Re today's emails with DSN

[mum2westiesGill]

Her favourite meal is Sunday roast, that’s not so bad as long as you don’t go crazy with the potatoes, and I often do stew-type meals with green veg (she will eat some) and no potatoes or rice at all.

I like a nice Sunday roast too. What sort of stew type meals do you do? How do you work out the carbs for them?

broccoli, carrots, peas and green beans though, have to have at least one of those all the time just to make sure she will eat something healthy!

Broccoli is one of my favourites - I could eat it on a sandwich lol. Carrots, peas and green beans are also my favourites

 

[mum2westiesGill]

Gill, you are getting too keen!! 😉 Why would you calculate a correction much less inject one when you are in range? You don't need a correction unless you are not in range and 6 is between 5 and 8 last time I checked. OK you might have a bedtime snack to bring your levels up a bit but correcting to 6.5 is just confusing in my opinion.

I like that about getting too keen it's made me chuckle. With MySugr bolus advisor the negative correction which I mentioned is.....

target range is 5-8mmol and 6.5 is mid range

so at bedtime I only had insulin for the carbs I had

 

[rebrascora]

I know, but you calculated a correction for a reading of 6 which is within range, so no need to correct anything!

 

[Sally71]

I know, but you calculated a correction for a reading of 6 which is within range, so no need to correct anything!

You are right that a BG in range doesn’t need to be corrected, but Gill is trying to understand how her bolus calculator works, and that will always aim for the mid point of the range, which is 6.5 with the limits she has set. And that means that even if you are technically still in range it will try to give tiny corrections (a pump would give a correction of 0.1 if it calculated that it was needed). Yes this may be nitpicking but that’s how these things work. Other bolus calculators may do it slightly differently, I haven’t a clue how my daughter’s new pump does it other than it’s a bit different!

 

[Sally71]

I like a nice Sunday roast too. What sort of stew type meals do you do? How do you work out the carbs for them?


Broccoli is one of my favourites - I could eat it on a sandwich lol. Carrots, peas and green beans are also my favourites

As far as I’m concerned the carb count in stews is negligible, all I put in is meat, onions, garlic, mushrooms, sometimes other veg such as leeks or peppers and the only sauce comes from wine, tinned tomatoes or oxo cubes and water. I suppose the peppers, tomatoes and oxos must have some carb in, but the portion size which ends up on my daughter’s plate is small enough to make these amounts not worth trying to count. Stew plus green veg with no rice, potato or pasta is as near as damn it zero carbs in my opinion, and it seems to work!
I was always taught that most veg (apart from potatoes and one or two others) contain so little carbohydrate and are so slow to digest that they will have no effect on your blood sugar at all and therefore don’t need to be counted.

We like things like coq-au-vin, other chicken ones containing chorizo or dumplings (count those at 5-10 each, mainly just by guessing), beef goulash, bolognaise (my own recipe which is probably nothing like a true bolognaise any more! And always have that with pasta or wraps so obviously have to count those), a lamb one which contains a tiny bit of potato, and I used to do a pork one with white wine but I went off that one! Most of these are just from recipe books which I’ve picked up over the years.

 

[mum2westiesGill]

9.0- 6.5 = 2.5 ÷ 3 = 0.83333333 (rounded down to 0.5)
49 ÷ 10 = 4.9 (rounded up to 5.0)
5.0 + 0.5 = 5.5

Have I worked this one out ok?
I won't do these workings out all the time because I know it must be getting annoying for some members but at the moment as mentioned above I'm interested in knowing how the bolus calculator works.

It's today that I feel as if it's all going wrong meaning 4.6 at breakfast then 9.0 at lunchtime.

 

[rebrascora]

but Gill is trying to understand how her bolus calculator works, and that will always aim for the mid point of the range, which is 6.5 with the limits she has set. And that means that even if you are technically still in range it will try to give tiny corrections

But her bolus calculator isn't trying to do that, it is just bolussing 1.5 units for the 16g carbs she inputted. It is not offering a correction. because she is nicely in range.
I appreciate that Gill is trying to get her head around the maths but it is important not to lose sight of when a correction is necessary and when it isn't.
To try to correct for being 0.5 mmols from the centre of your target range is taking things too far with MDI and in fact your BG meter is not accurate to that level anyway. I am not trying to be critical but just saying not to lose sight of the overall goal which is to keep levels within range, or in this case since it was a bedtime reading, above range, since she was aiming to push her levels above 8 to go to bed.

 

[mum2westiesGill]

But her bolus calculator isn't trying to do that, it is just bolussing 1.5 units for the 16g carbs she inputted. It is not offering a correction. because she is nicely in range.
I appreciate that Gill is trying to get her head around the maths but it is important not to lose sight of when a correction is necessary and when it isn't.
To try to correct for being 0.5 mmols from the centre of your target range is taking things too far with MDI and in fact your BG meter is not accurate to that level anyway. I am not trying to be critical but just saying not to lose sight of the overall goal which is to keep levels within range, or in this case since it was a bedtime reading, above range, since she was aiming to push her levels above 8 to go to bed.

My DSN said if my BGL is below 8 then have 10-15g carbs with no insulin. Last night because I had a larger snack which was 26g carbs I told the bolus advisor to just bolus for the extra carbs which was 16g, then I had still had a 10g booster of carbs to stop me dropping in the night. The bolus advisor told me to bolus for 1.5 units which was for the 16g carbs.

 

[mum2westiesGill]

Since I've started using MySugr app bolus advice and not my DSN's advice for corrections over 10mmol this is my first meal where I wanted to take insulin after my meal because I wasn't sure how much I would eat. In this case on MySugr I do my before meal test and because it takes longer than 15 minutes to eat a meal I then can't get any bolus advice so I have to manually re-enter the test result from before the meal to get bolus advice as seen in the pic.



6.6-6.5 = 0.1 ÷ 3 = 0.0333333333 so no correction needed
84 carbs ÷ 10 = 8.4 rounded up to 8.5 units

 

[Sally71]

View attachment 18216
9.0- 6.5 = 2.5 ÷ 3 = 0.83333333 (rounded down to 0.5)
49 ÷ 10 = 4.9 (rounded up to 5.0)
5.0 + 0.5 = 5.5

Have I worked this one out ok?
I won't do these workings out all the time because I know it must be getting annoying for some members but at the moment as mentioned above I'm interested in knowing how the bolus calculator works.

It's today that I feel as if it's all going wrong meaning 4.6 at breakfast then 9.0 at lunchtime.

9 isn’t bad, why do you think it has all gone wrong? You are only just outside range, not actually hypo or hyper, and not within the double figures which your DSN finds so alarming. I’d say those numbers are pretty bloody good. NOBODY stays perfectly in range all the time, it can’t be done!

 

[Sally71]

But her bolus calculator isn't trying to do that, it is just bolussing 1.5 units for the 16g carbs she inputted. It is not offering a correction. because she is nicely in range.
I appreciate that Gill is trying to get her head around the maths but it is important not to lose sight of when a correction is necessary and when it isn't.
To try to correct for being 0.5 mmols from the centre of your target range is taking things too far with MDI and in fact your BG meter is not accurate to that level anyway. I am not trying to be critical but just saying not to lose sight of the overall goal which is to keep levels within range, or in this case since it was a bedtime reading, above range, since she was aiming to push her levels above 8 to go to bed.

It probably did calculate a correction, but it was so tiny it rounded it down to 0
To be honest I think such small adjustments on pumps are a bit daft too, does 0.1 more or less really make any difference? Pumps are soooo precise, yet human bodies and blood testing equipment are not! But we are told to just let the pump get on with it, which is easier than overriding it so we don’t override it unless we have a very good reason!
I get your point, I’m just trying to help Gill understand the sums which she seems to be doing now 🙂

 

[mum2westiesGill]

9 isn’t bad, why do you think it has all gone wrong? You are only just outside range, not actually hypo or hyper, and not within the double figures which your DSN finds so alarming. I’d say those numbers are pretty bloody good. NOBODY stays perfectly in range all the time, it can’t be done!

Thank you that's made me feel better.

 

[Sally71]

That’s what people mean about you trying to “micromanage” your diabetes. Yes we’d all love to have numbers perfectly in range all the time but it’s pretty much impossible with type 1 and you could send yourself mad trying. Sometimes you just have to accept that it isn’t going to work today, try again tomorrow. And if you’re only just outside range then it’s not worth worrying about!

 

[mum2westiesGill]

I’m just trying to help Gill understand the sums which she seems to be doing now 🙂

@Sally71
Is the teatime one correct?

 

[Sally71]

Yes spot on 🙂
And I think that's what @rebrascora is trying to say, with a BG of 6.6 you are right in the middle of your range so you wouldn’t normally even think about doing a correction because your BG is exactly where you want it. I get though that you just want to understand what the calculator is doing, i think you are a bit like me. Just telling me “if this happens, do that” isn’t enough for me, I need to understand WHY I’m doing it (and why that and not something else)

 

[mum2westiesGill]

At bedtime it all went wrong

Bedtime 22:45pm
BGL 3.6
Carb advice 12g
Comments I don't know where this came from! Had 3 jelly babies to treat hypo

Bedtime 23:03pm
BGL 3.3
Carb advice 12g
Comments Still hypo and dropped even lower! Had 3 more babies to treat hypo

Bedtime 23:20pm
BGL 3.6
Carb advice 12g
Comments 3 more jelly babies to treat hypo. Started getting a bit upset about this now

Bedtime 23:39pm
BGL 7.1
Carbs 3g
Insulin (correction) 0.0 units
Insulin (food) 0.5 units
Bolus advice (total) 0.5 units
Comments had 1 bag of mini cheddars at 13g carbs but told bolus advisor 3g so wouldn't get as much insulin

6/8/21
Waking 6:28am
BGL 5.2
Carbs 0.0g
Insulin (correction) 0.0 units
Insulin (food) 0.0 units
Bolus advice (total) 0.0 units
Insulin (basal) 16 units
Basal advice (total) 16 units

 

[rebrascora]

Sorry to see that you hypoed so persistently last night but looks like you managed it absolutely brilliantly to wake up this morning on 5.2! Give yourself a big pat on the back!
Any idea why you hypoed. Have you double checked carb count for your dinner? Did you have a particularly active day yesterday? Was the weather particularly hot/close in sunny Skegness?

 

[mum2westiesGill]

Sorry to see that you hypoed so persistently last night but looks like you managed it absolutely brilliantly to wake up this morning on 5.2! Give yourself a big pat on the back!
Any idea why you hypoed. Have you double checked carb count for your dinner? Did you have a particularly active day yesterday? Was the weather particularly hot/close in sunny Skegness?

Thank you for saying how brilliantly I managed the persistent hypo - I think it did actually please me this morning when I woke up on the 5.2!
I've no idea at all why I hypoed - one thing I did was to re-enter the BGL from 18:44pm which was before my tea and injected after eating because I had pizza for tea and like eating out I wasn't sure how much I would eat - hubby cut the pizza in half but maybe I should've weighed the half I had to make sure it was the weight it said it was on the packaging - what do you think? Here are the carb counts - I weighed the mushrooms out but as I say not the pizza



I don't think I was any more active than I usually am.
The weather wasn't hot and wasn't cold just in-between but in Filey not Skegness - Skegness is where we're going on holiday in a couple of weeks time.

 

[Sally71]

Pizzas are one of the worst things to cope with, even if you got the carb count right they contain a lot of fat which slows down digestion. So quite possibly your insulin got working a lot faster than the pizza got digested! And unfortunately all pizzas are different, bought ones, frozen ones, takeaway ones, deep pan or thin crust etc etc so there isn’t really one rule you can follow to avoid the same thing happening again
You woke up with a good number though so must have done something right!

 

[rebrascora]

but in Filey not Skegness

Oops! 😳 The two holiday resorts are forever interconnected in my mind because as a child we either went to Butlins at Filey or Butlins at Skegness, so I knew you lived at a Butlins town but typical of me, I picked the wrong one! Happy memories of both though so no offence intended! 🙂