Author Topic: Finally got bolus insulin.  (Read 1885 times)

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Offline Quantum Learning

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Re: Finally got bolus insulin.
« Reply #45 on: 21 November 2016, 10:38:35 AM »
I think it could well be the omeprazole complicating things, I hadn't thought of that but then again nothing ever seems simple for me does it? If I try the experiment again I'll definitely lower the fat.

I'll read think like a pancreas again & try & work out my ratios by weight. Endo appt is in Jan, speaking to the DSN in a couple of weeks.

I tried chicken/turkey hot pot last night, weighed everything this time & worked out carbs for whole thing to be 160. I don't have as much as half so worked on 60g for me and bolused 6 units but with my IR it should maybe be more. Thing is I'm still being on the cautious side so I understand BG's will be higher than I'd like but it's the patterns I'm not always understanding.

Start point higher again, not sure why other than been in some discomfort with my upper abdomen. Spoke too soon about those lovely 5's & 6's I'd been seeing.  :(

B4 meal 8.5
Bolused 6 units after eating this time
1hr after 9.6
2hr after 13.1
3hr after 9.2
4hr after 8.7
Don't know what happened after this as I went to bed.

It does appear that my highest peak last night was after 2 hrs. When I eat VLC my peak is always after 1hr, going down after 2 regardless of how much fat is in it.
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9% Chol
Metformin SR 2000mg, Candesarten Cilexetil 4mg Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

Offline nytquill17

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Re: Finally got bolus insulin.
« Reply #46 on: 21 November 2016, 01:23:25 PM »
So I suppose my question is, with a fantastic reading of 6.7 after 4 hrs how could I know what would happen over the next 2 hrs?

Short answer is - you couldn't! I would have done the same as you. In fact I had a very similar situation happen to me recently, I forget now what I had had for dinner but it was something pretty carby and I had already injected something like 14u for it in a split dose. Tested before bed and was 8.something, thought "yay I got it right for once!" In the back of my mind, I knew that there was a chance I might be wrong and still need yet more insulin, but knowing I still had IOB left, was hours out from the meal and was about to go to bed, the possibility I might just have "gotten it right" for once was equally strong - and if that was the case, and I added more insulin, I'd risk a nighttime hypo. So I went with my gut, assumed I was spot on, and went to bed without correcting. Woke up at 16 something. Dammit.

You just can't predict how every situation will go and get it down perfectly. Oddly enough, I find that life with insulin is actually LESS about mathematical precision in my BGs than it appears to be for D&E T2s. If I stopped to analyze every time my BG didn't do what I thought it would by 1 or 2 points, or heck, even by 3-5 points, I would go insane. There's just too many converging factors that I'd never be able to pin down with any certainty. That's why you can do the same thing on different days and get different results.

Of course when you're learning, as you are QL, what is the most likely "best response" for various different situations, it DOES pay to analyze these things a bit. But it's normal for it to be crazy-making, so learning to let go ("huh. That happened. I don't completely know why - and I guess I never will now! Oh well, what's done is done!") and move on is another important skill to acquire! One as vital to my own continued survival and sanity, anyway, as carb counting.


As to actual, concrete advice. Something I ran across quite a while ago, forget where now (could probably find it again if I looked though), but the idea was that above a certain amount, 30-40g for most people, the insulin-carb relationship "goes non-linear." That is, if your ratio is 1:5 and you eat 30g, you'll likely need 6u to cover that meal. On the other hand, if you eat 60g, you'll likely need something like 15u or even 18u to cover that meal - not 12u as the math would predict. I have certainly found that to be true in my case!

Timing also goes non-linear at that point. That is, where with a smaller and/or lower-carb and/or lower-fat meal, I can probably count on a "normal" post-meal curve, rising for the first two hours and falling again for the rest, and hopefully back where I started by hour 4 or 5, for a larger/higher-carb/higher-fat meal I don't always know what to expect, but I know not to expect it to behave normally! Usually I will see like you did, the meal will take longer to digest than the insulin duration, so that once I hit the 5-hour mark where the premeal insulin has worn off, BGs will continue to rise without any extra input from me. For particularly large or carby meals I can often see this continue long into the night. Sometimes I even add a unit onto my nighttime basal when I am dead sure this is going to be the case (**another non-textbook technique that I can't in good conscience recommend to anyone**).

If I'm eating a high-carb meal, and I do rather frequently sadly, my rule of thumb is "take what you think you'll need...and then take about half that again!" When the meal - and the dose - end up being massive I usually do split it up. I'll take maybe 15-20% of my planned dose (ok, I don't actually calculate percentages, I usually just go "oh let's start with...5u?") "up front," i.e. while I'm still cooking the food, and let that start working. Then just before I start eating I'll take another 30-40%. And another dose just after I've finished eating. And check up on things in a few hours and see if I need more corrections. That gets most of the dose "front-loaded" but also gives me a "tail" that will continue working an hour or two longer than the rest, knowing that the meal will still be digesting then.

Even then I still often find that my BG the next morning will be higher than I would like. But you do your best each time, and sometimes it works and sometimes it doesn't. Sometimes it doesn't make any sense at all!

"Moderate carb" btw is something you will get better at with time. While you were focused on maintaining a strict VLC diet, you worked off of the idea "if it has carbs, don't eat it." And now that you've got insulin, you've been working off the basis of making recipes, i.e. specific favorite meals and foods that were off-limits for you before and that are NOT designed with carb-counting in mind. Right now you are enjoying eating all your favorite "forbidden" foods that you haven't had in ages without it being a total disaster on your BGs (and I know you don't feel this way, but trust me, these experiments have NOT been total disasters, far from it!) That's an important and necessary thing to do when you get insulin, I think! :) There has to be SOME reward to all of this, right? ;) But admittedly these are not ideal learning situations; these are "INS 202: advanced problems in using insulin" kinds of meals.

Eventually you will come to settle on more of a "middle way" where you are eating meals that are not VLC in nature but that are geared towards an amount of carbs that your body can tolerate and that you can easily dose for. Probably around 30-40g per meal, maybe more, maybe less, you'll find out! In other words, you get to a point where you're familiar enough with carb counting and far enough away from your previous habits of carb restriction that the question becomes not "what can I eat that's not low-carb" but "what would I like to eat today that's around 30g or 40g?" And that's where I suspect that you will really start to feel that there's a benefit to using bolus insulin, because you will get both the increased flexibility with food compared to VLC *and* hopefully see your BGs where you'd like them to be a bit more often. Not every day and not all the time, because sadly, injected insulin just can't hold a candle to naturally-produced insulin when it comes to tight, smooth control. There will always be days that don't make sense because we never have all the information (to say nothing about the ability to respond quickly and precisely) on the outside of our bodies that our pancreases had on the inside. But you'll see better numbers more often than what you'd been seeing once your own insulin, for whatever reason, went more or less Ts-up, and with less draconian measures on the food front needed to achieve those results :)
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: Finally got bolus insulin.
« Reply #47 on: 21 November 2016, 04:07:06 PM »
Nyquil's right - for us insulin dependent ones - it's very essential to be able to recognise 'exactly why I went hypo then' however it isn't always necessary to over-analyse the higher ones.  When it is 'way out' of what we expect of course we do ask ourselves why, but as she says there isn't always an answer.  In which case, shrug and move on!  We'll never have the same day exactly tomorrow anyway so we can't spend THAT much time on one little glitch, we'd have no time left for what we want or need to do, would we?

Pete says eg 'Can we have baked beans' with whatever's for tea.  (Gammon today) And I frequently say 'Well you can, but I can't!' cos I've already decided we're having mash, which we haven't had for ages and we both like - so we're having green beans and there's an end to it cos more carb would be a disaster.  And he's just eaten cake with his afternoon cuppa and I didn't, so tough.  LOL  He just had to get used to it and anyway the green beans (ie the fresh ones you eat whole in their pods) will most likely need throwing away if we don't eat them tonight.

So that's that - a 30/35g carb dinner.  I know on Thurs the plan is spag bol and garlic bread cos Corinne (daughter) has invited us as we're spending the weekend away with them.  So I'll only have max 40g carb of spag (which I can eyeball reasonably successfully) and one slice of bread and do a split bolus for it cos I can.  I'll check again about 10pm and correct if necessary then, then not worry overnight (don't go to bed that early) and sort it out on Friday morning - lots of activity planned on Fri and Sat (safari park and illuminations, next day Xmas market, a big one - God knows what food will be available and I might be eating!) so I'm not bothered if I'm running higher - in fact it's better to avoid hypos full stop during this time - not a weekend I'm going to repeat every month for the rest of my life, so why worry !  It's a TREAT.  Treats are SPECIAL !
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: Finally got bolus insulin.
« Reply #48 on: 21 November 2016, 04:42:24 PM »
Even the hypos, honestly. Sometimes it's just "huh. That was weird." Of course they do make you a bit more conservative for a while just in case something is up (most usual culprit is a sudden change in basal needs) or in case it was "pilot error," but sometimes the same circumstances will give you a hypo one day and not another.

And yeah, there are plenty of circumstances where I would much prefer to "run higher" than to try too hard to maintain tight control and end up in trouble! Like when you're out and about for long periods, or enjoying a special occasion or event. Or when you're on vacation seeing the sights (everything is different then anyway). Or when I'm teaching a class! Basically at those times my BG goal is just to not have symptoms (whether from highs or lows) that are going to interfere with me enjoying myself or accomplishing my tasks.

In fact that's usually my main goal most of the time :P I just want to keep my BGs in a range where I can do the things I need and want to do without feeling tired, irritable, hungry, panicky, having blurry vision, whatever. When I can manage that, I remind myself that I met my goals for the day no matter what my actual numbers were. And on days I don't manage it, I remind myself that sh*t happens, and I *do* have a disease, it's not that outrageous that I might sometimes feel unwell or experience complications and it's no reflection on me as long as I did my best! (and note that some days "my best" means actually I did very little at all diabetes-wise because diabetes was dragging down my mental health and the best thing to do on balance, to distribute my finite self-care resources and make sure I could keep going later, was to take a day off - as much as we ever get one, that is. In order to keep some plates spinning sometimes I have to allow other plates to wobble for a bit!)
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 Liam

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Re: Finally got bolus insulin.
« Reply #49 on: 21 November 2016, 06:49:52 PM »
I've been thinking about you on and off today. My advice now is to forget about peak testing right now. Get the before meal and 4hr results that you want then go back and check peaks. I just think it is too much to try and take on peaks. Maybe I'm wrong and your all ready to do it?

I'm sort of in the same place myself right now, everything is wrong and I've spent ages playing around with the fine tuning when really I need to get the major bits right first. For me it is getting all the basal insulin bits right. I did what I always do and tested overnight (biggest bit of basal) since getting that right fixes about 1/3rd of my days BGs. I've just about got that flat now and need to work on ratios before bed.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline Quantum Learning

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Re: Finally got bolus insulin.
« Reply #50 on: 21 November 2016, 07:43:13 PM »
Thanks everyone, lots to think about and digest (at least there's no carbs  ;) )

I realise I am a complete beginner at this and need to stop being so anxious about it all, I've also realised when nothing makes sense and I feel out of control all I have to do is go back to LC for a while, which is my default comfort zone and chill for a few days before trying again.  :)
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9% Chol
Metformin SR 2000mg, Candesarten Cilexetil 4mg Omeprazole 20mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir.

Offline Pattidevans

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Re: Finally got bolus insulin.
« Reply #51 on: 21 November 2016, 08:17:53 PM »
I can't argue with anything anyone has said since my last post.  Particularly since I seem to have taken my finger off the button, eating too many carbs (cos I know what amount is good for me and I'm going waaay past that).  It's not easy to keep on top of it day in and day out.  I more or less did it for what?..... years actually, but sometimes other things in life take over.

So do please be a little bit kind to yourself and do not beat yourself up too much Q!  You've had waay to much on your plate over the past year or so and something has to give sometimes!
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline sedge

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Re: Finally got bolus insulin.
« Reply #52 on: 21 November 2016, 09:50:05 PM »
Agree with Patti - I'm due an A1c very very soon and there's not a snowball's chance in Hell it's going to be 50 !
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