My D - need some help please

[everydayupsanddowns]

Thank you Mike,
So if I'm having tea and doing my bolus at 19:00 pm approx then I decide I may like to snack on a little something at about 21:00 ish would you bolus for that then? Also when snacking should I get the bolus advice from my accu-chek bolus advisor?

Yes I would use the Expert for that myself. The Expert will be keeping track of your 'meal rise' after your eve meal (how much you are happy for that meal to raise your BG while the insulin kicks in) and it will also be tracking what correction (if any) you have going from teatime and can factor all of that - as well as whatever ratio you eventually set for late evening and the 'target range' you have working for that time block too. To get the very best out of the Expert I found it best to always ask it the question (ie see what it said) then either accept that advice, or do my own thing. The best thing about the Expert IMO was that you could set it up and it would balance LOTS of different and varying factors all at the same time. And if it wasn't working quite right/giving effective advice I could change the settings by very small amounts and not worry about the maths involved!

Re the "absolutely nothing wrong with snacking in the evening" sometimes I thnk I'm doing wrong and maybe that's why i miss out or get ambarresed at mentioning the little "snippet of information"

No need to be embarrassed at all! (though I do know what you mean). It's only that people might see a change of 11-16 and think either your meal dose was wrong or basal was out and suggest a change that would have you running around in circles!!

It would be really interesting to see what happened of you spent all of this week 'trusting' the Expert all the time and using it for EVERYTHING you ate. It's the only way really to see if different settings on the Expert could do with a bit of tweaking 🙂

 

[mum2westiesGill]

Hi Mike or anyone else,

Once the initial set up of the Expert was done between yourself, the meter rep and HCP/DSN did you then tweak the settings yourself or wait until each time you see your DSN?

 

[everydayupsanddowns]

I was happy to tweak the settings myself, but if you are unsure perhaps it would be good to consult your DSN with what you are planning on doing to get their thoughts?

Do you have an email address for them?

 

[mum2westiesGill]

Maybe it would be a good idea to consult first.

My own DSN
- is also the practice nurse at my GP surgery - she's off at the moment due to falling down some concrete steps & breaking her ankle in July this year. At the moment I have to see the GP who specialises in diabetes.
It's so hard at the moment trying to get any appointments for anything at all at my surgery at the moment due to 2 out of 4 of them going to work at another place much of the time and as for also trying to get a nurses appointment with them being down a nurse - grrrrrr 😡

My other DSN
- is a "propper" DSN who runs the diabetic drop in centre once a week - I don't have an email for her but I do have a phone number but It might be easier to pop along to the drop in clinic and show her my print out of my recent results.
- I know her quite well because she did the Insulin X-Pert course which I went on in April & she was the one who was at the meet along with the roche rep to get my Expert meter.

 

[everydayupsanddowns]

Maybe it would be a good idea to consult first.

My other DSN
- is a "propper" DSN who runs the diabetic drop in centre once a week - I don't have an email for her but I do have a phone number but It might be easier to pop along to the drop in clinic and show her my print out of my recent results.
- I know her quite well because she did the Insulin X-Pert course which I went on in April & she was the one who was at the meet along with the roche rep to get my Expert meter.

She certainly seems like the right person - as she will most likely know/understand the Expert 🙂

 

[mum2westiesGill]

Mon 21.10.2013
16.4 - 10:46 - breakfast - 1.5 CPs - 5u QA
10.6 - lunchtime - 6.5 CPs - 8u QA
6.8 - 18:39 - teatime - 5.0 CPs -5u QA
11.0 - 22:32 - bedtime - also 24u BI

during the evening/between teatime & bedtime - snacked on scotch eggs x 2 - 4.3g carbs each = 8.6g carbs - had no QA because it was under 10g carbs

 

[bennyg70]

Mon 21.10.2013
16.4 - 10:46 - breakfast - 1.5 CPs - 5u QA
10.6 - lunchtime - 6.5 CPs - 8u QA
6.8 - 18:39 - teatime - 5.0 CPs -5u QA
11.0 - 22:32 - bedtime - also 24u BI

during the evening/between teatime & bedtime - snacked on scotch eggs x 2 - 4.3g carbs each = 8.6g carbs - had no QA because it was under 10g carbs

Mikes absolutley right - You have to bolus for these snacks!!

We all snack, and we all have to treat them differently. Sometimes if I have a snacky evening, ill inject 4 or 5 times for bits and peices!!!

Even 8.6 g carbs which you had. If your ratio if 10 / 1 then I would be giving myself a half unit or a unit dependent on what my bloods were doing. Otherwise I would expect a rise of between 2 or 3, and if Im say 8 at the time, then Im up to 10 and out of bounds!

To make things even more complicated the protein in the egg may also be pushing your bloods up during the night, but thats a different story futher down the line.

 

[trophywench]

Gill

The thing about tweaking stuff is, DO keep a note of what it was set at before - then if the tweak doesn't work, you can revert to the original and try summat else, can't you?

I never used to tweak until I was taught to carb count, and because the course ran over 4 weeks, there was plenty of chance to 'try it and see' with the DSN's on tap by phone if we needed to ask in order to decide whether to do something or not.

As your one has a drop-in, get down there like a shot!

 

[mum2westiesGill]

Tue 22.10.2013
16.2 - 3:37 - during night
7.8 - 6:04 - during night
3.8 - fasting/hypo - 2.5 CPs - 0u QA - jelly babies 5
5.3 - 10:20 - breakfast - 1.5 CPs -1.5u QA
14.0 - 15:04 - lunchtime - 4.8 CPs - 7.5u QA
3.7 - 19:59 - hypo - 2.5 CPs - jelly babies 5
5.9 - 20:15 - teatime - 3.2 CPs - 3.5u QA
15.3 - 22:42 - bedtime - also 24u BI - already taking antidepressants from a few years back, had dosage upped from 10mg to 20mg last year but feeling very stressed out this evening
- but meter also was deffinitely advising to take 1u QA - which I did - but why?
during the evening/between teatime & bedtime - no snacking

 

[everydayupsanddowns]

Not sure when you took that 1u QA Gill? If at bedtime, then purely because to get you back to 10ish from 15 you'd need at least one unit at your current ratios.

As to the rather erratic pattern of numbers after meals, I suspect that could well be down to those lows. They do have a tendency to make your liver a bit twitchy.

 

[mum2westiesGill]

Not sure when you took that 1u QA Gill? If at bedtime, then purely because to get you back to 10ish from 15 you'd need at least one unit at your current ratios.

When I did my bedtime test that's when my meter was advising me to take 1u QA which is what I went along with.

 

[everydayupsanddowns]

When I did my bedtime test that's when my meter was advising me to take 1u QA which is what I went along with.

I'm pretty sure that advice was based on your bedtime reading of 15 then.

Having said that you are dropping a LOT overnight (from 16 to hypo from 3.30am onwards) There is no way that should be happening. Have you asked your DSN about that?

 

[mum2westiesGill]

Having said that you are dropping a LOT overnight (from 16 to hypo from 3.30am onwards) There is no way that should be happening. Have you asked your DSN about that?

Not been able to get in touch as yet with my DSN/Practice nurse or the DSN who runs the drop in.

Was wondering whether to alter the targets slightly but then again I might wait until I can speak to my/DSN
my current targets:
8 lower target/12 upper target - may alter to 7 & 11
4 lower target/7 upper target - may alter to 6 & 8
4 lower target/7 upper target - ditto
4 lower target/7 upper target - ditto
8 upper target/12 upper target - 7 & 11

 

[trophywench]

So let's see, that's

9
7
7
7
9

A bit better - but still a work in progress 😉 eh Gill ?

 

[mum2westiesGill]

Hi trophywench (Jenny),
I've not altered the targets as yet but.....

I called my diabetes drop in centre this morning re what Mike said

Having said that you are dropping a LOT overnight (from 16 to hypo from 3.30am onwards) There is no way that should be happening. Have you asked your DSN about that?

before the clinic had started & spoke with the DSN there (not the usual one as she's busy at the hospital but apparently I can phone her there whenever).
The DSN this morning wanted to know a bit about me first so I asked her exactly what she wanted to know then she wanted me to read my BGs from last Sunday 20.10.2013 & due to the fact I'm higher at bedtime at the moment then dropping low early on (apart from 2 hypos on Tuesday which I think may have been too much housework 😡) I'm going to alter my teatime ratio from 1:10 to 1.5:10 & see how that goes for a few days - obviously as we all know we can only do one thing at a time with our diabetes - grrrrr 😡 😡

 

[mum2westiesGill]

Wed 23.10.2013
17.0 - 3:15 - during night - so after going to bed on Tuesday
4.0 - 8:20 - fasting - Wednesday
7.9 - lunchtime - 4.8 CPs - 5.5u QA
10.1 - 19:40 - teatime - 2.0 CPs - 3.5u QA
11.3 - 22:04 - bedtime -1.7 CPs - 0.5u QA - re the CPs & 0.5u QA this was my evening snack of a paket of discos - meter advised to have 1.5u QA but I changed it to 0.5u because i don't like having QA before going to bed to sleep
- 22:38 - BI -24u

 

[everydayupsanddowns]

The DSN this morning wanted to know a bit about me first so I asked her exactly what she wanted to know then she wanted me to read my BGs from last Sunday 20.10.2013 & due to the fact I'm higher at bedtime at the moment then dropping low early on...

I'm going to alter my teatime ratio from 1:10 to 1.5:10 & see how that goes for a few days - obviously as we all know we can only do one thing at a time with our diabetes - grrrrr 😡 😡

Not to counter what your DSN has advised, but I'm rather surpeised they haven't looked at basal first???

You went from 16 to hypo with pretty NO mealtime dose active, and the change (if I understand it right) is to increase your evening mealtime dose by 50%. This may well help your bedtime reading... but unless you can stop those big overnight drops I wonder whether you will go hypo overnight more often. I'm not surprised you are wary of injecting rapid insulin near bedtime if you drop 13mmols/L without!

 

[mum2westiesGill]

Not to counter what your DSN has advised, but I'm rather surpeised they haven't looked at basal first???

She mentioned basal but then said about increasing the evening mealtime dose - Myself I'm thinking maybe the basal should be reduced

unless you can stop those big overnight drops I wonder whether you will go hypo overnight more often.

Yes I do very much want to stop the overnight drops - & hypos 😡


Maybe another option would be to inject but make sure I inject well before having my evening meal to give the insulin a good chance to start working & also reduce the basal -hmmmm what to do - thoroughly

I'm not surprised you are wary of injecting rapid insulin near bedtime if you drop 13mmols/L without!

I've never liked bedtime QA dosing

 

[Northerner]

...Maybe another option would be to inject but make sure I inject well before having my evening meal to give the insulin a good chance to start working & also reduce the basal -hmmmm what to do - thoroughly I've never liked bedtime QA dosing

I would have to agree with Mike. If you drop by double figures overnight then increasing your evening meal dose is surely only going to make it more risky You might end up at a lower figure before bed, but then even lower in the early hours.

I always try to ensure that my evening meal dose (and therefore my meal) is around 5 hours before bed. That way I can be more or less sure that any drop is due to basal problems and that is what I would need to look at. The figures you have given here:

Wed 23.10.2013
17.0 - 3:15 - during night - so after going to bed on Tuesday
4.0 - 8:20 - fasting - Wednesday

would suggest to me that it's unlikely to be your mealtime insulin that is dropping you, unless you injected and ate sometime after midnight, so it's the basal that is causing the fall.

 

[everydayupsanddowns]

As this is rather an extreme situation (your late evening highs AND your huge drops overnight) in your shoes I think I *would* change both things at once.

At the moment if I was in your position I would see these adjustments as 'firefighting' those big swings rather than fine tuning. You are still at the stage where you are basically 'roughing-in' your Expert settings.

Ideally you would skip evening meal and test every 2 hours from lunchtime to, say, midnight or even 6am and see what is happening when you *only* have basal active, but you may prefer to just wing it

Incidentally... dont forget that you don't need to worry about the maths any more, so there's no need to change from 1:10gCHO to 1.5:10gCHO (a 50% increase) you can set the Expert to calculate 1.1:10g or 1.2:10g and it will do all the tricky calculations to you, so you only need to change things quite carefully rather than risking exchanging highs at bedtime for hypos all evening!