marc]

Eating out shouldn't be a problem you just have to know the carb counts and in someways eating out is easier as they normally will give you the same amount each meal. Infact some places already have the values places like Eat, McDonalds and KFC have the carb counts for most of their meals at the stores. McDonalds and KFC have the figures on the back of the tray mats. Infact McDonalds had it all worked out when I was diagnosed back in 89 and had little cards. A lot of other places have the figures on their websites. Some smartphone apps have the carbs too. Iphone has Carbs & Cals and also a good one called Track 3 which has most UK major restaurants in it.

With the insulin you have at the same time each day it doesn't have to be late at night I do have it at 11pm but that works for me. Speak to your DSN about moving your long acting insulin plus most people have an hours grace around when they inject it. So I can inject just after 10pm till 12am and be fine. But speak to your DSN about changing the time. Compared to two injections a day of mixtard which I did from 89 to 2008 to MDI I would never go back. The only place I will change to now is a pump.

Marc

Marc

 

[uselesspancreas]

eating out is a problem for me as i haven't got a clue unless i read a packet and have a calculator handy.
add to that im vegetarian with a dairy allergy.
mcdonalds doesn't ever feel like a meal im always hungry after one. i feel like every meal has to count as i cant eat anything else till the next mealtime. boring and regimental.
i can see how this would work for a meat eater as meat has no carbs but as a veggie its hateful to be hungry and want something you cant have I used to love banana sandwiches but my blood sugars rocket after one now so i dont bother.
my fall back is toast and that's getting boring.

(having a bad day 😡)

 

[trophywench]

Hiya U-P !!

Imagine how much worse it must be to be put onto MDI and told NOT to carb count under any circumstances, although one had already been doing just that since 1972 - which is exactly what me and a lot of people were told - by the so-called DSN at our Diabetic Clinic at a large teaching Hospital in the West Midlands, as recently as 14 years ago.

Anyway not to worry now, water under the bridge .....

Soooooooooooo - what actual training have you had in carb-counting? Should be a week-long course, either all at once or one day a week for 4 or 5 weeks. (Either DAFNE, BERTIE or one of the courses based on the same principles.)

What aids have you been furnished with?
- I'm thinking eg lists of stuff; playing with plastic/real food and 'guessing the carb count'; the Collins Gem CALORIE Counter book, a newer production with full colour pics called 'Carbs and Cals' which enables you to 'eyeball' meals if you aren't au fait with the process.

What checks were made by your team to ensure that you fully understood all the principles of Dose Adjustment and were competent before they abandoned you to your own tender self-care?

Like all things D - it can do your head in to begin with and that's a fact - but honest - you do get used to it and life as you know it, does resume!

If you haven't actually been offered such a course, then fear not as there is an Online one you can have a go at which we can certainly point you at - if you are prepared to spend the time to do it and want to learn?

 

[trophywench]

PS are you veggie or vegan? ie do you eat eggs or fish or cheese? - all protein, not just meat!

If you need to snack or eat when it isn't a 'mealtime' then as long as you 'shoot' for it you can, but need to take care as too much insulin floating about is likely to lead to weight gain anyway and you do have to be careful with 'dose stacking' so it's best to try and avoid snacks whilst you are getting to grips with the carb-counting lark - but not necessarily 'For Ever'. Unless you want to!

 

[ypauly]

Your long acting insulin shouldn't be a problem re: set time if it's a problem of an evening take it of a morning or some other time that isn't a problem, or with advice of your DSN you could even split it to half before bed and half when you awake.

As for the taking over your life. I think we have all had that feeling at some point but it does get easier with experience, practice and training.

 

[ypauly]

PS are you veggie or vegan? ie do you eat eggs or fish or cheese? - all protein, not just meat!

If you need to snack or eat when it isn't a 'mealtime' then as long as you 'shoot' for it you can, but need to take care as too much insulin floating about is likely to lead to weight gain anyway and you do have to be careful with 'dose stacking' so it's best to try and avoid snacks whilst you are getting to grips with the carb-counting lark - but not necessarily 'For Ever'. Unless you want to!

What's this dose stacking you speak of? Is this something I should know?

Actually I have heard it quite a few times on here just never thoguth to ask.

 

[FM001]

What's this dose stacking you speak of? Is this something I should know?

Actually I have heard it quite a few times on here just never thoguth to ask.

Dose stacking or stacking insulin is when you inject multiple doses in a very short space of time. Insulin like novorapid has an insulin profile of up to 5 hours so basically could still be active to this point, injecting 2 or 3 hours after the previous dose means you stacking insulin up before the previous dose has been exhausted - more often than enough this can lead to unexplained hypo's.

 

[FM001]

surely its not supposed to be like this
ive been diabetic for 20 yrs but changed to basal regime in september now i feel like it rules my life.
i wake for breakfast and cant eat it til ive carb counted it and blood tested ( some mornings its low so have pre brekkie of jelly babies as machine wont tell me what to inject till im above 4.
then i have to make sure ive got a snack with me mid morning
dinner is a bind before sept i used to sometimes miss this now im starving and want to eat so have to remember carry sandwiches everywhere as i cant carb count anything unless its packaged.
and by teatime im hungry same procedure as breakfast.
then cant got to bed early as i have to stay up till the same time to take my long acting.
this week i went out christmas shopping 😡 and got home too late for my lunch as i was having to have an early tea so went hungry.
and as this will be my first christmas im already fed up loking at the carbs of things im going to have to rule out.
am i getting my knickers in a twist over nothing or am i doing something wrong ??

Unless I'm mistaken you are talking about MDI here, if so then there is no reason why you need to snack between meals unless you choose so or are running low. Same with mealtimes, you can miss lunch out or delay the time you eat to suit yourself. The basal dose doesn't need to be taken at a set time each day and provided it's within an hour of your usual time then it shouldn't be a problem.

3 months on basal bolus isn't long enough and it does take time to get use to carb counting so don't despair.

 

[Copepod]

Uselesspancreas - when you changed to MDI (presumably from bimodal - two injections per day) did you get any help in setting basal dose? Perhaps that needs lowering, as you're waking up too low - or perhaps splitting basal dose into two injections would help to prevent a peak in the wee small hours.

Regarding eating foods without labels - while it's not as accurate as weighing, a slice of the same size of bread is basically the same carb content, so if there's a platter of sandwiches on offer, I just count up number of slices of bread and assume each one contains approx 10g carbohydrate; for fruit, I only count bananas at approx 25g each, cakes and biscuits can also be estimated if I want to eat one. For me, pub meals are so rare (first one since the summer tomorrow, in fact) that estimating carb content of potato / pastry / bread etc is acceptable. If I ate out more often, I might carry a carb counting book. I have worked on estimating weights of food at home, by estimating by sight, then weighing to check, so that I can estimate by sight reasonably well when out.

Anyway, 3 months is only the beginning - worth going back to whoever changed your regime for more advice.

 

[everydayupsanddowns]

I just count up number of slices of bread and assume each one contains approx 10g carbohydrate

I'd say nearer 15g per 'medium' slice. 20g if it's thick But a sarnie with 2 slices is almost always gonna be around 30-40g.

As you say, fruit (apples/pears/bananas etc) usually 15-20g each

Also the old chestnut of 'hen's egg' sized potato = 10g (then guestimate from there).

Uselesspancreas

Hi and welcome to the forums. Sorry you are having a rough time in the early days of basal:bolus. But stick with it. Once you have got used to it it's a much more subtle and flexible way of dosing insulin for meals. As others have said some of the problems you are experiencing would appear to be down to teething troubles with your initially-suggested doses. I expect these might have been estimated using one of those rules of thumb (500 rule/100 rule etc) which may not apply exactly in your case. If you find you *have* to snack between meals of you go hypo then either your meal dose is wrong, or your basal is too high. Try missing a meal completely and testing in between to see if you still drop. If your BGs move more than 1-2mmol/L up or down between meals and your last rapid-acting was more than 4-5 hours ago then that suggests your basal dose is out.

If you don't get on with taking your basal late at night you can move that earlier in the evening, or even take it in the morning. As has been suggested you can also split this dose into two injections 12-hours apart which can help cope with some people's varying 'background' needs better, but that's probably something for another thread.

Hope you stick with it and work through these tricky first few weeks. Most of the problems you mention were solved (not created) for me by moving to basal:bolus. Give it time and keep at it.

Not sure why it was suggested you change? Was your Dr/clinic concerned about recent/historic HbA1c results or something?

 

[Natalie123]

Hi and welcome. I'm glad I have found someone else who finds carb counting a pain in the bum! Although I find it time consuming and annoying it has helped my sugar levels to be more constant so it is worth it in my opinion.

Perhaps you should invest in a carbs and cals book. It has pictures of different foods on a plate in different portions so you can just look at the pictures, compare to your own meal and it will give you the carb content. Very easy. Here is a link to the book:

http://www.amazon.co.uk/Carbs-Cals-...3052/ref=sr_1_1?ie=UTF8&qid=1323260576&sr=8-1

Other things that have helped me is to make a list of meals I have on a regular basis like sandwiches, jacket potatoes, eggs on toast etc so that I don't have to work it out every time. Also, you don't need to be too accurate, to the nearest 5 or 10g is fine. Also don't count vegetables (except sweetcorn and tinned tomatoes), dairy, protein .. just potatoes, bread, pasta, rice etc

You mention being hungry quite a lot. Is this only since starting basal-bolus? If so it is a sign that your insulin is lasting longer than your food - this is also suggested by your need to snack. Eating slower release foods (low GI) will help, brown bread, wholemeal pasta and plently of protein and vegetables with a meal has been really important to me. For example I swapped cereal for seeded toast, eggs, mushrooms and tomatoes for breakfast, sandwiches, fruit and crisps for lunch to salad, crusty bread, cheese and natural yogurt with berries and seeds.

 

[imtrying]

Hi and welcome. I'm glad I have found someone else who finds carb counting a pain in the bum! Although I find it time consuming and annoying it has helped my sugar levels to be more constant so it is worth it in my opinion.

Perhaps you should invest in a carbs and cals book. It has pictures of different foods on a plate in different portions so you can just look at the pictures, compare to your own meal and it will give you the carb content. Very easy. Here is a link to the book:

http://www.amazon.co.uk/Carbs-Cals-...3052/ref=sr_1_1?ie=UTF8&qid=1323260576&sr=8-1

Other things that have helped me is to make a list of meals I have on a regular basis like sandwiches, jacket potatoes, eggs on toast etc so that I don't have to work it out every time. Also, you don't need to be too accurate, to the nearest 5 or 10g is fine. Also don't count vegetables (except sweetcorn and tinned tomatoes), dairy, protein .. just potatoes, bread, pasta, rice etc

You mention being hungry quite a lot. Is this only since starting basal-bolus? If so it is a sign that your insulin is lasting longer than your food - this is also suggested by your need to snack. Eating slower release foods (low GI) will help, brown bread, wholemeal pasta and plently of protein and vegetables with a meal has been really important to me. For example I swapped cereal for seeded toast, eggs, mushrooms and tomatoes for breakfast, sandwiches, fruit and crisps for lunch to salad, crusty bread, cheese and natural yogurt with berries and seeds.

Natalie, I totally agree with you. I find it a pain, and for a while I felt like my whole world revolved around it and that I didn't have time for anything else. I also experienced those feelings you are having U-P - that you eat because you've injected, even though you may not feel like it, but now I carb count before I eat, eat and then inject when I've finished so I can make adjustments if needed. I tend to snack on nuts inbetween meals if I need to so I don't need to inject, and then just test, carb count, eat and inject at meals. It is a pain, but like Natalie said, it's totally worth it. My HBA1c is now down to 7.4% (it was 9.8% before I started taking care of myself). So please stick at it.

Maybe just try carb counting at one meal per day, and then see how you get on....shouldn't then feel like such a big ordeal. And then build it up.

Good luck, and please use everyone on here if you're struggling 🙂

 

[uselesspancreas]

Natalie, I totally agree with you. I find it a pain, and for a while I felt like my whole world revolved around it and that I didn't have time for anything else. I also experienced those feelings you are having U-P - that you eat because you've injected, even though you may not feel like it, but now I carb count before I eat, eat and then inject when I've finished so I can make adjustments if needed. I tend to snack on nuts in between meals if I need to so I don't need to inject, and then just test, carb count, eat and inject at meals. It is a pain, but like Natalie said, it's totally worth it. My HBA1c is now down to 7.4% (it was 9.8% before I started taking care of myself). So please stick at it.

Maybe just try carb counting at one meal per day, and then see how you get on....shouldn't then feel like such a big ordeal. And then build it up.

Good luck, and please use everyone on here if you're struggling 🙂

Thank you Natalie !!! im glad its not just me that finds this a pain in the bum.
thank you everyone for your suggestion etc.
whats MDI ?

i haven't been on a course there's one scheduled for January and i know i have to go so i can exist/live but quite frankly talking about this makes me sooo bloody angry and so far ive had one meeting with a dietitian who just questioned the fact i wanted to snack !! i used to enjoy food now i hate it !!
. (i felt like this 20 yrs ago when i hated the world for making me diabetic ! and i know that's absolutely ridiculous!)

I find if im late with a meal depending on my activity i either go low or high. I dont have the confidence to guess anything as ive already made a mistake and that was just adding up what a packet said.

I definitely dont want to break up the long acting jab id probably forget it or jab the wrong one. also i work evening twice a week so it fits in fine for those days.

when i said about having to eat when i didn't want to here's the example.
homemade veggie sausage casserole ( pots beans etc) i carb counted for the whole pot injected for it and started to eat but my eyes were bigger than my belly so i struggled to finish it but i had to as id injected for it - hope that makes sense now.
ive turned down the Christmas do as it was a 5 course meal and the thought of it scared me. I feel a freak especially when it was suggested i ring up and ask the chef about carbs.
ive got the carbs and cals book but i dont trust my guesswork and flicking through the book i get gradulally more frustrated and angry.
i blood test with the aviva expert and its a godsend as it adjusts dosage and tells me what to jab.
i think for the last 20 years ive winged it and somehow got away with it but at least i felt like i was living a life now its my life ruled by food, carbs, eating and jabbing.
gone are the days when i could pop in the chippy on the way home and as for a take away - clueless !!!!
I said yesterday was a bad day !!! lol

 

[Robster65]

Hi again.

It sounds as if you've been in denial for 20 years and are now trying to come to terms with what you've got.

Sadly, whatever insulin regime you're on, you need to eat the right amount at the right time to match insulin. The joy of basal/bolus is that you choose when you eat/inject and how much. It does have limitations btu the mixed insulin regime is meant to have set mealtimes, qantities of carbs and you shouldn't skip meals or snack. I'm amazed you got away with it for so long.

Did you test your BG very often ?

On a more positive note, once you feel a bit more confident about carb counting, which will come with practice, you can work out your doses a bit more accurately and stop the swinging of BGs.🙂

It is a far better and more flexible system than mixed.

Rob

 

[everydayupsanddowns]

Hi again UP

Do you know what sort of levels you were getting before you changed to MDI (multiple daily injections)? Without the ability to increase the dose for the meal there's no way I could have coped with a takeaway, but while it's not something we do all the time , we can hit the chippy without it causing complete BG havoc. On mixed insulin I could only have meals of identical carb counts (and had to count them). I've not just been able to eat without counting since diagnosis!

 

[Robster65]

Forgot to add. MDI is multiple daily injections which is commonly 4 or more a day, such as you're on now.

The idea is that the twice a day mixed jabs give insulin peaks at fixed times so you have to eat a fixed amount of carbs to match. No variation.
Although you obviously were able to get away with lees or none somehow without going hypo.

On MDI basal/bolus, your basal is there at a low level 24 hours a day to cover the glucose output from your liver and the bolus can be given at any time to suit when you eat and the amount is calculated (by your expert meter) as a ratio. SO if you eat 60g of carbs and you have a ratio of 10g carbs to 1u on insulin, you'll inject 6u. If your BG is high pre meal, you can add a unit or two to correct it so it will be within range before the next meal, etc.

Hence why MDI is more flexible and preferred by most. The only regime better is a pump, which requires more work and confident carb counting and is not easy to get for most.🙂

Rob

 

[uselesspancreas]

Hi again.

It sounds as if you've been in denial for 20 years and are now trying to come to terms with what you've got.

Sadly, whatever insulin regime you're on, you need to eat the right amount at the right time to match insulin. The joy of basal/bolus is that you choose when you eat/inject and how much. It does have limitations but the mixed insulin regime is meant to have set mealtimes, qantities of carbs and you shouldn't skip meals or snack. I'm amazed you got away with it for so long.

Did you test your BG very often ?

On a more positive note, once you feel a bit more confident about carb counting, which will come with practice, you can work out your doses a bit more accurately and stop the swinging of BGs.🙂

It is a far better and more flexible system than mixed.

Rob

see that's what this regime was sold to me as 'flexible' and it certainly doesn't feel like it. I always have my long acting at 11.30pm but i decided to go to bed so had it early 10pm but had the same snack as always before bed but woke up in the night hypo. maybe there was a connection maybe there wasn't.

on the mixed i had lows in a regular pattern mid morning usually and yes i had highs too.
i had never ever been told anything about carb counting when diagnosed ! and before if i didn't fancy lunch i didn't bother now i have to clock watch for lunch depending when im having my evening meal. im attempting not to inject for meals too close together if you know what i mean.

I used to enjoy food now i wont eat anything unless i know the carbs for it. and its soo restricting. I think your probably right about the denial but now i feel im going to life the rest of my miserable no chocolate/no nice things life in my diabetes straight-jacket.
I think im boring myself now about all this ( and everyone else too) and doubt il feel any better unless my pancreas suddenly starts working again - as if !!!
i hope to feel better after the course in January but ive still got Christmas to go through which im completely dreading
OMG a mince pie is the equivalent of 4 1/2 piecess of bread. pointless carbs id feel better with toast.