Dr Katharine Morrison

[PattiEvans]

I'd just like to add that the information I posted came from Dr Katharine Morrison who is a co-author of dsolve.com a GP and prominent mover and groover diabetic wise in the formulation of guidelines for Scotland. Katharine has been a member of forums for a while and a very informative person. Her son is T1 which led her to specialise.

 

[Ellie Jones]

The Scottish guide lines I should imagine would work the same as the UK Guidelines have a mixture of people from consultants to laypeople...

Just checked and she still listed with her GP practice in Scotland! As part of her array of letters MD etc she's an Homoeopathy qualified doctor... which is were her interest lay before her son's diagnoses..

She's an advocate for extreme low carbing as you can see from her website, her aim is to turn extreme low carbing into main stream standard dietary advise for all diabetics in Scotland at least... She's had at least one Article published in a medical journal but not one of the top main ones though.. Shall try to find a link to it.

Her son must be around 20 now, as it's quite a while since I've know her via forums.. He didn't follow an extreme Bernstein 30g carb diet, but was very moderately low and a extreme testing and injecting regime I do wonder if he still follows the practices his mum taught him!

Personally I don't like medical professionals pushing an Extreme low carb diet as standard practice for any diabetic for various reasons... As control and carb amounts should be something decided at patient level between their HCP's and themselves not metered out like an Ikea flat pack instruction manual..

We might be diabetic but were are still human

 

[trophywench]

I still dunno Ellie, another thing I recall was her talking about her son split bolusing for eg pizza which was actually jolly useful and new info for some of us at that time. I'd heard of it but no-one had ever explained to me the nuts and bolts of doing it.

I wouldn't have thought pizza would be thought of as ultra low carb in anyone's book?

Whatever........

 

[Ellie Jones]

Trophwench

Her son was on moderately low carb diet and not the ultra low diet she promotes..

A conversation I had with her in late 2009

"(Son) injects 12-20 times a day. This is because he sticks to 7 units or less for each injection.

This ensures meal insulin works when it is supposed to and reduces possible long term fat/skin changes.

It seems a lot but it is a great way to get pump style control without the disadvantages of the pump. Also the jags are all small in volume so are usually painless."

I can link to this thread..

When I explained that I found that 6-9 injections a day really impeded on my daily routine hece the pump oh I did say I was gobsmacked by the amount of injections he's was having

She returned with this

" (son) didn't want one. The insertions were too painful and you could feel the canula was in. They also came out when they were not meant too. Other users warned of problems with DKA due to pump failure, abcesses and scarring." And his HbA1c was 6.3% 6 month previous 6.7%

So a high level of input for not a brilliant out come..

A person got to sleep, and you tend to inject while awake, so if we make an assumption of 8 hours kip and 16 hours awake, then her son is inject every 48-1hr 20 minutes but there is one very important factor in all this that she seems to have overlooked..

Insulin stacking

 

[trophywench]

Well I for one would have killed for those A1c's - never had anything under 7.2 in my entire 40 years Ellie! (until this last one after I got the pump, I cried when they told me what it was)

Some 7's but a lot of low 8's. And twice in the last 12 years, it was under 7.5.

I dunno about stacking. It's so rare for me to jab again after less than about 4 hours I couldn't possibly predict what would happen in my body. I'd just jab for the carbs and hope for the best. But if someone was doing a split bolus for a pizza-effect lunch it could happen to them at dinner time - so I expect they'd get it sorted if that was a habit.

Would a mod like to split this thread as we aren't exactly On Topic, are we? 😱

 

[Northerner]

Would a mod like to split this thread as we aren't exactly On Topic, are we? 😱

Haha! I was doing it whilst you were posting!

Personally I would NOT like to be taking so many injections a day - it would really feel as though my life was dominated by diabetes

 

[FM001]

Personally I would NOT like to be taking so many injections a day - it would really feel as though my life was dominated by diabetes

Nor I 😱 that is a astonishing amount of injections for such a young lad to inject each day and it would take over his life completely - does this doctor suggest all type 1's on mdi follow this route?

 

[cherrypie]

Dr. Katharine Morrison promotes Bernstein for management of Diabetes doesn't she?

 

[fencesitter]

Crumbs ... William does a split dose for pizza but that's it.
To use this method all the time, you'd need to really understand the profile of the food you were eating and how it followed the profile of your insulin. There are infinite variations too, assuming you eat different combinations of foods at each meal.
Do pumpers make complicated calculations like this every day?? Re. stacking. Another one that pumpers must have cracked?
Don't think this method would prove popular with most people on MDI ... four jabs seems like plenty 🙂

 

[trophywench]

Well - on a pump the Bolus Wizard takes care of Insulin on Board - we were only discussing this on another thread the other day - I have absolutely no idea whatsoever how to calculate that in, because fast-acting doesn't release itself in a flat curve - during its working time, it rises to a peak and then tails off, so I would have no REAL idea where on the curve of that graph of the last jab, I was at any given time thereafter.

But Miladdo also used to use 3 insulins - a normal long acting and fast acting, with the addition of Humulin S which is a longer-acting 'fast' one ...... you have got to understand A Lot to combine eg Novorpaid and Hum S successfully. (I couldn't even combine Hum S with Hum I without losing hypo awareness and crashing me car - so I would have nightmares if that was the only insulin in the world.) (probably just shoot meself and get it over with)

Some people still like only 2 jabs a day though, and we respect them, it's their decision anyway. So if someone else wants to have 12 that's also 100% fine by me. Come to that - I don't object to other people dogging if that's what floats their boat - just as long as they don't expect me to join in!

 

[novorapidboi26]

I believe most would rather use the pump for such a regime, the pros outweigh the cons in this situation..........

And I would of thought being on a moderately low or even ultra low carb diet would eliminate the need to inject as much, as you only inject for carbs..........

interesting though..........

*flys off to investigate further*

 

[Copepod]

Enjoyed your analogy with dogging, Trophywench, although I know some males who won't run through certain car parks at certain times, where I am happy to run alone 🙂

I agree that people should do what works for them.

As an adult, I can decide how many injections to have in a day - in my case, changing from 1 to 2 injections of long acting insulin in each 24 hours, improved my control greatly, and I usually have 3 short acting injections per day, but occasionally eg on trans Atlantic flights or marshalling on expedition adventure races through the night, have 4 or 5 short acting injections in 24 hours.

 

[Phil65]

Well - on a pump the Bolus Wizard takes care of Insulin on Board - we were only discussing this on another thread the other day - I have absolutely no idea whatsoever how to calculate that in, because fast-acting doesn't release itself in a flat curve - during its working time, it rises to a peak and then tails off, so I would have no REAL idea where on the curve of that graph of the last jab, I was at any given time thereafter.

But Miladdo also used to use 3 insulins - a normal long acting and fast acting, with the addition of Humulin S which is a longer-acting 'fast' one ...... you have got to understand A Lot to combine eg Novorpaid and Hum S successfully. (I couldn't even combine Hum S with Hum I without losing hypo awareness and crashing me car - so I would have nightmares if that was the only insulin in the world.) (probably just shoot meself and get it over with)

Some people still like only 2 jabs a day though, and we respect them, it's their decision anyway. So if someone else wants to have 12 that's also 100% fine by me. Come to that - I don't object to other people dogging if that's what floats their boat - just as long as they don't expect me to join in!

You just made me spit my tea out!

 

[Pumper_Sue]

I believe most would rather use the pump for such a regime, the pros outweigh the cons in this situation..........

And I would of thought being on a moderately low or even ultra low carb diet would eliminate the need to inject as much, as you only inject for carbs..........

interesting though..........

*flys off to investigate further*

Unfortunately for most type 1's this is not the case. If I just had a protien and fat meal I would need twice as much insulin and over an extended period to cope with it.

Having a balanced diet with carb management allows me to use very little insulin.

 

[novorapidboi26]

Unfortunately for most type 1's this is not the case. If I just had a protien and fat meal I would need twice as much insulin and over an extended period to cope with it.

Having a balanced diet with carb management allows me to use very little insulin.

I would never suggest a carb free diet, purely because of ketones, but a low carb diet for most would reduce insulin intake would it not?

Everyone's different, yeah!

Why would your requirements double............?

Would this be basal or bolus.........

You might expect an increase in basal needs maybe......

 

[trophywench]

Cos Sue is Sue - some folk do have to bolus for protein.

If you do it's alleged to need 50% of what you'd have for the equivalent g of Carbs, and fat is alleged to be 10%. But as it happens I don't need to bolus for either, just Carbs. Also, and I have absolutely no idea whether it makes a difference or not, Sue also has Addison's - which may or may not have any effect whatsoever.

Can't remember the last time I actually had anything that didn't contain any carbs - I mean I nick a bit of meat whilst carving it, or lick a spoon or eat the bit of cheese that crumbled off or whatever - but very rare No Carb.

 

[PattiEvans]

I would never suggest a carb free diet, purely because of ketones, but a low carb diet for most would reduce insulin intake would it not?

Everyone's different, yeah!

Why would your requirements double............?

Would this be basal or bolus.........

You might expect an increase in basal needs maybe......

Oooh er... I seem to have started something here! I only posted to point out that I had got the information regarding Statins from a genuine medical source. Interesting conversation though.

Novorapidboi - I am 3 weeks into using an insulinx meter which calculates doses for me. Interestingly I have reduced my total daily bolus from around 30u to around 11u without reducing carbs and without seeing significantly higher BGs - in fact they are only a tad high in the evening and I need to re-set the meter for that time. OK I am counting carbs more carefully, but even so, my meals are the same as they were previously. I had heard that you could be on too much insulin, but as I wasn't previously living in hypo city, this has all come as rather a surprise.

The meter takes into account any insulin "still on board" when it makes these calculations together with your current BG level. So you are much safer if you are actually stacking insulin a bit. I have my brekkie at 8.15 on a work day and have to have lunch at 12.20 (daft I know, but I do 3hrs 20 mins in one job in the morning and then 3.45 in another in the afternoon) so there you have insulin very slightly stacked.

 

[novorapidboi26]

There could be many factors resulting in the need to bolus for non carb items I suppose..........

But generally I thought only pumpers did this through lack of slow acting insulin, which in theory mops up the slower absorbed carbs in vegetables and in protein and fat.........and not all pumpers as well............

So if most Type 1s are pumper then yeah........................

This is just what I have been led to believe, but could be a load of codswallop........

 

[novorapidboi26]

Oooh er... I seem to have started something here! I only posted to point out that I had got the information regarding Statins from a genuine medical source. Interesting conversation though.

Novorapidboi - I am 3 weeks into using an insulinx meter which calculates doses for me. Interestingly I have reduced my total daily bolus from around 30u to around 11u without reducing carbs and without seeing significantly higher BGs - in fact they are only a tad high in the evening and I need to re-set the meter for that time. OK I am counting carbs more carefully, but even so, my meals are the same as they were previously. I had heard that you could be on too much insulin, but as I wasn't previously living in hypo city, this has all come as rather a surprise.

The meter takes into account any insulin "still on board" when it makes these calculations together with your current BG level. So you are much safer if you are actually stacking insulin a bit. I have my brekkie at 8.15 on a work day and have to have lunch at 12.20 (daft I know, but I do 3hrs 20 mins in one job in the morning and then 3.45 in another in the afternoon) so there you have insulin very slightly stacked.

I also use this meter, its great..............only cons is it doesn't allow you to alter correction factors with regards to BG level...........

How long did you put in your bolus lasts, I said 4 hours, but think its more..?

 

[Northerner]

...Novorapidboi - I am 3 weeks into using an insulinx meter which calculates doses for me. Interestingly I have reduced my total daily bolus from around 30u to around 11u without reducing carbs and without seeing significantly higher BGs - in fact they are only a tad high in the evening and I need to re-set the meter for that time. OK I am counting carbs more carefully, but even so, my meals are the same as they were previously. I had heard that you could be on too much insulin, but as I wasn't previously living in hypo city, this has all come as rather a surprise....

Wow Patti, that's an incredible reduction in bolus! Your previous 30 units bolus wasn't that much more than I'm usually on (I'm 22-25 units). Wonder what would happen if I started using one of these meters?