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

[trophywench]

A deep mince pie is approx 40g of carbs according to Tesco's packet. One slice of medium sliced white Warburton's bread again according to the packet, is give or take 18g of carbs. Thus a mince pie roughly = a sandwich. 2 slices of bread. Not 4 1/2 slices! Or did you mean, 4 x half a slice?

Know what you mean with having to eat the lot because you'd injected, but how about this idea as a temporary fix? - work out the carbs, eat your meal, dock off the approx value of the carbs you did not eat (if any) - and inject? - it's not perfect, you are better injecting before, but it would prevent you having to eat what you don't want to.

I went through a phase when I was otherwise ill and never knew if I'd finish my meal or have to give up at some point, and that's what I had to do.

 

[Robster65]

I also used to often inject after or during a meal so it can be done. As said, not perfect but you can adjust things pretty finely once you know what you're doing.

It seems you're unfairly comparing your current situation to the past 20 years of not really living as a T1. If you'd been following the regime as it is meant to be, you'd be able to see the difference.

We all go through phases of anger and depression with diabetes, but at some point it has to be accepted that it's keeping us alive and without insulin and carb counting we'd soon whither away and die.

Don't give up on it. Perservere, keep posting and asking questions and we'll happily tell you what you need to know to make life pretty much normal. But acceptance is your biggest hurdle.🙂

Rob

 

[Northerner]

Isn't it strange, your thoughts on basal/bolus are completely different to mine! True, I've never known anything different, and I think this is part of the problem that you have with it - you have become so used to your routine and way of doing things that this all seems so alien to you now and you're having to think about things you had got used to just 'knowing' through experience before.

I like to space my meals around 5 hours apart, but there's quite a lot of flexibility with timing. If I want to eat 4 hours after my last meal then I do, I just include a slight adjustment to account for my blood sugar at the time, which I know from experience would go a little lower due to me having the tail-end of the previous meal's bolus still active. If I want to skip a meal, I do, I just don't need to inject. Surely on mixed insulin you HAD to eat whether you wanted to or not, and at certain times due to the peak of the fast-acting element of the mixed insulin, otherwise you would go low?

I can inject my lantus at night two hours either side of the previous night with no problems. If you are hypoing then the chances are your dose needs decreasing.

Regular meals become easy to inject for - I gave up carb-counting most of my meals a long time ago because I know what dose I require for them through experience. Perhaps you should think of yourself like a newly-diagnosed person and stop comparing how things are now to how you used to do things - might help you to embrace the new way of doing things! 🙂

 

[shiv]

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'm sat here eating a Lindt chocolate bunny. I promise you, when MDI is used properly, there is pretty much nothing you 'can't' eat. You need to take the appropriate amount of insulin for the carbs you eat. What are you finding restricting? If you want to skip a meal, because you won't take fast acting insulin, you can skip a meal. If you want to eat extra portions, then go ahead!

If you are worried about carb counting, which it sounds like you are, use the Carbs and Cals book to help you. You mentioned you have it, so shove it in your handbag and pull it out when you're out and about. The carb counting course you mentioned you're going on in January will really help you too. You say you won't eat anything unless you know the carbs for it - my advice is to get out and learn the carbs 🙂 another useful little book is the Collins Gem Carb counting book, it's tiny and has loads of food in there. The more you experiment, the more you will learn about food. Don't be frightened by it 🙂 remember, as well as the amount of carbs being important, the GI of the food is important too - for example, white bread has a high GI and for most people will spike their BG up, so you'd need to take insulin ASAP for it. Pizza on the other hand, as an example, for most people is very slow releasing, so slow that some people split their injection so they take some at the time of the meal and some a couple of hours later to try and match the insulin to the release of carbs. Otherwise, if they took all the insulin in one go, they might end up hypo quite quickly and high later on.

Lantus has a 1 hour 'window', so if you go to bed a bit earlier than usual, you should - in theory - be fine to take it an hour before (or after) normal.

Where are you based?

 

[Copepod]

Great advice from Shiv regarding chocolate rabbits etc 🙂

As another example of what can be got away with on MDI - this morning, I ate my breakfast (with covering insulin reduced a bit because of planned exercise in hour after injections), then cycled a mile and did 30mins of physical care work, then cycled another 1 mile to Post Office, then another mile to supermarket, then cyled mile home and had a cup of tea and packet of crisps (with insulin) while dealing with post and reading papers for work tomorrow, then came to computer to check emails, here etc. I have midday meal when I feel like I need a break from computer / reading. Tonight is running group Christmas meal at pub, so I'm cycling a mile to a friend's house for a lift, then not running because of knee injury (4.5 months ago), then getting lift back, then cycling to bedtime carework, then home again. No idea how I could contemplate that on bimodal insulin!

 

[MeanMom]

Hi U P

IMO it's a disgrace that you have been left to cope with an insulin regime that you clearly not comfortable with. The MDI regime that you now have is very flexible which is why many many children use it, with all the random lives that children lead. Yes, carb counting is very scary at first but it is not vital to be exact and if in doubt assume less carbs rather than more would be the best way whilst you are learning. With a child they eat at different times and different things, my daughter nearly always skips breakfast on a weekend often has her long acting late, injects after a meal (kids do this a lot) has a small snack and doesn't inject at all (less than 15 carbs ) or has a large snack (Choc bar yesterday) and injects for it having guessed the carbs or found on the packet or in a book. Childrens lives can be really random so they wouldn't be put on MDI if it wasn't suitable and flexible. It really is 🙂

Please keep coming on here and asking questions, it's how most of us pick things up. And keep with it it will be worth it in the end (very soon).

And have a mince pie- k had two yesterday😱

 

[Pigeon]

Hi UP, glad you have found this forum and are asking questions - there are bound to be other people in the same boat as you.

Just a quick thought about your sausage casserole and not being able to eat all of it, one thing you could do is drink something like orange juice to make up for the carbs you didn't eat. E.g. if the meal was 100g carbs and you injected 10U for this, then only ate half, you could have 500ml orange juice to make up the other 50g carbs. Easier than stuffing down food you don't want!

Try to stick with it, it will all be so worth it in the end. i remember the frustrating confusing days too, but I'd never go back to mixed insulins now.

 

[uselesspancreas]

Hi UP, glad you have found this forum and are asking questions - there are bound to be other people in the same boat as you.

Just a quick thought about your sausage casserole and not being able to eat all of it, one thing you could do is drink something like orange juice to make up for the carbs you didn't eat. E.g. if the meal was 100g carbs and you injected 10U for this, then only ate half, you could have 500ml orange juice to make up the other 50g carbs. Easier than stuffing down food you don't want!

Try to stick with it, it will all be so worth it in the end. i remember the frustrating confusing days too, but I'd never go back to mixed insulins now.

thanks for the tip with the orange juice !!!!
definitely frustrating and confusing.
i dont have much choice but to stick to it but right now i hate it ! ( it can only get better lol)

if i snack i make it a special k bar or similar this i dont inject for but surely if i have mince pie(s) id have to inject for them so my question is . . .
what if its mid morning mid afternoon or in other-words fairly close to a meal wont the extra dose of insulin mess everything up as im under the impression it work for around 3 hours ??
trying to space meals out evenly is the struggle at the moment.

at work tonight there was a tin of chocs i thought to hell with it I WANT ONE !! (actually i had 4)😱😱 this is my first arrh moment since September Christ knows how Christmas will be.
wouldnt it just be nice to eat something before analysing it ??

i dont know anyone else on this regime except for you guys on here so thank you for your tips and help. 🙂

 

[shiv]

Hi UP,

Re: having injections between each meal. The insulin you take - novorapid I presume? - is there to cover carbs you eat. So taking an extra injection to cover your carbs should be fine. I do it all the time (I am on a pump, and a grazer by nature). You are right that it lasts for 3 or 4 hours, but if you are eating extra carbs, you need extra insulin to help process the glucose in that food. It is worth keeping a track of it to stop it 'stacking' up and causing a low later on (mainly when the peaks of both injections collide) but to be perfectly honest - and this isn't advice, just experience! - I tend to find that only happens either with a couple of large injections, or with lots of injections close together.

If I had 4 chocolates from a tin I'd probably need a unit or so to make sure I didn't end up higher later on. It *is* frustrating having to carb count everything, I totally agree, and it's why I have a weird relationship with food - but I know the consequences of not carb counting and thus not having decent control, so I'd much rather carb count!

As Pigeon says, if you inject for X amount of carbs, it doesn't really matter what form those carbs take (casserole or juice or cake or biscuits or whatever!) as long as you eat enough to cover the insulin.

Hope that helps 🙂

 

[trophywench]

Kind-of, BUT !!!

If in doubt - under-estimate. So you test, and your BG is 6.0. So if a Special K Chocolate bar is 17.5g of carb and if your ratio is 1u to 10g of Carb - you take 1u. Because the bit of bar left over from the insulin, which will raise my BG to about 8.0, isn't enough to send me into DKA and kill me.

If before you ate the bar, your BG was 8.0 then I'd have 2u with it, because the bit of extra insulin left over from the bar, will only reduce my BG to about 7.0 and wouldn't be enough to send me hypo.

Let's be 100% clear about this - I know that :-

10g fast-acting carb increases my BG by 3.0 mmol/L (ish)
1u fast-acting insulin reduces my BG by 3.0 mmol/L (ish)

and it is necessary to know both these values for you specifically, before you start being gung-ho about doing stuff like this.

Once you've done DAFNE and have all this nailed down - then there are 2 meters you can use which you program with all your values and correction rates/factors, and they will give bolus advice taking into account any 'Insulin on Board'. (The Accu-Chek Expert and the Insulinx) Both of these are only available via DSN's because they are expensive and need you to be a bit of an expert first in order to program em right, before you can get the best out of them. The former is in fact, used with the Roche pumps as the bolus wizard instead of that being built-in to the pump itself.

Finally the Good News is that only 2 days of the year are virtually carb-free. One is 25th December and the other is your birthday! Remember - alcohol actually reduces our BG, so you may be able to get away with snacking more over Xmas than at any other time of year - but not in excess - a drunken stupor looks very much like a severe hypo and vice-versa, so enjoy yourself - but just don't go too berserk! 😉