My Recent BGs - comments wanted please

Hi,

Before I pay a visit to my diabetic drop in centre I'm looking for some comments on my recent BGs.

Dates - what's been going on lately

A while before Wed 11.12 bedtime BGs were much higher then fasting BGs where there was a huge drop so for several weeks I slowly decreased BI (lantus)

Then ALL BGs went higher ie mostly in the teens

Wed 11.12 - started with headcold

got a bit better in between

Fri 27.12 - ear infection - antibiotics for 1 week

Mon 30.12 - put meter on +10% for illness & use this for every QA injection

Wed 01.01 - put meter on +12% for illness & use this for every QA injection - has this just become a habit now to be doing this?

Most BGs are in the teens

Mon 06.01 - increased BI from 12u to 14u

The odd single figure BG is now creeping in

I think you need to split your background insulin dose..........

Any chance on a move to Levemir....?

novorapidboi26 said:
I think you need to split your background insulin dose..........

Any chance on a move to Levemir....?

Just from your description of your change to your Lantus dose...........

You seem to be just looking at the pre bed and fasting levels when considering a change, now this is good, its the best place to start, but what about your background needs during the day.

Every time you increase or decrease your Lantus in order to hold steady overnight you will be effecting your daytime blood sugars.

Thats why a split would be good, as you could adjust the background for the day and night separately, and so if there was an issue with dose you can focus on fixing it without disturbing the problem free portion of the day...

Levemir is a shorter acting background with less of a peak, probably better suited to most who are splitting. Th effects of any change you make to Levemir can also be seen the next day. Lantus can be split and work but any dose change needs time to settle in before you see results.......

Looking for comments for my latest BGs please

Hi please can I have some comments on my results. Also should I be blousing for suppers. I eat these after doing my bedtime test. I usually have a sandwich 2 slices of bread - 18g cho per slice so 36g cho in total.

Hi,

Just to answer you question about bolusing for suppers

yes, you should, any carb going in should be matched with insulin, why would you think it shouldn't?


Some general comments on your results:

22/01/2014:

There was no BG test done at 9:15 breakfast, this was only 30 minutes from your fasting level, however knowing the morning hormonal activity its likely you could have been higher than 8.7 at 9:15, its good habit to always test just before bolusing for accurate corrections, you could have even gave your insulin at the fasting level, so as to give it time to get started, 30 minutes may be too long for some folk, but definitely 10 minutes minimum.

Did you have any lunch this day...?

22:30 you had no insulin or correction for your food and high BG?.....is that right, and if so, why?

I realize you have asked the question as to whether to do this at the start....


23/01/2014:

8:29 - No correction, any reason?

Just a general comment about data input to the diary, you should try and show corrections as + 1 etc, this lets you and other know what proportion of the total QA insulin you took was a correction.

22:11 - No correction, I see you would have had insulin on board, but it would only have had an hour left, unlikely to drop your 15.3 on target.


24/01/2014:

08:27 - No correction, there's a pattern emerging, I could understand holding back a correction if you were going to eat a short time later, but the diary doesn't show this.

Any reason?


Much the same is going on on the 25th.


Sorry if they were lots of criticisms as opposed to solutions.........

Hi NRB,

Thank you so much for obviuosly having a good look at my diary.

Re bolusing for suppers after me asking this question a lot here and there & after seeing your answer I think I'm finally going to start taking QA for suppers which are carby - no more being scared of taking QA for carby suppers


Some general comments on your results:

22/01/2014:

I didn't test at 9:15 because I actually ate breakfast that morning at 8:42 then bolused after. I always prefer to bolus before eating but that morning we were away from home in a B & B......

Just to confirm there was no lunch this day.

22:30 yes no insulin or correction because of me being scared to bolus before bed - hopefully I'm going to get over this problem the more I realise that anything with carbs in should be matched with insulin.


23/01/2014:

8:29 It's not really been entering my mind of late to do a correction 1. when doing a fasting BG also a while before my breakfast 2. maybe with my Accu-chek Aviva Expert meter I'm used to all corrections being included with bolus advice.

I did do this a while back. Now that I've got my new meter how would I remember the corrections which the meter shows because when I've done a BG test & the bolus advice screen shows up it shows seperately how much insulin for correction & how much for carbs then the total. When I go back into my data on the meter it only shows the total ie not broken down seperately into corrections & carbs. I know I have 1 unit to bring me down 3mmol.

22:11 Agreed no correction done & also I had supper which takes me back to being scared of bolusing at bedtime.


24/01/2014:

Thanks for picking up on me not doing corrections - same as 8:29 on 23/01/2014

Once again thanks for having a good look through and any comments/criticisms are welcomed.

So I think that because your scared to bolus at night, this is resulting in highs in the morning, which in turn is making it harder to get more stable during the day....


I think the odd missed correction may also be responsible for the odd high here and there also....

I think your meter is doing a good job, I too have a fancy function on my pump that gives a final dose, it also provides the other information but as a result I will need to go looking for corrections when i am evaluating a dose.

when you learn with DAFNE you use something called a step wise approach which requires the patient to write all there QA and correction information down, because you missed this and because you have a fancy meter your not in the habit of writing all the info down, but having it all there really does make it much easier to see what's happening.......

so get in the habit of writing it down on a customised log book (excel spreadsheet) with all the info you need....I only write down the last three days if I want to pin point a problem area......

I think its simple enough to work out your QA and correction separately from a single dose as long as you have a BG reading, and CHO with ratio.....

you should definitely try giving insulin for supper, if your scared just set some alarms over night to monitor it, and to build your confidence......

I shouldn't really say this but its my experience and belief that your liver will assist your recovery from a hypo no problem every time, the problem is if you drop again soon after the first one, then your liver will already be depleted some.....

basically if you did go low you will recover, and also probably wake.....provided you have normal hypo symptoms, which it seem you do......have some faith...... ....

your not having a lot of carbs at night though are you........a sandwich...so 40g max......you will be fine........

novorapidboi26 said:
So I think that because your scared to bolus at night, this is resulting in highs in the morning, which in turn is making it harder to get more stable during the day....

- 28/01/2014
starting to get over my fears of bolusing before bed


I think the odd missed correction may also be responsible for the odd high here and there also....

- ok

I think your meter is doing a good job, I too have a fancy function on my pump that gives a final dose, it also provides the other information but as a result I will need to go looking for corrections when i am evaluating a dose.

- I must admit it took a while at first before I learned to put my trust in it but once you do it's a good friend

when you learn with DAFNE you use something called a step wise approach which requires the patient to write all there QA and correction information down, because you missed this and because you have a fancy meter your not in the habit of writing all the info down, but having it all there really does make it much easier to see what's happening.......

so get in the habit of writing it down on a customised log book (excel spreadsheet) with all the info you need....I only write down the last three days if I want to pin point a problem area......

- will try to start doing this

I think its simple enough to work out your QA and correction separately from a single dose as long as you have a BG reading, and CHO with ratio.....
- so how would you work this out?

you should definitely try giving insulin for supper, if your scared just set some alarms over night to monitor it, and to build your confidence......

- as said earlier a bit of confidence is building up