# Correction doses



## Natalie123 (Mar 7, 2011)

Hi all,

I know very little about correction doses and wondered if anyone can give me some tips! When I was first diagnosed I was told to only take insulin with meals and not to correct for hypers. In the end I got fed up with feeling ill when I was high and started to correct slightly. 

My GP recently said that there is nothing wrong with correcting but that I usually over correct, starting a high - low - high - low ... cycle. I have never actually been told how to go about correcting and wondered how quickly would you expect your sugar levels to go back down after correcting and how much would you take? I usually take 2 - 4 units if I am 15 or 16 and check every 30mins / hour but this is usually after dinner in the evening and I then sometimes have a night time hypo.


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## Copepod (Mar 7, 2011)

If you haven't seen a diabetes specialist nurse, then can you ask your GP to refer you to a clinic where you can consult one? They can go through all aspects of your ratios, injection timings etc, much better than anyone on this board.

Not sure what insulin regime you are using, but realistically, it's only possible to correct when on basal bolus regime (long acting insulin once or twice a day, plus short acting insulin with meals).


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## Northerner (Mar 7, 2011)

It's a very good question Natalie!  Corrections can vary from person to person, and also their effect can vary according to other circumstances, such as time of day, whether you are high because of an illness or infection etc. 

As such, you need to discover for yourself just what ratio you need to use as your correction factor, just as you would for your food bolus ratios. Some people find that 1 unit will bring levels down 3 mmol/l, others find that it will only bring them down 1 mmol/l - some may need more. As discussed elsewhere this morning, if the correction dose is large due to very high levels, then it may not be as efficient as a smaller dose. 

It sounds like you have a fairly good idea of what your correction factor is, but you need to be careful about correcting when you already have insulin 'circulating', as it probably will be for up to 4 or 5 hours after your meal bolus. This is known as 'stacking insulin' - you've already injected what you expect to cover your meal carbs, but then discover your levels are high a couple of hours later, so you correct, then end up hypo because the overall amount of insulin you have injected is too much for your carbs. It's better to try and reduce that spike by perhaps injecting, say, 15 mins prior to eating so the insulin has a chance to get working as your food is being digested.


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## Robster65 (Mar 7, 2011)

Hi Natalie.

I've never attended a course, so not sure how to work it out, but we read somewhere that 1u would correct 2mmol/l and the DSN suggested 1:2.5mmol/l, so I work on that for corrections.

If you do 3 or 4 units at about 15, I can see why you may go hypo. I would stick with 2 at the most. I do sometimes go with 1u but it's such a hit or miss dose that it's not always worth trying. 

I've found that half an hour on Wii tennis is a good substitute if I'm not too high to exercise.

Rob


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## Natalie123 (Mar 7, 2011)

Hi again, Thanks for all the advice! I am on levemir twice a day and apidra before meals. Northerner - this sounds like what I am doing, stacking insulin, I will try to inject a bit earlier before dinner in future as I do tend to spike very quickly after meals - in the first half an hour or so after eating, sometimes I drop quickly after this especially at lunch but in the evening it tends to drop down a lot slower.


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## novorapidboi26 (Mar 7, 2011)

Everyone else has explained the concepts perfectly, but the main issue for me personally with corrections is the fact I need more the higher I am, which is most likely the same for everyone.

I actually have 4 correction ratios, if you can call it ratio, for 4 different ranges of blood glucose amount. It took a lot of testing and trial and error to work them out.

Say if you woke up high one morning and missed breakfast through lack of appetite and corrected, you can actually work out how much your correction dose has dropped you from your lunchtime reading, then you can establish how much 1 unit is dropping you at that level of blood glucose. Would give you a good place to start.

I would definitely speak to your team about it as they should be able to explain it better with your results in front of them....


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## everydayupsanddowns (Mar 7, 2011)

Natalie

Looks like you've had some good thoughts already. The only thing which occurs to me is to consider the profile of your insulin.

As far as I know (and everyone will be different so you really need to work this out for yourself) Apidra is likely to have a quick-in-quick-out profile for most people. Not sure whether there are other Apidra users who can share their experiences, but I know someone on another forum whose experience is that Apidra is pretty much 'done' after 3 hours. 

Understanding/trying to work out your own body's onset (before anything happens), peak activity, and duration (number of hours after which you know it'll have finished) is really valuable when trying to avoid stacking, time your doses to squash spikes and generally get the best out of it. You can usually look up the manufacturer's expectation of the insulin profile online, but as with everything - Your Diabetes May Vary 

Good luck!
M


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## chrismbee (Mar 7, 2011)

In the evening I correct at 1 unit per 1 mmol, BUT (here's where it gets tricky) I have been caught out before because your BG test is only an instant thing, so you don't necessarily know what your sugars are trending at, at the time ie. are they stable, rising or falling?
In addition to factors already mentioned above, your rate of absorption of food is linked to your activity, so if you ate a meal then slobbed in front of the telly, then you could quite possibly be higher than you expect 2,3 or even 4 hours later.  Trouble is that the insulin you took with the meal may have actually been sufficient, so an extra bolus could very well drop you into a hypo later.
One way of guessing whether it is activity-based absorption that has affected your BG is to re-examine what you ate, concentrating on the GI of the food that you had, before considering what bolus correction dose to use eg. increased fat content will slow down absorption anyway.
The other thing to consider is "Hobbs Law" (aka. sod factor) which can throw all reasoned logic out of the window! 
The hospital-based DSN's that I used to see were absolutely against correction boluses - the fact that I have been doing this to a greater degree of success resulted in us having to agree to disagree. Thing is, they aren't diabetics themselves and rely on text books, medical references and experiences of other patients - but we're all different, aren't we?


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## Phil65 (Mar 7, 2011)

Robster65 said:


> Hi Natalie.
> 
> I've never attended a course, so not sure how to work it out, but we read somewhere that 1u would correct 2mmol/l and the DSN suggested 1:2.5mmol/l, so I work on that for corrections.
> 
> ...




Rob,

Natalie needs to see her DSN for advice on correction doses/ratios, many people are wildly different.  I adjusted an unusual high of 17 (post breakfast this morning ) with 10 units of humalog and by lunchtime I was 4.2


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## novorapidboi26 (Mar 7, 2011)

Phil65 said:


> Rob,
> 
> Natalie needs to see her DSN for advice on correction doses/ratios, many people are wildly different.  I adjusted an unusual high of 17 (post breakfast this morning ) with 10 units of humalog and by lunchtime I was 4.2



How long after your breakfast was that...........? What went wrong?and have you had another low this afternoon?


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## Phil65 (Mar 7, 2011)

novorapidboi26 said:


> How long after your breakfast was that...........? What went wrong?and have you had another low this afternoon?



2 hours after breakfast (porridge with a bit of golden syrup, counted carbs, not an unusual breakfast) DP maybe.........been fine since, no probs


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## scanz (Mar 7, 2011)

I was going to ask about correction because my readings after dinner and before bed are always high. I've been put on a fixed basal bolus regime with novarapids of 10 units before breakfast, 8 at lunch, 10 for dinner and then 14 lantus before bed (or 11pm which is what i've been sticking to each night). During the past 10 days since leaving the hospital my readings before breakfast and lunch are okay and are getting lower day by day, but as I say after dinner/before bed I haven't been below 10.8 and average around 14. 

Now it could be what i'm eating/amount i'm eating as I am still learning and i'm not going to lie i'm finding it difficult not to nibble. So I may wait until I meet my dietitian on Friday before taking any action in regards to how many units I take. However, if i'm constantly getting high numbers in the evening surely I need to increase the amount of units? As I keep reading, it's all about trial and error as we are all different and this makes me want to try and 'correct', but then I think I should just stick to my fixed units and listen to the doctors.


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## Natalie123 (Mar 7, 2011)

Hi, When I was first diagnosed I spoke to my DSN every few days - she was brilliant, I read out my test results down the phone and she would advice me what to do with the insulin. It sounds like you need to put up your dose before dinner maybe by 1 unit but I would discuss with your diabetes specialist nurse first maybe over the phone if you have a long wait until your next appointment. An average of 14 is high but being newly diagnosed it will take a while to find the right dose - sounds like you are doing well so far though


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## Northerner (Mar 7, 2011)

scanz said:


> ...if i'm constantly getting high numbers in the evening surely I need to increase the amount of units? As I keep reading, it's all about trial and error as we are all different and this makes me want to try and 'correct', but then I think I should just stick to my fixed units and listen to the doctors.



How long do they want you to stay on fixed units, and do they ever suggest changes to the amounts? I was on fixed doses of NR initially, but rang the DSN several times a week with my readings and she suggested changes to the doses. It certainly does look like you need more for your evening meal, so it's worth getting in touch with the DSN and asking what you should do - no point in running high for the sake of a little adjustment


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## everydayupsanddowns (Mar 7, 2011)

Scanz

Forgive me, you've hit a bit of a sore spot with me. Have your team told you to eat a certain number of grams of carbs at each of your meals?

Simplistically, for every diabetic 1u of insulin will process x grams of carbs (10g say). So if your doses are fixed, then all your breakfasts (or whatever) need to hit the same carb value. Has insulin action been explained to you in this way?

M


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## Northerner (Mar 7, 2011)

everydayupsanddowns said:


> Scanz
> 
> Forgive me, you've hit a bit of a sore spot with me. Have your team told you to eat a certain number of grams of carbs at each of your meals?
> 
> ...



When I was first diagnosed there was no account taken of how much carb was in my meals, nor was I told how much to eat. Crazy, I now know, but I seemed to cope just about until I learned to carb count.


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## everydayupsanddowns (Mar 7, 2011)

But that's the thing isn't it Northie... If (as a carb counter) you take the same number of units every day, that MUST mean you are eating the same number of grams of carbs. Just specifying fixed doses is a complete nonsense. Those doses will equate to an amount of carb at each meal. It only remains for scanz to work out what level that is.


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## scanz (Mar 7, 2011)

Northerner said:


> How long do they want you to stay on fixed units, and do they ever suggest changes to the amounts? I was on fixed doses of NR initially, but rang the DSN several times a week with my readings and she suggested changes to the doses. It certainly does look like you need more for your evening meal, so it's worth getting in touch with the DSN and asking what you should do - no point in running high for the sake of a little adjustment


They haven't said how long i'll be on the fixed units for. My next appointment with my DSN isn't for a few weeks and i'm meeting my dietitian on Friday, but perhaps I should call my DSN and see what they say? Or just wait to see my dietitian - she actually gave me more information about diabetes than my DSN did.. 



everydayupsanddowns said:


> Scanz
> 
> Forgive me, you've hit a bit of a sore spot with me. Have your team told you to eat a certain number of grams of carbs at each of your meals?
> 
> ...


No, they haven't said to eat a certain amount of carbs and yes, I understand that 1 unit of insulin equates to 1 CP/10g carbs. I've been doing my best to 'carb count', but i'm still learning.


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## shiv (Mar 7, 2011)

scanz said:


> No, they haven't said to eat a certain amount of carbs and yes, I understand that 1 unit of insulin equates to 1 CP/10g carbs. I've been doing my best to 'carb count', but i'm still learning.



I think that's Mike's point - 1u =/= 10g carbs. It's a starting point for lots of people (you have to start somewhere of course!) but in reality, everyone needs different things, and often people need different ratios at different times of day! I used to be on 1:5g for breakfast, 1:7g for lunch and 1:10g at tea time.

Definitely ring the dietician and DSN


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## Robster65 (Mar 7, 2011)

Just to add a note to what you said earlier about nibbling. That's always going to be a bit of a naughty one but on MDI with proper carb counting, you can, in theory have snacks and inject to cover them.

If you are eating in between meals, you are better off trying not to do this, at least until you get a better feel for how your food and insulin affect your BGs.

Rob


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## scanz (Mar 7, 2011)

Robster65 said:


> Just to add a note to what you said earlier about nibbling. That's always going to be a bit of a naughty one but on MDI with proper carb counting, you can, in theory have snacks and inject to cover them.
> 
> If you are eating in between meals, you are better off trying not to do this, at least until you get a better feel for how your food and insulin affect your BGs.
> 
> Rob


Yes, I need to cut out the snacks. I've read up a bit about the GL Diet and making more filling meals, going to try a few things this week.

Out of curiosity, how often do you all see/speak to your DSN? I feel like I should be seeing/speaking to them more often...


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## Robster65 (Mar 7, 2011)

For me it's probably every 6 months or sooner if needing advice.

I think when I was first diagnosed it had a health visitor come round weekly but the NHS was a different beast then ! 

Rob


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## shiv (Mar 7, 2011)

I see mine every few months, but if you are newly diagnosed, I would ask to see them as frequently as possible (unless of course you don't have anything to ask or discuss!). Mine is pretty flexible - I can usually call the week or two before I want to see her to get an appointment - not like the consultant which can take months.


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## scanz (Mar 7, 2011)

Hmm okay, thanks. I think i'll wait to see my dietitian on Friday and in the mean time try as hard as I can to cut out the snacks, make more filling meals and see how it goes.


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## Natalie123 (Mar 7, 2011)

Scanz, let us know how the more filling meals go! Where did you find the information on the GL diet and meals from? I am always hungry and find I snack a lot too - I could do with cutting down a bit! I find I have to snack before meals sometimes as I need the carbs to stop me having a hypo.


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## shiv (Mar 7, 2011)

Natalie123 said:


> Scanz, let us know how the more filling meals go! Where did you find the information on the GL diet and meals from? I am always hungry and find I snack a lot too - I could do with cutting down a bit! I find I have to snack before meals sometimes as I need the carbs to stop me having a hypo.



Have you spoken to someone about the hypos? I'm really sorry, I can't remember - are you on a basal/bolus regime? If so, you shouldn't be eating to feed the insulin - the insulin should match what you are eating.


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## Northerner (Mar 7, 2011)

Natalie123 said:


> Scanz, let us know how the more filling meals go! Where did you find the information on the GL diet and meals from? I am always hungry and find I snack a lot too - I could do with cutting down a bit! I find I have to snack before meals sometimes as I need the carbs to stop me having a hypo.



These are good books about the GL Diet:

http://www.diabetessupport.co.uk/boards/showthread.php?t=7719


http://www.diabetessupport.co.uk/boards/showthread.php?t=7337


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## Natalie123 (Mar 7, 2011)

Yea, I'm on levemir and Apidra. I have spoken to lots of people about it. I think my insulin seems to last longer than my food. I was changed to Apidra from Novorapid as it apparently acts quicker and wears off quicker too. It helped a bit much not a huge amount. My DSN last told me that it seems I will have to keep snacking to keep the sugars up otherwise I go too high after meals. At the moment I go up to about 13 after breakfast from 6ish and then drop rapidly to 6 again about 2 hours later.


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## Robster65 (Mar 7, 2011)

Hi Natalie

What do you eat for breakfast out of interest ?

Rob


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## Natalie123 (Mar 7, 2011)

Northerner said:


> These are good books about the GL Diet:
> 
> http://www.diabetessupport.co.uk/boards/showthread.php?t=7719
> 
> ...


Thanks! Will have to get one or both! Any idea which would be best for a veggie who eats fish? Don't worry if you don't know, I can usually adapt recipes anyway.


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## Natalie123 (Mar 7, 2011)

Robster65 said:


> Hi Natalie
> 
> What do you eat for breakfast out of interest ?
> 
> Rob


Rob, Usually 2 slices of granary toast and either a poached egg or tomatoes/mushrooms. I used to eat cereal branflakes or shredded wheat) but this was really bad, I tried yogurt with nuts, seeds and fruit but I got too hungry and it didn't help much anyway. Any suggestions would be much appreciated (I don't eat meat though)!


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## Robster65 (Mar 7, 2011)

My suggestion was going to be my amazing muesli/yoghurt combo but you've spoilt it now ! 

I don't know of anything lower GI-wise.

Rob


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## Natalie123 (Mar 7, 2011)

the museli and yogurt combo is good though  sorry for spoiling things for you!!


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## scanz (Mar 7, 2011)

Natalie123 said:


> Thanks! Will have to get one or both! Any idea which would be best for a veggie who eats fish? Don't worry if you don't know, I can usually adapt recipes anyway.


Both are excellent books Natalie. They are what i've been reading, both very easy to read and explain everything in simple terms. Both contain really good ideas/recipes which can be adapted to meet your needs. They can be picked up on the Amazon market for reasonable prices


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## Robster65 (Mar 7, 2011)

The basics of slowing down digestion and therefore absorption seem to be to keep starchy carbs in big lumps (potatoes, etc) and to eat higher GI foods with fats (in moderation) or proteins with seeds, nuts, etc that are hard to digest and slow it all down.

I would imagine the classic fry up is about as slow as it gets but not terribly healthy.

Seedy toast with poached eggs is quite slow btu I've just discovered that eggs raise BG also and need to be accounted for in the bolus. May be something you could experiment with ?

Rob


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## Natalie123 (Mar 7, 2011)

oh - I didn't know about eggs raising BG! You learn something new everyday here


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## Robster65 (Mar 7, 2011)

I think I read it on here ages ago but didn't believe it, but since I eat a lot of eggs I've found out the error of my ways.

One of the more knowledgeable members may be able to clarify. I'd be interested to find out more myself.

Rob


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## Northerner (Mar 8, 2011)

Natalie123 said:


> oh - I didn't know about eggs raising BG! You learn something new everyday here



It's one of those things about diabetes that doesn't apply to everyone. Some people find that they need to inject for an egg as though it is 5g carbs, although many others find it has no effect on their levels.


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## FM001 (Mar 8, 2011)

Natalie123 said:


> oh - I didn't know about eggs raising BG! You learn something new everyday here





In theory they shouldn't raise blood glucose, a large egg contains 0.2g of carbohydrate and doesn't need to be covered by insulin.  Eggs are a source of protein and protein on its own without carbohydrates would require a bolus dose, but eating toasted bread with eggs should only need enough insulin to cover the carbs in the bread.  

Correction doses between meals are not advisable according to the people behind dafne, the exception to this would be when blood glucose is above 13 where ketones are possible danger such as times of illness.  The dangers of injecting between meals is the insulin overlaps which can cause hypoglycemia 2 or 3 hours later, according to dafne a 1 unit correction is enough to lower blood glucose by 2-3 mmol/l but I find that this can vary depending upon the time of day.  I personally don't inject between meals and wait until my next meal to correct, experience has taught me that my previous unexplained highs and lows were in part due to correcting higher than normal bg's and having to treat with glucose afterwards.


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## Northerner (Mar 8, 2011)

That's pretty much my experience too Toby. I have only corrected or injected between meals half a dozen times since diagnosis nearly 3 years ago! Diabetes is complicated enough, and corrections or extra boluses just make it impossible for me sometimes!


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## FM001 (Mar 8, 2011)

Northerner said:


> That's pretty much my experience too Toby. I have only corrected or injected between meals half a dozen times since diagnosis nearly 3 years ago! Diabetes is complicated enough, and corrections or extra boluses just make it impossible for me sometimes!





Pleased I am not the only one then, in fairness my dsn did tell me this for years but I did not take on board her advice until I seen the light.


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## Phil65 (Mar 8, 2011)

everydayupsanddowns said:


> But that's the thing isn't it Northie... If (as a carb counter) you take the same number of units every day, that MUST mean you are eating the same number of grams of carbs. Just specifying fixed doses is a complete nonsense. Those doses will equate to an amount of carb at each meal. It only remains for scanz to work out what level that is.



It soooooooo winds me up when I hear stories like this!!! And utterly amazes me to how common this is, almost as bad as a DSN or consultant asking how much insulin do you take!!!! insulin/carbs.......not rocket science, why fixed doses for so long!!


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## chrismbee (Mar 8, 2011)

Phil65 said:


> It soooooooo winds me up when I hear stories like this!!! And utterly amazes me to how common this is, almost as bad as a DSN or consultant asking how much insulin do you take!!!! insulin/carbs.......not rocket science, why fixed doses for so long!!




My reply to the stock question at clinic about how many units you take:
"Uh, anywhere between 2 and 20 - depends on what I'm eating and what my BG is".
S'pose this should be followed up by:
"Yeah, I am alive, my brain does function"
but I fear the irony would be lost on them


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## Phil65 (Mar 8, 2011)

chrismbee said:


> My reply to the stock question at clinic about how many units you take:
> "Uh, anywhere between 2 and 20 - depends on what I'm eating and what my BG is".
> S'pose this should be followed up by:
> "Yeah, I am alive, my brain does function"
> but I fear the irony would be lost on them



LOL, similar to my response.....but mine's a bit ruder!


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## Northerner (Mar 8, 2011)

I'm always puzzled by that, they know I count carbs! My consultant just picked an average for each meal and recorded that. The thing is though, that even those numbers aren't always a true reflection of the kind of doses I am having. For example, my insulin doses have dropped by approx 45% over the past couple of weeks as I am exercising more, so it would be Hypo City if I was given the old doses for any reason!


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## Robster65 (Mar 8, 2011)

It illustrates how the whole structure of diabetes care is firmly rooted in the past. There are beacons of excellence here and there led by progressive consultants/DSNs/GPs but the grass roots are way behind. DUK should really be leaning heavily on this instead of sending out leaflets and hoping they're read and understood. 
Maybe a few threatened prosecutions for medical negligence ?

Rob


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## Phil65 (Mar 8, 2011)

Northerner said:


> I'm always puzzled by that, they know I count carbs! My consultant just picked an average for each meal and recorded that. The thing is though, that even those numbers aren't always a true reflection of the kind of doses I am having. For example, my insulin doses have dropped by approx 45% over the past couple of weeks as I am exercising more, so it would be Hypo City if I was given the old doses for any reason!



Fixed doses also means you can't take an extra jab to cover an ice cream on a nice sunny afternoon (without going high) or any other carb treat!


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## Robster65 (Mar 8, 2011)

Phil65 said:


> Fixed doses also means you can't take an extra jab to cover an ice cream on a nice sunny afternoon (without going high) or any other carb treat!



It also encourages a bad relationship with food. I hated mealtimes through most of my teenage life. To be forced to eat a set amount at a set time is a surefire way of giving someone an eating disorder.

Rob


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## shiv (Mar 8, 2011)

It's why I still eat breakfast even if I don't want to. I have eaten breakfast pretty much every single day of my life, because as a child and a teen I did not have a choice in the matter. I obviously know now I don't have to force it down, but most of the time I eat anyway regardless if I want to or not!


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## Robster65 (Mar 8, 2011)

Apart from being ill and incapable, I don't think I've ever missed a main meal since I was nearly 14. I enjoy food now but at one time it was a chore.

Could JDRF do anything to publicise the bad side of fixed dose regimes ?

Rob


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## shiv (Mar 8, 2011)

Ahh, probably not. None of us are trained medical professionals are thus can't give advice on what regime is better than the other.


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## everydayupsanddowns (Mar 8, 2011)

Just to play devil's advocate (and I agree that asking what your doses are these days is a bit silly)... I CAN see some sense in it. Sort of.

My appetite doesn't really change that much. More often than not a balanced meal for me contains a not dissimilar amount of carbs, with a reasonably regular dose (trips to the chippy/takeaways/eating out notwithstanding). 

So even though I calculate each meal I find it easier and more effective to eat relatively regular amounts of food.

If my 'normal' doses rose steadily over a number of years it would seem to indicate some sort of other issue (insulin resistance perhaps).

Yes they *should* be asking about our ratios, not our doses, but I suspect many diabetics they see in clinic would give a completely blank look if asked what their i:c ratio was.

M


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## Robster65 (Mar 8, 2011)

In which case, it's back to DUK to do something proactive. I can see certain reasons why healthcare pros want newly diagnosed to get used to the routine of injecting and eating regularly so they and the patient can see things settle, but it could be done with MDI in a slightly more rigid way, then loosened up as knowledge is gained.

Grrr.

Rob


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## Robster65 (Mar 8, 2011)

everydayupsanddowns said:


> Yes they *should* be asking about our ratios, not our doses, but I suspect many diabetics they see in clinic would give a completely blank look if asked what their i:c ratio was.
> 
> M



Which illustrates how poor the education system is and how much they need to be dragged into the 20th, let alone 21st century !! 

Rob


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## shiv (Mar 8, 2011)

Whenever they used to ask me how much insulin I'd take at each meal, I'd be straight with them and tell them that it varied at different times of day, how much I was eating, what I was eating, etc. They usually just went with a middle figure to work off.


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## shiv (Mar 8, 2011)

Robster65 said:


> In which case, it's back to DUK to do something proactive. I can see certain reasons why healthcare pros want newly diagnosed to get used to the routine of injecting and eating regularly so they and the patient can see things settle, but it could be done with MDI in a slightly more rigid way, then loosened up as knowledge is gained.
> 
> Grrr.
> 
> Rob



I kind of agree, but the one thing that always plays on my mind is that at some hospitals (I think it's Leeds and UCLH) they put children onto pumps at diagnosis, which clearly shows they do not feel that fixed doses etc are the best way to do it for newly diagnosed children, nor are they necessary to gain the best control.

I agree that perhaps having a slightly rigid diet to begin with - as you say just to get a feel for what and how things work - is not a bad idea. But it's really down to the individual - if you want to carry on as before diagnosis and eat what you want, you need to learn pretty quickly how to match insulin to that food! That also requires a supportive and proactive team though.


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## Robster65 (Mar 8, 2011)

Agreed Shiv 

All fixed doses will do is to put people off because it's too regimented or get them hooked on the routine and scared to adjust once on MDI (as I was for years and you with your meals).

Rob


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## shiv (Mar 8, 2011)

When I worked in the hospital, I met a man who had been on 2 x daily injections for something like 60 years. He was too scared to change over to MDI. I understand that - that's why I was on fixed doses until I was 18! I was scared to change. But I'm so glad I did, I can't imagine life like that again 

Just thinking outloud here, so ignore the rambling. When you're diagnosed as an adult, I think it's totally down to the person as to how they approach it - you get a lot of people who are very scared by the diagnosis (quite understandably) and will just do as their health care professional says to the letter, and you get others who are really proactive and want to carb count etc so they can continue eating as before. I think each point of view needs to be respected, but to encourage everyone to look at MDI at a minimum to allow best control. End ramble!


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## Phil65 (Mar 8, 2011)

shiv said:


> When I worked in the hospital, I met a man who had been on 2 x daily injections for something like 60 years. He was too scared to change over to MDI. I understand that - that's why I was on fixed doses until I was 18! I was scared to change. But I'm so glad I did, I can't imagine life like that again
> 
> Just thinking outloud here, so ignore the rambling. When you're diagnosed as an adult, I think it's totally down to the person as to how they approach it - you get a lot of people who are very scared by the diagnosis (quite understandably) and will just do as their health care professional says to the letter, and you get others who are really proactive and want to carb count etc so they can continue eating as before. I think each point of view needs to be respected, but to encourage everyone to look at MDI at a minimum to allow best control. End ramble!



Good post Shiv


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## Phil65 (Mar 8, 2011)

Robster65 said:


> In which case, it's back to DUK to do something proactive. I can see certain reasons why healthcare pros want newly diagnosed to get used to the routine of injecting and eating regularly so they and the patient can see things settle, but it could be done with MDI in a slightly more rigid way, then loosened up as knowledge is gained.
> 
> Grrr.
> 
> Rob



Totally agree Rob!


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## Phil65 (Mar 8, 2011)

Robster65 said:


> Which illustrates how poor the education system is and how much they need to be dragged into the 20th, let alone 21st century !!
> 
> Rob



Correct again!........unfortunately!!


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