Confused :(

[Lilllaura87]

I've had diabetes 13 years but since I was 17 I've pretty much been left to my own device! ( I'm 24 now) this was due to my hospital doctor never being available for my check ups and a on call doctor taking his place who seamed to just not take an interest. I recently went into DKA and am trying so hard to sort myself out. I went to see a diabetic specialist nurse on Thursday which I was really looking forward too so I could start from scratch and srot myself out! She was 45 mins late for the appointment and by the time I got to see her it was nearly time for her to finish work! She wizard through this big terms about diabetes I didntrecognize and made me feel stupid when I mentioned to her that 'back in the day' I was never told about 'carb counting' and bolus and basual insulin. I asked her about this carb counting corse they were supposed to be sending me on and she said now there was no funding in my area for this, so she set me up on an 'accu-check arica expert' blood test monitor. She was typing in all this info and didn't explain a thing to me, she said that she had set my hypo warning to 4.0 ( which I never go low until it's about 3) and I have to aim to keep my sugar levels between 6-8 ( fair enough but that's never going to happen) she also quickly explained my ratio is 1 unit of insulin to 10g of carbs, and gave me a book so I could work out how many carbs I was eating. Anyways just as I was about to real off my long list of questions she had to go.. Now I'm stuck in limbo and am scared to use this monitor as I don't have a clue how this carb thing works and not even sure how many carbs I'm meant to have in a meal/day!

I feel really let down and more confused that when I went to see her.. AND she said she couldn't see me until the 17th of July - so I'm q bit ********...

Rant over lol x

 

[jopar]

I've got a similar meter to yours, but it's also acts as my remote for my insulin pump (an Accu-chek Combo)

Firstly your meter..

Any BG that is below 4mmol/l needs treating hence why she set it at 4mmol/l if you get this on your meter and you aren't just about to have a meal or snack, you really need to have at least a small amout of carbs 10g grams or so, to ensure that your bg doesn't drop below 4mmol/l, and enough to keep you going to your next meal or snack..

It sounds with your carb ratio's and corrections she's put in the adverage which they tend to start you off on.. You could try these see how they pan out, but keep meter/hypo kit on you at all times just incase you need them..

Meals/snacks there isn't a limit you choose the amount you want to eat, then work out your dose of insulin.. But it's not quite eat what you want, if you want good control you need to understand how different carbs react, and there is a point at which you won't be able to match your insulin profile to suit the adsrobtion of carbs..

Foods such as pizza, pasta and high fat content foods, tend to have a slow adorption, so when you inject your insulin dose in one shot you can find that you end up hypo then your bg raises a lot around the 3 hour mark... So sometimes for these types of meals it's better to split the injection into two parts, one before you eat and the rest either after you've eaten or with a small gap after you've eaten... This is a bit of trial and error to find what spilt and timeing suits you best..

I suggest you buy a book called Using Insulin by John Walsh, this is a very good book explaining how to use and work out the verious aspects of basal/bolus control..

Also it's handy to get a carb counting book, and a set of scale to wiegh with..

Take a look at this online carb counting course by the Bournemouth hospital

www.bdec-e-learning.com/

And ask away,

if the nurse didn't give you the hand book for your meter I can find it on line for you just give us a shout, and remember if you don't want to use the bolus wizard side of it at the moment, you can use it as a normal BG meter, this way at least when you see the nurse she can't still down load your data onto their computers.

 

[HLW]

You need to mention beforehand to the nurse if you want things explained in less medical terms. If there was anything in particular she said that you didn't know what it meant, if you remember you can always ask on here and I'm sure someone will be able to explain.

A hypo is below 4, that is the definition of a hypo. You should treat it as a hypo if it is below 4 even if you are not getting symptoms.

She said if you eat 10g carbs you inject 1 unit rapid insulin, so if you eat 20 you inject 2. If you eat 100 you inject 10. Etc. To start with, just eat what you consider a normal healthy diet and see how it goes. Use the carb counting book she gave you to estimate the amount of carbs in what you are eating, and inject a suitable amount based on this. Make a note of what you eat and when, and the amount of insulin you inject, both types, and take this with you when you next see the DSN so you can discuss any possible improvements.

Does the meter have an instruction manual? Have a read of it, and then see how you get on with the meter, then when you see her again you will know exactly which functions of the meter you need to discuss with her.

The 17th isn't too far away. Make a written list of questions, and when you next see the nurse say you have a list of questions you need answering there and then, and do not leave until they are answered, your health is important so don't be fobbed off.

 

[Lilllaura87]

Thanks guys, you have really helped!

One other question if you don't mind... Ive always looked for the sugar content in food, if the sugar content in this the main factor or am I now I'm looking for out for just that carbs?

 

[jopar]

You look for the carb content (the whole carb not the little box underneath where it says xxx sugar)

Carb counting isn't just about working out how much insulin to take, as you may need to adjust your insulin to dose to reflect exercise that you have or are about to do, if you are unwell or stressed you may have to adjust your dose a bit..

So it's best when you start out to not only keep a very good BG diary and doses used, but expand the picture so that you note down what type of carbs you've eaten, any exercise you do, stress levels, whether it was a work day or day off.. if you're ill etc..

The better picture you can build will help you understand your BG data better, and make things easier to indentify the patterns off... It's hard going first off but well worth the effort as you settle into what is what, and how much you may need to decrease/increase your insulin dose or perhaps have a carby snack to cover certain level of exercise then you can lower the amount of data collection down to basic's..

 

[Lilllaura87]

Wow! Who knew I would know so little about diabetes after 12 years! :S

 

[wendy_doncaster]

Hi, I was in the same boat as you when I finished Uni... as I moved away from home, I dropped off the radar of the specialist services. I know I could have chased an appointment, but I really thought that I had a good grasp of my diabetes and how to control it! But things change so much so quickly in the advice that is given to Diabetics. I've had diabetes for 13 years now and I'm still learning new things. I have been seeing my DSN for a few months and I'm still learning about carb counting. I've found that recording food, exercise, BGs and insulin really sorts out my levels, when I get into a routine I can be more relaxed with the diaries, but testing is really important.

The key to successful carb counting is getting your background insulin right, which means that when you test after fasting (first thing in the morning) you are between 4-7, after going to bed with a BG of between 7-9 and not going hypo in the night. If you keep going hypo in the night, or waking up high, then your background needs adjusting. But be careful, only adjust by 1-2 units per day, and leave for at least 2 days to give the change of insulin dose chance to take effect.

When it comes to carb counting during the day, some times of the days may need more or less insulin per 10g. For example, I need 1.5 units per 10g in the morning. This is completely individual and why it's important that you keep a diary to see how you react to your dose throughout the day.

I hope I've not confused you more, I'm quite shocked at how you were treated considering how important good control is to your long term health! Like HLW said, don't leave that next appointment until you have all your questions answered!

 

[Snodger]

Once you are able to check the carbs in your book/on the packet, and you are into regular blood testing, a really useful thing to do is keep a diary of what is happening to you. eg like this:
8am. Blood sugar 6.5. Ate 30g carbs - 3 units bolus insulin
12.30. Blood sugar 9.5. Ate 40g carbs - 4 units bolus insulin
18.30. Blood sugar 11.5. Ate 40 g carbs - 4 units bolus insulin
WENT TO THE GYM at 19.30
22.30. Blood sugar 7.5. No food. Took 16 units basal insulin.

if your results were like this, you would be able to see that actually, you personally need slightly more insulin per carb than the doc suggested. Eg you started fine, but were a bit high at lunch, and got higher each time you ate. I've also put in some exercise at the end of the day because exercise makes insulin more effective and also uses up blood sugar. (That's why I made the final bg result at a lower level).

Just keep a record of it for a couple of days to see what's going on, and then try upping the insulin ratio. eg 1.5 units for every 10g of carbs. And keep writing it down in the diary.
If this does help, but you want support with it, let us know - happy to try and advise if it helps.

PS if you have an iPhone, look for the 'carbs and cal' app which you can use to work out carbs in meals in restaurants etc.
PPS don't feel bad that you didn't know all this stuff. Lots of people were diagnosed during that particular period where docs didn't think it necessary to explain carb counting - and lots of us have struggled for years. It makes me so angry, how many people were let down... but that's a rant for another day!