Munjeeta
Well-Known Member
- Relationship to Diabetes
- Type 1
I wrote a really long reply already and my computer crashed so here goes take 2? Days 4 and 5, better late than never!
Day 4
Probably the most harrowing of all the days, but also possibly the most useful.
It began as usual with the dissection of all our bg levels over the previous 12 hours on leaving. So useful and got progressively more so across the course of the week as patterns were noticed and changes made. All of us made changes to ratios and most of us made changes to our basal doses too ? mine was reduced from 11 to 10 in the morning and 16 to 14 in the evening although I?m not sure that both don?t need to be lowered slightly more ? now I know what I?m looking for!
First session (the morbid one, so skip if you don?t want to read about diabetic complicatins) was about the annual review, clinics really. What to expect, and what the stuff we?re told actually means. It led onto an in depth discussion about complications ? what they are, how they come about and most importantly the importance of good bg control in preventing them. I won?t go into too much depth, just give you the basics of what I came away with. The whole thing was covered very scientifically and made us all more aware of the impact of bad control, but not in such a way as to scare us. Although it was made very clear that even good control does not guarantee 100% prevention. We discussed retinopathy, neuropathy and nephropathy, the chance of getting all respectively can be reduced by about 70%, 60% and 50% with good control. And moreover, and HbA1c increase from the ideal of 6.5% can lead to a 25% increase in risk of long term complications (certainly made me worry about my 8.0% average over the last year or so, and higher before then). We discussed BP and cholesterol too. No matter how many times I am explained to about what BP actually is I don?t seem to retain the information! Maybe this time? BP is expressed as a larger number over a smaller number. This now makes sense to me! The larger number is the working reading, the smaller number is the resting reading. When the armband is put around your arm, the main artery carrying blood from the heart is squashed. When it is released, the heart beats and pushes the blood through, the force of this is measured as the ?systolic? pressure ? the big number ? and can be heard through a stethoscope as a whoosh. When the whooshing sound has gone, the force of the blood is measured as the ?diastolic? pressure which is understandably less. Ideally the systolic reading should be 135-140 and the diastolic reading around 80-85. Cholesterol also now makes sense: HDLs (High Density Lipoproteins) are good and LDLs (Low Density Lipoproteins) are bad. LDLs build up naturally in blood vessels but the larger the quantity the more they build up. This leads to narrowing of the vessels. Occasionally the surface of the vessel can crack, it then clots which leads to a blockage of the vessel, leading to heart attacks. Kidney damaged is also linked to both cholesterol and BP, as they are so closely linked themselves. High BP increases the amount of protein pushed out into urine by damaged kidneys, this further increases BP which further damages kidneys. Eek. Definitely an incentive to keep the old BP and cholesterol levels down. The emotional effect of diabetes was also discussed ? thank goodness.
This session was quite hard work. We were given an awful lot of information and also lots of corresponding statistics. The overall message though was positive, and it was good to finally feel like I have all the information I may need and to have the chance to ask LOTS of questions. Overall, the doctor basically said to make sure you go to clinics as an active partner. Think about questions to ask and write them down so you don?t forget. Also, something I didn?t know, was that we can ask for a cop of the clinic letter to be sent to us as well as our GPs, something I?ll definitely be doing next time.
Second session was a bit more light hearted ? exercise. Lots of things affect BG where exercise is concerned: injection sites; when last injection was done; overall sensitivity to insulin etc etc. Basic message was, that if doing exercise think of WHY you?re doing it. If to lose weight then try and manage exercise with insulin rather than having to snack to keep levels up ? good advice! In general, short acting insulin should be reduced by 50% and long acting by 30-35% when exercising (strenuously). And we were reminded that exercise can affect bg levels for up to 48 hours because it makes the muscles absorb insulin more quickly and efficiently. You should always test before doing exercise: if <5.5 you should postpone it, have a snack and test 15 mins later. If bg is high due to lack of insulin in your body your muscles will start to burn glucose for energy then run out and ask for more, so your liver will pump out a whole load BUT if there?s not enough insulin to help cells use this glucose your bg levels will rise and when insulin IS taken your muscles will be super sensitive often leading to hypos. Phew! Basically, the advice was to record exercise and effects on bg as well as what you do ? it affects us all differently so only by trying things out do we really understand what?s going on for us. The best time to exercise too is just before a meal. So when you eat your muscles and liver are able to replenish their glucose stores immediately hopefully reducing chance of hypos later on. Now I just need to be brave enough to go and put all of this into practise?
Last session was all about food labels ? really interesting! The dietician was really cynical about GDA?s on packaging, and rightly so by the sounds of things! She said that the average woman needs to consume 1500 calories daily and the average man needs 2000, of which 50% should be obtained from carbohydrates, 35% from fats and 10-15% from proteins. The total carbs is what we need to be looking at to work out insulin doses but the breakdown of carbs into sugars and starch gives us an idea of how quickly the food will be absorbed by our bodies. Low sugar/ high starch will be absorbed more slowly than high sugar/ low starch. If eating something high sugar/ low starch (like sweet and sour) always balance with something lower GI like brown rice to slow absorption.
Day 5
Very brief and basically just a round-up of the week. We discussed our individual blood glucose levels again, and discussed what we would do when we started being a little (!) more active. Although mainly, the point is that we now have the beginnings of the knowledge to make changes ourselves. On Friday itself I felt totally lost, like my safety blanket was being pulled out from under me, but now, a day later, I feel a lot more confident than I though I would to alter things.
We briefly discussed sweeteners and the basic message was to vary them if they are used a lot. Also some are not heat stable so break down at high temperatures.
Lastly we discussed travelling and were told that if there is a time difference of <4 hours not to worry. Insulins abroad often come in different strengths so if getting some make sure you check as you will need matching equipment to ensure you get the right dose. Finally, and most usefully, on average an aeroplane meal has between 30-40 grams of carbohydrate!
So. Overall. The week was brilliant. I have tried to give as much info as I have been able to, but really, the most important and most useful thing about the week is the discussion that arises from the various topics. Meeting other people in the same situation as you is priceless. Watching the same blips that happen to you happen to other people is lovely, especially in such a supportive atmosphere. And for me watching someone else go hypo and seeing yourself mirrored in them is fascinating (the fascination was reciprocated when I too got confused and sweaty!!) I have come away from it feeling like I have a support network, and that I know more than I did before, I have more confidence in myself and feel a bit more positive about it all. It was all very practical and honest which I appreciated more than anything. Role on the 6 week meet-up!
Day 4
Probably the most harrowing of all the days, but also possibly the most useful.
It began as usual with the dissection of all our bg levels over the previous 12 hours on leaving. So useful and got progressively more so across the course of the week as patterns were noticed and changes made. All of us made changes to ratios and most of us made changes to our basal doses too ? mine was reduced from 11 to 10 in the morning and 16 to 14 in the evening although I?m not sure that both don?t need to be lowered slightly more ? now I know what I?m looking for!
First session (the morbid one, so skip if you don?t want to read about diabetic complicatins) was about the annual review, clinics really. What to expect, and what the stuff we?re told actually means. It led onto an in depth discussion about complications ? what they are, how they come about and most importantly the importance of good bg control in preventing them. I won?t go into too much depth, just give you the basics of what I came away with. The whole thing was covered very scientifically and made us all more aware of the impact of bad control, but not in such a way as to scare us. Although it was made very clear that even good control does not guarantee 100% prevention. We discussed retinopathy, neuropathy and nephropathy, the chance of getting all respectively can be reduced by about 70%, 60% and 50% with good control. And moreover, and HbA1c increase from the ideal of 6.5% can lead to a 25% increase in risk of long term complications (certainly made me worry about my 8.0% average over the last year or so, and higher before then). We discussed BP and cholesterol too. No matter how many times I am explained to about what BP actually is I don?t seem to retain the information! Maybe this time? BP is expressed as a larger number over a smaller number. This now makes sense to me! The larger number is the working reading, the smaller number is the resting reading. When the armband is put around your arm, the main artery carrying blood from the heart is squashed. When it is released, the heart beats and pushes the blood through, the force of this is measured as the ?systolic? pressure ? the big number ? and can be heard through a stethoscope as a whoosh. When the whooshing sound has gone, the force of the blood is measured as the ?diastolic? pressure which is understandably less. Ideally the systolic reading should be 135-140 and the diastolic reading around 80-85. Cholesterol also now makes sense: HDLs (High Density Lipoproteins) are good and LDLs (Low Density Lipoproteins) are bad. LDLs build up naturally in blood vessels but the larger the quantity the more they build up. This leads to narrowing of the vessels. Occasionally the surface of the vessel can crack, it then clots which leads to a blockage of the vessel, leading to heart attacks. Kidney damaged is also linked to both cholesterol and BP, as they are so closely linked themselves. High BP increases the amount of protein pushed out into urine by damaged kidneys, this further increases BP which further damages kidneys. Eek. Definitely an incentive to keep the old BP and cholesterol levels down. The emotional effect of diabetes was also discussed ? thank goodness.
This session was quite hard work. We were given an awful lot of information and also lots of corresponding statistics. The overall message though was positive, and it was good to finally feel like I have all the information I may need and to have the chance to ask LOTS of questions. Overall, the doctor basically said to make sure you go to clinics as an active partner. Think about questions to ask and write them down so you don?t forget. Also, something I didn?t know, was that we can ask for a cop of the clinic letter to be sent to us as well as our GPs, something I?ll definitely be doing next time.
Second session was a bit more light hearted ? exercise. Lots of things affect BG where exercise is concerned: injection sites; when last injection was done; overall sensitivity to insulin etc etc. Basic message was, that if doing exercise think of WHY you?re doing it. If to lose weight then try and manage exercise with insulin rather than having to snack to keep levels up ? good advice! In general, short acting insulin should be reduced by 50% and long acting by 30-35% when exercising (strenuously). And we were reminded that exercise can affect bg levels for up to 48 hours because it makes the muscles absorb insulin more quickly and efficiently. You should always test before doing exercise: if <5.5 you should postpone it, have a snack and test 15 mins later. If bg is high due to lack of insulin in your body your muscles will start to burn glucose for energy then run out and ask for more, so your liver will pump out a whole load BUT if there?s not enough insulin to help cells use this glucose your bg levels will rise and when insulin IS taken your muscles will be super sensitive often leading to hypos. Phew! Basically, the advice was to record exercise and effects on bg as well as what you do ? it affects us all differently so only by trying things out do we really understand what?s going on for us. The best time to exercise too is just before a meal. So when you eat your muscles and liver are able to replenish their glucose stores immediately hopefully reducing chance of hypos later on. Now I just need to be brave enough to go and put all of this into practise?
Last session was all about food labels ? really interesting! The dietician was really cynical about GDA?s on packaging, and rightly so by the sounds of things! She said that the average woman needs to consume 1500 calories daily and the average man needs 2000, of which 50% should be obtained from carbohydrates, 35% from fats and 10-15% from proteins. The total carbs is what we need to be looking at to work out insulin doses but the breakdown of carbs into sugars and starch gives us an idea of how quickly the food will be absorbed by our bodies. Low sugar/ high starch will be absorbed more slowly than high sugar/ low starch. If eating something high sugar/ low starch (like sweet and sour) always balance with something lower GI like brown rice to slow absorption.
Day 5
Very brief and basically just a round-up of the week. We discussed our individual blood glucose levels again, and discussed what we would do when we started being a little (!) more active. Although mainly, the point is that we now have the beginnings of the knowledge to make changes ourselves. On Friday itself I felt totally lost, like my safety blanket was being pulled out from under me, but now, a day later, I feel a lot more confident than I though I would to alter things.
We briefly discussed sweeteners and the basic message was to vary them if they are used a lot. Also some are not heat stable so break down at high temperatures.
Lastly we discussed travelling and were told that if there is a time difference of <4 hours not to worry. Insulins abroad often come in different strengths so if getting some make sure you check as you will need matching equipment to ensure you get the right dose. Finally, and most usefully, on average an aeroplane meal has between 30-40 grams of carbohydrate!
So. Overall. The week was brilliant. I have tried to give as much info as I have been able to, but really, the most important and most useful thing about the week is the discussion that arises from the various topics. Meeting other people in the same situation as you is priceless. Watching the same blips that happen to you happen to other people is lovely, especially in such a supportive atmosphere. And for me watching someone else go hypo and seeing yourself mirrored in them is fascinating (the fascination was reciprocated when I too got confused and sweaty!!) I have come away from it feeling like I have a support network, and that I know more than I did before, I have more confidence in myself and feel a bit more positive about it all. It was all very practical and honest which I appreciated more than anything. Role on the 6 week meet-up!
