Looking for a dietician specialising in Type 1, preferably in London area

[janedent]

You may find a half unit pen useful for your basal too. I think on another post you mentioned you recently reduced your dose from 4 to 3. Percentage wise that is a large drop and you may benefit from 3.5 units, for example.

Excellent suggestion. Thank you Helli.

 

[SimonP]

I suppose that if there is one burning question that's always on my mind, it's: when deciding how many units to take, is it best to err on the side of BS going to high (ie 10 - 12) or BS going too low (3-4)? Not that you can always predict it correctly of course, but I always find myself dithering between 2 numbers..

We're all different, but my preference is to err on the side of running lower during the day (as I can always have a snack), unless I'm out and about and unable to source food in which case I err on the side of running higher (e.g. out in the evening sorts of things, though then it's partially in the exercise bucket with walking, dancing, etc.); running higher overnight (as I'll be asleep), running higher if driving; running higher if exercising (as it will simply delay the inevitable requirement to eat a bit.)

Of course I do aim to get it right each time too! 🙂

 

[Tdm]

Thank you everydayupsanddowns. My time in range is usually (and currently) around 88%. 1% is hypos.
I was getting quite a few hypos (ie I'd had about 10 in a week) plus I'd been feeling unusually tired for a few weeks when I saw the nurse, so I suppose that was his reason for saying 41 wasn't good.
I find it odd that hypos often don't show up on the daily graph even though the alarm has gone off.
I suppose that if there is one burning question that's always on my mind, it's: when deciding how many units to take, is it best to err on the side of BS going to high (ie 10 - 12) or BS going too low (3-4)? Not that you can always predict it correctly of course, but I always find myself dithering between 2 numbers..

If hypos don't show, its prob because libre has reconsidered and realised it was being a bit of a drama queen and projecting ahead wrongly. It does that!

 

[janedent]

If hypos don't show, its prob because libre has reconsidered and realised it was being a bit of a drama queen and projecting ahead wrongly. It does that!

I did not know that! Sometimes when I get a hypo I do a finger prick test to check and they never show up as hypos. But I assumed the time delay on Freestyle Libre was the culprit there.

 

[Robin]

I did not know that! Sometimes when I get a hypo I do a finger prick test to check and they never show up as hypos. But I assumed the time delay on Freestyle Libre was the culprit there.

The algorithm on the Libre tries to catch up the time lag by predicting where it thinks you will be in 15 minutes time, so if you’ve got a downward trend, it will assume it will continue. But if you’ve balanced your carbs and insulin, and are about to turn the corner, you may never reach the level predicted. So that gets reflected in the graph later on when it’s realised you levelled out.

 

[Bruce Stephens]

But if you’ve balanced your carbs and insulin, and are about to turn the corner, you may never reach the level predicted. So that gets reflected in the graph later on when it’s realised you levelled out.

I think that may be happening. It also seems possible that we do reach the levels given and they don't appear on the graph because the graph is only using the 4 readings an hour. (I don't know which is true, or closer to the truth.)

 

[DianeD]

I would always err on the side of BG going too high - you can always add extra insulin but you can't take it away.
However, given your doses are relatively low, I would also recommend requesting a half unit pen. These are available or most insulins. However, I am not sure if they are available for the cheaper biosimilar insulins like Trurapi. If this is the case, I would argue that you need a different insulin (e.g. NovoRapid) which can use half unit pens. Otherwise, you are potentially using more insulin than needed and the cheaper insulin is a false saving.

Ooops sorry, I veered off topic there with a bit of a rant. My apologies.

Trurapi is available as a cartridge and the junior star pen gives half units if that is the one you are on

 

[Tdm]

The algorithm on the Libre tries to catch up the time lag by predicting where it thinks you will be in 15 minutes time, so if you’ve got a downward trend, it will assume it will continue. But if you’ve balanced your carbs and insulin, and are about to turn the corner, you may never reach the level predicted. So that gets reflected in the graph later on when it’s realised you levelled out.

I had so many 'hypos' on libre that didn't actually happen..and libra redrew its graph after the event! You could see the scanning dots were well off the graph...as you can see in example at about 2pm. Not sure ifs its so obvious now its a cgm but it was obvious when you had to scan
(By the way the attached is a couple months after diagnosis...its a bit flatter now)

 

[janedent]

The algorithm on the Libre tries to catch up the time lag by predicting where it thinks you will be in 15 minutes time, so if you’ve got a downward trend, it will assume it will continue. But if you’ve balanced your carbs and insulin, and are about to turn the corner, you may never reach the level predicted. So that gets reflected in the graph later on when it’s realised you levelled out.

Trurapi is available as a cartridge and the junior star pen gives half units if that is the one you are on

Thanks. I'm on Novorapid. I think they do half units. I will ask.

 

[Robin]

Thanks. I'm on Novorapid. I think they do half units. I will ask

I’m on Novorapid, I have the novopen echo, which not only does half unit doses, but shows you when you last injected, and how much, which I find invaluable for those 'did I, didn’t I?' moments!'

 

[janedent]

We're all different, but my preference is to err on the side of running lower during the day (as I can always have a snack), unless I'm out and about and unable to source food in which case I err on the side of running higher (e.g. out in the evening sorts of things, though then it's partially in the exercise bucket with walking, dancing, etc.); running higher overnight (as I'll be asleep), running higher if driving; running higher if exercising (as it will simply delay the inevitable requirement to eat a bit.)

Of course I do aim to get it right each time too! 🙂

It's a good point you make about different times of day influencing the decision on whether to err on the side of high or low. I was at work a couple of days ago in a situation where my brain needed to be really sharp and I saw I was plummeting towards a hypo. It took 15 minutes and a lot of sneaky gulps of orange juice to turn the corner. That made me realise I'd rather err on the side of high if I know I need to be completely on the ball, because I don't feel highs but I do feel lows.

 

[Bruce Stephens]

I’m on Novorapid, I have the novopen echo, which not only does half unit doses, but shows you when you last injected, and how much, which I find invaluable for those 'did I, didn’t I?' moments!'

The current version is the Novopen Echo Plus. In addition to those features it can (with the right phone app, for example LibreLink) be scanned to get all of the doses (or some large number; I'm not sure how many it remembers).

 

[SimonP]

It's a good point you make about different times of day influencing the decision on whether to err on the side of high or low. I was at work a couple of days ago in a situation where my brain needed to be really sharp and I saw I was plummeting towards a hypo. It took 15 minutes and a lot of sneaky gulps of orange juice to turn the corner. That made me realise I'd rather err on the side of high if I know I need to be completely on the ball, because I don't feel highs but I do feel lows.

Same for me in meetings (and teaching) I'll err on the higher side as recovering from a hypo takes quite a chunk of useful time out otherwise.