# New and feeling like I’m never gonna get there.



## Chris04 (Jul 13, 2020)

Hi everyone.  I was rushed into hospital at the end of March, seriously ill.  I don’t actually remember much about it.  I had had a bad cough for three weeks, which needed antibiotics but didn’t seem to improve.  I started being really sick and couldn’t keep anything down.  When I got to the stage where I was slurring my speech and rambling, my husband and daughter sent for an ambulance.  I think they thought I had Covid.  The hospital told them they would phone them every hour but it didn’t look good.
All I remember is a doctor, in PPE coming to me and telling me I had tested negative for Coronavirus.
It was only when I was on the main ward, I was told I had diabetes and one of my kidneys had stopped working.
I also had fluid in my lungs.  To cut a long story short. after a week I was sent home ”for my own safety” as we had Covid patients
on the ward.
The hospital consultant diagnosed me as type 2.  Firstly saying I would be on tablets but at the last minute that was changed to insulin.
In the last couple of weeks that has been changed to type 1...not definite but that’s what they think.
No matter how much I count carbs, I can’t seem to get my levels stable.
I thought I was beginning to see some hope last week but then I took a bad UTI.  The gp prescribed antibiotics but my levels just kept rising.  Then Sat they were at 27 and my ketones were 2.7.  I didn’t know what to do.  I took the extra 2 that the booklet I got said to do but still it wouldn’t come down.  There was no one to ring.  I tried the helpline the nurse had given me but it said it was no longer available.  In desperation I phoned dalriada..  The doctor was very concerned and told me to go to the hospital right away which I did.  Luckily I brought my testing kits with me as the doctor wanted to admit me right away....I honestly did not want to go back into hospital....so I asked her if I could test them again before she would ring the ward.  When I did...they were down..both glucose and ketone...so she said she was relieved and let me go home with a promise to ring them before bed...or earlier if things started to go wrong again.  I decided to just keep taking 2 extra units every 2 hours and I have thankfully reached today.  Unfortunately I finished the antibiotics today and I’m still stinging,  thankfully it’s nowhere near as bad as it was but it’s not away and levels are still quite high.  Ketones are down though so I’m not as worried.
Thing is...I take recurrent UTI’s.  Will this happen every time?   What are the safest antibiotics to take.  I am feeling totally overwhelmed at the minute.  My life is revolving around this.  I haven’t started back to work yet as I work with special needs kids but when we do...I don’t know if I will be able to do it.  I’m sorry for the long winded post.  Just feeling a bit down today.


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## everydayupsanddowns (Jul 13, 2020)

Hello @Chris04 and welcome to the forum!

My goodness! what a story you have been living through. It sounds extremely stressful and worrying for you.

I suspect the sequence of illnesses you have had have made things extremely difficult to get any kind of stability. Illness, and even simply recovering from illness or injury typically requires increased insulin doses. But insulin is a tricksy beast and needs treating with caution, and increases need to be made carefully to avoid potentially disastrous hypos.

This can mean a bit of fire fighting and corrections from time to time. And it can be very useful to have a ‘sick day rules’ framework to help you.






						Sickday rules pdf
					

Sick day rules flowchart from Leicester diabetes centre. Particularly useful for people with Type 1 Diabetes during the Coronavirus outbreak.




					www.t1resources.uk
				




Hopefully your UTIs (which are more common when BG is elevated, and elevate BG in turn... vicious circle!) will settle down and leave you alone soon.


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## Chris04 (Jul 13, 2020)

Thank you.   I will definitely look at this.


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## trophywench (Jul 13, 2020)

Two things that help when you have very high ketones are 1. Extra insulin, and you need as much as you need, there are no rules almost as to how much more - you just need to keep testing your BG at least every 2 hours and 2. drinking as much plain unadulterated tap water as you can stomach, interspersed with the odd cup of freshly brewed tea but best to stay off coffee with a UTI as that alone can irritate the bladder.  You will absolutely spend a lot more time weeing and will be uncomfy for a while until the UTI subsides a bit BUT ketones can kill us though UTIs can't generally - so afraid that's just tough.

With all my years diabetic - I was pretty gobsmacked to say the least when I had to increase my long acting insulin up to 300% when I broke a kneecap - ketones of 4 to begin with then quite a few days over 3, and it took nearly 3 months to get it back down to what it was before I fell over.

So yeah - you certainly are firefighting and if it was hard for me with 45 years experience under my belt - it's going to be far harder for you.  Don't try to fight it - please try to just go with the flow of what you need to do when you need to do it.

Now - which insulins and what doses of them are you on?


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## leonS (Jul 14, 2020)

You are to be congratulated - you did  rvery thing right, Increased the insulin, frequent testing, got help by phone, went to A&E.

With more experience and much more nerve you might have increased the insulin even more, but basically what you did worked.

Well done.


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## Ditto (Jul 14, 2020)

Hello and welcome to the forum @Chris04


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## Chris04 (Jul 15, 2020)

Thank you everyone for your help.  I haven’t replied before because my daughter broke her toes? going upstairs. She didn’t want to go to A & E so she strapped them together and has been trying to manage.  Then last night her husband broke his foot...don’t ask...he simple fell off the bottom stair.  What is it with them and stairs lol.  The have a four year old son so it’s pretty difficult at the minute.  He went to hospital and has to go back Friday.  I wanted to go round to help but she won’t hear tell of it.  She’s more concerned about me.  Anyway enough...i am on Novorapid (counting carbs) and Toujeo 9 units plus Metaformin at night.  I originally came out of hospital with Novomix but no matter how I tried, I couldn’t stabilise my BS.  I either was sky high or having a hypo. To be honest the Toujeo seems to do nothing...usually increases levels. Unfortunately, with the Covid 19 stilL out there, I can’t attend any clinics or training sessions.  I so appreciate your help.  Thank you.


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## leonS (Jul 15, 2020)

The Toujeu insulin is not supposed to bring your levels down. Ir is used to replace or supplonent the trickle of insulin that is needed all the time to allow all the cells of the body ro use glucose as a fuel so that they can do what ever it is that they are supposed to do.

If the dosage is correct BG should not go up or down by very much when there is no food (carbs) being digested and no Novorapid insulin active.

The Novorapid should take care of meals and can also be used to adjust BG levels. You need some numbers:

How much Toujeu to inject each day.

Carb to insulin factor; for each ten gms of carb inject X units of insulin.

Correction factor: one unit of insulin will change BG by X mmol/L.

These numbers are provided as pure guess work by your HCT and WILL need adjustment, a log of food, insulin, and BG tests will be needed to allow this to be done


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## Chris04 (Jul 16, 2020)

Goodness it’s so overwhelming.  I have so much to learn.  I know I was told to take 1 unit of insulin for every 10 carbs,  also to correct by 1 for every 3 over 10.  That’s it.  I have been doing this to the best of my ability.  I have never been told how to bring BG levels down if they are very high...only to eat 4 jelly babies if I have a hypo.  This  worries me because I take frequent hypos and just before I took the UTI I took one which wouldn’t come up, so I had to take 3 lots of jelly babies.  If i keep that up I’ll end up the size of a house.  Of course then it shoots upl. How on earth do you do it?  I feel so inadequate.


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## leonS (Jul 16, 2020)

Actually you do know, sort of, how to bring your high levels down. They  are saying one extra unit of insulin will bring the level down by 3 mmol/L. They are also saying do not bother to correct unless your BG is over 10 mmol/L. So if you test before a meal and the result was 13 just add one extra unit to the pre-meal dose to correct this high. You can correct a low too; subtracting one unit from the dose will cause a rise of 3 mmol/L.

A good number to know is your jelly baby to BG convertion factor. ie one JB will raise the BG by X mmol/L. This will allow you to know how many JBs ro eat. Remember JBs take time to work so I set the kitchen timer for 15 (or 20) mins and only test when it rings. If it's more than 4, fine, just test again in half an hour. It is easy to panic and eat like a demented Billy Bunter. How do you find this factor? - suck one and see!

Complicated? Yes, but in a few weeks you will wonder what the problem was.


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## trophywench (Jul 16, 2020)

Ah - and I will say - CHEW the JBs, don't try and swallow them mega fast - because the glucose in them (or anything else) starts being absorbed via the insides of the cheeks when the teeth and saliva get going.  Some people on here didn't know that, hence why I'm repeating it.  

Those JBs are intelligent, they know why diabetics ae eating them - yet some of our 'gang' have been biting their heads straight off and swallowing them whole and thus never heard the JBs shouting 'Eat me slower!' or  'Chew me!'

They laugh and giggle like we're tickling them, when we eat them properly.

As Michael Caine (never) used to say, 'Not a lot of people know that'.


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## Chris04 (Jul 16, 2020)

Lol no I do chew them....I like jelly babies lol. But thank you for making sure... and I will work out how much 1 of them raises my BG.  It feels so good to be able to talk to people who know what they are doing.  I still have the infection and have a few more days of antibiotics ahead.  If my levels are over 15 but my ketones are ok, should I take extra insulin between meals to bring BG down or just leave it and correct at next meal.  I’m sorry..I know no body expects the Spanish Inquisition lol ..but I’ve a million questions...as you can see lol.


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## everydayupsanddowns (Jul 17, 2020)

Chris04 said:


> Lol no I do chew them....I like jelly babies lol. But thank you for making sure... and I will work out how much 1 of them raises my BG.  It feels so good to be able to talk to people who know what they are doing.  I still have the infection and have a few more days of antibiotics ahead.  If my levels are over 15 but my ketones are ok, should I take extra insulin between meals to bring BG down or just leave it and correct at next meal.  I’m sorry..I know no body expects the Spanish Inquisition lol ..but I’ve a million questions...as you can see lol.



It will be interesting for you to take a look at how they work for you. The ‘baseline’ suggestions you have been given

1u = 10g carbs
1u = 3mmol/L drop in BG 

also generally have an expectation that

10g carbs = 3mmol/L rise in BG

But these are just general guides, and part of improving your diabetes management involves a bit of experimentation and seeing how those are actually working for you in practice.

For instance... you may discover that at breakfast for you

1u  = 8g carbs or...
1u = 12g carbs

Which is not quite so easy to work out in your head! But if you generally eat the same breakfast each day you can do the sums on a calculator and just use that dose 

If you would like some help and support with this style of diabetes management thereis a free online course you can do called BERTIE





						Welcome - BERTIE Online
					






					www.bertieonline.org.uk


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## leonS (Jul 17, 2020)

Do I correct now of wait 'till the next pre-meal injection is due?
It depends. First on the clock, if the meal is due soon then add. If it is a long way off extra dose. If it is bedtime the extra dose, but be careful that you do not over treat.

Did you test too soon and have some short acting insulin still working? - better perhaps not to treat at all in this case. Did you miss a dose or get the dose wrong? - perhaps better to inject a correction sooner rather than later. You will need to test again later.

Do NOT expect perfection and under treat both highs and lows rather than over treating them, until you get more knowldge
pf how things work for YOU - if it works for YOU most of the time then it is right.


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## trophywench (Jul 17, 2020)

@Chris04 - I reckon 1 JB ought to increase the BG by 1.0, as it is generally reckoned that a menage a trois of em is 10g carb.  (which is exactly the same as 3 from a tube of Rowntree's fruit pastilles)


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## SB2015 (Jul 17, 2020)

Hi @Chris04 Welcome to the forum.  Sorry you have needed to join but it is a good place for help, advice and support.

One thing I do is have a 15 min alarm after treating a hypo.  I get very impatient with them, especially if I am busy.  The alarm makes me wait and avoids me testing too early and then over treating the hypo and shooting up after.  It still seems like an age, but really helps.


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## Bruce Stephens (Jul 17, 2020)

trophywench said:


> I reckon 1 JB ought to increase the BG by 1.0, as it is generally reckoned that a menage a trois of em is 10g carb.



According to the packet I happen to have by me, 4 Jelly Babies are 21g (so 3 would be around 15g).


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## trophywench (Jul 17, 2020)

Ah! - fat little ^^&&$&£%s !


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## leonS (Jul 17, 2020)

Yes, but what 10 gms does is a personal thing, according to my SDN it raises the BG by between 3 and 7 mmol/L.


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## Bruce Stephens (Jul 17, 2020)

leonS said:


> Yes, but what 10 gms does is a personal thing, according to my SDN it raises the BG by between 3 and 7 mmol/L.



Yes, like everything else, it depends. The general advice for a hypo is 15g, wait 15 minutes, and test again. (Testing with a test strip, since Libre or similar won't show anything for another 15 minutes or so.)

But someone following a low carb diet (and taking very little bolus insulin) might reasonably do something radically different. (One person I met treated her hypos with a handful of nuts.)


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## Chris04 (Jul 17, 2020)

everydayupsanddowns said:


> It will be interesting for you to take a look at how they work for you. The ‘baseline’ suggestions you have been given
> 
> 1u = 10g carbs
> 1u = 3mmol/L drop in BG
> ...


Thank you.  I will.


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## Chris04 (Jul 17, 2020)

SB2015 said:


> Hi @Chris04 Welcome to the forum.  Sorry you have needed to join but it is a good place for help, advice and support.
> 
> One thing I do is have a 15 min alarm after treating a hypo.  I get very impatient with them, especially if I am busy.  The alarm makes me wait and avoids me testing too early and then over treating the hypo and shooting up after.  It still seems like an age, but really helps.


I do this.  I set the alarm then it scares the life out of me lol.


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## Chris04 (Jul 17, 2020)

Thank you everyone.  I will try and take onboard everything you have said.  I attended an online webinar today by Freestyle Libre.  Talking about keeping your BS in the green.  Apparently it should ideally be there 70% of the time....mine is 25% at the minute.  Granted that is with the infection.  I am trying very hard...and trying to learn as much as I can. I really appreciate all your help.


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## SB2015 (Jul 17, 2020)

Chris04 said:


> Thank you everyone.  I will try and take onboard everything you have said.  I attended an online webinar today by Freestyle Libre.  Talking about keeping your BS in the green.  Apparently it should ideally be there 70% of the time....mine is 25% at the minute.  Granted that is with the infection.  I am trying very hard...and trying to learn as much as I can. I really appreciate all your help.


Chris as a newly diagnosed it would be a miracle if you were managing to get 70% in range.
This takes time and there are plenty of us that will wobble from this frequently.
With an infection it is even harder to achieve and levels just go bonkers.
Be patient.  This is a marathon not a sprint.

Just keep asking questions.  Tap into the experience on here.
I know that I have learnt most of what I know about my D management from others on here.


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## leonS (Jul 17, 2020)

Perhaps she had very big hands.

Thirty grms of nuts contains about 1-3 grms of carbohydrate depending on type (cashews contain a bit more at 6 grms). This is not going to be all quick acting sugar either.

So don't try this at home!

A hypo is a hypo no matter how you got there. The body will respond to a hypo and raise the BG by releasing hormones to make the liver pump out glucose. This may be what was happening here.


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## Bruce Stephens (Jul 17, 2020)

leonS said:


> Thirty grms of nuts contains about 1-3 grms of carbohydrate depending on type (cashews contain a bit more at 6 grms). This is not going to be all quick acting sugar either.
> 
> So don't try this at home!



It was a group meeting with a couple of the DSNs and the dietician did roll her eyes a bit at that, saying that it wouldn't work for many people.


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## Chris04 (Jul 17, 2020)

SB2015 said:


> Chris as a newly diagnosed it would be a miracle if you were managing to get 70% in range.
> This takes time and there are plenty of us that will wobble from this frequently.
> With an infection it is even harder to achieve and levels just go bonkers.
> Be patient.  This is a marathon not a sprint.
> ...


Thank you for your encouragement ...I was feeling a bit down earlier but I’m fine now.


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## SB2015 (Jul 17, 2020)

For the first two weeks I was just given a target of stay in single figures if you can.
They don’t rush into getting lower levels as your body needs to adjust back to ‘normal’ after a big shock fo DKA?

As I learnt more I gradually got more idea of what I was doing.  I quickly realised that the more I ate the higher my levels went, so started to think about carbs, and adjusting the Bolus (Novorapid) doses. you are already well down that road.  

You are doing very well, and you are not alone.  Folks in here will help in any way that they can.
Give yourself a pat on the back and just keep the questions coming.
We are here for you.


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## Chris04 (Jul 17, 2020)

SB2015 said:


> For the first two weeks I was just given a target of stay in single figures if you can.
> They don’t rush into getting lower levels as your body needs to adjust back to ‘normal’ after a big shock fo DKA?
> 
> As I learnt more I gradually got more idea of what I was doing.  I quickly realised that the more I ate the higher my levels went, so started to think about carbs, and adjusting the Bolus (Novorapid) doses. you are already well down that road.
> ...


Thank you so much.  I weighed and counted everything tonight ...and I’ve just had a hypo.  If I’m reading this right, because it’s happened a few times at night, I may have to reduce my carb to insulin ratio before evening meal.  Would that be right?


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## SB2015 (Jul 18, 2020)

Good morning @Chris04 .   In general when analysing what happens to my levels I tend to blame any weird results within four hours of a meal in my carb ratio.  Outside that time I would be looking at my background insulin.

For my carb ratios I was started on a ratio of 1:10, but found I needed less than that.  So I took my ratio up to 1:11, and so on until it was right.  Not sure what your Maths is like but putting the carb number up will mean you end up with less insulin.  I also find I needed different amounts of insulin at different times of the day.  I range from 1:10 in the morning to 1:14 in the evening, but remember we are all different.  I also found that reducing the amount of carbs I ate at meals (when we started counting carbs we realised just how many we were eating!!) the doses of insulin were smaller so if I got things wrong with carbs or if my ratios were out  a bit it had less impact on the smaller doses.
I may have gone into overload so will stop.
(Who needs Sudoku to keep the brain active when you have T1!!)

At this stage Chris, keep in close contact with your DSN.  They are there to help you and will want to keep a check on things.  When is your next follow up appointment?


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## Chris04 (Jul 18, 2020)

Good morning @SB2015. I have been trying to contact her for weeks.  She last said to me..phone me next week and we’ll see about increasing your Toujeo.  I rang and left a message but she didn‘t reply.  I phoned again after I took the infection because my ketones were up and left a message telling her but she still hasn’t replied.  Her message on the answering machine has changed to say they are busy but will deal with things in order of priority.  I guess she’ll get back to me when she can.  Other than that I don’t have any appointments.


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## everydayupsanddowns (Jul 19, 2020)

Bruce Stephens said:


> According to the packet I happen to have by me, 4 Jelly Babies are 21g (so 3 would be around 15g).



Yes I think when I did some weighing once of the JBs in the larger bags they were 5-6g each, so 15-18g for a trio.

There are also smaller JBs in the little ‘funsize’ bags though which might be more like the size you were thinking of @trophywench ?


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## SB2015 (Jul 19, 2020)

Chris04 said:


> Good morning @SB2015. I have been trying to contact her for weeks.  She last said to me..phone me next week and we’ll see about increasing your Toujeo.  I rang and left a message but she didn‘t reply.  I phoned again after I took the infection because my ketones were up and left a message telling her but she still hasn’t replied.  Her message on the answering machine has changed to say they are busy but will deal with things in order of priority.  I guess she’ll get back to me when she can.  Other than that I don’t have any appointments.


I do remember that they felt I was trying to run before I could walk just after my diagnosis, and they wanted me to ‘slow down’ a bit.  However ....

If you get no reply on Monday, I think I would try emailing the consultant or at least copy him in to an email you send the DSN.  I didn't realise for a while that here they are in the same part of the hospital.  Sometimes I find this approach prompts a response from one or the other.  However I realise it may be different where you are.  Just keep trying.


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## Chris04 (Jul 19, 2020)

SB2015 said:


> I do remember that they felt I was trying to run before I could walk just after my diagnosis, and they wanted me to ‘slow down’ a bit.  However ....
> 
> If you get no reply on Monday, I think I would try emailing the consultant or at least copy him in to an email you send the DSN.  I didn't realise for a while that here they are in the same part of the hospital.  Sometimes I find this approach prompts a response from one or the other.  However I realise it may be different where you are.  Just keep trying.


Possible.  I don’t think I’ll email though cause I don’t want to pester them.  I’m sure she’ll get back to me at some point.  You guys are helping me a lot anyway.  My levels are staying up round 23/24.  Ketones are 0.1 though so i’m not panicking.  I take extra insulin and I have a hypo so I’m just trying to get the adjustment right.  The infection hasn’t gone so I will have to ring GP in morning to see if i need yet more antibiotics.  Thanks again.


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## trophywench (Jul 19, 2020)

Your BG is 23/24?  That's horrifically high!  You can't go on like that.

For God's sake ring the hospital!


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## SB2015 (Jul 19, 2020)

Chris if your levels are in the 20s don’t wait for them to ring you.Get some help.  

I am amazed that your ketones are as low as they are.
You are yo-Yoing at present from high to low.  You need help to to get that oscillation lower.


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## Chris04 (Jul 19, 2020)

When Dalrihada sent me to hospital last weekend, the doctor there, once levels had come down, said not to worry about my levels’s going high as long as my ketones were ok.  I will try and get the nurse again tomorrow and see what she says.  Thank you everybody.


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## trophywench (Jul 19, 2020)

You've mentioned this dalriada a couple of times - what is it?


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## NotWorriedAtAll (Jul 19, 2020)

trophywench said:


> You've mentioned this dalriada a couple of times - what is it?


I googled it and I think it is an out of hours GP service in Northern Ireland.


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## trophywench (Jul 19, 2020)

NotWorriedAtAll said:


> I googled it and I think it is an out of hours GP service in Northern Ireland.



Ah - Bing told me it was an ancient name for part of Scotland!  We may all be part of the UK, but the health service in NI is nothing whatever like it is in the other 3 countries.


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## Chris04 (Jul 20, 2020)

NotWorriedAtAll said:


> I googled it and I think it is an out of hours GP service in Northern Ireland.


You are absolutely right...it is our “Out of hours”


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## Chris04 (Jul 20, 2020)

trophywench said:


> Ah - Bing told me it was an ancient name for part of Scotland!  We may all be part of the UK, but the health service in NI is nothing whatever like it is in the other 3 countries.


You think the doctor at the hospital was wrong?


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## trophywench (Jul 20, 2020)

I'm just very concerned about how much damage to your body the constantly too high BG is wreaking, Chris.

I'd be dead on my feet if mine were that high for more than an hour.  Anything above approx 14 my meter beeps at me and tells me to check for ketones, cos it's the ketones that cause organs to fail since they literally turn the blood acidic.


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## Chris04 (Jul 20, 2020)

trophywench said:


> I'm just very concerned about how much damage to your body the constantly too high BG is wreaking, Chris.
> 
> I'd be dead on my feet if mine were that high for more than an hour.  Anything above approx 14 my meter beeps at me and tells me to check for ketones, cos it's the ketones that cause organs to fail since they literally turn the blood acidic.


I phoned my GP this morning and she has prescribed different antibiotics. She told me to phone the nurse about the high levels.  So I tried again but I only got the answering machine.  My Ketones are still ok,  though how I don’t know.  I am trying to bring the levels down.. I know I need my Toujeo adjusted but the nurse told me weeks ago not to adjust it.  She said then that she would look at it again the following week but that never happened.  I think if she doesn’t get back to me. I will raise it by 1 myself.  Do you self adjust your long lasting insulin?


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## rebrascora (Jul 20, 2020)

Hi Chris

Yes many of us adjust our basal (long acting) insulin ourselves but the nurses like us to have been on an intensive course like DAFNE (Dose Adjustment For Normal Eating) or whatever your local equivalent is, which gives you information on how and when to adjust it. Toujeo is a very long acting insulin and it may take a day or 2 or even 3 for any change to take effect. They normally start you on a very conservative dose to begin with to bring your levels down slowly and then increase it steadily to bring your readings more down into range once they see how you are reacting to it. I would say that it is up to you if you want to try an increase of one unit if the nurse still doesn't get back to you but if you do decide to do that, make sure you have plenty of time over the next 2-3 days and plenty of test strips to monitor your BG regularly to keep you safe and you should not increase it again within that 3 day period at least. 
These are really difficult times so whilst you shouldn't be left to try to manage this yourself, I don't think it would be unreasonable to do so if you are not getting any response from the people who are supposed to be helping you. Just be very cautious if you do decide to increase it. 
Make sure if you leave another message not to address it to one specific person (ie a named DSN) as they may not be available and make sure to say that it is urgent and you have left several messages before over the past few weeks and no one has got back to you.
Good luck and keep us posted with whatever you do and any problems that arise.


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## Chris04 (Jul 20, 2020)

rebrascora said:


> Hi Chris
> 
> Yes many of us adjust our basal (long acting) insulin ourselves but the nurses like us to have been on an intensive course like DAFNE (Dose Adjustment For Normal Eating) or whatever your local equivalent is, which gives you information on how and when to adjust it. Toujeo is a very long acting insulin and it may take a day or 2 or even 3 for any change to take effect. They normally start you on a very conservative dose to begin with to bring your levels down slowly and then increase it steadily to bring your readings more down into range once they see how you are reacting to it. I would say that it is up to you if you want to try an increase of one unit if the nurse still doesn't get back to you but if you do decide to do that, make sure you have plenty of time over the next 2-3 days and plenty of test strips to monitor your BG regularly to keep you safe and you should not increase it again within that 3 day period at least.
> These are really difficult times so whilst you shouldn't be left to try to manage this yourself, I don't think it would be unreasonable to do so if you are not getting any response from the people who are supposed to be helping you. Just be very cautious if you do decide to increase it.
> ...


Thank you so much.  I will wait and see if anyone phones just incase.  They have me on the waiting list for DAFNE but understandably it will probably not happen for a while.


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## trophywench (Jul 20, 2020)

@Chris04 - there is another such course, which was licensed by the NHS for delivery to Type 1 diabetics, but teaches the same skill - ie Dose Adjustment For Normal Eating.

The alternative course is called BERTIE and is available online!





						Welcome - BERTIE Online
					






					www.bertieonline.org.uk
				




I did the original version of this (some of us were involved in the Beta testing of it) just before I did the official course at my hospital which was based firmly on BERTIE but local courses have to have a different name, so the Coventry etc course is CARBS 4 1.

I would still recommend you do the 'real' one even if you complete the online course - you pick up as much from other folks' lived experiences as you do from the 'Theory' info.


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## trophywench (Jul 20, 2020)

PS - yeah ! to the extra 1u Toujeo.  Try it and test test test.   'Suck it and see' indeed! - accept that you are the guinea pig in an experiment and enjoy the voyage of discovery.


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## Ian Brown (Jul 20, 2020)

Hi Chris04,

I've used cranbury capsules for UTIs before, or the light juice has a slightly lower sugar content. It might help. I believe it changes the PH of the urine and helps kill the bugs.

Beware the fructose content though.  I don't know of a sugar free brand, maybe someone else here does.

Best of Luck


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## Bruce Stephens (Jul 20, 2020)

trophywench said:


> I would still recommend you do the 'real' one even if you complete the online course - you pick up as much from other folks' lived experiences as you do from the 'Theory' info.



Yes, the interacting with other people matters, as do discussions with the people running it: they can give answers to specific questions. (I understand DAFNE online is supposed to be starting shortly, so for some people that'll be an option.)


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## everydayupsanddowns (Jul 20, 2020)

Chris04 said:


> I phoned my GP this morning and she has prescribed different antibiotics. She told me to phone the nurse about the high levels.  So I tried again but I only got the answering machine.  My Ketones are still ok,  though how I don’t know.  I am trying to bring the levels down.. I know I need my Toujeo adjusted but the nurse told me weeks ago not to adjust it.  She said then that she would look at it again the following week but that never happened.  I think if she doesn’t get back to me. I will raise it by 1 myself.  Do you self adjust your long lasting insulin?



If you are on ABs, the underlying infection could well be wreaking havoc with your BGs.

Have you been working through ‘sick day rules’ to help adjust your doses?






						Sickday rules pdf
					

Sick day rules flowchart from Leicester diabetes centre. Particularly useful for people with Type 1 Diabetes during the Coronavirus outbreak.




					www.t1resources.uk


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## Chris04 (Jul 21, 2020)

Thanks everyone.  I received a call today from the diabetic nurse in charge, who looked after me when I was in hospital.  He has increased my Toujeo from 9 to 11.  I’ve to wait and see how it goes until Thursday, then if it’s still above 10 in the mornings, I’ve to increase it again to 12 and ring them next week.  I am experimenting with the ratio to see if that helps.  I wasn’t sure if I should still be following the Sickday rules or not as my ketones are not up.  My BS was 14 this morning which was definitely an improvement and they have stayed (15 at one point) around there.  It’s not great I know but definitely an improvement.  I will look into BERTIE.  You have all been so helpful...I’m not sure what I would’ve done without you to be honest.  Thank you again.


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## SB2015 (Jul 21, 2020)

Hi @Chris04 

I have two tables which I follow, one is for high BG, and the other for sick days.
Whatever is happening I follow the rules to get the levels back down.  Like @trophywench I feel very rough when I am above 14 so just want them back down ASAP.  (Having said that I was wondering why my level was at 18 when I got the podiatrist!!  I had calculated my insulin for the whole cheese scone but failed to deliver it!!  We all wobble at times)

Glad that they have advised in the increase of your Touejo and you have a plan for the next week.
Keep in touch.


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## Chris04 (Jul 22, 2020)

SB2015 said:


> Hi @Chris04
> 
> I have two tables which I follow, one is for high BG, and the other for sick days.
> Whatever is happening I follow the rules to get the levels back down.  Like @trophywench I feel very rough when I am above 14 so just want them back down ASAP.  (Having said that I was wondering why my level was at 18 when I got the podiatrist!!  I had calculated my insulin for the whole cheese scone but failed to deliver it!!  We all wobble at times)
> ...


More questions lol.  You say you have a table for high BG.  Can you tell me what I’m supposed to do if my levels are high after the infection totally goes? I mean before the UTI, my BG was higher thank it should have been.  I was counting everything etc but the nurse never gave me any way to bring it down So I assumed I had to put up with it until it came down itself.  After learning on here I realise that was wrong.


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## rebrascora (Jul 22, 2020)

Getting your basal dose right will probably bring it down so hang fire with any bolus insulin corrections until you get that basal insulin dose sorted.... as I said it will take up to 3 days to settle once you increase it, so see how that goes first.


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## SB2015 (Jul 22, 2020)

Hi @Chris04

It sounds like the increases in your basal insulin are beginning to have an impact.

Have a look back at the link in @everydayupsanddowns post.  Mine is much the same using the quick acting to correct errors I make in other things.  This gives you general formulas to use. Is your nurse still saying nothing about doing corrections to bring high levels down?  It will take some time to get the basal insulin sorted but I would want her to advise you on what to do in the meantime. You should be taught how to do corrections with the quick acting insulin.  Please keep asking about this.

Do the sick day rules that you have been given tell you how to increase your insulin to bring them down.  The difference between my charts that include ketones is simply the frequency at which I would do a repeat check on BG. Mine then advises me how to work out a correction.  We are not allowed to advise on changes to your doses,  we can only refer your to general advice.  Hence we keep telling you to go back to your DSN.  However you have picked up the idea that there are strategies that they can teach you and that people would not choose to stay high.

You will get there.


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## everydayupsanddowns (Jul 23, 2020)

Chris04 said:


> I was counting everything etc but the nurse never gave me any way to bring it down So I assumed I had to put up with it until it came down itself.  After learning on here I realise that was wrong.



It might be helpful to ask your nurse about ‘correction factors’, which is an extra snifter of insulin that is added to the calculated meal dose to attempt to reduce any extra glucose above your ideal ‘mid range’ BG before your meal.

Even better you could ask about a ‘smart meter’ or bolus calculator which your Nurse can help you set up, and which helps calculate doses with more subtle ratios and correction factors, which you can then round up or down to either units or half-units depending on the pens you have. They can really help take the faff out of the whole calculation business


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## Chris04 (Jul 23, 2020)

Hi everyone.  The other nurse told me about adjusting ratios.  I don’t have half units on my pens so difficult to increase by 1 eg 1 in 11, has to be 1 in 12 to make any real difference.  I just wondered if you have to wait until mealtime,  or can you adjust in between ....or  if your BS starts soaring at bedtime?  I’ve never heard of a “smart meter”. But I will definitely ask the nurse, if I get speaking to her.


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## trophywench (Jul 23, 2020)

So .... let's tell you how to fathom out your own carb to (fast acting) insulin ratio and correction jab doses.

Test BG before you eat.  Now calculate the carbs in something easy, eg a slice of bread or two biscuits - just read the wrapper.  Let's say 20g carb.  Eat it and see how much it increases your BG by testing hourly after, and seeing when it stops increasing. 

Similarly for correction doses, when BG is higher than you want inject 1u of fast acting and test test test exactly the same.  How quickly does it reduce your BG and by how much?

I know that 1 unit of Novorapid reduces my BG by 3.0 on the meter, and therefore also know that for each 10g carb, I need 1u insulin - because 10g carb eaten without any Novorapid increases my meter reading by 3.0.


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## Chris04 (Jul 23, 2020)

Th


trophywench said:


> So .... let's tell you how to fathom out your own carb to (fast acting) insulin ratio and correction jab doses.
> 
> Test BG before you eat.  Now calculate the carbs in something easy, eg a slice of bread or two biscuits - just read the wrapper.  Let's say 20g carb.  Eat it and see how much it increases your BG by testing hourly after, and seeing when it stops increasing.
> 
> ...


That’s great thanks.  I have to increase my basal to 12 tonight (is still reading high...13 first thing) so I’ll see what my BS is like in morning.  This makes things a lot clearer.


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## Chris04 (Jul 24, 2020)

Help!  The nurse from the hospital told me if my morning BS was still above 10..I had to increase my basal from 11 to 12.  I did that last night...and I had 3 hypo’s during the night and today I can’t get my BS to stay up.  Crawls up for a little while then drops again.  I have eaten that many jelly babies, I would be happy if I never saw another one.  Is this the Basal causing the lows, or is there something else going on?


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## rebrascora (Jul 24, 2020)

Hi Chris

How long did you give the previous increase to work before increasing again. Toujeo can take a long time for any changes to have their full effect, so it may well be the further increase in basal which is responsible and possibly a bit of honeymoon effect where your pancreas is trying to be helpful and chucking out a bit of insulin itself here and there which can make things pretty unpredictable. 
Morning fasting readings can also be affected by Dawn Phenomenon which might be showing a higher reading than it should be in reality... ie a falsely high reading. When do you take that reading? ... before you get out of bed or just before breakfast or somewhere in between? DP effects people in different ways. Some see a steady increase from the early hours (particularly at this time of year when dawn is early) and others like myself don't see our BG start to rise due to DP until we get out of bed. I have to take 2 units of NR as soon as I get up every morning to counteract DP plus whatever I need to cover breakfast. 
If it was me I would drop my basal insulin back down again by one unit and then investigate any possible DP effect in the morning, but be aware you may continue to struggle with hypos tonight until that extra dose of Toujeo gets out of your system.... that would be my thoughts.
Good luck and perhaps have some full sugar coke or orange juice to hand instead of the jelly babies for through the night as liquid sugar is sometimes quicker to take effect and easier than chewing sweets when you wake up in the night.


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## Chris04 (Jul 24, 2020)

rebrascora said:


> Hi Chris
> 
> How long did you give the previous increase to work before increasing again. Toujeo can take a long time for any changes to have their full effect, so it may well be the further increase in basal which is responsible and possibly a bit of honeymoon effect where your pancreas is trying to be helpful and chucking out a bit of insulin itself here and there which can make things pretty unpredictable.
> Morning fasting readings can also be affected by Dawn Phenomenon which might be showing a higher reading than it should be in reality... ie a falsely high reading. When do you take that reading? ... before you get out of bed or just before breakfast or somewhere in between? DP effects people in different ways. Some see a steady increase from the early hours (particularly at this time of year when dawn is early) and others like myself don't see our BG start to rise due to DP until we get out of bed. I have to take 2 units of NR as soon as I get up every morning to counteract DP plus whatever I need to cover breakfast.
> ...


I have no idea to be honest.  I have struggled for weeks with high BS, now I can’t get it to stay up at all.  I took the increased basal for 3 days like the nurse said to but it was still 13/15 in mornings...which is an improvement but he told me to increase it if it was over 10.  The basal is the only thing I can think would be doing it.  I have had a load of hypos today.  It goes up and I think...great...then not long later its down again.  I usually take my levels as soon as I come down in the mornings.  Same time every morning.  According to the nurse I am not getting DP.  I will reduce the basal back down to 11 tonight. I have ordered the MiaoMiao because now I am worried incase I take one during the night and don’t realise.  Thank you for your advice...I appreciate it.


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## rebrascora (Jul 25, 2020)

Hi Chris. 
How did you manage last night going back to the lower dose and how are things going today? Hope things are a bit steadier.
Not sure how the nurse can be sure you are not getting DP.... or do you have a Libre?


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## everydayupsanddowns (Jul 26, 2020)

Hope things have settled for you over the weekend @Chris04 

Lots of hypos in a day like that can be scary, and exhausting!


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## Chris04 (Jul 26, 2020)

everydayupsanddowns said:


> Hope things have settled for you over the weekend @Chris04
> 
> Lots of hypos in a day like that can be scary, and exhausting!





rebrascora said:


> Hi Chris.
> How did you manage last night going back to the lower dose and how are things going today? Hope things are a bit steadier.
> Not sure how the nurse can be sure you are not getting DP.... or do you have a Libre?


Hi all,  Yes I found it very scary to be honest.  My BS went high again around Midnight so I guess it was the basal.  I’m back on 11 and my BS is back to being high in the mornings.  I am finding it all very confusing.  I really don’t know if I am ever going to be able to do this.  I do everything I’ve been told but I still can’t get it right. Sorry just feeling a bit down today.  I’ve got to ring the nurse sometime this week so we’ll see what happens. They are so busy though so I am not counting on speaking to anyone.   I don’t know what I would have done without this forum and that’s the truth so I thank you all.  Yes, by the way, I have a Libre.


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## everydayupsanddowns (Jul 26, 2020)

Chris04 said:


> My BS went high again around Midnight so I guess it was the basal. I’m back on 11 and my BS is back to being high in the mornings.



Ugh! Sounds really grim 

Have you thought about using either Levemir with 2 different basal doses a day, one for overnight and one for daytime?

Or an insulin pump, with a fully flexible basal pattern?


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## rebrascora (Jul 26, 2020)

I agree with Mike that it may be that the profile of Toujeo just doesn't correspond with your basal needs and a split dose of Levemir would allow you to adjust your daytime and night time basal insulin separately to get a better balance. I need less than half the basal insulin at night than I do during the day so I inject 5 or 6 units of Levemir at night and 16 in the morning to keep me on a levelish playing field. I wouldn't manage on Toujeo at all. Ask the nurse about changing basal insulin.


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## Chris04 (Jul 26, 2020)

everydayupsanddowns said:


> Ugh! Sounds really grim
> 
> Have you thought about using either Levemir with 2 different basal doses a day, one for overnight and one for daytime?
> 
> Or an insulin pump, with a fully flexible basal pattern?


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## Chris04 (Jul 26, 2020)

everydayupsanddowns said:


> Ugh! Sounds really grim
> 
> Have you thought about using either Levemir with 2 different basal doses a day, one for overnight and one for daytime?
> 
> Or an insulin pump, with a fully flexible basal pattern?





rebrascora said:


> I agree with Mike that it may be that the profile of Toujeo just doesn't correspond with your basal needs and a split dose of Levemir would allow you to adjust your daytime and night time basal insulin separately to get a better balance. I need less than half the basal insulin at night than I do during the day so I inject 5 or 6 units of Levemir at night and 16 in the morning to keep me on a levelish playing field. I wouldn't manage on Toujeo at all. Ask the nurse about changing basal insulin.


Thanks.  I didn’t know you could do that. I will ask the nurse if I get talking to her.  Surely they will suggest something soon.


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## rebrascora (Jul 26, 2020)

This is where the forum comes into it's own in terms of learning what is available rather than just accepting what you are given and trying to make the best of it. 
There will be people who find Toujeo really suits them and the same with Tresiba. Both are very long acting insulins which provide a steady amount of basal insulin day and night, but many of us have an irregular routine or our bodies have a slightly different circadian rhythm and we need less through the night and more through the day or perhaps less on the days and nights following when we are more active and more when we have sedentary days. I adjust my night time Levemir on a nightly basis by half or one unit, depending upon what I did during the day. So if I have been for a long walk/run that day or a lot of manual work I dial it back in the evening and if the next day I have a fairly inactive day, then I put it back up that night. With your basal insulin, those changes could take 2-3 days to come into effect whereas with mine (Levemir) I see the effect within the next 12hr period.
You can request to try different insulins or ask for bits of kit like Freestyle Libre or a pump or even a half unit pen. Your DSN or consultant will probably want to know why you feel a change might be beneficial or why you think the technology would help you and there may be criteria that you need to meet for them to give you the green light but knowing what is available and asking for it is the first step along with discussing the problems you are having and it really helps to keep a diary of your readings and insulin doses and food intake so that they can see the problems you are having more clearly. It also shows that you are taking an active role in managing your diabetes and I think that makes them more inclined to be supportive than people who blindly follow what they are told to do and don't do anything to help themselves.


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## Chris04 (Jul 29, 2020)

You’re right.  I will see if I can get a pen with half units.  I think this would help a lot.  I will also see what they think about changing the Toujeo.  
The only thing is, I can’t change my basal dose myself until I do the Daphne.  So I’m reliant on them to do that.  It is getting there though.  I have changed my morning ratio to 1 in 8 and it keep my BS more in range..though I do have a dip mid morning where I have to have a snack.  The same after lunch.. 1/8 and it dips around 3 but apart from that it’s pretty much in range.  Then 1/15 in evening.  It’s not completely right yet but I think a half unit pen would make a difference.


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