Best ways to keep control

Hi Beth,
Don't be too hard on yourself you've taken a good step forward just by posting here.

Are you carb counting?
If not I suggest have a look at the Bournemouth Diabetes Learning Program
http://www.bdec-e-learning.com/
I started by doing their online course & I learned so much. You can do it at your own pace.

You do need to do frequent testing and record it, but it does pay off.

We all have off days but the important thing is to restart as soon as possible - oh and don't expect miracles, this is diabetes after all!

HI. Yes, do focus on measuring enough to set your Basal right and then get the Bolus roughly right i.e. the typical ratio you need. Then even if you forget to check you have a chance of getting your blood sugar nearer what it should be assuming you don't forget to inject. Your morning fasting sugar should be between 5 - 7 mmol so adjust your Basal in small steps of 1 unit and leave it for a few days before you make any further changes and do test to avoid any hypos. Your Bolus should be adjusted to have a blood sugar level of less then 8.5 where you can 3 hours after a meal. If you do this a few times you will be able to work out your ratio having carb-counted. Then even if you don't check, your injected units will hopefully be nearer the mark? I hope I haven't conflicted with your DN's advice. Let us know if there is any conflict and do discuss with your DN.

I keep my blood sugar stable by eating rye bread steadily during the day, until 4pm. (It's effect lasts well into the night.)

I don't need to count carbs. And I barely need to adjust my insulin at all. I only need to check my blood sugar quite a lot - once per waking hour, on average. (I mostly use visually read testing strips, incidentally.) My blood sugar is near normal most of the time.

If you get the basal dosage right it reduces the chances of going low. A cgm would be a great help getting this right & it would warn you of lows (& highs).
If you have seizures then I should think you'd have a pretty good case for getting one. Talk to your diabetic nurse.

I know your problem very well.
Few months ago I had the same problems but I started to handle it.
First believe in you! You can controll or better to say you can manage your diabetes but you need to structure your day a little bit.
Try to start with little steps: Test your bloodsugar 3 times the day.
I have a fantasic app to note my bloodsugar down and to motivate me.
It's an app in which you have to controll your diamonster like a tamagotschi.
You recieve points for testing and noting down your bloodsugar.
Also I know the problem to be afraid of low bloodsugar!
I had and have the same.
I ate much more than I needed to bring my bloodsugar high and tried to keep my bs always high to avoid low bs.
It's hard to give advice but you perhaps it helps to keep in your mind that you want to achieve a good hba1c.
Thats your aim and therefor you need to accept also low bs sometimes.
I hope I could help you at least a little bit and sorry for my Bad english but I'm from Germany and not so skilled in english
Keep in your mind: you can achieve everything you want to!


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At some point, you will decide to take it into your own hands and do the 'work' required to improve control, but until you get there, you could ask for some intensive support from a specialist nurse. Ask to see them weekly for a while, get encouragement and help in establishing a testing and weekly review of your results, your insulin, your activity and your food.

Alternatively (or in addition) ask if you can loan a continuous glucose monitor. When you can see the immediate effect of each decision you make minute by minute re. your control, it's a wonderful incentive to make things better! I bought one and it's transformed my diabetes life. Sadly it's unlikely you'd get funding for one permanently but even a week would give you lots of info and might inspire you to improve things. Good luck - YOU are the only person who can decide when to take action, but there's lots of help available if you just ask for it, making it clear what a difference it might make to you. You are worth it (as they say...)!


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Hello Beth

An insulin pump doesn't work magic. Its ability to control bg levels ok greatly depends on bg tests being done throughout the day (about 6-8) and at times, getting up in the night to test as well. Unless you test and tell the pump what the levels are, it wont know how much insulin you need to cover the carb that you want to eat. So, start testing bg levels and using the results, you can then check on whether the pump settings are correct or need changing.

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Hi Beth - it does take work, but the work is worth it both in the short term and long term. I figure you carb count as you are on the pump, have you talked through with your hospital about the seizures and how scared you are of them and how this means you run high - I would definitely ask them for a continuous glucose monitor for a bit so that you can tighten your control without that fear as you can set your alerts on the machine so you have plenty of notice of dropping plus it will help you sort your doses out - again it requires you to work it out but hopefully the hospital will be able to work alongside you with it and offer advice. Before all that I would just increase your testing (at least 4 times a day) and then work with your nurse/hospital or parents to adjust your insulin requirements so that you can bring your HBA1c down - the more you take control of it the more confident you will feel (and better), and you'll know more about how you react to your insulin and exercise and foods. The Bdec course is a good one - you may know all of it but it is good.

I guess trying to avoid lows and tighten up…I would try and get a routine of testing and eating…I would try and eat good food - so things with some lower glycaemic index stuff in like pasta, new potatoes, rice as the carbs - not so much white bread and stuff that will give you a big high after eating them…stuff that digests a little slower and so will keep you sugars a bit more stable. Try not to over react to the hypos too - so have your 3 dextrose tablets and then check after 10mins and treat again if you need to, absolutely stay on top of the hypo and check to make sure you have come up and are out of danger, I've read that it isn't necessarily how low you go that can cause fitting but the length of time that you are hypo for too that has an impact as well - I know the temptation is to panic and just eat loads, but do try and resist as again it means you shouldn't need to deal with a really big spike after a hypo and so end up in that up and down classic trap that many of us fall into. The other thing is do it gradually, set yourself targets and work on one meal/time at a time, don't try and do it all at once.

Hopefully some of that will be useful Good luck I really hope you get some good help from your hospital, it is all worth it - look after yourself.

Hi
It is just a case of following what you have learned when you got the pump.
So, carry out some testing over a few days(weeks evens), doesn't have to be back to back.

Do the usual testing slots;
Midnight to 3am
3am to 6am
6am to 9am
9am to 12
12 to 3pm
3pm to 6pm
6pm to 9pm
9pm to midnight

over a course of few days miss a meal between breakfast, lunch and dinner. If your BG remains the same then the Basal is correct, if it's low(decrease) high(increase).(Same, method applies when a sleep) So, if its 6 before breakfast and then before lunch it is still 6 then your basal is correct but if it is 9 then you need to increase basal rate. I had done loads of testing and it really pays off.
Get the basal right before tackling bolus.
Chin up

Ross