latest dsn/dietitian meet

[D_G]

Hi all hope your ok, not been around too much lately due to unpredictable internet connections! Seriously theyare doing my head in arghhh!

Anyway i had my second meet with my dsn and dietitian last week, said i was doing well and they both looked at my food diary i had been keeping and said my numbers were good! they said i worry too much about everything...which is actualy true! and they said i test too much!?? so they told me to only test before meals and before bed.....

however (as shiv pointed out when reading my blog) surely i should be testing my 2 hour post meal in order to see if my ratio is correct?? or does it not matter what i am between meals (such as going really high), just as long as i come back down before the next meal??

On the upside they are going to get me some new 4mm needles to try and also a contour usb for free!!! and having my very first HBA1C in the next month or two......😉

 

[shiv]

however (as shiv pointed out when reading my blog) surely i should be testing my 2 hour post meal in order to see if my ratio is correct?? or does it not matter what i am between meals (such as going really high), just as long as i come back down before the next meal??

i just read your reply - my DSN got me to go 2 weeks without doing 2 hour tests to see if i had got my ratios right. i personally test after 2 hours as my levels are unpredictable and can shoot up if i'm not careful.

my DSN also said the same to me - i was causing some of my hypos as i would see a high reading and panick.

it might be something you want to experiment with? try a few days without, try a few days with, see what you are happy with?

 

[D_G]

Yea that does sound like a good idea thanks🙂

have done some tests and some breakfast foods i spike up in the 10s after the 2 hours!! and yea i panick and it ruins my day coz i feel like i have failed, but when i check again before i have lunch they are back to normal so does that mean i have the right ratio?

They also said to test less to save my fingers pain lol which i totally agree with there, and i am finding that testing less during one day makes me think less about the diabetes and as i am seeing normal numbers i can enjoy my day more 🙂

 

[shiv]

Yea that does sound like a good idea thanks🙂

have done some tests and some breakfast foods i spike up in the 10s after the 2 hours!! and yea i panick and it ruins my day coz i feel like i have failed, but when i check again before i have lunch they are back to normal so does that mean i have the right ratio?

it could just mean that you need to take your insulin earlier so it meets the peak of the food - if that makes sense? say take it 15 mins before you eat, so the insulin has time to get in and get working. ideally you want your insulin and your carbs to meet at the same time (that's what Joe Solo said hehe!)

 

[D_G]

I take my insulin 20 mins prior to eating

told the nurse this at meeting and she said i should inject just before, so i tried this and rocketed! so have gone back to my 20 mins before again....

 

[bev]

I take my insulin 20 mins prior to eating

told the nurse this at meeting and she said i should inject just before, so i tried this and rocketed! so have gone back to my 20 mins before again....

Then you have proved that your DSN doesnt know what she is talking about.😱
The reason to inject at least 10 minutes before is that it takes 10 minutes at least for the insulin to start working - so injecting at the same time as you start to eat means that your insulin might take 20 minutes to start working and your food could start working seconds after putting it into your mouth!

I cant believe she has told you not to check inbetween meal times? If you only check pre-meal - how can you know what affect foods are having 2 hours after eating? If you have good level pre-meals then thats great - but its the inbetween times that counts as this is what sends levels up and causes spikes. If I only checked Alex pre-meal - we would very rarely do corrections - its *because* I check at the 2 hour mark that I know he has spiked and we normally try to time the insulin differently for that particular food or we do a dual wave etc or we start looking at basals. If Alex spiked up to 17 after 2 hours - I need to know about it so I can correct him - it is just not good practice to leave a high level until the next meal!

Just because you dont *know* that you have spiked - doesnt mean that you arent adding to your load for future complications!

Always remember that levels are just cold hard data - it is not a personal thing - it doesnt mean *you* have failed - it is just your body's way of telling you that there is something amiss that needs adressing - whether it is timing or basal or bolus. But the very worst thing you can do is to 'ignore' the spikes as these add up to complications and that is what we are all trying to avoid.

Personally, I would keep testing as long as you undersand why you are doing so and as long as you use the data to make changes.🙂Bev

 

[rachelha]

I have been told I test too much as well. I have big problems with post meal spikes, which cause me a lot of worry due to being pregnant. When I asked the consultant what I could do about it, I was first told not to test - ridiculous, and then told the pump would help - also not helpful as I am still on the waiting list and wont get it until after I have given birth.

The things I have found help are injecting ~20 mins before eating, and if I am having a yoghurt or fruit etc. with my meal actually leaving it about an hour or after the meal and eating it then, (but including it in the pre meal insulin calculation). I think for me the insulin takes ages to kick in.

I did not know you could get 4mm needles, they must be really tiny - fantastic.

 

[sofaraway]

I personally don't test at 2 hours very often at all, only usually if I am eating out or think there is a chance of being too high or low if I had to guess at the carbs. I
Found that I tested much more when I was first carb counting and working out my ratios. But since I have pretty stable levels I don't need to test at 2 hours.
If you are higher a 2 hours and then back to range by 4, so when the insulin is done working, then the dose was right just the timing needs tweeking.

 

[D_G]

I know i was really suprised when she told me not to check inbetween meals! i even challenged it but she said it was due to the fact that when i test inbetween meals and see a high reading i panick and worry myself too much, but as bev said surely this is dangerous as these high spikes could cause me complications later

I am already injecting 20 mins prior to eating and still get the two hour ( sometimes even one hour) spike, but then 3-4 hours later i am back down to near enough what i started with i dont see how i can change anything else

Obviously a high sugar for a loong time is dangerous, but is it as dangerous if it only stays high for say a couple of hours until you come down again? or is it just the same!

Cant wait to try those needles, im getting a couple of boxes on friday to test as they are not available on prescription yet!

 

[bev]

I know i was really suprised when she told me not to check inbetween meals! i even challenged it but she said it was due to the fact that when i test inbetween meals and see a high reading i panick and worry myself too much, but as bev said surely this is dangerous as these high spikes could cause me complications later

I am already injecting 20 mins prior to eating and still get the two hour ( sometimes even one hour) spike, but then 3-4 hours later i am back down to near enough what i started with i dont see how i can change anything else

Obviously a high sugar for a loong time is dangerous, but is it as dangerous if it only stays high for say a couple of hours until you come down again? or is it just the same!

Cant wait to try those needles, im getting a couple of boxes on friday to test as they are not available on prescription yet!

If you were on a pump you could do whats called a 'superbolus' where you decrease the basal at the time of the peak and add it into the bolus for the food and this helps to stop the spike! As far as i am concerned any high for however long will do damage in the long term. The hba1c isnt just a measure of complications, its the swinging from high to low and the spikes that adds on the risk of complications. So if you have 3 meals a day and you spike 3 times - then this all adds up. You could try injecting 30 minutes before the food and see if that works for you? Or you could try splitting the dose - so give half up front and then half at the 2 hour point and in theory this helps to lessen the spikes.🙂Bev

 

[Northerner]

If you were on a pump you could do whats called a 'superbolus' where you decrease the basal at the time of the peak and add it into the bolus for the food and this helps to stop the spike! As far as i am concerned any high for however long will do damage in the long term. The hba1c isnt just a measure of complications, its the swinging from high to low and the spikes that adds on the risk of complications. So if you have 3 meals a day and you spike 3 times - then this all adds up. You could try injecting 30 minutes before the food and see if that works for you? Or you could try splitting the dose - so give half up front and then half at the 2 hour point and in theory this helps to lessen the spikes.🙂Bev

Something else to try, of course, is to eat fewer carbs in your meals and make sure the carbs you have are low GI/GL so that they release their sugar more evenly so the spike never gets high. I know they say we can eat anything (within reason!) on insulin, but getting the peaks to match the spike is so hit and miss unless you minimise it by eating the right foods. I've proved that tonight with my yummy cake! 😱

 

[D_G]

Something else to try, of course, is to eat fewer carbs in your meals and make sure the carbs you have are low GI/GL so that they release their sugar more evenly so the spike never gets high. I know they say we can eat anything (within reason!) on insulin, but getting the peaks to match the spike is so hit and miss unless you minimise it by eating the right foods. I've proved that tonight with my yummy cake! 😱

Yea i do tend to go for wholesome foods such as i dont eat white bread and pasta, awlays wholemeal 🙂 i have to eat at least 30-40g carbs with every meal as instructed by dietitian

 

[Vicsetter]

I've proved that tonight with my yummy cake! 😱

I'm getting jealous, how can I persuade my gp to give me some bolus insulin so i can eat cake.😱