Hey guys

[everydayupsanddowns]

Hope your changed basal dose has begun to settle now @James B

Sounds like you have been having a tough tome of things. Hang in there... it will get better and you will find a way through the maze.

If you’d like another opinion, you might try the new NHS helpline https://forum.diabetes.org.uk/boards/threads/nhs-diabetes-advice-helpline.87070/

 

[James B]

Hi guys, thought I’d check back on the thread! The diabetic team called me to check how I was doing and she noted that I was dropping quite low and questioned how I felt about carb counting. Which I replied I feel fairly confident with it just counting carbs in processed foods and rice etc and not counting carbs in protein or veggies. She’s said the approach I was taking for the past three days was correct dropping my ratio to 10g = 0.5 units of basal but also told me I shouldn’t be changing anything without consulting the team. But on this occasion I was correct to do so. She did mention it was the honeymoon period and explained what this meant in detail. She mentioned I’m scanning my libre way to much so I’m gunna try stopping doing it as the insulin works for 4 hours. She did mention the feeling dizzy and like I’m low is likely my body readjusting to a normal blood glucose as I was really high when diagnosed; around 18 and she thought I may have been this high for quite a while. I did mention the reason I was scanning so much was because I feel ill constantly and feel like I’m low and then panic when it’s around 5 2 hours after a meal she’s said not to worry because it the calculation was correct it’ll go back up and that different food groups like fat and protein means a delayed response in the carbohydrates being digested. So overall I feel slightly better but still concerned with exercising as my blood glucose does still seem to drop low for example I had sausages and wedges today around 100 carbohydrates I was 7.0 before this meal so I took 5 units And two hours later I’m 4.9 hoping this will go back up as another thing I’d do is eat more food without insulin to make sure I was around 7 which did work but if the body will do it itself I am just eating extra carbs aren’t I? The dietician did say my blood glucose shouldn’t change to much if I’m just walking and to try having half the amount of insulin at the meal before the walk so I’m assuming (she called when I was working and didn’t really have time to talk to her so didn’t ask everything necessary) that if I eat a sandwich for lunch 35 g of carbs my new basal will be 2 so I would just need 1 unit to cover this. She also advised me to take hypo treatment with me. I’ve also been told that they won’t call me regularly anymore that I just need to call them if i need to ask a question so this must mean that they think I’m managing well?Thanks everyone for your input I’d have probably just ignored it if they hadn’t called and who knows how that would have turned out. James

 

[James B]

I don’t think I could manage without the help of everyone on this forum your expertise is impeccable and your support is very much appreciated. I hope one day to become as knowledgeable and can help people as much as everyone here does. Definitely feel there should be more focus on diabetes in teaching and in general life. I was legitimately clueless before the diagnosis and my parents both have type 2 diabetes although my dads body now reacts like a type 1 and my cousin has type 1 though we aren’t close.

 

[everydayupsanddowns]

thanks for the update @James B

I am really quite surprised but some of the suggestions you have been given to be honest.

There is absolutely no problem in scanning Libre often. The average user scans 16 times per day, and double that is nor particularly unusual. The only thing you DO have to bear in mind, is not to react to every wobble that the Libre shows, and to remember that doses last for 4-6 hours, and that you may well have lots of ‘active insulin’ when BG appears to be high - which means it will come down in time.

So don’t be afraid to watch and wait, and see how different meals react, how they absorb and how your BG rises then falls as your dise works its course.

If you overreact early on (probably what your nurse was worries about) you can end up stacking insulin and causing yourself hypos and all sorts of confusion.

But there’s no problem in scanning lots at all. in fact the more information you have, the more likely you are to develop better strategies, dose timing options etc.

 

[James B]

which s

thanks for the update @James B

I am really quite surprised but some of the suggestions you have been given to be honest.

which suggestions and why?

 

[everydayupsanddowns]

As for reductions for meal bolus (not basal - basal is your ‘background’ insulin dose), I think you will have to experiment a little to see whether halving the dose works for you.

Do you have a half unit pen?

And when are you next due to check with them about dose adjustmens?

You dont want to be carrying on for weeks with an adjustment that isn’t working while you wait to speak to them.

Perhaps when adjustments are next made you could ask for clarification of what to do if x happens - “what do I do if I keep having the hypos?“ and “what do I do if I suddenly end up in the teens 4 hoirs after the meal?” just to get their advice if the suggestion doesnt seem to be working after a week.

 

[everydayupsanddowns]

which s

which suggestions and why?

Sorry! I hit ‘post’ then went back to edit as I was making a cup of tea 😛

 

[James B]

As for reductions for meal bolus (not basal - basal is your ‘background’ insulin dose), I think you will have to experiment a little to see whether halving the dose works for you.

Do you have a half unit pen?

And when are you next due to check with them about dose adjustmens?

You dont want to be carrying on for weeks with an adjustment that isn’t working while you wait to speak to them.

Perhaps when adjustments are next made you could ask for clarification of what to do if x happens - “what do I do if I keep having the hypos?“ and “what do I do if I suddenly end up in the teens 4 hoirs after the meal?” just to get their advice if the suggestion doesnt seem to be working after a week.

Hi,

I'll be honest I don't think the amount of Basal I take really does that much 18 still keeps me steady over night so I could go lower I guess? I don't have a half unit pen she has advised to round down the unit if below 7 and round up the unit if above 10 e.g. 6.3 before a meal - eat a sarny 35 g carbs with the ratio 10 g = 0.5 unit to take 2 units for that sandwich. Alternatively 10.5 before the sarny would mean 3 units. I'm not really sure how to tell if its working cuz im still not going back to the level i was at prior to the meal and I'm not sure how I would approach this. My numbers don't suggest having hypos my numbers are pretty good I just feel miserable and like I'm in a hypo all the time.

 

[everydayupsanddowns]

I don't have a half unit pen she has advised to round down the unit if below 7 and round up the unit if above 10

Yes that’s good advice, but I was just thinking that the extra options may come in handy because some of your doses are getting quite small, and once you get down to 2 or 3 units, the only options you have are carb adjustment or significant dose reduction (eg halving or reducing by a third) where a half unit pen would allow a bit more finesse?

 

[James B]

Yes that’s good advice, but I was just thinking that the extra options may come in handy because some of your doses are getting quite small, and once you get down to 2 or 3 units, the only options you have are carb adjustment or significant dose reduction (eg halving or reducing by a third) where a half unit pen would allow a bit more finesse?

I'm not really sure what you mean? Could you try to explain?

 

[everydayupsanddowns]

I'm not really sure how to tell if its working cuz im still not going back to the level i was at prior to the meal and I'm not sure how I would approach this.

Have you tried skipping a meal entirely? To see what happens when there is no bolus/meal insulin acting?

Lunchtime or evening meal are easiest to skip (because breakfast can be a bit twitchy)

If you hold steady when you dont eat, then your meal doses should only have enough ’oomph‘ to get you back to around the pre-meal level 4-6 hours after eating.

If you are dropping lots kore than this, you should mention it to your nurse.

 

[everydayupsanddowns]

I'm not really sure what you mean? Could you try to explain?

Say your dose is 2u, but it’s a bit too much. So you want to reduce it. With a whole unit pen, your only option is to take HALF the dose (reduce it to 1u). But that might not be enough.

One dose might not enough for the sandwich, the other slightly too much.

The only other option you would have is to keep the dose the same and adjust the the meal - take away half of one of the slices of bread, or add a few more carbs to ‘feed the insulin’.

If you had a half unit pen you could reduce the dose by only a quarter, dropping the dose to 1.5u, rather than all the way down to 1u

Hope that’s clearer?

 

[James B]

I do understand a little better,

I will see how I go for a week or so and then I may just ask for a half unit pen if I feel it will help. I've skipped breakfast a few times, usually on weekends cuz im so tired from the week and my glucose does stay pretty steady.

For example I missed breakfast yesterday and took my basal insulin (18) at 08:01 when my glucose was at 6.3 then when I came to eat my first meal of the day 111g of carbs i was at 5.1 and took 6 units bolusfor this meal. I did find myself dropping into the mid 4's and did snack to 'feed the insulin' but the highest i went whilst doing this was 7.0 at my evening meal I was at 5.8 and had 84 g of carbs i took 3 units of bolus and had a snack of 12 g of carbs (no bolus) and went to bed at 6.4 waking up at 6.1. Does this suggest to you that my basal is about correct or still to high?

 

[everydayupsanddowns]

Those numbers look pretty good to me, and it sounds like you are doing a great job.

If those were my results I wouldnt be able to draw any conclusions about basal (background) apart from breakfast-lunch which looks pretty good.

Well done for catching the mid-4 too and nudging that back to 7

If you are regularly dipping to the low 4s like that, you could ask your nurse about your lunch ratio - and remember it doesnt have to change much to make a big difference - especially since you are used to rounding your doses. eg 10g:0.4u would reduce your doses by 20% - though you’d need a calculator on your phone to work them out!

111 divided by 10 = 11.1
11.1 x 0.4 = 4.44 = 4u (or 4.5u if you had a half unit pen)

 

[James B]

Luckily maths was one of the things I was good at at school! Still use my phone to double check the maths though. Can never be too sure

 

[Inka]

You’re managing really well @James B 🙂 You’ve learnt loads already and you’re picking things up really quickly. You should be proud.

One thing I will say is not to put too much pressure on yourself to be perfect. Please don’t be under the impression that everyone else with Type 1 has ideal blood sugars 24/7. We don’t. Yes, experience helps, but Type 1 is still a hard job most days and everybody has out of range numbers or has something that ‘goes wrong’. Our bodies aren’t machines. They’re affected by so much - stress, illness, exercise, temperature, etc etc, and however well we learn things, do great calculations, plan ahead, something can still throw things out and mess up our blood sugars. I found accepting that - that perfection wasn’t achievable 100% of the time - helped me relax a little.

The rough feeling you get when you’re in the 5s might be your own insulin kicking in a little and adding to the drop. I find that when my blood sugar is falling quite fast, I can feel like I’m low even in the 5s and 6s. It’s not a nice feeling. I usually have a few sips of water and sometimes a tiny bite of something sweet just to slow the drop. It helps psychologically too.

I have a pump but also pens to use when needed. I have a half unit pen and find it invaluable. Not just for boluses but for corrections too. I think you’re on Humalog? I have the half unit pen for that. It’s called the Luxura HD Pen. My GP prescribed it at my request. If you’re as sad as I am and like to know what colour pens are, it’s a dark forest green and nice and robust with a solid metal feel. It also comes with a case (and yes, I really am that sad as to care about pen colours).