Martin isn't hugely active but has found that if we plan to go out for a gentle walk (a couple of miles on the flat - we live on the Somerset Levels) or he wants to mow the lawn, then he should skip or dramatically reduce the bolus at the preceeding meal or he will invariably go low.
Thank you for widening our understanding of Martin's circumstance. That trial and learning is invaluable for all of us and it sounds as though he is getting the measure of his responses and bolus needs.
He also finds a walk around the village of about a mile is good for reducing a high.
Good. Some people find twice up and down the stairs is sufficient, I don't. That would tend to be perceived by my body as anaerobic exercise which produces an initial further high; in anaerobic state my body thinks I'm in fight or flight mode and releases extra glucose from the liver's store to help me fight! Then I've got more to deal with. So a steady walk or gentle stroll is ideal. It can still take a while to show as a reducing BG, but I've become quite confident that my walk will produce a good outcome and let my G7 tell me.
Breakfast and lunch are fairly repeatable and always around 50 to 55gm of carb, and of the same sort of carb. Evening meal bit more varied. His alarm is set at 4.5 so he catches 90% of hypos before they happen.
May I suggest try a higher setting, such as 5.6 with the blatant aspiration of no more hypos. Suggest he treats that Alarm as an Alert and adjusts his responses accordingly.
He doesn't bother with the high alarm as he looks at his readings frequently anyway
Fair enough. In effect I know when I'm drifting high and generally don't need that alert. But sometimes I am truly busy and distracted with niff-naff and trivia, so the high alert is a useful reminder when it occurs and then repeats 20 or 30 mins later, which G7 allows with its array of settings.
Incidentally there was nothing like this advice from my DAFNE course. Not just because CGM was not discussed but all the focus was on what (bolus or basal) to adjust and by how much before a meal. In between just ignore and do nothing, unless you've gone hypo then how to respond. I was tearing my hair out when she said we should expect to go hypo frequently - wanting to scream out WHY? Why hasn't your Libre already told you that a low is coming. But it wasn't in the syllabus! DAFNE (Dose Adjustment For Normal Eating) has a significant content about managing meals; rather less about managing daily living, in my opinion. CGM helps daily living.
and he doesn't tend to take correction doses outside of meal boluses. The diabetes nurse didn't seem keen on that but I think it was because of his/our lack of experience with the whole shebang but we are very much more confident now about what we are doing and more willing to experiment.
I used to take lots of small (tiny even) corrections but these days do this a lot less frequently. I certainly check as I'm going to sleep and will correct if I'm above 10 (for me = 2units at 1:2; apparently that is pretty aggressive and 1:3 was recommended as sufficient; but it works for me. Otherwise a couple of hours above 13 will trigger me to do something like a bolus, normally just a walk or mowing etc will be enough.
A small but perhaps useful passing observation: I find my body's natural resistance to insulin increases when I'm above 8 or certainly 9. So my bolus correction ratio has been established by trial and learning from already being somewhere above 10 and thus my natural resistance is already factored in. BUT if I eat when much above 8 then somehow my bolus is never quite sufficient. That resistance is preventing my bolus from doing its suff so efficiently and I used to never quite get the full correction anticipated - ie eat while high results in staying high. I have 2 different ways of managing this:
Wait until I'm at 8 and definitely falling, then eat as normal. This is my preferred way, but it irritates my better half hugely and I do understand that reaction. Sometimes the wait can be a couple of hours.
If waiting is not a reasonable option I'll hold back on eating the full meal I've bolused for. Sometimes as simple as half the potatoes, or just not eat the planned desert. Then my BG will invariably fall eventually and I can then make a considered decision on whether to eat the uneaten bit later.
I didn't learn that from DAFNE and was told I should never inconvenience myself in such a way. I was told I should increase my correction bolus as the right solution; but by how much, I asked? Trial and error was the reply. But doesn't this mean my correction ratio is fundamentally flawed, I asked? A blank look was the answer and I was confused.
Your experience in hospital sounds very frightening. I won't even begin to go into the saga of what happened during the three visits in three days to A&E when he was building up to being admitted as an emergency with DKA. And it's interesting that you think your records were changed as we are sure the same thing happened.
I know for certain my records were changed and I showed the alteration to another youngish Surgical Dr who I trusted and had been saying the protocol couldn't be wrong because it was a tried and tested process. Then she went silent when she saw the original text now manually amended. I regret not taking a photo.
