Maths For Diabetes

I was trying to work out how much carbohydrates for every unit of insulin I needed to take and how many mmol/l above target for every extra unit I needed to take. Here is the information I had: I consumed approximately 286g of carbohydrates over the course of a day, I took 23 units of fast acting insulin on that day and all that left me at the 7mmol/l you see in the photo. The 8 units there don't count because that is my long acting insulin dose I take every night at 10pm. I made a slight mistake in calculating the carbs per unit. I said 286÷23=1x instead of =x+1 (target reading + 1. The target is 6mmol/l). 286÷23=12.4 to one decimal place. It should have been 12.4=x+1 => 12.4-1=x=11.4. But having it at 12.4 allows for days that I'm more active when I would be a bit more sensitive to insulin so I'll leave it at 12.4g carbs per unit. 

The next thing was working out how many mmol 1 unit of insulin covers. I wasn't sure how to do this but here's what I did. It'll give me a close enough rough guide. 23 units of insulin over the course of the day left me at 7mmol/l. 23=7x, 23÷7=x=3.3 to one decimal place. So take one unit for every 3.3mmol I'm above target. This may or may not allow for the amount of carbohydrates consumed but, like I said, it's good as a rough guideline. There are variables outside this that will affect what my reading is like snacking between meals which I don't test or dose for, how long after my last dose I snack (which can leave excess glucose in my blood when the dose wares off) and being more active than anticipated between meals (which can lower my glucose). So my calculations can't be 100% accurate. This rough guideline should help give me more control than winging it for the previous two years. "Should" being the operative word!

I have the time at the moment to research and work out the nutrients in dishes that aren't already in the food section of my health app and input them manually. Once I input info manually the app stores it for me for future use. Once any food has the nutrients in the app I can see how much carbohydrates in a meal as the app adds it up for me. I can calculate how many units needed then. If I didn't have the time I'd still be winging it and would say keep doing what works for you to anyone else who hasn't got the time to be working out carbs in a meal and calculating the amount of insulin to take with them. Another thing is I don't round up where the digits after the decimal point are closer to the number above (eg. 6.9 I'd take 6 units). When I first started counting carbs I was using 11g/unit, rounded from 11.1 and a meal had 40g of carbs. I took 4 units because it was closer to 44 than 33. I ended up going hypo just before my next meal. That is why I now go with the whole number and ignore what's after the decimal point when calculating units to cover a meal.

A Quick Update

 I've decided to update all the recipes on the blog to include nutritional values if I can since I've a health app that allows me to log macro and micro nutrients of the food I eat. I started today by updating the salmon fillet with nectarine infusion recipe in the blog post titled "The Feels And A Recipe". Over the next few months every home made dish that I haven't logged into the app before, or can't search the app for, will need nutritional values researched and worked out regardless of whether it's on the blog or not. Except for recipes in Jenna Zoe's Plant-based Paleo cook book which has nutrients. Well, it has macro nutrients but not micro nutrients with each recipe, but that's enough to let me know the minimum information I need for the app and the carbohydrates in a dish for the purposes of how much insulin is needed to cover a meal. So that's the plan for the blog if I'm not posting something, which means I'll have to be active on the blog again even if it appears that there's nothing new on it.

Managing Diabetes

I changed my phone recently to a Samsung because the Samsung health app allows me to log meals and it gives me an outline of the main nutrients taken from meals based on the data input. I can also log blood sugar and, importantly, insulin doses. I did a rough calculation a couple of days after I started using the app. It worked out at taking one unit of insulin for every approximately 11.1g of carbohydrates I consume. I rounded off to 11g. So now I take one unit of fast acting insulin for every 11g of carbs plus one unit for every 2.5mmol I'm over 6mmol/l before a meal. The carbs for my evening meal the following day was about 40g - less than 44, more than 33 but closer to 44. So I rounded to the nearest 11 which was 44 and took 4 units for it. At the time of testing before taking my long acting insulin before bed my blood sugar had dropped to 4.1mmol/l. I allow for a drop of 3mmol overnight when taking long acting insulin. So this meant I had to eat before bed. Had I taken three units of insulin instead of four I would have been above 6.5mmol/l. I would have still taken a half a teaspoon of raw honey to prevent a low and stabilise my blood glucose but the point being I will always round down to the nearest 11g in future. Lesson learned. So, for example, if there are 54g of carbs I'll still take four units instead of five. I won't take five units until 55g or above to be sure.

This evening I had a Dr. Coys chocolate bar while out & about. But it didn't seem to affect my blood glucose. It read 5.9 before my evening meal. Here's where I'm getting to the point of the picture. The carbs for my evening meal worked out at about 90g this evening, warranting an eight unit dose. But I decided to give myself seven units because I didn't want to be below 6.9 taking lantus. With the 2.5mmol for every unit guideline I figured I should be approximately 8.5mmol/l taking long acting insulin. As you can see, those seven units left me at 8.6mmol/l at long acting dose time. 

It really does seem that the help of this app will give me greater control over my diabetes over time.

When Diabetes Behaves

I took insulin before breakfast around 10.15 yesterday morning. Went on a bus journey after that. Close to 14.30 I felt like I might be going low while sitting talking to someone. I tested myself and my blood sugar read 6.1mmol/l. So I continued with what I was doing without having to worry about my blood sugar. I didn't eat at all while I was away until I was on the 17.30 bus home. It was 17.36 when I tested myself and took insulin to eat though. 3 hours after testing myself and over 7 hours since took insulin and ate anything and my blood sugar still read 6.1! It's amazing. It wasn't even lower. I wasn't very active but still, I hadn't eaten for more than 7 hours when I normally go 4 hours between meals. I jokingly texted the person I was talking to earlier that they must be good for my diabetes because my blood sugar was the exact same as when I tested earlier. Sometimes diabetes just behaves itself it seems. Knowing how it behaved itself could be useful for future journies and activities while I'm away.

 I ate a bar of chocolate on the way home from the bus though, which pushed my sugar to 12.2 (exactly double the previous 2 readings) when I tested before taking my long acting insulin last night.

Trying To Access Glucometer Insulin Settings

 Today I want to talk about my meter not working the way it used to and my efforts to get Abbott to allow me to change that. My meter is a Freestyle Optium Neo. It used to be able to allow me to log my insulin doses. I don't know why but at the end of March this year that function just disappeared from it. I have the Freestyle Auto-Assist software on my laptop and, as can be seen in the first photo, meter settings can be changed from here like date and time. I can also generate reports to see how my insulin doses (if the function still worked) and blood glucose are trending. The one I want is insulin settings.

This is where the long acting and meal doses can be set. I just need access to this in order to be able to log my doses in my meter again. I don't need a new meter. But there's a catch:

As you can see from the third image, I cannot access insulin settings without a code. I went on the Abbott freestyle website and got a customer service number. I called the number and got through to a woman who sounded Eastern European and English obviously was not her first language. She took the serial number of my meter, recommended I download the Libre view software and said she'd call me back the following day. My meter does not work with the libre software even though the Libre View website suggests it should be compatible. I discovered this by not being able to access my meter on the laptop from the usb connection from either Libre View or Auto-Assist when the libre software was downloaded. So I got rid of the libre from the laptop. Just as well because my diabetic nurse accesses my meter from Auto-Assist at our appointments. Meanwhile I went back to the freestyle website and got a contact email for customer service and explained the situation. The woman I called rang me back the next day and I explained the situation and how the libre didn't work for me. She told me I would have to contact my diabetic nurse to get her to contact an area representative for my region and get a code. She was unable to give me a code herself. The following day I got a reply to my email. It said: "Regarding your query, please be kindly informed that this access code can only be obtained from the healthcare professionals, therefore may we kindly advise you to contact your healthcare professional in order to set up or change the insulin dose values". 

I can understand a newly diagnosed patient not being allowed access. But I have been managing diabetes for more than one and a half years and all I want is to be able to log doses in my meter again. When I was at my appointment with the diabetic nurse a month ago she said she didn't have a code for optium neo meters and didn't make an effort to get one, that I'm aware of, and that is why I went to the effort of contacting Abbott myself. 

 

HbA1c

It's been a while since I posted. I planned to post today when I got my HbA1c result Monday. Indeed I'm partly doing it to avoid doing something else not health related. I come up against mental barriers sometimes when trying to accomplish certain tasks and I procrastinate and distract myself to get rid of the anxiety. Doing this blog today is another distraction. I can even struggle to stay focused and driven at the best of times and that happens with the task of keeping up with this blog too, hence why it it took so long between posts this time. Anyway, I'll do a mental health post another day.

I went to the diabetic nurse Thursday of last week. It was hard to believe it had been October when I saw her last because of the corona virus. I didn't even get to talk to her over the phone for my last appointment in April because she was up in the wards instead of in the outpatients. I talked to her colleague that day. All went well with my appointment on Thursday and I got blood taken for my HbA1c afterwards.

I'm striving for continuous improvement and my results have shown that with one caveat, one of them isn't included in the tweet above because it wasn't in the list of results taken with a normal blood test. It was taken with a finger prick and a detector that isn't as accurate as the normal blood test. I have a sticker in a 2019 diary with that one. The label on the sticker reads DCA Vantage. That test gave up a HbA1c reading of 51 mmol/mol. The other two results after it have been in the sixties. To be honest, I wasn't expecting my latest one to be lower than October. I told the nurse I was expecting it to go up a bit but she reckoned at the end of the appointment that it would be down and she was right. My averages over the winter were very high as the honeymoon period was long gone. But I made adjustments to how I dose with insulin in the spring and even recently changed my meals around a bit and it worked out well.

I wonder will I ever be in the fifties again? That's a long term diabetes goal to strive for.