Think Like A Pancreas?

[Faith*]

Hi all,

Just wondering if I can chat to those of you that have read this book by Gary Scheiner?

I used to say my control was pretty decent, although having unexplained highs/lows and just sometimes having random things happen. I used to think that most diabetics must be the same and this is as good a control I could get. However, since I've finished reading this book I've changed my entire way of thinking.

I'm currently going back to basics, checking that my basal is correct and am surprised to find out that it was a little off, I've actually had to increase my basal to compensate for the amount of background glucose my liver is releasing and am now focusing on altering/trying different insulin to carbohydrate ratios.

Admitedly things are a little frustrating at the moment because I'm still having the unexplained highs and lows so I'm now trying to understand how the foods and the absorption of food works in relation to insulin.

I just wondered did anyone else find this book useful/helpful and what did it do for you? Did it help you eventually sort yourself out?

Thanks

 

[Hilary52]

Just ploughing thru it at the moment. Let you know when I have finished it!


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[SamJB]

I found it really useful. I learned to adjust my insulin as and when I exercise. Definitely brought me better control. Its become second nature to me now. What in particular are you struggling with?

 

[Lyndesay]

Just received the book so I'm looking forward to reading it

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[dawnmc]

Heard its good book, so is Dr Bernsteins Diabetes Solution.

 

[noblehead]

Fantastic read and a must for all type 1's, it's been a while since I've read it and keep meaning to pick it up again.

Too many things to mention what I found useful in his book, the chapters covering stress and physical activity was particularly useful and covered it in more detail than I'd learnt on the DAFNE course, above all else I found his advice on Bolus Timing one of the best parts of Gary's book.

I was always afraid to inject well before eating but what he said about injecting so that the insulin would peak at the same time as the food made perfect sense, his explanation was based on pre-prandial bg readings and the type of foods eaten which would determine when to bolus, this has helped me reduce my postprandial highs quite considerably so really pleased I read what he had to say on bolus timings.

As Gary is a long-term type 1 himself the book was based on much of Gary's own experiences and not just what he's learnt in text books, the book is good in that he doesn't push any particular views or diets, basically he just gives you the tips, advice and knowledge to go away and experiment yourself to see if what he says works.

As I say a good book :thumbup:

 

[carandol]

I started reading this yesterday (I'm a Type 2 who started injecting insulin at the end of last year). Finding it comforting, rather than useful, as its confirming that my own NHS diabetes team are actually giving me good advice, and I'm doing pretty well.

 

[ivinghoe]

I`ve read it through and too found it has improved my understanding of diabetes. Actually having some numbers to work from and slowly tune in my doses has certainly made my control better. My health team are good but they do not have the necessary time to explain the finer points about control.
For me personally the unexplained highs and lows are due (I think ! ) to my very variable work activities. This added to high fat in my former diet had me struggling to keep myself under reasonable control. I now know it was the high fat in my meals causing a long elevated blood glucose the following day followed by a sudden drop when the fat cleared my system ..ie i would run in the 10s all day from waking to around 3pm despite correcting in the breakfast bolus which would normally have me in range by lunchtime on other days
I would test at 3pm and have a low 8 and then test before coming home and have a bs of 2.1 ( I have virtually no hypo awareness)
I was stumped until I read through the book and finally realised what was going on.
Reading the book through a couple of times 6 months apart is worth the effort I think

 

[Faith*]

thanks for all the replies guys.

I too agree it is an absolutely fantastic book. It's really helped me to narrow down and half explained the 'unexplained highs/lows' It's genius really. I mean this just goes to show how little education they teach you upon first diagnosis. The fact that this book probably taught me more than I've known and learned in the last 17 years. It's madness!

Noblehead - I was exactly the same, when he said to bolus a little before your meal I was thinking 'oh no, i'll go hypo' but I've been fine. Steady sugars. Peaking at a nice 10mmol and then coming back down to 7.5mmol. Amazed just doesn't do it justice.

SamJB - agreed, it has been brilliant in helping me with the exercise. I was struggling with this so much as I would hypo almost instantly and no matter what I did seemed to work. Since finishing the book all it took was eating a few extra carbs before running and then changing my insulin to carb ratio's for breakfast. I can now run every morning hypo free

At the moment I'm running all the basal testings to ensure the settings are correct for my pump. I did the overnight test last night and it was 90% spot on. I'm fasting from 2pm today to check the evening basal and then I think I'll check the morning basal Friday morning whilst I'm off work.

I'm so happy I can't even explain haha :lol:

 

[Faith*]

I`ve read it through and too found it has improved my understanding of diabetes. Actually having some numbers to work from and slowly tune in my doses has certainly made my control better. My health team are good but they do not have the necessary time to explain the finer points about control.
For me personally the unexplained highs and lows are due (I think ! ) to my very variable work activities. This added to high fat in my former diet had me struggling to keep myself under reasonable control. I now know it was the high fat in my meals causing a long elevated blood glucose the following day followed by a sudden drop when the fat cleared my system ..ie i would run in the 10s all day from waking to around 3pm despite correcting in the breakfast bolus which would normally have me in range by lunchtime on other days
I would test at 3pm and have a low 8 and then test before coming home and have a bs of 2.1 ( I have virtually no hypo awareness)
I was stumped until I read through the book and finally realised what was going on.
Reading the book through a couple of times 6 months apart is worth the effort I think

It's amazing how the fat plays a part in the absorption of foods isn't it. Have you managed to sort the sugars out now or are you still playing around with it?

At the moment I#m referring back to chapters to help me but I think your right, I'll be giving myself a refresher every 6-12 months.

 

[noblehead]

Faith, I do still think you have to tread carefully as Gary suggests and take into consideration pre-prandial bg readings and the glycemic index of the foods eaten, personally I wouldn't dare inject 30 mins or more before eating but I'm quite happy to inject up to 20 mins depending on the above

When I was first changed over to fast-acting analogue insulin I was told that Novorapid could be injected immediately before or after eating, this was good news having been on animal insulin where you had to wait 30 mins before eating and Human insulin where you had to wait 10-15 mins, however I now know that to match the peak of your insulin to that of your food injection timing is so important as the book says.

Fat as you say can play havoc with blood glucose readings, it was interesting what he had to say about it causing a secondary blood glucose rise by causing insulin resistence.

 

[ivinghoe]

Hi Faith
I`m still having to tweak basals and bolus ratios slightly as the weather and temperatures effect what I do at work but I now have a good idea when things are starting to stray what I need to do to get the sugars levels back on course.
I have had a tough time in the past Summer months with a rollercoaster ride of highs and lows.. I work outdoors doing "Estate work" which is very much like a gardener/groundsman/tree surgeon all rolled up into one job and I have about 70 acres to keep under some sort control... its almost as hard as looking after my diabetes!
I read the book for the first time last July and have just finished a second read through.
Last June my hba1c was 10.6mmol so not that was not that hard to improve on tbh but in January I was 7.1mmol (55% in new money) so I was chuffed to improve my control by so much. So was my consultant. I did do a dafne course last year too which I enjoyed but the vast majority of what I am using day to day has come from the book.
I didnt realise how precise I needed to be with my insulin and how everything I did effected my control .. not just in the few hours after but the following night and even the following day.

 

[Faith*]

@noblehead - oh definitely, I'm still a bit skeptical, I tend to wait 10 minutes before eating after giving the bolus. So far this seems to be working for what I'm eating. Another way round it that works great with my porridge in the morning is to deliver the bolus 60% just before I eat and then 40% over 30 minutes through my pump. I'm considering reading a book on glycaemic index next. Depends how much my brain can take lol Although I love that a snickers bar is medium GI but then next to it says warning high fat content!

@ivinghoe - really glad you got your hba1c down, that's an amazing improvement well done! I dread to think what will happen once the summer comes, I'm too used to operating in this freezing cold weather we've been having.

 

[noblehead]

The beauty of a pump Faith

With my morning porridge I inject inject on waking and wait 15 mins before eating, it seems to deal with any postprandial spikes although traditional porridge oats are low-gi.

I had a quick look at the chapter that deals with bolus timings, one thing I noticed Gary didn't mention was where you inject can make a difference when on MDI, for example injecting insulin in the stomach will work much faster than in the arms, thighs and buttocks, if you were to say inject your bolus into the thigh or buttocks then any delay would be unnoticeable compared to injecting in the stomach....if you get what I mean :roll:

 

[Faith*]

That's interesting. I used to really struggle with that. A lot of the time I would avoid my stomach because I remember always going hypo after tea. I couldn't use my arms either as it used to hurt so badly. I was left to just legs and buttocks Funnily enough I do have a similar thing on the pump though, if I've inserted the cannula into a dodgy patch of skin it will slow absorption down. Sometimes I end up having to change the entire thing which can get very annoying.

So far so good, i've been between 5 -7.8 for 2 days. The only bad thing is i've either over calculated today's lunchtime bolus or doing all my housework in 2 hours caused me to have a hypo. Then, naturally, I rebounded up to 12.2. Just when I had it perfect haha

 

[squeezelouise400]

This book has been amazing.
The correction doses for high blood sugars have saved me from the DKA vulture umpteen times. I no longer need to be admitted to hospital, I see my diabetes specialist once a year and my GP even less than that. I am well, I am healthy and as far as I am concerned there is nothing wrong with me. I do however, take my diabetes very seriously and manage my control very carefully and the effort is well worth it.

I particularly love the exercise bolus multiplier, I can go for a 12 mile walk, my blood sugars will remain on target before and afterwards. I need to eat no extra food and I keep the basel insulin running on my pump.

I admit I made notes, as I was reading the book as I wanted to put into practice the formulas and techniques suggested.

I would advise people to read it, and maybe re-read parts of it before putting techniques into practice. I learnt more from this book than I did on the DAFNE course.

I just hope other people have the success I have had with it!