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Do you meet your targets?

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Spearmint

Well-Known Member
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Had to ring my daughters nurse again to find out what to change as she is still all over the place with her readings and i couldn't work out which insulin to change and how to change it.
As an example, her readings in a day are as low as 3.8 and as high as 15.9 and i said i felt that was too much of a difference and i would like her readings to not deviate so much.
Afterall the whole point of them changing her from premix to basal/bolus was to get better stability and lower her Hba1c.
Her nurse said her readings were not that bad and that i am aiming for perfection which i will never get and that most people don't actually reach the targets!

That made me wonder what the point in having them is and also how many people do or don't reach them in general?
 
What a daft thing for her to say.

What other people do has nothing to do with your daughters results, diabetes is an individual thing.

I don't hit my targets all the time, but it does stop me from trying!!

the point in having them is you have something to aim for, the results that enable you to have the longest and healthiest life really :)

There is nothing wrong in aiming for great results, infact everyone should try to acheive whatever targets they have set for themselves.

The basal/bolus regime is great for eliminating highs and lows, but it can be tricky to know how exactly to tweak things, especially when it's a new thing!

Don't let comments like that discourage you. There is every reason to aim for good control and no reason why you can't eventually acheive it either :)
 
hi

we dont hit dylans targets all the time and i do believe its almost impossible to have perfect results everytime but that doesnt stop us trying to get those perfect numbers. if we gave up trying what would that say about us as parents my nurse did tell me its harder to get balanced numbers in kids as they are unpredictable and when u just think u have cracked it they grow and their needs change. dont listen to ur nurse carry on striving for those numbers its what we do as parents :)
anna marie
 
Target ranges on one hand are important as we do need a guide to work by but we have to be realistic, we are diabetic not superhuman, and nobody on this earth is perfect so why the heck should we be!

The aim of the game is to hit the target as much as possible, also learn how to deal and handle the misses...

Rules go like this

Hits, you pat yourself on the back, and try to remember why it worked..

Miss

1, You don't beat yourself up
2, You think about what happen, check your data to see if there is a reason or a pattern
3, You think what, if , how to change something to see if you can avoid it next time.
4, once this is completed you then forget that it happened and start afresh with the next target.

Never dwell on the past you can't change that but you might be able to change the future! The better you keep things in perspective the more likely you'll going to hit rather than miss..

And the most important rule of them all... Don't set yourself up to Fail by setting unrealistic targets that are unachieveable... Small steps cover greater distances..

I have very good success rate with hitting my targets, but I wouldn't expect you to look at mine, and say why can't I do that, I'm a lot different to your daughter, been playing the game for a long time now, got different kit I don't have growth spourts, my raging teenage hormones legged it years ago :cry:

Biggest problem is if you get stressed because you aren't managing the target hitting as well as you would really like, then your daughter is going to become worried, scared of failing etc... The out come of thisis a child whose afraid of upsetting you so will start hiding information etc so it will make it more difficult for you to help her manage her diabetes or she may decided to bury her head in the sand, why try to control it when I'm failing etc... Not a good out comes..

You need a healthy balance between the two, if you fail fine try again perhaps change something etc go with the flow to a degree..
 
My target for Khaleb is between 4mmol and 10.5 mmol. We stay in this most of the time but he is sometimes slightly higher before bed and on days we travel or have appointments that clash with meal times. I move the goal posts from time to time depending on the circumstances. When he was younger he had more variations but as the years roll on more and more things become predictable and it is easier to avoid highs and lows that are far from target. Khaleb is already intellectually impaired so I try to have as few hypos as possible. I still average 2 or so a week but they are only mid to high 3's and nothing lower. Basal/Bolus works well for us but he still has controlled amounts of carbs at each meal. I don't limit his carbs but they are all counted and fit into the amount of insulin he has. Extra snacks means extra jabs so that only happens on special occassions.

I can only say that I feel what is the right amount of insulin/food for Khaleb. If I think I'm feeding him more than he needs to feed the insulin I back it off or if he is hungry much earlier than meal times I start to increase his insulin and food quantity. I judge which insulin to change by morning wake up bsl or I test at the 2 hour and 3 hour mark after meals to see how much he is dropping/rising. Trial and error but only in small stages tweaks some of the highs/lows. I keep good records that show graphs so if he is high/low overall I'll adjust his long acting or if has big peaks and troughs I'll try and fix his short acting.

Don't think there really is perfection with T1 (especially kids) as there are too many variables but if you give yourself a reasonable target you should be able to hit it a good percentage of the time.
 
Thanks to everyone who has replied :)

jopar said:
Target ranges on one hand are important as we do need a guide to work by but we have to be realistic, we are diabetic not superhuman, and nobody on this earth is perfect so why the heck should we be!

And the most important rule of them all... Don't set yourself up to Fail by setting unrealistic targets that are unachieveable... Small steps cover greater distances..

Biggest problem is if you get stressed because you aren't managing the target hitting as well as you would really like, then your daughter is going to become worried, scared of failing etc... The out come of thisis a child whose afraid of upsetting you so will start hiding information etc so it will make it more difficult for you to help her manage her diabetes or she may decided to bury her head in the sand, why try to control it when I'm failing etc... Not a good out comes..

You need a healthy balance between the two, if you fail fine try again perhaps change something etc go with the flow to a degree..
Click to expand...

I am not after perfection, just 'normal' levels if that makes sense?
I would like better stability to make all the extra 'work' worthwhile!
My first target is to get her to test between 5 and 9 before meals
If i can manage that then i can try and 'tackle' the inbetween meal readings

I am feeling frustrated because i don't fully understand it, i know the insulin is currently 'wrong' but i don't know which one to change or which way to change it :?
I said to the nurse i had a few theories but i didn't know if they were right or not, she said my thoughts were logical but didn't offer any opinions of her own on it.

Oh, i keep my feelings well hidden from my daughter and she is not at all worried by any of her levels except if she is low because she hates the low feelings.

If there was only 1 reading that was out i could probably work out what to do differently but it is the fact that everything is all over the place i am struggling to understand what is going on and why it is happening.
I decided yesterday to try and conquer the nights because i thought if i could get her sorted out during the night it would make the daytime easier to work out.
I know i can only do my best for her and i have read and read about everything and the different insulins but i don't have the experience or enough knowledge to work this out for myself.

I am very stubborn and determind so i WILL make this work :lol:
I just need a bit of help
 
I think most of us would be telling fibs if we said our levels were spot-on all the time.

The Contour USB I have really lays it out for you, pie/bar charts of my levels above and below my specified window.
 
ill3st said:
I think most of us would be telling fibs if we said our levels were spot-on all the time.

The Contour USB I have really lays it out for you, pie/bar charts of my levels above and below my specified window.
Click to expand...

I would be happy if we could meet the targets on more days than we don't
 
Hello Spearmint
I'm rather new to this (son diagnosed March 2011) but he's been on basal/bolus from the start. First of all, apols if none of this is news to you :lol: but I hope it helps!
Advice I've had is that getting the basal right lays the foundation for everything else, and certainly for my son that seems to be the case. Are your daughter's readings before meals and first thing in the morning within the target range?
Once you're satisfied with the basal, then you can get to work fine tuning the fast acting. I think most people have a different ratio of carbs to insulin at different times of day. We did it like this: write down the numbers before eating and 2 hours later. See if they're in your target range - if so, continue to use that carb:insulin ratio for that particular meal until it stops working (the ratios do seem to change, maybe down to hormones or a change in exercise levels). If not, adjust and see how you get on next time. Treat breakfast, lunch and dinner separately as they may well require different ratios.
It does require rather alot of finger sticking at first, but once you're happy with the ratios I think it's OK to just test before meals and when you feel something's not quite right. If everything's going well, great - if not, do another analysis and see how things are changing.
Best wishes - hope things get steadier soon.
Catherine
 
wsmum said:
Hello Spearmint
I'm rather new to this (son diagnosed March 2011) but he's been on basal/bolus from the start. First of all, apols if none of this is news to you :lol: but I hope it helps!
Advice I've had is that getting the basal right lays the foundation for everything else, and certainly for my son that seems to be the case. Are your daughter's readings before meals and first thing in the morning within the target range?
Once you're satisfied with the basal, then you can get to work fine tuning the fast acting. I think most people have a different ratio of carbs to insulin at different times of day. We did it like this: write down the numbers before eating and 2 hours later. See if they're in your target range - if so, continue to use that carb:insulin ratio for that particular meal until it stops working (the ratios do seem to change, maybe down to hormones or a change in exercise levels). If not, adjust and see how you get on next time. Treat breakfast, lunch and dinner separately as they may well require different ratios.
It does require rather alot of finger sticking at first, but once you're happy with the ratios I think it's OK to just test before meals and when you feel something's not quite right. If everything's going well, great - if not, do another analysis and see how things are changing.
Best wishes - hope things get steadier soon.
Catherine
Click to expand...

Hi Catherine
Any info is great, it can only add to what i already know :)

I did not know about the different ratios but i did manage to work out by myself that she needs more insulin at breakfast time than the rest of the day, so she has 1:10 for breakfast and 1:15 for lunch and dinner although last night the dinner ratio was changed to 1:20 and i might end up changing the lunch ratio to that as well but i am going to wait a few days and see what happens.
Doing 8 tests in a 24 hour period at the moment.
I am pretty sure that everything is wrong at the moment but like you say if i can get her basal rates right that the rest should be easier to work out.

Thanks for your good wishes :)
 
spearmint

I woud invest in one of these books, Using Insulin by John Walsh or Think like a Pancrease by Gary Sheinier, both about the basla/bolus regime these will give you a good insight to what's when how to interpetate etc..

Another site you can take a look at is here viewtopic.php?f=16&t=21990 this is Bournemouth's hospital's diabetic's online carb counting course...

These will help to build you a picture on how isulin/carbs/exercise all work, how to see that pattern in BG results that will say it's background insulin or quick insulin needs tweaking/changing etc. And there will be times even with a lot of experience under your belt you won't see the woods through the trees (at that point I normally get hold of my nurse, and say what would you do)

My consultant and my team will tell you 'there's no right way of doing and there's no wrong way, the right way is the way that works for you'

It's good that you have theories, it shows that you are taking on board whats happening trying to work it out etc, this will hold you in very good stead indeed, and your nurse should be working through your theory, explaining which parts would fit with your data, and parts that don't giving you a explaination why that part of the theroy might be misslead by something else..

One of the books I suggested, and looking at the bdec site wil help you understand how both insulins work, how carbs may interest and exercise and how to use these to intreprated your bg data so that you can identify which part needs the tweak..

I'm also with wsmum that getting the basal profile sorted first as if this is wrong, all your other calculations for the fast acting will be as well... Basal's rates being out is probably one of the highest causes behind control problems...

Sadly a lot of HCP will concetrate on the quick acting insulin first leaving the basal side of things to a slap dash method of adjusting the background insulin, only true way of finding out if it's correct is the fasting test, there are ways that this can made easier with splitting into time blocks etc but it seems that HCP's don't actually like doing this.. When fasting your BG shouldn't deviate from the starting BG by +/- 2mmol/l

Management side, yes to start with it does take a lot of work, but there should be a point when you can ease back to a monitoring level, reading to increase workload if necessary, some people do fall into the trap where they end up over managing causing all sorts of problems with over-corrections etc..
 
Thanks jopar

I did the b-dec online course yesterday!
Passed all the tests apart from the visualising carbs.
I found it easy to see what to change dose wise on the example dairies on there as there was only 1 thing out but i am struggling with my daughter as i think most of it is out.

I have sat and worked out when each dose of insulin is at peak activity and when it is wearing off to try and work out which one to change first but i think i have just confused myself even more :oops:

Yesterday she was low after school, today she was low at lunch when she is usually high but she was higher before breakfast today.
Will see what happens tomorrow morning before i change anything though.
 
I would say that the results you are getting are not worryingly bad. It is very hard to control someone else's diabetes when you cannot predict whether she is going to be flying round the playground at lunchtime or in the library reading, for instance. Either way she is going to need different amounts of insulin for her lunch and other meals.

You have already studied the peak times for her insulins, and you can use that for a fair guess at which one is to blame. A pretty good rule of thumb is that if her levels are mostly low and needing correcting (which can, of course, cause corresponding highs), then the fault is probably in the long acting insulin. Also if she has hypos in the early hours of the morning long after her short acting insulin is out of commission, that is going to be the basal as well... having said that, sometimes I am sure that too much short acting contributes to my night time hypos, but maybe we'd best not go there... too weird! :?

If her hypos - in my book, anything under 4, but that is entirely personal and different for us all - are happening now and then between meals, but not regularly then it is likely to be the short acting that's the problem. Whatever you do, do not change both at once or you will never find out which one it is. (Now I'm picturing you thinking 'Does she think I'm stupid?' because that is so obvious.)

I am surprised that you have not been given any education about insulin/carb ratios. The DAFNE (Dose Adjustment for Normal Eating) courses are being rolled out across the country, at least they were a while back, I don't know if 'cuts' have made them think it's cheaper not to educate us :shock: , but someone can tell us if they are still going and becoming more available. I don't know whether they are using the system for children yet: I believe there was some idea that it wasn't a good idea, but that will just start me off on another rant. It is essential to understand how to work out those ratios and how to adjust them according to your daughter's exercise patterns - or unpatterns because she is little and exercising to order I don't suppose is possible.

The one variable that is impossible to predict is emotion which can mess things up royally. It so often happens that the exact same routine can be followed one day after another with completely different results because one day there was adrenalin in the system and the next there wasn't. Or brewing for a cold or other infection messes things up too.

I have often likened diabetes control to being on a seesaw, trying to keep it balanced with both ends off the ground. One end only has to sneeze to upset the balance because it is so fine, and that can represent the odd sneaked mars bar that didn't get injected for, or the mad run around the block racing her friends. But the variable you can't control is the crazy guy standing in the middle of the seesaw jumping unpredictably from one side to the other bringing the thing crashing down without warning. That guy is called emotion and bugs, and just has to be dealt with after the event.

I learnt more in the five days of DAFNE course than I had in thirty years of trying to manage the thing without any scientific knowledge of how to work it out. I can only imagine how much harder that must be doing it third party for someone little. The course has allowed me to predict the crazy guy better and to keep both ends of the seesaw off the ground much of the time. You have looked up the online course, but it's worth seeing if the pair of you could attend a DAFNE course if they do them for children. It would give you so much more confidence and knowledge.

Everyone has said that you will never get it perfect and they are right. If you expect perfection you will always be disappointed and the targets you have set yourself are very tight. Don't worry if they don't work out all the time, it's not the end of the world and I know we all like to stay stable and it's best if we can, but the safety marker really is the HbA1c, and if that can stay reasonable then the long term outlook is not a worry.

Good luck. :)
 
Quick PS: DAFNE recommend that you give a response to a night time, long acting caused incident, two or three chances to see if it is regular before changing the long acting insulin. I think I need to do some revising... (trots off to look up her notes and learn it all again... )
 
Margi said:
Quick PS: DAFNE recommend that you give a response to a night time, long acting caused incident, two or three chances to see if it is regular before changing the long acting insulin. I think I need to do some revising... (trots off to look up her notes and learn it all again... )
Click to expand...

Thanks for all your info, really appreciate it :)

The hospital want her to be more stable, they want me to have better control and they want her Hba1c back under 8.
I would like more stability and the rough predictability that i used to have with her.
I know i will never get her levels spot on all the time but i would like to at least try to manage it some of the time to start with and then most of the time. I do not mind odd unexplained days of readings but to be consistently out on a daily basis means that something needs changing.

There are several areas i want to do something about but i know i can only tackle one thing at a time, my first choice is to try and get her sorted out overnight as this might help during the day a bit too.
Thursday i changed her Levemir to 5pm with her Novorapid before dinner instead of at 7:30pm before bed because she has been going to bed testing 6-8 but at 10pm 12-15, she was coming down slightly at 3am and then testing 8-10 upon waking at 7am.
I don't think it is good for her to be high all night and i wondered if it is too long til the Levemir kicks in after the Novorapid has worn off, her nurse was not keen on me increasing the Levemir because she was coming down a bit overnight.
Since changing the timing she is still going up high at 10pm but she is staying at more or less the same level at 10pm, 3am and 7am so although she is still high i have gained some stability.
My next thought is to increase her Levemir at 5pm from 10 to 12 and decrease the morning Levemir from 10 to 8.

My thought is that if i can get her to wake up at a good level it might make sorting out the day readings a bit easier.

I fully expect her to be all over the place today though as we are out for day, having lunch at a chinese buffet restaurant - not a great idea at this early stage but it has been planned and booked for months!
 
sounds as you'll on the right track,

One suggestion with the Levimer, is only change one of the injecting doses at a time see how this pans out first.. If you make changes to both injections as the same time, you won't know which worked and which didn't!

Chinese buffet tonight, it's planned so don't worry roll with it best you can..

When it comes to foods like chinese which tends to be high fat type foods, this can cause some problems with the diabetic.. Due to the fats slowing down the adsorbiton so you are going to have to watch out for hypos and a high later on tonight and she may wake up in the morning higher, so to an extent tomorrow, deal with her levels making any necessary adjustments to treat high or lows, but don't use the data collected for making long term adjustments as they stand a good risk of being out..

when I was on injections, I used to spilt my dose into two injection, some before I started eating, then the rest after I eaten... This helped to avoid a low before going high due to the slowness of adsorbtion and I could adjust my second jab if needed..

Chinese foods is very difficult to work out the carb value for, what you find is that a lot of diabetics tend to have faviourate resturant or takeaway, will have a similar meal that they've done a process of guestimating the carbs, working out their insulin split for best results then stick with it..

Do extra BG testing starting about an hour after her Meal, then every hour for about 3 hours or so, if she will allow you I know some children don't like this,, But it will give you good information for her next chinese meal out
 
Hi

Carb counting and using carb ratios often gets mentioned on the forum. When I first joined the forum in 2008 I often wondered how people found out what their insulin to carb ratios were. Often people spoke of going on a DAFNE course so I just presumed that DAFNE staff worked out the calculations for people. I didn't realise that you could do it all yourself at home by bg testing 6 times a day and writing down the amount of carb that you eat at each meal and then either adjust your insulin up or down or adjust the carb up or down so that you start to have good bg targets.

These are some threads worth having a look at that will explain ratios, correction doses etc

viewtopic.php?f=19&t=17899

viewtopic.php?f=19&t=18553
 
jopar said:
sounds as you'll on the right track,

One suggestion with the Levimer, is only change one of the injecting doses at a time see how this pans out first.. If you make changes to both injections as the same time, you won't know which worked and which didn't!

Chinese buffet tonight, it's planned so don't worry roll with it best you can..

When it comes to foods like chinese which tends to be high fat type foods, this can cause some problems with the diabetic.. Due to the fats slowing down the adsorbiton so you are going to have to watch out for hypos and a high later on tonight and she may wake up in the morning higher, so to an extent tomorrow, deal with her levels making any necessary adjustments to treat high or lows, but don't use the data collected for making long term adjustments as they stand a good risk of being out..

Chinese foods is very difficult to work out the carb value for, what you find is that a lot of diabetics tend to have faviourate resturant or takeaway, will have a similar meal that they've done a process of guestimating the carbs, working out their insulin split for best results then stick with it..

Do extra BG testing starting about an hour after her Meal, then every hour for about 3 hours or so, if she will allow you I know some children don't like this,, But it will give you good information for her next chinese meal out
Click to expand...

Hi and thanks for replying again

Most days she is lower in the afternoon and before dinner than she is before breakfast and lunch so i thought if i was going to increase the evening Levemir that i might need to decrease the morning one as she'll have both in her system for a few hours - i shall see what she tests in the morning and maybe go with your suggestion of leaving it the same.

If we were having chinese takeaway i could probably work out the carbs more accurately!
But being a buffet i knew i would not be able to keep track with how much she was eating and of what so i just guessed that she would eat the equivalent of a takeaway portion of rice and noodles which i had carb amounts for and gave her 8 units of Novorapid.
Before we ate at 12:10 she was 8.9 which is not too bad for her lately then at 14:00 she was 7.6 which i thought was great but then before dinner at 17:00 she was 22.7 :shock:
She has just tested 9.4 at 20:00 which i am pleased with as we had KFC for dinner which i worked out beforehand and also gave a correction dose.
So i am thinking that next time she has chinese we might want to do the injection after she eats!


Thanks iHs, her ratios seemed to have changed this week but i have only changed 1 mealtime at a time and the changes so far seem to be working better.
 
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