Help with correct basil amount please , really struggling

[Upset Racoon]

Hi,

I have posted before and sorry I did not reply , I very much appreciate your really helpful and informative responses 🙂

I’m really struggling with this , I have recently been having 15 as my basil amount. I’m on lantus and Novorapid .

I will attach a photo and is it possible for you to tell if 15 is too high or the correct amount ? I have the lantus at about 8-9 each morning , depending on what time I wake up

With the image I attached , It does seem to go down quite a lot , is that a good indicator alone it’s maybe too high a dose?

It’s just when I used to have 14 , I seemed to guess quite big amounts of novorapid ( way off the suggested 1:10 g carb ratio ) eg 8 for a slice of bread and two eggs . it spiked to 9 …

It’s just too confusing, and I have huge doubts as to if I’ll ever get anywhere near to managing this correctly

My mental health isn’t great anyway , the last thing I needed was this .

Each spike / hypo leads to some damage , it’s horrible

I’ve heard recurrent hypos can lead to cognitive decline ,, great .. I already stutter and sometimes struggle to find the correct words etc

I’ve been ‘dealing’ with this by sometimes eating one meal a day , and maybe an oatcake for dinner , just to avoid the extremely confusing insulin dosages

Also I think on the graph where it shows it’s close to being a hypo but ‘isn’t’ I did have hypo symptoms so guessing it was an actual hypo.

Please help, very much appreciated, Thank you

 

[Upset Racoon]

Had two glucose tablets ,,, I scanned just now and it’s says 3.7 still. ( I know its 15 mins behind )

I had 5 units for this evenings dinner . I had a slice of bread ( I think around 17g of carbs ( with sardines in tomatoe sauce ( extremely low, around 1.5 g) , a scotch egg which is around 20t of carbs and 3 slices of cheese ( guessing carb free ??) and a spring onion ( guessing next to nothing )

It’s just I had the scotch egg a few days ago where I injected 2 and it spiked to 9+ so that’s why I done 3 plus the two for the bread .. no idea : absolutely no idea . And now of course I’ve had two glucose tablets and half a 6g biscuit .. surely that may result in a spike ?? Absolutely hate this is so so much , I feel I no longer can eat !

Apart from an omelette ( I can eat that without any insulin , that’s on the 15 basal dosage though ) or some very boring pumpkin seeds for dinner ( just to avoid me miscalculating insulin and causing further damage to myself .

 

[Bruce Stephens]

I will attach a photo and is it possible for you to tell if 15 is too high or the correct amount ?

The graph looks close to flat to me so I'd guess the basal is OK. Just looks like you injected a bit too much bolus. But even that doesn't look badly out. I think if you'd noticed you were going low slightly earlier you could have eaten a bit more and avoided the hypo entirely. And by the looks of it you haven't gone that low anyway, so I very much doubt that kind of hypo will do any damage (people without diabetes can (rarely) go that low.

Everybody else with Type 1 (and most other people on insulin) will have gone lower than that, many times. (Not that hypos are harmless. They're well worth trying to avoid. But it looks like you're doing just fine at that. No need to avoid eating.)

You're 99% in range over the last 24 hours, so that's hardly chaos! (I get that kind of result about once a fortnight, roughly.)

For dinner you've eaten about 40g and 5 units was a bit much. So maybe try the basic 1 unit for 10g (so 4 units rather than 5) and see if that works OK, or 5 units and eat a bit more. (Bear in mind that these calculations aren't that accurate. Day to day we all find things vary a bit. An advantage of Libre is that we can see what's happening and react to it.)

 

[Bruce Stephens]

It’s just I had the scotch egg a few days ago where I injected 2 and it spiked to 9+

But if that was a spike and then you returned to something close to normal, that's more a timing thing. And maybe it's not worth worrying about anyway: people without diabetes have spikes (sometimes over 10) after eating. The goal for most of us is over 70% between 3.9-10.0, and you got 99% over 24 hours.

 

[rebrascora]

Are you kidding!! That graph is absolutely brilliant, so I wonder if perhaps you have too high an expectation of what is achievable. I mean, really, it is great.
Your overnight levels are very stable mid range which is ideal and tells you that your basal dose is right at the moment. I say "at the moment" because It can and almost certainly will change over time, but at the moment it is as good as you could hope to get. Those fluctuations up to 10 and down to baseline of 4 are perfectly normal and will not be causing you any damage, even if you drop a bit below 4 although this is to be avoided as much as possible. Having hypo sensations when you get near 4 is really good, rather than a bad thing as it tell you that your hypo awareness is very effective. These sensations are your early warning system, so you want them to happen. They are not causing you harm.

I am not sure if you are aware of the Time in Range facility on your Libre but you are aiming for more than 70% Time in Range with less than 4% below 3.9. You have 99% TIR which is exemplary, so please be extremely happy with this graph. I can tell you I would be positively boasting about it.

The drop in the late afternoon evening may be due to the effects of activity through the day and if you see a pattern of that happening, then you would probably be well advised to adjust your evening insulin ratio ever so slightly to prevent it or you could just have a small snack when you see it starting to head down below 5.... particularly towards bedtime when you would be aiming for it to be a bit higher to go to bed on. Have you been given a target number to aim for at bedtime and if you are below that, to have a small carb snack to lift your levels a bit?

Anyway, really just wanted to encourage you not to worry and say that you are doing fantastically well (not average but way above average) and even though I consider myself to have pretty good control I would be happy to swap you that day's graph for the vast majority of mine.

 

[rebrascora]

Gosh!.... I have also just noticed that you have your range set below 9.... Looks like maybe 8 or 8.5?
The TIR stats I quoted are for a range of 3.9-10 so I would recommend you change your upper limit to 10, especially since you are struggling with anxiety. It is perfectly acceptable and to a large extent assumed that our levels will go above 10 for some of the time and indeed non diabetic people do this too. The guidance actually allows for us to be above 10 for as much as 25% of the time and still be doing well, so please do not feel that you daren't eat in case you go too high. As long as you are not going up to 15 every day and then coming back down to 4 or less, you are managing your diabetes well. A short spike up to 10-13 most days would not be considered a problem or indeed unusual.

We all want to manage our diabetes as well as possible, but this has to fit into normal everyday living not doing our utmost to keep in extremely restricted range at the expense of living and enjoying ourselves. There is a real threat of developing eating disorders and diabetes burn out if you try too hard. Finding a good balance between reasonably good management and enjoying life, is key to living well with diabetes.

 

[cameron]

I agree with everything above. I think the basal dose looks about right and slightly tweaking your insulin-to-carb ratio seems to be the priority. Have you ever been on a carb counting course?

I'm sorry to hear that you feel you can't eat anymore - it's important to enjoy your food. It could be that you're setting yourself some pretty high expectations at the expense of your mental health. A conversation with your doctor or diabetes nurse might be useful. They can help reassure you and set realistic goals for you to work towards. You're doing so well and better than you think! 🙂

 

[CoventryTrev]

You are 99% in range in a 24 hour period. That's great!! Well.done!!
I'm lucky if I get to 50% on a good day.

 

[everydayupsanddowns]

Sorry to hear you are feeling so down with your diabetes @Upset Racoon - and the mental health challenges it is sending your way.

I wonder if perhaps you have read some rather alarmist material on the internet full of doom and despair about any one reading above a certain level?

There is a lot of that about. And I take it with a pretty hefty pinch of salt.

CGM traces from people without diabetes show significant glucose variation (down into the threes and up into double figures), and I think it’s a stretch for us to thunk we have to do ‘better’ than a fully functioning pancreas!

The international consensus recommendations on Time in Range suggest that 70% between 4-10 is excellent BG management, as long as only 4% of time dips below 4, and not too much time goes above 12-13.

So rather than seeing your 9s after meals as a ‘spike’ I think you should see them as being pretty optimal.

I’ve been playing this game for 30+ years, and have had far more wobbles than your graph suggests and still have almost nothing to show for my guesswork and occasional lapses.

Be kind to yourself, and recognise how well you are doing. Perfection isn’t possible in T1, but you can find a balance between effective BG management (most of the time) and still having a life 🙂

 

[Upset Racoon]

Thank you everyone for your absolutely lovely helpful answers, I will try to remember what you say 🙂 Still struggling of course, but will try not to worry