Tips from FFL

[bev]

I just thought I would post a few bits of information we learnt from FFL.

To treat a hypo - ONLY fast acting carbs are required - NO slow acting needed - that is for all people whether on injections or pumps.

Diabetics should bolus for every meal 15 minutes before eating - not when they are about to eat and certainly not after. The reason for this is that it takes so long for the insulin to start working that the food has already spiked up within the first hour. Studies have been done and have proved that if you bolus 15 to 20 minutes before eating this has a huge impact on yoru hba1c results. If you have a young child and not sure about how much they will eat - just give half the amount of insulin as 'down payment' until you do know and then you can give the rest during the meal or just after.

If you miss just 1 bolus for a meal - you increase your hba1c by 0.5%.

Hba1c is not the 'only' measure of how well you are controlling your diabetes. The 'deviation' from high to low levels through a days recordings is more signigicant. So if you fluctuate between 3 and 18 for example - you are at more risk of complications than if your levels were steady at 10 for the day.


For fatty foods (people on pumps) - you should do your normal bolus 15 minutes before eating and then increase your temp basal to 150% for eight hours afterwards to help with the release of fat. The graphs to prove this point spoke for themselves.

There was a lot more - but my brain is full at the moment, so when I think of anything else I will add them to this list.🙂Bev

 

[Hazel]

Thanks Bev for sharing these points with us

Very interesting

 

[bigpurpleduck]

Bev,

Thanks so much for sharing!

The 'bolus 15mins before meal' is something I haven't done, so will definitely be trying it from now on.

The fatty foods advice sounds great, too - hopefully it will help with my pizza problem 🙂

Thanks again!

 

[Twitchy]

If you miss just 1 bolus for a meal - you increase your hba1c by 0.5%.

Hba1c is not the 'only' measure of how well you are controlling your diabetes. The 'deviation' from high to low levels through a days recordings is more signigicant. So if you fluctuate between 3 and 18 for example - you are at more risk of complications than if your levels were steady at 10 for the day.

Thanks Bev! Good info, I will have to try & sort my life out & bolus before eating...but oh my goodness, re the 1 missed bolus = hba1c incr by 0.5% - oh crumbs, I'm in touble!! Chaotic house means this happens more often than I'd like... panicking now!! Seeing doc on 15th so I guess I'll see how bad things are then

Re the swings - my doc told me this some years ago, but when I had my run in with my GP's surgery "DSN" & she was grilling me as to why diabetics need test strips when she can just look at their hba1c, she just looked totally blank when I pointed out that it wouldn't tell her anything about the swings from high to low - how scary is that?! 😱 (Sigh...)

 

[Robster65]

Hi Bev.

Not sure I like the sound of treating a hypo without some long term carbs as a backup. There are situations when the next few hours need to be catered for, such as exercising.

Also, the 15 mins before might be too much if the meal is very low GI. The humalog can kick in and start to rise before the carbs properly get going maybe ?

But food for thought.

Rob

 

[bev]

Hi Bev.

Not sure I like the sound of treating a hypo without some long term carbs as a backup. There are situations when the next few hours need to be catered for, such as exercising.

Also, the 15 mins before might be too much if the meal is very low GI. The humalog can kick in and start to rise before the carbs properly get going maybe ?

But food for thought.

Rob

Treating a hypo in this way is just to treat the hypo. If you *know* that you are going to do some exercise or similar - then yes of course have some 'free carbs' - but this isnt treating the hypo - this is preparing for exercise - two different things. I do understand the reluctance to make the change - but I promise you that it does work and stops those awful high rebounds after treating the hypo.

The 15 minutes before works for every meal - it doesnt matter what the GI is. 2 minutes after eating any food - it is starting to reach your blood stream - so it needs insulin to start doing its thing. If you can give the insulin a head start then your dramatically cutting down food spikes in the first hour after eating. Now, if you are on a pump (cant remember if you are) then you can alter the way the insulin is delivered for low GI or fat or whatever else needs accomodating - but the point is to let the insulin start working before any food hits the blood stream. If you are on injections then you could consider a split dose so you give yourself half 15 minutes before the meal and then the rest either at the end of the meal or test, test and test to see when the peak happens for that particular food🙂Bev

 

[MeanMom]

I'm sorry but from our (very limited) experience some of these do not work for K.

She has treated a hypo only with glucose a couple of times when she was a school and felt rotten both times (didnt test so i have no actual figures) She was sent home one day. She always has at least a biscuit and usually a full 15g Carb snack now She doesnt have bad rebounds

Novorapid works really quickly - K was injecting before her meals but once had a hypo WHILST EATING because we had waited a while to be served (only about 10 mins after injecting til starting to eat - hypo was within about 30 mins of injecting) She now always injects straight after meals. Understand she would be better to 'split' but she doesnt want to have 2 injections each meal

The advice about avoiding swings is interesting as it is the quick 'ups and downs' that make K feel worse. she can be 12 all day and feel fine but go from 11 down to six and she feel hypo, and go from 6 up to 11 again and she can feel 'high'. can see this could cause long term problems too

Perhaps like everything with D different things work for different people

 

[Robster65]

It sounds scary Bev ! 😱

I used to inject 15 minutes before on the old porcine insulins but was told that the analogs don't need the delay. I'd need to do it a few minutes at a time to trust it.
For 10 or more years I've been injecting after meal, but have recently been persuaded to inject after, which I always knew was better but it would depend if I had seconds or a pudding, etc.
Now I'm more of a good boy and stick to what's on my plate 😱

But splitting doses would be a prob, I suspect for many more than me, since I struggle to avoid bruising on 3 humalogs and 2 Lantus. But, as I say, excellent to hear what the latest research is finding. Just need to get us luddites to incorporate it all. 🙄

Rob

 

[Northerner]

I'm sorry but from our (very limited) experience some of these do not work for K.
...Perhaps like everything with D different things work for different people

I think this should certainly be borne in mind - as we have always said, people's personal experiences can be quite different to what is expected, so the tips should be considered as guidelines only. I think what Rob said about exercise is a good case in point - for me, I don't need extra carbs prior to exercise, or to reduce my insulin: the carbs or insulin reduction are needed some hours after exercise when my liver and muscles start to 'recover' their glycogen stores from the blood glucose, causing it to fall. So, I not only have to treat a hypo, but ensure that I stay 'topped up'. Similarly, if I have a night hypo I'll have fast sugar and then some slow acting as the hypos are being caused most likely by a surfeit of basal which I can't lower after injecting, so need to 'cover' for the remainder of the night.

 

[katie]

From my own experience, injecting 15 minutes before a meal works - less spikage! but sometimes it's just not practical.

I definitely think that you sometimes need a longer acting hypo treatment though, for example if you are still on your way down or if you want to go back to sleep.

 

[sofaraway]

Diabetics should bolus for every meal 15 minutes before eating - not when they are about to eat and certainly not after. The reason for this is that it takes so long for the insulin to start working that the food has already spiked up within the first hour. Studies have been done and have proved that if you bolus 15 to 20 minutes before eating this has a huge impact on yoru hba1c results. If you have a young child and not sure about how much they will eat - just give half the amount of insulin as 'down payment' until you do know and then you can give the rest during the meal or just after.

This is one of the major things I took away, the graph that was shown really surprised me. I thought that injecting right before eating would give better results than giving after, but no real difference, the only difference was giving some time before eating. I have asked to be emailed the graph so I will post when I have it, if anyone is interested.

The other thing I found amazing was type 1's using Victoza

 

[aymes]

Thanks Bev, interesting stuff, sounds like it was a great weekend!

Just with my mod hat on though, it's just worth pointing out that any tips on here should not be taken as medical advice and if you are considering making changes to your treatment you should discuss them with your healthcare team first to get advice specific to you.

Right, mod hat off, pink glittery one from my profile pic back on... 😉

 

[bev]

Thanks Bev, interesting stuff, sounds like it was a great weekend!

Just with my mod hat on though, it's just worth pointing out that any tips on here should not be taken as medical advice and if you are considering making changes to your treatment you should discuss them with your healthcare team first to get advice specific to you.

Right, mod hat off, pink glittery one from my profile pic back on... 😉

I understand what your saying - but all these things are available on the internet and in the book 'think like a pancreas' anyway - so I was just picking out the relevant bits to share - not giving medical advice at all.🙂Bev

 

[bev]

I'm sorry but from our (very limited) experience some of these do not work for K.

She has treated a hypo only with glucose a couple of times when she was a school and felt rotten both times (didnt test so i have no actual figures) She was sent home one day. She always has at least a biscuit and usually a full 15g Carb snack now She doesnt have bad rebounds

Novorapid works really quickly - K was injecting before her meals but once had a hypo WHILST EATING because we had waited a while to be served (only about 10 mins after injecting til starting to eat - hypo was within about 30 mins of injecting) She now always injects straight after meals. Understand she would be better to 'split' but she doesnt want to have 2 injections each meal

The advice about avoiding swings is interesting as it is the quick 'ups and downs' that make K feel worse. she can be 12 all day and feel fine but go from 11 down to six and she feel hypo, and go from 6 up to 11 again and she can feel 'high'. can see this could cause long term problems too

Perhaps like everything with D different things work for different people

Hi Carol,
You are absolutely right that D does different things to different people and I was not trying to dictate what everyone should or shouldnt be doing. I am only relaying what the worlds top experts have researched and what advice they are giving.🙂

Regarding the hypo that K suffered. I would hazard a guess that she was very low (in the absence of a meter reading) - which probably would have required 2 x fast acting treatments to bring her up to within range. Perhaps this is why she felt so ill - because it was a prolonged hypo as opposed to a 10 minute one.😱

I completely understand why you dont want to inject before a meal - but it would be interesting to see what effect this has on K's levels within the first hour. If she were to have the opportunity to wear a CGM - this would be a great way of seeing what was actually going on. I can only repeat that the graphs that we were shown of many many diabetics (both adults and children) proved beyond any doubt that the way forward is to inject before the meal - and - at least 15 minutes before. I am wondering whether the hypo that happened during the meal could have perhaps been a hypo that was already on its way down and needed treating before any injection was given - just a thought.

Just another fact that shocked me was that only 15% of children in the UK have a hba1c of 7.5% or under....The experts who presented this information were also shocked and said that care over here could do with a shake up as this just isnt good enough. I am happy to say that Alex is in that 15% - but it does take a lot of hard work and effort to get it there.🙂Bev

 

[grandma]

I allways did inject 10 . 15 mins before a meal for over 35 years and did not do to bad. But since I went on Dafne thy say after meal and I have never been right since Getting real frustraterd with it all now. Think I will go back to what I was doing before I have never felt so unwell.

 

[bev]

I allways did inject 10 . 15 mins before a meal for over 35 years and did not do to bad. But since I went on Dafne thy say after meal and I have never been right since Getting real frustraterd with it all now. Think I will go back to what I was doing before I have never felt so unwell.

Hi Grandma,
How odd that you should be told to do this. Did they explain why you should inject after eating at all.😱🙂Bev

 

[MeanMom]

Bev im sorry i wasnt trying to cast doubt on what you were saying - only that we have a different experience which is VERY limited. Thank you for your advice re the two hypos (when I asked Dsn about both instances she just shruugged and didnt offer explanation) both are worth thinking about.

I have to say I have learnt far more on here than from Dsn and I want to thank everyone 🙂

 

[fruitloaf]

Thanks Bev those are really interesting techniques. I can see how injecting a little while before a meal would work but from a practical point of view this could be a problem for me as I would not know exactly when I was going to eat. I always inject before I eat because otherwise I will forget to inject afterwards or leave it too long. Until now I have had a rule that I only inject when food is infront of me on the table so the idea of injecting 15 minutes before is a little scary as I know how easily I am distracted! I'm very bad at treating hypos properly but even when I do have glucose tablets to treat them I often hypo again later in the day, when I have a biscuit as well I often go too high!

 

[Robster65]

I think what you touched on there Bev, about needing a shake up over here and what Grandma said about conflicting advice, shows that possibly the biggest area of investment should be in educating the professionals and keeping them updated.

They do seem to spend the bare minimum today and hope it'll be someone else's problem to sort. If nothing else, there should be clear guidelines for ALL health professionals to follow so that we are able to look after ourselves in the best possible way.

Sadly, lowest immediate cost is the criteria for NHS care. In the US they do at least look at the longer term and try to mitigate against future costs.

Very interesting information, whether of practical use to all or some of us, but thanks for passing it on.

Rob

 

[grandma]

Hi Grandma,
How odd that you should be told to do this. Did they explain why you should inject after eating at all.😱🙂Bev

well they said that you might give yourself to much if you dident want to eat it all and because I was grtting the grandkids meals ready Isome times went to long and hypo but now I carnt seem to get my BG back down. Igo back to see them on Wedensday dont know whatthey will say but I have never been this high. I carnt be that thick that I am not doing what they said right but even Doctor says I was better before I went