# Dr Katharine Morrison



## Pattidevans (Nov 23, 2011)

I'd just like to add that the information I posted came from Dr Katharine Morrison who is a co-author of dsolve.com a GP and prominent mover and groover diabetic wise in the formulation of guidelines for Scotland.  Katharine has been a member of forums for a while and a very informative person.  Her son is T1 which led her to specialise.


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## Ellie Jones (Nov 24, 2011)

The Scottish guide lines I should imagine would work the same as the UK Guidelines have a mixture of people from consultants to laypeople...

Just checked and she still listed with her GP practice in Scotland!  As part of her array of letters MD etc she's an Homoeopathy qualified doctor...  which is were her interest lay before her son's diagnoses..

She's an advocate for extreme low carbing as you can see from her website, her aim is to turn extreme low carbing into main stream standard dietary advise for all diabetics in Scotland at least...  She's had at least one Article published in a medical journal but not one of the top main ones though..  Shall try to find a link to it.

Her son must be around 20 now, as it's quite a while since I've know her via forums..  He didn't follow an extreme Bernstein 30g carb diet, but was very moderately low and a extreme testing and injecting regime I do wonder if he still follows the practices his mum taught him!

Personally I don't like medical professionals pushing an Extreme low carb diet as standard practice for any diabetic for various reasons...  As control and carb amounts should be something decided at patient level between their HCP's and themselves not metered out like an Ikea flat pack instruction manual..

We might be diabetic but were are still human


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## trophywench (Nov 24, 2011)

I still dunno Ellie, another thing I recall was her talking about her son split bolusing for eg pizza which was actually jolly useful and new info for some of us at that time.  I'd heard of it but no-one had ever explained to me the nuts and bolts of doing it.

I wouldn't have thought pizza would be thought of as ultra low carb in anyone's book?

Whatever........


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## Ellie Jones (Nov 24, 2011)

Trophwench

Her son was on moderately low carb diet and not the ultra low diet she promotes.. 

A conversation I had with her in late 2009 

"(Son) injects 12-20 times a day. This is because he sticks to 7 units or less for each injection.

This ensures meal insulin works when it is supposed to and reduces possible long term fat/skin changes. 

It seems a lot but it is a great way to get pump style control without the disadvantages of the pump. Also the jags are all small in volume so are usually painless."

I can link to this thread..

When I explained that I found that 6-9 injections a day really impeded on my daily routine hece the pump oh I did say I was gobsmacked by the amount of injections he's was having

She returned with this 

" (son) didn't want one. The insertions were too painful and you could feel the canula was in. They also came out when they were not meant too. Other users warned of problems with DKA due to pump failure, abcesses and scarring."  And his HbA1c was 6.3% 6 month previous 6.7%

So a high level of input for not a brilliant out come..

A person got to sleep, and you tend to inject while awake, so if we make an assumption of 8 hours kip and 16 hours awake, then her son is inject every 48-1hr 20 minutes but there is one very important factor in all this that she seems to have overlooked..

Insulin stacking


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## trophywench (Nov 24, 2011)

Well I for one would have killed for those A1c's - never had anything under 7.2 in my entire 40 years Ellie!  (until this last one after I got the pump, I cried when they told me what it was) 

Some 7's but a lot of low 8's.  And twice in the last 12 years, it was under 7.5.

I dunno about stacking.  It's so rare for me to jab again after less than about 4 hours I couldn't possibly predict what would happen in my body.  I'd just jab for the carbs and hope for the best.  But if someone was doing a split bolus for a pizza-effect lunch it could happen to them at dinner time - so I expect they'd get it sorted if that was a habit.

Would a mod like to split this thread as we aren't exactly On Topic, are we?


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## Northerner (Nov 24, 2011)

trophywench said:


> Would a mod like to split this thread as we aren't exactly On Topic, are we?



Haha! I was doing it whilst you were posting! 

Personally I would NOT like to be taking so many injections a day - it would really feel as though my life was dominated by diabetes


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## FM001 (Nov 24, 2011)

Northerner said:


> Personally I would NOT like to be taking so many injections a day - it would really feel as though my life was dominated by diabetes





Nor I   that is a astonishing amount of injections for such a young lad to inject each day and it would take over his life completely - does this doctor suggest all type 1's on mdi follow this route?


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## cherrypie (Nov 24, 2011)

Dr. Katharine Morrison promotes Bernstein for management of Diabetes doesn't she?


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## fencesitter (Nov 24, 2011)

Crumbs ... William does a split dose for pizza but that's it. 
To use this method all the time, you'd need to really understand the profile of the food you were eating and how it followed the profile of your insulin. There are infinite variations too, assuming you eat different combinations of foods at each meal. 
Do pumpers make complicated calculations like this every day?? Re. stacking. Another one that pumpers must have cracked?
Don't think this method would prove popular with most people on MDI ... four jabs seems like plenty


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## trophywench (Nov 24, 2011)

Well - on a pump the Bolus Wizard takes care of Insulin on Board - we were only discussing this on another thread the other day - I have absolutely no idea whatsoever how to calculate that in, because fast-acting doesn't release itself in a flat curve - during its working time, it rises to a peak and then tails off, so I would have no REAL idea where on the curve of that graph of the last jab, I was at any given time thereafter.

But Miladdo also used to use 3 insulins - a normal long acting and fast acting, with the addition of Humulin S which is a longer-acting 'fast' one ...... you have got to understand A Lot to combine eg Novorpaid and Hum S successfully.  (I couldn't even combine Hum S with Hum I without losing hypo awareness and crashing me car - so I would have nightmares if that was the only insulin in the world.)  (probably just shoot meself and get it over with) 

Some people still like only 2 jabs a day though, and we respect them, it's their decision anyway.  So if someone else wants to have 12 that's also 100% fine by me.  Come to that - I don't object to other people dogging if that's what floats their boat - just as long as they don't expect me to join in!


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## novorapidboi26 (Nov 24, 2011)

I believe most would rather use the pump for such a regime, the pros outweigh the cons in this situation..........

And I would of thought being on a moderately low or even ultra low carb diet would eliminate the need to inject as much, as you only inject for carbs..........

interesting though..........

*flys off to investigate further*


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## Copepod (Nov 24, 2011)

Enjoyed your analogy with dogging, Trophywench, although I know some males who won't run through certain car parks at certain times, where I am happy to run alone 

I agree that people should do what works for them. 

As an adult, I can decide how many injections to have in a day - in my case, changing from 1 to 2 injections of long acting insulin in each 24 hours, improved my control greatly, and I usually have 3 short acting injections per day, but occasionally eg on trans Atlantic flights or marshalling on expedition adventure races through the night, have 4 or 5 short acting injections in 24 hours.


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## Phil65 (Nov 24, 2011)

trophywench said:


> Well - on a pump the Bolus Wizard takes care of Insulin on Board - we were only discussing this on another thread the other day - I have absolutely no idea whatsoever how to calculate that in, because fast-acting doesn't release itself in a flat curve - during its working time, it rises to a peak and then tails off, so I would have no REAL idea where on the curve of that graph of the last jab, I was at any given time thereafter.
> 
> But Miladdo also used to use 3 insulins - a normal long acting and fast acting, with the addition of Humulin S which is a longer-acting 'fast' one ...... you have got to understand A Lot to combine eg Novorpaid and Hum S successfully.  (I couldn't even combine Hum S with Hum I without losing hypo awareness and crashing me car - so I would have nightmares if that was the only insulin in the world.)  (probably just shoot meself and get it over with)
> 
> Some people still like only 2 jabs a day though, and we respect them, it's their decision anyway.  So if someone else wants to have 12 that's also 100% fine by me.  Come to that - I don't object to other people dogging if that's what floats their boat - just as long as they don't expect me to join in!



You just made me spit my tea out!


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## Pumper_Sue (Nov 24, 2011)

novorapidboi26 said:


> I believe most would rather use the pump for such a regime, the pros outweigh the cons in this situation..........
> 
> And I would of thought being on a moderately low or even ultra low carb diet would eliminate the need to inject as much, as you only inject for carbs..........
> 
> ...



Unfortunately for most type 1's this is not the case. If I just had a protien and fat meal I would need twice as much insulin and over an extended period to cope with it.

Having a balanced diet with carb management allows me to use very little insulin.


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## novorapidboi26 (Nov 24, 2011)

Pumper_Sue said:


> Unfortunately for most type 1's this is not the case. If I just had a protien and fat meal I would need twice as much insulin and over an extended period to cope with it.
> 
> Having a balanced diet with carb management allows me to use very little insulin.




I would never suggest a carb free diet, purely because of ketones, but a low carb diet for most would reduce insulin intake would it not?

Everyone's different, yeah!

Why would your requirements double............?

Would this be basal or bolus.........

You might expect an increase in basal needs maybe......


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## trophywench (Nov 24, 2011)

Cos Sue is Sue - some folk do have to bolus for protein.  

If you do it's alleged to need 50% of what you'd have for the equivalent g of Carbs, and fat is alleged to be 10%.  But as it happens I don't need to bolus for either, just Carbs.  Also, and I have absolutely no idea whether it makes a difference or not, Sue also has Addison's - which may or may not have any effect whatsoever.

Can't remember the last time I actually had anything that didn't contain any carbs - I mean I nick a bit of meat whilst carving it, or lick a spoon or eat the bit of cheese that crumbled off or whatever - but very rare No Carb.


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## Pattidevans (Nov 24, 2011)

novorapidboi26 said:


> I would never suggest a carb free diet, purely because of ketones, but a low carb diet for most would reduce insulin intake would it not?
> 
> Everyone's different, yeah!
> 
> ...


Oooh er... I seem to have started something here!  I only posted to point out that I had got the information regarding Statins from a genuine medical source.  Interesting conversation though.

Novorapidboi - I am 3 weeks into using an insulinx meter which calculates doses for me.  Interestingly I have reduced my total daily bolus from around 30u to around 11u without reducing carbs and without seeing significantly higher BGs - in fact they are only a tad high in the evening and I need to re-set the meter for that time.  OK I am counting carbs more carefully, but even so, my meals are the same as they were previously.  I had heard that you could be on too much insulin, but as I wasn't previously living in hypo city, this has all come as rather a surprise.

The meter takes into account any insulin "still on board" when it makes these calculations together with your current BG level.  So you are much safer if you are actually stacking insulin a bit.  I have my brekkie at 8.15 on a work day and have to have lunch at 12.20 (daft I know, but I do 3hrs 20 mins in one job in the morning and then 3.45 in another in the afternoon) so there you have insulin very slightly stacked.


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## novorapidboi26 (Nov 24, 2011)

There could be many factors resulting in the need to bolus for non carb items I suppose..........

But generally I thought only pumpers did this through lack of slow acting insulin, which in theory mops up the slower absorbed carbs in vegetables and in protein and fat.........and not all pumpers as well............

So if most Type 1s are pumper then yeah........................

This is just what I have been led to believe, but could be a load of codswallop........


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## novorapidboi26 (Nov 24, 2011)

Pattidevans said:


> Oooh er... I seem to have started something here!  I only posted to point out that I had got the information regarding Statins from a genuine medical source.  Interesting conversation though.
> 
> Novorapidboi - I am 3 weeks into using an insulinx meter which calculates doses for me.  Interestingly I have reduced my total daily bolus from around 30u to around 11u without reducing carbs and without seeing significantly higher BGs - in fact they are only a tad high in the evening and I need to re-set the meter for that time.  OK I am counting carbs more carefully, but even so, my meals are the same as they were previously.  I had heard that you could be on too much insulin, but as I wasn't previously living in hypo city, this has all come as rather a surprise.
> 
> The meter takes into account any insulin "still on board" when it makes these calculations together with your current BG level.  So you are much safer if you are actually stacking insulin a bit.  I have my brekkie at 8.15 on a work day and have to have lunch at 12.20 (daft I know, but I do 3hrs 20 mins in one job in the morning and then 3.45 in another in the afternoon) so there you have insulin very slightly stacked.



I also use this meter, its great..............only cons is it doesn't allow you to alter correction factors with regards to BG level...........

How long did you put in your bolus lasts, I said 4 hours, but think its more..?


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## Northerner (Nov 24, 2011)

Pattidevans said:


> ...Novorapidboi - I am 3 weeks into using an insulinx meter which calculates doses for me.  Interestingly I have reduced my total daily bolus from around 30u to around 11u without reducing carbs and without seeing significantly higher BGs - in fact they are only a tad high in the evening and I need to re-set the meter for that time.  OK I am counting carbs more carefully, but even so, my meals are the same as they were previously.  I had heard that you could be on too much insulin, but as I wasn't previously living in hypo city, this has all come as rather a surprise....



Wow Patti, that's an incredible reduction in bolus! Your previous 30 units bolus wasn't that much more than I'm usually on (I'm 22-25 units). Wonder what would happen if I started using one of these meters?


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## novorapidboi26 (Nov 24, 2011)

The meter doesn't really do anything that you cant do on paper.............

I suppose without it you could round up you carbs, not consider on board doses, but it shouldn't really drop your dose significantly, provided your on the right dose initially..........

But I would recommend it Alan.........


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## Pattidevans (Nov 24, 2011)

novorapidboi26 said:


> The meter doesn't really do anything that you cant do on paper.............
> 
> I suppose without it you could round up you carbs, not consider on board doses, but it shouldn't really drop your dose significantly, provided your on the right dose initially..........
> 
> But I would recommend it Alan.........



No, it doesn't do anything you can't do on paper, it just does it a heck of a lot quicker and easier if you have fed it the right information when setting it up, but what I was trying to say was that it showed up the fact that I was taking too much insulin when working it out for myself because I was working on the wrong ratio.  This leads to your liver putting out more glucose and becomes a spiralling effect where you keep on increasing your doses.

It was only at the course we did when it was set up that my ratios were worked out (by me on a formula we were given) and actually they weren't far out and were less than half what I had assumed them to be.


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## novorapidboi26 (Nov 24, 2011)

Pattidevans said:


> No, it doesn't do anything you can't do on paper, it just does it a heck of a lot quicker and easier if you have fed it the right information when setting it up, but what I was trying to say was that it showed up the fact that I was taking too much insulin when working it out for myself because I was working on the wrong ratio.  This leads to your liver putting out more glucose and becomes a spiralling effect where you keep on increasing your doses.
> 
> It was only at the course we did when it was set up that my ratios were worked out (by me on a formula we were given) and actually they weren't far out and were less than half what I had assumed them to be.




Have you done DAFNE?

The end result is good anyway...............I am surprised you didn't go low if you were taking half of what your on now........almost everyone that attends a DAFNE course is on too much background insulin..............how is yours?


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## Ellie Jones (Nov 24, 2011)

Yes Dr Katherine ideology is very much based on Bernstein 

Yep both with MDI and with my old pump I used to mentally have to calculate my IOB..  It's harder with the pump when you are calculating the extended or multi-wave bolus..  And if the truth was know with the pump extended/Multi-wave my IOB was partly based on a gut instinct stab in the dark  But in the 3 years of was using the Spirit I only knowingly stacked my insulin once..  So either my calculation was right or when it comes to a stab in the dark I've got spot of aim

As to the protein/fat I think that with MDI it's impact can be masked by the fluctuations within the basal profile so probably not as noticeable as using a pump where you are working from a much flatter basal profile...  As it can be the not allowing for the protein/fat impact that can cause a lot of control issues for the diabetic..

Now that I've got the Combo pump I do use the bolus wizard makes life easier.

Bernstein doesn't like insulin pumps and for patients like me who are sensitive to insulin and the pump can deliver the minute dosages required..  He instructs them to dilute their insulin to achieve the correct strength/dose rather than use a pump


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## Northerner (Nov 24, 2011)

Ellie Jones said:


> ...Bernstein doesn't like insulin pumps and for patients like me who are sensitive to insulin and the pump can deliver the minute dosages required..  He instructs them to dilute their insulin to achieve the correct strength/dose rather than use a pump



What??? Seems (bordering on) the obsessive to me. So, that's 3 insulins, 20 jabs a day and diluting your insulin, plus an extreme low carb diet....no thanks!


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## novorapidboi26 (Nov 24, 2011)

Ellie Jones said:


> Bernstein doesn't like insulin pumps and for patients like me who are sensitive to insulin and the pump can deliver the minute dosages required..  He instructs them to dilute their insulin to achieve the correct strength/dose rather than use a pump



WOW, I can see that catching on..................


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## Pattidevans (Nov 24, 2011)

novorapidboi26 said:


> Have you done DAFNE?
> 
> The end result is good anyway...............I am surprised you didn't go low if you were taking half of what your on now........almost everyone that attends a DAFNE course is on too much background insulin..............how is yours?



No I haven't done a DAFNE or similar course.  I was diagnosed T2 8.5 years ago by the GPs nurse because of my age.  It was only this summer that I finally got to see an endo who did a CPeptide test and pronounced that I was T1, not just due to the results of the CPeptide, but also to do with symptoms at time of diagnosis (rapid weight loss, ketones) so anything of a diabetic education nature was denied to me.  Having said that, there's not actually much in the way of diabetes education in my neck of the woods - there are currently over 100 people waiting for a course that is 4 x half days.  

Meantime I pretty much educated myself, did the BDEC online course, read John Walsh's "using insulin" and Gary Scheiner's "Think like a Pancreas".  But if all you ever see is the GPs nurse, you don't have a lot of support for working things out, I've had to do it for myself.  Don't get me wrong, as far as it goes the GPs nurse is very good and has certainly been helpful in getting me anything I asked for, including the referral to the Endo when I finally told her that I was having a diabetic identity crisis because I was pretty certain I was mis-diagnosed!

The tide has been turned a bit now and I had an invitation to the insulinx course and then this week a long appointment with the Dietitian to do the start of carb counting, but she said I knew what I was doing re carbs and I don't have to go back unless I want to.  I've also got an appointment with the DSN at the clinic on 6 Dec to review progress since the Insulinx course.

So in answer to your question of am I on too much basal, yes I do believe I am, in fact I know I am.  I have reduced Levemir by 3u at night and 2u in the morning now and things seem to be going well so far.  It needs further reduction and I think that will probably influence bolus ratios yet again since at current levels the basal may be propping the bolus up.  I'm hanging in there until I see the DSN.


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## novorapidboi26 (Nov 24, 2011)

You seem to be doing a great job with the resources you have well done.........if you want to chat about the meter or other issues, ask away.........

How much basal are you on currently?


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## trophywench (Nov 24, 2011)

Can I just lob a comment in here, that Patti is one of the Admins on www.diabetes-support.org which was started by her and TerryG in 2008 due to the forum they (and quite a few of us) were using at that time (Diabetes Insight) when the owner of that one decided to close it.

So it took off when this here forum was still in the planning stages or in its very early days.  

Prior to that - and the emergence of forums! - Patti was a member of the newsgroup ASDUK wher she 'met' the aforesaid TerryG and an Australian bloke called Alan Shanley - he of blog, 'Painless Pricks' and 'What on Earth can I Eat' fame.

If I tried to write a whole Biography of her, we'd be here till next week at least but by heck, you'd be in stitches .......


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## novorapidboi26 (Nov 24, 2011)

trophywench said:


> Can I just lob a comment in here, that Patti is one of the Admins on www.diabetes-support.org which was started by her and TerryG in 2008 due to the forum they (and quite a few of us) were using at that time (Diabetes Insight) when the owner of that one decided to close it.
> 
> So it took off when this here forum was still in the planning stages or in its very early days.
> 
> ...



Nice..............


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## Pattidevans (Nov 24, 2011)

LOL@Trophywench, you have blown my cover!  Seriously though, I often look in here and learn something new.

Novorapidboi - I'm currently on 21u basal (11 & 10u Lev), if my boluses are averaging 11u per day then I think my basal should be around 11u total, however I'm not confident to just bring it down that low in one go, so I'm doing it a bit at a time.  This weekend I am going to try some basal testing, at least overnight and another day in the morning.  I suspect that as the basal comes down I shall need to balance it with ratios, I have a notion that I shall end up with a TDD of around 30 on a 50/50 ish split.

The Insulinx is a bit of a revelation - I would really like to get my hands on an Aviva Expert though for comparison purposes.


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## Northerner (Nov 24, 2011)

Pattidevans said:


> LOL@Trophywench, you have blown my cover!  Seriously though, I often look in here and learn something new.
> 
> Novorapidboi - I'm currently on 21u basal (11 & 10u Lev), if my boluses are averaging 11u per day then I think my basal should be around 11u total, however I'm not confident to just bring it down that low in one go, so I'm doing it a bit at a time.  This weekend I am going to try some basal testing, at least overnight and another day in the morning.  I suspect that as the basal comes down I shall need to balance it with ratios, I have a notion that I shall end up with a TDD of around 30 on a 50/50 ish split.
> 
> The Insulinx is a bit of a revelation - I would really like to get my hands on an Aviva Expert though for comparison purposes.



Interesting Patti. My TDD is split about 25/75 (25% basal!) - seems it's the opposite of yours currently, but about the same TDD! Diabetes, eh?


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## Pattidevans (Nov 24, 2011)

Northerner said:


> Interesting Patti. My TDD is split about 25/75 (25% basal!) - seems it's the opposite of yours currently, but about the same TDD! Diabetes, eh?


Surely our bolus doses depend on what we eat don't they?  I mean I eat more or less the same amount of carbs most days, somewhere between 100 & 120g, but if someone was eating say 250 they'd need more?  I guess you stick to a fairly low carb diet?

I was quite surprised on the morning of the Insulinx induction course when we were told to put down our average TDD and the young woman opposite me was on a total of 80u.  She wasn't overweight and not a teenager.  They then asked us to divide the TDD by 50 to find your carb to insulin ratio (my TDD at the time was 56 and my insulin carb ratio therefore 1.1u) I figured this was a bit odd cos your TDD would depend on the amount of carbs you eat per day.  I have subsequently tweaked my ratios to 1:6g mornings, 1:8u lunch and 1:6u dinner - even so am on lots less insulin than I was.  I wonder if the young woman on 80u TDD has found the same thing.  It would be good to get the people on the induction day back together to see how people have found it but I doubt it will happen.

Q for Novorapidboi re: the meter.  What can you do if you change your mind about what you're eating after you've logged the dose?  i.e. if you suddenly decide to add a biscuit or something?


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## novorapidboi26 (Nov 24, 2011)

I would simply test my blood again, and record it that way, obviously the reading is of no use, but the meter knows this and will only offer you a dose for that item............which will be at your normal ratio if within an hour of your previous injection..............

I am about a 50/50 split also........................

As far as insulin goes I would prefer to have large basal dose alongside small bolus doses............


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## Ellie Jones (Nov 24, 2011)

You just run it through the bolus wizard, and it will tell you whether you need more insulin or not...  And it will be keep tabs of the calculation as you go a long...

The expert meter and Combo remote are both the same with the exception the Combo has the software and bluetooth to communicate with and work the pump..

Is it just your basal insulin or has your bolus insulin dropped as well?

It seems that the HCP like you to have a split in the region of 45/55 or somewhere in this region..  I think that I must sit around 40/60 but a lot will depend on activity levels, if quite active then your basal is going to be a lower than your bolus insulin,,


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## Northerner (Nov 24, 2011)

Pattidevans said:


> Surely our bolus doses depend on what we eat don't they?  I mean I eat more or less the same amount of carbs most days, somewhere between 100 & 120g, but if someone was eating say 250 they'd need more?  I guess you stick to a fairly low carb diet?
> ...



No, what I meant was you said your daily bolus was around 11 units and your levemir about double that - with me it's the other way around, I have far less lantus than novorapid. I started on 20 units of lantus and it has been as low as 3, a reduction of 85% since diagnosis. My novorapid has reduced by about 50% since diagnosis, now around 22-25 units. I tend to eat a similar amount of carbs each day, around 140-180g (creature of habit!)


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## FM001 (Nov 24, 2011)

For the first time in my life I now have a 50/50 split after reducing my lantus down to 18 units yesterday


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## novorapidboi26 (Nov 24, 2011)

toby said:


> For the first time in my life I now have a 50/50 split after reducing my lantus down to 18 units yesterday



So you only have 18 units of bolus roughly........is that low ratios, or low carbs...


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## trophywench (Nov 24, 2011)

novorapidboi26 said:


> As far as insulin goes I would prefer to have large basal dose alongside small bolus doses............



That's puzzled me - why?


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## Northerner (Nov 24, 2011)

trophywench said:


> That's puzzled me - why?



And me - hadn't noticed it earlier! Surely you need the amount of basal you need to cover what happens all day, whether you eat or not, and bolus is just for food? If I increased my basal to a 50/50 split I'd be constantly hypoing


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## trophywench (Nov 24, 2011)

Well exactly, it'd mess all yer ratios up!


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## Pattidevans (Nov 24, 2011)

Ellie Jones said:


> You just run it through the bolus wizard, and it will tell you whether you need more insulin or not...  And it will be keep tabs of the calculation as you go a long...
> 
> The expert meter and Combo remote are both the same with the exception the Combo has the software and bluetooth to communicate with and work the pump..


Ellie I'm not on a pump, we're discussing the Abbot Insulinx meter and how it works which is a little different to the Expert.

I'm not sure why you'd want to be on more basal than bolus unless you are discussing pumping which I couldn't contribute to since I am on MDI.  I find if I get my basal correct then I can do without meals etc but I can't quite get the feel of 75% basal as I'd be hypoing if I didn't eat.


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## Pumper_Sue (Nov 25, 2011)

Northerner said:


> And me - hadn't noticed it earlier! Surely you need the amount of basal you need to cover what happens all day, whether you eat or not, and bolus is just for food? If I increased my basal to a 50/50 split I'd be constantly hypoing



100% Alan, you need what you need nothing more nothing less


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## Robster65 (Nov 25, 2011)

Am I right in thinking that your liver's output will increase if you skip a meal ?

Hence, basal needs are different from normal eating days ?

Rob


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## novorapidboi26 (Nov 25, 2011)

trophywench said:


> That's puzzled me - why?



This is just a preference as opposed to a widespread observation of the basal/bolus split.........

You can only give yourself the right amount of basal, any more and you would hypo.............

I was just stating that I would like to have my maximum basal dose possible, accompanied by bolus doses with small insulin/carb ratios.............

Some MDI users may find they are taking more bolus insulin without realizing its compensating for an inadequate background supply......

Yesterday I worked out my basal/bolus split to be 60/40...............


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## novorapidboi26 (Nov 25, 2011)

Robster65 said:


> Am I right in thinking that your liver's output will increase if you skip a meal ?
> 
> Hence, basal needs are different from normal eating days ?
> 
> Rob



I would of thought that your body would use its stores of energy in the fat and muscle before getting the liver to pitch in................

I suppose if it was a regular thing, the livers output would change.....


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## Robster65 (Nov 25, 2011)

novorapidboi26 said:


> I would of thought that your body would use its stores of energy in the fat and muscle before getting the liver to pitch in................
> 
> I suppose if it was a regular thing, the livers output would change.....


 
But it would still spill glucose into the bloodstream at a rate determined by what the liver thinks we need. Which is unlikely to match what we are randomly doing.

eg. If you skip a meal and go for a walk, the liver may decide you're going to continue walking all day and carry on pushing glucose for an hour after you sit down. Your BG could go up into the teens, overpowering your normal basal needs.
Because, if you have a recent meal in your stomach, your liver will just sit back with its feet up and let your stomach drip feed glucose (depending on GI of course!).
It's something of a grey area for me. I don't skip meals, and don't basal test. I just adjust until I get the BG i want before meals and at 1 or 2 hours.

Rob


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## everydayupsanddowns (Nov 25, 2011)

AFAIK the 50:50 split for basal and bolus is suggested as it is what is seen in those lucky blighters still to have a functioning pancreas (how they worked this out I am not sure).

John (Pumping Insulin) Walsh suggests that most T1Ds will have between 40-60% split basal to bolus. If you notice that yours is outside this he recommends running basal tests to ensure that your needs are what you think they are. Similarly if corrections rise above 8% of TDD he says you should start testing again.

In somecases the recommendation is to begin again from TDD to re-set basal and bolus to 50:50, and reset i:c ratio and sensitivity using those 'rules of thumb' (eg 500 rule etc).

I think I'd have to be getting really dodgy numbers to go that far. As people are saying 'you need what you need'. On the other hand of course Patti would have said a few weeks ago that she 'needs' far more bolus than she is currently taking, and yet readings before/after the same meals seem to be behaving.

This D lark is enough to do your head in that's for sure!


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## novorapidboi26 (Nov 25, 2011)

I can see your logic, but I dont know if the liver responds on a short term basis like this.............

although I may be contradicting myself, as I need to fill my belly in the morning in order to stop the DP, but dont know if this is a totally different process from the usual secretion from the liver............

you dont basal test..............? How so.............?


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## Robster65 (Nov 25, 2011)

novorapidboi26 said:


> I can see your logic, but I dont know if the liver responds on a short term basis like this.............
> 
> although I may be contradicting myself, as I need to fill my belly in the morning in order to stop the DP, but dont know if this is a totally different process from the usual secretion from the liver............
> 
> you dont basal test..............? How so.............?


 
Because I get the results I'm after (on a good day) by doing what I do. It's taken a long time to get there but we've tried to be analytical about the test results. Knowing about what the previous meal does is important and can throw a spanner in if, for example, you see a good BG before tea but it was pasta which could be propping up a high basal dose.

I think the liver does respond fairly rapidly. If you have an empty stomach and you need to ump up and run, it will respond to the stress hormones by squirting some glucose out and continuing to do so after a fairly complex sequence of events involving other hormones and depleting the muscle glycogen, etc.

But it doesn't always know when to stop, so basal needs could be very different for eating/non-eating. This is as I understand it. If I have it wrong, it would be helpful to have it explained in a simple way 

Here, we tend to sit down for a bit, then go off wandering round for a bit and maybe lug stuff about. That would give the liver a good work out.

Rob


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## everydayupsanddowns (Nov 25, 2011)

Not much on this thread about Katherine Morrison any more! Is splitting a split thread a little OTT?


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## novorapidboi26 (Nov 25, 2011)

Robster65 said:


> Because I get the results I'm after (on a good day) by doing what I do.



LOL, very vague, each to their own..............

The basal requirement is the foundation of any insulin regime, how will you know its working without testing......?

I always go Off Topic Mike!,......


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## Robster65 (Nov 25, 2011)

novorapidboi26 said:


> LOL, very vague, each to their own..............
> 
> The basal requirement is the foundation of any insulin regime, how will you know its working without testing......?
> 
> I always go Off Topic Mike!,......


 
Seems to be working for me (also HbA1c ) 

I don't suffer DP or wild swings without explanation normally.

As for Dr Morrison, just reading what's been said about her, she seems to be obsessive. But obv I don't know her. I read it as she was experimenting on her son with a very intensive regime. Have I misunderstood ?

Rob


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## Northerner (Nov 25, 2011)

Robster65 said:


> Seems to be working for me (also HbA1c )
> 
> I don't suffer DP or wild swings without explanation normally.
> 
> ...



I'm afraid that's pretty much how I read it - I can't imagine he came up with that on his own - we've all read stories of how teens/youngsters are reluctant to test/inject at school, can you imagine how 'different' you would feel if you were doing it at the start of every lesson? (In my days, lessons lasted 45 mins, which I believe is the frequency we estimated for the number of jabs/waking hours)

As for basal, I went to bed on 5.6 last night and woke to 5.0 which is pretty much what happens every night, so I know my basal to be spot on. 

As far as I know the liver responds to various stimulants to release glucose, things like glucagon, cortisol etc. - all parts of the wonderful chemical jigsaw of the endocrine system.


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## Robster65 (Nov 25, 2011)

Northerner said:


> I'm afraid that's pretty much how I read it - I can't imagine he came up with that on his own - we've all read stories of how teens/youngsters are reluctant to test/inject at school, can you imagine how 'different' you would feel if you were doing it at the start of every lesson? (In my days, lessons lasted 45 mins, which I believe is the frequency we estimated for the number of jabs/waking hours)
> 
> As for basal, I went to bed on 5.6 last night and woke to 5.0 which is pretty much what happens every night, so I know my basal to be spot on.
> 
> As far as I know the liver responds to various stimulants to release glucose, things like glucagon, cortisol etc. - all parts of the wonderful chemical jigsaw of the endocrine system.


 
I think the basal question may come down to lifestyle choices. I've never really subscribed to the "diabetes needn't change your life" ethic.

I see it as a compromise. Ideally, we should all be eating snacks every couple of hours and injecting small amounts to cover them, alongside a 'pottering' style of exercise. We'd have perfect A1c's.

But real life complicates it by demanding 3 main meals a day and erratic exercise patterns with a lot fo sitting around. So I try to pander to the diabetes as much as I can (be bothered ) but don't expect to be able to do exactly what I want all the time without a few swings high and low.

Like you, my overnight is dropping about 1mmol normally at the mo. That's fine for me. As long as I keep active-ish, my premeals are mainly 4s or 5s and I don't tend to get spikes in between, so I'm happy what I'm doing is working until it all changes again.

Rob


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## HOBIE (Nov 25, 2011)

Dont get the gun out yet Trophy !    Thanks every bod for a good read !!      I love my pump takes a lot of stress out of things !


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## HelenM (Nov 25, 2011)

I would direct you to her site so you could read more about her beliefs but my virus checker says it is unsafe containing 
 2 Drive-by Downloads 


> A drive-by download is computer code that takes advantage of a software bug in a Web browser to make it do something that the attacker wants?such as run malicious code, crash the browser, or read data from the computer. Software bugs that are open to browser attacks are also known as vulnerabilities.



If anyone here is able to contact Dr Morrison it might be a good idea to tell her!


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## trophywench (Nov 25, 2011)

Well let's hope someone does that.


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## mcdonagh47 (Nov 25, 2011)

Robster65 said:


> Seems to be working for me (also HbA1c )
> 
> I don't suffer DP or wild swings without explanation normally.
> 
> ...



I've been aware of Dr. K for 4 or 5 years and her son. And I have always thought that the doodah will probably hit the fan when the boy is old enough to take care of his diabetes for himself.

As for a Doctor haunting the support groups and trading on the Dr. in front of their name, the BMA should look into the professional ethics of that. We dont want Doctors in diabetic support groups  do we ??? Doesnt it defeat the object of diabetics supporting each other.

Isn't this Dr. K the doc associated with the saying, "Its you leg or the bread" ?


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## cherrypie (Nov 25, 2011)

Just google Katharine Morrison and she appears on low carb diabetes blogs and forums as a staunch low carb/high fat supporter and has even used the Atkins diet for herself.  Note the spelling...Katharine as opposed to Katherine in the topic title.


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## mcdonagh47 (Nov 25, 2011)

cherrypie said:


> Just google Katharine Morrison and she appears on low carb diabetes blogs and forums as a staunch low carb/high fat supporter and has even used the Atkins diet for herself.  Note the spelling...Katharine as opposed to Katherine in the topic title.



She has also claimed on support groups to eat 18 eggs a week.....cluck,cluck,squawk, cluck.... I'd be banned for gaseous emissions


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## Northerner (Nov 25, 2011)

cherrypie said:


> Just google Katharine Morrison and she appears on low carb diabetes blogs and forums as a staunch low carb/high fat supporter and has even used the Atkins diet for herself.  Note the spelling...Katharine as opposed to Katherine in the topic title.



I've changed it in the title, thanks cherrypie


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## trophywench (Nov 25, 2011)

McDonagh - I would just say Dr K has most certainly not ever haunted DSF, neither has she ever tried to 'foist' any of her ideas on the members thereof.  She's told us what some of them are.

We also have members who happen to be midwives or psychologists or employment lawyers or plumbers or insurance brokers - but primarily they are diabetics!

None of them give professional advice, although admittedly I did ask the plumber by PM if he could tell me something we needed to know about our central heating boiler - and he was very helpful !  LOL


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## mcdonagh47 (Nov 25, 2011)

trophywench said:


> McDonagh - I would just say Dr K has most certainly not ever haunted DSF, neither has she ever tried to 'foist' any of her ideas on the members thereof.  She's told us what some of them are.



Where did you get the word "foist" from ? Not from me.
Who mentioned DSF ?  not me.

By all means ask a plumber for advice on a support group but dont ask a Doctor on a Support Group for advice on your diabetes, it would be simply unprofessional of them to give advice on your case without having access to your medical file.


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## everydayupsanddowns (Nov 25, 2011)

mcdonagh47 said:


> ...As for a Doctor haunting the support groups and trading on the Dr. in front of their name...



Errrrrrr......


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## Robster65 (Nov 25, 2011)

I don't really have a problem with doctors on support forums, especially if they're prepared to clarify medical facts that mere mortals may not have access to.

I'm concerned about her homeopathic interests. But she doesn't seem to be advocating them for diabetes management.

All in all, I dont think I would have trust in her but clearly other people do.

Rob


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## trophywench (Nov 25, 2011)

Wonder how much cake she eats then (18 eggs)  LOL

Depends what you do with the eggs before you eat em really, as to whether gaseous emissions follow or not!


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## FM001 (Nov 25, 2011)

I'm confused with this thread  is she a practising gp or not?


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## Robster65 (Nov 25, 2011)

Last summer I was eating up to 3 poached eggs a day on toast for tea. Obviously, my emissions are classified and cannot be discussed on an open forum 

But the worst thing was the BG rising 3 or 4 hours later and staying elevated into the night.

I stopped eating them after a while and miss them terribly. 

Rob


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## Robster65 (Nov 25, 2011)

toby said:


> I'm confused with this thread is she a practising gp or not?


 
http://www.ballochmylemedicalgroup.co.uk/staff.asp

Rob


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## FM001 (Nov 25, 2011)

Robster65 said:


> http://www.ballochmylemedicalgroup.co.uk/staff.asp
> 
> Rob




Cheers Rob


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## Pattidevans (Nov 25, 2011)

To my knowledge "Katharine" is a member of at least 3 diabetes support forums and posts as a member, as a parent with a diabetic son.  She does not use the title Dr.  I can't remember how I found out she was a Dr some years ago but obviously I did.  I don't recall her ever trying to push her theories.  She would tell you how her son managed his diabetes but not suggest you should follow suit.  I've found some of her knowledge very helpful from time to time.  I also found her a pleasant and helpful member.

I don't think it's fair to castigate her for doing things she hasn't (to my knowledge) done.


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## mcdonagh47 (Nov 25, 2011)

time to close this thread ? Dr. K is clearly a divisive figure and one we shouldn't spend too much time discussing.


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