New meds regime .....

[Rachette]

Hi
Was re diagnosed T1 in May following initial T2 diagnosis in March, this year.
Yesterday my medication was change to that of a "typical T1 format". I now find myself injecting 4 times a day
The main injection of the day (Lantus) was given at 8pm and the other with my food at 6pm.
I went to be bed on the highest BS I've had so far at 20.9. I was extremely uncomfortable.
Where did I go wrong?

Thank you.

 

[catherinecherub]

Hi @Rachette,

I will bump your post up for an answer.

 

[Eldorado]

Hi
Was re diagnosed T1 in May following initial T2 diagnosis in March, this year.
Yesterday my medication was change to that of a "typical T1 format". I now find myself injecting 4 times a day
The main injection of the day (Lantus) was given at 8pm and the other with my food at 6pm.
I went to be bed on the highest BS I've had so far at 20.9. I was extremely uncomfortable.
Where did I go wrong?

Thank you.

Hi Rachette
Sorry to hear that. It must seem very confusing.
If I had more information I could perhaps hazard a guess. Eg what was your BG before the meal at 6.00pm and how much fast acting insulin did you inject? How much cho did you eat? I allow one unit of Humalog for 10g of cho, but you may be different. You'll also have to take into account your before meal BG when calculating your insulin dose. You also need to know your insulin sensitivity ratio (correction factor) so that you can make any necessary adjustments.
This all sounds horribly complicated I know. I've just started using the AccuChek Aviva Exoert BG meter, which does all these calculations for you. I'm really pleased with it. Might be worth checking it out?

 

[Rachette]

Thanks catherinecherub

Thanks for reply Eldorado.
BS just before meal were 7.6
I took 4 units of humalog with the meal as directed by DSN
yesterday.
Here's where I can't ansa your questions as I honestly don't know. I ate a pasta based dish (high carbs I know but having not eaten very much that day I thought would be ok)
I'm ashamed to admit I have no idea how to calculate.
As you say this is all very complicated and up until yesterday I have been injecting once in the morning and once at night (humulin) during my 11 week diabetes experience. I haven't had any conversations with DSN about calculating carbs to insulin ratio.
Will have a look at the BS meter you mentioned.
Thank you.

 

[Heathenlass]

Hi Rachette, and welcome

I would advise that you arrange to speak to your DSN as soon as possible , as a fixed dose twice a day won't really help you, and you really need some assistance with the education side of things . A face to face chat with the DSN would be the best option so she can go through your regime and the reasoning behind it with you. In the meantime, there are some excellent links from this webpage , but please don't try and adjust your dosage before speaking to your DSN it does say on the webpage that it is for children and young people, but the explanations and principles are the same for all ages :

http://www.diabeteseducationscotland.org.uk/Patient/Type1_Level1.aspx

Signy

 

[Rachette]

Thanks for reply Heathenlass
Sorry, my mistake, for the confusion here.
What I meant to say was from diagnosis (March '15) to yesterday I have been on Humulin twice a day.
I believe this was because my team believed I would be T2?
As of May 15th and following relevant blood tests they revealed I was in fact T1.
First app with consultant, following this new diagnosis, was yesterday where they promptly switched me to Lantus once a day and Humalog with each meal (so 3 times a day)
So BS very high last night with new regime, maybe ?

 

[dancer]

Thanks for reply Heathenlass
Sorry, my mistake, for the confusion here.
What I meant to say was from diagnosis (March '15) to yesterday I have been on Humulin twice a day.
I believe this was because my team believed I would be T2?
As of May 15th and following relevant blood tests they revealed I was in fact T1.
First app with consultant, following this new diagnosis, was yesterday where they promptly switched me to Lantus once a day and Humalog with each meal (so 3 times a day)
So BS very high last night with new regime, maybe ?

It will take time for you to be stabilised on your new regime but you need help from your DSN and a dietician. I think it's ridiculous that you've been given so little help. I knew my hospital was good, now I think it's wonderful!

Once they give you adequate information, you'll soon settle into the Type 1 way of life. You should certainly ask to go on a DAFNE course, or equivalent, so that you can inject for the carbs you eat, rather than eat for the insulin you inject.

 

[donnellysdogs]

In next couple days and long term do test:
1) as soon as you wake up
2) before every meal
3) 2hrs after every meal
4) before bed

If possible at 3amish just to see what happens overnight but not every night with a bit of luck

Write down the times and the doses and the foods you eat as well.

Do this until your next appt (or phone up DSN) in interim to get advice on levels and changes to make.

It is important thst you do this just to get patterns...

 

[Rachette]

It will take time for you to be stabilised on your new regime but you need help from your DSN and a dietician. I think it's ridiculous that you've been given so little help. I knew my hospital was good, now I think it's wonderful!

Once they give you adequate information, you'll soon settle into the Type 1 way of life. You should certainly ask to go on a DAFNE course, or equivalent, so that you can inject for the carbs you eat, rather than eat for the insulin you inject.

Thanks for the advice , I intend to call DSN on Monday and ask some more questions (she is lovely) as it was all a bit too much to take in yesterday. I got very upset and just wanted out of there.

 

[teacher123]

It will take time for you to be stabilised on your new regime but you need help from your DSN and a dietician. I think it's ridiculous that you've been given so little help./QUOTE]

The Diabetic Nurse I was assigned to was meant to phone me on Monday. I gave her the benefit of the doubt and waited until Tuesday afternoon...phoned Tuesday afternoon and Wednesday and still hasn't got back to me. Beyond a joke but thankfully my BG levels are coming back into good range 2 hours after my meals.

Today was, 5.9 when woke up, 3.9 just before lunch (annoying), 6.8 before dinner and now 6.7 before bed.

 

[Rachette]

In next couple days and long term do test:
1) as soon as you wake up
2) before every meal
3) 2hrs after every meal
4) before bed

If possible at 3amish just to see what happens overnight but not every night with a bit of luck

Write down the times and the doses and the foods you eat as well.

Do this until your next appt (or phone up DSN) in interim to get advice on levels and changes to make.

It is important thst you do this just to get patterns...

Thank you, I have been trying to do this and I definitely do before each meal but need to set a reminder to do the 2 hours after each meal.

 

[Daibell]

Hi. You need to carb count. I will never understand why DNs don't teach this at the time they start insulin as mine did; it took 10 minutes and it isn't rocket-science. I started as most do with 1 unit of rapid insulin to 10gm of carbs. From that you tweak your ratio slightly based on experience what your meter says over the next few weeks.

 

[Eldorado]

Hi Rachette
If you're finding carb counting a pain, I can recommend the app 'My Fitness Pal'. It's a calorie and exercise tracking app. It has an incredibly extensive food database and you can key in your own recipes. It gives you all the nutritional data including calories and carbohydrates per portion. If you have a PC, tablet or smartphone, do give it a try. I wouldn't be without it! And it's FREE!

 

[Rachette]

Hi. You need to carb count. I will never understand why DNs don't teach this at the time they start insulin as mine did; it took 10 minutes and it isn't rocket-science. I started as most do with 1 unit of rapid insulin to 10gm of carbs. From that you tweak your ratio slightly based on experience what your meter says over the next few weeks.

Thank you for your post.
I agree, it isn't rocket science .... once you know how. I also agree that it should be done when the meds are given out for the first time, which when you consider I sat with both the DSN AND the diabetic dietician, on Friday, that would have been the most logical thing to do. It didn't happen though and I can only assume that was my fault as I was in a mess and wanted to get out of there.

 

[Rachette]

Hi Rachette
If you're finding carb counting a pain, I can recommend the app 'My Fitness Pal'. It's a calorie and exercise tracking app. It has an incredibly extensive food database and you can key in your own recipes. It gives you all the nutritional data including calories and carbohydrates per portion. If you have a PC, tablet or smartphone, do give it a try. I wouldn't be without it! And it's FREE!

Thank you for your post.
Great Idea I will definitely look into this, thanks.

 

[Daibell]

Thank you for your post.
I agree, it isn't rocket science .... once you know how. I also agree that it should be done when the meds are given out for the first time, which when you consider I sat with both the DSN AND the diabetic dietician, on Friday, that would have been the most logical thing to do. It didn't happen though and I can only assume that was my fault as I was in a mess and wanted to get out of there.

Oh dear. I hope the dietician kept quiet about having loads of starchy carbs with every meal etc. I'm lucky that I have never been offered a dietician appointment.