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First day carb counting - reassurance please!!

M

Mogwai

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6
Location
Kent
Evening,

As the subject says I've just done my first carb counting day of a course and have calculated my Novorapid dose and am somewhat concerned with the difference between my calculated dose and the normal size I would take.

My calcs were for Lasagne and chips (classy I know :p), 250g of chips came in at 70g carbs and the Lasagane portion came in at 29, current glucose level was 2.7 mmol above target.

So total grams carbs = 99g (9.9 CP), rounded up to 10 and I've included an adjustment of 1 unit for the 3 units over target (rounded up) so in total have taken 11 units of Novorapid.

What concerns me is that I would normally have stuck a pin in me for 28 units for this meal (worked out through trial and error!) :shock: :?

The course leader said not to be concerned if the levels are widely different to what I'm used to but this seems an extreme difference i.e. less than 40% of my normal dosage!

Should I be concerned, am I doing it right, do I ignore my old methods, should I book in for a drip at A&E ( :P )

Any advice gratefully received.

Mog
 
You have done the right thing, I am a DAFNE convert, at first it seems like you're taking nowhere near enough insulin, and to be honest your levels will probably run a bit high to start with, but honestly it will settle down, trust your DAFNE tutors, they really do know what they are talking about I know how you feel though, in the old days (pre-DAFNE) I would think nothing of whopping 20+ units in for evening meal, but that's all changed now, and it truly does work. Stick with it, good luck xx
 
Neicy - Many thanks for the reply, I was almost certain I was right but it's just so different! Thanks for putting my mind to rest and I shall move away from the Novopen :) x
 
Well, I don't know what they told you and what you learned at DAFNE since they are very ...keen on keeping their methods to themselves

How did you arrive at the 10u Novo for 10CP? If that is based on what you normally eat and the insulin you normally take, then it's fine - but if that's just the initial guess then you are right to be concerned.

Thing is, if you had the same meal yesterday and had to take 28u of Novo with it to get acceptable readings (post-meal BG within 3 mmol/l of pre-meal readings), then you obviously should take the same dose today. Duh. If you have correctly worked out your insulin to carb ratio based on this, then it should have given you the same result.

So, important questions to answer:
1) Where did the 1u:10g carbs come from?
2) Where did the 1u for "3 units over target" come from [which seems a bit low to me - if you're normally taking 30u for dinner, daily total will probably be 100ish, so rule of 100 suggests 1u per "1 mmol/l over target"].
3) What are your normal pre-meal and post-meal readings for that meal you have worked out that 28u dose for?

Edit to add: Something to add to the speculation
Then they announced they wanted everyone to start on a baseline regime which they’d tweak during the week. Dafne has discovered, they said, that people tend to take too much basal which actually buggers up control. So would I please take 24u of basal.

At the time the figure seemed plucked from a hat. It certainly hadn’t reflected the fact that it was the figure I already used. In retrospect, I’m certain they were applying some variant on the principles of 0.5-0.8 units of insulin per 1kg of body weight to give a TDD (total daily dose), that most people need about one unit of basal per hour, and keeping the basal and bolus split somewhere near 50/50.

They also asked that, on the morning of the course, I take 1u of rapid for every 10g of carb. Fair enough. I was doing one to nine anyway.
Click to expand...
If that's where your numbers come from, then they're just trying to start from a clean slate - throw out all you've learned about your insulin requirement, and re-learn them during the course. I am not convinced that that's the smartest way of going about things.
 
HI AMB,

Regarding your 10u to 10CPs question it's actually 10u to 1CP, 1CP being 10g Carbs, this is where I got the:

1) 1u:10g carbs from, as instructed by the nurse
2) the 1u to 3mmol was again given by the nurse, it was actually given as 1u to 2-3mmol but for safety factor we were told to stick to 1u:3mmol
3) Tbh I have never 'worked out' units to take, it has all been guess work through trial and error for the past 8 years hence after 2 years of me shouting at my Local Health Authority that they have put me on the course! (they only put me onto Rapid/Levemir about 4 months ago and had been on Novomix before that). It's definitely a case of starting from scratch with the course.

thanks for replying

Mog
 
Looks like those are just initial guesses then - so if you think that a dose might be wrong then it quite possibly is wrong. You'll learn how to find the correct dose during the course. Good luck.

And sorry if I sound a bit hostile towards DAFNE but I think all secrecy with a secret members' graduates' club is inappropriate for a structured education program paid for by the NHS.
 
Stick with it Mog, I can absolutely vouch for the fact that it does work, and honestly can change the way you manage your diabetes and therefore your life. There are a couple of apps you could use which I have found to be really useful, the first one is "carbs and cals" which gives you a carb counting guide, with pictures of different portions, really useful if you are eating out, and also gives you a food diary, which I have found really useful, another is "Diabetes plus" which works like your DAFNE diary, but helps you chart your BG levels and insulin taken, it also gives you statistics which include your estimated HBA1C results, based on the information you enter in to it. I realy do believe DAFNE is a great regime, I have never had an HBA1C below 9.5 prior to DAFNE, i have been T1 for15 years and frequently had BG levels in the teens and twenties. The highest reading I have had since being on DAFNE is 13.4 and that was after a complete pig out, and on reflection I didn't give myself the correct insulin dose, bizarrely because it seemed such a huge amount of insulin I darn't take it. Now of course I am a bit wiser and know to trust the maths? Good luck and keep posting I would love to know how you get on, wait till you get sick day rules, they will blow your mind!!! Lol xx
 
Thanks for all the replies peeps,

Amb - no problem all info is good info in my eyes but I know what you mean regarding the 'club' aspect of the course, tbh I thnk it should be mandatory for all new diabetics to attend one but the govt would never accept the cost despite the fact it would save them money in the long run, only discovered yesterday that you can get meters which detect ketones as well yesterday!!

Neicy - ta again, guess I've been lucky at guessing as my HBA1Cs have been around 8, bought the Carb & Cals app last night, will look into the Diabetes Plus.

Last nights inj actually seemed to work! was 9.2 before and 9.4 afterwards so may have to work on the correcting, this mornig's not so good so far - 11.2 on waking, 13.7 before morning sandwich, and 14.8 now! Ho hum I'm sure it will al come in line sometime :)
 
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