Living with diabetes > Insulin and medication

Meter hindering rather than helping

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nytquill17:
This topic has been split off from http://diabetes-support.org.uk/diabetesforum/index.php/topic,1791.0.html where I had mentioned that my A1c had got worse since I had started relying on my Insulinx meter for dosing advice.  Didn't want to derail the other thread as it was quite important.

Why not go back to the old way, if you feel you got better results with it, Patti?  There's nothing that says you have to keep using it, especially not if your previous method was more useful or intuitive or whatever to you.  Or what if you just turned off the calculator function for a while and see what you get?  Or take the insulin YOU think you should take for a while, log that in the Insulinx and then after a sufficient amount of time do the math backwards.  "Okay I had X u of insulin for Y g of carbs, divide X into Y and get what should be my actual ratio that I'm actually using in my head without knowing it when I just look at my plate and guess."

It just bugs me because I never heard you complain about having to work out your insulin doses yourself, so it doesn't seem like it was such a big deal for you, but now you're hanging on for dear life to this meter that is supposed to make that bit easier, which wasn't that important to you, but is making your control worse, which IS important to you.

Unless perhaps there is something else going on concordant to your using the Insulinx that is causing your control to be more difficult as well.  Lifestyle changes and all that.  Which is where going back to the old way for a while might be useful - then you could see by comparison whether it's really the calculating meter that trips you up or if it's something else that's changed and the meter is a red herring.

Pattidevans:
I keep on thinking that if I could just get the carb ratios right the meter would work to make control better, but my ratios seem so high e.g. 1u:4g that it's silly.

I think I may give it a holiday for a few days - I have the Freedom Lite now which uses the same strips.  It may just be that something has "changed" making control harder, I know there are days when I simply can't get below 7.

nytquill17:
But Patti...if your ratio is 1:4 then it IS.  It simply is.  It's just a number to plug into a formula - not a measure of your degree of personal success or failure as a diabetic or how "normal" or "not normal" you may be.  That number is there to help you, not to help anyone else and not to evaluate or judge you.

You always said before how you felt you had to take a lot of insulin, remember?  I mean before you would come up with a guesstimate dose looking at your whole meal, and then only eat half of it and it would turn out right.  Which means you actually needed twice that had you eaten the full plate, but you never did, and through force of experience you managed to come up with the right numbers anyway.  You just had that extra half-plate in there mucking up the way you thought about your estimates, but not actually mucking up your estimates themselves, if you see what I mean?

Concrete example: if you had been saying "I need 1:6 for supper" and dosing 1:6 plus an extra unit or two and then only eating half your meal and still ending up with good readings afterwards...well doesn't that mean your ratio has always actually been 1:3 or even 1:2? (considering you were tacking on extra units to your "ratio")  Because that's what you were taking anyway, but just telling yourself it was really 1:6 "plus a bit" and then eating a lot less than you thought you had dosed for.

What I mean is I think you've always needed fairly high (relatively speaking) ratios of insulin.  I don't think that's anything new.  What's new here is your having to add up what you actually eat, and what you actually take, and coming face to face with your actual ratio and not the one you thought you had.  But I don't think the ratio itself has really changed, if you see what I mean?  And it's certainly nothing to be ashamed of.  I've said it before and I'll keep saying it, you need what you need, end of argument.  Even if what you need is "a lot more than other people," because you're not other people so you don't have to give a flying flip what other people do.  Eyes on your own paper, please, no looking around! ;)


But somehow that little number is bothering you so much that it is getting in the way of you having the control I know you are capable of.  It seems to me the logical thing to do is either to get rid of the precision that's putting you off - take an Insulinx holiday and go back to the way you were doing it before, if that makes you feel comfortable enough to do what you actually NEED - or to get rid of this fear/embarassment/doubt/whatever it is that is preventing you from making full use of the precision you have.  The only thing that's silly here is you not doing whatever you need to do in the end to get back on top of this, and allowing the meter that is supposed to help you, derail your control instead.  All that meter is is a glorified calculator, in the end.  It doesn't know anything you don't and it's not set to evaluate your treatment regime.  It's not any smarter than you make it - it's still YOUR brain running the show, and that thing is just a tool to help you run it.  What do you do with a tool that is more hindrance than help?  You chuck it out and get something that works!


Sorry for the hijack, but I couldn't let that pass without saying something! :)

everydayupsanddowns:
Didn't see the thread this split from, but I SO recognise the sentiment.

A few weeks in to having the Expert (when settings were far from perfect) I realised how much I wanted it to work. But the way the calculations were made and balanced meant that I needed to provide it with 'Expert' numbers not 'actual' numbers (notwithstanding all the valid points nytq makes above about concealing 'actual' numbers in day-to-day SWAGing).

My target range, insulin duration, sensitivity etc were eventually all set on the Expert not based on what I believed they actually are, but merely on the values that seemed to allow the software to make decent guesses.

I am doing exactly the same with the pump. And the numbers are all completely different. Arguably this is partly down to the difference between continuous infusion, but I also think there is a fair amount of 'software developer' factor. The way the developers have put the equations together/suggested insulin profile curve, weighting for this that and the other etc.

If I went back to doing it 'manually' my guess is that I'd have to go for a different set of numbers again - probably those based mostly on 'what happened last time'

:)

Pattidevans:
I think that before the meter I had settled into a sort of regime where I knew more or less what to take for what meals - although I probably have a more extended range of meals than a lot of peeps, I'm still a bit of a creature of habit a lot of the time e.g. during the week breakfast is always 15g carb and lunch 30g unless it's winter and I take soup in which case it would be 40g.  So at breakfast I'd think, "Yesterday I had the same and 4u wasn't enough because I was 6.7 before lunch so I'll take another 1u"  Or "Well I went by car yesterday and I'm walking today so I'll stick at 4u" and at lunch "Yesterday 5u wasn't enough to get me down to 5 after the insulin has finished after lunch, so today I'll take 6u".

I've realised that dinner most days only actually varies by about 5g carb unless we don't have fruit for afters then it'll vary by about 15 - 20g carb.

At the end of the day the control has only varied by less than 1mmol or 38 to 45 in new money.  I do have less hypos these days, though I've never particularly been bothered by mild hypos (I mean above 3).

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