Hi again
@Mbabazi,
You are getting excellent advice from others and I'll try to not add to any possible confusion or contradictions. But 2 comments made by you leap out at me:
The 20 mins before eating is a time period that you should NOT consider to be set in concrete. You can and should "pre-bolus" as many or as few minutes before a meal as is necessary (and sometimes this could be a "post-bolus" of x many minutes). 20 mins is a generic start period - but with trial and learning you will come to find that YOU need an optimum period for YOU to get your insulin to be in the right place in your blood to coincide with the digestion of the food (carbs in particular) that you have eaten and that have arrived in your blood converted into glucose. Your guiding Nurse should be able to look at your results and offer suggestions for adjusting that 20 mins. But if you feel the pre-bolus time needs tweaking YOU should be prepared to take ownership of that adjustment.
There are all sorts of valid and correct explanations for this, which I think could confuse matters by delving into these right now. But just accept that the pre-bolus time can vary from meal to meal - both the type of meal (eg a savoury breakfast of toast and beans (any eggs are carb free) vs a dairy and fruit breakfast will digest very differently and become glucose in your blood at different speeds); and the time of day - many of us find NovoRapid works at a different speed from breakfast to lunch to dinner times so many of us have different pre-bolus times at different times of day. YOU eventually have to start spotting these quite subtle pre- (or post-) bolus timings for your body. You won't learn this instantly!!
If you decide to adjust your pre-bolus times just keep a note of such changes and help your Nurse with that bit of the detective work! Also don't get too stressed about the preciseness of a pre-bolus time period; in practice (in real life) events change and times slip etc, even without the inherent variability of your own metabolism on any one day at different times of the day.
Yes, currently your guidance is to take 4 units with each meal and that is fine. BUT for you and your Nurse to be able to learn anything about how much insulin you actually need for each different meal, you need to help with that detective work and keep the variables in this science experiment on YOUR body to a reasonable minimum. In the near future you will have a much improved sense of carb counting and how much insulin is needed for different breakfasts, different lunches and different evening meals. You are not going to be constrained to identical meals for the rest of your life.
But right now if you can plan for the next week or two to have very similar breakfasts and different but similar repeatable lunches and different again but still repeatable dinners then you will provide yourself and your Nurse with clear data about what works for you and your 4 units and what doesn't work. Then your Nurse can confidently adjust the 4 units for different meal types as well as for any specific meal.
In practice this is often very easy for breakfasts; most of us are creatures of habit and will tend to have very similar breakfasts for months at a time. Likewise lunches can often be simple and repeatable (usually for speed and convenience). It is dinners that can be quite varied, particularly for the bigger carb hitters; eg potatoes, rice or pasta?
Importantly do NOT arbitrarily decide to have a very low or zero carb meal. You are now taking insulin and your body will NEED some carbs, thus glucose, to work with. If you should unluckily choose a standard meal that does give you a significant spike that doesn't recover [Edited to add] then just go with it and discuss with your Nurse an appropriate adjustment.
I don't find a snack just before bed is at all necessary. But I can see that in previous times, when CGM was not readily available to anyone, this might have been sensible advice for early days of insulin and BG management. But it certainly was NOT a "standard" for my first 12 months with no pancreas and only finger pricking.
Actually, from trying to read back into this quite lengthy thread, I can't see if you do yet have any CGM. Could you possibly please clarify that ?
I'll let others explain this, but for the record I've been very close to my current 71kg for the full 4 years since I instantly became insulin dependent; I was 75 kg in the months preceding my diagnosis, a weight I was unhappy with. Right now the important thing is to get you onto a stable Multiple Daily Insulin (MDI) regime and if you need extra snacks .... you need what you need.
Finally we are all different in how we manage food and insulin. No member can tell you definitively what is right or wrong - just offer clues about what has worked for each of us. Nor can your Nurse; he/she will have experience from helping other patients but that experience may not be perfect for you. So there could be moments when you must accept that YOU will need to own YOUR decisions and that will define your moment of Graduation into this illustrious but challenging College!
