How long were you on fixed doses for?

[jlarsson]

As mentioned never taught about carb counting not even when changed to Novorapid which was pushed for more flexible eating. As for protein and fat forget it. They basically weren't a factor for rising levels. Told carbs were the only thing that would raise me.

Never forget the beginning of me really starting to improve my control and observing the effects of different foods Asked my DSN why I was noticing rises with meat and cheese. Her response was you shouldn't, there are no carbs in these, it must be your dosing errors. As a result my control was erratic and no where near as good as it could have been for years.

Unfortunately a vast amount of what I know today I've had to research and learn myself.
Looking back it makes me angry regarding the lack of information I was given.

While I understand your anger, reality is that each and every one of us has different circumstances in how our bodies react to what we're consuming, how much insulin we need to cover for what we're consuming, and so on. Not to mention allergies, metabolism and whatever other factors there are.
Even if we were all provided with the same detailed explanation of everything, it would still only apply to some people and possibly even have the adverse affect to some. What should be taught is how to better analyse ourselves, but for that to happen there needs to be better training for the people training us as well.

 

[KK123]

I'm keen to know when people were first tested and trained for carb counting.

At my diagnosis in November, I was given some advice on how and when to test and inject. I was prescribed a fixed split basal and bolus doses and sent on my merry way.

The same nurse at the hospital saw me again in December and said to carry on as I was.

Then at the end of December, I saw a dietician who concluded I didn't eat **** anyway and to carry on as I was.

Then I saw a consultant at the end of Jan who said my A1C had come down from 152 to 40, that everything was great and to carry on as I was.

Then I saw my own GP a few weeks later, mostly just to introduce myself to her. She used me to train a student how to take bloods and give a flu jab, and told me to carry on as I was.

Then I was called into my surgery for my "annual review" with the DSN there (and an appointment a week earlier to have more bloods done). She at least tested my feet and sorted out my prescriptions so that they were on repeat rather than acute.

I also have an appointment at the eye hospital later in the year. But at what point would I expect to learn how to adjust doses and who instigates that?

Hi Bertyboy, I note you say you are doing fine on the regime you are currently on so do you still think you need to change it or are you looking to the future (ie in case your levels go haywire etc)? Are you looking for more flexibility around each individual meal?, I think it would help if you tell us your aim as I am sure there are many 'tips'. I haven't received any info re a carb course and am almost one year on from diagnosis but I understand you don't get offered one during the first year???, bit late after that in my opinion.

 

[mountaintom]

I started carb counting after a few weeks. My dsn and dietician weren’t keen on the idea and tried to persuade me to wait a little longer but I insusted and my dietician has since helped me with ratio adjustments. Eating at home is fine because you can weigh stuff and take your time but eating out can be tricky!
The carbs and Cals app is handy.

 

[Ledzeptt]

I was started on a fixed dose (Levemir) for my first year after diagnosis. To be honest, I was initially overwhelmed by diabetes and other other health issues at that time.

I learnt about multiple doses and carb counting from this forum and asked to switch regime. I don’t know if/when it would have been offered to me.

 

[Bertyboy]

I was never "trained" in carb counting.
One locum consultant once told me to try 1 unit of bolus insulin for 10g carbs.
There are online courses such as https://www.bertieonline.org.uk/ if you want to teach yourself.

I finally went on the local equivalent of the DAFNE course 12 years after being diagnosed. The purpose of this was to jump through one of the hoops to get a pump.
Thankfully, my area are a little more considerate than some: it was 5 consecutive Monday evenings: so no need for a week off work.

By the way, I missed this. Thanks for the link. That looks like just what I need.

I should point out, the issue with a week off is not that my employer would deny it, it's just that I dread having significant time off because of the inevitable pile of stress on returning.

 

[NoKindOfSusie]

My dsn and dietician weren’t keen on the idea and tried to persuade me to wait a little longer

Don't they always. On every subject. About everything. "Just wait and see..."

Err no. I brought it up when they were going through the part where they treat you like a five year old no wait that's all of it. It was during the "this is how you inject" session. She said "below your belly button in an area shaped like a big smile!" so I stuck it in and she went "oh oh oh, you're brave!" Patronising b***h. So at that point the assumption was that it would be fixed and I already knew that wasn't how it was really done, and said "well what if I need to eat more because I'm working really hard" and she said "well perhaps we can wait and see" so I said "er no, I know there's a ratio thing."

And we went back and forth on it until she figured out that I am capable of multiplying things by fifteen and that has been what I have been doing all this time.

It doesn't work very well but what does. I don't know why it's fifteen to one for me and it seems to be ten to one for other people but I have a feeling it may actually be more than fifteen to one, more like 18.75 to one assuming starting from under 8 if my big folder full of spreadsheets is right.

Post edited for language

 

[Bertyboy]

What insulin are you on? As some fixed doses insulin isn't suitable for carb counting. You may need to be prescribed different kinds of insulin before bertie courses or dafne courses.

See what @urbanracer has regarding experience?

I was on fixed dosed insulin but due to my extreme insulin resistance I was changed to Toujeo300 and novarapid.
In preparation for an operation and nurses administering my insulin doing their job without fear of giving me nearly 300units of insulin daily. As Toujeo300 is triple strength basal.

I'm on Levemir split basal and Novorapid. I do adjust it when my fasting levels are high, but I haven't looked up about ratios or anything like that. The problem is that I'm paranoid about overdoing it. Just now, I've tested for my commute home and I'm 4.0 (hence I'll be stuck in the office for a while longer until I go legal again) - that's because I was 8.9 pre-lunch so I notched up the Novorapid to 8.
As others have said, it's mostly about trial and error anyway. (as long as the error isn't too severe!)

 

[Bertyboy]

Hi Bertyboy, I note you say you are doing fine on the regime you are currently on so do you still think you need to change it or are you looking to the future (ie in case your levels go haywire etc)? Are you looking for more flexibility around each individual meal?, I think it would help if you tell us your aim as I am sure there are many 'tips'. I haven't received any info re a carb course and am almost one year on from diagnosis but I understand you don't get offered one during the first year???, bit late after that in my opinion.

Hi,

So, I had been doing fine on the fixed regime, and I suppose 'generally' I don't need to change that. In fact, I was doing really well and being a bit smug about it. However, the last three weeks, I don't know what happened but I have struggled to keep levels in quite such tight check - they keep drifting off into the 8s and 9s. I have had a cold very recently, so it could have been that bubbling under for a couple of weeks prior, or it could have been stress from work..who knows. As a result, I've been wanting to adjust so that I feel less ****** but I haven't given myself the time to gen up on what I need to do to calibrate things. It sounds like the Bertie website will show me how to calculate my ratios.
On the other hand, I haven't had a proper hypo yet so the prospect still terrifies me (as I live alone, travel a lot and spend a lot of time in the office alone in the evenings). I think I need to man up!

 

[mountaintom]

Don't they always. On every subject. About everything. "Just wait and see..."

Err no. I brought it up when they were going through the part where they treat you like a five year old no wait that's all of it. It was during the "this is how you inject" session. She said "below your belly button in an area shaped like a big smile!" so I stuck it in and she went "oh oh oh, you're brave!" Patronising b!tch. So at that point the assumption was that it would be fixed and I already knew that wasn't how it was really done, and said "well what if I need to eat more because I'm working really hard" and she said "well perhaps we can wait and see" so I said "er no, I know there's a ratio thing."

And we went back and forth on it until she figured out that I am capable of multiplying things by fifteen and that has been what I have been doing all this time.

It doesn't work very well but what does. I don't know why it's fifteen to one for me and it seems to be ten to one for other people but I have a feeling it may actually be more than fifteen to one, more like 18.75 to one assuming starting from under 8 if my big folder full of spreadsheets is right.

I have different ratios for different times of the day. Have you thought about that?

 

[mountaintom]

Hi,

So, I had been doing fine on the fixed regime, and I suppose 'generally' I don't need to change that. In fact, I was doing really well and being a bit smug about it. However, the last three weeks, I don't know what happened but I have struggled to keep levels in quite such tight check - they keep drifting off into the 8s and 9s. I have had a cold very recently, so it could have been that bubbling under for a couple of weeks prior, or it could have been stress from work..who knows. As a result, I've been wanting to adjust so that I feel less ****** but I haven't given myself the time to gen up on what I need to do to calibrate things. It sounds like the Bertie website will show me how to calculate my ratios.
On the other hand, I haven't had a proper hypo yet so the prospect still terrifies me (as I live alone, travel a lot and spend a lot of time in the office alone in the evenings). I think I need to man up!

You’ve not had a hypo and been diagnosed a year?!?

 

[NoKindOfSusie]

You’ve not had a hypo and been diagnosed a year?!?

What does "a hypo" mean.

Does "I feel like I just ran a 5k only I didn't" mean hypo? I feel like that all the time.

Does "shivering and sweating and ready to eat the entire contents of the fridge" mean hypo. This happens twice a week.

Does "lying in bead shaking so hard it hurts and unable to remember where your kitchen is or how to get there" mean hypo. Once a month?

 

[Antje77]

I've never been on fixed doses.
I was diagnosed with 'diabetes' end of november 2017, bought a meter and read the internet before having my first date with the nurse at my GP, armed with a weeks'worth of readings, was put on gliclazide (after I told the nurse at the GP they coudn't give me metformin according to the leaflet), started to tell my nurse gliclazide wasn't doing enough according to my meter by christmas, put on basal insulin in january and started nagging her about bolus right away.

Got a date with her for the bolus insulin on which she informed me she was going on holiday for two weeks and that she rather would start MDI after she got back. I told her I didn't want to wait while having high sugars and got her to prescribe me novorapid after promising I would be very careful not to shoot myself in a bad hypo right away. Saw her again about three weeks after that and presented her with nice numbers on my meter.
As long as I keep doing that she'll let me do anything I want, like keep my HBA1C under 40, telling her I want Tresiba and Fiasp, testing a lot, injecting an average of about 8 times a day and treat a mild hypo with a beer when it's after five PM. These are all things she has learned that aren't right. She doesn't know too much about diabetes, but she's very open minded and interested, and she trusts me.
I still don't carb-count, seems very complicated to me, but I'm fine with insulin-guessing and giving myself some slack with complicated meals.

 

[mountaintom]

What does "a hypo" mean.

Does "I feel like I just ran a 5k only I didn't" mean hypo? I feel like that all the time.

Does "shivering and sweating and ready to eat the entire contents of the fridge" mean hypo. This happens twice a week.

Does "lying in bead shaking so hard it hurts and unable to remember where your kitchen is or how to get there" mean hypo. Once a month?

Below 4 mmol/L

 

[Bertyboy]

You’ve not had a hypo and been diagnosed a year?!?

4.5 months.

 

[ickihun]

I'm on Levemir split basal and Novorapid. I do adjust it when my fasting levels are high, but I haven't looked up about ratios or anything like that. The problem is that I'm paranoid about overdoing it. Just now, I've tested for my commute home and I'm 4.0 (hence I'll be stuck in the office for a while longer until I go legal again) - that's because I was 8.9 pre-lunch so I notched up the Novorapid to 8.
As others have said, it's mostly about trial and error anyway. (as long as the error isn't too severe!)

I don't carb count and I do trial and error with novarapid but I often do basal rate testing to ensure I'm on the correct about of basal units. You?

 

[Bertyboy]

I don't carb count and I do trial and error with novarapid but I often do basal rate testing to ensure I'm on the correct about of basal units. You?

I must confess, I've seen people on here talk about basal rate testing, but I'm not sure what it is.

 

[ickihun]

I think @catapillar may have the link as I have it saved on another gadget which is commissioned mainly by the kids.
I hope she is able to pass it on to you?

 

[Glucobabu]

I was diagnosed Type 1 in 1975 and put on fixed dose of a mixture of soluble (fast acting) and cloudy (slow acting) insulin twice a day. The dose was very rarely altered based on urine test results (there were no meters then). Then HbA1c came along so the dose was adjusted possibly every 6 months. Numerous new improved insulins came along some with terrible results. Monotard by Novo in particular was disastrous for me. Even with access to meters and test strips there was no talk of dose adjustments at all. Oh no, that would be too dangerous for a layperson like you! Finally I was offered Dafne course in 2013 and it proved to be an eye opener. It gave me so much more confidence and skill to adjust my own dose to what I eat and when. I often inject 6-7 times in a day and feel so much better for it. I feel we are finally living in a very enlightened world. The next step would be to provide CGM to every diabetic who needs it.

 

[ickihun]

I must confess, I've seen people on here talk about basal rate testing, but I'm not sure what it is.

You could try searching this forum and see if it comes up.
I'm using my phone data at mo and for some reason this forum is not connecting well. It may be O2 thou.

 

[db89]

I must confess, I've seen people on here talk about basal rate testing, but I'm not sure what it is.

Here you are - I used the MySugr article on this to do basal testing. Ignore the part about pumps as the info is also applicable to MDI. You'll probably also need the blood sugar converter from this website to swap the mg/dl to the mmol/l we use in the UK.