Re today's emails with DSN

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mum2westiesGill

mum2westiesGill

Well-Known Member
Relationship to Diabetes
Type 1
1st email
- I asked what she regards as being higher BGL readings
- DSN reply - they usually say they're of concern when they get into double figures
- I asked if that's when it reaches 10mmol
- DSN reply - as soon as it reaches 10mmol it's considered too high but there will be times when you know why it's high so don't need to give a correction dose
- I asked or double checked with her if I'm best still doing corrections over 10mmol? - this has been her advice for the last few weeks
- DSN reply - you should do a correction dose if advised to by mysugr app
- I asked so in future should I ignore your advice of correcting over 10mmol and go with the advice of MySugr app?
- DSN reply - think you need to try and stick to one routine. You trust the MySugr app so let's go with that and if you start having lots of hypos we can review it
- I told her I've been sticking to one routine which is the advice which she gave me to only correct if over 10mmol. I also said that I will ignore her advice from now and just go with the advice of MySugr app

1. What does anyone think of this/these emails?
2. here's a pic of my lunchtime mysugr advice - so a 0.5 correction advised
Screenshot_20210803-135915_mySugr.jpg
 
Personally I don't use any app I just common sense based on my previous experience and what I've been eating or doing; also what I'm about to do.
 
Many thoughts spring to mind, I don’t know how helpful they are though!
1. She wants to make her mind up, not so long ago she was complaining that corrrecting over 8 was too much and that’s why you changed it to over 10. I seem to remember she wanted you to only correct over 12 but you didn’t like that. Now she’s saying go with MySugr which will correct if you’re any tiny bit over your target!
2. It’s all very well saying your readings are “of concern” when they go over 10, but it’s pretty much impossible to keep it below that all the flippin’ time, I’d like to see her get it perfect every day, night, weekend, holiday.... it can’t be done!!
3. If you trust MySugr then go with that, as I’ve said many times it’s the same as Roche pumps and we’ve used pumps for 9 years and just do whatever it says, put the carbs in, it decides whether a correction is needed, we don’t cancel the correction if BG is only 8 we just let it do it. So no reason why you shouldn’t either, if you prefer for some reason to only correct over 10 and it’s been working for you then carry on with that. It should also do negative corrections (i.e. take a bit off the bolus) if you are a bit on the low side.
4. You’ve been working hard adjusting your Tresiba trying to get your numbers within a better range, I can’t help you with that as we don’t use long acting insulin, but your DSN ought to acknowledge that you are doing your best with a condition that is very difficult!
It’s up to you how you carry on though, either trust the app completely or do what you were doing before and mostly trust the app but only correcting over 10, whatever you like best, it’s your diabetes 🙂
 
DaveB said:
Personally I don't use any app I just common sense based on my previous experience and what I've been eating or doing; also what I'm about to do.
Click to expand...
Hi @DaveB I use the app because I've been used to relying on a bolus advisor since 2013 which I got through going on a carb counting course called X-pert insulin - the meter I got through the course was the Accu-chek aviva expert meter which has got a built in bolus advisor. I knew the Accu-chek aviva expert was being discontinued so I got the next best meter which is the Accu-chek mobile meter but instead of having a built in bolus advisor it is connected to the MySugr app.
 
mum2westiesGill said:
1st email
- I asked what she regards as being higher BGL readings
- DSN reply - they usually say they're of concern when they get into double figures
- I asked if that's when it reaches 10mmol
- DSN reply - as soon as it reaches 10mmol it's considered too high but there will be times when you know why it's high so don't need to give a correction dose
- I asked or double checked with her if I'm best still doing corrections over 10mmol? - this has been her advice for the last few weeks
- DSN reply - you should do a correction dose if advised to by mysugr app
- I asked so in future should I ignore your advice of correcting over 10mmol and go with the advice of MySugr app?
- DSN reply - think you need to try and stick to one routine. You trust the MySugr app so let's go with that and if you start having lots of hypos we can review it
- I told her I've been sticking to one routine which is the advice which she gave me to only correct if over 10mmol. I also said that I will ignore her advice from now and just go with the advice of MySugr app

1. What does anyone think of this/these emails?
2. here's a pic of my lunchtime mysugr advice - so a 0.5 correction advised
View attachment 18174
Click to expand...
Update
my next email
- I emailed a screen shot of my lunchtime advice from mysugr and I explained that MySugr tries to get you back to the middle of your target range but I think I've got that bit wrong about what it tries to do.
- DSN reply - yep get what the app is saying. Go with it and if your BGLs start fluctuating we can review it.

Exactly @Sally71 why can't she make her 'swear word' mind up!!
reminds me of the song by Bucks Fizz - making your mind up
 
She may just be trying to encourage you to be a bit more independent in your management xx
 
Yes it does aim for the exact middle of your target range
 
Sally71 said:
Many thoughts spring to mind, I don’t know how helpful they are though!
1. She wants to make her mind up, not so long ago she was complaining that corrrecting over 8 was too much and that’s why you changed it to over 10. I seem to remember she wanted you to only correct over 12 but you didn’t like that. Now she’s saying go with MySugr which will correct if you’re any tiny bit over your target!
2. It’s all very well saying your readings are “of concern” when they go over 10, but it’s pretty much impossible to keep it below that all the flippin’ time, I’d like to see her get it perfect every day, night, weekend, holiday.... it can’t be done!!
3. If you trust MySugr then go with that, as I’ve said many times it’s the same as Roche pumps and we’ve used pumps for 9 years and just do whatever it says, put the carbs in, it decides whether a correction is needed, we don’t cancel the correction if BG is only 8 we just let it do it. So no reason why you shouldn’t either, if you prefer for some reason to only correct over 10 and it’s been working for you then carry on with that. It should also do negative corrections (i.e. take a bit off the bolus) if you are a bit on the low side.
4. You’ve been working hard adjusting your Tresiba trying to get your numbers within a better range, I can’t help you with that as we don’t use long acting insulin, but your DSN ought to acknowledge that you are doing your best with a condition that is very difficult!
It’s up to you how you carry on though, either trust the app completely or do what you were doing before and mostly trust the app but only correcting over 10, whatever you like best, it’s your diabetes 🙂
Click to expand...
Thank you so much for your brilliant reply. I'll go with her new advice of going with mysugr and see what she has to say about my 'new' levels and also see what her next lot of advice is! Yes I have found it does negative corrections. With it being the same as the Roche pumps which you use and you do whatever it says can I ask what sort of levels you get?
 
Kaylz said:
She may just be trying to encourage you to be a bit more independent in your management xx
Click to expand...
I'm not sure about that I can't make my mind up :D
I just hope now that she can make her mind up when she says that all my MySugr parameters and my things like my target range, i:c ratios, and correction factors don't need changing and just leave them.all as they are. Re my i:c ratios of 1:10 for everything except breakfast where it's 1:8 she said to not have lots of different ratios because it just ends up too confusing.
 
I think using what my sugar says is a good idea. It will likely give you tighter control. You may end up with a few more hypos but you can then take that data and make changes. I would suggest doing what it says for two weeks before you review and decide if it’s right for you (unless you get a run of obvious hypos at the same point in each day). You’re doing a lot of work with your management and sometimes when you’re looking at the close detail it’s less easy to see the bigger picture. Your target of 4-7 (or 4-8) is never going to be 100% what you’re aiming to do it have fewer hypers and fewer hypos so that the curve of your BG is flatter when averaged over time (2-3 months).

In defence of your DSN I think you are looking for specific answers when there are many answers she could give that would all be good enough to give you decent management. I think for you that variation in responses is frustrating and so going with the algorithm on my sugar will be easier.

I think you should be congratulated for all the effort you’re putting in. You take so much interest in all your data. But I would caution you not to micro manage it to the point where you’re getting stressed. Having okay BG levels is better long term than having good BG levels but it causing you stress. As long as you’re enjoying your data gathering and tweaking it’s fine but if you start to get weary of it your numbers are good enough when averaged to give you a decent HBA1C.
 
Thebearcametoo said:
I think using what my sugar says is a good idea. It will likely give you tighter control. You may end up with a few more hypos but you can then take that data and make changes. I would suggest doing what it says for two weeks before you review and decide if it’s right for you (unless you get a run of obvious hypos at the same point in each day). You’re doing a lot of work with your management and sometimes when you’re looking at the close detail it’s less easy to see the bigger picture. Your target of 4-7 (or 4-8) is never going to be 100% what you’re aiming to do it have fewer hypers and fewer hypos so that the curve of your BG is flatter when averaged over time (2-3 months).

In defence of your DSN I think you are looking for specific answers when there are many answers she could give that would all be good enough to give you decent management. I think for you that variation in responses is frustrating and so going with the algorithm on my sugar will be easier.

I think you should be congratulated for all the effort you’re putting in. You take so much interest in all your data. But I would caution you not to micro manage it to the point where you’re getting stressed. Having okay BG levels is better long term than having good BG levels but it causing you stress. As long as you’re enjoying your data gathering and tweaking it’s fine but if you start to get weary of it your numbers are good enough when averaged to give you a decent HBA1C.
Click to expand...
Thank you. When you say tighter control what do you mean? Re if I get a few more hypos I hope someone on the forum will be able to advise on whether I need to make changes on my MySugr app - I will post pics on this thread of my MySugr calculations which obviously will show my BGL levels. Also I will keep things simple and unless I feel hypo or funny as I call it I will carry with just testing from meal to meal.
 
mum2westiesGill said:
Thank you. When you say tighter control what do you mean? Re if I get a few more hypos I hope someone on the forum will be able to advise on whether I need to make changes on my MySugr app - I will post pics on this thread of my MySugr calculations which obviously will show my BGL levels. Also I will keep things simple and unless I feel hypo or funny as I call it I will carry with just testing from meal to meal.
Click to expand...
Tighter control is just doing things like a correction for 8 when you were only doing them above 10.

I disagree with your DSN about having different ratios for different meals. I think if you’re working it out old school then yes it’s easier to keep it simple but if you’re using an algorithm in a meter, pump or app then why not use it to get the best ratio ‍♀️ Do what works for you. But for now I wouldn’t change anything and just data gather for a couple of weeks.
 
Gill, the thing about diabetes is, nothing is set in stone, and that includes your DSN's advice! When presented with new information it makes sense for her to suggest a different strategy. I think she may have been concerned that by keeping to her very specific advice about corrections you were getting stressed when the results weren't as you expected.

Just remember that you are the one in charge, and don't get too hung up on figures - nobody's life is so static that by doing the same things all the time they can get good results day after day, week after week. All you can do is give new strategies a good try and if it doesn't work, try something else. You manage your diabetes, don't let it manage you!

Good luck! 🙂
 
Sally71 said:
It should also do negative corrections (i.e. take a bit off the bolus) if you are a bit on the low side.
Click to expand...

@Sally71 or any other forum member I found this in the mySugr bolus calculator manual


Screenshot_20210803-175407_Drive.jpg

My hypo limit is set to 4.0mmol
The lower boundary of my target range is 5mmol (5mmol-8mmol)
 
mum2westiesGill said:
Thank you so much for your brilliant reply. I'll go with her new advice of going with mysugr and see what she has to say about my 'new' levels and also see what her next lot of advice is! Yes I have found it does negative corrections. With it being the same as the Roche pumps which you use and you do whatever it says can I ask what sort of levels you get?
Click to expand...
They’re OK most of the time, would probably be better if my daughter didn’t eat such a high carb diet but ho hum, I can’t force her to eat food she doesn’t like! (Yes I did try to wean her on to a variety of fruit and veg but unfortunately she decided she didn’t like most of them...)

When she was first diagnosed I was like you and tried to get perfect control all the time, and would get very stressed when we got high ones. Which didn’t help my daughter, especially as she was only little at the time and we were trying to teach her that diabetes was just part of life now and not something to be feared. It took quite a few months before I learned to relax a bit, what helped enormously was the DSN saying “there’s no point having perfect numbers all the time if that’s all you think about, you have to be able to relax a bit and enjoy life too”. Without completely forgetting that you have diabetes of course, but she’s so right. Another great quote from her is “just do whatever works”, so if you find you have to keep reducing doses because you’re going low all the time, then do that. If you have to put them all back up again a couple of weeks later because you’re going high now, then do that. If you find you need a different carb ratio for every meal then do that if it’s what works best, if having the same ratio all day works then do that. Especially when you have the bolus calculator to do all the working out for you, if you didn’t like technology and did all the working out in your head then you might prefer to stick with easier calculations even if your BGs weren’t quite so tight.

As far as tight control goes, it’s up to you how tight you aim for, just remember that perfection is impossible and it’s quite likely with diabetes that you do things a particular way one day and get perfect numbers, do everything the same and eat exactly the same meals the next day and you’re all over the place, high one minute and low the next. Your control seems pretty good to me, you don’t get many high ones and the ones you do get aren’t terrible! We have Dexcom high alerts set to 14, which is probably a bit high but if we set it much lower it would be going off all the time and driving us mad, and you don’t always need to correct, sometimes it’s only gone that high briefly because you’ve eaten.

So we have a different pump now which calculates things a bit differently, but again we just let it get on with it. Input carbs at mealtimes and pump will correct even if we’re only 7 (it can do very tiny corrections!), in between we don’t correct unless it goes over 14 (and pump will know if there’s a previous correction still working or if we’ve got too much active insulin and will reduce the size of the correction if necessary, or sometimes won’t allow one at all). And it doesn’t usually get it wrong. We are in range 60-70% of the time which could possibly be a bit better but we’ve got other stuff going on at the moment which isn’t helping and the DSN is happy enough, last hba1c was 51 which is apparently better than most of the other kids at their clinic. So that will do for me!
 
Sally71 said:
They’re OK most of the time, would probably be better if my daughter didn’t eat such a high carb diet but ho hum, I can’t force her to eat food she doesn’t like! (Yes I did try to wean her on to a variety of fruit and veg but unfortunately she decided she didn’t like most of them...)

When she was first diagnosed I was like you and tried to get perfect control all the time, and would get very stressed when we got high ones. Which didn’t help my daughter, especially as she was only little at the time and we were trying to teach her that diabetes was just part of life now and not something to be feared. It took quite a few months before I learned to relax a bit, what helped enormously was the DSN saying “there’s no point having perfect numbers all the time if that’s all you think about, you have to be able to relax a bit and enjoy life too”. Without completely forgetting that you have diabetes of course, but she’s so right. Another great quote from her is “just do whatever works”, so if you find you have to keep reducing doses because you’re going low all the time, then do that. If you have to put them all back up again a couple of weeks later because you’re going high now, then do that. If you find you need a different carb ratio for every meal then do that if it’s what works best, if having the same ratio all day works then do that. Especially when you have the bolus calculator to do all the working out for you, if you didn’t like technology and did all the working out in your head then you might prefer to stick with easier calculations even if your BGs weren’t quite so tight.

As far as tight control goes, it’s up to you how tight you aim for, just remember that perfection is impossible and it’s quite likely with diabetes that you do things a particular way one day and get perfect numbers, do everything the same and eat exactly the same meals the next day and you’re all over the place, high one minute and low the next. Your control seems pretty good to me, you don’t get many high ones and the ones you do get aren’t terrible! We have Dexcom high alerts set to 14, which is probably a bit high but if we set it much lower it would be going off all the time and driving us mad, and you don’t always need to correct, sometimes it’s only gone that high briefly because you’ve eaten.

So we have a different pump now which calculates things a bit differently, but again we just let it get on with it. Input carbs at mealtimes and pump will correct even if we’re only 7 (it can do very tiny corrections!), in between we don’t correct unless it goes over 14 (and pump will know if there’s a previous correction still working or if we’ve got too much active insulin and will reduce the size of the correction if necessary, or sometimes won’t allow one at all). And it doesn’t usually get it wrong. We are in range 60-70% of the time which could possibly be a bit better but we’ve got other stuff going on at the moment which isn’t helping and the DSN is happy enough, last hba1c was 51 which is apparently better than most of the other kids at their clinic. So that will do for me!
Click to expand...
Thanks for another great reply. Your daughter sounds like me with the high carb diet.
 
Now using MySugr Bolus advice
so no more following DSN's advice to only correct over 10mmol as mentioned earlier in this thread.

Lunchtime was 13:58pm and the pic showing mysugr advice is earlier on in this thread

Teatime was 19:39pm
my teatime carb ratio is 1:10
Screenshot_20210803-194116_mySugr.jpg
 
I think the thing you need to remember is that the DSN, much like this forum, can only make suggestions. There are many different strategies so that’s why you’ll get different ideas given at different times. How you treat your diabetes, including how you decide how to calculate your insulin doses, is a decision that you have to make for yourself.
 
Bedtime - below 8mmol so had 2 bags of mini cookies 26g of carbs - don't like having insulin on going to bed so told the bolus advisor 13g of carbs so I would get a smaller amount of insulin.
Screenshot_20210803-230138_mySugr.jpg
 
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