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Major crisis - action plan help needed

L

LandyAli

Newbie
Messages
4
Hi,

I’m desperate for some support in putting an action plan together to get me out of a major crisis-mode situation.

Sorry in advance for the detail but if I start on the emotional side of what is happening I might not make any sense.

Can anyone advise what would be the 1st, 2nd and 3rd things that you’d do in a similar situation to get back to normality? Am so overwhelmed that I can’t think straight anymore.

Some background:
Type 1 for 22 years, female aged 48.
Lantus basal dose in evening.
Humalog bolus dose at 1u:10g CHO.
HbA1 usually high 7s.
Early Dafne adopter (via research project in Bristol before called Dafne).
Monitored via local GP for last 5 years (bad move!)

Current State:
Major life events has led to stress build up over last 2 years (death, abusive partner, divorce, financial instability)
Other intercurrent illnesses being treated (currently on waiting list for operation to treat one of these).
Repeated infections for past year treated with anti-biotics leading to repeated thrush infections.
Intensive monitoring over last 4 weeks has not shown any trends other than complete choas. Now have zero motivation to try anymore.
Changes made to try to get things on track include moving Basal dose up by 15%, Bolus does up by 100% (now 2u:10g CHO). Also been applying illness rules to bolus doses and not one iota difference in BS levels at post-meal. Have re-set my CHO counting skills using the Carbs and Cals iphone app and also diabetes monitoring app to record everything. BS graph of standard day zig zags from hypo to hyper and back again by day, week, month.
HbA1 now 9.4
No ketones even when pre-meal BS up for days in 18-20 mmol range – have even started using huge bolus doses just to get BS down but doesn’t last from day to day.

Regards, Ali
 
Hello Ali

Firstly welcome to this forum. There's a lot of help within the threads posted by different members.

Stress can really mess up bg levels big time. My close friend died earlier this year and it made me very sad and my bg levels really increased as well. I coped with testing my levels every 2-3hrs (I have a pump) and put my pump on TBR (temporary basal rate) of 150% for about 12hrs during the day until the stress level started to get back to more normal.

Although you say that you have increased your carb ratios to 1u:5g carb, is this for the whole of the day or do you vary it according to different times of the day when you eat a main meal? Bg testing 6 times a day is key to getting your carb ratios correct so that you are not going really high or really low. Many people find that their carb ratios alter at breakfast, lunch and eve meal. Very few are able to stay on the same ratio all day long.
 
Hi,

Thanks so much for the reply. Yes I've been using same ratio for every meal. I test 8 to 10 times a day during intensive monitoring at waking up, drive to work, pre-breakfast, 2-hr post-breakfast, pre-lunch, 2-hr post-lunch, drive home, pre-dinner, 2-hr post-dinner, bedtime and occaisionally during night. If not in intensive monitoring then alway at drive times and most pre-meals.

Working out breakfast, lunch & dinner ratios would be good I reckon. Will sit down and look at the last 4 weeks of BS checks to see if I have enough pre- and post- tests that line up enough to get a decent ratio from.

I'm tired though.
 
Hi

What you've got to do is get hold of a bg monitoring diary (Accu chek do a good bg monitoring book that is really for pump users and has columns in it for entering amounts of carb eaten, etc but can be used by anyone using MDI as well. Just tell them that you use one of their bg monitors lol). Try and adjust your ratios by testing and writing the levels down. Another thing to get hold of is an insulin pen that will deliver in 0.5u increments as that will help a lot. I never altered my insulin to carb, I altered my carb to insulin. I'm not very good at maths so I found it easier to use for example 1u:8g carb and then just divide the 8g into whatever amount of carb I was going to eat and then use that to calculate. All ratios can be adjusted so you should be able to get things a bit better.
 
OK here's the results for the 1st step of my action plan (thanks so much for the help) all ratios are rounded up to nearest .25g CHO:

Breakfast 1u:4.5g CHO
Lunch 1u:3.75g CHO
Dinner 1u:5g CHO

Will start applying these today and try to hang-on for a few days. Am smiling now because at least I'm now doing something rather than sitting here feeling sorry for myself.
 
Hi

If you are able to use the ratios all ok (I would need a calculator lol) then you'll only know if they are ok by testing like I said. Not sure what your ideal target bg is but mine is 6-7mmol, so whatever yr target is before you eat you need to try and get yr 2-3hr bg test after you eat to be no more than 3mmol above yr target. If its way above then dont eat any carb until your next main meal, if its the same or below yr target then you will need to eat a snack but how much carb you'll need to eat, depends on how low bg has gone. It's all trial and error really.

Do you know how to calculate a correction dose? Do you know about the 100 rule?
 
The 100 rule? No I don't know it but I do know that my total daily does of insulin is less than this - usually comes in around 60 units.

Is this something I need to get on board with?
 
Hi
Welcome to the site. I am a type one diabetic on injections rather than a pump. Sorry to hear your struggling at present. Not sure how the pump works.Stress does and infection as we all know raise our blood sugars, as if you have been through so much stress and painful situations have you thought about seeing a counsellor, You can refer yourself but you may have to pay a fee unless your gp can help. Talk to your dns to see what they suggest. It sounds like you may have depression (which i wouldn't be surprised after reading your story), but remember you are not alone we are all here to help.
I find a twenty minute walk can bring my bg level down,
If you would like to privately message me please feel free. I am 42yrs old and have been diabetic 36yrs.
Take care and hope all goes well
Tracey69
 
LandyAli said:
The 100 rule? No I don't know it but I do know that my total daily does of insulin is less than this - usually comes in around 60 units.

Is this something I need to get on board with?
Click to expand...

Hi

The 100 rule is used to calculate correction doses. Ideally it works best when people have figured out their correct total daily dose of insulin which at the moment you haven't been able to as you are finding your way through adjusting your ratios. The idea is to divide your correct TDD into 100 and whatever that amounts to you use that to calculate a correction.

The best thing for the time being is to work on the rule that 1u of insulin will lower your bg levels by 1.5mmol. So if your bg is over your target before a main meal you use the correction formula to figure out a dose and then add that to your insulin to carb ratio. For example if yr bg is on 12mmol and you need to do a correction to get back to having an acceptable bg level, take 8mmol away from 12 and that will give you 4. If 1u lowers yr bg level by 1.5mmol - 4 divided by 1.5 equals 2.67 so you will need to do a correction of about 3u plus whatever yr insulin to carb ratio is you are using.

Many people tend to over correct initially and go hypo (I definately did) so that is why I have used 8mmol to correct to instead of 6 or 7mmol. It's just a safeguard until you find what your true TDD is. I use 25u per day so using the 100 rule, 1u would lower me by 4mmol.

If you google BDEC carb counting there's a good website that explains carb counting, carb ratios and correction doses.
 
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