Gary_W
01-18-2007, 03:56 AM
...so something for everyone with a bit of luck :smile:
Very long post, so probably best to go grab yourself a coffee before we start.
I only found this site a week ago and have been reading through the wide range of interesting posts ever since. A few of the things I have read have been incredibly helpful, hence the 'thank you' to those who contribute on here for the benefit of us all. As you'll see, it's starting to make a difference already.
Now for my 'hello'. I'm 37 and was diagnosed as type 1 when I was 25. I have an older brother whose type 1 turned up when he was 3, so at least mine had the decency to leave my childhood alone. These days, I use Lantus at night and NovoRapid for bolus.
Anyway, my reason for coming here at all in the first place was that I have been feeling pretty lousy for a long time now. Blood glucose seeming to bounce off the endstops and rarely stick in the good bits. Either 3 or 18. Not much fun at all really. The only good news was that I always get hypo warning signs and am able to treat in time, but you can still do without them. My last HBA1c was 8.0. Not great, but when you consider how often I go hypo then it tells a story of how often I've had the highs...
2 years ago, I changed from hospital based care to GP based care(that's your local office based doctor for our friends elsewhere in the world). My reason for doing so was that the hospital based care I received locally was nothing short of shocking. Multiple cancelled appointments, inconsistant and inaccurate advice and generally feeling like I was on my own with this one. I was told that I would be under a diabetes specialist nurse at the GP, and anything she couldn't handle would be refered back to the hospital. I liked the sound of this, as at least I could get an appointment which didn't get cancelled...
Anyway, last week I finally got sick of the fact that I feel ill pretty much constantly. I got a telephone appointment with my specialist nurse. She's a very nice lady, but it turns out she's not a specialist in diabetes at all. She's a practice nurse that has been on a short course. As such, when I told her what had been going on, she told me that she didn't know how to help and that I would have to go back to the hospital. I called the hospital and was told that, as I was under GP care, I had been discharged as a patient and they were not allowed to help me. If I wanted help or advice I would have to get my GP to write to them and re-refer me.
So here is the rant. Or one of them anyway. The NHS over here is all about waiting list targets. My local hosptial was failing on its targets to see patients within a certain timescale. So it farmed out as many patients as possible to primary care and reduced its patient load so it could meet its targets. Had I known that I was being discharged and that the local person could do little more than take blood and discuss the results, I wouldn't have gone down this route. I wonder how many more people in the UK are now cared for by practice nurses with a small amount of diabetes knowledge? Not ragging on my local nurse, as I have a lot of time for her. Just a system putting the work in the wrong places to make the figures look good.
The good news is that the waiting list initiative above has worked. My (excellent) GP wrote a referal and I have a hospital appointment in 10 days time. Which is good for the NHS.
Anyway, rather than waiting for the appointment, I got hold of the hospital again and after a fairly bloody battle with the receptionist, I got through to speak to a guy who IS a specialist nurse. The whole team has changed at the hosptial and I feel very positive about going back there. He gave me a few bits of advice that have already changed my life. The advice given is nothing new to most of you here, as I now realise, but I was completely ignorant of these facts. Searching here has taught me more and I've made some more changes that have also had a beneficial effect.
So the things I've learned from him:
1. The specialist told me about a carb ratio. Until now, I have been working entirely on guesswork. I know that this is going to seem astonishing to most of you, but I have genuinely never known that there was an actual ratio. I have always adjusted my bolus dose with meals, but have taken a best guess. He told me to have a go with 1 unit per 10g and see how it went, and get back to him for help if needed prior to the appointment.
2. He asked about the amount I inject. Answer was 35 of Lantus at night, about 8 NovoRapid in the morning, nothing at lunchtime and between 10-12 units of NovoRapid with my evening meal. Unless I go hypo, I don't eat between meals, besides having a glass of milk and maybe a biscuit before bed. He told me that not injecting at lunchtime was crazy if I was eating carbs. Which I always do. I explained that if I inject anything I'd definately go hypo late afternoon.
3. He also asked how I would treat a hypo. To which the answer is carefully on a good day, fridge emptying if you get one of the real bad ones where you eat till you stop shaking and then have an 18 blood sugar.
In response to this, I found this site for more details and got some carb counting books. It seems to work fine. A bit hard to say as I've had a horrible cold for the last few days which always adds to the excitement of our lives, but for the most part the improvement has been astonishing. Use of our kitchen scales has also shown that I clearly eat a lot more than I thought I did. So I've cut back on the carbs and (at the moment) go with the 1:10 ratio.
Cannot remember the poster or the post on here (sorry, searching again has not helped) but a big thank you to whoever posted the opinion that Lantus should only be 25%-50% of your overall insulin. I realise that I have been using Lantus like the old style 'mix short and long acting in the same syringe and inject before breakfast. The short sorts out breakfast, the long sorts out lunch'. Lantus, as most of you seem to know, is just not designed to do this. Strangely enough, my brother (on Levemir) is doing similar things to me (as in way too much Levemir, not enough bolus).
I have always told the doctors here what my doses have been and not one has ever batted an eyelid before now.
I have reduced the Lantus to 20, and it works. I also found the link saying that you do not need a snack with Lantus, and you should aim to go to bed with a blood glucose of 5-6. A real alien concept to me; previously, if I was less than 7.5 before bed I'd have a couple of biscuits or risk waking up badly hypo.
We have two kids that have been waking us up a fair bit at night, which has made the testing easy. The last two nights I have gone to bed at 5.0, been 5.0 during the night and woken up as 5.0. Which means the Lantus is doing its job. Or have I got this wrong?
Due to learning more about Novorapid profile, I have had the confidence to give correction doses at 2 hours post meal if needed. Again, something I would not have done and it is thanks to this site.
Man-flu not widthstanding, I have felt so much better this last week I cannot believe it. Shame I didn't know about ratios before or about the fact that Lantus does NOT do the same job as the older insulins out there.
If anyone has any specific advice, I'd be glad to receive it. I won't tinker with this too much more until the cold goes, but am keen to learn. I always thought I had a pretty good handle on diabetes theory but I'm happy to admit I was wrong.
Specific things I need to understand better now include
1. Is there a 'rule' for how much more to inject when you are ill? Or is it a best guess plus test very regularly (my current technique)
2. Advice on discovering my ratio at differnt times of day would be good. It seems like I need a fair bit more bolus to counteract morning carbs.
Thanks for reading. Sorry for the long haul :hello:
Gary
Very long post, so probably best to go grab yourself a coffee before we start.
I only found this site a week ago and have been reading through the wide range of interesting posts ever since. A few of the things I have read have been incredibly helpful, hence the 'thank you' to those who contribute on here for the benefit of us all. As you'll see, it's starting to make a difference already.
Now for my 'hello'. I'm 37 and was diagnosed as type 1 when I was 25. I have an older brother whose type 1 turned up when he was 3, so at least mine had the decency to leave my childhood alone. These days, I use Lantus at night and NovoRapid for bolus.
Anyway, my reason for coming here at all in the first place was that I have been feeling pretty lousy for a long time now. Blood glucose seeming to bounce off the endstops and rarely stick in the good bits. Either 3 or 18. Not much fun at all really. The only good news was that I always get hypo warning signs and am able to treat in time, but you can still do without them. My last HBA1c was 8.0. Not great, but when you consider how often I go hypo then it tells a story of how often I've had the highs...
2 years ago, I changed from hospital based care to GP based care(that's your local office based doctor for our friends elsewhere in the world). My reason for doing so was that the hospital based care I received locally was nothing short of shocking. Multiple cancelled appointments, inconsistant and inaccurate advice and generally feeling like I was on my own with this one. I was told that I would be under a diabetes specialist nurse at the GP, and anything she couldn't handle would be refered back to the hospital. I liked the sound of this, as at least I could get an appointment which didn't get cancelled...
Anyway, last week I finally got sick of the fact that I feel ill pretty much constantly. I got a telephone appointment with my specialist nurse. She's a very nice lady, but it turns out she's not a specialist in diabetes at all. She's a practice nurse that has been on a short course. As such, when I told her what had been going on, she told me that she didn't know how to help and that I would have to go back to the hospital. I called the hospital and was told that, as I was under GP care, I had been discharged as a patient and they were not allowed to help me. If I wanted help or advice I would have to get my GP to write to them and re-refer me.
So here is the rant. Or one of them anyway. The NHS over here is all about waiting list targets. My local hosptial was failing on its targets to see patients within a certain timescale. So it farmed out as many patients as possible to primary care and reduced its patient load so it could meet its targets. Had I known that I was being discharged and that the local person could do little more than take blood and discuss the results, I wouldn't have gone down this route. I wonder how many more people in the UK are now cared for by practice nurses with a small amount of diabetes knowledge? Not ragging on my local nurse, as I have a lot of time for her. Just a system putting the work in the wrong places to make the figures look good.
The good news is that the waiting list initiative above has worked. My (excellent) GP wrote a referal and I have a hospital appointment in 10 days time. Which is good for the NHS.
Anyway, rather than waiting for the appointment, I got hold of the hospital again and after a fairly bloody battle with the receptionist, I got through to speak to a guy who IS a specialist nurse. The whole team has changed at the hosptial and I feel very positive about going back there. He gave me a few bits of advice that have already changed my life. The advice given is nothing new to most of you here, as I now realise, but I was completely ignorant of these facts. Searching here has taught me more and I've made some more changes that have also had a beneficial effect.
So the things I've learned from him:
1. The specialist told me about a carb ratio. Until now, I have been working entirely on guesswork. I know that this is going to seem astonishing to most of you, but I have genuinely never known that there was an actual ratio. I have always adjusted my bolus dose with meals, but have taken a best guess. He told me to have a go with 1 unit per 10g and see how it went, and get back to him for help if needed prior to the appointment.
2. He asked about the amount I inject. Answer was 35 of Lantus at night, about 8 NovoRapid in the morning, nothing at lunchtime and between 10-12 units of NovoRapid with my evening meal. Unless I go hypo, I don't eat between meals, besides having a glass of milk and maybe a biscuit before bed. He told me that not injecting at lunchtime was crazy if I was eating carbs. Which I always do. I explained that if I inject anything I'd definately go hypo late afternoon.
3. He also asked how I would treat a hypo. To which the answer is carefully on a good day, fridge emptying if you get one of the real bad ones where you eat till you stop shaking and then have an 18 blood sugar.
In response to this, I found this site for more details and got some carb counting books. It seems to work fine. A bit hard to say as I've had a horrible cold for the last few days which always adds to the excitement of our lives, but for the most part the improvement has been astonishing. Use of our kitchen scales has also shown that I clearly eat a lot more than I thought I did. So I've cut back on the carbs and (at the moment) go with the 1:10 ratio.
Cannot remember the poster or the post on here (sorry, searching again has not helped) but a big thank you to whoever posted the opinion that Lantus should only be 25%-50% of your overall insulin. I realise that I have been using Lantus like the old style 'mix short and long acting in the same syringe and inject before breakfast. The short sorts out breakfast, the long sorts out lunch'. Lantus, as most of you seem to know, is just not designed to do this. Strangely enough, my brother (on Levemir) is doing similar things to me (as in way too much Levemir, not enough bolus).
I have always told the doctors here what my doses have been and not one has ever batted an eyelid before now.
I have reduced the Lantus to 20, and it works. I also found the link saying that you do not need a snack with Lantus, and you should aim to go to bed with a blood glucose of 5-6. A real alien concept to me; previously, if I was less than 7.5 before bed I'd have a couple of biscuits or risk waking up badly hypo.
We have two kids that have been waking us up a fair bit at night, which has made the testing easy. The last two nights I have gone to bed at 5.0, been 5.0 during the night and woken up as 5.0. Which means the Lantus is doing its job. Or have I got this wrong?
Due to learning more about Novorapid profile, I have had the confidence to give correction doses at 2 hours post meal if needed. Again, something I would not have done and it is thanks to this site.
Man-flu not widthstanding, I have felt so much better this last week I cannot believe it. Shame I didn't know about ratios before or about the fact that Lantus does NOT do the same job as the older insulins out there.
If anyone has any specific advice, I'd be glad to receive it. I won't tinker with this too much more until the cold goes, but am keen to learn. I always thought I had a pretty good handle on diabetes theory but I'm happy to admit I was wrong.
Specific things I need to understand better now include
1. Is there a 'rule' for how much more to inject when you are ill? Or is it a best guess plus test very regularly (my current technique)
2. Advice on discovering my ratio at differnt times of day would be good. It seems like I need a fair bit more bolus to counteract morning carbs.
Thanks for reading. Sorry for the long haul :hello:
Gary