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Right, when do you stop the fixed doses

Discussion in 'Type 1 Diabetes' started by Diabeticger, Jul 7, 2020.

  1. Diabeticger

    Diabeticger Type 1 · Well-Known Member

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    And start dosing for what carbs your going to eat , missed my annual appt due to covid next appt is October, I'm 18 months diagnosed and im on a 14 units of novorapid (4-5-5) daily and 14 units of lantus (1 dose at bedtime) my diet is pretty good and I'm managing to get my mmol down to an average of 6.6 , but some days it might go up to 9 or down to 4.5, when does the comprehensive carb counting and bolusing start, I sometimes feel hungry and not wanting to eat incase it spikes my blood, and I've stopped eating the nice stuff ( which I dont really mind but would like to splurge once in a while) l know we cant give medical advice but an idea of how long before they give you "free reign" to somewhat look after yourself

    Also seen some people on here and other discussion groups that split their bolus and Basel doses , is this reccomend by a physician or just knowledge
     
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  2. MarkMunday

    MarkMunday Type 1 · Well-Known Member

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    It is up to you really. Whatever puts you in control and provides you with the freedom you want. Don't expect to get detailed directions on this. We are all different and have to figure out what works best. Test and measure.
     
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  3. Fairygodmother

    Fairygodmother Type 1 · Well-Known Member

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    Good morning @Diabeticger, we’re you offered a telephone consultation for the annual appointment that you missed? We’re you assigned a DSN (Diabetes Specialist Nurse) at your surgery?
    If you’ve a DSN then maybe you could ask for a telephone appointment with them, but if you’ve not been assigned one then you maybe could ring your surgery and request that you’re assigned to one for the area you live in.
    We can’t tell you when you’ll begin to adjust the insulin to the food you eat but it sounds as though you’re keeping a note of your blood sugars which is a vital part of knowing your own needs. If you keep a record of your blood sugars on waking, before meals, two or three hours after meals and before you sleep, and note the amount of carb in each meal you eat then it will help the nurse or consultant who sets you on the dose for injecting for what you eat. Maybe you’re doing this already?
    There are some texts that might help you. Some of us use Carbs and Cals (maybe you’ve already got it) and a set of scales that weighs in grams so we can calculate the amount of carb in what we eat. There are a few other texts that do this, and the internet is a good source of carbs in foods info too, as are the labels on some shop bought products.
    Hope this helps.
    You seems to have your blood sugars in a good range - well done!
     
  4. Daibell

    Daibell LADA · Master

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    Hi. My personal opinion on the subject of carb-counting it that it should be started from the 1st day which is not what most surgeries or clinics do. My lovely DN started me carb-counting when she started my Bolus. it took all of 20 minutes and a Roche leaflet with pictures of carb portions; she spotted that I'm a bit of a nerd! 18 months is far too long to delay carb-counting. Most people like me are started on 1 unit of Bolus to 10gm of carb. It is important to test frequently to avoid a hypo and if worried start with a lower dose of insulin. Talk to the nurse if you can make contact to get specific advice for yourself.
     
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  5. UK T1

    UK T1 Type 1 · Well-Known Member

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    It is something that your diabetes team need to guide you through.

    When you do it depends on when you're ready. I was put on the wrong fixed doses and hypo-ed all the time, so came to carb counting much sooner than you. But I still had to discuss it with my team and they guided me through the switch, eventhough I'd done lots of reading already.

    It doesn't have to happen at a routine clinic, it can be done with phone calls and emails so if you're wanting to get the ball rolling, I'd get in touch with your DSN and say you've been reading up about it.

    It will depend on how easy you find it too, and I guess the impression you make? My team said they stopped telling people about carb counting because people found it too hard! But as I'd already done the reading they were more than happy to guide me through it.

    Re splitting basal - again that came from my diabetes team a while ago as new research had come out showing levemir isn't active for as long as originally thought when I got put on it over 14 yrs ago. They asked me to do some more finger prick tests to confirm, and my bloods were going up 20ish hrs after I'd had my levemir, showing the levemir wasn't acting the full 24hrs. I'd talk to your team because I've heard lantus does act longer than levemir so splitting might not be necessary for you.

    Hope that helps!
     
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  6. iblamedan

    iblamedan Type 1 · Member

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    I've only been diagnosed a month and they started me carb counting on a ratio of 1:10 on Monday after 3/4 weeks of fixed dose, but I was on higher (9 8 8 and then 7 of long acting). From day One i did start carb counting and recording to get into the habbit and so i could see what changed my BG more food wise.

    I've also had appointments each week with the specialist (DSN) but Im in Wales.

    I liked the fixed dose as it gave me some confidence to see what diff foods done. But my typical diet I didn't eat that many carbs so I'm down on average so far to (3 3 4 and still 7 for long acting)
     
  7. becca59

    becca59 Type 1 · Well-Known Member

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    Sorry that you feel adrift from hospital support and have still not started carb counting. Can you ring? I was sent a letter to say my appointment had been cancelled but gave me a number to ring if support was needed. I did ring and got good support quickly. Like others have said, I too started carb counting immediately. I was given 3 choices of treatment and I chose basal/bolus and carb counting. Left with literature and good support by phone to achieve it. Ring your team.
     
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  8. kaylz91

    kaylz91 Type 1 · Well-Known Member

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    I started 2 weeks after being diagnosed, self taught as fixed doses were causing too many hypo's, don't wait to be told, enquire, there are old timers that still don't carb count and adjust accordingly but things might not move along until you bring it up yourself xx
     
  9. jackois

    jackois Type 1 · Well-Known Member

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    For some reason I never had a course on this, and started with the information given at the hospital and the follow ups with the local Diabetes Clinic. The diabetic nurse at the clinic steered me to https://www.bertieonline.org.uk/ which gave me good info around carb counting online. Worth having a look.
     
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  10. Diabeticger

    Diabeticger Type 1 · Well-Known Member

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    Thanks for all the replies, much appreciated, I will contact my team to see what they say , I've no problem with restricting what I eat , but sometimes I feel more hungry than others and will eat a bit more then boom, spikes , think I would feel better for it if I could be sure of not spiking when I ate a bit more when I needed it , I am carb counting ( kinda), I've split my doses to 4 units for breakfast which only eggs or a cooked breakfast wont spike me, due to nearly zero carbs, 5 units for lunch and dinner , again I've no problem with that , just sometimes I'm still hungry after eating , suppose its all a learning curve
     
  11. Nicole

    Nicole · Active Member

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    Hi - in the absence of formal advice, it sounds as if you'd like a little more flexibility in your routine. I think we've all gone through a phase after diagnosis in which we were strict and rigid with our routines and have subsequently relaxed a bit. Sadly some people end up burning out emotionally and totally giving up on testing and taking insulin consistently.
    So it is important to make your regime works for you and I hope you will eventually get given a carb counting/bolus course! What you can do is read some books e.g. Think Like A Pancreas or Bright Spots and Landmines are both written by type 1s with the former being a medic as well.
    OR if you're confident with the basal, why not experiment with a treat and see what your insulin/carb ratio might be? A DN will normally advie 10g carb to 1 unit of insulin as a starting point but you could always make that bigger e.g. 15g per 1 unit if you wanted to be cautious. Insulin acts over about 4 hours so you should just observe what happens by testing at 2 and 4 hours as well as before the dose.
    The other thing is the correction dose e.g. how much insulin do you take to bring your bg down by 3 mmol?

    Generally I'd say that if you've weaned yourself off the 'bad stuff' that is great because those foods tend to make it harder to get dosing right as does exercise, stress etc. but you will doubtless know that by now and at least we can control what we eat!

    Good luck. Both books are on Amazon and the latter is available free on Diatribe's site.
     
  12. UK T1

    UK T1 Type 1 · Well-Known Member

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    Hi again, just to pick up on something you've said - if you're only having eggs for breakfast and having 4 units of novorapid then I'd be wondering if your basal dose is correct. Novorapid should be used as a bolus to counteract the total carbohydrate in your meals. If I literally just had eggs (no toast, no sausages, no sugar or lots of milk in tea/coffee) then I wouldn't need any novorapid as the carbs are so little that my basal (levemir in my case) would deal with that.

    There are threads on here about basal testing - the idea being that your glucose levels should stay stable (with some natural variation, they won't stay exactly the same) when you're fasting and just have basal insulin in your system.

    I agree with the post above - while fixed doses can work a treat, it is nice to have the option and know how to be a bit more flexible. Otherwise you risk 'burn out' and resenting having to match your diet to your insulin. When you carb count you eat what you want and match the insulin to the carbs you've eaten. That means you don't have to eat if you're not hungry, but also are able to have a treat or extra snack if you're still peckish!

    Edited to clarify - no carbs in eggs but I mean possible dash of milk in tea!
     
  13. Sadjers

    Sadjers · Member

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    Something my DN recommended to help me work out my insulin/carbs (IC) ratio was to eat a standard meal. The "standard" meal is 1g of carb per kg of body weight. And only eat the good stuff. Ie no refined carbs and not too much fat. Use your current IC ratio and monitor your sugars for four hours to work out whether its correct. If you keep these test meals standard, you might be able to get consistent results and perhaps eventually good results. Best of luck.
     
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  14. Sadjers

    Sadjers · Member

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    I noted various comments about eggs. I have to increase my insulin when I eat two or more eggs. I guess we're all different.
     
  15. Fairygodmother

    Fairygodmother Type 1 · Well-Known Member

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    Hi @Diabeticger, I hope you’ve been able to contact your nurse/doctor/consultant now and arrange a telephone consultation. We’re all different, and everyone’s needs vary. If you’re feeling hungry then the sooner you talk with them the better.
    A number of us have been talking about your need to inject for eggs, but it seems you don’t have any carb for breakfast. There’s another reason too that may explain why you need the insulin in the morning: the simyogi effect when the liver pumps glucose into the bloodstream to give a boost of energy to start the day. For some people it happens at a set time in the early hours, and for some it happens as soon as they begin moving in the morning.
    If we get this, but don’t make the insulin ourselves that’s needed to get the glucose into the cells then we need to inject some. A lot of us need to inject a bit of insulin to cover it as well as what we need for any carbs at breakfast. The amount, and timing of insulin for the simyogi, or foot on the floor, varies for each of us.
    Not everyone has this, but as I said, we’re all different.
     
  16. Diabeticger

    Diabeticger Type 1 · Well-Known Member

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    Thanks for support folks, got onto my nurse, and she gave me the go ahead to increase / decrease my doses , have to do a few weeks of trial and error to see what spikes me and what doest , but I'm much happier with a bit of freedom
     
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  17. TypeZero.

    TypeZero. · Well-Known Member

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    You’ve been waiting for too long. You would first need to sit down and discuss with a dietitian in working out your ratios and your insulin sensitivity factor (how much 1 unit of insulin lowers your BG by).

    Everyone is different to be honest with you. I’m diagnosed for about 3 months and I started carb-counting on the third week after returning from the hospital. In my first two weeks I was kind of carb counting but was adjusting my food according to the fixed bolus regimen rather than the other way round. With me I found it pretty easy to understand because my insulin requirements were exactly what the average adult requires: 1 unit of insulin per 10g and 1 unit of insulin also lowers BG by 3mmol/L.

    Basal doses are sometimes split in two if a single dose doesn’t last you a whole 24hours. This usually happens if you’re on Levemir, Lantus lasts for about 20-24 hours so wouldn’t require two doses.

    In terms of splitting your bolus, I have tried this but I have usually found that it makes no change for me. Splitting your bolus is usually done in slow-digesting high carb situations, some people do it for pizza but I don’t really split my boluses.
     
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