Hello everyone, I don't just know where to hang my post, I hope it is the convenient place. The theme is as follows.My treatment (I hope you know how it goes) consists of an injection of Levemir (one basal) in the morning, another at night and before food and dinner a dose of novorapid (fast).Well, yesterday because of stupid circumstances, I was left without insulin novorapid in food.In spite of this, my 12 portions.In the afternoon I picked up my 4th of sandwich and on top of my york jam and cheese crepes that a friend made.How much would you say I had at dinner?With insulin and in normal conditions I have some problem to control my glucose before dinner, I usually have hyperglycemia.Before your astonishment I will tell you that I was 74 of glycemia.I stayed 5 minutes embobado.Does anyone have a possible explanation?If I tell this to my endocrine kills me.I hope they can forgive me. Thanks in advance and greetings;)
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Do not ultrarapid insulin on breakfast? Do you eat 12 rations of carbohydrates in food?: Shock: I imagine that it will be something like 6 HC, 4 proteins, 2 fats
In the snack, do you normally insulin?If you eat carbohydrates, I mean ...
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At breakfast I don't wear, because the night's lEVEMIR still takes effect and compensates for me.Lunch either.In the food 12 portions enter me, giving as a ration 10g of carbohydrates (sorry for the confusion XD) along with 9u of novorapid.In the snack consumption hydrates without insulin, 4 portions.All this in normal conditions.
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What you tell is strange:
At breakfast, you don't get insulin ... I suppose you will drink milk+cookies (or similar) .... the 3 or 4 rations of HC are almost certain, unless you have breakfast water At lunch, you don't put insulin either ... unless you drink coffee/pole/tea or vegetables ... almost anything will upload you minimum 1-2 rations of HC In the food, you eat 12 rations of HC: shock: (which would become about 24 cookies Maria 8)) And you put 9 insulin units ... except the other day you did not have insulin and did not put yourself. In the snack, you eat another 4 rations of HC ... also without insulin. Dinner data, not quantified: twisted:
And you come to say that you normally have problems controlling hyperglycemia before dinner ... except the other day that you did not put insulin in food and arrived with 74 to dinner (which you consider hypoglycemia).
The summary is that, right?
Odds: 1º.- You are on honeymoon with monumental insulin reserves ... fact that does not seem to confirm the 9 insulin units in food 2º.- Make barbarities of physical exercise tomorrow, afternoon and night;either working either by amusement ... what would come to explain the amount of food you eat. 3º.- Have lada diabetes 4º.- You have a huge and so exaggerated dose of basal that it makes the food not need insulin, except when its action ends;It would be necessary to see, therefore, what values you get up. 5º- you confuse HC with green lettuce things, and that glymia rises little. 6º.- All of the above are correct, complying with simultaneous timely. 7º.- File X, already mentioned. 8º.- The other possibilities require greater personal deepening.
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One thing that I would rule out in this file x is that you are not in "honeymoon" (according to your presentation post you are 17 years old and you have diabetes since the age of 11, which has been with diabetes for about 6 years) that could beOne of the things that could explain because at certain times of the day it seems that you do not need extra insulin to make an intake, but it will be that not that a "honeymoon" of more than 2 years is almost impossible.
As you comment the treatment you have is Levemir + Novorapid which is a normal basal-bolus treatment in our day (basal insulin = Levemir, insulin in bolus = novorapid).
People who have that same treatment if they make 3 meals a day (breakfast, food and dinner) puts 5 injections per day (2+3):
- 2 Levemir (one every 12 hours). - Novorapid (one at each meal).
And if they make 4 meals a day (breakfast, food, snack and dinner) puts 6 injections per day (2+4):
- 2 of Levemir (one every 12 hours). - Novorapid (one at each meal).
And if they made 5 meals a day they would need 7 injections per day (2+5) etc etc
If, as you comment, at breakfast and in the snack you do not need a novorapid I would say that everything indicates that you have basal insulin (Levemir) of Mas, it is left over to let it be seized everywhere, I say it especially for breakfast that is the time of the day of the dayin which more insulin is needed in bolus by ration of carbohydrates.
The important thing is that if the dose of basal insulin (in your case Levemir) is well adjusted the simple fact of eating a crumb of bread needs insulin in bolus (in your case novorapid) and in your case this is not being fulfilled.
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I inject a barbarity of insulin Levemir, 64 units. That does not compensate for the lack of novorapid because normally I have been very hypers lately, so my doctor has raised a mixture, Novomix 50%. There is no error in HC.I begin to believe in the existence of X. Jajaje files
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I inject a barbarity of insulin Levemir, 64 units. That does not compensate for the lack of novorapid porke normally having been quite hypers ultimately
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Let's see, as TNT has explained above, the Bolus-base treatment is based on an ultralight insulin (Lantus or Levemir) + ultra-granted insulin (Humalog, Novorapid, Apidra). The ultra -grape is essential in this treatment, every time you eat you have to get ultrarapida ... there is no more option, unless you do not eat.
1 HC unit is equivalent (theory) at 50 mg/dl of glycemia ... that is, 2 cookies rise approximately 50 glycemia (some a little more, some a little less, but the HC uploads glycemia always) 64 Units is, indeed, a barbarity ... Not because of the amount, but because you do not put insulin every time you eat carbohydrates ... It is a nonsense, it is not logical to add slow insulin to compensate for the HC of breakfast, lunchand snack ...: shock: And it is no use ... Levemir will never be able to compensate 4 rations of HC alone, let's not speak if you had a sedentary life .... Even more nonsense, if possible, introduce a mix50, that the only thing you will get is to cause a Russian mnotaña profile ...
The normal thing is that you have hypers, of course you have hypers, with that insulin pattern you have to have them ...
On the other hand, it is also true that insulin needs in adolescence are triggered to unsuspected limits.In this case, if you go up the basal you also have to climb the Bolus ... it is not worth climbing only 1 of the 2 because you will always have hyperglycemia.
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I believe that Basal and Bolus are independent, each one has a different function assigned.My last hemoglobin is 7.4 so the treatment does not just go wrong.As for the Novomix50, the idea is to have a bit of NPH in the snack to compensate for the lack of Bolus.If you are freaking out with the marked guideline, without the marked guideline to have a hypo is even more scandalous :)) :)) Thank you all and greetings
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My last hemoglobin is 7.4 so the treatment does not just go wrong.
Do not be confused, if it is "working" the treatment is pure chiripa because you are applying what I miss me is that you have no more hypoglycemia y:
I inject a barbarity of insulin Levemir, 64 units. That does not compensate for the lack of novorapid porke normally having been quite hypers ultimately
If you don't clarify it a bit that is a buried.
This is a mistake from your doctor: <BLOCKQUOTE RAFA0809 "" = "" REL = "" That you are not clear about what is a basal-bolus treatment is a problem but to some extent it is a passable and solveing problem (you are only a patient, there may be several reasons why, maybe no one has explained how abasal-bolus treatment) but that your doctor does not know how basal-bolus treatment works The matter for me becomes an important error (he is a professional, he is supposed to know the disease and the treatments of the treatments of thedisease).
Putting mixed insulins in a basal-bolus treatment is basically worse, you do not need more than two types of insulin in a basal-bolus treatment, what you have to do is apply these two types of insulin well.
On top of putting a mixed insulin when you are precisely less formed every 12 hours, being scheduled in this way you have secured the "supply" of slow insulins 24 hours (more fogying to put a mixed one).
With the mixed by the middle you are going to have many problems, the mixed are very difficult to adjust (if you manage to adjust the dose to also have a good post-Comida it is very easy for the NPH doseFrom the night, the opposite can also happen, that you are short in the mixed dose causing you to have a high post-food and that you do not correct the snack) also that there will be a moment of the day where you have three different insulinsworking (diurna + two of the mixed) which makes it more difficult to find the culprit when you have incorrect glycemia values.
If you want to snack (which seems very good to me) use insulin in Bolo (in your case the novorapid) that is what it is for.
Sorry if the post hasIt has been a bit hard but it is what there is, with the information you have given we can tell you that you are not doing things well and that the mixed far from fixing something will make things worse.
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It seems to me very well your post.In First of Luegar I consider that I have quite clear the system, "even if it doesn't seem like it."I am advised by an endocrine that I imagine know about the subject more than those present.I am a rather active person so I can do without the insulin that I do not wear.If I do not inject and I do not upload my glucose, so that I am going to inject myself to cause fainting?I think each patient is exceptional, and you should not look for similarities.My question was about that hiccup that I had, that for my day by day with the treatment I do not fit anywhere.I regret that I have taken you here and I like help for your part. Greetings to all
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My question was about that hicc All the answers you are receiving are in the same direction (possible cause: incorrect application of a basal-bolus treatment) and are being given by veterans, now that I repeat the principle, you are free to decide who to ignore.
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Let's see Rafa, do not get up;), you have been asking for advice and I think what they have told you is very consistent.I also think that you have a very decompensated guideline, a lotProfessional that is .....: Shock: It does not seem to me that you understand the basal-bolus guideline and if you understand it you do not apply it so it does .... If you adjust the basal and apply the novorapid that you need for the ration of hydrates you will stop having those hyperglycemia and hypoglycemia so accused. And if you don't want us to think, don't ask: mrgreen:
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Let's see gentlemen, I don't get much less, we are here to debate and criticisms are contrarctive.At any time I have said that you do not think, on the contrary I do the post, the only thing that gave me the impression that we were not diverting from the subject. How do you propose the adjustment?Lowering and rising novorapid apart from injecting before each intake?Greetings to the "present" hahaha: mrgreen:
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You need to start by adjusting well Levemir, that is essential and then adjust the novorapid.The parameters that indicate that it is well adjusted is to see how you get up and how you follow in the periods between meals. When you have the basal adjusted then you must apply the novorapid that you need for the ration of hydrates that you eat, you always have to get a novorapid when you eat hydrates, do you know how much insulin you need for each ration of hydrates you eat?If you have a diabetes educator, it is the one who should teach you to calculate all this. And what you have to be very clear is that Levemir does not serve to cover meals, it is only a basal insulin, it keeps you stable in the periods that we do not eat.
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Leaving you has given me an impression of something that may be happening to you ... Apart from everything they have told you about basal-bolus treatment, I totally agree and you are likely to get on basal.
The feeling, is that one of the reasons why you may have reached the situation of putting so on so much because you had hyperglycemia, is that being your quite abundant meals, you have slower digestions.That may have made glycemia, despite being fine at 2 hours of rapid insulin injection (if not, you would also have to adjust it), when the effect of insulin and digestion follow, the blood glucose continues to rise.It is just a sensation, although it is most likely that your body is accustomed to those amounts and that the digestions are normal, but it is a factor to take into account.The solution if that were, because it would happen, between putting the rapid of two punctures, or going to the insulin pump to use dual and square bowling ...
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I think I am doing well, chirpa luck or whatever they want to name.That is why I am afraid to change and start modifying things. If I change with certainty or because I have no choice :?. The issue of bombs comments to stup-endo, and said that in my state it is dicil that they give me one because it costs money and in Valencia they only give it to the people who cost a lot to control.Let's see what I do ...:-/ All the best
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Hooooolas again.
I am also from Valencia ... Without knowing it, can they take you at the General Hospital or at Arnau?Doctor JC Ferrer or Doctor Juan Girbés? I bet especially for the latter, given the comment made on the insulin pump: Twisted:
The hospitals have a maximum number of bombs to be put in a year (euros theme).They put them according to their criteria, not necessarily by gravity.
The proposal of the changes comes from your part or the endocrine, who wants to put a mix 50 ... And that, patients but not profane in the matter, sounds very rare. The normal thing is what we have been telling you. Now, you are the first interested and knowledgeable about how things are going.
To evaluate your treatment, what is usually done is to perform a full profile of digital glutemia and write everything you do and eat. That is, blood glucose controls: for at least 3 days in a row or alternate (recommended 1 week, but as they are with reactive strips ... :() Get 7 daily glycemia, before each meal and 2-3 hours laterof each meal; Point amounts of food (HC, fats, proteins ...) and amount of insulin. Obviously everything with their corresponding hours.
With that information, what happens is analyzed. Example: You get up at 115, Breakfasts 4 rations of HC (do not get ultra -granted insulin and 32 Levemir units), at 2 hours you are in 230. Do not lunch. Before eating you arrive with 130, you eat 12 HC rations and you put 9 novorapid units. 3 hours after eating you are at 100 HC 2 portions and don't get a novorapid You arrive at dinner with 180, dinner 6 rations and you put 5 novorapid units and another 32 of Levemir 3 hours later you are 170 At 4 in the morning you are with 120 At 9 when you get up the next day you are 90
More less, that would be an example of a glycosilada of 7.4
Without all that information (and several days), which I suppose I will have handled the endocrine (the same is very supposed), to make you make changes with a mix50 in the afternoon is a recklessness. The Mix 50 has 50% fast and 50% slow ... so you should eat (more) to compensate for the fast insulin you are getting into.
