Excellent advice from
@martindt1606. Particularly about too much info now can confuse and lead to bad habits. Thus slow steps needed to feel the beneficial foundation for the future.
However, Ronnie, I (like you and Martin) went through that frustration of inadequate guidance and bad assistance, which I attributed to Covid overwhelming my DSN's workload. I subsequently found she was a delightful person but well adrift on my needs after a TP; eventually she became a major liability for me by endorsing, behind my back, my GP's decision to ration my test srips to 4 x daily. After I politely questioned the competence of both my GP and my DSN and got that sorted I knew I had to take ownership of my D if things were ever going to improve.
Also, like you Ronnie I had turned 70, previously enjoyed good health and was outwardly fit and healthy. I just was not ready to be treated like a geriatric, confined to my house by not just D, but by unsatisfactory bowel and bladder control; even time in my garden was challenging. Getting someone willing to address the wider picture needed me to be politely forceful, but also needed some understanding by me of how the NHS worked, how the culture of Specialists thriving in their narrow necked silos could be encouraged to think holistically (and for about a year I came under 6 Specialists in 2 Counties). Ronnie, unlike yourself, I lived within reach of appropriate Specialists at the top of their game and within my reach geographically: my challenge was getting into their Clinics with a GP bunkered down behind a locked door unwilling to see anyone face to face and difficult to even get an email dialogue going about how to get appropriate referrals to the right people.
So YES baby steps and YES be very alert to acquiring a surfeit of information that can distract and dilute how you can make any headway.
However, Ronnie, accepting that only now have you really grasped the need to carb count and now its time to move on from that past frustration: you do now know and BERTIE on line can help with the training for that. So may I suggest this must be one of your vital Baby Steps. Until you've started the counting process, you can't verify if your counts are sensible and your presumed insulin to carbs ratios ar correct. There is some complexity to all of that, but daunting as it might feel, it is doable and there is plenty of help both on this Forum and I used Gary Scheiner's book Think Like a Pancreas as my start point for learning. I refined this after BERTIE and from comments within the Forum.
Note Scheiner early on makes the point that a main meal needs to be at least 30gms of carbs to deflect the body's consequent conversion of proteins and fats into blood glucose. This means at least some bolus for 30 gms carbs, but probably factored down to reflect recent exercise/ activity. 3 x meals at 30 gms carbs is still very much in the low carb world; my typical main meal is 50+, unless I have specifically joined a low carb family meal. But equally my early meals in excess of 100 gms carbs are a thing of the past, for various reasons.
Acquiring a surfeit of useful info is tricky to manage. It is natural to read about something you didn't previously know and to want to hoover that up to store for future use. It is also natural for us well-intentioned Forum members to want to share whatever we think may help you. I can be very guilty of that.
The next Baby step I think that is essential for you is to get your basal dose confirmed as correct first. Wrong basal dose and your bolus is chasing a moving target. Please remind me are you on Lantus? One experiment you could make is to repeat the same breakfast 3 days running and on the 3rd day post bolus by only when you areseeing a clear rise. Clarify if your BG is dropping after that meal because of basal rather than bolus. Normal basal testing processes are to divide the day into 3 bits and fast through 1/3 of a day to see how your basal is doing through those 8 hrs. It means you need 3 days to do this and you can only start an 8 hr fast when your IoB from any bolus has fully dissipated. This process of basal testing is also more usually done by T1s who might still be creating some home grown insulin; but I don't see why it won't work for us with our TPs and nothing home grown.
Final Baby Step, this is very contentious, but try and establish if YOUR DSN has experience of post whipple and TP patients. I assumed my former DSN understood my difficulties, but I was wrong. I don't want to undermine your working relationship with her. But by asking her to explain the rationale for current or future decisions might help sort out what she really understands. My personal hobby horse would be to establish why you aren't on the basal of Tresiba right now. Get that variable fixed and the maths/ algebra /science becomes a little easier. Your age and natural lack of growth hormones lends itself to a very dependable long acting basal. No basal requirement is constant through any 24 hr period. Having a basal that is optimised for the period from bedtime to breakfast can provide safe steady nights. Then the day is managed by food, bolus and activity - regardless of what the ultra long Tresiba basal is bringing to the daytime party.
Meanwhile Ronnie, you and I agree that a face to face would be less demanding than endless writing. An interim solution would be for you to show us 3 x screenshots from your Libre Log book reports of the next 3 days. We will need to know precisely when you took both basal and bolus as well as when you ate a main meal or snack that could alter your daily graph. If you were unduly active ( eg those short walks) when and for roughly how long. From those 3 daily graphs some detective work can be done - and there are some on the Forum who are brilliant that analysis stuff (I'm OK, but know others who are sharper than me in this).
Possibly better to start a new thread for these screenshots seeking the Sherlock Holmes characters and hope we keep our observations focused to just that data; we might not! Digression is a strong point by us!
