# My D - need some help please



## mum2westiesGill (Oct 1, 2013)

Looking through some of my recent threads some of you may see that I've been on 2 holidays just lately
- Lanzarote 14.8.2013 - 22.8.2013
- Haven, Primrose Valley 14.9.2013 - 28.9.2013

I've really enjoyed both but now need some guidance/help/tips if anyone's got any to get back on track properly with the D


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## trophywench (Oct 1, 2013)

Well - what's your prob exactly Gill?

Carb creep or what?


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## mum2westiesGill (Oct 1, 2013)

trophywench said:


> Well - what's your prob exactly Gill?
> 
> Carb creep or what?




- BG results - a lot of highs
- Bedtime & fasting tests - not doing these all of the time
- Carbs - at times just taking very random guesses and not checking properly like I was doing
- Not keeping my diary up to date ie not marking down what I've eaten but am trying hard to get this back on track now


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## Northerner (Oct 1, 2013)

Gill, you were doing so well, but it sounds like you might have suffered a bit of diabetes burnout from everything. Keep things simple I'd say - test on waking and before meals but don't worry unduly about the readings (but do record them!). Just to get back into the swing of things - don't try to tackle everything at once, or feel that you have to, baby steps and build confidence and habits so it feels more natural and not a chore


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## mum2westiesGill (Oct 1, 2013)

Northerner said:


> Gill, you were doing so well, but it sounds like you might have suffered a bit of diabetes burnout from everything



Yes I know and admittedly like you say I'm now suffering a  diabetes burnout from everything




Northerner said:


> Keep things simple I'd say - test on waking and before meals but don't worry unduly about the readings (but do record them!)



testing on waking and before meals and making sure I record readings will be easy to do




Northerner said:


> don't try to tackle everything at once



but what about bedtime testing as well - I'm really out of the habit of doing this due to probably late nights


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## trophywench (Oct 1, 2013)

Well Gill there's very little point in bodging holes in yourself to get blood out, if you don't do anything constructive with the readings, is there?

So why not tackle it one day at a time instead - tomorrow I will ... do whatever, and mean it and do it.

Once you start doing it again, you'll carry on doing it.

It is futile to argue LOL


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## mum2westiesGill (Oct 3, 2013)

Northerner said:


> Keep things simple I'd say - test on waking and before meals



1st day of trying to get back on track

Wed 02/10
*15.4* - fasting - 09:02
*10.4* - lunch - 14:31 - 5u QA - 1:1
*10.3* - dinner - 19:09 - 4u QA - 1:1
- BI - 22:01 - 24u
*13.3* - bedtime - 22:54


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## Northerner (Oct 3, 2013)

whiskysmum said:


> 1st day of trying to get back on track
> 
> Wed 02/10
> *15.4* - fasting - 09:02
> ...



Well done on getting things underway again Gill  It looks like your lantus probably needs increasing, but I would take a couple more days readings to get a better picture  Keep up the good work!


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## everydayupsanddowns (Oct 3, 2013)

Nice and steady there Gill! If you'd started a bit lower it would look pretty spot-on!

Did you add anything in to correct the numbers that are higher than you'd like?


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## mum2westiesGill (Oct 3, 2013)

Northerner said:


> Well done on getting things underway again Gill  It looks like your lantus probably needs increasing, but I would take a couple more days readings to get a better picture  Keep up the good work!




Thank you. it's good that I've got somewhere like this to come to  . I also thought that about the lantus but like you say I'll take a couple more days readings to get a better picture.


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## mum2westiesGill (Oct 3, 2013)

everydayupsanddowns said:


> Nice and steady there Gill! If you'd started a bit lower it would look pretty spot-on!
> 
> Did you add anything in to correct the numbers that are higher than you'd like?




Thank you!

I didn't do any correction to the higher numbers but I must admit that I do usually correct at 10 or over. The 5u would have been approx 50g of carbs eaten and the same with the 4u ie approx 40g of carbs eaten.


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## mum2westiesGill (Oct 4, 2013)

Thu 03/10
*no test *- fasting - was going out with a friend for coffee so missed doing test, also had hot chocolate with the marshmallows  
*17.6* - lunch - 14:36 - 3.5u + 4u corr QA - 1:1
*12.5* - dinner - 18:31 - 2u + 2u corr QA - 1:1
 - BI -22:08 - 24u
*16.4* - bedtime - 22:53


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## Northerner (Oct 4, 2013)

whiskysmum said:


> Thu 03/10
> *no test *- fasting - was going out with a friend for coffee so missed doing test, also had hot chocolate with the marshmallows
> *17.6* - lunch - 14:36 - 3.5u + 4u corr QA - 1:1
> *12.5* - dinner - 18:31 - 2u + 2u corr QA - 1:1
> ...



The argument for increasing the lantus is looking very strong Gill. Your correction at lunchtime worked better than the evening one. I think you will probably need to do some basal testing and then consider changing your mealtime ratios once you have got the basal right.


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## mum2westiesGill (Oct 4, 2013)

Northerner said:


> The argument for increasing the lantus is looking very strong Gill




Yes it is I think/know





Northerner said:


> Your correction at lunchtime worked better than the evening one.




What I forgot to mention was that during the evening while sat watching tv I was snacking on a packet of crisps - discos  . Also after my tea I had 2 Asda smartprice mousses which were 12.5g carbs each but I didn't do any extra QA for them


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## Northerner (Oct 4, 2013)

whiskysmum said:


> What I forgot to mention was that during the evening while sat watching tv I was snacking on a packet of crisps - discos  . Also after my tea I had 2 Asda smartprice mousses which were 12.5g carbs each but I didn't do any extra QA for them



Ah, that would account for the higher level at bedtime then


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## mum2westiesGill (Oct 5, 2013)

Fri 04/10
*no test *- fasting - no excuse today for not doing this!
*10.3* - lunch - 12:55 - 3.5u + 1u corr QA - 1:1
*12.8* - dinner - 19:32 - 4.5 + 2u corr QA - 1:1 - then a further 2u QA at 20:37 due to having a chinese: prawn fried rice/dash of curry sauce
 - BI -22:11 - 24u
*no test *- bedtime

can't get away from all these red numbers


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## mum2westiesGill (Oct 6, 2013)

Sat 05/10
*11.1* - fasting - 10:09 
*7.0* - lunch - 14:54 - 3.5u QA - 1:1
*no test *- dinner - no dinner
 - BI -22:15 - 24u
*no test *- bedtime


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## trophywench (Oct 6, 2013)

Why aren't you testing at bedtime, or even when you have your evening basal, Gill?


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## mum2westiesGill (Oct 6, 2013)

trophywench said:


> Why aren't you testing at bedtime, or even when you have your evening basal, Gill?




Evening basal time is near to 10:00pm ish then bedtime us usually 11:00pm ish or probably a bit later and by then I'm sort of like too tired. Would the evening basal time be too early to do my bedtime test?


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## mum2westiesGill (Oct 7, 2013)

Sun 06/10
*no test *- fasting
*5.3* - lunch - 13:08 - 3.5u QA - 1:1
*no test *- dinner - no dinner
 - BI -22:28 - 24u
*16.7* - bedtime


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## Redkite (Oct 7, 2013)

Hi Gill, you need some more data to work with! . Can you think of a way to incorporate more tests into your daily routine?


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## Northerner (Oct 7, 2013)

whiskysmum said:


> Evening basal time is near to 10:00pm ish then bedtime us usually 11:00pm ish or probably a bit later and by then I'm sort of like too tired. Would the evening basal time be too early to do my bedtime test?



What I always did with my lantus is test before injecting it and inject it just before going to bed, that way it was all part of my bedtime ritual. It didn't seem to matter if I went to bed at different times, so might be worth trying it that way


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## mum2westiesGill (Oct 7, 2013)

Northerner said:


> What I always did with my lantus is test before injecting it and inject it just before going to bed, that way it was all part of my bedtime ritual. It didn't seem to matter if I went to bed at different times, so might be worth trying it that way




Thanks for the tip Alan seems like a good thing to do


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## mum2westiesGill (Oct 7, 2013)

Redkite said:


> Hi Gill, you need some more data to work with! . Can you think of a way to incorporate more tests into your daily routine?




I always test before each meal but any suggestions to incorporate more tests would be appreciated please.


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## Redkite (Oct 7, 2013)

Perhaps make it a habit to do a test at the same time you brush your teeth?  That way you'll get one in the morning even if you've skipped brekkie, and one at bedtime.  Personally the only way I can remember to do anything these days is to be a creature of habit!


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## Northerner (Oct 7, 2013)

What meter do you have Gill? Do you have software on your computer for it? The software I have used will highlight the problem areas, which may be too many highs, too many hypos, which particular days you have problems on, or what times of the day need closer attention.


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## mum2westiesGill (Oct 8, 2013)

Northerner said:


> What meter do you have Gill? Do you have software on your computer for it? The software I have used will highlight the problem areas, which may be too many highs, too many hypos, which particular days you have problems on, or what times of the day need closer attention.




My current meter is this one - bayer contour next usb

http://www.bayerdiabetes.co.uk/sect.../meters/bayer-contour-next-usb-meter/Overview


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## Northerner (Oct 8, 2013)

whiskysmum said:


> My current meter is this one - bayer contour next usb
> 
> http://www.bayerdiabetes.co.uk/sect.../meters/bayer-contour-next-usb-meter/Overview



It's the same as mine - have you downloaded the Glucofacts software from the website? It's free and will give you more detail than if you just use the cut down version on the meter itself.


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## mum2westiesGill (Oct 8, 2013)

Yes I've got it but just not used it for sometime


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## Northerner (Oct 8, 2013)

whiskysmum said:


> Yes I've got it but just not used it for sometime



Give it a go today then, see if you can spot troublesome areas


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## mum2westiesGill (Oct 8, 2013)

Mon 07/10
*2.9* - fasting - 7:41 - ate 4 jelly babies plus an extra 2 with this hypo then at 7:57 BG was *7.7*
*7.4* - breakfast - 10:16 - 3.5u QA 1:1
no test - lunch - no lunch
*9.7* - dinner - 18:22 - 5u QA 1:1
*17.5* - bedtime - 22:23
 - BI -22:26 - 24u

during the evening I snacked on 1 pkt of disco crisps 17.6g carbs




Northerner said:


> What I always did with my lantus is test before injecting it and inject it just before going to bed, that way it was all part of my bedtime ritual. It didn't seem to matter if I went to bed at different times, so might be worth trying it that way




so this seemed to work well last night - but it was then somewhere between 11:00 & 11:30 ish when I actually went up to bed


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## Northerner (Oct 8, 2013)

That's quite a plunge in levels overnight Gill, you might have to set your alarm for some 3am tests to find out what is going on. Previous results have suggested that you need to increase your lantus, but this seems to show it needs reducing!


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## everydayupsanddowns (Oct 8, 2013)

whiskysmum said:


> no test - lunch - no lunch
> *9.7* - dinner - 18:22 - 5u QA 1:1
> *17.5* - bedtime - 22:23
> - BI -22:26 - 24u
> ...



That seems to suggest to me Gill that you *cannot* safely eat a pack of discos (almost 20g carbs and about half of your breakfast carbs) without adding an extra snack bolus.

I think that pack of crisps, combined with not correcting your 9.7 at dinner time look like they resulted in the very high reading at bedtime.

No problem with you having that evening snack... but if you have it you will need to dose for it IMO!


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## Northerner (Oct 8, 2013)

everydayupsanddowns said:


> That seems to suggest to me Gill that you *cannot* safely eat a pack of discos (almost 20g carbs and about half of your breakfast carbs) without adding an extra snack bolus.
> 
> I think that pack of crisps, combined with not correcting your 9.7 at dinner time look like they resulted in the very high reading at bedtime.
> 
> No problem with you having that evening snack... but if you have it you will need to dose for it IMO!



But worrying then that Gill's levels dropped nearly 14 mmol/l overnight  A lower bedtime level might have made things worse. If it was me I would try an evening/overnight basal test.


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## everydayupsanddowns (Oct 8, 2013)

Northerner said:


> But worrying then that Gill's levels dropped nearly 14 mmol/l overnight  A lower bedtime level might have made things worse. If it was me I would try an evening/overnight basal test.



Yes, apologies... you typed your reply while I was typing mine and I'd missed a bit of the thread that included the previous nights very high results.

Absolutely no way that BG should be dropping that much overnight. It's positively terrifying! 

I think some of those extra factors (like snacking without boluses) are adding complexity to the picture and maybe Lantus has been increased to try to get better pre-breakfast numbers (when actually the problem is high numbers before bed)?

Fasting tests will certainly clear the picture!


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## mum2westiesGill (Oct 9, 2013)

Tue 08/10
*16.0* - fasting - 7:38 
*11.2* - breakfast - 11:23 - 3.5u QA + 2u corr 1:1
*11.3 *- lunch - 14:34 - 5u QA + 2u corr 1:1
*7.5* - dinner - 19:22 - 6u QA 1:1
*9.6* - bedtime - 22:27
 - BI -22:30 - 24u

 no snacking during the evening


Wed 09:10
*9.6* - during the night - 03:43 - does  this need to be spot on 03:00am?
*3.9* - fasting - 8:27, also hypo - ate 4 jelly babies + 1 extra  
*9.4* - 08:59


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## mum2westiesGill (Oct 10, 2013)

whiskysmum said:


> Wed 09:10
> *9.6* - during the night - 03:43 - does  this need to be spot on 03:00am?
> *3.9* - fasting - 8:27, also hypo - ate 4 jelly babies + 1 extra
> *9.4* - 08:59



Wed 09.10 (cont)
*10.4* - breakfast - 11:10  - 3u QA + 1u corr - 1:1
*no test *- lunch - no lunch
*9.4* - dinner - 19:36 - 4u QA - 1:1, also at 20:45 had a further 3u QA for dessert
*12.3* - bedtime - 22:29
- BI - 22:31 - 24u

Thu 10.10
*16.9* - during night - 3:19
*13.5 *- fasting - 7:16


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## everydayupsanddowns (Oct 10, 2013)

Much steadier Gill!

Just need to get the starting point down a bit!


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## mum2westiesGill (Oct 10, 2013)

Hi Mike,
Do you think maybe increase the lantus by 2u?


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## everydayupsanddowns (Oct 10, 2013)

whiskysmum said:


> Wed 09.10 (cont)
> *10.4* - breakfast - 11:10  - 3u QA + 1u corr - 1:1
> *no test *- lunch - no lunch
> *9.4* - dinner - 19:36 - 4u QA - 1:1, also at 20:45 had a further 3u QA for dessert
> ...



Well from what i can see during the day you only wobbled a few mmol/L, rising a little overall and then during the night you dropped a little.

To me that suggests that your Lantus is probably about right, as if you'd started at 5.5 you would have a pretty good set of numbers there!

Personally I would leave Lantus alone for a few days (or only increase by 1mmol/L) and see if your corrections will get you close to being 'in range'. Remember that any adjustments you make to Lantus will have an affect on your numbers pretty much over the whole 24 hours, while corrections will stop working 4-5 hours after you have injected them.


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## mum2westiesGill (Oct 11, 2013)

Thu 10.10
*16.9 *- during night - 3:19
*13.5* - fasting - 7:16
*10.8* - lunch - 13:29 - 4u QA + 1u corr
*21.5* - dinner - 18:57 - 6.5u QA - no correction done due to having beer 2 pnts, from previous experience beer does push my levels right up  
*17.6* - bedtime - 22:34


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## novorapidboi26 (Oct 11, 2013)

How much beer did you have......?


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## mum2westiesGill (Oct 11, 2013)

novorapidboi26 said:


> How much beer did you have......?




Thanks for questioning, yes it was 2 pints of beer but you've jogged my memory & I also had a bag of quavers - the large one


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## novorapidboi26 (Oct 11, 2013)

Everyone is different but for me personally I wouldn't 'not correct'  a 21.5 just because I had a few beers......

I assume this was because you expected to drop because of the alcohol....?

I actually don't need an insulin reduction till the next day personally...

Did you correct the bedtime 17.6?

Do you take insulin for your beer? If you regularly have say 2 pints in a sitting/night, you could take insulin for it........10g roughly a pint I think...


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## everydayupsanddowns (Oct 11, 2013)

novorapidboi26 said:


> Do you take insulin for your beer? If you regularly have say 2 pints in a sitting/night, you could take insulin for it........10g roughly a pint I think...



That's what I quite often do (after a bit of trial and error)

Just got fed up of being in the teens after a couple of pints!


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## bennyg70 (Oct 14, 2013)

Gill,

I think you need to establish yourself a set of basic groundrules, you seem to be constantly firefighting and for me its impossible to tell from your numbers what is going on. 

The positive thing is you have addressed to yourself you want to get on track.

The first thing you need to do is some REAL basal testing with no food or alcohol consumed at all. I still think (I can remember saying this a while back) that your basal is way too high. And infact its your QA ratios and approach to snacking / drinking and carb counting that is out?

Me for example:

1 ) I need to bolus for any snack over 5g carbs (10 grams will push me up by 3mmol/l)
2 ) If I drink beer, I need to bolus for it 
3 ) The foods you eat - Chinese's etc - Full of the other things on top of carbs -  such as proteins and fats. They can play havoc with the BG a little later on.

I dont think anyone could suggest a way forward until you have basal tested.

1) Ensure your basal is thee or there abouts
2) Look at your QA ratios for each main meal time of day
3) Look at how things such as beer and snacks can effect you.

Break it down and tackle it one step at a time

Just my opinion - Hope it makes sense

Benny


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## mum2westiesGill (Oct 17, 2013)

whiskysmum said:


> Fri 11.10
> *9.7* - fasting -8:38
> *7.8* - breakfast - 11:00 - 3 CPs - 4u QA
> *12.3* - lunch - 14:31 - 3.4 CPs - 5.5u QA
> *4.3* - dinner - 19:22 - 4 CPs *19.1* - bedtime - 22:25 - 24u BI






whiskysmum said:


> Sat 12.10
> *no test *- fasting
> *19.4* - breakfast - 10:23 - 1.5 CPs - 6u QA
> *14.5* - lunch - no lunch, not hungry
> ...






whiskysmum said:


> Sun 13.10 (cont)
> *10.4* - dinner - 19:24 - 3.1 CPs - 4 5u QA
> *11.0* - bedtime - 22:43 - 24u BI
> 
> ...





Mon 14.10.2013 (cont)
*13.8* - 11:13 - breakfast - 3 CPs - 5.5u QA
*13.1* - 14:25 - lunch - 3.5 CPs - 4.5u QA
*8.7* - 18:26 - 6u QA
*15.6* - 22:44 - bedtime
 - BI - 22:45 - 24u

Tue 15.10.2013
*no test *- fasting
*11.0* - 10:31 - breakfast - 1.5 CPs - 1.5u QA
*no test *- lunch - no lunch
*13.5* - 19:33 - teatime - 5 CPs - 5u QA
*18.4* - 22:13 - bedtime
- BI - 22:15 - 24u

Wed 16.10.2013
*4.9* - 8:49 - breakfast - 1.5 CPs - 1.5u QA - yey got one BG in target range  
*15.5* - 14:09 - lunch - 4.8 CPs - 8u QA
*9.0* - 20:13 - teatime - 3 CPs - 4u QA

 

So now is it going to be
- 2 or 3 nights on the run basal testing
- decrease basal from 24u to 
- increase basal from 24u to


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## mum2westiesGill (Oct 18, 2013)

Wed 16.10.2013 (cont)
*14.3* - 22:36 - bedtime - also BI 24u

Thu 17.10.2013
*no test *- breakfast
*8.7* - 14.55 - lunch - 4.8 CPs - 6u QA
*14.0* - 18:22 - teatime - 4 CPs - 6.5u QA
*7.2* - 22:33 - bedtime - also BI 24u

Fri 18.10.2013
*4.4* - 11:09 - breakfast - 3 CPs - 2.5u QA
*10.6* - 12:55 - after breakfast
*15.6* - 14:48 - lunch - 5 CPs - 8.5u QA


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## mum2westiesGill (Oct 19, 2013)

Fri 18.10.2013 (cont)
*9.3* - 19:21 - teatime - 3.2 CPs - 4.5u QA
*11.9* - 22:59 - bedtime - also BI 24u

My targets at the moment are:
4-7 - breakfast
4-7 - lunch
4-7 - teatime
8-12 - bedtime


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## mum2westiesGill (Oct 20, 2013)

Sat 19.10.2013
*6.0* - 10:29 - breakfast - 1.5 CPs - 1.5u QA
*7.8* - 13:35 - lunch - 3 CPs - 3.5u QA
*6.0* - 18:43 - teatime - 3 CPs - 3u QA
*14.2* - 22:30 - bedtime - also 24u BI


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## trophywench (Oct 20, 2013)

Sorry Gill, didn't know you were posting on this thread - so I'll repeat the question I PM'd and emailed in response to your queries, on here.  I presume you understood the explanation of what the '0.2u Insulin' meant.


Say your BG is a perfect premeal 6.5 and you are going to eat 37g of carbs, that should be 3.7u of insulin, shouldn?t it. What does your meter actually tell you to take? ? I don?t know this - as I only had the meter when I had the pump - so with me it will say I need 3.7u and that?s exactly what I will bolus. You can?t do that though and can only inject to the nearest 0.5u at best depending on what pen you have. So what does it say?


But now I have another question.

What is your 'Target' BG set at on the meter?


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## HOBIE (Oct 20, 2013)

Good luck it sounds right to me


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## mum2westiesGill (Oct 20, 2013)

trophywench said:


> Sorry Gill, didn't know you were posting on this thread - so I'll repeat the question I PM'd and emailed in response to your queries, on here.  I presume you understood the explanation of what the '0.2u Insulin' meant.



Hi Jenny,
That's ok - I got your pm & email - thank you very much for this.

The 0.2u is the insulin which is unused or what you still have on board




trophywench said:


> But now I have another question.
> 
> What is your 'Target' BG set at on the meter?



I posted all my targets which are set on my meter on this thread

"Accu Chek Aviva Expert Bolus Advisor - got it - helppp! Reply to Thread"


whiskysmum said:


> Settings for my meter
> 
> my time blocks:
> 0.00 5.30
> ...


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## trophywench (Oct 20, 2013)

Right, so the meter will try to correct you to 10 in the early hours and 5.5 the rest of the time, cos it goes for the middle of whatever range you enter, with 4 being the minimum number you are allowed to enter.  The 10 is too high for starters.

And 5.5 as a daytime target is marginally on the low side IMHO, with long acting insulin floating about, but 4 is also too low as the bottom really, you'll have far better results to start with if you aimed for a midpoint of 7 and changed it to 6.0 to 8.0.  

NB  It doesn't actually use that 4 there in the Time Blocks, to understand when it has to tell you that you are hypo - it does that anyway below 4 every single time whatever it says in the time blocks.

You have to remember (if you ever knew this?) that your A1c will always be lower than your meter average so if you set the mid-range too low, you'll have a ridiculously low A1c, which wouldn't be healthy.

I know it sounds counter-intuitive but if you initially aim for a higher number and you can get that to even you out, then it will be comparatively easy to tweak that.

Having told the meter what you want to be, which is on the high side anyway - why aren't you taking it's advice?  Except when you've had a lot of alcohol in the evening of course, and surely you don't have THAT much most nights?  On the nights you do indulge you could just ignore the correction dose it comes up with, or halve it or something?  Or would you typically actually be too hissed to be sensible about it?  You have to learn to accept what it says and that can be hard, been there done that myself. 

You don't appear to have answered the other question about what it would tell you if you entered an odd number of carbs, that doesn't work out to a whole number - does it round up/down or not?


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## everydayupsanddowns (Oct 20, 2013)

From memory when I was using the Expert it would do all the calculations (meal carbs and + or - correction to get you to mid-range, then round up or down to nearest 0.5u or 1u depending on what you had said your pen allowed.


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## mum2westiesGill (Oct 21, 2013)

Sun 20.10.2013
*2.3* - 10:28 - hypo - 1.5 CPs - 0u QA - jelly babies x 4
*6.8* - 10:44 - breakfast - 3 CPs - 3.5u QA
no test - lunchtime - no lunch
*11.5* - 19:04 - teatime - 5.7 CPs - 7.5u QA
*16.2* - 22:36 - bedtime - also 24u BI


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## everydayupsanddowns (Oct 21, 2013)

whiskysmum said:


> Sun 20.10.2013
> *6.8* - 10:44 - breakfast - 3 CPs - 3.5u QA
> no test - lunchtime - no lunch
> *11.5* - 19:04 - teatime - 5.7 CPs - 7.5u QA
> *16.2* - 22:36 - bedtime - also 24u BI



Did you snack in the evening after your meal Gill and/or nibble on anything between breakfast and teatime?


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## mum2westiesGill (Oct 21, 2013)

everydayupsanddowns said:


> Did you snack in the evening after your meal Gill and/or nibble on anything between breakfast and teatime?




Yes during the evening whilst sat watching tv - x factor, strictly  - I had 1 but may have been 2 mini scotch egg 4.3g carbs each & 1 small bag of discos


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## everydayupsanddowns (Oct 21, 2013)

whiskysmum said:


> Yes during the evening whilst sat watching tv - x factor, strictly  - I had 1 but may have been 2 mini scotch egg 4.3g carbs each & 1 small bag of discos



There is absolutely nothing wrong with snacking in the evening Gill, but you simply **MUST** dose for it if you want to avoid those very high levels at bedtime.



> *Kp Crisps - Discos- Salt & Vinegar 28g Bag *
> Serving Size: 28 g, Calories: 145, Fat: 8g, *Carbs: 16.9g*, Protein: 1g



So along with your scotch eggs you are having what looks like 20g of carbs with no insulin.

The good news is that on the basis of your current settings posted elsewhere you are getting almost exactly the rise one might expect. Roughly 3mmol/L per 10g of carbs and (with not all the correction finished and snack digested) you rose around 4 mmol/L.

I think it's quite difficult for people to give you their thoughts too if you are not mentioning these snacks - without that snippet of information it could look like your basal was waaaaaaay to low, when in fact it was more likely to be the snack that caused the rise


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## mum2westiesGill (Oct 21, 2013)

everydayupsanddowns said:


> There is absolutely nothing wrong with snacking in the evening Gill, but you simply **MUST** dose for it if you want to avoid those very high levels at bedtime.
> 
> 
> 
> ...




Thank you Mike,
So if I'm having tea and doing my bolus at 19:00 pm approx then I decide I may like to snack on a little something at about 21:00 ish would you bolus for that then? Also when snacking should I get the bolus advice from my accu-chek bolus advisor? 

Re the "absolutely nothing wrong with snacking in the evening" sometimes I thnk I'm doing wrong and maybe that's why i miss out or get ambarresed at mentioning the little "snippet of information"


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## everydayupsanddowns (Oct 21, 2013)

whiskysmum said:


> Thank you Mike,
> So if I'm having tea and doing my bolus at 19:00 pm approx then I decide I may like to snack on a little something at about 21:00 ish would you bolus for that then? Also when snacking should I get the bolus advice from my accu-chek bolus advisor?



Yes I would use the Expert for that myself. The Expert will be keeping track of your 'meal rise' after your eve meal (how much you are happy for that meal to raise your BG while the insulin kicks in) and it will also be tracking what correction (if any) you have going from teatime and can factor all of that - as well as whatever ratio you eventually set for late evening and the 'target range' you have working for that time block too. To get the very best out of the Expert I found it best to always ask it the question (ie see what it said) then either accept that advice, or do my own thing. The best thing about the Expert IMO was that you could set it up and it would balance LOTS of different and varying factors all at the same time. And if it wasn't working quite right/giving effective advice I could change the settings by very small amounts and not worry about the maths involved!



whiskysmum said:


> Re the "absolutely nothing wrong with snacking in the evening" sometimes I thnk I'm doing wrong and maybe that's why i miss out or get ambarresed at mentioning the little "snippet of information"



No need to be embarrassed at all! (though I do know what you mean). It's only that people might see a change of 11-16 and think either your meal dose was wrong or basal was out and suggest a change that would have you running around in circles!! 

It would be really interesting to see what happened of you spent all of this week 'trusting' the Expert all the time and using it for EVERYTHING you ate. It's the only way really to see if different settings on the Expert could do with a bit of tweaking


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## mum2westiesGill (Oct 21, 2013)

Hi Mike or anyone else,

Once the initial set up of the Expert was done between yourself, the meter rep and HCP/DSN did you then tweak the settings yourself or wait until each time you see your DSN?


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## everydayupsanddowns (Oct 21, 2013)

I was happy to tweak the settings myself, but if you are unsure perhaps it would be good to consult your DSN with what you are planning on doing to get their thoughts?

Do you have an email address for them?


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## mum2westiesGill (Oct 21, 2013)

Maybe it would be a good idea to consult first.

My own DSN
- is also the practice nurse at my GP surgery - she's off at the moment due to falling down some concrete steps & breaking her ankle in July this year. At the moment I have to see the GP who specialises in diabetes. 
It's so hard at the moment trying to get any appointments for anything at all at my surgery at the moment due to 2 out of 4 of them going to work at another place much of the time and as for also trying to get a nurses appointment with them being down a nurse - grrrrrr  

My other DSN
- is a "propper" DSN who runs the diabetic drop in centre once a week - I don't have an email for her but I do have a phone number but It might be easier to pop along to the drop in clinic and show her my print out of my recent results.
- I know her quite well because she did the Insulin X-Pert course which I went on in April &  she was the one who was at the meet along with the roche rep to get my Expert meter.


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## everydayupsanddowns (Oct 21, 2013)

whiskysmum said:


> Maybe it would be a good idea to consult first.
> 
> My other DSN
> - is a "propper" DSN who runs the diabetic drop in centre once a week - I don't have an email for her but I do have a phone number but It might be easier to pop along to the drop in clinic and show her my print out of my recent results.
> - I know her quite well because she did the Insulin X-Pert course which I went on in April &  she was the one who was at the meet along with the roche rep to get my Expert meter.



She certainly seems like the right person - as she will most likely know/understand the Expert


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## mum2westiesGill (Oct 22, 2013)

Mon 21.10.2013
*16.4* - 10:46 - breakfast - 1.5 CPs - 5u QA
*10.6* - lunchtime - 6.5 CPs - 8u QA
*6.8* - 18:39 - teatime - 5.0 CPs -5u QA
*11.0* - 22:32 - bedtime - also 24u BI

during the evening/between teatime & bedtime - snacked on scotch eggs x 2 - 4.3g  carbs each =  8.6g carbs - had no QA because it was under 10g carbs


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## bennyg70 (Oct 22, 2013)

whiskysmum said:


> Mon 21.10.2013
> *16.4* - 10:46 - breakfast - 1.5 CPs - 5u QA
> *10.6* - lunchtime - 6.5 CPs - 8u QA
> *6.8* - 18:39 - teatime - 5.0 CPs -5u QA
> ...



Mikes absolutley right - You have to bolus for these snacks!!

We all snack, and we all have to treat them differently. Sometimes if I have a snacky evening, ill inject 4 or 5 times for bits and peices!!!

Even 8.6 g carbs which you had. If your ratio if 10 / 1 then I would be giving myself a half unit or a unit dependent on what my bloods were doing. Otherwise I would expect a rise of between 2 or 3, and if Im say 8 at the time, then Im up to 10 and out of bounds!

To make things even more complicated the protein in the egg may also be pushing your bloods up during the night, but thats a different story futher down the line.


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## trophywench (Oct 22, 2013)

Gill

The thing about tweaking stuff is, DO keep a note of what it was set at before - then if the tweak doesn't work, you can revert to the original and try summat else, can't you?

I never used to tweak until I was taught to carb count, and because the course ran over 4 weeks, there was plenty of chance to 'try it and see' with the DSN's on tap by phone if we needed to ask in order to decide whether to do something or not.

As your one has a drop-in, get down there like a shot!


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## mum2westiesGill (Oct 23, 2013)

Tue 22.10.2013
*16.2* - 3:37 - during night
*7.8* - 6:04 - during night
*3.8* - fasting/hypo - 2.5 CPs - 0u QA - jelly babies 5
*5.3* - 10:20 - breakfast - 1.5 CPs -1.5u QA
*14.0* - 15:04 - lunchtime - 4.8 CPs - 7.5u QA
*3.7* - 19:59 - hypo - 2.5 CPs - jelly babies 5
*5.9* - 20:15 - teatime - 3.2 CPs - 3.5u QA 
*15.3* - 22:42 - bedtime - also 24u BI  - already taking antidepressants from a few years back, had dosage upped from 10mg to 20mg last year but feeling very stressed out this evening
- but meter also was deffinitely advising to take 1u QA - which I did - but why?
during the evening/between teatime & bedtime - no snacking


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## everydayupsanddowns (Oct 23, 2013)

Not sure when you took that 1u QA Gill? If at bedtime, then purely because to get you back to 10ish from 15 you'd need at least one unit at your current ratios.

As to the rather erratic pattern of numbers after meals, I suspect that could well be down to those lows. They do have a tendency to make your liver a bit twitchy.


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## mum2westiesGill (Oct 23, 2013)

everydayupsanddowns said:


> Not sure when you took that 1u QA Gill? If at bedtime, then purely because to get you back to 10ish from 15 you'd need at least one unit at your current ratios.




When I did my bedtime test that's when my meter was advising me to take 1u QA which is what I went along with.


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## everydayupsanddowns (Oct 23, 2013)

whiskysmum said:


> When I did my bedtime test that's when my meter was advising me to take 1u QA which is what I went along with.



I'm pretty sure that advice was based on your bedtime reading of 15 then.

Having said that you are dropping a LOT overnight (from 16 to hypo from 3.30am onwards) There is no way that should be happening. Have you asked your DSN about that?


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## mum2westiesGill (Oct 23, 2013)

everydayupsanddowns said:


> Having said that you are dropping a LOT overnight (from 16 to hypo from 3.30am onwards) There is no way that should be happening. Have you asked your DSN about that?




Not been able to get in touch as yet with my DSN/Practice nurse or the DSN who runs the drop in.

Was wondering whether to alter the targets slightly but then again I might wait until I can speak to my/DSN
my current targets:
 8 lower target/12 upper target - may alter to 7 & 11
 4 lower target/7 upper target - may alter to 6 & 8
 4 lower target/7 upper target - ditto
 4 lower target/7 upper target - ditto
 8 upper target/12 upper target - 7 & 11


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## trophywench (Oct 23, 2013)

So let's see, that's

9
7
7
7
9

A bit better - but still a work in progress    eh Gill ?


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## mum2westiesGill (Oct 24, 2013)

Hi trophywench (Jenny),
I've not altered the targets as yet but.....

I called my diabetes drop in centre this morning re what Mike said



everydayupsanddowns said:


> Having said that you are dropping a LOT overnight (from 16 to hypo from 3.30am onwards) There is no way that should be happening. Have you asked your DSN about that?




before the clinic had started & spoke with the DSN there (not the usual one as she's busy at the hospital but apparently I can phone her there whenever). 
The DSN this morning wanted to know a bit about me first so I asked her exactly what she wanted to know then she wanted me to read my BGs from last Sunday 20.10.2013 & due to the fact I'm higher at bedtime at the moment then dropping low early on (apart from 2 hypos on Tuesday which I think may have been too much housework  ) I'm going to alter my teatime ratio from 1:10 to 1.5:10 & see how that goes for a few days - obviously as we all know we can only do one thing at a time with our diabetes - grrrrr


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## mum2westiesGill (Oct 24, 2013)

Wed 23.10.2013
*17.0 *- 3:15 - during night - so after going to bed on Tuesday
*4.0* - 8:20 - fasting - Wednesday
*7.9* - lunchtime - 4.8 CPs - 5.5u QA 
*10.1* - 19:40 - teatime - 2.0 CPs - 3.5u QA
*11.3* - 22:04 - bedtime -1.7 CPs - 0.5u QA - re the CPs & 0.5u QA this was my evening snack of a paket of discos - meter advised to have 1.5u QA but I changed it to 0.5u because i don't like having QA before going to bed to sleep
- 22:38 - BI -24u


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## everydayupsanddowns (Oct 24, 2013)

whiskysmum said:


> The DSN this morning wanted to know a bit about me first so I asked her exactly what she wanted to know then she wanted me to read my BGs from last Sunday 20.10.2013 & due to the fact I'm higher at bedtime at the moment then dropping low early on...
> 
> I'm going to alter my teatime ratio from 1:10 to 1.5:10 & see how that goes for a few days - obviously as we all know we can only do one thing at a time with our diabetes - grrrrr



Not to counter what your DSN has advised, but I'm rather surpeised they haven't looked at basal first???

You went from 16 to hypo with pretty NO mealtime dose active, and the change (if I understand it right) is to increase your evening mealtime dose by 50%. This may well help your bedtime reading... but unless you can stop those big overnight drops I wonder whether you will go hypo overnight more often. I'm not surprised you are wary of injecting rapid insulin near bedtime if you drop *13mmols/L* without!


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## mum2westiesGill (Oct 24, 2013)

everydayupsanddowns said:


> Not to counter what your DSN has advised, but I'm rather surpeised they haven't looked at basal first???



She mentioned basal but then said about increasing the evening mealtime dose - Myself I'm thinking maybe the basal should be reduced




everydayupsanddowns said:


> unless you can stop those big overnight drops I wonder whether you will go hypo overnight more often.



Yes I do very much want to stop the overnight drops - & hypos 


Maybe another option would be to inject but make sure I inject well before having my evening meal to give the insulin a good chance to start working & also reduce the basal -hmmmm what to do - thoroughly 




everydayupsanddowns said:


> I'm not surprised you are wary of injecting rapid insulin near bedtime if you drop *13mmols/L* without!



I've never liked bedtime QA dosing


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## Northerner (Oct 24, 2013)

whiskysmum said:


> ...Maybe another option would be to inject but make sure I inject well before having my evening meal to give the insulin a good chance to start working & also reduce the basal -hmmmm what to do - thoroughly  I've never liked bedtime QA dosing



I would have to agree with Mike. If you drop by double figures overnight then increasing your evening meal dose is surely only going to make it more risky  You might end up at a lower figure before bed, but then even lower in the early hours.

I always try to ensure that my evening meal dose (and therefore my meal) is around 5 hours before bed. That way I can be more or less sure that any drop is due to basal problems and that is what I would need to look at. The figures you have given here:


> Wed 23.10.2013
> 17.0 - 3:15 - during night - so after going to bed on Tuesday
> 4.0 - 8:20 - fasting - Wednesday


would suggest to me that it's unlikely to be your mealtime insulin that is dropping you, unless you injected and ate sometime after midnight, so it's the basal that is causing the fall.


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## everydayupsanddowns (Oct 24, 2013)

As this is rather an extreme situation (your late evening highs AND your huge drops overnight) in your shoes I think I *would* change both things at once.

At the moment if I was in your position I would see these adjustments as 'firefighting' those big swings rather than fine tuning. You are still at the stage where you are basically 'roughing-in' your Expert settings.

Ideally you would skip evening meal and test every 2 hours from lunchtime to, say, midnight or even 6am and see what is happening when you *only* have basal active, but you may prefer to just wing it 

Incidentally... dont forget that you don't need to worry about the maths any more, so there's no need to change from 1:10gCHO to 1.5:10gCHO (a 50% increase) you can set the Expert to calculate 1.1:10g or 1.2:10g and it will do all the tricky calculations to you, so you only need to change things quite carefully rather than risking exchanging highs at bedtime for hypos all evening!


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## mum2westiesGill (Oct 24, 2013)

everydayupsanddowns said:


> As this is rather an extreme situation (your late evening highs AND your huge drops overnight) in your shoes I think I *would* change both things at once.



Hi Mike,
Hope you're still around somewhere on here before teatime & bedtime  - So which both things do you mean?




everydayupsanddowns said:


> Incidentally... dont forget that you don't need to worry about the maths any more, so there's no need to change from 1:10gCHO to 1.5:10gCHO (a 50% increase) you can set the Expert to calculate 1.1:10g or 1.2:10g and it will do all the tricky calculations to you, so you only need to change things quite carefully rather than risking exchanging highs at bedtime for hypos all evening!


Cheers thank you very much for letting me know this  

If I was changing any ratio eg the evening meal one which time block would I go to please?
my time blocks:
0.00 5.30
5.30 12.00
12.00 16.00
16.00 21.30
21.30 0.00


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## mum2westiesGill (Oct 24, 2013)

Northerner said:


> I always try to ensure that my evening meal dose (and therefore my meal) is around 5 hours before bed. That way I can be more or less sure that any drop is due to basal problems and that is what I would need to look at.



Thank you


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## everydayupsanddowns (Oct 24, 2013)

Hi there, sorry didn't see this earlier.



whiskysmum said:


> Hi Mike,
> Hope you're still around somewhere on here before teatime & bedtime  - So which both things do you mean?



Thing 1 - You seem to have too much basal active at night (because even though you go to bed really high, you then drop a *very long way* when your meal dose should be finished).
Thing 2 - Your level at bedtime is too high. This *might* indicate that your evening meal dose is too low. On other moths though it is down to a small snack but no insulin.



whiskysmum said:


> Cheers thank you very much for letting me know this
> 
> If I was changing any ratio eg the evening meal one which time block would I go to please?
> my time blocks:
> ...



Depends when you eat. 16.00-21.30 (ie 4pm - 9.30pm) would cover my evening meal times. If that's the case for you, then you could try a small tweak there?

Are you planning on chatting these through with DSN?


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## mum2westiesGill (Oct 26, 2013)

Thu 24.10.2013
*6.6* - 10:51 - breakfast  - 3.0 CPs - 3.5u QA
*8.7* - 14:53 - lunchtime - 4.5 CPs - 5.5u QA 
*10.0* - 18:55 - teatime - 4.0 CPs - 5.5u QA
*7.7* - 23.11 - bedtime -3.0 CPs - 0 QA - no QA taken because i don't like taking QA before goping to bed to sleep
 - 23:11 - BI -24u
no snacking during the evening

Fri 25.10.2013
*10.5* - 10:40 - breakfast  - 1.5 CPs - 3u QA
*4.7* - 14:33 - lunchtime - 4.5 CPs - 4u QA 
*9.8* - 18:59 - teatime - 2.0 CPs -4.5u QA
*4.3* - 22:58 - bedtime -8.1 CPs - 0 QA - wow!   a lot of CPs there I know it involved:
sandwich(chse sprd) 2 slcs(30g)/discos 28g pkt/rich tea biscuits 2(11.8g)/choc digestive 2(21.6g)(81g) - I was in a very hungry mood - no other snacking during the evening
 - 23:11 - BI -24u

Sat 26.10.2013
*4.3* - 10:24 - breakfast - 1.5 CPs - 1u QA


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## Northerner (Oct 26, 2013)

It's looking to me like you have too much basal overnight Gill. Without the food you would have been in a bit of trouble I suspect. From Friday night to Saturday morning you needed 80g of carbs in order to wake at the same level you went to bed at  

Having said that it's difficult to know how you can achieve predictable results overnight if you are eating variable amounts of carbs not covered by QA insulin (and I perfectly understand you not wanting QA before bed). Presumably you wish to continue eating before bed with no QA, in which case you will be relying on your basal to bring levels down. If your basal level was set to a dose that just dealt with your liver's output overnight then you would wake with very high levels. You could find out what your basal overnight needs should be by eating nothing at all after your evening meal and testing through the night (since without the extra carbs you basal dose would probably be too high). But as soon as you start having carbs before bed again your waking numbers will be high.

Does that make sense?


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## mum2westiesGill (Oct 26, 2013)

Northerner said:


> Does that make sense?



So nothing at all to eat from evening meal onwards until the next morning  ? I can try it not tonight but in the next couple of nights. 

I went ahead last night with the changing of the teatime i:c ratio and changed it from 1:1 (1u of insulin to every 10g carbs) to 1.5u:1 (1.5u to every 10g carbs). I've got plenty of jelly babies to hand  . I'm going to give it 5/6 days to 1 week & see how things are going. I can always monitor more often.


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## Northerner (Oct 26, 2013)

whiskysmum said:


> So nothing at all to eat from evening meal onwards until the next morning  ? I can try it not tonight but in the next couple of nights. ...



Well, in an ideal world you would establish exactly what your basal requirements are overnight by not eating after your evening meal and then testing and adjusting your basal until it keeps you at a good, steady level overnight. Then you would need to work out what QA insulin you need (and what ratio) for the supper you are going to eat and inject for it. So, the basal should (in theory) match your liver's output, and te QA would match what you eat before bed.

When I was first diagnosed I used to drop quite a lot overnight so had to eat to keep my levels up. Once I had reduced my basal so that I didn't need to eat I just stopped having anything carby after my evening meal because, like you, I didn't want to inject before bed.


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## mum2westiesGill (Oct 27, 2013)

Sat 26.10.2013
*4.3* - 10:24 - breakfast - 1.5 CPs - 1u QA
*8.5* - 15:48 - lunchtime - 4.2 CPs - 5u QA 
*13.4* - 19:53 - teatime - 3.0 CPs - 5u QA - should've been an extra 2u correction but I didn't do this correction as I was going for an evening out involving alcohol - maybe approx 4 whisky & diet cokes & 1 smirnoff ice
*10.5* - 22:32 - bedtime - 24u BI - 8.7 CPs - 0 QA - wow!   another night with a lot of CPs there, it was due to a Mcdonald's on the way home which involved:
 mayo chkn(38g)/smarties McFlurry(49g)(87g)


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