T1 Databetic

because it's a numbers game! Nothing in this blog should be taken as medical or legal advice. I am a patient with type 1 diabetes sharing my journey. You should talk to your own healthcare team before making any changes to your own treatment.

[t1databetic]

The daily battle. Sharing for Diabetes Week. Find out more at www.diabetes.org.uk

[t1databetic]

I was just guessing at numbers and figures Pulling the puzzles apart Questions of science, science and progress Do not speak as loud as my heart

Coldplay - Lyrics from The Scientist

[t1databetic]

When calculations go wrong

[t1databetic]

As you know I’ve been battling the change in my insulin requirements for quite a while now. I’m not wanting to jinx it but I think I might have found the right balance.

So what’s changed?

Background insulin is split 4 or 5u in the morning (dependant on my activity level) and 12u at night. So a…

[mirtasan]

Do you mind me asking….what do you think is causing your needs to go up so much? I’m not judging, just asking. I’ve had Type 1 for almost 30 years and I’m not very insulin sensitive anymore. I know, it sucks. :(

[t1databetic]

There's nothing wrong with asking questions :)

My insulin requirements have changed a lot since diagnosis, sometimes increasing, sometimes decreasing. Which suggests that sometimes I still managed to produce some insulin of my own. People talk about this phase as the honeymoon period, which suggests it should be something nice, but I've found it anything but!

This particular change happened whilst I had a cold and I'd assumed things would return to normal once I'd got over it. It was also a sizable change compared to others. In the past my changes have just been a couple of units at a time (at most).

My healthcare team don't like it when I say I feel disappointed when my insulin requirements increase, but it is how I feel - until I consider the new amounts "normal" for me.

At the end of the day it's a means to an end, so it shouldn't matter whether it's 5 units, 12 units or 35 units, it is the outcome that is the most important thing.

I know some people that have had type 1 much longer than I have switched insulins and seen their requirements reduce, others have started taking other drugs as well as their insulin that has helped reduce resistance. Insulin resistance in type 1s seems to be a popular research area at the moment, so hopefully more solutions are on the way!

Of course the other thing we need to be mindful of is lipoatrophy, as this can cause big problems for insulin absorption. Thankfully I've not had problems with this and I try to rotate my injection sites all the time to minimise the risk, but it is a worry.

I hope that answered your question and things are going well for you

[t1databetic]

Am I in control?

As you know I've been battling the change in my insulin requirements for quite a while now. I'm not wanting to jinx it but I think I might have found the right balance. So what's changed? Background insulin is split 4 or 5u in the morning (dependant on my activity level) and 12u at night. So a total of 17u... it wasn't that long ago I was on a total of 6u! Ratios for breakfast, lunch and dinner are 2u per 10g, 1u per 10g and 1.25u per 10g (up from 1u per 10g) respectively. When I have changes in my insulin requirements I always find it frustrating how long it takes me to find the "new rules". It's because I tend to go for a slow and steady approach - a control thing... but perhaps I should be more bold in making changes? For now, I'll celebrate the fact that I'm the one in control again and not my diabetes - long may it last!

[t1databetic]

Changing Ratios

Annoyed that I've spent the entire night worrying about my blood sugars. It's the first night of using an increased ratio for my evening meal. I will know the outcome at midnight, unless the ratio is too high, in which case I'll go hypo... and that's all I've be thinking about all night.... will I go hypo?

[t1databetic]

A great blog post on something we can find hard to acknowledge ourselves

[t1databetic]

Meeting the practice nurse

After going to the GP surgery last week for my new patient appointment, today I saw the diabetes practice nurse.

Given the problems I’ve been having overnight with my control I was expecting a bad HbA1c result. So it was a pleasant(ish) surprise to learn it was 7.5% (or 58.5 mmol/mol in new money) - I was expecting something a lot worse! So despite this being my highest result post DX I’m not as upset as I’d thought I’d be… and the bonus is, I have a good target to aim for in three months time!

One of the other test results discussed was my B12 levels. It’s clear that these are on the way down again and it is looking likely that I will need to have B12 injections going forward. The practice nurse suggested I book an appointment with the GP to introduce myself and discuss this issue - I will most probably wait until next month to do that unless I start feeling the effects of low B12 levels sooner.

[t1databetic]

Lows are calling

Today I've been lurching from one low to another. No matter what I did, a hypo was just around the corner :/

I guess the issue is that I need to reduce my daytime Levemir even though I'm in the process of increasing my overnight Levemir to deal with the high bgs I have in the morning.

Night time increases are now on the back burner whilst I sort out my daytime hypos. If I have too many changes going on at the same time I find it difficult to understand what change made what effect, so the rule I work with is

"One small, incremental change at a time"

Morning bgs are not in the 20s anymore but still need tweaking, but dealing with hypos easily trumps highs for me.

First morning Levemir tweak starts tomorrow!

[t1databetic]

Diabulimia: This is when people with diabetes deliberately skip insulin doses in order to lose weight. Diabulimia is a very dangerous condition that isn't recognised as a medical term.

[t1databetic]

In pursuit of perfection

This evening I planned to eat a bar of chocolate on the train journey home, but once I had tested my blood glucose level I changed my mind.

I’m disappointed in myself for changing my mind as nothing should stop me from eating anything I want. I just need to inject the right amount of insulin for the number of carbohydrates consumed.

So why didn’t I eat the bar of chocolate?

Quite simply, the number I saw on the meter was in my eyes perfection and given the fleeting nature of perfection, I didn’t want to lose something so precious.

[t1databetic]

Making Life Difficult

New Improved Recipe, Improved Flavour or in this case "New thicker creamier recipe" - all these kinds of phrases set off alarm bells in my head. Why? Because normally it means a change in the amount of carbohydrates in the product and therefore a change in the amount of insulin I need to take with it.

At least with the change in ingredients for this Muller Greek Style Corner it is announced on the packaging, however many changes in formulas aren't always advertised and you can easily fall into the trap of assumptions and find your blood sugars going out of control.

A mathematician in all of us!

However there is something else that makes life difficult. If you are an insulin dependent diabetic like myself, you have to be good at maths! These two examples aren't too bad, but they illustrate the point.

Let's take the Muller Corner first. The nutrition information states that there is typically 16g of carbohydrate per 100g of product, but this pot contains approximately 150 grams. So I need to multiply the 16g by 1.5, giving a total of 24 grams.

With the Marks and Spencer product you typically get 16.4 grams of carbohydrate per 100 grams, but this pot contains 205 grams. Helpfully they do provide some nutritional information on a per pot basis, but unfortunately not the carbohydrate value, so again I must calculate the amount 16.4 * 2.05 = 33.62 grams <-- did you manage to do that in your head? No, neither did I, I just rounded down the calculation to 16.4g * 2 = 32.8 grams - good enough when on the go!

The real problem comes when you have difficult weights and carbohydrate values to multiply, eg. 43 grams of something whose carbohydrate value is 17.8 grams per 100 grams. If your numbers aren't in range when making these calculations, it can take some time to be confident that you have calculated correctly.

And then there is the worst of all. A food package with nutritional information per 100 grams, a summary which includes some nutritional information on a per pack basis but not the carbohydrate value and worse still no indication of the weight of the product in question!

A great example of this can be found on this blog: http://anniecoops.com/2012/12/02/a-maths-test-a-white-witch-and-the-dark-art-of-diabetes/

If you are wondering how you work it out... it's simple!

First you look at the nutrition per 100g

Energy 259kcal Carbohydrate 21.8g

Then look at the per pack value for energy:

Energy 554 kcal

and then do the following calculation in your head:

( 554 kcal / 259 kcal ) * 21.8 grams = 46.63 grams

With diabetes a growing problem in the population you would have thought big organisations such as Sainsburys, Marks and Spencer and Muller would be tuned in to this growing need to know the total carbohydrate values of their products. For those without diabetes, many have latched on to a number of diets that use carbohydrate as the limiter, yet it would seem these big organisations would prefer us all to have a mathematics degree!

Maybe with a little bit of nudging we can make life easier for everyone.

[t1databetic]

The "New Patient" Checkup

I’ve recently moved home and therefore, by default, I have moved GPs.

It’s an interesting (and unbelievably slow!) process, thankfully my previous GP sent me off with a good stock of insulin, needles, lancets, test strips and statins.

I identified an appropriate GP in my area, filled in and handed back all the paperwork during the Easter holiday and I finally received my new medical card last week.

Hurrah! So I needed to get my repeat prescription sorted.

On ringing up the GP surgery I was “invited” to attend a new patient checkup; should I need to see the diabetes nurse that would be scheduled during this visit.

Today was the day of that new patient appointment and I was hoping that by the end of it I’d be setup with my ability to order repeats online, get a replacement sharps bin and have confirmation on how to dispose of used insulin cartridges.

What actually happened?

No one was at reception, but that didn’t matter as a touch screen computer allowed me to check-in by providing my date of birth and the first initial of my surname. I’d arrived in plenty of time so spent it looking at the various posters and leaflets strewn around the waiting area… nothing covering diabetes.

At the allotted time I was called in and after introductions I was asked a number of questions:

How would I describe my general health, Good Bad? Good

How many units of alcohol do I consume per week? Special occasions only, so one unit

Do I smoke? No

I was then asked to stand on the scales and then had my blood pressure taken.

I raised all my questions, but instead of answers I was booked in to see the diabetes practice nurse next week who will apparently be able to give me the answers I need and be able to setup my repeat prescription on the system. I quickly realised that if I didn’t get my bloods done today then I’d have to sort out a third visit! After a brief conversation it was agreed that all appropriate blood samples would be taken before I left. I even managed to convince them to check my B12 levels! Going forward however I would have to visit during the mornings to get my blood work done.

So a pretty disappointing appointment. I was asked three questions I had already answered on the paperwork I’d filled out at Easter, they weighed me but they already knew my weight because, guess what?, I’d told them on the paperwork! So the only piece of information they learned from my visit today was my blood pressure.

For me, all I got from the appointment was another appointment and a pot to pee in!

Roll on next week!

[t1databetic]

Testing before dinner

So a disappointing 13.8 mmol/L. I guess I shouldn't have rounded down my insulin for that last treat as that would have put me around 10.8 mmol/L, closer to my ideal :-)

So a bg like that needs a 2 unit correction to hopefully get me back to where I want to be before bed. Dinner has an approximate carb total of 92g. My bgs will judge me at bedtime as to how good my estimation skills are!

Total insulin injected: 11 units

Photo: Testing kit, bg diary and fast acting insulin pen

[t1databetic]

A sneaky bank holiday treat!

Since I took a smidgen more insulin than required for lunch, I rounded down for these treats... 5 units of Apidra this time (I would normally take 6 units)

[t1databetic]

What I love about Costa is they have a wonderful website to provide nutritional information about all of their food and drink products which makes insulin calculations an absolute dream!

So todays bank holiday treat came to a grand total of 98.9g of carbs and, since my blood glucose level was a wonderful 6.2 mmol/L, I took 10 units of Apidra and no correction dose.

[t1databetic]

The routine of breakfast

I always weigh my breakfast. At the moment I am still eating through what is now a limited supply of Morgungull, which is an Icelandic cereal that is fairly low in carbohydrates (and calories!). I have 60 grams of this with 40 grams of semi-skimmed milk. In total it equates to 29.3 grams, so I know it's a simple 6 units of Apidra plus any correction dose required in the morning to get my numbers on track for the day.