How long were you on fixed doses for?

[becca59]

You could try searching this forum and see if it comes up.
I'm using my phone data at mo and for some reason this forum is not connecting well. It may be O2 thou.

It’s not connecting on EE either, think it is the forum.

 

[LooperCat]

I’ve been thinking back, I think I was on a mixed pig insulin for a while before basal/bolus. But not for long, I don’t think.

 

[catapillar]

On a basal bolus regieme your basal is supposed to keep you flat-ish when not eating (to bring you up) or bolusing (to bring you down. There is a guide on how to basal test here - https://mysugr.com/basal-rate-testing/ - units are in mg/dL to convert to mmol divide by 18.

Once you have your basal at the right dose then you can check you're using the right insulin to carb ratio. Read "think like a pancreas", do the Bertie online course, ask to go on DAFNE or your local carb counting course - a carb counting course won't just be how to count carbs, it will be how to manage type 1, sick day rules, exercise, meting other people with type 1 and dealing with the same frustrations.

For adults diagnosed with type 1 they don't like to offer DAFNE in the first 12 months because a newly diagnosed adult is likely to be honeymooning, which will make establishing an insulin to carb ratio more difficult.

 

[etmsreec]

What does "a hypo" mean.

Does "I feel like I just ran a 5k only I didn't" mean hypo? I feel like that all the time.

Does "shivering and sweating and ready to eat the entire contents of the fridge" mean hypo. This happens twice a week.

Does "lying in bead shaking so hard it hurts and unable to remember where your kitchen is or how to get there" mean hypo. Once a month?

They can be symptoms of hypos. what happens if you take rapid-acting sugars when that happens?
What's your blood glucose level when those things happen?
What's your "usual" glucose level (although we all know there's no such thing as normal)? Do you tend to run high or low?

 

[etmsreec]

As long as I keep doing that she'll let me do anything I want, like keep my HBA1C under 40, telling her I want Tresiba and Fiasp, testing a lot, injecting an average of about 8 times a day and treat a mild hypo with a beer when it's after five PM. These are all things she has learned that aren't right. She doesn't know too much about diabetes, but she's very open minded and interested, and she trusts me.
I still don't carb-count, seems very complicated to me, but I'm fine with insulin-guessing and giving myself some slack with complicated meals.

I hope you're joking!
Treating hypos with beer?
Insulin guessing?

First off, never count carbs in beer. Alcohol lowers blood glucose, and impairs the liver's ability to naturally counteract lower blood glucose (your liver won't dump glycogen into your blood stream if it's already processing alcohol.) Only count the carbs with things like alcopops. Even then, it's necessary to compensate for the alcohol content.
Insulin guessing seems very hit and miss, and carb counting really isn't that complicated. It's only the confidence of evaluating a meal when eating out that's complicated.

 

[etmsreec]

I was diagnosed in Liverpool in 1981. I was in hospital (Alder Hey) for ten days, whilst my glucose levels normalized and they educated me on doing my own injections, swapping needles, sterilizing syringes, and counting carbs. The counting was more "55grms of mashed potato will be this many carbs, so you'll need this many for the insulin that you're taking.
Manually mixed Actrapid and Monotard, twice a day. If one missed lunch, it was almost certain that an ambulance and admittance to A&E would result!
I was changed off manual mixing in about 2001, changing to insulin pens and basal/bolus. Still much the same regimen, with fixed insulin doses and fixed meal sizes. Only when I moved back to the north west in 2004, back to Arrowe Park, and saw the consultants and DSNs there (like Kay) did I get to go on the Whistle course (the locally run course, similar to DAFNE), did I finally get flexibility in what I eat and the knowledge of how to adjust the insulin for meal sizes and changes in carbs.
I'm happy to say that, since being on basal/bolus, I've not had a hypo that I wasn't able to deal with, and I haven't had to be admitted to A&E. The last such episode was in about 1997, thankfully.
In the time since diagnosis I've gone from Actrapid/Monotard (which got discontinued), through Lantus (made me drowsy), Levemir (split dosing made things complicated), and now on Tresiba (now less complicated, but 30+ years of injections make my sites a bit lumpy.) Fast acting insulin isn't always that fast acting, which can be interesting, too.
Biggest lesson learned recently? Get up when the alarm goes off, rather than turning over and thinking, "another ten minutes". Turning over results in hormones being released, to give me a kick in the pants, which guarantees a VERY high glucose level about two hours after.

 

[Antje77]

I hope you're joking!
Treating hypos with beer?
Insulin guessing?

First off, never count carbs in beer. Alcohol lowers blood glucose, and impairs the liver's ability to naturally counteract lower blood glucose (your liver won't dump glycogen into your blood stream if it's already processing alcohol.) Only count the carbs with things like alcopops. Even then, it's necessary to compensate for the alcohol content.
Insulin guessing seems very hit and miss, and carb counting really isn't that complicated. It's only the confidence of evaluating a meal when eating out that's complicated.

Hoho, I said mild hypo, so drinking a beer will nudge my bg up a bit when it's between 3.7 and 4.0. I definitely have to inject for beer, so it seems useless to first eat sweets and then inject for the beer. I might do the same with a slice of bread. I find it much easier to get it right after the low if I do this. 3.6 and under, or when going lower fast, I use something faster to treat a hypo. I didn't advise anyone to do as I do, but I do what works for me.
Insulin guessing might seem very hit and miss, but it isn't for me. I don't see a reason to change what I'm doing as long as it works well. Should things get harder in the future, I might look into carb counting. I'm afraid my stats wouldn't look like this if I never counted carbs for beer. Those 2% hypo's are usually not lower than 3.4, and mostly higher. I've never had a hypo when sleeping, as far as I know, and I've been using the Libre for 8 months or so.

 

[jdixon551]

I've never been on fixed doses.
I was diagnosed with 'diabetes' end of november 2017, bought a meter and read the internet before having my first date with the nurse at my GP, armed with a weeks'worth of readings, was put on gliclazide (after I told the nurse at the GP they coudn't give me metformin according to the leaflet), started to tell my nurse gliclazide wasn't doing enough according to my meter by christmas, put on basal insulin in january and started nagging her about bolus right away.

Got a date with her for the bolus insulin on which she informed me she was going on holiday for two weeks and that she rather would start MDI after she got back. I told her I didn't want to wait while having high sugars and got her to prescribe me novorapid after promising I would be very careful not to shoot myself in a bad hypo right away. Saw her again about three weeks after that and presented her with nice numbers on my meter.
As long as I keep doing that she'll let me do anything I want, like keep my HBA1C under 40, telling her I want Tresiba and Fiasp, testing a lot, injecting an average of about 8 times a day and treat a mild hypo with a beer when it's after five PM. These are all things she has learned that aren't right. She doesn't know too much about diabetes, but she's very open minded and interested, and she trusts me.
I still don't carb-count, seems very complicated to me, but I'm fine with insulin-guessing and giving myself some slack with complicated meals.

Hi, it sounds like you're doing everything pretty well so far, so well done for adjusting so quickly. If you would like more information I really would recommend the carb counting courses that will be run in your area. You can ask your GP or Consultant to refer you. They are usually 3 days to a week long however the learning you get will really help you to become self sufficient and teach you valuable information which is a must including correction doses, your insulin ration, how to work out the amount of carbs in a food and then work out your insulin, sick day rules. You may feel that a week is impossible to take off work, however legally your work have to allow you the time off, and a planned week getting the info you need is much better than needing a month off because things have gone awry...it really is invaluable and I cannot recommend it enough.

For the short term I would recommend downloading the 'Carbs and Cals' app. This has every type of food on there and gives you portion pictures and the amount of carbs (as well as fat, protein and other useful info) each product and portion contains. You can use it out and about and at home and makes calculating easy. You just apply your current ratio to the amount of carbs in each portion e.g if you take 1 unit per 10g of carbs an 80g portion would mean 8 units of insulin. I love this app and still use it now, really helpful when you're in a restaurant and have no access to scales!

I hope this helps good luck with it all.

 

[jdixon551]

Hoho, I said mild hypo, so drinking a beer will nudge my bg up a bit when it's between 3.7 and 4.0. I definitely have to inject for beer, so it seems useless to first eat sweets and then inject for the beer. I might do the same with a slice of bread. I find it much easier to get it right after the low if I do this. 3.6 and under, or when going lower fast, I use something faster to treat a hypo. I didn't advise anyone to do as I do, but I do what works for me.
Insulin guessing might seem very hit and miss, but it isn't for me. I don't see a reason to change what I'm doing as long as it works well. Should things get harder in the future, I might look into carb counting. View attachment 25884 I'm afraid my stats wouldn't look like this if I never counted carbs for beer. Those 2% hypo's are usually not lower than 3.4, and mostly higher. I've never had a hypo when sleeping, as far as I know, and I've been using the Libre for 8 months or so.

Oh dear!! Beer will eventually bring your bloods down (as will all alcoholic beverages, no matter how sugary) so using them to treat a low is extremely risky and injecting insulin with alcohol should be practised with caution. The guessing the insulin is hit and miss and will not protect you from developing complications quickly! You will speed up the rate of eye damage, damage to your gums and teeth (which is an expensive problem!) and many other diabetic complications including problems with your kidneys. It really is so important to not be so relaxed about these things as in the long term it can cause much damage. It might seem frustrating but the work pays off in a long healthy life!

 

[Antje77]

Hi, it sounds like you're doing everything pretty well so far, so well done for adjusting so quickly. If you would like more information I really would recommend the carb counting courses that will be run in your area. You can ask your GP or Consultant to refer you. They are usually 3 days to a week long however the learning you get will really help you to become self sufficient and teach you valuable information which is a must including correction doses, your insulin ration, how to work out the amount of carbs in a food and then work out your insulin, sick day rules. You may feel that a week is impossible to take off work, however legally your work have to allow you the time off, and a planned week getting the info you need is much better than needing a month off because things have gone awry...it really is invaluable and I cannot recommend it enough.

For the short term I would recommend downloading the 'Carbs and Cals' app. This has every type of food on there and gives you portion pictures and the amount of carbs (as well as fat, protein and other useful info) each product and portion contains. You can use it out and about and at home and makes calculating easy. You just apply your current ratio to the amount of carbs in each portion e.g if you take 1 unit per 10g of carbs an 80g portion would mean 8 units of insulin. I love this app and still use it now, really helpful when you're in a restaurant and have no access to scales!

I hope this helps good luck with it all.

Thank you for your friendly and informative answer. I live in the Netherlands and they don't do carb counting courses here. The main problem with carb counting is that I'm a chaotic cook. I like to throw everyting in the pot, and then add more stuff in the next few days, or I eat something else with it. Which makes it pretty much impossible to weigh and reweigh and calculate the carbs in the changed meals. And really, I'm happy as it is (and so is my nurse).

 

[Antje77]

Oh dear!! Beer will eventually bring your bloods down (as will all alcoholic beverages, no matter how sugary) so using them to treat a low is extremely risky and injecting insulin with alcohol should be practised with caution. The guessing the insulin is hit and miss and will not protect you from developing complications quickly! You will speed up the rate of eye damage, damage to your gums and teeth (which is an expensive problem!) and many other diabetic complications including problems with your kidneys. It really is so important to not be so relaxed about these things as in the long term it can cause much damage. It might seem frustrating but the work pays off in a long healthy life!

Thanks for the warning. but I really do believe I'm pretty much last in line for complications. I'm very much not slacking with handling my diabetes and it usually doesn't frustrate me either. I included an image of my Libre to make everyone feel more at ease about my control. Those 2% hypo's are usually not lower than 3.4, and mostly higher. I've never had a hypo when sleeping, as far as I know, and I've been using the Libre for 8 months or so.

 

[janeridal]

Frankly, if your HbA1c is down to 40 you're doing fine whatever method(s) you're using. What are you hoping to gain from further teaching?

 

[jlarsson]

Thanks for the warning. but I really do believe I'm pretty much last in line for complications. I'm very much not slacking with handling my diabetes and it usually doesn't frustrate me either. I included an image of my Libre to make everyone feel more at ease about my control. Those 2% hypo's are usually not lower than 3.4, and mostly higher. I've never had a hypo when sleeping, as far as I know, and I've been using the Libre for 8 months or so. View attachment 25886

Maybe it's just me but your target range seems a bit low, no? 3,9 is hypo territory for most people, I think. I have mine set to 5,2 to 8,4. Other than that, you're doing hell of a lot better than me, so well done.

 

[mountaintom]

Do you use strip tests?

 

[jdixon551]

I'm keen to know when people were first tested and trained for carb counting.

At my diagnosis in November, I was given some advice on how and when to test and inject. I was prescribed a fixed split basal and bolus doses and sent on my merry way.

The same nurse at the hospital saw me again in December and said to carry on as I was.

Then at the end of December, I saw a dietician who concluded I didn't eat **** anyway and to carry on as I was.

Then I saw a consultant at the end of Jan who said my A1C had come down from 152 to 40, that everything was great and to carry on as I was.

Then I saw my own GP a few weeks later, mostly just to introduce myself to her. She used me to train a student how to take bloods and give a flu jab, and told me to carry on as I was.

Then I was called into my surgery for my "annual review" with the DSN there (and an appointment a week earlier to have more bloods done). She at least tested my feet and sorted out my prescriptions so that they were on repeat rather than acute.

I also have an appointment at the eye hospital later in the year. But at what point would I expect to learn how to adjust doses and who instigates that?

Hi, it sounds like you're doing everything pretty well so far, so well done for adjusting so quickly. If you would like more information I really would recommend the carb counting courses that will be run in your area. You can ask your GP or Consultant to refer you. They are usually 3 days to a week long however the learning you get will really help you to become self sufficient and teach you valuable information which is a must including correction doses, your insulin ration, how to work out the amount of carbs in a food and then work out your insulin, sick day rules. You may feel that a week is impossible to take off work, however legally your work have to allow you the time off, and a planned week getting the info you need is much better than needing a month off because things have gone awry...it really is invaluable and I cannot recommend it enough.

For the short term I would recommend downloading the 'Carbs and Cals' app. This has every type of food on there and gives you portion pictures and the amount of carbs (as well as fat, protein and other useful info) each product and portion contains. You can use it out and about and at home and makes calculating easy. You just apply your current ratio to the amount of carbs in each portion e.g if you take 1 unit per 10g of carbs an 80g portion would mean 8 units of insulin. I love this app and still use it now, really helpful when you're in a restaurant and have no access to scales!

I hope this helps good luck with it all.

 

[Bertyboy]

Frankly, if your HbA1c is down to 40 you're doing fine whatever method(s) you're using. What are you hoping to gain from further teaching?

So, whilst I believe I started with really good control on fixed doses and low carb intake, the last few weeks (since that A1C result) have been a lot harder. I haven't managed to figure out why, but I've been waking with a generally high fasting BG, then ending up a bit low by the early evening. So, I suspect I should do this basal rate test. I bought Think Like a Pancreas last night and I'm working through that, so I'll keep you posted.

 

[Antje77]

So, whilst I believe I started with really good control on fixed doses and low carb intake, the last few weeks (since that A1C result) have been a lot harder. I haven't managed to figure out why, but I've been waking with a generally high fasting BG, then ending up a bit low by the early evening. So, I suspect I should do this basal rate test. I bought Think Like a Pancreas last night and I'm working through that, so I'll keep you posted.

Do you test before getting out of bed or only after getting dressed, washing hands, go to the toilet, making coffe or whatever? Makes a big difference to me, my bg shoots up as soon as I get out of bed (so I test and inject before doing so). A fasting sugar and a waking up sugar are often not the same.

 

[Bertyboy]

Do you test before getting out of bed or only after getting dressed, washing hands, go to the toilet, making coffe or whatever? Makes a big difference to me, my bg shoots up as soon as I get out of bed (so I test and inject before doing so). A fasting sugar and a waking up sugar are often not the same.

I get up, have a dump, a shower, get dressed, feed the cats then test and inject before heading to the office.
I presume you are referring to this morning glory thing where the liver produces more glucose? I never considered that. But it did use to be OK.

 

[mountaintom]

I get up, have a dump, a shower, get dressed, feed the cats then test and inject before heading to the office.
I presume you are referring to this morning glory thing where the liver produces more glucose? I never considered that. But it did use to be OK.

A liver dump?

 

[Bertyboy]

A liver dump?

It sure feels like it some mornings.