Replies to This Discussion

Permalink Reply by Sam on May 5, 2012 at 7:37am

which particular smart phone apps have you found for this? I resisted getting a smart phone for about as long as I can-- but I suppose it is time.

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Permalink Reply by Oakville27 on May 5, 2012 at 8:14pm

I've tried two apps on my iPhone: Glucose Buddy and Diabetes Pilot.

Glucose buddy is free and well-reviewed, so I tried that first but found it to be difficult to input data (I log a LOT since I'm new and trying to figure out how everything affects me) - it just took a while to put in data and didnt seem very flexible if I wanted to add a note for an entry or something like that.

Diabetes Pilot cost a few bucks but I find it to be totally worth it. It's easy to punch in a quick note (snack, meal, exercise, meds, etc) and I can make notes as I want (why did I take that extra unit before eating, etc.).

I'd suggest trying a free one or two first and see how you like them - you may have a completely different experience than I did with glucose buddy, for example.

The only thing I've found is that I'm way faster at writing stuff in my notebook so I'll have to go back and update my app later if I miss a few entries. Ive actually got about a week's worth of data to load so I can share it with my CDE.

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Permalink Reply by acidrock23 on May 5, 2012 at 7:51am

It's also sort of useful to keep track of changes. When I was "off the ranch", I'd just guess all the time, if it'd run up, guess and take some more, etc. which led to lots of hair raising ups and downs. With a gizmo (e.g. my pump...) it's pretty easy to see where I've been and come up with ideas about where to go next?

Re specific apps, Glucosurfer.org is run by a member and has a couple of things I like a lot: a very good graphic rendering of your BG graph, incorporating insulin boluses, food and exercise in a convenient picture. At one point, they also were incorporating a means of taking pictures of food so if you had x square inches (or CM, as they are in Germany...) of pizza or salad or whatever and got a result that was "off", you could have a pic of it handy for next time? I used "Lose It" to track food for a while, although it didn't incorporate BG into it's measures, it was handy and I noticed a few things BG-wise, simply by tracking what I was eating.

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Permalink Reply by Leo2 on May 5, 2012 at 7:59am

In 90 days you could ask for a CGM, a Dexcom.

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Permalink Reply by Sam on May 5, 2012 at 8:12am

why 90 days?

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Permalink Reply by MyBustedPancreas on May 5, 2012 at 10:08am

Well, there's a few things wrong with your post here:

1. If I was that high, I wouldn't eat! I would get my BG down first (preferably under 200) and then eat something.

2. When you're high, your correction factor is going to probably be different. Usually, my correction (or insulin sensitivity factor) is 1:40 - for every unit I take, my BG will drop by about 40 points. HOWEVER, once I'm over about 280, I get more insulin resistance and my ISF becomes more like 1:20.

3. I think you also made a math error (which someone points out below), but no, I would not do a full correction again 2 hours after eating. You would still have some insulin working in your system and correcting again at that time would probably cause a really wicked low a couple of hours later when all that insulin kicks in. That said, if my numbers hadn't budged, I would probably do a partial correction.

But I think you hit the nail on the head - this is an art form. And everyone reacts differently under different conditions.

If you are able to obtain health coverage that allows you to get a pump, definitely consider it. The bolus wizards really take the headache out of the math factor once you get everything set properly.

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Permalink Reply by Sam Iam on May 5, 2012 at 10:44am

I second all of the other advice. Most likely, any doctor or diabetes educator you encounter will not be diabetic. The information they give you will either be textbook or clinical. Not first hand. Novolog / Lantus will not work like it says it will on the bottle. Smaller shots will be more accurate and consistent than large shots.

Go to Walmart or some place, and buy a cheap monitor and a couple hundred cheap test strips. I reuse lancets a lot, just cuz i'm too lazy to change them, but it's never caused a problem. Then, just test your BG a lot. This is the only way to figure out how your D works.

Be patient and relax. Consider yourself fortunate that you have much, much better tools available to you now, than if you were diagnosed 50 years ago.

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Permalink Reply by Terry on May 5, 2012 at 12:33pm

Sam - I like your advice here. While the textbook and clinical advice that we receive from doctors and diabetes educators is generally ok, it is simply a starting point that each of us can use for further experimentation.

Matthew - I'm sure you've seen the auto industry disclaimer that "your mileage may vary" or YMMV. Many here have adopted the sentiment that "your diabetes may vary" or YDMV. In fact many believe, including me, that your diabetes will vary.

As much as the medical professionals may consider their advice as definitive, your acceptance of their advice as such may be hazardous to your health!

If you want to do well with your diabetes, you must test, test, test. It may help to write down your experience so that you can begin to spot some patterns and start to see the forest instead of individual trees.

If you take this disease seriously, you will never cease to test, analyze, adjust, and test again. Diabetes control is a moving target. Just when you think you've settled on the right algorithm, the rules will surely change.

As a few others have suggested, you need to understand the concept that insulin is used up over time and if you check your blood sugar two hours post meal, then you need to estimate how much insulin is still active (also know as IOB or insulin on board. Then you can factor that amount into any needed correction.

It may seem like a lot to learn but your efforts will make life easier, not harder.

Good luck to you!

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Permalink Reply by Sam Iam on May 5, 2012 at 2:14pm

I would also add a simple rule: You can NOT eat whatever you want.

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Permalink Reply by LaGuitariste on May 5, 2012 at 7:46pm

Sigh. Truer words were ne'er spoken.

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Permalink Reply by Spock on May 5, 2012 at 6:42pm

Chill. Take a happy pill. Relax and educate.

There is a huge difference between the insulin to carb ratio and the correction ratio. Correction will tell you what 1 unit of insulin will reduce your glucose level. Mine is 1 to 65. So, if I am 180, one unit would bring me to 125 in 4 hours. So you need to understand both ratios.

Also be wary of the insulin on board. It takes about 4 hours for fast acting to be disspated in your body. The bolus wizard is a fantastic tool for all ratios and on board insulin. If you have one, program and use it--it does the thinking (well, calculation) for you.

Good wishes to you!

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Permalink Reply by LaGuitariste on May 5, 2012 at 7:45pm

"When I check my BG level 2 hours from the moment I put the fork down... Let's say my sugar is at 220 now. DO I CORRECT THIS? or do I wait FIVE hours and check before the next meal."

OK, I'm too lazy to read all the replies, so I'm just going to answer this one question to the best of my ability:

The answer is NO, you do not want to correct again before your last correction if fully metabolized, because then you will be in danger of STACKING insulin, which can be very bad, resulting in hypos. What you do want to do is NOTE the time and the value and then use that information to adjust your correction factor in the future. Then you want to test again at four hours and, if you're still above target, do another correction.

For example:

You test and you're at 320. Your current IC ratio is 1:20. You're correcting to 120.

You calculate a correction at 320 - 120 = 200 / 20 = 10 IU and you inject that.
(Let's ignore the bolus part of your injection for now.)
You test at 2 hours and you're at 220. You resist the impulse to "stack" and wait.
You test at 4 hours and you're at 180.
OK, what did you learn? Your injection of 10 IU was supposed to drop you 200 mg/dl (or one unit for twenty mg/dl or 1:20), but in fact it only dropped you 140 mg/dl (or one unit for fourteen mg/dl or 1:14.)

Make a note of that "dropping power" and use it to adjust your correction factor in the future. When you're more sure about your actual correction factor, doing additional corrections (not waiting for the next meal) will become more safe. Sometimes I do (conservative) corrections right before bed, because I'm so sure of my factor after tweaking it for months.

Maybe next time you'll need to correct a 220, and perhaps you'll calculate it thus:
220 - 120 = 100 / 18 = 5.5 if you have a half-unit pen or syringe.

That is, you inched down your correction factor to a number between your original 1:20 and your suspected new ratio of 1:14, because it's usually not a good idea to make sudden moves in treating diabetes. That 1:14 might have been a fluke due to exercise, alcohol or some other factor; don't leap down to it, inch your way down to it and test, test, test.

If your factor is off the other way, raise it to 1:21 or 1:22 and test, test, test.

I have fairly crappy insulin resistance and my doc's started me at a correction factor of 1:30, which was like injecting water. Now I'm at 1:4.8 (morning) and 1:6 (evening) and this seems to be about right. I didn't leap there, however. I inched there, because there are so many other things to take into consideration: dawn phenomenon, infections or not, exercise or not, (for women) hormonal weirdness or not, usual and customary carb intake, usual and customary protein intake, whether or not you calc for gluconeogenesis from the protein, insulin resistance caused or ameliorated by other medications or conditions (e.g. thyroid, steroids), alcohol consumption or not, etc.

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