Hello everybody

[Teapot99]

Hello @Teapot99, welcome to the Forum (and great username!).

Can I clarify please, is it just carb counting you want to get up to speed with or do you need a refresh on the fundamentals of getting your basal right along with bolus insulin calculating? I ask, because it took me a while to appreciate that counting the carbs was only the start of a process that led to the right amount of bolus insulin.

Hello @Proud to be erratic, thank you for you comment! I’m am getting into carb counting but feel like I need to trust the whole carb counting process more as I am having hypo anxiety and stressing about going low so running my blood levels higher. I am working through this with my diabetes nurse at the moment but it’s taking time as it’s a step by step process and I’m sort of hoping to see miracles as soon as possible - which I know isn’t reality!

 

[Teapot99]

I don't bother ringing them I just use the online form

Sensor Support Form | United Kingdom | FreeStyle Libre | Abbott

Need help? Fill in our online sensor support form for Patients from United Kingdom for your FreeStyle Libre 2 or 3 sensor today.

www.freestyle.abbott

You can try turning the phone on and off and then bluetooth on and off but the issue usually comes back as it's probably an issue with the sensor itself so as soon as I've had the "Signal Loss" and "Scan again in 10 minutes" a couple of times, I rip it off, replace it, and report it - they have always sent a replacement within a couple of days - it's annoying but usually sorted pretty quickly 🙂

@mashedupmatt thank you so much. I have used this form before I think, a few times, when my sensor has fallen off I will definitely fill the form in when I have an issue. Thank you for sending the link over - much appreciated

 

[Proud to be erratic]

Hello @Proud to be erratic, thank you for you comment! I’m am getting into carb counting but feel like I need to trust the whole carb counting process more as I am having hypo anxiety and stressing about going low so running my blood levels higher. I am working through this with my diabetes nurse at the moment but it’s taking time as it’s a step by step process and I’m sort of hoping to see miracles as soon as possible - which I know isn’t reality!

I'd read your thread (well to be truthful galloped through it) and increasingly wondered with your 20 yrs background as T1 that maybe a refresh overall might help.

I noted that you had already touched upon prebolus timings; many (most?) of us find with Novarapid our natural insulin resistance is higher at the start of a day and decreases as the day goes on. That insulin resistance is often increased if our starting BG is already highish. This is one influence for prebolus time. We're trying to get our insulin to arrive into our blood stream at about the same time digested food is releasing glucose from that digestion into our blood. Now, of course another influence for prebolus time is whether the meal eaten digests rapidly or is slowed down by its fat content. Before getting you bogged down in this potentially daunting complexity, I'd like to go a couple of steps back into some useful generalities about estimating bolus.

There has been a very recent post and responses when @MarcR asked about "Insulin Calculation". He was actually asking about bolus insulin. A longstanding T1 forum member, @helli, provided a short but extremely useful summary with her perspective on this quandary. I quickly did a cut and paste of that reply into my D notepad and I'm pasting that here, more or less verbatim, just with tiny formatting differences for my notepad. My italics.

There are a number of factors involved with insulin dose calculation:
1. starting BG.
2. insulin sensitivity - by how much does 1 unit of insulin reduce your BG?
3. insulin to carb ratio - how many grams of carbs do you need for 1 unit of insulin?
4. plans - are you about to do something that needs more (e.g. stressful) or less (e.g. cardio exercise) insulin?
5. insulin on board - do you have any active fast acting insulin in your body?
6. insulin to protein ratio - if we eat a low carb meal, we also need to consider the protein. But this part of the bolus is typically taken later.
All these points differ from person to person.

Basal is the "insulin foundation". Just like a house, if your foundation is wrong, you are building on an unstable base.

Age of diagnosis is irrelevant in terms of dosage and number of units of insulin is very personal. For some people 10 -12 units is a lot. For some people it is low. Maybe they have not been taught to carb count - some people are advised to take fixed doses, for various reasons do not adjust their dose according to what they eat.

It has been mentioned a few times - they need to talk to the professional who looks after their diabetes care such as a DSN.

You might well find these points a useful starting point, then perhaps ask questions for any of these points that need amplifying from generic into actual examples. I firmly subscribe to the principle that getting your basal right first is essential. If my basal has drifted out of kilter (and things do naturally change with diabetes) then my bolus dosing frequently doesn't do what I was expecting.

Have you come across Gary Scheiner's book "Think Like a Pancreas"? I found his relaxed style of writing very easy to get along with and although he is from the USA he puts in many examples and always gives our European numbers as well as in the American units. He is T1 himself and a practicing sports diabetes therapist.

 

[Proud to be erratic]

I should have added that Scheiner early on in his book states that "Diabetes is Complicated, Confusing and Contradictory". It is so true. Yet despite all of that we do find ways of getting our minds around most of that complexity - and here you are 20+ yrs on!

 

[helli]

@Teapot99 welcome to the forum and well done on taking the bull by the horns with carb counting. I remember when I started and how I was anxious about it. It does become second nature although I still make mistakes but I take them as learning opportunities.
@Proud to be erratic mentioned the "fundamentals of getting your basal right". This is often missed or disregarded. But I think of it like building a house where the basal is your foundations and the boys is the bricks. If your foundations are unstable, it doesn't matter whether you get your bricks level, your house is still unstable.
So, for me when I do a insulin to carb ratio reset, I start with a basal test to make sure I have the right foundations before adding bricks.
Sorry for the dodgy analogy but I hope you understand the importance of getting your basal dose right before you try carb counting for your bolus.

 

[everydayupsanddowns]

Welcome to the forum @Teapot99

Sorry to hear about your nasty low BG. They can really shake you up, and it’s a way that your body deliberately puts you into full-on PANIC mode quite deliberately so that you can’t ignore the warnings. So don’t berate yourself for heeding that level of anxiety-inducing-hormones and sensations surging around. Plus really nasty lows like that always remind me of my relative fragility, and of just how powerful a hormone insulin is.

Hopefully your worries will be subsiding by now, and it’s great that you are re-embracing carb counting.

It can be a bit more art than science at times and Diabetes Maths is a pretty dark art at that!

For me carb counting was learning what seemed to be a pretty logical and understandable approach (this much carbohydrate in food needs this much insulin to process it) but really quickly I had to start adding exceptions to the rules - nuances of dose timing… adjustments for different times of day… different seasons… different levels of activity… illness… activity… stress and excitement.

It’s like one of those games that takes 5 minutes to learn, but a lifetime to master.

But however you are getting on with it, and however frustrating you find it on days where you did it right, but your diabetes throws a curveball with some unforeseen variable, to my mind T1 diabetes with carb counting is going to be more ‘kept in it’s box’ than T1 diabetes without.