A rollercoaster week: food ratios and basal tests.

The main things to have come out of this week are the realisations that:
a) I am challenged when it comes to working out ratios; maybe I need to get some of my kids onto it - I reckon they'd be less stumped than I was yesterday!
b) I have become VERY reliant on my super-duper-whizzy Rapid Calc App...

These realisations began to manifest themselves on Friday when I emailed my week's worth of readings to Lisa. I forgot, that I had given her the wrong ratios when I filled in my pre-assessment form; I changed them to give me slightly more insulin at breakfast time and at dinner time. But it's the form these ratios came in that caused the confusion!

My Rapid Calc App, wonderful though it is, calculates my ratios per gram of carbohydrate so they come as a ratio of Carb:Insulin (in my case, I was taking a ratio of 1:0.18 at breakfast and 1:0.2 at lunchtime).

After receiving my weekly readings (along with some incomprehensibly scribbled notes about having changed my ratios) Lisa emailed back, somewhat confused about my ratios, and suggested I change my breakfast I:C ratio to 1:7 and my dinnertime ratio to 1:8. I had absolutely no idea what that meant in terms of my C:I ratios.

So... I sat down and tried to work it out (on the piece of paper J had used to remind him to take his wash bag skiing!). I then appealed for help on Facebook because I tied myself in knots!

Eventually (and with a little mathematical help from my -disappointingly male - friends, where's a girl who can do ratios?!) I reached the conclusion that the changes that Lisa was proposing would mean my ratios would change from 1:5.5 to 1:7 at breakfast and 1:5 to 1:8 at dinner time. I wasn't sure about this. Since my basal has been reduced, I have found I have needed to up my ratios slightly. 

Yesterday I tried the change, along with lowering my basal from 16 to 14 again after a drop of nearly 60 md/dL (129 to 71) on Thursday night.

But what I found was that I was running consistently high. I haven't had a reading below 233 since Friday evening and it's now Sunday afternoon. Today, I emailed Lisa back and explained that I was going to put my ratios back to 1:5.5 and 1:5. At least then we have a starting point that doesn't mean I'm always high. 

I hope that she won't think I'm panning her advice - I really want to get my levels down - but, today, when my readings have been high, I just really want them to come down.

Overall, my analysis was better this week! I analysed twice, yes, I know, I'm home alone and I have time to play with! First I analysed my readings using my usual setting-myself-up-to-fail parameters. Better than last week: 32.5% of my readings were in range. But then I repeated the analysis using the ranges I agreed with Lisa (90-160 pre-meal and <160 2 hours after eating); this time 47.5% of my readings were in range. I am aiming for 70% and <3 hypoes. I am crawling in the right direction, finally!

Christmas Day again?!

Today I woke up at 5am. Normally when I wake up around this time I get irritable and annoyed, with the thought that my alarm is not going to be long at the front of my mind This morning was different, a little like Christmas morning when waking up early is only ever a good thing! As a child, anyway… This morning it was with a mixture of excitement and apprehension that I signed into Skype around 6am to await my ‘First Visit’ with Dr. Scheiner’s Integrated Diabetes Service. I wasn’t disappointed.

The appointment began with a face to face with Dr. Scheiner and a nurse, Linda, also a type 1 diabetic. It introductions and questions about Korea and then it was just me and Linda to talk nuts and bolts of daily diabetes care. She had my records from the last few weeks in front of her and kept referring back to them throughout the meeting.

The main things I took away from the meeting were:

• My current target levels are slightly unrealistic. I have been being hard on myself, trying to get my levels within this magic range of 74 – 126. While these are, admittedly, the ranges of perfection, it was nice today to be told that I can relax these limits just slightly: my premeal target should (for now, at least) be between 80-160. After meals, I am looking for a rise of no more than 200. I should also be aiming to have no more than 3 hypoes a week.

• The importance (and method) behind accurate basal testing. Lisa told me that I really need to do some day time bolus tests, especially as my Levemir seems to be holding me fairly stable overnight. To do this, I need to fast over each mealtime on different days. Breakfast-wise, I should have a large snack before bed, then take my morning Levemir dose, but then eat nothing until 11 or so am, testing every so often to check, Over lunch, this would mean an early breakfast before testing intermittently between 11 and late afternoon. Dinner time would be similar: lunch as usual, testing from around 4 and having a late dinner. Doing this will help me to judge whether my basal dose is also steady for the day: the idea being that my blood sugars should vary little with no food or bolus insulin floating around my system.

• As a general day-to-day rule, I should try to leave a 3 hour gap between meals and snacks to avoid topping up the food already in my body, thus not giving my levels time to return to “normal”.

• Where possible exercise (exercise?!) should be done 1 and a half to 2 hours after a meal, and I should reduce my bolus dose for that meal by a third. This is new to me. I always thought that exercise was best done before a meal! But I guess the body needs insulin to feed its muscles and just before a meal insulin levels are too low to do this properly. 

There were a couple of tweaks made to my lunch- and dinner-time ratios too… Now I just need to see how it goes!

By the time I’d reached school I’d received a summary, from Lisa, of all the things we’d talked about.

I am feeling positive and looking forward to the next appointment which I have scheduled for a month’s time. In the meantime I have to send my written records (more detailed! I somewhat trailed off last week…) to Linda every few days for advice on adjustments between now and the next appointment.

I am so grateful I browsed Amazon that day… Just looking to read about other people’s experiences with what I live with every day. If I hadn’t, I wouldn’t have found Dr. Scheiner’s book and as a result, wouldn’t have had this morning’s meeting. It feels like I have some support. And, while I do feel a little frustrated that I am not able to see through the fog myself, I do have the clarity to realize that subjectivity is a huge impairment to this.

My final point for today is that writing this blog is finally starting to help: analysing and recording my blood sugar levels has made me do at least some of it on my own; I am starting to see patterns I couldn't see and making changes myself. I just need some extra help to make sense of it all.

Portion sizes and the GI Index. I have a lot to learn!

I’m feeling a little more positive this week. On Tuesday I had a pretty bad day, but a game of Carcassonne with friends helped me to see the brighter side of life again!

My blood sugars have not been hugely better: last week my standard deviation was303, this week it was 299; last week 16% of readings were in range, this week 19% were (click here for this week's analysis in all it's sugary glory!). Towards the beginning of this week I was waking up in the 300’s, which had a hugely negative impact on life in general. Having attempted to figure out my overnight basal doses a few weeks ago, I had lowered my evening Levemir dose from 18 to 14. It turns out this was far too big an adjustment and resulted in the highs. I then put it up to 16 and had a couple of days of more respectable morning readings.

But my overnight readings are still not level. I never seem to return to the normal range before bed, and I have not yet managed to work out why this is. It could be a number of things, all related to my evening meal:

1. going to bed before my insulin has stopped working (meaning there is still some short-acting insulin to impact on my levels)
2. getting my ratio of insulin:carbs wrong for this meal
3. eating too much
4. my food still being in my system before bed.

Where 1. And 4. are concerned… This could be an issue. I tend to try and leave the recommended three hours after eating before I go to bed, but I know that short-acting insulin can work for longer than this. As for my food, my evening meals are often fairly carb heavy. I normally eat fairly low-fat meals with low GI ratings (brown rice/ pasta as a rule, and lots of veg and beans). I don’t yet understand the intricacies of the way insulin works with different kinds of food but I do know 2 things: low GI foods are absorbed slowly and fat slows down absorption too. Maybe my low GI dinners are not being covered correctly by my insulin dose. It may be that I need top up my ratio or even split my dose.

2. and 3. however I don’t know about… I don’t think I eat THAT much at dinner time. Often because I’ve over-corrected a hypo earlier in the evening and don’t have room (something I only did once this week, progress!). But it may well be that my understanding of portion size is completely skewed. I’ve got a lot of detective work to do!

The other achievement for this week was exercise. Only once, mind, but that’s better than nonce… On Thursday I walked 8km back from school and boy did it feel good! It had a massive impact on my blood sugars too: the next day,  I had 2 hypoes, one almost 24 hours later. Just goes to show how positive an impact it would have if it became a more regular part of my life.

On Friday I had my diabetic clinic with Dr. Kim at the Haeundae Paik Hospital. The appointment was good – we talked about the pump and he has given me the go-ahead, on the condition that I spend 7 days in hospital initially. While for some people this might be the definition of hell, for me this is just what I needed to hear. The pump is going to be hard work at first. If I can be in a controlled environment while my daily doses are calculated and tweaked I think it will give me the confidence to do it independently. At home, the thought wouldn’t really have crossed my mind, but here, so far away from the comfort blanket of England and the NHS, I can’t think of anything better. The only thing, which I, in my whirlwind of excitement didn’t consider, is the cost of 7 days as an in-patient. I may need to start saving now…

Finally this week I am gearing up for my appointment with Dr. Scheiner, about which I am still super excited but the nerves are starting to creep in. In preparation for the phone appointment I had to fill in a 13-page self-assessment form. It was thorough and this makes me hopeful.