Author Topic: Weight Loss  (Read 1444 times)

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Offline KarateMadMum

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Re: Weight Loss
« Reply #15 on: 17 April 2015, 03:23:30 PM »
Hi all, thanks again for all the info! Have read, book marked and taken notes!

I think my long term  is sorted... I am injecting 34 at 11pm and my bloods at 9am are with normal... still struggling to work out how much to inject according to what I eat... I have this...

When you start on multiple insulin injections or the pump, you should be given a ratio by the Diabetes Team but this will change as you grow and needs to be reviewed every few months. 
Below are the instructions on how to test insulin carbohydrate ratio
1. Test your blood glucose before a meal 2. Eat the test meal (see below for examples) with the amount of insulin you normally use 3. If you are high before the meal, do not use a correction dose for the purposes of this experiment 4. After 2 hours, test your blood glucose again if you are using the correct ratio your blood glucose should be within 2-3mmol of the before meal level.  If your blood glucose is higher, you need more insulin per 10g carbohydrate 5. After 4 hours, check your blood glucose again and it should be the same as the before meal level.
Examples of test meals
Test meals need to have an easy calculated amount of carbohydrate that works quite quickly e.g.
Test meal 1
• 2 Weetabix and 200ml (1/3 pint) of milk = 20g + 10g = 30g carbohydrate
Test meal 2
• 2 medium slices of toast and 100ml of fresh orange juice = 30g + 10g = 40g carbohydrate
Test meal 3
• sandwich as 2 slices medium bread or packet sandwich with label + muller light yogurt = 30g + 17g carbohydrate
Test meal 4
• medium jacket potato with cheese = 50g carbohydrate
 
Calculate the insulin
  1 units per 20g
1 unit per 10g 1 units per 7g 1 units per 5g
Test meal 1 (30g) 1.5 units 3 units 4.5 units 6 units Test meal 2 (40g) 2 units 4 units 6 units 8 units Test meal 3 (47g*) 2.5 units 5 units 7.5 units 10 units Test meal 4 (50g) 2.5 units 5 units 7.5 units 10 units
* You must round up or down to the nearest 10g (If you are unable to give 1/2 units of insulin, either wind up or wind down the dose of insulin) 
Example of a test meal
• Blood glucose before eating 9mmol/L • Normal ratio is 1 unit per 10g of carbohydrate • A meal is 30g therefore 3 units of insulin given before meal • Blood glucose 2 hours after eating 15mmol/L • Blood glucose 4 hours after eating 13mmol/L 
Conclusion
1 unit per 10g is not enough insulin.  Try increasing it up to 1 unit per 7g and repeat test meal.
It is important to note that sometimes the ratio varies dependent on the meal, quite often breakfast needs a higher ratio than other meals and the fine tuning can only be done by checking blood glucose before and after individual meals. 

plan om tackling that tomorrow... have joined a gym and am going to look at what classes they do... am moving forward slowly!
DX T2 2001 Insulin  from Feb '15
Novarapid 14,16,18 Lantus 33
Metformin, Atorvastatin, Quetiapin, Diazepam, Lorazepam, Zopiclone, Levothyroxine, Ranitidine, Propanalol, HRT, Venlafaxine

Offline nytquill17

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Re: Weight Loss
« Reply #16 on: 17 April 2015, 05:32:50 PM »
That is basically sound advice, if a bit idealistic about the actual number goals! Ideally you'd run these tests a few times before making any changes, because any one day's readings can always be a fluke / down to something else!

I don't think you really need a specific "test meal" either - you just need something that is not too huge, not too high in fat content OR in carb content ('cause that affects how quickly it will digest and how long it will affect your BGs), and for which you have counted the carbs accurately. So it's important to weigh and measure accurately, read the packet, etc. Later on when you're pretty sure of your ratios, "guesstimating" is allowed ;) but when you're running tests, better to be precise!

Side note - ratios can be talked about in one of two ways. Either 1u:Xg or Xu:10g. That is, either you're talking about how many grams of carbs one unit of insulin will cover for you, or you're talking about how many units of insulin it would take you to cover 10g of carbs. It's the same thing in the end, so which one you use is a matter of how you want to do the math. Personally I prefer the first way; I find it easier to grasp.


Other side note: in my personal experience, which from what I hear is similar to lots of other insulin users as well, my ratios for meals and corrections hardly ever change. To give you an idea, I might think about experimenting with them once a year or sometimes less! On the other hand, my basal doses change at least once a month if not more often (granted I'm a student so my stress levels are all over the place during term time!).

This is important for two reasons. 1) It's generally the opposite of what a lot of doctors and nurses think/do. They will often prefer to adjust your mealtime doses endlessly and (in my experience) seem to think of basal doses as some kind of holy grail that should only be moved around as a last resort! (This is an example of "textbook thinking" in diabetes). So you need to know that it's okay if your experience on this subject differs from the impression your doctor or nurse seems to have. Very often real life diabetic experience is different from what the textbook says. Trust your experience in that case! 

2) You should not expect your long-acting dose to be a case of "set it and forget it" - I don't mean to imply that that's what you think, but it's important to go on not thinking it! :) It'll change, often. You haven't done anything wrong if one week your readings seem to have gone A over teakettle for no good reason or if you "can't seem to find the right dose" because it keeps moving around. That's just the way of things. There's a whole huge constellation of hormones and things affecting your BG moment by moment, some of which modern science probably doesn't even know about yet, and even the ones we do, how could we ever keep up from the outside? So our job isn't to make those A/T times not happen, but to stay vigilant for those changes and try to adapt to them (but without being too hasty, see above about flukes!).
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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Re: Weight Loss
« Reply #17 on: 17 April 2015, 10:27:43 PM »
The only purpose of a test meal is that it is not a HUGE amount of carbs and that the carb isn't particularly low or high GI, plus not too much fat.  So a meat sandwich is brill, but melted cheese on toast wouldn't be.

It is certainly the way that we were taught on the local equivalent of BERTIE, Nytquil - and DAFNE has something identical.  So from that I'd say - it's the way the NHS does it here.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline nytquill17

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Re: Weight Loss
« Reply #18 on: 17 April 2015, 10:41:43 PM »
Sedge - I think we're saying the same thing (like I said, not huge amount of carb, not high fat, carbs counted). I just think calling it a "test meal" can make it sound like something very technical and lab-coat-y, and that might put some people off feeling like they can do this on their own. Also I thought it was worth explaining WHY a test meal is a test meal, i.e. what does it actually have to contain/not contain so that people can DIY it.
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."