COMPLETE DATA - 3 Years Old child, Type1 Diabetes, Insulin Hypoglycemia, Intermittent, Bloating 1 Month

This is an online E-log book to discuss our patient's De-identified health data shared after taking his/her/guardian's consent. Here we discuss our individual patient's problems through a series of inputs from the available global online community of experts with the aim to solve those patients' clinical problems with the collective current best evidence-based input. 

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COMPLETE PATIENT DATA LOG

 3/20/24

INITIAL HISTORY IN ENGLISH

Patient Advocate: Respected Sir,

I am a patient advocate. My patient was born on 30/04/2021, with a birth weight of 2.8 kg. On 25/02/24, the patient experienced a fever for one evening. Since then, her body has gradually become weaker, though her appetite has significantly increased. However, there has been no improvement in her physical condition, and she is drinking a lot of water, to the point that two diapers were not sufficient overnight. After observing this for a few days, we consulted a doctor on 03/03/24. The doctor prescribed some medication and advised some tests. However, the medication did not seem to work. 

On 08/03/24, we consulted another doctor, who also advised further tests. These revealed that the patient has Type 1 diabetes. The doctor admitted the patient to the hospital for 5 days, and on 13/03/24, they were discharged with instructions to administer insulin 3+1 times daily. 

The patient is now at home and follows the following diet:

- 7:30 am: Wakes up and eats two cream cracker biscuits

- 9:30 am: Eats a bowl of oats

- 11:30 am: Has a fruit (orange, sweet lime, guava, apple, or pomegranate)

- 1:00 pm: Eats rice with dal, vegetables, or vegetables with egg/fish

- 4:30 pm: Eats two biscuits

- 5:00 pm: Has fruit or puffed rice

- 9:00 pm: Eats dalia (broken wheat) with vegetables

INITIAL HISTORY IN BENGALI

Patient Advocate: Respected Sir,

                        আমি একজন রোগীর অ্যাডভোকেট। আমার রোগীর জন্ম 30/04/2021 তারিখ, জন্মের সময় তার ওজন ছিল 2.8 কেজি l গত 25/02/24 তার একবেলার জ্বর হয়েছিল তারপর থেকে তার শশীর টা ক্রমশ দূর্বল হয়ে পড়ছে আবার খাওয়া দাওয়া আগের থেকে অনেক বেড়ে গেছে,কিন্তু শাশীরের কোনো উন্নতি নেই জল ও খাচ্ছে প্রচুর একরাতে দুটো ডায়াপার   দিয়েও হচ্ছিল না । এমন কয়েকদিন দেখার পর 03/03/24 তারিখে ডাক্তার দেখানো হয় । ডাক্তার কিছু ঔষধ দেন এবং কিছু টেস্ট করতে দেন ।সেই ঔষধ খেয়েও কিছু কাজ হচ্ছিল না ।এরপর 08/03/24 তারিখে আবার এক ডাক্তার দেখানো হয় , তিনি কিছু টেস্ট করতে দেন  সেখানে ধরা পড়ে রোগীর টাইপ 1 সুগার হয়েছে। ডাক্তার রোগীকে 5 দিন হাসপাতালে ভর্তি রাখেন । 13/03/24* তারিখে তাকে ছেড়ে দেন এবং প্রতিদিন 3+1  ইনসুলিন নিতে বলেন ।এখন এভাবেই রোগী বাড়িতে আছে । রোগী সকল 7.30 তে ঘুম থেকে উঠে দুটো ক্রিম ক্রেকার বিস্কিট খায়, 9.30 am সে এক বাটি ওটস নেয়, 11.30 am একটি ফল (কমলা/মৌসম্বি/পেয়ারা/অ্যাপেল/বেদানা) নেয়, 1.00 pm  ভাত (ডাল, সবজি/সবজি,ডিম/মাছ,সবজি) নেয়, 4.30pm দুটো বিস্কিট 5.00pm ফল/মুড়ি নেয় 9.00pm ডালিয়া সবজি দিয়ে নেয়।

PaJR PHR Moderator: Bhalo hoye jabe. Chinta nei 

Roj unar ghontai ghontai Ki Ki activities korchen ebong roj Ki Ki khacchen shetar plate er chobi please ekhane janaben. Khawar aage koto dose insulin load korlen tar chobio janaben

Ektu describe kore deben 

Bhaat are daal are doi?

Patient Advocate: Ghum theke 8am uthe duto suger free biscuit kehechhe. 9.45am Gajar,beet, squash,beans,Pepe diye bhat sathe dim kusum bad diye, sange gajar r aashar salat l

Breakfast er age

PaJR PHR Moderator: Sugar free kimba Jekono biscuit avoid kora dorkar.

Oguno simply moida 

Tar theke Lal muri kimba Lal Khoi jeguno dhaan theke banano would be better

Patient Advocate: 19/3/24

Before lunch 101

After dinner 233

Ekhaner doctor boleche dine duto time korte

Sir o to onek chhoto  oke manano khub kasto , ek bar kanna shuru korle r thame na jatakshan na oi jinish ta oke deoa hay ।

PaJR PHR Moderator: Hain kintu kone jinish? 

Bhalo Khabar o bhalo lagbe nishchoi. Jeguno khotikarok sheguno amra bhabi sushshadhoo kintu ashole oguno hoito ekkebarei sushshadhoo noi kintu onyo der dekhe ore shei dharona hocche. Dui bhai boner ebong barir shobar aeK hi khabar khawa uchit

Patient Advocate: Sakal 11.30am mosambi 1pc medium size

1.45pm insuline 3mg

2.00pm lunch sakal 9.30am Tai repeat

Sorry Sir sakale 9.15am 3mg insulin deoa hoyechhilo

PaJR PHR Moderator: Ota mg noi 

Unit habe. Apni ota "U" likhte  paren

Patient Advocate: Ok

Luncher dui (2) ghanta por 36 ,sathe sathe duto biscuits abong ekta 15grm er lojence dilam 

5.30pm ekata chaler guror plain pithe(পিঠে)

Sir, insulin ki bandho hobe seta ki sambhab?

Sir muri ki dite parbo, murir glycemic index bole 80-90, please suggest me sir

PaJR PHR Moderator: Hain Jekono khawar plate a ekta proportion kore dewa jete pare. 

Niche details share korchi

Sabdhane dite habe. Sugar high howar theke low hoye jawa ta beshi khoti karoK bishesh Kore baronto bacchader khetre. 

Aer aage eto ta kom kokhono hoyechilo? 

36 howar aage kimba pore Kono koshto lokkho korechilen?

Patient Advocate: Chart madhya ekdin same time 28hoyechhilo।

Kashto bolte hat pa kanpa

PaJR PHR Moderator: Aekhon theke before lunch insulin ta bondho rakhun 

Lunch er aage insulin na niye du ghonta bade janaben kalke

Aekhon theke ore ebong barir sobar khawar thala guno aeibhabe sajano habe 👇

https://medicinedepartment.blogspot.com/2023/09/the-healthy-plate-diet-in-bengali-telegu.html?m=0

Patient Advocate: 9.30pm e gajar, beans, squash diye dalia

Dinner er age 2unit abar ghumanor samay 4unit insulin deoa hoyechhe

3/21/24

Patient Advocate: Good morning Sir

AJ sakal 7.35am ghum theke uthe alpo muri kheyechhe, 9.45am  bhat chholar Dall, Lao dogar sabji, 25grm machh r gajar , sasha r salat

PaJR PHR Moderator: Ajke blood glucose dekhen ni? Insulin koto niyechilen breakfast er aage? 

Lunch aer aage insulin bondho rekhe lunch er du ghonta baade blood sugar ta koto thake janaben (dorkar hole aeK hi sample lab aeo pathate paren lunch er du ghonta bade) 

Apnar local daktar keo janiye rakhben

Apnar local daktar keo amader sompoorno kothopkothon ta janiye rakhben

Patient Advocate: Ajke breakfast er por test korbo, insulin breakfast er age neoa hoyechhe l

Agami 23 March doctor er check up achhe l

Suger test er sampurna data record ache local doctor ke dekhabo l

Breakfast er du ghanta por suger leve 72

Dupur 12tay apple r Kamala mile 100grm

PaJR PHR Moderator: Hain kintu ore bortoman record dekhe bojha jacche je lunch aer proti du ghanta bade 3U insulin nile khub dangerous bhabe ore sugar ta fall Kore jacche tai ore lunch aer aager insulin ta bortoman a bondho rakha proyojon ebong bondho rekhe ajke lunch aer du ghonta bade sugar ta kemon thakche sheta janaben

Patient Advocate: Thik achhe sir

1.30pm gajar, squash, Pepe r sabji diye bhat sathe 25grm machh

4 tay suger 147

PaJR PHR Moderator: Dinner er aageo sugar ta Kore janale bhalo hoto. 

Aer aage proti din oi somai ta beshi dekhacchilo jehetu lunch aer por hypoglycemia howai abar beshi Kore sugar khete dite hocchilo

Patient Advocate: 5pm khub kanna korchhilo pray 1 ghanta tarpor ekta suger free biscuit dilam r 1/2 bati muri ।

7pm 70% dark chocolate tar 15 minutes por 1/2 atta roti

9.15pm suger 132

Dinner gajar,Pepe,beans, squash diye dalia songe 1/3 chamach ghee

3/22/24

PaJR PHR Moderator: Thik ache. Dinner er aage sugar ta dekhe mone hocche bikeler biscuit, muri are dark chocolate a kono khoti hoini

Patient Advocate: AJ sakal 7.15am ghum theke uthe 1PC biscuit alpo muri

9.30am gajar, squash,tometo,Pepe diye bhat sathe 1/2 dim kusum chhara abong salat

Before lunch

PaJR PHR Moderator: Kono insulin neben na lunch er aage

Patient Advocate: Na

Lunch e gajar, beans, squash, tometo diye bhat sange 1/2 dim, 15gmr machh abong salat

Ghum theke uthe bikel 5pm muri 10grm dark chocolate

3/23/24

Patient Advocate: Yesterday rat 9.30pm gajar, squash, Pepe diye dalia songe ghee r salat

After dinner

AJ sakale 8.00am ghum theke uthe gajar squash Pepe sedho diye ghee bhat kheyechhe, insulin nebar por

PaJR PHR Moderator: 👍

Patient Advocate: 1.00pm sasha gajar kacha

2.15pm gajar, squash chhola dal diye bhat

Ajke Siliguri te doctor dekhate jachhi Tai sabkichhur time ulot palot hoye gelo

AJ ekhaner doctor ke dekhalam onake ei grouper khatopokathan  balam ebong ekhon je luncher ager insulin ta bondho kore deoa hoyechhe seta bolechhe, uni bollen je Ami sadharon eisab patient ektu stable hole baire giye dekhiye ante boli l 

Tobe je doctor er suggestion amra nichhi tar field ta janle oner Mone ekta satisfaction asto

Ei doctor bollen luncher ager ta ekebare bondho na kore tin Bela 2u kore nite bollen

Luncher por suger level👇👇👇

6.15pm 1pc biscuit ektu muri

8pm atar ruti 1/2

PaJR PHR Moderator: Eta Ki ajke luncher aage insulin 2U newar 2 ghonta por?

Patient Advocate: Na ajke lunch aage kono insulin neoa hay ni

PaJR PHR Moderator: Amader field ta diabetes

Patient Advocate: Thank you Sir

PaJR PHR Moderator: Bhalo korechen 

Aekhon ota lunch aer aage bondho reKhe lunch er 2 ghonta baade majhe majhe blood sugar ta Kore janaben 

Soptahe eK din fasting, breakfast er du ghonta baade, lunch er du ghonta baade, dinner aer du ghonta baade ta Kore janaben

Patient Advocate: Ok

PaJR PHR Moderator: Unake apnar Chart er shuru theke lunch aer 2 ghonta baader blood sugar guno dangerously fall Kore jawa ta dekhiye bojhano gechilo?

Patient Advocate: Ekdom Sir

Er janya dose er poriman komiye 3u theke 2u kore dilo tin belai

9.45pm gajar,Pepe matarsuti diye dalia

Aaj dinner er age 2u insulin deoa holo

PaJR PHR Moderator: Kintu uni etao dekhechen je bortomane lunch er aage 0U niyeo blood sugars normal aashche. Tahole keno 2U newa habe? Hoito amra je bhabe ekhane roj follow up korte parchi sheta okhane sombhob habe na bole?

Parle plate aer chobi guno share korben

Patient Advocate: Suger test er plate ta ki Sir ?

PaJR PHR Moderator: Khawar plate guno

3/24/24

Patient Advocate: AJ sakal 7.30am ghum theke uthe alpo muri tarpor 9.45am gajar,Pepe, squash,beans diye bhat

Sorry ota 9.45hobe na 8.45 hobe

3.15pm gajar, beans, squash,dim (kusum bade) diye bhat sange gajar r sasha salat

6.15pm muri

Aajo barite back karar janya time ulot palot hoye gelo

PaJR PHR Moderator: Ajke 5:15 PM (lunch er du ghonta bade) sugar ta kemon chilo jante parle bhalo hoto kintu bujhte parchi oi somoi hoito apnara gari te chilen

Patient Advocate: Aaj sakale 2u, lunch er aage kono insulin neoa hay ni, eiabasthay dinner er age suger level 180

Aaj 7.45pm 1/2 roti

10.00pm gajar tometo beans squash diye dalia

Dinner er age 2u insulin deoa hoyechhe

3/25/24

PaJR PHR Moderator: Dinner er aage ektu beshi gotokaaler traveling er jonye hoito

Patient Advocate: Hote pare

Sakal 7.45am ghum theke uthe ektu muri 

9.30am gajar, Pepe, beans, squash diye bhat sange salad

PaJR PHR Moderator: Description er saathe chobi o share korle bhalo hoi

Patient Advocate: Thik achhe Sir

1.45pm gajar, beet, beans, squash, Pepe , mung dal diya bhat sange salad

PaJR PHR Moderator: Insulin newa hoini bodh hoi?

Patient Advocate: Sakal e hayechhe 2u breakfast er age

Bikel 4.30pm 1/2 sandrsh

7pm muri khehechhe

9.45pm  beans, squash, Pepe diye dalia songe salat

3/26/24

PaJR PHR Moderator: Before dinner Insulin?

Patient Advocate: 2u

Sakal 8am ghum theke uthe muri kheyechhe

Before breakfast

2u insulin

PaJR PHR Moderator: Breakfast er du ghonta bade?

Patient Advocate: Murir  sange olpo garur dudh

PaJR PHR Moderator: Kotai? 

Post breakfast sugar ta kotai newa?

Patient Advocate: Breakfast karlo to 9.50am

PaJR PHR Moderator: O accha tahole sugar value ta fasting sugar chilo?

Naki sugar ta muri khawar por?

Jekono khabar jeta sokale prothom khawa hoi bigyan bhitti te shetai breakfast

Patient Advocate: Muri khabar por

PaJR PHR Moderator: Kotokkhon por?

Patient Advocate: Muri kheyechhe 8.00am blood test hoyechhe 9.15am

PaJR PHR Moderator: Test always fasting kimba Jekono khawar du ghonta bade korben nahole confusion habe

Patient Advocate: Ok

11.30am 50grm paka bell

1.45pm Pepe, beans, squash, beet diye bhat sange two pcs chicken  abong salat

Luncher du ghanta por

Luncher age kono insulin neoa hoy ni

PaJR PHR Moderator: 👆Breakfast a Ki kheye chilo?

Patient Advocate: Murir  sange olpo garur dudh

PaJR PHR Moderator: Kintu muri to 8"00 AM a kheyechilo 

9:50 AM a Ki kheyechilo?

Patient Advocate: Muri kheyechhe 8am

9.30am gajar Pepe beans diye beet diye bhat sange salad

PaJR PHR Moderator: 9:30 AM a 2U insulin niyechilo?

Patient Advocate: Yes Sir

Sir or krimi hoyechhe Noworm syrup ki deoa jabe?

Tobe ajke dibo na l

PaJR PHR Moderator: পুনর্বিবেচনা: 

8:00 AM মুড়ি গরুর দুধ (চিনি দিয়ে?)

 সকাল ৯:৪৭ ব্লাড সুগার ৬৭ সকাল 

9:50 AM 2U ইনসুলিনের পরে সকালের নাস্তায় গাজর, মটরশুটি, বীট, ভাত, সালাদ 

1:45 PM দুপুরের খাবারের পর ইনসুলিন নেই পেঁপে, মটরশুটি, স্কোয়াশ, বিট, চিকেন, ভাত, সালাদ 

4:44 PM রক্তে শর্করা 269 আমাদের অজান্তেই সে কি অন্য কোন মিষ্টি খেতে পারে?

Revision:

8:00 AM Muri cows milk (with sugar?) 

9:47Am blood sugar 67

9:50AM 2U insulin followed by breakfast carrot, beans, beet, rice, salad 

1:45 PM No insulin followed by Lunch 

Papaya, beans, squash, beet, chicken, rice, salad 

4:44 PM blood sugar 269

Could he have consumed any other sweets he may have consumed without our knowing?

Jekono syrup dile ore blood sugar bere jete pare

Patient Advocate: Dudh e kono suger chhilo na

11.30am paka bell 50grm

O ajke sarakshan Amar sange chhilo uporer baire kono khabar khay ni

Bell er theke ki suger level bere jete pare ?

PaJR PHR Moderator: Ote Chini dewa hoyechilo?

Patient Advocate: Na, halka noon

PaJR PHR Moderator: Goto kaal lunch aer aage shara din Ki Ki niyechilen ektu time soho list Kore Dekhte habe 

Goto kaal lunch aer du ghonta bade blood sugar koto chilo?

Patient Advocate: Gato kaal before lunch chhilo 66, r dinner er du ghanta por chhilo 150

Sakal e muri

9.30am gajar, Pepe, beans, squash diye bhat sange salad

11.45 am 1PC Kamala (orange )

1.45pm gajar, beet, beans, squash, mung dal diye bhat sange salad

PaJR PHR Moderator: Before naki lunch aer du ghonta por?

Patient Advocate: 150 chhilo dinner er du ghanta por

PaJR PHR Moderator: O tahole lunch aer du ghonta bade goto Kal newa hoini? 

Always khawar du ghonta bade neben. Before newa shob somoi proyojon nei jodi na insulin newar por hypoglycemia 'r ashonka thake

Patient Advocate: Thik achhe Sir

5.30pm alpo muri

7.45pm roti 1/2

9.45pm squash,Pepe diye dalia sange sasha r salat

Er age 2u insulin

Shoyar age 4u insulin

3/27/24

PaJR PHR Moderator: 2U insulin lispro 

4U insulin lantus 

উপরের পদ্ধতিতে তাদের নামও দিলে ভালো হবে

Patient Advocate: Ok

7.30am ghum theke uthe alpo muri aar cha

8.50am 2u insulin

9.00am Pepe, squash barite banano paneer (without fat) diye bhat sange salad

PaJR PHR Moderator: 9:00 AM 2U insulin before breakfast 

11:00 AM blood sugar 56?

Patient Advocate: Yes Sir

PaJR PHR Moderator: Any symptoms? 

Given her anything to eat after seeing the report?

Patient Advocate: No Sir

One Guava and 50grm ripe papaya

PaJR PHR Moderator: Kotai? Blood sugar ta dekhar por ?

কোন উপসর্গ? 

রক্তে শর্করার পরিমাণ কম দেখে আপনি কি তাকে কিছু খেতে দিয়েছেন?

Patient Advocate: Hay Sir blood suger dekhar por

PaJR PHR Moderator: আপনি যদি আজ দুপুরের খাবারের আগে তার শর্করা পরীক্ষা করতে পারেন এবং আমাদের জানাতে পারেন তবে ভাল হবে

Patient Advocate: ঠিক আছে

কোনো রকমের symptom নেই suger level কমার পড়ে খাবার রুচি পায়খানা প্রসাব সব ঠিক আছে

Before lunch

PaJR PHR Moderator: Thik ache. 

Aekhon lunch aer aage insulin newar dorkar nei

Patient Advocate: Luncher age insulin to apni bolar por theke neoa hoy na

PaJR PHR Moderator: Hain goto kaal jodio lunch aer du ghonta baader sugar ta dekhe mone hoyechilo abar shuru korte hote pare. 

Ajke lunch aer du ghonta baader sugar ta janaben

Patient Advocate: আজকে দুপুরের খাবারের পর sugur leve ছিল 117

বিকেলে ঘুম থেকে উঠে 5.30pm মুড়ি, 6.45pm 1pc সুগার ফ্রি বিস্কুট, 7.45pm 1/2 pc আটার রুটি খেয়েছে l

PaJR PHR Moderator: 👍

Patient Advocate: 10pm gajar, squash, beans, badbati abong soyabean diye dalia sanga salat

Khaoar age 2u

Khaoar por 4u insulin

3/28/24

PaJR PHR Moderator: Bhalo 

Insulin ta janabar somoi always aei bhabe complete information ta janaben :

2U lispro (aspart) khawar aage 

4U lantus (glargine) khawar por

Patient Advocate: Thik achhe

Sakal 7.45am 50ml dudh(swar bar karar por) abong 15 to 20grm muri

PaJR PHR Moderator: Ajke breakfast er aage kichu insulin newa hoyechilo?

Kono fasting kimba pre breakfast blood sugar value kora hoyeche?

Patient Advocate: Sakal 9.45am insulin 2u

10.05am beans, badbati, squash, gajar, mung dal diye bhat, sange salat.

Ajke fasting test hoyni, Lunch er age karbo

Sir আপনি কয়েক দিন ধরে রোগী সম্বেন্ধে বুঝলেন, একবার যদি সামনে থেকে দেখে আর কিছু টেস্ট করতে হলে করে দেখে যদি কোনো সলিউশন থাকে তাহলে আমরা সেইভাবেই এগিয়ে যেতাম । তাই স্যার আপনি যদি মে মাসে কোনো ডেট দিতেন তাহলে খুবই উপকৃত হতাম l এত আগে ডেট চাইলাম কারণ আমাদের ট্রেনের টিকিট কাটতে হবে তাই l

11.30am 1/2 মৌসুম্বি 7-8 pcs আঙুর

Before lunch

PaJR PHR Moderator: Jekono somai aaste paren

Patient Advocate: Ok thank you Sir

PaJR PHR Moderator: Ajke lunch aer du ghonta baader ta ektu beshi habe mone hocche

Patient Advocate: Lunch 2.00pm beans, badbati, gajar, squash,mung dal diye bhat sange machh ar salad

Amar o Mone hochhe Tai , test kore dekhbo

PaJR PHR Moderator: যদি আমরা অনুমান করতে পারি যে এটি উচ্চতর হতে চলেছে আমরা এই ধরনের অনুষ্ঠানে দুপুরের খাবারের আগে 1U যোগ করতে পারি

If we can anticipate that it's going to be high we may add 1U before lunch on such occasions

Patient Advocate: ঠিক আছে

Return ticket ta koy din pore katbo Sir?

PaJR PHR Moderator: 1 week

Patient Advocate: Ok, thank you Sir

5.30pm oats and sasha

9.45pm 2u insulin

10am gajar, squash, beans, badbati diye dalia songe machh ar salad

10.30pm 4u insulin

Sir amra 19th May train e chapbo 20th May apnar sathe dekha karbo

3/29/24

Patient Advocate: Dinner er por suger level 56

Aaj sakale breakfast er age suger level 35

Ok ki ekhon theke tin(৩) belai 1u  kore insulin deoa jabe

Dinner du ghanta por suger test karar por ghumiye ghumiye breastmilk kheyechhilo

7.45am muri dudh duto(2) khejur, 6-7ta kishmish deoa hoyechhe

PaJR PHR Moderator: Aei breakfast aer aage insulin daen ni asha korchi?!

Patient Advocate: Na deoa hoy ni

Suger level ta eirakam thakle ki ajke sakale insulin deoa jabe?

PaJR PHR Moderator: Na ekdom na

4U lantus to o roj raatei nito tai na? Koto din holo aei dose ta shuru kora hoyechilo? 

2U lispro o to aek hi bhabe tokhon thekei nicchilo tai na?

Patient Advocate: 13/03/24 tarikh theke 4u lantus deoa hoyechhe

13/03/24 tarikh theke 3u kore dine tinbar , 21/03/24 tarikh theke 3u kore du bar

24/03/24 tarikh theke 2u kore du bar

PaJR PHR Moderator: Aaste aaste mone hocche ore insulin requirement ta kome aashche. 

Aekhon aei somoi insulin dewar aage khub sabdhanota obolombon korte habe

Koyek din blood ta insulin newar aage ebong newar du ghonta bade test kore dekhle bhalo habe

Test aer jonye bar bar prick korle o Ki sojjo korte pare naki somosya hoi. Aajkal prick na Kore continuous glucose monitoring aer jonye machine pawa jai. 

https://www.freestyle.abbott/us-en/products/freestyle-libre-cgm-kids.html#:~:text=Patients%20ages%204%2D17%20are,through%20their%20parent%20or%20guardian.

Patient Advocate: Ekhon Mone 10.00 am suger level 192

10.00am 2u insulin

10.15am beans, badbati, squash, gajar, ichchhe diye bhat sange dimer sada portion, salad

Etar price Kato Sir?

PaJR PHR Moderator: Aekhon sugar ta dekhe janaben

https://www.amazon.in/FreeStyle-Libre-Sensor-Glucose-Monitoring/dp/B0849WHJQN/ref=sr_1_1?crid=1WHGF3XVLRI0U&keywords=freestyle%2Blibre&qid=1700466622&sprefix=freestyle%2Blibr%2Caps%2C228&sr=8-1&th=1&gclid=Cj0KCQjwzZmwBhD8ARIsAH4v1gUvlwR9uh17mfs36QD3kIkPrLYQqx-_HV-kHUAuvBtkqZMdMiVXx3YaAqrLEALw_wcB

Aekhono 4 bochor er theke choto bacchader upor temon proyog hoini

Patient Advocate: Er to three hote one month baki

Luncher age

6.00pm 6grm  of dark chocolate

6.45pm oats and salad

PaJR PHR Moderator: Luncher du ghonta por bodh hoi aajke are kora hoini?

Patient Advocate: Na Sir

Participant 1: Who's the patient primary caretaker ?

PaJR PHR Moderator: Not them

Participant 1: Hellos Patient Advocate, 

Given this is Type 1 case , I contacted a founder of the NGO who are helping kids and adults with type 1 diabetes. 

The NGO name is blue circle diabetes foundation run by Nupur Lalwani and team. 

For using CGM they have requested to connect with you. 

If you are okay with, I will share your contact details with her.

Please let me know.

PaJR PHR Moderator: Also translate this into Bengali with google translate for smoother communication

Participant 2: দেবুকে জানাই,

টাইপ ১ ডায়াবেটিস নিয়ে কাজ করা একটি এনজিও'র (অলাভজনক সংগঠন) প্রতিষ্ঠাতার সাথে যোগাযোগ করেছিলাম। এই এনজিও'র নাম হলো ব্লু সার্কেল ডায়াবেটিস ফাউন্ডেশন, এটি নুপুর লালwani  ও তাঁর টিমের দ্বারা পরিচালিত হয়।

এটি যেহেতু টাইপ ১ এর ক্ষেত্রে, তাই কন্টিনিউয়াস গ্লুকোজ মনিটরিং (CGM) সম্পর্কে জানতে তাঁদের সাথে যোগাযোগ করা হয়েছিল। তারা আগ্রহী হয়েছেন এবং এ বিষয়ে আরও আলোচনা করার জন্য আপনার সাথে যোগাযোগ করতে চান।

আপনি যদি সম্মত হন, তাহলে কি আমি আপনার যোগাযোগের তথ্য নুপুর লালwani  ও তাঁর টিমের সাথে শেয়ার করতে পারি?

Patient Advocate: Parents

You can

Participant 1: Okay., 

  

I am assuming they will be able to understand English or Hindi

ঠিক আছে.,

আমি ভুল হলে আমাকে সংশোধন করুন @~দেবুর অভিভাবক এবং আমি এই নম্বরটি শেয়ার করছি।

আমি ধরে নিচ্ছি তারা ইংরেজি বা হিন্দি বুঝতে সক্ষম হবে

Patient Advocate: হ্যাঁ স্যার

Er por aro ekta list achhe

PaJR PHR Moderator: Otao please share korun

Patient Advocate: Ok , korchhi

PaJR PHR Moderator: 👆March 20 r aei value lunch aer por, after lunch AL jeta 36 aeshchilo shetao chart a enter kore din

March 21 after lunch ta 147 apnar Chart a add Kore din

Chart a parle insulin aer dose tao mention korben

Patient Advocate: 13/03/24 tarikh theke 4u lantus deoa hoyechhe

13/03/24 tarikh theke 3u kore dine tinbar , 21/03/24 tarikh theke 3u kore du bar

24/03/24 tarikh theke 2u kore du bar

PaJR PHR Moderator: Ekhane dekhun shudhu March 20 r apnar entry ta Participant 3 AI er madhyome kibhabe shajiyechen 👇

March 20 table of 2F's sugars with the insulin doses added:

| Time | Insulin | Sugar Level |

|------|---------|-------------|

| 7:35 AM | - | - |

| 9:45 AM | 2U aspart | - | 

| After breakfast | - | 72 (2 hours after breakfast) |

| 12:00 PM | - | - |

| 1:30 PM | 2U aspart (withheld) | - |

| 4:00 PM | - | 147 (2 hours after lunch) |

| 5:00 PM | - | - |

| 7:00 PM | - | - |

| 9:15 PM | 2U aspart | 132 (pre-dinner) |

| After 9:15 PM | 4U glargine | - |

Note: The insulin dose of 2U aspart was withheld before lunch due to the dangerous hypoglycemia mentioned in the conversation.

Aajke dinner aer por dekhe dorkar hole lantus ta komiye dewa jete pare nahole abar aaj sokaler moton kalkeo fasting kome na jai

Dinner kotai Kore?

Patient Advocate: 10.00pm

PaJR PHR Moderator: Lantus ta ajke kom neben 2U

Patient Advocate: ঠিক আছে

3/30/24

PaJR PHR Moderator: 👏👏

Aaste aaste aekhon insulin requirement ta komche. Shurur deeKe type 1 Diabetes a aerokom aaste aaste insulin requirement kome aasha ta anek khetre dekha jai jetake bola hoi "honeymoon" phase

Patient Advocate: AJ sakal 8am 50ml dudh ar muri khai niye 15-20grm

তাহলে কি insulin টা বন্ধ হতে পারে ?

PaJR PHR Moderator: Na eta ekta samoyik phase. Kichu din bondho hoye giye abar dorkar hote shuru korbe. Tai jonye etar naam "honeymoon." 

Aei jonye aei phase tai monitoring aro beshi joroori hoye othe keno Ki kokhon abar insulin dorkar hote shuru korbe bola mushkil.

Patient Advocate: 9.45am insulin 2u

10.00am gajar, broccoli, squash, badbati, beans, paneer diye bhat sange salad

PaJR PHR Moderator: Post breakfast sugar?

Patient Advocate: 12.00 noon ae karbo

Post breakfast

11.30am one apple

1.30pm gajar, broccoli, squash, badbati, beans diye bhat sange salad

5.30pm dark chocolate 8grm

6.30pm masala oats & salad

9.45pm insulin 2u

10.00pm gajar, squash, beans, badbati, tometo diye bhat sange salad

10.30pm insulin 2u

3/31/24

Patient Advocate: 7.30

7.30am ghum theke uthe dudh muri khai kheyechhe

9.30am 2u insulin

9.45am gajar , Pepe, squash, beans, badbati, kancha kala, tometo diye bhat

Post breakfast sugar level 148

12.00noon 8-10pcs grapes, one pc  mousambi

Participant 1: I believe Nupur has spoken with the parent about type 1 and CGM. 

We can take the next step.

PaJR PHR Moderator: What would be the next step?

Participant 1: Who has the CGM that we sent last time , I will try to arrange the reader

If parent approves for CGM we can plan something’s here

PaJR PHR Moderator: We have a departmental patient fund group where all resources that we receive to take care of our patients are logged and archived 👇

Patient Advocate: 1.30pm Pepe, beans, squash, tometo, kancha kala, badbati diye bhat sange machh and salad

5.30 pm dark chocolate 10grm

6.30pm masala oats and salad

9.45pm 2u insulin

10.00pm beans, squash, tometo, gajar, badbati diye dalia sange machh and salad

PaJR PHR Moderator: 👍

4/1/24

Patient Advocate: Post dinner suger level 250

PaJR PHR Moderator: Aer modhye kichu mishti chilo?

Barir sobai 10:00 PM dinner na kore Ki 8 PM kore 10:00 ghumote parben?

Bacchar pokkhe 12:00 AM abar blood sugar korano mushkil hote pare naki ota ghumer modhyei kore fela jai?

Dark chocolate tar chobi pathaben. Koto % dark?

3:30 PM lunch aer por asha kori sugar ta thik chilo?

Patient Advocate: Na kichhu mishti chhilo na

10.00pm ghumano ektu muskil hoye jabe

Blood test ta ghumer madhya kore fela jay

Lunch 1.30pm kore chhilo

Lunch er por test Kora hoy ni

Test Kora hoyechhilo breakfast er du ghanta por je ta chhilo 148

PaJR PHR Moderator: Raate insulin lantus koto niyechilen? 

Kotai?

Patient Advocate: Lantus 2u

PaJR PHR Moderator: Aro komano jete pare

Kotai?

Patient Advocate: Sir, balchhilam je rate to duto insulin deoa hay ar Sara rat onek ta gap hoye Jay ar pray sakale sugar level niche thake, sei karonei or sakal er insulin ta lunch er aage deoa jabe ki ?

9.30am beans, squash, tometo, gajar, badbati, Pepe, paneer diye bhat sange salad

PaJR PHR Moderator: এই প্রশ্নের উত্তর বোঝার জন্য আমাদের স্বাভাবিক ইনসুলিন নিঃসরণের শারীরবৃত্তীয়তা বুঝতে হবে। 

সাধারণত ইনসুলিন যে কোনও খাবারের পরে শরীরের অভ্যন্তরে নিঃসৃত হয় এবং তাই যৌক্তিকভাবে আমাদের প্রতিটি khawar পরে ইনসুলিন নিতে হবে যা বর্তমানে তার মধ্যে ইনসুলিন লিসপ্রো দিয়ে প্রতিস্থাপিত হচ্ছে। 

এছাড়াও অল্প পরিমাণে ইনসুলিন নিঃসরণ হয় যা সাধারণত না খেয়েও সব সময় ঘটে এবং এটি ইনসুলিন ল্যান্টাস দ্বারা প্রতিস্থাপিত হচ্ছে। 

আবার যেমন আমরা দেখেছি যে ইনসুলিনের প্রয়োজনীয়তা বর্তমানে ওঠানামা করছে কারণ এটি দেখা যাচ্ছে যে দুপুরের খাবারের আগে সম্ভবত তার শরীর থেকে কিছু ইনসুলিন নিঃসৃত হয় যে ক্ষেত্রে আমরা বাইরে থেকে কিছু দিতে পারি না অন্যথায় সে হাইপোগ্লাইসেমিয়াতে যেতে পারে। 

বর্তমানে প্রাতঃরাশের 2U ইনসুলিন হাইপোগ্লাইসেমিয়া তৈরি করছে না যা  bujhiye দেয় যে সকালের নাস্তার আগে শরীরের ইনসুলিন নিঃসরণ কম হয়।

To understand the answer to this question we may need to understand the physiology of normal insulin secretion. 

Generally insulin is normally secreted inside the body after any meal and hence logically we need to take insulin after every mean which is currently being replaced in her with  the insulin lispro. 

Also there is a small amount of Insulin secretion that happens all the time normally even without eating and that is being replaced by insulin lantus. 

Again as we have seen the Insulin requirement is currently fluctuating as it appears that before lunch there is possibly some insulin being secreted by her body in which case we can't give any from outside or else she may go into hypoglycemia. 

Currently the breakfast 2U insulin is not producing hypoglycemia suggesting that the body's insulin secretion is less before breakfast.

Patient Advocate: Ok thank you Sir

11.30am mousamu one pc and 4-5 pcs grapes

12.45pm beans, squash, tometo, gajar, badbati, Pepe, paneer soyabean diye bhat sange salad

Participant 1: I will try to arrange a reader for CGM.  

Patient Advocate can you share model number of you phone ? Which  mobile phone are you using

Perfect , it has NFC.

We start with CGM

Patient Advocate: Two hours later of lunch suger level 259

5.30pm dark chocolate 8grm

6.30pm oats and salad

PaJR PHR Moderator: Eta dekhe mone hocche ajke lunch aer aage 2U lispro newa jeto

Patient Advocate: 9.30pm 2u insulin

9.45pm gajar, squash, Pepe, broccoli , patal diye dalia songe salad

10.30pm insulin 2u

4/2/24

PaJR PHR Moderator: Aajke lunch aer aage sugar dekhe dorkar mone hole 1U lispro

Patient Advocate: 👍

8.00am  khai diye dudh

9.15am 2u insulin

9.30am gajar, Pepe, beans, squash, uchchhe, patal, tometo diye bhat sange dim ar salad

Two hours later of breakfast sugar level 150

PaJR PHR Moderator: 2U before breakfast was ideal for her today

Patient Advocate: 11.30am apple one pc 

1.15pm 1u insulin

1.30pm gajar, Pepe, beans, squash, uchchhe, patal, tometo, soyabean diye bhat sange salad

PaJR PHR Moderator: 3:30 Pm blood sugar?

Patient Advocate: Ektu barir baire chhilam Tai Kora hoy ni

5.30pm dark chocolate 8grm

6.30pm oats and salad

Before dinner sugar level 204

9.40pm insulin 2u

9.50pm pepe, beans, badbati, squash, patal diye dalia sanga salad

4/3/24

Patient Advocate: 8.00am muri diye dudh

9.20 am 2u insulin

9.40am gajar,pepe,beans,squash,uchche,patol, tomato diye Bhat sange dim ar salad

11.40am one Apple

Lunch er age sugar level 165

Lunch gajar, pepe, beans, squash, patal, tomato soyabean ar sing mach diye bhat sange salad

PaJR PHR Moderator: Lunch kotai?

Lunch er aage insulin 1U niyechilen?

Patient Advocate: Lunch koreche 1.45pm

Lunch er aage 1 U insulin deowa hoyeche

4/4/24

Patient Advocate: Yesterday 4.30pm Tak dai

6.45pm oats and salad

9.50pm 2u insulin

10.00pm gajar, pepe, beans, badbati, squash diye dalia sanga salad

10.30pm 2u insulin

AJ sakal 7.30am sugar level 50

7.30am khai muri diye dudh

PaJR PHR Moderator: Tar por du ghonta baade blood sugar?

Patient Advocate: 9.30am Pepe, squash, beet, kancha kala, badbati, tometo diye bhat sange salad and dim

Er aage 2u insulin

PaJR PHR Moderator: Raate Lantus ta aro komiye 1U kora jete pare

11:30 AM sugar Ki jana jabe

Patient Advocate: Before lunch sugar level 194

1.30pm Pepe, beans, squash, tometo, badbati, kancha kala diye bhat sange salad ar machh

PaJR PHR Moderator: 1U diyechen? 

Lunch er 2 ghonta baader ta obosyoi janaben

Patient Advocate: 1u insulin deoa hoyechhe befor lunch

Lunch du ghanta por suger level 216

5.30pm Tak dai 4-5 chamach 

7.00pm pasta and salad

Before dinner 2u insulin

9.45pm squash, Pepe, beans, matarsuti diye dalia songe machh ar salad

Potty r poriman ta tulonamulok Kom chhilo ahke

4/5/24

PaJR PHR Moderator: Pete jol jomeche kina ultrasound Kore dekha dorkar

Patient Advocate: Jal jamar Karan ta ki ?

Ultrasound korar por sei jal ta ki abar test korte hobe jodi korte hoy Tobe ki test korte hobe?

PaJR PHR Moderator: Aage jol ache kina dekha jaak.

Patient Advocate: Ok jachhi sir ultrasound korte

7.30am dudh khai,  1/2 aata roti 

11.30 am sugar level 58

11.30am insulin 1u

11.40am gajar pepe, beans, squash, sajna data diye bhat sange e

Ultrasound korate jaoyar janya khaoate deri hoye gelo

PaJR PHR Moderator: Ultrasound aer report a kichu janalen?

Ultrasound a confirm kore bojha jacche ota just gas aer jonye. 

Eta dekhe amra sobai aashostto holam!

Patient Advocate: Gas er janyo Lanzol Junior deoa jabe ki Sir?

PaJR PHR Moderator: Na dewai bhalo kenoki o kono osubidhe feel korchena. Lanzol ta sudhu matro samoyik relief dewar jonye ebong otar alhada side effects o ache 

Aaste aaste kome jabe.

Patient Advocate: Thik achhe Sir

2.30pm gajar, Pepe, beans, squash , sajna data diye dalia sanga dim ar salad

6.00pm Tak dai 50ml

7.00pm pasta and salad

9.30pm  2u insulin

9.45 pm beans, squash, pepe diye dalia sanga salad

10.30pm 2u insulin

4/6/24

PHR Moderator: Goto kaal lunch kotai ebong Ki kheyechilen ebong koto unit insulin niyechilen?

Patient Advocate: Gata kaal er lunch

Luncher age insulin neoa hoy ni

Dinner er age sugar level 235

AJ sakal 7.15 am dudh diye khai

PaJR PHR Moderator: 👍

Patient Advocate: Sir khaoar  jinisher madhya kono kichhu add ba less korte hobe jate or shashir fit and strong thake r gas ba onyo kono samasya na hay ?

PaJR PHR Moderator: Dudh ta komale gas ta kichu ta komte pare 

Baki gas er jonye chintar kono karon nei

Patient Advocate: 9.30am 2u insulin

9.45am pepe , squash, badbati, ichchha diye bhat sange salad

11.30am alpo bedana r alpo tormuj (watermelon) kheyechhe

Egulo chulkochhe

1.30pm insulin 2u

1.40pm pepe, squash, badbati,uchchhe, paneer diye bhat sange salad

Luncher age sugar level 230

Sir patient fan chhara ghumote chay na ar edike or sharir ta khuboi garam

PaJR PHR Moderator: Fan chaliye ghumote pare

Aeguno allergy theke hocche

Patient Advocate: Egulor suger er sathe kono samparko aachhe

PaJR PHR Moderator: 11:30 AM a bodh hoi sugar dekha hoini?

Patient Advocate: Na Sir

PaJR PHR Moderator: Generally noi 

Oshudh aer reaction thekeo anek somoi aei dhoroner allergy hote pare

Patient Advocate: ekhon insulin chhara onno kono oshudh to nichchhe na

PaJR PHR Moderator: 3:40 PM a lunch er du ghonta bade o na?

Patient Advocate: Kono ki Skin Specialist ke dekhabi ki?

Lunch er pore ki Nebo?

PaJR PHR Moderator: Hain local daktar Ke Jekono notun kono somosya hole oti obosoyee janiye rakhben

Blood sugar?

Patient Advocate: Hay Sir

PaJR PHR Moderator: Mane amra besh kichu Din dhore dekhchilam lunch aer du ghonta por sugar ta khub low hoye jacchilo tai aekhon lunch aer du ghonta bade kemon ache sheta bojhar jonye

Eta lunch er teen ghonta bade?

Patient Advocate: Hm.

Sharir ta garam kisher theke Sir ?

PaJR PHR Moderator: Ore temperature ta proti char ghontai mepe mepe ekhane janaben

Patient Advocate: Thik achhe

PaJR PHR Moderator: Eta jokhon dekhlen tokhon kono koshto chilo jemon kampuni?

Patient Advocate: Na kono kapuni chhilo na ulte aro fan na chalale kanna kati shuru kore day

Ekhono garam achhe

PaJR PHR Moderator: Gorom a fan na chalaleo shorir gorom hote pare

Temperature ta mepe janale bhalo hoi

Patient Advocate: Or garam dekhe fan ta bandho kore dei kintu o kanna kati kore pore abar chaliye dei

Ektu pore janachhi, ekhon ekjon Skin specialist dekhate niye jachhi

5.50pm temperature 101F

Sir Doctor ei ousudh gulo dilo r tin saptaha por abar dekhate ballo

Ar ballo ei alargee ta sabar kshetrei hay sugar er patient er ektu basi hay 

To Sir ei ousudh gulo ki ekhon khaote parbo?

Eta ki Sir insulin theke hochchhe?

9.30pm insulin

9.45pm beans squash Pepe diye dalia songe salad

10.10pm temperature 101F

4/7/24

Patient Advocate: Sakal 7.30am sugar level 97

Aaj sakale Khali khai

7.30am temperature 99F

Ei Doctor er madhya sir Ami confidence Kom dekhla Tai sir pore ekjon Physician MD ke dekhalam uni nicher medicine gulo dilo egulo khaoano jabe ki ?

Laveta M syrup 5 ml at HS

ATAREX lotion to apply locally

9.45am insulin 2u

10.00am beans, badbati, squash, Pepe, tometo, soyabean diye bhat sange salad

11.45am paka pepe 25g and tormuj 50grm

12.00noon temperature 98.5F

PaJR PHR Moderator: Hain khawano jabe

11:45 AM a Ki blood sugar dekha hoyechilo? 

Asha korchi CGM device ta pele bar bar needle prick Kore test korar koshto ta kombe

Patient Advocate: Na dekha hoyni

1.30pm insulin 2u

1.45pm beans, badbati, squash, Pepe, tometo diye bhat sange machh and salad

PaJR PHR Moderator: 3:45 PM a asha korchi dekha jabe

Patient Advocate: Hobe SIR

4.00pm sugar level 165

5.10pm temperature 98F

5.15pm Tak dai

5.45pm almond 2pcs

6.45 pm pasta and salad

9.30pm insulin 2u

9.45pm beans, badbati, squash Pepe, tometo diye dalia songe machh and salad

4/8/24

Patient Advocate: 10.20pm 2u insulin and

Syrup 5ml

PaJR PHR Moderator: Gas er jonye hoye thakle kono chinta nei

Patient Advocate: Ki kore bujhbo eta kiser theke hochchhe?

PaJR PHR Moderator: Ultrasound Kore onyo kono chinta jonok bishoi theke hocchena sheta bojha jacche  

Gas ta normally intestine aer movement ta shothik na howar jonye hoi

Patient Advocate: Eta thik ki kore Kara jay?

খাওয়া দাওয়া কোনো কিছু পরিবর্তন করতে হবে কি না কোনো ঔসধ দিতে হবে ?

PaJR PHR Moderator: Eta khawa ebong activities er upor depend Kore. 

Roj Kar khawar chobi ebong roj Kar ghontai ghontai activities share korle bola jabe bishesh Kore Jei Din guno hocche ebong Jei Din guno hocchena shediner khawa ebong activities compare Kore. 

http://userdrivenhealthcare.blogspot.com/2024/02/pajr-daily-activities-sharing-guide-in.html?m=1

Patient Advocate: Thik er por theke activity guno share karbo

7.30am ghum theke uthe 5-6pcs nuts alpo khai

8.30am adha ghanta hatahati koreche

9.30am 2u insulin

9.45am squash, badbati, beans soyabean and paneer diye bhat sange salad

12.00noon mousambi

12.15 ektu nachanachi korechhe

After breakfast

PaJR PHR Moderator: 11:30 AM?

Patient Advocate: Hay Sir

1.30pm insulin 1u

1.45pm squash, badbati, beans, paneer diye bhat sange salad

2.30pm to 5.30pm ghum

5.30pm dai 

6.00pm to 7.00pm  হেঁটেছে

7.00pm oats

7.30pm to 8.00pm হেঁটেছে

9.30pm 2u insulin

9.45pm squash, patal,e,  pepe, beans diye dalia songe salad 

10.30 pm 2u insulin

Before dinner sugar level 290

Sir patient er protidin sakale pet fola thake na kintu bikal theke onek ta fola thake er janya khete chay na 

Er janya ki karbo Sir ?

4/9/24

Patient Advocate: Sakal 7.30am ghum theke uthe 1/2 pc ata ruti,  alpo khai

PaJR PHR Moderator: Goto kaaler moton bikele doi deben ebong haanthaben. Amar mone hoi ote kichu ta better habe. 

Eta ekta diurnal variation jeta khub sombhoboto enteric neural autonomy'r karone

Patient Advocate: Thik achhe

Oki Sir pre dinner e pasta/cornflakes dudh diye/ oats khete parbe ?

9.30am 2u insulin

9.45am gajar, pepe, beans, squash, tometo, paneer diye bhat sange salad

PaJR PHR Moderator: Eguno jodio processed food ebong temone healthy noi tao majhe modhye khete pare

Patient Advocate: 👍

10.15am to 11.30 kheladhula

11.30 am paka pepe kheyechhe

12.00noon  to 1.00pm kheladhula

1.20pm 1u insulin 

1.30pm gajar, pepe, beans, squash, Tometo, machh diye bhat sange salad kheyechhe

2.30pm to 5.15pm ghum

5.30pm dai

5.45pm to 6.30pm khelDulo

6.30pm pasta and salad

7.00pm to 8.00pm hatahati

9.30pm 2u insulin

9.45pm beans, squash, badbati, patal diye dalia songe machh and e

10.15pm 2u insulin

4/10/24

Patient Advocate: After dinner sugar level 123

Sakal 8.00am sugar level 92

8.00am ভেজা বাদাম আর অল্প খৈ

8.30am to 9.15am একটু বই নিয়ে নাড়া চাড়া করা

9.15am to 9.45am hatahati

9.45am 2u insulin

10.00am gajar, pepe beans, squash, tometo, soyabean diye bhat sange dim ar salad

10.30am to 12.00noon হালকা খেলাধুলা করা ,

12.00noon একটা বেদানা

আবার একটু খেলাধুলা করা

1.15pm 1u insulin

1.30pm gajar, squash, Pepe, tometo, soyabean ar alpo dim diye bhat sange salad

এরপর 2.00pm থেকে ঘুম

3.45pm sugar level 130

5.00pm টক দই

5.30pm 6.30 pm hatahati

6.30pm pasta

7.00pm to 9.30pm hatahati , বাই নিয়ে হাতাহাতি করা এবং ঘরে খেলাধুলা, নাচানাচি

9.30pm 2u insulin

9.45pm beans, squash, tometo, gajar, pepe diye dalia songe salad

4/11/24

Patient Advocate: সকাল 7.30am ঘুম থেকে উঠে খৈ 

7.30 am suger level 91

9.45am insulin 2u 

9.30am gajar, Pepe, squash, badbati, patal, paneer, soyabean diye bhat sange salad

11.45am mousamu 1pc

1.15pm insulin 2u

1.30pm pepe, squash, badbati, patal, gajar, machh diye bhat sange salad

5.30pm 1/2 সন্দেশ, দই

7.00pm pasta

9.30pm 2u insulin

9.45pm beans, badbati, squash, gajar and machh diye dalia songe salad

Dinner er age suger level 188

10.15pm insulin 2u

4/12/24

Patient Advocate: Aaj sakal 7.30am ghum theke uthe 5-6pcs nuts and alpo khai

9.30am 2u insulin

9.45am beans, badbati, tometo, squash, Pepe, soyabean diye bhat sange salad

11.45am 1pc mousambi

1.15 pm 2u insulin 

1.45pm beans, badbati, tometo, squash, Pepe, paneer diye bhat sange salad

Before lunch

PaJR PHR Moderator: At 1:10 PM before the insulin?

Can you share the blood sugars at 3:45 PM 2 hours after lunch?

11:45 AM mousambi with sugar?

Patient Advocate: Insulin er age neoa

Khali mousqmbi, sugar deoa hoy na

After lunch

PaJR PHR Moderator: At 3:45 PM?

Patient Advocate: Na 4.20

পেট টা এখন খুব ফল ওর পটি তে খুব গন্ধ হচ্ছে লোকে কি কোনো ঔষধ দেবেন কি? 

পেট ফোলা টা যে একেবারে কমছে না l

PaJR PHR Moderator: 👆Aei din pet fola lokkho korechilen?

O kono koshto bolche?

Patient Advocate: হ্যাঁ স্যার প্রতিদিনই ফোলে, খালি সকলের দিকটা ফোলা টা থাকে না l

PaJR PHR Moderator: Ote ore kono koshto hoi?

Patient Advocate: Na kastor Katha bole na kintu potty ta shakta ar gandho hay

ওর খেলাধুলা চলাফেরা মোটামুটি কার্যকলাপ প্রতিদিন একই রকম

PaJR PHR Moderator: Oguno jodi thik thake tahole ojotha onyo oshudh na khawai bhalo

Patient Advocate: Bikel hole je pet ta fule Jay, saijanya bolchhilam

PaJR PHR Moderator: Taate ore kono osubidhe hocchena. 

Ota intestine aer movement ta bikeler deeke slow hoye jawar jonye

4/13/24

Patient Advocate: Or potty te je khub durgandha hochhe

5.30pm টক দই

7.00pm pasta with salad

9.30pm আজ একটা অনুষ্ঠান বাড়ীতে গিয়ে কোলে বসে একটু মাছ মাংস মুখে দিয়েছে

10.15pm  3u insulin যেহেতু আজকে একটু বাইরের জিনিস খেয়েছে

10.30pm gajar, squash, beans, badbati, tometo diye dalia songe salad

11.15pm 2u insulin

PaJR PHR Moderator: Bairer jinish khelei beshi insulin dorkar habe eta hoito bhaba uchit hobe na. Shothik bhabe blood sugar dekhe insulin aer dose ta bibechona kora uchit habe jar jonye khawar aage ebong khawar du ghonta porer blood sugar dutoi important

Ore Potty'r chobi ta pathaben

Potty te jedin beshi durgondho habe eta lokkho korte habe je taar aager din o gom er toiri podartho beshi kheyechilo kina. Gluten sensitivity theke eta hote pare

Bojha jacche je oi bhabe 1U bariye dewa ta dangerous hote parto!

Patient Advocate: 9.45am 2u insulin

10.00am দই, 1/2 কালা দিয়ে অল্প ছাতু তারপর অল্প ভাত পেঁপে কুয়াশ, গাজর টমেটো, করলা, পানির, সয়াবিন দিয়ে সঙ্গে salad

12.00noo  mousambi

1.30pm 1u insulin

1.40pm gajar, Pepe, squash, tometo, Karla, sajna, paneer, soyabean diye bhat sange salad

Bikal 6.00pm টক দই

6.30pm one pc biscuit

7.30pm বাড়িতে বানানো আটার পাস্তা সঙ্গে স্যালাড 

9.45pm 2u insulin

10.00pm pere, squash, gajar, Karla diye dalia songe salad

4/14/24

Patient Advocate: Dinner ege sugar level 349

Sakal 7.30am ghum theke uthe 5-6pcs nuts and khai

9.40am 2u insulin

9.45am alpo khichuri aar gajar, Pepe, squash, tometo diye bhat sange salad

PaJR PHR Moderator: Checked at 9:40 PM?

Paticipant 1 Any update on getting her a CGM?

Participant 1: I am arranging a reading next week , but when is the patient expected to come to hospital ?

PaJR PHR Moderator: How about letting them start using it even before they come taking help of their local doctor?

Participant 1: The sensor needs to be activated with reader

Where does the patient stays ?

Okay , is there any doctor that can use reader

PaJR PHR Moderator: Would it be possible to have a call with Patient Advocate to assess if he can handle the logistics along with the local doctor?

Participant 1: We can try , I will have to arrange a reader and CGM in his area

Can you confirm the city ?

Patient Advocate: 11.45am after breakfast sugar level 305

Ajke lucher age ki 1u e insulin dibo Sir

PaJR PHR Moderator: Lunch kotai?

Participant 1: Oh , let me check how can we get sensor and reader there

Will be able to confirm tomorrow as the courier service are close today

Patient Advocate: We will came by 20th may.

1.30pm e lunch

Participant 1: Let me confirm the sensor expiry working with Abbott

Patient Advocate: Sir sab kichhu to ekoi rakam chhilo tahole hatat  kore eto bere gelo Keno suger ta?

1.30pm 2u insulin

1.40pm gajar, Pepe, squash, tometo, paneer and 1pc chicken diye bhat sange salad

PaJR PHR Moderator: Sugar কেন বাড়ছে এবং কমছে তা বোঝার জন্য আমাদের প্রতিদিন চিনির মানগুলির আরও ডেটা থাকতে হবে যেমন প্রতি খাবারের আগে এবং দুই ঘন্টা পরে। একবার আমরা একাধিক সূঁচের কাঁটা এড়াতে তার শরীরে CGM ডিভাইসটি সংযুক্ত করতে পারলে, তার চিনির বৃদ্ধি এবং হ্রাসের কারণগুলি আরও ভালভাবে বোধগম্য হবে।

To be able to decipher why the sugars are rising and falling we need to have more data of sugar values everyday such as before and two hour after every meal. Once we can connect the CGM device to her body to avoid multiple needle pricks, the reasons for her sugar rise and fall would become better understandable

তার রাতের খাবারের আগে আমাদের কাছে যা কিছু তথ্য আছে তা থেকে, রাতের খাবারের আগে তার উচ্চ শর্করার জন্য দায়ী করা যেতে পারে উচ্চ ক্যালোরিজেনিক খাবারের জন্য যা সে রাতের খাবারের আগে খেয়েছিল।

[4/13, 10:33 PM] Patient Advocate 2F Diabetes1: Bikal 6.00pm টক দই

6.30pm one pc biscuit

7.30pm বাড়িতে বানানো আটার পাস্তা সঙ্গে স্যালাড 

[4/14, 9:30 AM] Patient Advocate 2F Diabetes1: Dinner ege sugar level 349

From whatever data we have before her dinner, her higher sugars before dinner can be attributed to the higher calorigenic foods she appears to have consumed before dinner.

Patient Advocate: এগুলো আগেও খেয়েছিল

আগে এতত বাড়ে নি l

PaJR PHR Moderator: Aage upore ae khabar guno blood sugar ebong insulin dose sohith onyo date a lekha thakle share korun

👆Ae charao aer aager honeymoon phase tao kete jabar jonye eta hote pare

Patient Advocate: Lunch er dui ghanta por suger level 300

আর পেট ফোলা টা কিন্তু কিছুতেই কমছে না l

Insulin dose gulo ki revise korben ?

4/15/24

Patient Advocate: Bikel 5.30pm Tak dai

7.00pm barite banano lal attar pasta sange salad

9.30pm 3u insulin

9.45pm squash, Pepe, tometo, patal, diye dalia songe one pc chicken and salad

Bed time 3u insulin

Sakale  6.45am sugar level  73 

sakale 7.30am nuts and 1/2 আটার রুটি

PaJR PHR Moderator: উপরে যেমন আগে বলা হয়েছে, ইনসুলিনকে সুনির্দিষ্টভাবে সামঞ্জস্য করতে সক্ষম হওয়ার জন্য, খাবারের দুই ঘন্টা পরে এবং আগে রক্তে শর্করার মানগুলি যত্ন সহকারে সংগ্রহ করা প্রয়োজন। আমরা এটি পেতে অক্ষম ছিলাম কারণ এটি আরও শিশুর চাপ সৃষ্টি করবে এবং তাই আমরা CGM ডিভাইসের জন্য অপেক্ষা করছিলাম।

ক্ষণস্থায়ী হাইপোগ্লাইসেমিয়া ক্ষণস্থায়ী হাইপারগ্লাইসেমিয়ার চেয়ে বেশি বিপজ্জনক। অনুগ্রহ করে আপনার স্থানীয় ডাক্তারের সাথে সর্বদা আমাদের সমস্ত পরামর্শ শেয়ার করুন কারণ তিনিই আপনার সন্তানের অবস্থার সর্বোত্তম বিচারক কারণ তার কাছে সরাসরি তাৎক্ষণিক প্রবেশাধিকার রয়েছে।

As told above earlier, to be able to adjust the insulin precisely, one needs meticulous collection of blood sugar values two hours after and before meals. We were unable to obtain that as that would cause further child stress and hence we were waiting for the CGM device. 

Transient hypoglycemia is more dangerous than transient hyperglycemia. 

Please share all our suggestions with your local doctor always as she is the best judge of your child's condition as she has direct immediate access to the child. 

4/16/24

Patient Advocate: Good morning Sir

গত কাল সারাদিন বিডিও অফিসে এ ইলেকশন এর কাজে ব্যস্ত থাকার জন্য কালকের আপডেট দিতে পারি নি l গতকাল তিন বার Lispro 2u করে  এবং রাতে। Lantus 3u দেওয়া হয়েছে l

কাল লাঞ্চের দু ঘন্টা পর BS ছিল 303

আজ সকাল 7.30am 4-5pcs nuts এবং 10-12grm খৈ 

9.45am BS 100

10.00am gajar, sajna, paneer, squash, tometo, patal, Pepe diye bhat sange dim ar salad

আজ সকাল 9.50am insulin 2u

Sir আমি  শিলিগুড়িতে যে endocrinologist দেখাতাম উনি ফোন রিপ্লাই দেয় না l আর আমাদের এখান থেকে শিলিগুড়ি গিয়ে ডাক্তার বাবুকে দেখিয়ে ফিরে আসতে  দুদিন লেগে যায় কারণ একদিন এত লং জার্নি বাচ্চা কে নিয়ে করা যায় না l

তাই আজকে আমাদের কুচবিহার এ একজন MD কে দেখাবো l

PaJR PHR Moderator: Hain MD Ke dekhalei jotheshto

Patient Advocate: ঠিক আছে, ধন্যবাদ স্যার

11.30am mousambi

12.10pm suger level 103

1.15pm insulin 1u

1.30 pm gajar, sajna, squash, tometo,patal, Pepe, diye bhat sange chingri machh ar salad

4/17/24

Patient Advocate: 5.30 pm Tak dai

7.00pm pasta and salad

9.30pm 2u insulin

9.45pm badbati, squash gajar, pepe, patal diye dalia sanga chingri machh ar salad

10.30pm 3u insulin

Dinner er du ghanta por BS 303

AJ sakal 7.45am nuts and khai

9.45am Blood suger 113

10.10am gajar,sajna , squash, Pepe, tometo, soyabean diye bhat sange paneer and salad

11.30am বেদানা

1.15pm blood suger 208

1.25pm insulin 2u

1.40pm gajar, Pepe, squash, sajna, tomato diye bhat sange machh and salad

4/20/24

Patient Advocate: গতকাল ডিনার এর পর BS ছিল 63

তখন ওকে 1/2 চামচ চিনি দেওয়া হয়েছে

আজ সকাল 7.40am ঘুম থেকে উঠে nuts এবং খৈ

9.30am 2u insulin

9.45am Pepe, Tometo, squash, sajna, soyabean , diye bhat sange dim ar salad

গত দু দিন ইলেকশন ডিউটি থাকার কারণে কোনো আপডেট দিতে পারি নি l

11.45am mousambi

Before lunch BS 237

1.45pm Pepe, squash, tometo, sajna, soyabean diye bhat sange salad

PaJR PHR Moderator: Dinner er 2 ghonta por?

Patient Advocate: Hay dinner er du ghanta por

PaJR PHR Moderator: Insulin Lispro 2U niyechilo? Sugar test Korar kotokkhon aage Lantus ta niyechilo?

Patient Advocate: Lispro 2u deoa hoyechhilo

Suger test korar 1.15 hours age

PaJR PHR Moderator: Dinner ta lispro'r kotokkhon baade kora hoyechilo?

Patient Advocate: 15 minutes por

PaJR PHR Moderator: Na lispro newar 15 minutes aer beshi deri kora jai na

Tar aagei kheye newa uchit nahole blood sugar ta aeibhabe fall korte pare

Patient Advocate: 10-15 minutes er madhya khaono hay

Sir khaoar porer samay to   dharbo khakhon theke, khaoar shurur samay theke na shesher samay theke Karan or khete 30 minutes samay lage

PaJR PHR Moderator: Thala niye boshben ebong insulin newar saathe saathei khawa shuru 

Ae chara shedin shara dine are kichu osadharon lokkho korechilen jar jonye eta hoye thakte pare?

Shuru

Dinner a Ki kheyechilo?

Patient Advocate: Regular ja khay sabji r singi machh

Bikel 5.30pm টক দই

7.00pm পাস্তা সঙ্গে স্যালাড

9.30pm blood suger 264

9.30pm insulin 2u

9.40pm beans, badbati, squash, Pepe diye dalia songe salad

10.30pm 3u insulin

4/21/24

Patient Advocate: Sakal 7.45am nuts and khai

9.30am 2u insulin

9.40am gajar Pepe squash beans badbati paneer diye bhat sange dim ar salad

Sakal ghum theke uthe khai khaoar age blood suger chhilo 86

11.30am alpo paka  Bel r tarmuj 

1.30pm 2u insulin

1.45pm Pepe, squash, beans, badbati, sajna, soyabean, paneer diye bhat sange salad

PaJR PHR Moderator: 👍

Patient Advocate: 4.00pm blood sugar 91

5.00pm Tak dai

6.45pm pasta and salad

4/22/24

Patient Advocate: 9.30pm 2u insulin

9.45pm beans, squash, Pepe, tometo soyabean diye dalia songe salad

10.30pm 2u insulin

11.45pm blood suger 259

Sakal 7.45am ghum theke uthe 5-6pcs nuts and khai

PaJR PHR Moderator: 👍

Patient Advocate: Sir kono din rate kono din bikele suger te bere jachhe l eta kirakam hochhe or activity abong khaoa daoa ekoi rakam aachhe to bayar ta bujhtei parchhi na l

PaJR PHR Moderator: Asha korchi aage jemone prokash korechilam, ore protyek ta khawar aage ebong du ghonta por jedin blood sugar ta jana jabe shedin amra ore insulin dose ta shothik titrate korte parbo blood sugar ta protyek khawar er aage pore shothik aanar jonye.

Tar jonye amra bhabchilam apni ekhane ashar aagei jodi CGM device ta pahunche jeto tahole khub bhalo hoto. Ekhane ashar por abar kothai pawa jabe shekhane giye nite hote pare. 

Participant 3 Any idea where they can obtain a CGM device that can be delivered to them for this 3 year old child. 

Paticipant 1 has already initiated the process but I'm worried the patient may reach us before the CGM reaches them and we may have to get another one here.

Paticipant 1 Any update on if your team is sending it to them to their address before May?

Patient Advocate: Thik achhe Sir apnara Jodi ekhon pathanor byabostha korte paren tahole ami upokrito hobo abong apnader prati kritagya thakbo

Participant 2: Will find and update sir

PaJR PHR Moderator: Aeki proshner uttor apnar korar aagei ami likhte shuru korechilam ebong share korlam upore. 

Amader eta bujhte habe je tottho gunor ektao jodi missing hoi tahole bujhte asubidhe habe. 

Ki Ki tottho lagbe :

Jeta apni janacchen :

Khabar chobi time 

Insulin dose time 

Jeta janano jacchena :

Proti ta khawar aager blood sugar ebong insulin are khawar du ghonta baader sugar 

Jeta arektu sonkhepe ontoto soptahe ekbar janano jete pare :

Khali pet fasting ebong proti ta khawar du ghonta baade dine ontoto char bar o jodi koriye janate paren soptahe jekono aeK din tahole byapar ta ektu bojha jai

Paticipant 1 er saathe apnar phone a kotha hoyeche?

Patient Advocate: Na Sir kono kotha hobe ni l

9.45am 2u insulin

9.55am gajar, Pepe, squash, tometo, uchche, soyabean diye bhat sange salad

সকালে খাওয়ার দু ঘন্টা পর ☝🏻

Eta kintu bhat khaoar por

PaJR PHR Moderator: 11:55 AM?

Patient Advocate: Hay Sir

12.00noon ekta  bedana

1.40pm 2u insulin

1.50pm gajar, Pepe, squash, uchche, paneer diye bhat sange salad

4.00pm blood suger 259

Bikel 5.30pm Tak dai

8.00pm oats and salad

9.45pm 2u insulin

9.55pm pepe, beans, squash, gajar,  soyabean diye dalia sanga salad

Ajke doctor er kachhe niye giechhilam . Oi doctor Babu dupurer insulin ta 1u bariye 3u dite bollen ebong proti disher por test kore pathate bollen

4/23/24

Patient Advocate: 10.45pm insulin 3u

Dinner er du ghanta por blood suger 314

Sakal  blood suger 113 7.15am nuts and 1/2 aata roti

9.35am 2u insulin

9.45am pepe, squash, badbati, patal paneer soyabean diye bhat sange dim ar salad

Ei khabarer du ghanta por blood suger 100

PaJR PHR Moderator: Dinner er du ghonta bade mane 11:55?

Patient Advocate: Gatakale dinner er du ghanta por

PaJR PHR Moderator: Tahole 11:45 PM?

Patient Advocate: 11.45pm ei 314

11.45am one mousambi

1.30pm 2u insulin

1.40pm Pepe,, squash, badbati, patal, machh diye bhat sange salad

3.40pm blood suger 239

5.30pm Tak dai

7.00pm oats and salad

4/24/24

Patient Advocate: Rate khaoar age 2u insulin

Khaoar por shoyar samay 3u insulin

Dinner er du ghanta por Mane 11.50pm blood suger 273

PaJR PHR Moderator: Lunch ebong dinner er aage blood sugar check kore insulin lispro (aspart) ta 0.5U barano jete pare ( jetuku bortoman tottho saamne ache tar bhittite)

Patient Advocate: Sakal e ghum theke uthe blood suger 154

0.5u baranor options nei one u kore barano kamano jay

7.30pm nuts and 1/2 roti

Gata 22/04 doctor ke dekhanor por lunch er aage 1u insulin barate bolechhilen to aj theke lispro 2-3-2 u kore deoa shuru korlam Sir?

PaJR PHR Moderator: Jedin barano komano habe shedin ontoto sugar guno khawar du ghonta bade check kora dorkar

Participant 3, Paticipant 1 

Interesting issue in this patient's context :

"Most of the available pens in the market deliver insulin in 1 U increments, a few deliver in half-units (0.5 U). Half-unit pens (HUPs), compared to 1 U pens, can further improve the accuracy and precision in insulin therapyCitation13. Young people and elderly, who need very small insulin dosages, are much benefited by the use of HUPs. Carbohydrate counting improves glycemic control and reduces glycemic variability. Half unit insulin delivery can more effectively match the insulin to carbohydrate ratio in people using carbohydrate counting to calculate insulin doseCitation9,Citation13. The main purpose of HUPs is to provide accurate insulin administration to an insulin-sensitive patient. HUPs improve treatment adherence leading to better clinical outcome and quality of lifeCitation13. HUPs that are available in the market are HumaPen Luxura HDFootnotei, NovoPen EchoFootnoteii, JuniorSTARFootnoteiii, Humalog Junior KwikpenFootnoteiv, and InPen."

https://www.tandfonline.com/doi/full/10.1080/03007995.2021.1898356

Ekhane ache 👇

https://m.indiamart.com/proddetail/humalog-junior-kwikpen-2850841647288.html

Patient Advocate: 9.40am insulin 2u 9.50am Badbadi, beans, squash, gajar, tometo, misti kumro, karla, soyabean, paneer diye bhat sange salad

Participant 1: Correct

Patient Advocate: 12.15pm  mousambi

1.40pm 3u insulin

1.50pm badbati, beans, squash, tometo, gajar, misti kumro, Karla, soyabean diye bhat sange salad

4.00pm blood suger 81

5.30pm Tak dai

7.00pm aatar pasta and salad

9.30pm 2u insulin

9.40pm gajar, squash, beans, badbati, tometo, mishti kumro diye dalia songe machh and salad

10.40pm 3u insulin

4/25/24

Patient Advocate: 11.50pm after dinner blood suger 59

Eta dekhar por 1/3 chhoto chamach er chini khaiye diyechi

Aaj sakale 7.45am ghum theke blood suger 98

7.50am nuts and 1/2 aata roti

PaJR PHR Moderator: 👆4:00 PM er blood sugar ta dekhe sotorko hoye 9:30 PM er aage ekbar blood sugar Kore temon bojha gele 1-1.5U dewa jeto

Patient Advocate: 9.45am 2u insulin

9.50am gajar, squash, beans, badbati, tometo,  diye bhat sange salad

12.00noon blood suger 102

12.00noon mousambi

1.30pm 2u insulin

1.40pm gajar, squash, beans, badbati, tometo diye bhat sange chicken and salad

3.55pm blood suger 67

PaJR PHR Moderator: Abar sugar komte shuru koreche 

Aebar abar 0.5U nahole 1U kore komiye dewa uchit

Patient Advocate: Tahole Aaj rate lispro ki 1u aar lantus 3u dibo ?

Jekhane gatokaal raate lispro diye chhilam 2u aar lantus 3u.

PaJR PHR Moderator: Hain

Patient Advocate: 5.00pm one candy

5.30pm Tak dai 

7.00pm oats and salad 

9.30pm 1u lispro

9.40pm beans, badbati, squash, Karla, chicken diye dalia songe salad 

11.45pm lantus 3u

4/26/24

PaJR PHR Moderator: মার্কিন যুক্তরাষ্ট্রের পেডিয়াট্রিক এন্ডোক্রিনোলজিস্ট ডাঃ রবি শঙ্কর এই দলে যোগ দিয়েছেন এবং পরামর্শ দিয়েছেন যে শিশুর পেট ফুলে যাওয়া সিলিয়াক রোগের কারণে হতে পারে। আমাদের পক্ষে কি এখানে গ্রুপে আলোচনা করা সম্ভব হবে যে কীভাবে আমরা শিশুকে গ্লুটেন মুক্ত খাবার দিতে পারি এবং তবুও তাকে খুশি রাখতে পারি?

Participant 5 a pediatric endocrinologist from USA has joined the group and has suggested that the child's abdominal bloating could be due to coeliac disease. Would it be possible for us to discuss here in the group as to how we may offer the child a gluten free diet and yet keep her happy? Paticipant 1 Participant 6 Patient Advocate Participant 3

Participant 1: Let me check if I have any nutritionist who have works with patient or this age group

Patient Advocate: 11.55pm  after dinner 

blood suger 332

PaJR PHR Moderator: Raate 0.5 komate parle bhalo hoto. 

Anyways blood sugar kome jawa ta aro beshi chinta jonok

Ore aer aage HbA1c test ta kora hoyechilo? 

Ektu oi report ta share korte parben?

Participant 7 Can you put all the content in this PaJR into a case report EMR in your online-learning portfolio and share the link. It would be essential for those who joined late to understand what has already transpired 

Or Participant 8 can do it but then she herself joined late

Thanks

Patient Advocate: Sakal e ghum theke uthe blood suger 117

7.30am nuts and 1/2 aata roti 

9.35am insulin 2u

Sir, patient ke protidin jerakam khaoa khaoano hay apatata sairakami dibo ki na kichhu paribartan karte hobe ?

PaJR PHR Moderator: March 10, 2024 Hba1c 8.3 around the time of her type 1 diabetes diagnosis I guess. 

Not sure if it was the HPLC method as the lab report doesn't mention it. Many labs in India use latex agglutination for hba1c and we have found here over a period of two years of testing that the values with latex hardlyParticipant 5

Patient Advocate: তাহলে কি আবার HBA1C টেস্ট করবো?

পুরোনো রিপোর্ট গুলি আবার পাঠাবো?

PaJR PHR Moderator: Na ota teen mashe ekbar koralei habe kintu koranor aage ekbar jene neben ora HPLC method use korche kina

Dekhi jara Ekhane shuru te chilen tara shob kichu joro korte paren kina are nahole ekbar shob kichu Participant 8 kimba Ke pathano jete pare

Patient Advocate: 9.45am gajar, squash, beans, badbati, tometo soyabean, paneer diye bhat sange salad

Participant 1: Have spoken to a nutritionist, she will be available on Sunday. 

She would need a brief about the patient. 

And what is expected result

Patient Advocate: 12.00noon blood suger 91

12.00noon mousambi 

1.30pm insulin 1u dilam Sir Karan ager sugar ta 91 esechhe

1.40pm gajar, squash, beans, badbati, tometo, soyabean, machh diye bhat sange salad

PaJR PHR Moderator: 👆Gotokal 2U newar por 67 aeshechilo aeijonyeo aro 1U diyechen

Patient Advocate: গত কাল breakfast er por blood suger ছিল 102 আবার dinner আগে 2u  নেওয়ার পর এসেছিল 67 ।কিন্তু আজকে breakfast পর 91 তাই আজকে 1u  দেওয়া হল

PaJR PHR Moderator: Dinner na lunch?

Patient Advocate: Sorry sir lunch

PaJR PHR Moderator: Ajke 3:40PM a insulin 1U newar por koto?

Patient Advocate: 1u insulin নেওয়ার পরেই 147

PaJR PHR Moderator: Ajke eta apni bhalo manage korechen 👏

Patient Advocate: একটু অন্য মন ছিল তাই একটু গণ্ডগোল হয়ে গিয়েছিল l

PaJR PHR Moderator: Na eta to gondogol hoini. Bhaloi hoyeche

Patient Advocate: আমি একটু অন্যমনস্ক ছিলাম

PaJR PHR Moderator: Oh accha lunch are dinner er terminology ta? Sheta temon kichu gondogol noi

Patient Advocate: Hay sir

Bikel 5.30pm টক দই 

7.00pm pasta and salad 

9.40pm lispro 2u

9.50pm beans, badbati, squash, gajar,patal, tometo, mishti kumro and machh diye bhat sange salad

10.30pm lantus 3u

4/27/24

Patient Advocate: কয়েক থেকে lantus টা পেটে পুষ করে সুজটা যখন বাইরে বের করছি বাইরে দুই তিন ফোটে পরে যাচ্ছে এতে ওর সুগার টা সকালেও বেশি থাকছে l এই lentus এর পেন  টার কি সমস্যা কোনো না অন্য কিছু?

11.50pm blood suger 238

সকালে ঘুম থেকে blood suger 138

7.45am nuts and khai

9.45am lispro 2u

9.50am gajar, squash, beans badbati, tometo patal, ghinga, soyabean, paneer diye bhat sange salad

PaJR PHR Moderator: Google translated for the other members 👇

"After pushing a few lantus in the stomach, when I take out the suja, two or three drops are left, so his sugar is more in the morning. Is there any problem with the pen Participant 5 Participant 3

Patient Advocate: 11.50am blood suger 154

12.00noon one mousambi 

1.30pm lispro 2u 

1.40Pm gajar, squash, beans, badbati, tometo, patal, jhinga, soyabean diye dalia sanga salat

3.55pm blood sugar 188

5.30pm টক দই 

7.00pm pasta and salad 

9.30pm lispro 2u 

9.40pm beans, badbati, tometo, squash, patal diye dalia songe salad 

11.20pm lantus 3u

4/28/24

PaJR PHR Moderator: Thanks for sharing this

Patient Advocate: Gatakal 11.50pm after dinner blood suger 155 

Sakal 7.45 am ghum theke uthe blood suger 137

7.45am nuts and khai

PaJR PHR Moderator: Insulin naam ebong dose tao mention korben jaate proti ta text aei puro data ta standalone fute uthte pare

Patient Advocate: 9.50am lispro 2u 

10.00am gajar, squash, beans, badbati, tometo diye bhat sange dim ar salad

Sir insulin lantus টা কি করব?

PaJR PHR Moderator: Janacchi.

Patient Advocate: 12.00noon তরমুজ 

1.30pm lispro 2u 

1.40pm gajar, squash, beans, badbati, tometo, diye bhat sange dim ar salad 

4.00pm blood sugar 127

PaJR PHR Moderator: আমাদের বিশেষজ্ঞ ডাঃ রবিশঙ্করের পরামর্শ: ইনসুলিনের ফোঁটা সবসময় দেখা যায়... এবং এইরকম একটি ছোট ডোজ দিয়ে কারো মধ্যে পার্থক্য হতে পারে। সুপারিশ হল সুইটি বের করার আগে 10 সেকেন্ডের জন্য কলমটি জায়গায় রাখুন। ল্যান্টাস (সানোফি অ্যাভেন্টিস দ্বারা তৈরি ইনসুলিন গ্লারজিনের ব্র্যান্ড নাম) এবং বাসাগলার (এলি লিলি দ্বারা তৈরি বায়োসিমিলার) এবং বাসালগ (ভারতে তৈরি বায়োসিমিলার) এর শক্তি হল U 100। যার মানে হল 100 ইউনিট/mL - যার মানে হল 3 ইউনিট 30 মাইক্রোলিটার। তাই সঠিক কৌশল ব্যবহার করা খুবই গুরুত্বপূর্ণ। সেই সাথে কম ডোজ (<10 ইউনিট) এর অর্ধেক জীবন ওঠানামা হতে পারে।

Suggestions from our expert Participant 18:

Drops of insulin are always seen… and may make a difference in someone with such a small dose. 

The recommendation is to keep the pen in place for a count of 10 seconds before pulling the needle out. 

The strength of Lantus (the brand name of insulin glargine manufactured by Sanofi Aventis) and Basaglar (biosimilar made by Eli Lilly) AND Basalog (biosimilar made in India) is U 100. Which means there’s 100 units/mL - which means 3 units is 30 microliters. 

So very important to use proper technique. That plus the short half life of low doses (<10 units) can result in fluctuations.

ল্যান্টাস ডোজ সম্পর্কে ডাঃ রবি শঙ্করের পরামর্শ: ল্যান্টাসের কম ডোজ (<10 ইউনিট) এ, কর্মের সময়কাল প্রায় 12-14 ঘন্টা এবং 24 ঘন্টা নয়। আমি তাকে 2 ইউনিট বিআইডিতে শুরু করব।

Participant 18's suggestions about lantus dose :

At such low doses (<10 units) of Lantus, the duration of action is about 12-14 hours and not 24 hours. I would start her on 2 units BID.

এর মানে হল আমরা তার স্থানীয় ডাক্তারের সাথে পরামর্শ করার পরে তার দৈনিক লিসপ্রোতে পরিবর্তন করতে পারি 1U-1U-1U এবং তার glargine দিতে সকালের নাস্তার সাথে 2U- দুপুরের খাবারে 0- রাতের খাবারের পর 2U

This means we can after consulting her local doctor, change her daily lispro to 

1U-1U-1U and 

give her glargine 

2U with breakfast-

0 at lunch-

2U after dinner

4/29/24

Patient Advocate: Gatakal luncher du ghanta por blood suger 127

5.30pm Tak dai 

7.00pm oats and salad 

9.30pm insulin lispro 2u

9.40pm beans, badbati, squash, gajar, patal diye dalia songe salad 

10.30pm insulin lantus 3u 

11.50pm blood sugar 94

Aj sakal 7.30am blood suger 123

7.30am nuts and muri

Lantus company r ek bhadra lokke phone Kara hoyechhilo tarpor kalrate ar samsya hoyni l

9.45am insulin lispro 2u 

9.50am gajar squash beans badbati tometo diye bhat sange soyabean and salad 

12.00noon mousambi 

1.30pm insulin lispro 2u 

1.40pm gajar squash, beans badbati tometo soyabean diye bhat sange salad

4/30/24

Patient Advocate: Gatakal 29/04/24, 3.50pm luncher du ghanta por blood suger 116

9.30pm 2u lispro 

10.30pm 3u lantus insulin 

11.40pm dinner er du ghanta por blood suger 90

Aj sakal 7.30am ghum theke uthe blood suger 65

7.30am nuts and chocolate biscuit 2 pcs

PaJR PHR Moderator: Lantus ta 1U raate komiye 1U sokale breakfast er por shuru kora jete pare?

Patient Advocate: আর Lispro টা?

PaJR PHR Moderator: 1U to 2U depending on the pre meal sugars

👆Ekhane aage janano hoyechilo dekhun

Patient Advocate: 9.30am Lispro 2u insulin 

9.40am gajar, squash patal, tomato, soyabean diye bhat sange salad

5/1/24

Patient Advocate: Gatakal 1.30pm lispro 2u

1.40pm gajar, squash patal, tomato, chicken diye bhat sange salad 

3.55pm blood sugar 121

5.30pm টক দই 

7.00pm oats and salad 

9.30pm 2u lispro insulin 

9.40pm beans, badbati, tometo, squash, chicken diye dalia songe salad 

11.00pm 3u lantus insulin

Aj sakal 8.00am blood suger 91

8.00am nuts and muri

9.45am 2u lispro insulin 

9.55am payesh muri

11.45am mousambi

1.30pm lispro insulin 2u 

1.40pm gajar pepe beans badbati squash machh diye bhat sange salad 

4.00pm blood sugar 128

5.15pm Tak dai 

6.45pm oats and salad 

9.30pm lispro insulin 2u 

9.40pm beans squash tometo patal Pepe machh diye dalia songe salad 

10.30pm lantus insulin 3u

5/2/24

Patient Advocate: Sakal  7.30am ghum theke uthe 5-6pcs nuts and aata roti 

9.30am 2u lispro insulin 

9.40am gajar Pepe Badbadi mishti kumro Lauer data soyabean paneer diye bhat sange salad 

12.00noon mousambi 

1.35pm 2u lispro insulin 

1.45pm gajar Pepe Badbadi mishti kumro Lauer data diye bhat sange dim ar salad

After lunch

PaJR PHR Moderator: At 3:45PM after 2U of lispro at 1:35PM?

Patient Advocate: হ্যা স্যার

5/3/24

Patient Advocate: Aj sakal 7.30am ghum theke uthe 5-6pcs nuts and aata roti 

9.30am lispro insulin 2u 

9.40am gajar Pepe squash badbati uchchhe patal paneer diye bhat sange salad 

11.40am blood sugar 168

12.00noon bedana 

1.40pm lispro insulin 2u 

1.45pm gajar pepe squash badbati uchchhe patal dim diye bhat sange salad 

5.00pm Tak dai

7.00pm aatar pasta and salad

9.30pm blood sugar 180

9.30pm lispro insulin 2u 

9.40pm gajar Karla badbati Pepe soyabean diye dalia songe salad 

10.35pm lantus insulin 3u

5/4/24

Patient Advocate: Sakal 7.45 ghum theke uthe 5-6pcs nuts and aata roti 

9.55am lispro insulin 2u 

10.05am gajar Pepe squash badbati patal paneer soyabean diye bhat sange salad 

1.45pm blood sugar 116

1.50pm lispro insulin 2u 

2.05pm gajar squash Pepe tometo patal Badbadi soyabean diye bhat sange salad

5.30pm টক দই 

7.00pm pasta and salad 

9.30pm lispro insulin 2u 

9.40pm squash badbati uchchhe patal tometo soyabean diye dalia songe salad 

10.30pm lantus insulin 3u

5/5/24

PaJR PHR Moderator: Summarizing these parental diet and insulin updates (again activity updates of energy expenditure missing) for benefit of being able to display those that stand out in a thematic manner (with constructive criticism for the patient data collectors and patient data communicator) :

Friday Morning data shared by the parent above in a multilingual format 👇

7:45 AM Wakes 

Breakfast 5-6 nuts (no image as to which nuts) + wheat Roti (again no image as to how many) 

First insulin before the second meal of the day :

Lispro 2U at 9:55 AM 

Second meal (second breakfast) of papaya, squash, carrot, String beans, pointed gourd, paneer, soybean (again no image and no estimate on quantity and quality) 

1:45 PM : Post breakfast glucose assessment on efficacy of the 9"55 AM 2U lispro comes as 116 mg/dl 

1:50 PM Pre lunch lispro 2U 

2:05 PM Lunch with almost similar stuff as in the second texted breakfast (again no images to suggest quantity and quality)

5.30pm sour yoghurt 

7.00pm pasta and salad 

9.30pm lispro insulin 2u 

9.40pm dinner with similar stuff as breakfast and lunch (squash badbati uchchhe patal tometo soyabean diye dalia songe salad) again no image to assess quantity and quality 

10.30pm lantus insulin 3u

Patient Advocate: গতকাল ডিনার এর পর ব্লাড সুগার 65

Sakal 7.30am ghum theke uthe 5-6pcs nuts☝🏻 

10-15grm khai

এই পরিমাণ বাদাম রাতে ভিজিয়ে সকালে দেওয়া হয়

এখানে ঝিঙে মিষ্টিকুমড়া বরবটি সজনা গাজর কুয়াশ টমেটো আছে

PaJR PHR Moderator: Eta Ki barir sobai khae naki sudhu o khai?

Patient Advocate: Na eta sudhu patient e khai .

PaJR PHR Moderator: Jemone amra aageo share korechilam, amra barir sobai jodi eta cheshta korte pari je jei poushtik aahar patient Ke dewa hocche sheta jodi sobai khai tahole 

1) Barir sobai poushtik aahar pabe 

2) Patient o barir sobar theke nijeke alhada mone korbe na

আপনি কখনও কখনও খাবারের আগে এবং কখনও কখনও খাবারের দুই ঘন্টা পরে চিনির পরীক্ষা করতে বেছে নেওয়ার কারণ কী হতে পারে তা আমরা জানতে আগ্রহী ছিলাম। শুক্রবার আপনি কি মনে করতে পারেন কেন আপনি তার দুপুরের খাবারের আগে চিনি পরীক্ষা করেছিলেন?

We were curious to know what could be the reason you sometimes choose to do the sugar test before meals and sometimes two hours after meals. On Friday can you recall why you did the sugar test before her lunch?

Patient Advocate: ওর এই রোগটা ধরা পরার আগেও ওর জন্য আলাদা খাবার তৈরি করা হতো কারণ ওর একটুকু লঙ্কা খেতে পারেন আর ওর সবজিগুলি একদম নরম করা হয় l আর একটু বড় হলে ওর খাবার আমাদের সাথেই তৈরি করা হবে l

দিনে 6 বার টেস্ট করা একটু অসুবিধা হয় যায়, তাই এখানকার ডাক্তার বলেছিল সকাল, দুপুর আর রাত মিলিয়ে দিনে একবার খাবারের আগে এবং পরবর্তী খাবারের পরে এমন করে পরিবর্তন করে টেস্ট করলে তিনদিনে সবগুলো সময়ই টেস্ট করা হয়ে যাবে l

Sakal 7.25am blood suger 83

9.30am lispro insulin 2u 

9.40am opre dekhano sabji gulo diye bhat sange salad 

11.30am one mousambi 

1.30pm lispro insulin 2u 

1.40pm jhinge misti kumro badbati sajna gajar squash tometo soyabean paneer diye bhat sange salad

5/6/24

Patient Advocate: Aj sakal 7.30am ghum theke uthe 5-6pcs nuts and aata roti 

9.30am lispro insulin 2u 

9.40am gajar squash patal tomato jhinga badbati soyabean paneer diye bhat sange salad 

11.00am blood suger 238

11.45am mousambi 

1.30pm 2u lispro insulin 

1.40pm gajar squash Pepe tometo patal jhinga badbati soyabean diye bhat sange salad

5/7/24

Patient Advocate: Gatakal 5.30pm tak dai

7.00pm oats and salad 

9.30pm blood sugar 118

9.30pm 2u lispro insulin 

9.40pm badbati squash patal tomato soyabean diye dalia songe salad 

10.30pm 2u Lantus insulin

Aaj 7.30am ghum theke uthe 5-6pcs nuts and aata roti

9.30am 2u lispro insulin 

9.40am jhinga badbati tometo squash patal soyabean paneer diye bhat sange salad

11.45am mousambi 

1.30pm blood sugar 132

1.30pm 2u lispro insulin 

1.40pm beans squash tometo patal jhinga soyabean chingri machh diye bhat sange salad

5.30pm Tak dai 

7.08pm aatar pasta and salad 

9.30pm 2u lispro insulin 

9.40pm gajar squash Pepe tometo soyabean diye bhat sange chingri machh and salad

5/8/24

Patient Advocate: 10.30pm 2u Lantus insulin 2u 

12.00mid night blood sugar 108

Sakal 7.30am ghum theke uthe blood sugar 119

Sakale 👇 nuts gulo r aatar roti kheyechhe

9.30am lispro insulin 2u 

9.40am gajar squash patal tomato badbati soyabean paneer diye bhat sange salad

11.45am apple

1.30pninsulin lispro 2u 

1.40pm gajar squash patal tomato sajna soyabean machh diye bhat sange salad

3.50pm blood sugar 124

5.30pm tak dai

7.30pm oats and salad 

9.40pm lispro insulin 2u 

9.50pm badbati squash patal tomato soyabean diye dalia sanga salad 

10.30pm lantus insulin 3u

5/9/24

Patient Advocate: Sakal 7.15am ghum theke uthe 5-6pcs nuts and aata roti 

9.30am lispro insulin 2u 

9.40am gajar Pepe Badbadi mishti kumro soyabean paneer diye bhat sange salad 

11.45am blood suger 209

12.00noon mousambi 

1.45pm 2u lispro insulin 

1.55pm gajar Pepe Badbadi mishti kumro soyabean paneer diye bhat sange salad 

5.30pm Tak dai 

7.00pm oats and salad

9.45pm lispro insulin 2u 

9.50 misti kumro badbati tometo squash patal diye dalia songe machher dim ar salad 

10.40pm lantus insulin 3u

5/10/24

Patient Advocate: 11.50pm after dinner blood sugar 81

Aaj sakale 7.25am ghum theke uthe 5-6pcs nuts and aata roti 1pc

PaJR PHR Moderator: আমাদের এখানে আগে পরিকল্পনা অনুযায়ী তার গ্লুটেন মুক্ত খাদ্য ব্যবস্থাপনা শুরু করতে হবে।

Āmādēra ēkhānē āgē parikalpanā anuyāẏī tāra gluṭēna mukta khādya byabasthāpanā śuru karatē habē.

We need to start her gluten free diet management as plannParticipant 5 Paticipant 1 Participant 4 Participant 6 We need your help with this by guiding Patient Advocate about the gluten free diet options for his three year old patient to prevent her abdominal bloating

Participant 1: Did connect with the nutritionist, she is out again till next Friday

I think we will have to find options

Patient Advocate: 9.30am lispro insulin 2u 

9.40am gajar squash patal tomato soyabean paneer diye bhat sange salad 

11.50am blood suger 148

1.30pm lispro insulin 2u 

1.40pm gajar squash patal tomato soyabean machh diye bhat sange salad 

5.30pm tak dai 

7.30pm oats and salad 

8.30pm 25grm vanilla ice-cream 

9.30pm blood suger 294

9.40pm squash badbati uchchhe mishti kumro machh diye dalia songe salad 

10.30pm lantus insulin 3u

PaJR PHR Moderator: Before dinner lispro?

Participant 4: Diagnosed of gluten sensitivity sir ? Couldn't understand the description.. will try Google translate

PaJR PHR Moderator: Diagnosis : Bloating and type 1 diabetes could be gluten sensitivity

Patient Advocate: Ota likhte bhule giyechhi 

Before dinner lispro insulin 2u

5/11/24

PaJR PHR Moderator: Will be grateful for your guidance on gluten free diet for this child

Patient Advocate: Aj sakal e 7.45am blood suger 84

7.45am 5-6 pcs nuts and khai

Participant 4: Will be on it sir... Shall share soon

As of now is the patient advocate already avoiding gluten sources ? Or is it yet to be started sir ? because in the description I see some biscuits and also oats (possible gluten contamination)

PaJR PHR Moderator: He hasn't started gluten restricted diet yet

Patient Advocate: 9.45am 2u lispro insulin 

9.55an misti kumro badbati tometo squash Karla soyabean paneer diye bhat sange salad 

11.30am mousambi 

1.45pm 2u lispro insulin 

1.55pm misti kumro badbati tometo squash Karla soyabean diye bhat sange salad 

4.10pm blood sugar 126

Participant 4: Ok sir.

Sir Can the patient advocate communicate in English with us or shall we frame diet plan and share after translating it

5/12/24

Patient Advocate: 4.30pm boil egg

7.00pm oats and salad 

9.30pm 2u lispro insulin 

9.40pm long beans, bitter gourd, pointed gourd, tometo, dalia with salad 

10.30pm lantus insulin 3u

Participant 4: Items to be avoided ❌

Wheat/ maida

Bread

Barley

Sooji/ Semolina 

Instant noodles like Maggi/ Pasta

Daliya

Vermicelli / Bambino 

Biscuits

Wafers

Few packaged snacks as kids may tend to eat (like Lays Chips/Kurkure)

Asafoetida/Hing

Cakes / Pastries

I see that oats is often given.... Have to purchase oats only with a *gluten free* tag as there is chance for potential contamination

PaJR PHR Moderator: Thanks. Great beginning. 

We can also share the Bengali google translated version below the English version.

তার ফোলা সম্ভাবনা কমাতে নীচে তালিকাভুক্ত আইটেমগুলি এড়ানো উচিত👇

 ❌ নিবেন না 

গম/ময়দা 

রুটি যব সুজি/ সুজি ম্যাগি/

পাস্তার মতো ইনস্ট্যান্ট নুডলস 

ডালিয়া ভার্মিসেলি / ব্যাম্বিনো

 বিস্কুট ওয়েফারস অল্প কিছু প্যাকেজ করা স্ন্যাকস যেমন বাচ্চাদের খাওয়ার প্রবণতা থাকতে পারে (যেমন লেস চিপস/কুরকুরে) 

হিং/হিং 

কেক/পেস্ট্রি

The items listed below are to be avoided to reduce the chances of her bloating 

Don't take  ❌

Wheat/ maida

Bread

Barley

Sooji/ Semolina 

Instant noodles like Maggi/ Pasta

Daliya

Vermicelli / Bambino 

Biscuits

Wafers

Few packaged snacks as kids may tend to eat (like Lays Chips/Kurkure)

Asafoetida/Hing

Cakes / Pastries

কোনো প্যাকেটজাত খাবার কেনার সময় অনুগ্রহ করে দেখে নিন এতে *গ্লুটেন ফ্রি* ট্যাগ আছে কি না, অন্যথায় তার খাবারের গ্লুটেন দ্বারা সম্ভাব্য দূষণের সম্ভাবনা সবসময় থাকে।

If purchasing any packaged food please check if it has a *gluten free* tag as otherwise  there is always a chance for potential contamination of her food with gluten

Patient Advocate: Ok Sir

Morning 7.30an 5-6pcs nuts and  puffed rice

9.45am pointed gourd, bitter gourd, pumpkin, papaya, chayote, soya chunk, egg and rice with salad 

11.55am blood sugar 106

12.15pm watermelon and  apple

1.35pm 2u lispro insulin  

1.45pm rice with pointed gourd, bitter gourd, pumpkin, papaya, chayote, soya chunk, fish and salad

5.45pm sour curd

7.00pm oats and salad 

9.30pm blood sugar 347

9.30pm 2u lispro insulin 

9.40pm rice with chayot, papaya, bitter gourd, pointed gourd, fish and salad

5/13/24

Patient Advocate: Morning 7.30am blood suger 135

7.35am 5-6pcs nuts and puffed rice

PaJR PHR Moderator: Not taken lantus yesterday?

Patient Advocate: Yes Sir neoa hoyechilo 3u lantus insulin

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, bitter gourd, tomato, long beans papaya, soyabean and salad

11.45am home made mango milk shake 

1.30pm 2u lispro insulin 

1.40pm rice with pointed gourd, bitter gourd, tomato, long beans, papaya, soyabean and salad 

4.00pm blood sugar 111

5.30pm sour curd 

7.00pm oats and salad

PaJR PHR Moderator: 👍

9.45pm 2u lispro insulin 

9.50pm rice with carrots, papaya, chayote, bitter gourd and salad 

10.40pm lantus insulin 3u

5/14/24

Patient Advocate: Morning 7.45am puffed rice

9.45am 2u lispro insulin 

9.55am rice with ☝🏻☝🏻chayot, papaya, rubbed gourd , long beans, soya chunk and salad 

12.00noon mousambi, grapes

1.00pm 25grm icecream

1.30pm blood suger 183

1.35pm 2u lispro insulin

1.45pm rice with chayot, papaya, rubbed gourd, long beans, soya chunk and salad 

5.30pm milk and puffed rice 

9.40pm 2u lispro insulin 

9.50pm rice with pointed gourd, tometo, long beans, papaya, chicken and salad

5/15/24

Patient Advocate: Yesterday 10.40pm lantus insulin 3u 

12.00midnight blood sugar 75

Morning 7.30am puffed rice with milk

PaJR PHR Moderator: 👍

Patient Advocate: 9.30am 2u lispro insulin 

9.40am rice with chayote, bitter gourd, tomato, long beans, papaya, fish and salad 

11.40am blood sugar 118

12.00noon mousambi grapes 

1.30pm 2u lispro insulin 

1.40pm rice with chayote, bitter gourd, tomato, long beans, papaya, fish and salad

7.00pm cheese flavour biscuit one pc 

7.30pm oats and salad

Participant 2: Not advisable

Patient Advocate: We try to keep this away but when the child is very stubborn , comfort is to given with one

Participant 2: Did you try slapping the baby when stubborn?

I mean,docs may not advise but quite a few parents do

Patient Advocate: No Sir

Participant 2: Good

Patient Advocate: Thank you

Participant 2: How are parents doing?

It should be really tough and beautiful struggle

Patient Advocate: 9.50pm 2u lispro insulin

10pm  rice with chayote, papaya, pointed gourd, tometo, soyabean and salad 

10.30pm 3u lantus insulin

5/16/24

Patient Advocate: Morning 7.45am blood suger 92

7.45am nuts and puffed rice with milk

9.30am 2u lispro insulin 

9.40am rice with chayote, papaya, pointed gourd, tometo, long beans, soyabean and salad 

11.45am mousambi and apple 

1.30pm 2u lispro insulin 

1.40pm same as previous dish and fish

4.00pm blood suger 120

5.00pm sour curd 

6.30pm oats and salad 

7.38pm  30grm suger free icecream 

9.45pm 2u lispro insulin 

9.55pm rice with chayote, papaya, pointed gourd, spiny guard, fish and salad

5/17/24

PaJR PHR Moderator: 👍

The child is visting us soon on 20th may. Participant 3 Participant 9 Paticipant 1 Can you suggest the best way we may procure the child friendly CGM earlier discussed here above to apply it on her to free her from daily pricks?

Participant 2: Paticipant 1 there's Freestyle Libre pro 3 available for kids and teens right?

Can we get them for this patient?

Participant 1: Abbott has Libre pro , Libre 14 days , Libre 2 and  Libre 3. 

Unfortunately we only have pro and 14 days available in India

PaJR PHR Moderator: Should we order it once they arrive here through your local pharmacy contacts?

Participant 2: Let me find out and update

Participant 1: We can order prior , it make take Color of days and also they have expire till sept 24.

PaJR PHR Moderator: Also need to check if they are compatible with his mobile

Participant 1: We can arrange one for this case , I belief the caretaker has NFC phone

Patient Advocate: Morning 7.30am nuts and puffed rice 

9.30am 2u lispro insulin 

9.40am rice with carrots, papaya, chayote, bitter gourd, pumpkin, long beans, paneer and salad 

11.45am apple 

1.30pm blood suger 189

130pm 2u lispro insulin 

1.40pm same as previous dish

5/18/24

Patient Advocate: Morning 10.00am blood sugar 212

10.00am 2u lispro insulin 

10.10am rice with bitter gourd, tomato, long beans, soyabean and salad 

1.30pm 2u lispro insulin 

1.40pm rice with bitter gourd, tomato, long beans, soyabean and salad

5.00pm lemon water 

6.30pm 1/2 glass lassy

9.30pm blood sugar 72

9.30pm 2u lispro insulin 

9.40pm rice with long beans, papaya, chayote, bitter gourd, tomato, soyabean and salad

10.30pm 3u lantus insulin

5/19/24

PaJR PHR Moderator: Is she currently on the train from your place to our hospital? How many kms?

Patient Advocate:

Train not start yet 

Train will start at 8.35am

8.45am one pc idli

10.00am 2u lispro insulin 

10.10am rice with bitter gourd, tomato, long beans, chayote and salad 

2.15pm 2u lispro insulin 

2.25pm rice with chayote, bitter gourd, tomato, long beans, paneer

Train e test Kara hochhe ne sir

PaJR PHR Moderator: Train kothai pahuncheche?

Patient Advocate: Bhubaneswar

PaJR PHR Moderator: 👆they are reaching tomorrow

Participant 2: Paticipant 1 

Can you send the name of sensor which is compatible?

Freestyle libre pro 3-kids?

PaJR PHR Moderator: This one 👇

https://www.freestyle.abbott/us-en/products/freestyle-libre-cgm-kids.html

Participant 2: Yes sir..there's Libre pro 3 too,just wanted to confirm which one is compatible to app

PaJR PHR Moderator: Patient Advocate's mobile phone needs to be compatible. He will know

Participant 1: Libre 3

Participant 2: What about the compatibility of phone?

Participant 1: App compatibility can not be confirmed, as they are not available in India

Participant 2: Not available bro

Participant 1: Any phone with NFC will do ,

Yes they are not

We will have to go with Libre

Or Libre pro

Participant 2: Adult ones?

Paticipant 1 these are available

PaJR PHR Moderator: Is the pediatric version for this 3 year old girl available?

Participant 2: No..this is regular size

Participant 1: Yes.  This is Libre 14 days

PaJR PHR Moderator: We need pediatric size for a 3 year old

Participant 2: It's not available in India sir.

We will have to go through Abbott company directly..

Let me give it a shot.

Can't guarantee.

Paticipant 1 Can you try it as well?

Maybe CSR?

PaJR PHR Moderator: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444498/

Participant 2: What's the babies latest hba1c?

PaJR PHR Moderator: Check this one if available 👇

https://www.dexcom.com/en-CA/pediatrics

Participant 2: Wait sir

Participant 1: I have spoken to them , I belief it’s not yet tested and approved in India

PaJR PHR Moderator: March 10, 2024 Hba1c 8.3 around the time of her type 1 diabetes diagnosis I guess. 

Not sure if it was the HPLC method as the lab report doesn't mention it. Many labs in India use latex agglutination for hba1c and we have found here over a period of two years of testing that the values with latex hardly ever cross 8-9!

Participant 2: Any family history of t1dm?

5/20/24

Patient Advocate: Good morning Sir, we have reached the Nalgonda Station

PaJR PHR Moderator: Please come to our OPD. 

Participant 9 Please admit one of the parents in the Special ward asap

Participant 9: Okay Sir

Participant 7: Sir they want to admit the child

Shall I admit both parent and child or just child

PaJR PHR Moderator: You are in OPD?

Participant 7: Yes sir

PaJR PHR Moderator: Admit the parent now. Child if necessary after they show her to the pediatrician with some bridging by Participant 15 like with the other 7M guided by Participant 10

Participant 7: Okay sir

Participant 10: The patient will be admitted to GM Unit 5 sir

PaJR PHR Moderator: What about her road to health card to be made from pediatrics by Participant 16 and Participant 17?

Patient Advocate: Sir apnar jinish tar Katha Mone rakhben 🙏🏾

Participant 1: Are we using 0.5 dose insulin pen , or is not required.

PaJR PHR Moderator: Oh ekkhuni dekhlam! 

Kalke niye nebo tahole

Yes we did discuss this earlier when we trying to optimize and titrate her insulin requirements but recently we forgot about it as the sugars appear to have become optimized

Participant 1: Okay

Patient Advocate: Thik achhe

Sir, tahole HBA1C ekhan theke ekbar kore neben?

PaJR PHR Moderator: 3 mash a ekbar korano hoi 

Ota aage abar kore temon labh nei

Patient Advocate: 10.50am blood sugar 73

12.50pm 2u lispro insulin 

1.00pm breakfast and lunch with the dish of hospital 

6.40pm one and half idli

8.50pm 2u lispro insulin 

9.00pm dinner with hospital dish

11.15pm after dinner blood suger 212

5/21/24

PaJR PHR Moderator: Hospital dinner? Any sweets?

Patient Advocate: No Sir

Participant 2: Any other associated deficiencies?(like vitamins/protein/calorie?)

Patient Advocate: Sir our discharge?

Participant 2: Why hurry?

PaJR PHR Moderator: The road to health is normal Participant 11 

Please share some review of literature around it with particular emphasis on "normal" is decided

Participant 11: https://www.webmd.com/parenting/baby/features/baby-growth-charts-what-influences-your-babys-growth

This is our patient’s growth chart

PaJR PHR Moderator: Yes Participant 12 Participant 7 We have evaluated and planned her further management and she can be discharged. Please prepare it and share the draft with me asap

Participant 13 Please help them get the device before they leave Hyderabad this Saturday. 

Participant 3 Please suggest some good locations for them to stay and visit in Hyderabad

Participant 2: Sure sir..

Any specific places they like to visit in Hyd?

PaJR PHR Moderator: What area do you think the two kids 3 and 6 would enjoy?

Participant 2: I'd suggest them to take a room somewhere around JNTU.

Will meet the kid and take him to nice places nearby(a mall etc) and my home too..

When are they returning?

PaJR PHR Moderator: Saturday

Participant 2: Okk..

Patient Advocate: Even though we don't have any specific place, but we need a good place from where we can visit easily the sight scene of Hyderabad

Participant 2: Nice..

Just install OYO app..You can book rooms for reasonable prices there.

And book a room closer to what you want to visit.

Just ping me wherever you stay,I'll try to catch up.

And maybe we can meet for a lunch one day at my home

Patient Advocate: Ok thank you Sir

Morning 7.30am puffed rice 

9.15am 2u lispro insulin 

9.25am 2pcs idli and cucumber 

12.30pm  mousambi 

1.40pm blood sugar 175

1.50pm  lunch with hospital dish 

6.00pm puffed rice 

9.10pm 2u lispro insulin 

9.20pm dinner with hospital dish and cucumber

5/22/24

PaJR PHR Moderator: Yesterday's last mile to first mile PaJR shared decision makings followed by today's journal club :

Yesterday morning parents asked about 

1) the 3 year old's prognosis and 

2) her future options toward receiving a needle free existence through either biological stem cell transplantation (for which we explained preliminaries and ticketed the need for a journal club shared below) or receiving a AI driven insulin pump (we had already had a journal club around that the link to which can be found in the description box of this PaJR) 

3) We also offered them to test a non invasive video game like device developed by IIT Hyderabad to be supported by Participant 13 in addition to the standard monitoring devices she's already on.

4) Her yellowing with normal bilirubin initially explained as hyper carotenemia is still uncertain as the yellowing appears to have been noticed even before she began her carrot diet 

UDLCO Journal club initiated by elective 2019 student :

Participant 16:

Transplantation of ESCs or iPSCs in T1DM can regenerate the islet β-cells and increase β-cell mass through differentiating to insulin-producing cells (IPCs), pancreatic progenitors, islet organoids, and interspecific pancreatic chimeras, which benefited the treatment of T1DM

iPSCs can be generated from the skin fibroblasts of T1DM patients. These iPSCs can differentiate into pancreatic cell lineages and generate T1DM SC β-cells, making autologous stem cell-derived pancreatic progeny transplantation for T1DM possible

Patient was presented at age 3 in diabetic ketoacidosis requiring hospitalization

Fibroblasts obtained from skin biopsies were cultured and infected with a combination of retroviruses encoding the transcription factors OCT4, SOX2, and KLF4. 

4 weeks after infections, colonies were picked based on their morphological resemblance to human ES cell colonies and expanded.

DiPS lines from both patients could respond to WNT3A and Activin A treatment to differentiate into definitive endoderm. 

Further differentiation toward gut tube endoderm, and pancreatic progenitors was achieved by supplying FGF10 and cyclopamine, and FGF10, cyclopamine, retinoic acid, and (−)-Indolactam V.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735559/

PaJR PHR Moderator: What did you learn from this? 

Which questions that we raised yesterday with the parents were answered in this article? 

1)The follow up of a 3 year old child with type 1? However there's limited data here only around one patient who was 21 years of age after being diagnosed at age of 3. 

How about searching for more type 1 patient data where we have many more 3 year olds followed till they were 50-60-70?

2) The question around the current status of stem cell therapy is also not adequately answered here as it's a 2009 report although it nevertheless talks about an exciting advance in developing functional beta cells from diseased individuals.

Participant 16: Sir we had discussed about _how_ a stem cell can be made to differentiate specifically into a pancreatic beta cell, which is explained here. 

Also, another interesting point is that they have used skin fibroblasts here which is less invasive than using stem cells from the bone marrow.

PaJR PHR Moderator: It is still a hypothesis as it's still not been trialled or it's ineffective? 

What about point 1 regarding prognosis of a type 1 detected at age of 3?

Participant 16: Not been trialled on humans sir. There are some limitations to it being experimented on humans. 

The second point I'm still looking it up sir

Patient Advocate: Sir, 

Khali Patient Advocate De ke discharge korechhe, Kakali De Das ke discharge koreni l

PaJR PHR Moderator: Participant 12 Participant 7 Participant 14 Discharge both the parents asap!

Participant 13: Can some one add him in the group

He is ceo of blue semi non invasive glucose monitoring device

PaJR PHR Moderator: Share the group invite link with him

Patient Advocate: Yesterday blood sugar after dinner 164

7.45am puffed rice 

9.45am 2u lispro insulin 

9.55am idli and cucumber 

12.00noon blood sugar 105

আমরা বের হচ্ছি স্যার l🙏🏾🙏🏾🙏🏾

12.15pm mousambi 

1.30pm 2u lispro insulin 

1.40pm hospital dish 

8.00pm boil egg 

9.15pm blood suger 108

9.15pm 2u lispro insulin 

9.25pm dinner

5/23/24

Patient Advocate: Before breakfast blood sugar 124

9.45am 2u lispro insuplin 

9.50am breakfast 

1.30pm 2u lispro insulin 

1.40pm lunch

7.00pm chicken and papad

10.00pm blood sugar 104

10.10pm dinner 

10.30pm 3u lantus insulin

5/25/24

Patient Advocate: Sir gatakal kichhu update dite parini, kal sakal theke  rat parjyanta ghora ghuri kore rate eshe ghumiyuporichhi

24/05/24

7.30am muri

9.30am 2u lispro insulin 

9.40am breakfast 

1.45pm before lunch blood sugar 66

1.45pm 2u lispro insulin 

1.50pm lunch 

3.00pm one cornetto butter squch icecream 

4.00pm watermelon and cucumber 

10.00pm blood sugar 54

10.00pm one sandesh

10.10pm 2u lispro insulin 

10.20pm biriyani 

10.45pm 3u lantus insulin

Today i.e. 25/05/23

6.30am muri

8.30one dark fantasy creak biscuit two pcs 

9.55am blood sugar 155

9.55am 2u lispro insulin 

10.05am  breakfast

Aaj sakal 8.30am  train e amra firchhi Sir 👋🏻👋🏻

5/26/24

Patient Advocate: 25/05/24

1.45pm 2u lispro insulin 

1.55pm lunch

6.00pm two cream biscuit 

7.00pm puffed rice 

9.45pm 2u lispro insulin 

9.55pm dinner 

10.30pm 3u lantus insulin

5/27/24

Patient Advocate: 26/0524

8.00am puffed rice 

9.10am boil egg 

1.00pm one 5rs Cadbury chocolate 

4.30pm blood sugar 39

4.30am one sandesh 

4.40pm 1u lispro insulin

4.50pm lunch

9.30pm  blood sugar 204

9.40pm dinner 

11.30pm 3u lantus insulin

Train e khaoar kichhu na paoay khaoate parini

27/05/24

8.00am puffed rice 

10.15am 1/2 pattis

11.00am boil egg 

3.00pm barite dhuke blood sugar 133

3.05pm 2u lispro insulin 

3.15pm rice with long beans, pointed gourd, bitter gourd, tomato, spiny guard, lady finger, rubbed gourd, brinjal, soyabean and salad 

7.15pm oats

9.30pm 2u lispro insulin 

9.40pm dinner with as same as recipe of lunch 

10.30pm 3u lantus insulin

5/28/24

PaJR PHR Moderator: Participant 13 I guess they couldn't get the hand held IIT Hyderabad device to test parallely along with standard care they are sharing?

Patient Advocate: Sir ,

Sattis sir er sathe jogajog hayni jadi sambhab hay courier e pathiye dile Ami upi e payment kore dibo l

PaJR PHR Moderator: Ekhane unake tag kore jogajog koriye dilam

Patient Advocate: 7.30am milk And puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pumpkin, long beans, pointed gourd, tometo, bitter gourd, spiny guard, soyabean amd salad 

12.00noon mango

1.30pm 2u lispro insulin 

1.40pm same as previous dish 

4.00pm blood suger 63

4.05 one lolypop and sandesh

PaJR PHR Moderator: Any hypoglycemia symptoms at 4:00 PM or was the lollipop given as a precaution?

Patient Advocate: No sir

5/29/24

Patient Advocate: 28/05/24

7.00pm oats and salad 

9.30pm blood sugar 155

9.30pm 2u lispro insulin 

9.40pm rice with pumpkin, long beans, pointed gourd, spiny guard, soyabean, fish and salad 

10.15pm 3u lantus insulin

29.05.24

7.45am blood sugar 64

7.45am milk and puffed rice 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, bitter gourd, pumpkin, long beans, tomato, spiny guard, soyabean paneer and salad

11.30am one pomegranate 

1.30pm  2u lispro insulin 

1.40pm rice with pointed gourd, bitter gourd, pumpkin, long beans, tomato, spiny guard, soyabean, fish and salad 

4.00pm blood sugar 60

4.15pm one Cadbury normal chocolate 

7.00pm oats

9.30pm blood sugar 212

9.35pm 2u lispro insulin 

9.45pm rice with tomato, pumpkin, long beans, green banana, fish and salad 

10.30pm 3u lantus insulin

5/30/24

Patient Advocate: 7.45am puffed rice 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, tometo, spiny guard, pumpkin leaf, soyabean, paneer and salad 

12.00noon lichi 3pcs

1.30pm blood suger 88

1.30pm 2u lispro insulin 

1.40pm rice with pointed gourd, tometo, spiny guard, pumpkin leaf, soyabean, fish and salad 

5.30pm jackfruit with puffed rice 

9.30pm 2u lispro insulin 

9.40pm rice with pointed gourd, tometo, spiny guard, pumpkin leaf, fish and salad 

10.30pm 3u lantus insulin

5/31/24

PaJR PHR Moderator: 👍

6/1/24

Patient Advocate: 31/05/24

7.30am blood sugar 85

7.30am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, pumpkin, pumpkin leaf, brinjal, spiny guard, ribbed guard, soyabean, paneer and salad

12.00 noon mango 

1.30pm 2u lispro insulin 

1.40pm same as previous dish and fish

4.00pm blood suger 60

4.05pm lolypop and jelly chocolate 

5.00pm jackfruit with puffed rice 

7.00pm oats

9.45pm 2u lispro insulin 

9.55pm as same as the dish of the lunch

12.00midnight blood suger 111

PaJR PHR Moderator: 1:30 PM lispro dose can be reduced. How much was it today?

Patient Advocate: 2u

PaJR PHR Moderator: 3:30 PM sugar?

Patient Advocate: 83

01/06/24

7.45am milk and puffed rice 

9.30am 2u lispro insulin 

9.40am rice with zucchini, long beans, pumpkin, brinjal, pointed gourd, green banana, soyabean and salad 

11.50am Blood suger 111

12.00noon mango 

1.30pm 2u lispro insulin 

1.40pm as same as previous dish and paneer

4.00pm blood sugar 83

6.30pm jackfruit with puffed rice and milk 

9.30pm 2u lispro insulin 

9.40pm as same as the dish of lunch 

10.30pm 3u lantus insulin

6/2/24

Patient Advocate: 2/06/24

7.30am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with tomato, pumpkin, long beans, pointed gourd, ribbed gourd, snake gourd, soyabean paneer and salad 

11.45am ripe papaya 

1.30pm blood sugar 214

1.30pn 2u lispro insulin 

1.40pm as same as previous dish and fish

5.30pm sour curd

7.00pm ripe jackfruit with milk and puffed rice 

9.30pm 2u lispro insulin 

9.40pm same as lunch dish

10.30pm 3u lantus insulin

6/3/24

Patient Advocate: 02/06/24

Blood sugar after two hours of dinner 112

Participant 2: Good

6/4/24

Patient Advocate: 03/06/24

7.30am milk with puffed rice 

9.50am 2u lispro insulin 

10.00am rice with pointed gourd, bitter gourd, tomato, spiny guard, pumpkin, soyabean and salad

12.00noon blood suger 90

12.00noon mango

1.45pm 2u lispro insulin 

1.55pm as same as previous dish 

5.00pm sour curd 

7.00pm wheat flour chapati 

9.45pm blood sugar 145

9.55ok as same as previous dish 

10.40pm 3u lantus insulin

PaJR PHR Moderator: Check out the difference in the data with the food on two subsequent days with the same insulin dose :

[6/2] Patient Advocate 2F Diabetes1: 2/06/24

9.45am 2u lispro insulin 

9.55am rice with tomato, pumpkin, long beans, pointed gourd, ribbed gourd, snake gourd, soyabean paneer and salad 

11.45am ripe papaya 

1.30pm blood sugar 214

[6/4] Patient Advocate 2F Diabetes1: 03/06/24

9.50am 2u lispro insulin 

10.00am rice with pointed gourd, bitter gourd, tomato, spiny guard, pumpkin, soyabean and salad

12.00noon blood suger 90

The only difference in ingredients here is "bitter gourd?"

Patient Advocate: 04/06/24

7.30am blood suger 138

7.30am milk with puffed rice 

10.00am 2u lispro insulin 

10.10am rice with pointed gourd, long beans, tomato, bitter gourd, sponge gourd, chayote, green banana, egg and salad 

12.00noon mango 

1.30pm 2u lispro insulin 

1.40pm as same as previous dish and fish 

3.50pm blood suger 164

5.30pm sour curd 

7.00pm oats 

9.30pm 2u lispro insulin 

9.40pm as same as lunch dish 

10.30pm 3u lantus insulin

6/6/24

Patient Advocate: 05/06/24

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, tometo, green banana, chayote, soyabean, egg and salad 

12.00noon mango 

2.00pm blood suger 90

2.00pm 2u lispro insulin 

2.10pm lunch with as same as previous dish 

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with the same dish of lunch except egg

10.45pm 3u lantus insulin

06/06/24

7.30am blood sugar 101

7.35pm milk with puffed rice

PaJR PHR Moderator: 👍

Patient Advocate: 9.45am 2u lispro insulin 

9.55am rice with chayote, spiny gourd, pointed gourd, long beans, tomato, soyabean, egg and salad 

12.00noon mango

1.45pm 2u lispro insulin 

1.55pm lunch

1.55pm lunch with same previous dish except egg and fish

4.00pm blood sugar 125

5.30pm sour curd 

7.00pm milk with puffed rice 

9.30pm 2u lispro insulin 

9.40pm dinner as same as lunch 

10.30pm 3u lantus insulin

6/7/24

PaJR PHR Moderator: 👍

6/8/24

Patient Advocate: 07/06/24

7.30am milk with puffed rice 

9.30am 2u lispro insulin।

9.40am rice with long beans, chayote, spiny gourd, pointed gourd, green banana, soyabean, egg and salad.

11.55am blood suger 94

12.00noon mango 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.00pm 10grm dark chocolate 

6.00pm sour curd 

7.00pm oats 

9.30pm blood sugar 212

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish 

10.30pm 3u lantus insulin

08/06/24

7.30am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, spiny guard, tomato, chayote, soyabean, egg and salad 

12.15pm mango 

1.45pm blood suger 81

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg 

5.00pm sour curd 

7.00am payesh with banana 

10.00pm 2u lispro insulin 

10.10pm dinner with same as lunch dish 

10.40pm 3u lantus insulin

6/9/24

Patient Advocate: 8/06/24

12.15am blood sugar after dinner 62

Then 3/4 teaspoon sugar (chini)

9/06/24

7.30am milk with puffed rice 

10.00am 2u lispro insulin 

10.10am rice with tomato, spiny gourd, pointed gourd, papaya, soyabean , egg and salad 

12.00noon ripe jackfruit 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and soyabean added chicken 

3.50pm  blood sugar 165

5.30pm sour curd 

7.00pm aata meggi

9.40pm blood sugar 162

9.50pm dinner with same as lunch dish 

10.30pm 3u lantus insulin

6/10/24

Patient Advocate: 10/06/24

7.30am milk with puffed rice 

9.45am 2u lispro insulin 

9.50am rice with papaya chayote, bitter gourd, tomato, pointed gourd, spiny gourd, egg and salad 

12.00noon blood sugar 78

12.00noon mango 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and added soyabean 

5.00pm sour curd 

7.00pm oats 

9.15pm one dark fantasy biscuit 

9.45pm blood sugar 278

9.45pm 2u lispro insulin 

9.50pm dinner with same lunch dish 

10.30pm 3u lantus insulin

6/11/24

PaJR PHR Moderator: Post dark fantasy glucose outcomes in this patient is a stark reminder of the sugar and maida in children's favorite biscuits? Participant 3 Participant 13

Participant 2: Tattoo and poster presentation for improved outcomes

Patient Advocate: 11/06/24

7.30am blood sugar 110

7.30am milk with puffed rice 

9.45am 2u insulin 

9.55am rice with papaya, pointed gourd, spiny gourd, chayote, soyabean, egg and salad 

12.00noon mango 

1.40pm 2u lispro insulin 

1.50pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 75

5.00pm sour curd 

6.30pm oats 

9.30pm 2u lispro insulin 

9.40pm dinner with same as lunch dish 

10.30pm 3u lantus insulin

6/13/24

Patient Advocate: 12/06/24

7.30am milk and puffed rice 

10.00am 2u lispro insulin 

10.10am sweet curd, puffed rice, mango and banana 

1.30pm blood sugar 300

1.30pm 2u lispro insulin 

1.40pm rice with pointed gourd, chayote, pumpkin, papaya, carrot, fish, one pc chicken and salad 

5.30pm sour curd 

7.00pm chapati of aata

9.30pm blood sugar 350

9.30pm 3u lispro insulin 

9.40pm rice with pointed gourd, tometo, pumpkin, papaya chayote, fish, one pc chicken and salad 

10.30pm 3u lantus insulin 

11.50pm blood suger 36

11.50pm one rasagolla and 1/2 teaspoon sugar

13/06/24

7.45am blood sugar 104

7.45am milk and puffed rice 

9.30am rice with pointed gourd, tometo, spiny guard, pumpkin, papaya chayote, soyabean, egg and salad

PaJR PHR Moderator: The sudden one unit increase in the pre dinner 9:30 P M lispro (to combat her hyperglycemia due to the sweet curd and aata) appears to have resulted in the 11:50 pm hypParticipant 5 

Patient Advocate what were the symptoms?

Patient Advocate: No symptoms has been found

6/14/24

Patient Advocate: 12.00noon mango

1.30pm 2u lispro insulin 

1.30pm rice with same previous dish except egg and include fish 

5.00pm sour curd 

7.00pm oats

9.30pm 2u lispro insulin 

9.40pm dinner with same as lunch dish 

10.30pm 3u lantus insulin 

11.50pm blood suger 105

14/06/24

7.45am milk with puffed rice 

9.30am rice with carrots, papaya, chayote, bitter gourd, pointed gourd, tometo, egg and salad 

11.15am ripe jackfruit 

11.45am blood suger 307

1.45pm 2u lispro insulin

PaJR PHR Moderator: No lispro in the morning?

One needs to be very careful about hypoglycemia unawareness.

More about it here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499525/

6/16/24

Patient Advocate: Yes given

15/06/24

7.30am milk and puffed rice 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, tometo, spiny guard, carrots, chayote, papaya, soyabean, egg and salad 

11.35am mango 

1.30pm blood sugar 146

1.30pm 2u lispro insulin 

1.40am lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.30pm oats

9.30pm 2u lispro insulin 

9.40pm rice with chayote, papaya, bitter gourd, tomato, spiny guard, fish and salad 

10.30pm 3u lantus insulin

Blood suger after dinner 77

6/17/24

Patient Advocate: 16/06/24

7.30am milk and puffed rice 

9.30am 2u lispro insulin 

9.40am rice with papaya, chayote, bitter gourd, pumpkin, pointed gourd, spiny guard, soyabean, egg and salad 

11.40am blood sugar 102

11.45am mango 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm roti of rice flour

9.45pm blood suger 377

9.50pm 2u lispro insulin 

10.00pm dinner with same as lunch dish 

10.40pm 3u lantus insulin 

12.00night blood suger 114

PaJR PHR Moderator: 9:45PM obdhi aager diner lantus er action kome aashche?

Is the previous day's lantus action coming down by 9:4 Participant 5

Patient Advocate: Tahole ki ajke lantus ta aro 1u bariye 4u kore debo Karan ager din o dinner er age sugar 300 opore chhilo

PaJR PHR Moderator: Ekhane duration of action er issue mone hocche. Dose er noi

Kintu dinner er pore 77 hoye gechilo

Amar notun phone theke aager shob WhatsApp message guno delete hoye geche.

Ore body weight ebong last hba1c ta kabe koto chilo janate parben?

Patient Advocate: Parbo Sir

HBA1C report on 10/03/24 was 8.3

Body weight last three month same position 13kg

6/18/24

PaJR PHR Moderator: When we plotted it on the road to health card her growth appeared to be in the right direction within the expected standard! 

Please share the image of the road to health card again and have you plotted her recent weight in it?

Participant 6 Can we find an online pediatric growth plotting app similar to the paper based road to health card?

Also Patient Advocate 10/3/24 was also the date her diabetes was diagnosed for the first time?

Was the hba1c repeated on 10/6/24 as discussed earlier that it needs to be repeated every 3 months?

Patient Advocate: 10/03/24 was first date of diagnosis 

I

On 10/06/24 HBA1C has not been done because they're not our house, they are in their mama,s house 

On returning it will be done

PaJR PHR Moderator: We salute our PaJR patients parents for their inspiring dedication and let's celebrate this day as PaJR parents day:

Check out this article as a food for thought to celebrate this day (Bengali translation below):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151965/

Abstract:

Introduction:

The management of childhood type 1 diabetes requires the active participation of parents. The aim of the present study was to describe the main characteristics of parents of children with type 1 diabetes, including objective burden regarding time spent on diabetes care, emotional distress (exhaustion, need for respite, quality of life), and symptoms of depression as well as anxiety.

আমরা আমাদের PaJR রোগীর পিতামাতাদের তাদের অনুপ্রেরণামূলক উত্সর্গের জন্য অভিনন্দন জানাই এবং আসুন এই দিনটিকে PaJR পিতামাতা দিবস হিসাবে উদযাপন করি:

এই দিনটি উদযাপনের চিন্তার খোরাক হিসাবে এই নিবন্ধটি দেখুন:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151965/

বিমূর্ত:

ভূমিকা:

শৈশব টাইপ 1 ডায়াবেটিস পরিচালনার জন্য পিতামাতার সক্রিয় অংশগ্রহণ প্রয়োজন। বর্তমান অধ্যয়নের লক্ষ্য ছিল টাইপ 1 ডায়াবেটিস আক্রান্ত শিশুদের পিতামাতার প্রধান বৈশিষ্ট্যগুলি বর্ণনা করা, যার মধ্যে ডায়াবেটিসের যত্নে ব্যয় করা সময়, মানসিক যন্ত্রণা (ক্লান্তি, অবকাশের প্রয়োজন, জীবনের মান) এবং বিষণ্নতার লক্ষণগুলি সহ পাশাপাশি উদ্বেগ।

Patient Advocate: 17/06/24

7.45am blood suger 121

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, bitter gourd, tomato, ribbed guard, egg and salad 

12.00noon ripe jackfruit 

1.45pm 2u lispro insulin 

1.50pm lunch with same as previous dish except egg and include fish 

5.30pm sour curd 

7.00pm mild and roti of rice flour 

9.30pm 2u lispro insulin 

9.40pm rice with jackfruit seed, pointed gourd, tometo, long beans, papaya, fish and salad 

10.30pm 3u Lantus  insulin 

11.55pm blood suger 235

6/20/24

Patient Advocate: 18/06/24

7.45am milk and puffed 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, bitter gourd, tomato, papaya, egg and salad 

11.45am blood sugar 236

1.30pm 2u lispro insulin 

1.40pm lunch with same as previous dish except egg and include fish 

5.30pm sour curd 

7.00pm oats

9.30pm blood sugar 304

9.30pm 2u lispro insulin 

9.40pm rice with chayote, papaya, pointed gourd, tometo, fish and salad 

10.30pm 4u lantus insulin

19/06/24

8.00am blood sugar 98

8.00am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with chayote, papaya, bitter gourd, pumpkin, long beans, egg and salad 

1.30pm 2u lispro insulin 

1.40pm lunch with same as previous dish except egg and include fish 

3.50pm blood sugar 90

5.00pm sour curd 

7.00pm chowmin

9.30pm 2u lispro insulin 

9.40pm rice with green banana, pointed gourd, papaya, long beans 

10.30pm 4u lantus insulin

PaJR PHR Moderator: Lantus 1 unit baranote, post meal guno o ektu beshi kome jacche.

Hypoglycemia hote sabdhane thakte habe

Dorkar hole lispro dose ta komano jete pare

Patient Advocate: Ok

6/21/24

Patient Advocate: 20/06/24

7.30am only puffed rice because digestive problems and seems to be dysentery 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, papaya, green banana, long beans, bitter gourd, soyabean, egg and salad 

11.50am blood suger 78

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm oats 

9.30pm blood sugar 267

9.30 pm 2u lispro insulin 

9.40pm rice with as same as lunch dish 

10.30pm 4u lantus insulin

6/22/24

Patient Advocate: 21/06/24

7.30am only puffed rice 

9.30am 2u lispro insulin 

9.40am rice with chayote, papaya, pointed gourd, green banana soyabean and salad 

11.50am mousambi 

1.30pm blood suger 152

1.40pm 2u lispro insulin 

1.50pm lunch with same previous dish and fish 

5.30pm sour curd 

7.15pm oats

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

PaJR PHR Moderator: Please  check for urine ketones with a ketostix.

Any acute illness in a type1 diabetic, one must check for ketones, even if the BG is low or normal

Patient Advocate: Monday will be done

PaJR PHR Moderator: Urine ketones are done to prevent emergencies

Patient Advocate: কিভাবে ?

PaJR PHR Moderator: Ketone positive thakle diabetic ketoacidosis er jonye emergency treatment shuru korte hote pare

Diabetic ketoacidosis jekono infection er fole precipitate hote pare

Patient Advocate: Ketone  ki sugar level bariya dey ki ?

PaJR PHR Moderator: Na onyo bhabe khoti korte pare bishesh kore acid level bariye

Tabe hain generally sugar barle ketones o barte pare tabe khub rarely sugar na barleo ketones bere giye khoti hote pare.

Urine Ketones barle next step hishebe amra immediately arterial blood gas kore, blood a acid er matra ta dekhe ni

Patient Advocate: Agami kal to Sunday, r aj sakale or to first urin kore felechhe ekhon Monday chhara ro hobe na,

Bairer theke ke ketones barar kono lakshan dekhe  bojhar upai acche? 

Ar Sir ketones control karar upai ki?

PaJR PHR Moderator: Emergency treatment of diabetic ketoacidosis involves iv fluids and iv insulin

First urine is not necessary for testing urine ketones

Patient Advocate: 21/06/24

Blood suger after dinner 212

22/06/24

7.30am puffed rice 

9.30am 2u lispro insulin 

9.40am rice with chayote, papaya, long beans, pointed gourd, green banana, soyabean, paneer and salad 

11.50am blood suger 162

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish 

5.30pm sour curd 

7.00pm oats

9.45pm 2u lispro insulin 

9.55pm dinner with same previous dish 

10.45pm 4u lantus insulin

6/23/24

Patient Advocate: 22/06/24

Blood suger before dinner 174

6/24/24

Patient Advocate: 23/06/24

7.30am blood suger 60

7.30am puffed rice and dates 2pcs

9.30am 2u lispro insulin 

9.40am rice with chayote, papaya, pointed gourd, green banana, soyabean, paneer and salad 

12.00noon mango 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish and fish 

3.45pm blood sugar 77

5.30pm sour curd 

7.00pm oats 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish and one pc mutton 

10.30pm 4u lantus insulin 

11.55pm blood sugar 70

Sir, Patient ke 21/06/24 tarikhe child specialist dekhano hoyechhilo karon o besh kayek  dine theke 3-4 times potty korchhilo ar pottyr poriman ta 3--4 time i onek ta poriman hochhilo tai doctor er kache niye giyechhilam । Kintu medicine guli ekhono deoa hoy ni Karan apni ketone test korte bollen tai ajke urine ketone test korar por seta apnake dekhiye apni jadi bolen tahole oi medicine guli dibo

PaJR Participant 5 medicines by the local pediatrician for the child's diarrhoea

PaJR PHR Moderator: Aekhon emnitei kome jaini?

Ore stools er chobi ta amake pm kore share korte parben?

Patient Advocate: Kal kore dibo

6/25/24

Patient Advocate: 24/06/24

7.30am milk with puffed rice 

9.30am 2u lispro insulin 

9.40am chayote, papaya, pointed gourd, pumpkin, soyabean and salad 

11.50am blood suger 106

12.00noon mango 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish and paneer 

5.30pm sour curd 

7.00pm oats

7.30pm banana, mango, jackfruit and sago mixed 40grm

9.30pm blood suger 267

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish 

10.30pm 4u lantus insulin

PaJR PHR Moderator: 👆 Congratulations to the patient's parents. From 8.3 to 6.6 in three months 👏👏

Patient Advocate: Phosphorus, Potassium and AST : ALT Ratio normal korar upay ta ki Sir ?

PaJR PHR Moderator: Oguno borderline.

Arek din repeat korle normal dekhate pare

Patient Advocate: Ok, thank you Sir

6/26/24

Patient Advocate: 25/06/24

7.30am medicine prescribe pediatrician 

7.40am milk with puffed rice 

9.30am 2u lispro insulin 

9.40am rice with chayote, bitter gourd, pumpkin, papaya, pointed gourd, paneer and salad 

12.00noon mango 

1.30pm blood suger 120

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except paneer and include fish 

5.30pm sour curd 

7.00pm oats 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish 

10.30pm 4u lantus insulin 

11.40pm blood sugar 72

25/06/24

There were also two times medicine after lunch and dinner

26/06/24

7.30am medicine prescribe by pediatrician 

7.40am milk with puffed rice 

9.30am 2u lispro insulin 

9.40am rice with chayote bitter gourd, pumpkin, soyabean and salad 

11.50am blood sugar 106

12.00noon mango 

1.30pm 2u lispro insulin

1.40pm lunch with same previous dish 

5.30pm sour curd 

8.30pm milk and puffed rice 

9.50pm blood suger 71

10pm 2u lispro insulin 

10.10pm dinner with as same as lunch dish 

10.45pm 4u lantus insulin 

Two times medicine after lunch and dinner

6/27/24

PaJR PHR Moderator: The sugar values are coming borderline and it would be nice to reduce lispro Participant 5 ?

Bortoman a apni pen use korchen naki syringe?

Patient Advocate: Pen

27/06/24

7.45am blood sugar 54

7.45am two pcs dates and milk with puffed rice 

9.45am 2u lispro insulin 

9.50am rice with pointed gourd, pumpkin, papaya, chayote, bitter gourd , soyabean, and egg 

12.00noon mango 

1.30pm blood sugar 

1.35pm 2u lispro insulin 

1.45pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 61

4.05pm one lolipop candy 

5.00pm sour curd 

6.30pm oats 

7.30pm ripe jackfruit 

9.55pm 2u lispro insulin 

10.05pm dinner with as same as lunch dish and salad 

10.45pm 3u lantus insulin

6/28/24

PaJR PHR Moderator: Reduce lispro dose asap.

If you can't procure the Humalog Junior Kwikpen 100iu Pre Filled Pen Of 3ml Solution For Injection to reduce the dose by 0.5 then currently reduce it by 1U

More about how to procure the junior kwikpen here👇 https://pharmeasy.in/online-medicine-order/humalog-junior-kwikpen-100iu-pre-filled-pen-of-3ml-solution-for-in Participant 5 Could you come across a similar page from India providing the same functionality through syringes instead of pen?

What was 1:30 PM blood sugar?

Patient Advocate: Ei lekhata bhulbasata hoye geche,  oi samay test kora jay ni

6/29/24

Patient Advocate: 28/06/24

7.45am puffed rice and milk 

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, pointed gourd, bitter gourd , soyabean and egg 

12.00noon blood sugar 81

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish and paneer 

5.00pm sour curd 

6.45pm fuse chocolate

8.45pm milk and puffed rice 

10.10pm blood sugar 173

10.20pm dinner with as same as lunch dish 

11.00pm 3u lantus insulin

6/30/24

Patient Advocate: 29/06/24

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, bitter gourd, papaya, green banana, spiny gourd, and soyabean 

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and paneer 

5.30pm sour curd

7.00pm oats 

9.45pm blood sugar 264

9.50pm 2u lispro insulin 

10.00pm dinner with as same as lunch dish and salad 

10.40pm 3u lantus insulin

PaJR PHR Moderator: Added sugar in sour curd?

Patient Advocate: Sour curd with sald not little bit of sugar

PaJR PHR Moderator: Check the sugar content in the oats. Is it a commercial packaged oats?

Patient Advocate:

PaJR PHR Moderator: 200 mg of sugar per serving

Patient Advocate: Ei oats ta daily khay, kintu sugar ta ei rakam majhe madhye bere jaoar Karan ta ki Sir ?

PaJR PHR Moderator: Jotodur anuman korchi ore pancreas thekeo majhe majhe kichu insulin beruchchhe jeta sugar ta kokhono kokhono fall koracche abar majhe majhe pancreas theke ekkebarei kichu beruchchhena jar jonye sugar ta bere jacche

Amader 30F er group aeo anketa aek dhoroner byapar dekha jacche

Patient Advocate: 30/06/24

7.45am blood sugar 108

7.45am milk and puffed rice 

9.45am  2u lispro insulin 

9.50am rice with papaya, spiny gourd, long beans,  pointed gourd, ribbed gourd, bitter gourd, soyabean and egg 

12.00noon mango 

2.00pm 2u lispro insulin 

2.10pm lunch with same previous dish except egg and include fish 

4.15pm blood sugar 147

6.15pm sour curd 

7.15pm maggi

9.45pm blood sugar 95

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch with and salad 

10.40pm 3u lantus insulin

Patient Advocate: It is for three times

1/7/24 (Day/Month/Year)

PaJR PHR Moderator: Children may appreciate a variation in their daily diet

Patient Advocate: 01/07/24

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

9.50am rice with pointed gourd, bitter gourd, chayote, papaya, long beans, spiny guard, soyabean and salad 

11.50am blood suger 161

12.00noon mango 

1.45pm 2u lispro insulin 

1.50pm lunch with same as previous dish and egg

6.00pm sour curd with salt

7.00pm maggi 

9.45pm blood sugar 81

9.50pm 2u lispro insulin 

10.00pm dinner with as same as lunch dish except egg and a small size papad

10.40pm 3u lantus insulin

2/7/24

Patient Advocate: 12.00night blood suger 91

PaJR PHR Moderator: Aeguno shob apnar local daktar jei dhoroner chart diyechilen shei dhoroner chart aeo shajacchen?

Otao ekhane share korte parben aager moton jemon otar chobi share korechilen?

Patient Advocate: কোন গুলোর ছাবি স্যার ?

PaJR PHR Moderator: Ekdom shuru te jei chart ta share korechilen jeta dekhe amra prothom ore hypoglycemia r kotha janai ebong insulin dose komate boli

Amar mone hoi shei chart guno apni nishchoi parallel bhabe toiri rekhechen apnar local pediatrician ke dekhanor jonye?

Aekhono porjyonto aei group a ja kothopokothon hoyeche aei group a oguno shob select kore, ebong tarpor copy kore ekhane abar paste korte parben jaate protyek ta kothopokothon er saathe date o thake jemon ami kichu ta niche kore dekhalam 👇

[30/06] Patient Advocate 2F Diabetes1: 30/06/24

7.45am blood sugar 108

7.45am milk and puffed rice 

9.45am  2u lispro insulin 

9.50am rice with papaya, spiny gourd, long beans,  pointed gourd, ribbed gourd, bitter gourd, soyabean and egg 

12.00noon mango 

2.00pm 2u lispro insulin 

2.10pm lunch with same previous dish except egg and include fish 

4.15pm blood sugar 147

6.15pm sour curd 

7.15pm maggi

9.45pm blood sugar 95

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch with and salad 

10.40pm 3u lantus insulin

[01/07] Patient Advocate 2F Diabetes1: It is for three times

PaJR PHR Moderator: Children may appreciate a variation in their daily diet

Patient Advocate 2F Diabetes1: 01/07/24

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

9.50am rice with pointed gourd, bitter gourd, chayote, papaya, long beans, spiny guard, soyabean and salad 

11.50am blood suger 161

12.00noon mango 

1.45pm 2u lispro insulin 

1.50pm lunch with same as previous dish and egg

6.00pm sour curd with salt

7.00pm maggi 

9.45pm blood sugar 81

9.50pm 2u lispro insulin 

10.00pm dinner with as same as lunch dish except egg and a small size papad

10.40pm 3u lantus insulin

[02/07] Patient Advocate 2F Diabetes1: 12.00night blood suger 91

PaJR PHR Moderator: Aeguno shob apnar local daktar jei dhoroner chart diyechilen shei dhoroner chart aeo shajacchen?

Otao ekhane share korte parben aager moton jemon otar chobi share korechilen?

Patient Advocate 2F Diabetes1: কোন গুলোর ছাবি স্যার ?

Patient Advocate: Thik achhe ami kore debo ektu samay niye Karan Sai March mas theke, onek gulo chhabi hobe l

PaJR PHR Moderator: Apatoto shudhu oi prothom chart ta ebong last chart ta share korun

Baki shudhu text guno copy paste korle habe

👆Ekhane jebhabe dekhano sheibhabe text hishebe pathan Patient Advocate 

Text guno ke chobi hishebe dile oguno ke amra case report a paste korte parbona.

Chobi shudu jeguno  apnar paper a banano ore blood sugar chart er shudhu sheguno pathalei habe

Patient Advocate: Ok

PaJR PHR Moderator: Aei chart tar kotha bolchilam

PaJR PHR Moderator: 👆 Eta aekhono apnar local daktar er jonye maintain korchen asha kori

Patient Advocate:

PaJR PHR Moderator: Well done Patient Advocate 👏👏

2/07/24

Patient Advocate:

7.40am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with chayote,  bitter gourd, ribbed gourd,  long beans, pointed gourd, soyabean, egg and  salad 

12.00noon sagu with mango and banana 

1.45pm blood suger  90

1.45pm  2u lispro insulin 

1.55pm lunch with same as previous dish except egg and include fish 

5.30pm sour curd with salt 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.45am 3u lantus insulin

03/07/24

Patient Advocate: 02/04/24

12.00midnight blood suger 63

Then 1/3 teaspoon sugar

03/07/24

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, green banana, chayote, bitter gourd, ribbed gourd,  soyabean 

12.00noo blood sugar 47

Than 1/2 teaspoon sugar 

One mango 

1.30pm 1u lispro insulin 

1.40pm lunch with same previous dish and egg

5.30pm sour curd with salad

7.00pm oats

9.30pm blood sugar 184

9.40pm 2u lispro insulin 

9.50pm dinner with as same as lunch dish 

10.45pm 3u lantus insulin

04/07/24

PaJR PHR Moderator: Needed to reduce night lantus too?

What's today's fasting?

Patient Advocate: 04/07/24

7.45am blood sugar 86

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.45am rice with pointed gourd, chayote, brinjal, soyabean, egg and salad 

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 73

5.30pm sour curd with salt 

7.00pm oats 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish 

10.30pm 2u lantus insulin

05/07/24

Patient Advocate: 04/07/24 blood sugar two hours later 78

PaJR PHR Moderator: 2 hours later in 4/7/24 was 11:30PM, two hours after dinner?

Patient Advocate: Yes

05/07/24

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, bitter gourd, long beans, pumpkin , spiny gourd, soyabean, paneer and salad 

12.00noon blood sugar 108

12.00noon  mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish 

5.30pm sour curd 

7.00pm oats 

8.30pm 1/2 bowl khichudi prasad in which 1.5 teaspoon of sweety  payesh also

9.30pm blood suger 366

9.40pm 2u lispro insulin 

9.50pm dinner with as same as lunch dish 

10.30pm 3u lantus insulin

06/07/24

PaJR PHR Moderator: The sweety payesh!

07/07/24

Patient Advocate: 06/07/24

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am chayote, bitter gourd, pumpkin, long beans, pointed gourd, soyabean 

12.00noon 1/2 mango

1.45pm blood suger 266

1.50pm 2u lispro insulin 

2.00pm lunch with same previous dish and paneer

5.30pm sour curd 

7.15pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish and salad 

10.40pm 3u lantus insulin 

12.00night blood suger 111

07/07/24

7.45am blood sugar 181

7.45am milk and puffed rice

Sir blood suger after dinner esechhilo 111 kintu sara raat ghumiye kichhu na kheye bede 181 hoyegelo kibhabe?

PaJR PHR Moderator:: Amader shorirer physiology te aemon bhabe kichu mechanism ache jaate overnight fasting holeo amader Liver theke glucose beriye rokte chole aashe ebong shei bhabe sugar taake fall hote dei na.

Kintu diabetics der khetre aei mechanism guno shothik kaaj kore na tai jonye proyojon er beshi sugar liver nijer store theke blood a pathiye dai

08/07/24

Patient Advocate: 07/07/24

9.45am 2u lispro insulin 

9.55am rice with spiny guard, chayote, green banana, long beans, pointed gourd, egg and salad 

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and fish 

4.00pm blood suger 233

5.30pm sour curd  

7.00pm oats

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.30pm 4u kantu insulin

Kantu> lantus

08/07/24

7.45am blood sugar 90

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny guard, pumpkin, green banana, chayote, long beans, bitter gourd, tomato, soyabean  and ghee

11.55am blood suger 263

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and paneer 

5.30pm sour curd 

7.30pm oats

9.45pm blood suger 154

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

10/07/24

Patient Advocate: 9.07.24

7.30am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, green banana, chayote, bitter gourd, tomato, spiny guard, pumpkin, soyabean and salad 

12.00noon mango 

1.45pm blood suger 183

1.50pm 2u lispro insulin 

2.00pm lunch with same as previous dish and egg 

5.30pm sour curd 

7.00pm oats 

8.30pm two teaspoons prasad ( khichudi)

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish except egg 

10.30pm 4u lantus insulin 

12.00night blood sugar 122

10/07/24

7.45am blood sugar 99

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pumpkin, soyabean and salad 

12.00noon mango 

1.45pm 2u lispro insulin

1.55pm lunch with same previous dish and egg 

4.00pm blood suger after lunch 123

5.30pm sour curd 

7.30pm one banana and grist ( two teaspoons)

9.30pm 2u lispro insulin 

9.40pm dinner with as same as previous dish except egg and include fish 

10.30pm 4u lantus insulin

11/07/24

Patient Advocate:

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with Spiny guard, chayote, papaya, long beans, sponge gourd, green banana , soyabean, egg and salad 

12.00noon blood suger 137

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

6.00pm sour curd 

7.15pm aata roti one pc with ghee and salt

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4U lantus insulin

13/07/24

Patient Advocate: 12/07/24

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, green banana, chayote, long beans, sponge gourd, soyabean,  egg and salad 

12.00noon blood suger 223

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.15pm banana 

9.45pm blood suger 44

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin 

12.00night blood suger 212

After suger level 44, 1/4 teaspoon jam was given

13/07/24

7.45am blood sugar 142

7.45am milk with puffed rice

PaJR PHR Moderator:

@Meta AI can you make out from the transcripts below as to what may have precipitated this child's hypoglycemia at 9:45PM on 12/7/24

[10/07, 23:42] Patient Advocate 2F Diabetes1:

 7.45am blood sugar 99

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pumpkin, soyabean and salad 

12.00noon mango 

1.45pm 2u lispro insulin

1.55pm lunch with same previous dish and egg 

4.00pm blood suger after lunch 123

5.30pm sour curd 

7.30pm one banana and grist ( two teaspoons)

9.30pm 2u lispro insulin 

9.40pm dinner with as same as previous dish except egg and include fish 

10.30pm 4u lantus insulin

[11/07, 23:37] Patient Advocate 2F Diabetes1: 7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with Spiny guard, chayote, papaya, long beans, sponge gourd, green banana , soyabean, egg and salad 

12.00noon blood suger 137

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

6.00pm sour curd 

7.15pm aata roti one pc with ghee and salt

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4U lantus insulin

[13/07, 08:36] Patient Advocate 2F Diabetes1: 12/07/24

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, green banana, chayote, long beans, sponge gourd, soyabean,  egg and salad 

12.00noon blood suger 223

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.15pm banana 

9.45pm blood suger 44

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin 

12.00night blood suger 212

[13/07, 08:38] Patient Advocate 2F Diabetes1: 

After suger level 44, 1/4 teaspoon jam was given

[13/07, 08:39] Patient Advocate 2F Diabetes1:

13/07/24

7.45am blood sugar 142

7.45am milk with puffed rice

Meta AI:

Based on the transcripts, it appears that the child's hypoglycemia (blood sugar level of 44) at 9:45 PM on December 7, 2024, may have been precipitated by a combination of factors, including:

1. Insulin doses: The child received multiple doses of lispro insulin throughout the day, including 2 units at 9:45 AM, 1:45 PM, and 9:45 PM.

2. Meals and snacks: The child had a relatively consistent diet throughout the day, with a mix of carbohydrates, protein, and vegetables. However, the dinner at 9:55 PM may have been digested quickly, causing a rapid drop in blood sugar.

3. Physical activity: There is no mention of physical activity in the transcripts, but it is possible that the child engaged in some physical activity during the day that may have contributed to the hypoglycemia.

4. Insulin sensitivity: The child may have been more sensitive to insulin than usual, which could have caused the blood sugar to drop more rapidly than expected.

The fact that the child's blood sugar level was 223 at 12:00 PM and then dropped to 44 at 9:45 PM suggests that there may have been a rapid decline in blood sugar levels in the evening. The administration of 1/4 teaspoon of jam after the hypoglycemic episode suggests that the child's caregivers were attempting to quickly raise the child's blood sugar levels.

PaJR PHR Moderator: Did she have any symptoms before or at 9:45PM yesterday?

Patient Advocate: No symptoms 

She was in normal activities like reading, dancing and playing

PaJR PHR Moderator: This is problematic!

@Narmeen Shah  did we share this before here and is it archived in your case report EHR link but anyways I'm resharing some literature review around this in the links below:

https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-019-0441-9

ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes

Full text link 👇

https://onlinelibrary.wiley.com/doi/full/10.1111/pedi.13443

Among patients aged <6 years (n = 46), 59% of care providers reported impaired awareness of hypoglycemia, and the rate of severe hypoglycemia was significantly higher in those reporting impaired awareness (33.3 vs. 52 episodes per 100 patient-years, P = 0.02). More patients with recurrent hypoglycemia reported impaired awareness of hypoglycemia (47 vs. 28%, P = 0.03).

Unquote

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752917/

Impaired awareness of hypoglycemia (IAH) therapies

Mistimed or imprecise dosing of insulin increases the likelihood of hypoglycemic events and recurrent episodes of hypoglycemia lead to the development of IAH (Cryer, 1993; Davis et al., 2000; Geddes et al., 2008; van Meijel et al., 2020; Muneer, 2021). 

Unquote

https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1271814/full

14/07/24

Patient Advocate: 13.07.24

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, sponge gourd, long beans, chayote, pumpkin, soyabean and salad 

12.00noon guava 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and paneer 

4.00pm blood suger 169

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin

14/07/24

7.30am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with chayote, bitter gourd, tomato, long beans, papaya, pumpkin, soyabean, egg and salad 

12.00noon blood sugar 99

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include chicken 

5.30pm sour curd 

7.00pm oats 

8.00pm jackfruit 

9.45pm Blood suger 308

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.45pm 4u lantus insulin

15/07/24

Patient Advocate:

Quantity of Jackfruit

PaJR PHR Moderator: Consumed yesterday at 8:00 PM?

Patient Advocate: Yes Sir

PaJR PHR Moderator: Luckily you were able to capture it's effect on the blood sugar inspite of, I presume, having no added sugar

Patient Advocate: It was without added sugar

PaJR PHR Moderator: Try giving her a piece of whole jackfruit to eat without making it into juice and then check the blood sugar after two hours

Patient Advocate: Ok Sir

16/07/24

Patient Advocate: 15/07/24

7.30am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, sponge gourd, chayote, bitter gourd, tomato, long beans,  soyabean and salad 

12.00noon mango 

1.45pm blood sugar 224

1.50pm 2u lispro insulin 

2.00pm lunch with same previous dish and paneer 

5.30 pm sour curd 

7.00pm one  banana and sweet (sandesh)

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

12.00night blood suger 180

17/07/24

Patient Advocate: 16/07/24

7.30am blood sugar 135

7.30am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, bitter gourd, pumpkin, long beans, sponge gourd, soyabean, egg and salad 

12..00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and fish 

4.00pm blood sugar 64

5.30pm sour curd 

7.00pm pineapple 

7.30pm payesh (with diabexy sugar)

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin 

12.00night blood suger 79

Sour curd

Payesh making with milk, kaun  rice and diabexy sugar

PaJR PHR Moderator: 👍

Making it with dates or raisins may have been healthier than adding artificial sweeteners

Patient Advocate: Ok thank you Sir

17/07/24

7.45am nuts and dates 

8.00am milk and puffed rice 

9.50am 2u lispro insulin 

10.00am rice with papaya, pointed gourd, bitter gourd, pumpkin, long beans, egg and salad 

12.00noon mango and sago mixed without sugar 

1.50pm 2u lispro insulin 

2.00pm lunch with same previous dish except egg and include roe 

4.00pm blood suger 249

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish and include one smal piece chicken

10.30pm 4u lantus insulin

18/07/24

PaJR PHR Moderator: 👍

Patient Advocate: 18/07/24

7.30am nuts and dates 

8.00am milk and puffed rice

19/07/24

Patient Advocate: 18.07/24

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, bitter gourd, pumpkin, papaya, chayote, sponge gourd, soyabean and salad 

12.00nonn blood suger 186

12.05pm mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and include fish 

5.30pm one egg

7.00pm oats

9.30pm blood sugar 70

9.30pm one small piece of creamy cake 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch with except fish and include papad

10.40pm 4u lantus insulin

19/07/24

7.30am nuts

7.45am milk and puffed rice 

9.45am 2u lispro insulin

9.55am rice with papaya, chayote, sponge gourd, long beans, paneer and salad

12.00noon mango 

1.45pm blood sugar 114

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except paneer and include fish 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as previous dish 

10.45pm 4u lantus insulin

20/07/24

Patient Advocate: 12.00night blood suger 168

PaJR PHR Moderator: 👍

Patient Advocate: 20/07/24

7.30am blood sugar 173

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, sponge gourd, tomato, spiny guard, pointed gourd, soyabean and salad 

12.00noon mango 

1.45am 2u lispro insulin 

1.45pm lunch with same previous dish and paneer 

4.00pm blood sugar 286

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

21/07/24

Patient Advocate: 21/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, green banana, Spiny guard , soyabean and salad 

12.00noon blood suger 250

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and fish 

5.30pm sour curd 

7.00pm oats 

8.30pm banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

22/07/24

Patient Advocate: 12.00night blood sugar 135

PaJR PHR Moderator: Any sugary foods or drinks taken yesterday morning?

Patient Advocate: No Sir

22/07/24

7.30am nuts and dates 

7.45am milk and puffed 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, sponge gourd, tometo, spiny guard, soyabean and salad 

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and paneer 

4.00pm blood suger 214

5.30pm sour curd 

7.00pm oats 

9.30pm blood sugar 279

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm lantus insulin 4u

23/07/24

PaJR PHR Moderator: Please share the picture of her sugar chart for the entire last week

Patient Advocate:

PaJR PHR Moderator: @Narmeen Shah thanks for updating the logs here regularly onto her EHR case report.

Nice to find it's already updated till 19/7/24

Narmeen Shah: Thank you sir.

Patient Advocate: 23/07/24

7.30am blood sugar 122

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, sponge gourd, chayote, green banana, Spiny guard soyabean, and salad 

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 230

5.30pm sour curd

Can lantus be increased by one unit? That is 4 to 5

PaJR PHR Moderator: But she's already having hypoglycemia. You may have to reduce the lispro

24/07/24

Patient Advocate: 23/07/24

7.00pm oats 

9.30pm blood sugar 259

9.45pm  3u lispro insulin 

9.55dinner with as same as lunch dish 

10.40pm 4u lantus insulin

Sorry Sir apnar ei message ta ami age dekheni, dinner er pore dekhechhi ।

12.00night blood sugar 185

PaJR PHR Moderator: If you are following the discussions in our 30F type 1 diabetes group managed by patient advocate you may have seen how that patient's regular insulin had to be completely stopped because of her hypoglycemia episodes and how currently she is doing well only on slow dose increments of lantus alone?

আপনি যদি রোগীর উকিল দ্বারা পরিচালিত আমাদের 30F টাইপ 1 ডায়াবেটিস গ্রুপের আলোচনাগুলি অনুসরণ করেন, আপনি হয়তো দেখেছেন যে কীভাবে তার patient er হাইপোগ্লাইসেমিয়া পর্বের কারণে তার নিয়মিত ইনসুলিন সম্পূর্ণরূপে বন্ধ করে দেওয়া হয়েছিল এবং বর্তমানে সে কীভাবে কেবল ল্যান্টাসের ধীর ডোজ বৃদ্ধিতে ভাল করছে?

Patient Advocate: Yes Sir

24/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, bitter gourd, tomato, long beans, papaya, chayote, sponge gourd, egg and salad 

12.00noon blood suger 285

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.15pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin

25/07/24

PaJR PHR Moderator: Increasing lantus without decreasing lispro could be problematic and drive episodes of hypoglycemia

Whenever dose changes need to be made we would need to get more blood sugar values pre and post two hours after meals

Always remember hypoglycemia is more dangerous than hyperglycemia.

Patient Advocate: 24/07/24

9.45pm blood sugar before dinner 248

25/07/27

7.30am blood sugar 124

Sir 

কয়েক দিন থেকে ব্লাড সুগার টা বেশি যাচ্ছে তাই গতকাল রাতে  খাওয়ার আগে টেস্ট করেছিলাম এবং সকালে ঘুম থেকে উঠে টেস্ট করে দেখলাম l

PaJR PHR Moderator: Thik ache lantus ek unit bariye ki hoi dekha jak

Patient Advocate: 25/07/24

7.30am blood suger 124

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am  2u lispro insulin 

9.55am rice with pointed gourd, tometo, long beans, bitter gourd, sponge gourd, chayote, papaya, soyabean and salad 

12.00noon mango 

1.45pm blood sugar 104

1.45pm 2u lispro insulin

1.55pm lunch with same previous dish and egg 

5.30pm sour curd 

7.00pm oats 

9.45pm dinner with as same as previous dish except egg and include fish 

10.40pm 5u lantus insulin

27/07/24

Patient Advocate: 26/07/24

7.30am blood suger 74

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, bitter gourd, tomato, long beans, papaya, chayote, and salad 

12.00noon mango 

2.30pm 2u lispro insulin 

2.40pm lunch with as same as previous dish and fish 

4.50pm blood sugar 211

5.30pm sour curd 

7.30pm banana 

9.30pm 25ml sugar free icecream 

10.10pm 2u lispro insulin 

10.20pm dinner with as same as lunch dish and one pc chicken 

11.00pm 5u lantus insulin

27/07/24

7.30am nuts and dates 

7.45am payesh( milk, rice, raisins and dates)

10.00am 2u lispro insulin 

10.10am rice with papaya, chayote, bitter gourd, tomato, long beans, green banana soyabean and salad 

12.15pm blood sugar 242

12.15pm mango 

2.00pm 2u lispro insulin 

2.10pm lunch with same previous dish and paneer 

6.00pm sour curd 

7.00pm sugar free icecream 

7.30pm oats 

10.00pm 2u lispro insulin 

10.10pm dinner with as same as previous dish 

10.45pm 5u lantus insulin

10.00pm blood sugar before dinner 183

28/07/24

PaJR PHR Moderator: 👍

Patient Advocate: Good evening Sir 

Sir patient er dan kaner (right ear) niche halka fulechhe aar byatha korchhe. Eta kisher theke aar etar janya ki karbo ? Or kintu ektu sardi legechhe .

28/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, sponge gourd, long beans, pointed, green banana, egg and salad 

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood suger 232

5.45pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin

29/07/24

PaJR PHR Moderator: ENT dekhano dorkar

Chobio share korun

30/07/24

Patient Advocate: 29/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, tometo, pumpkin, long beans, papaya, chayote, green banana egg and salad 

12.00noon mango

1.45pm blood sugar 207

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg 

4.00pm blood sugar 83

5.30pm sour curd 

7.38pm banana 2pcs

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin

PaJR PHR Moderator: Increasing the lispro by 1 unit before lunch nearly went close to a hypo!

31/07/24

Patient Advocate: 30/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin

9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pointed gourd, bitter gourd, pumpkin, egg and salad 

12.00noon mango 

1.45pm blood sugar 275

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 237

5.30pm sour curd 

7.00pm oats

9.45pm blood suger 93

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

31/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pumpkin, soyabean and salad 

12.00noon mango 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish and paneer 

4.00pm blood suger 101

5.30pm sour curd 

8.00pm 2pcs banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

01/08/24

Patient Advocate: 31/07/24

12.00night blood suger after dinner 166

Patient Advocate: 01/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, pumpkin, long beans, pointed gourd, tometo, paneer and salad 

1.45pm blood suger 259

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish 

5.45pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish and include fish

03/08/24

Patient Advocate: 02/08/24

7.30am blood suger 94

7.30am nuts and e

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, pumpkin, chayote, green banana, pointed gourd, egg and salad 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include paneer 

4.00pm blood suger 88

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish except paneer and include fish 

10.40pm 4u lantus insulin

04/08/24

Patient Advocate: 3/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, tometo, pumpkin, papaya, sponge gourd, ribbed gourd, bitter gourd and salad  

12.00noon mousambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish and paneer 

4.00pm blood sugar, 243

5.30pm sour curd 

7.00pm banana 

9.45pm 2u lispro insulin

9.55pm dinner with as same as lunch dish 

10..40pm 5u lantus insulin 

9.45pm blood sugar before dinner 199

05/08/24

Patient Advocate: 4/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, sponge gourd, bitter gourd, tomato, pointed gourd, and salad 

12.00noon blood suger 247

12.00noon mousambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish and fish 

5.30pm sour curd 

7.00pm banana 

9.45pm blood sugar 163

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin

06/08/24

Patient Advocate: 05/08/24

7.30am blood suger 98

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, bitter gourd, pumpkin, papaya, chayote, green banana, 

12.00noon mousambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish and paneer 

4.00pm blood sugar 126

5.30pm sour curd 

7.45pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin

6/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, green banana, pointed gourd, bitter gourd, tomato, egg and salad 

12.00noon blood sugar 137

12.00noon mousambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm oats

9.45pm blood suger 233

9.45pm 3u lispro insulin 

9.55pm dinner with as same as previous 

10.40pm 5u lantus insulin

07/08/24

Patient Advocate: 12.00night blood sugar two hours later of dinner 99

PaJR PHR Moderator: 👍

Patient Advocate: 07/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, green banana, sponge gourd, tomato egg and salad 

12.00noon mousambi 

1.45pm blood sugar 93

1.45pm 2u lispro insulin

1.55pm lunch with same previous dish except egg and include fish 

5.30om sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as previous dish 

10.40pm 5u lantus insulin

08/08/24

Patient Advocate: 12.10am blood suger after dinner 213

8/08/24

7.30am blood suger 52

No symptoms at all 

7.30am nuts, dates and 1/2 cream roll biscuit 

7.45am milk 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, ribbed gourd, tomato, green banana, egg and salad 

12.00noon mousambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm banana 

9.45pm blood suger 120

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

09/08/24

Patient Advoacte: 09/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, tometo, green banana, chayote, papaya, ribbed gourd, egg and salad 

12.00noon mousambi 

1.45pm blood sugar 190

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.15pm banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

10/08/24

Patient Advocate: 12.00night blood suger after dinner 150

10/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, bitter gourd, tomato, pointed gourd, green banana, egg and salad 

12.00noon mousambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg 

5.38pm sour curd 

7.00pm banana 

9.45pm blood suger 258

9.45pm 2u lispro insulin 

9.55pm dinner with as same as previous dish 

10.40pm 5u lantus insulin

11/08/24

Patient Advocate: 11/08/24

7.30am blood suger 136

7.30am nuts 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, green banana, tomato, egg and salad ( cucumber and lemon)

12.00noon moumita l

12.00noon mousambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg 

4.00pm blood suger 96

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin

12/08/24

PaJR PHR Moderator: 👍

Patient Advocate: 12/08/24

7.30am nuts 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, bitter gourd, tomato, chayote, papaya, green banana, egg and salad 

12.00noon blood suger 176

12.00noon mosambi

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg 

5.30pm sour curd 

7.00pm banana 

9.45pm blood sugar 134

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin

13/08/24

Patient Advocate: 13/08/24

7.30am nuts 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, green banana, bitter truth,  egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55am lunch with same previous dish 

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish except egg 

10.40pm 5u lantus insulin

PaJR PHR Moderator: Any symptoms at 6:30AM?

Patiet Advocate: No Sir

16/08/24

Patient Advocate: 15/08/24

7.30am nuts

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, brinjal Spiny guard, long beans, papaya, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin

16.08.24

7.30am blood suger 64

7.30am nuts 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, tometo, long beans, papaya,, chayote , green banana, bitter gourd, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 113

5.30pm sour curd 

7.00pm banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch with 

10.40pm 5u lantus insulin

17/08/24

PaJR PHR Moderator: Reduce lantus dose to 3U

Patient Advocate: Ok sir

18/08/24

Patient Advocate: 17/08/24

7.30am blood suger 67

7.30am nuts 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, bitter gourd, tomato, long beans, papaya, chayote, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg 

5.30pm sour curd 

7.00pm oats

7.15pm 1pc sweet (sandesh)

9.45pm blood sugar 290

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus

Dinner er age sugar onek ta high chhilo tai 2u na kamiye 1u kamano hoyechhe

PaJR PHR Moderator: The sugar before dinner gets worked on primarily by the lispro she's given while the lantus works on the basal sugar levels as reflected in her fasting levels which was still hypoglycemic as lantus wasn't reduced well enough!

রাতের খাবারের আগে চিনিটি প্রাথমিকভাবে তার দেওয়া লিসপ্রো দ্বারা কাজ করে. 

ল্যান্টাস বেসাল চিনির মাত্রায় কাজ করে যা তার উপবাসের মাত্রায় প্রতিফলিত হয় যা তখনও হাইপোগ্লাইসেমিক ছিল কারণ ল্যান্টাস যথেষ্ট পরিমাণে হ্রাস পায়নি!

Patient Advocate: 18/08/24

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, green banana, pointed gourd, tometo, long beans, egg and salad 

12.00noon blood sugar  105

12.00noon mosambi 

1.45pm 2u lispro insulin 

155pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm banana 

9.45pm blood sugar 167

9.45pm 2u lispro insulin

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin

20/08/24

Patient Advocate: 19/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, tometo, long beans, papaya, chayote, green banana, bitter gourd, egg and salad 

12.00noon mosambi 

1.45pm blood sugar 302

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg 

5.30pm sour curd 

7.00pm banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as previous dish 

10.40pm 3u lantus insulin

20/08/24

7.30am fasting blood sugar 180

7.30am nuts and dates 

7.45am milk with puffed rice

PaJR PHR Moderator: Increase lantus today to 4U

Patient Advocate: Ok Sir, I also think that

PaJR PHR Moderator: Wish we had the 0.5U kids pens easily available (link was shared earlier and is it archived in @Narmeen Shah 's case report?)to make the process of pediatrics insulin dose titration easier and better controlled

Patient Advocate: Eta pray shesher dike, porer Lantus ta 0.5u kids pen khoj karbo

Narmeen Shah: https://m.indiamart.com/proddetail/humalog-junior-kwikpen-2850841647288.html

https://pharmeasy.in/online-medicine-order/humalog-junior-kwikpen-100iu-pre-filled-pen-of-3ml-solution-for-in

Sir these links? Yes, they are archived in the case report.

Patient Advocate: 9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, green banana, long beans, sponge gourd,  pumpkin, egg and salad 

12.00noon mosambi 

2.30pm 2u lispro insulin 

2.45pm lunch with same previous dish except egg and include fish 

5.00pm blood sugar 216

6.30pm sour curd

7.30pm oats 

9.45pm blood sugar 276

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.45pm 4u lantus insulin

22/08/24

Patient Advocate: 21/08/24

7.30am nuts and dates 

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, sponge gourd, long beans,  pointed gourd, bitter gourd, tomato, green banana , egg and salad 

12.00noon blood sugar 176

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish 

5.30pm sour curd 

7.00pm oats 

9.45pm blood suger 175

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish except egg 

10.40pm 4u lantus insulin

23/08/24

Patient Advocate: 22/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, spiny gourd, sponge gourd long beans, pumpkin, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm oats

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin 

12.. 00night blood suger 114

23/08/24

7.30am blood sugar 144

7.30am nuts and dates 

7.45am milk and puffed rice

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, green banana, long beans, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood suger 248

5.30pm sour curd

Sir Aaj ke ki lantus 1u barano jabe ?

PaJR PHR Moderator: Lantus barano komano tar jonye either amader puro diner 7 point sugar profile dorkar 2-3 days jabot are nahole at least 2-3 diner por por fasting ta dekha proyojon

4PM er sugar ta depend korche 1:45 PM a newa lispro r upore

Patient Advocate: Thik achhe

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

24/08/24

Patient Advocate: 24/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, green banana, long beans, sponge gourd, egg and salad 

12.00noon apple and guava 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg 

4.00pm blood sugar 244

5.30pm sour curd 

7.00pm banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

26/08/24

Patient Advocate: 25/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, green banana, bitter gourd, tomato and salad 

12.00noon blood sugar 217

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and fish 

5.30pm sour curd 

7.00pm banana 

8.30pk one pc cream cake 

9.45pm blood sugar 379

9.45pm lispro insulin 3u

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin 

12.00night blood sugar 201

PaJR PHR Moderator: Today's fasting sugars?

Patient Advocate: Fasting 95

PaJR PHR Moderator: Better not increase lantus now

Yesterday's higher post meal sugars may need dose titration of her short acting lispro insulin just before her meals

27/08/24

Patient Advocate: 26/08/24

7.45am blood sugar 95

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, brinjal, tomato, spiny guard, pumpkin, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm banana 

9.45pm blood suger 157

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish except fish 

10.40pm lantus insulin 4u

PaJR PHR Moderator: The above data driven fact that her high post meal blood sugars since two days resolved without any changes of insulin dose suggests that diet and activities factors are involved in the previous highs and current lows.

@Patient Advocate can you share details about her diet and or activities that you feel may have made a difference to her sugars?

@Narmeen Shah thanks for updating her EHR case report till 23/8/24!

29/08/24

Patient Advocate: 27/08/24

Ei din amra barir baire thakar janya test Kara hoy ni

Insulin lispro 3 times before meal by 2u each

Aar lantus 4u at night

28/0824

7.30am blood suger 69

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, green banana, papaya, spiny guard, bitter gourd, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 119

5.30pm sour curd 

7.00pm oats 

8.15pm amul kool 3/4 bottle 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

PaJR PHR Moderator: Lantus aabar 3U kore dewa bhalo keno ki ota abar dangerous hypoglycemia r pothe niye choleche.

0.5U dose titration korte parle bhalo hoto

Patient Advocate: Ok Sir, ajke sugar level ta dekhe apnake janabo

PaJR PHR Moderator: Gotokal er fasting dekhe uporer montobbo korechilam.

Aajker fasting ta jaante parle bhalo hoto

Patient Advocate: 29/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, green banana, long beans, egg and salad 

12.00noon blood sugar 319

12.00noon mosambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 199

30/08/24

Patient Advocate: 5.30pm sour curd 

7.00pm banana 

9.45pm blood sugar 210

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

PaJR PHR Moderator: Lispro should have been 3 units before breakfast yesterday and 2 units before lunch

Lantus should have been 3 units

Patient Advocate: 30/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya,  long beans, tomato and salad 

12.00noon mosambi 

1.45pm blood suger 275

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish 

5.30pm sour curd 

7.45pm oats

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm  4u lantus insulin

31/08/24

Patient Advocate: 12.00night blood suger 210

01/09/24

Patient Advocate: 31/08/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, tometo, pumpkin, chayote, papaya, long beans, and salad 

12.00noon mosambi 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish and paneer 

5.00pm prasad (fruits and mix of flour, milk, banana palm fruit, raisins)

7.00pm blood suger 253

7.30pm sugar free icecream 

9.45pm 2u lispro insulin 

9.55pm khichudi and previous vegetable 

10.40pm 4u lantus insulin

Patient Advocate: 1.09.24

7.30am blood suger 80

7.30am nuts and dates 

7.45am milk and puffed

02/09/24

Patient Advocate: 9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, green banana, long beans, Spiny guard, pumpkin, egg and salad 

12.00noon mosambi, apple

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 228

5.30pm sour curd 

7.00pm oats

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

PaJR PHR Moderator: (Gotokal er fasting dekhe uporer montobbo korechilam.

Aajker fasting ta jaante parle bhalo hoto) 👆

03/09/24

Patient Advocate: 2.09.24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, sponge gourd, long beans, green banana, soyabean and salad 

12.00noon blood suger 267

12.00noon  mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish 

5.30pm sour curd 

7.00pm banana 

9.45pm blood sugar 107

9.45pm 2u lispro insulin

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

04/09/24

Patient Advocate: 03.09.24

7.30am nuts and dates 

7.45am milk 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, tometo, papaya, long beans, bitter gourd, spiny gourd, egg and salad 

12.00noon mosambi 

1.45pm blood sugar 257

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 140

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin 

12.00night blood sugar 179

04/09/24

7.30am blood sugar 174

7.30am nuts and dates 

7.45am milk

05/09/24

Patient Advocate: 9.45am 2u lispro insulin 

9.55am rice with pointed gourd, ribbed gourd, long beans, bitter gourd, spiny gourd, tomato, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 211

5.30pm sour curd 

7.00pm little bit of dosa and banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pn 4u lantus insulin

06/09/24

Patient Advocate: 5.09.24

7.30am nuts and dates 

7.45am milk

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, green banana, papaya, long beans, bitter gourd, egg and salad 

12.00noon blood sugar 249

12.00noon mosambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 71

5.30pm sour curd 

7.00pm banana 

9.30pm pizza

9.45pm 2u lispro insulin 

9.55pm rice with as same as lunch dish 

10.40pm 4u lantus insulin

PaJR PHR Moderator: 2 unit of lispro appears less and 3 units appears dangerously close to hypoglycemia!

If only we could procure 2.5

Check fasting sugars to decide the suitability of the current lantus dose

Patient Advocate: Ok Sir

6.09.24

7.30am blood sugar 135

7.30am milk and puffed rice

07/09/24

Patient Advocate: 9.45am 2u lispro insulin 

9.55am rice with chayote, green banana, papaya, long beans, pointed gourd, tomato, bitter gourd,spiny gourd and salad 

12.00noon  mosambi 

1.45pm blood sugar 174

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish include fish 

5.30pm sour curd 

7.00pm banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

08/09/24

Patient Advocate: 7/09/24

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd chayote brinjal tomato fish and salad 

12.00noon mosambi 

1.45pm blood sugar 148

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish 

5.38pm sour curd 

7.00pm banana 

9.45pm 2u lispro insulin 

9.55pm khichdi 

10.40pm 4u lantus insulin 

12.00noon blood sugar 45

PaJR PHR Moderator: 12:00 AM hypoglycemia!? Any symptoms?

Patient Advocate: No Sir 

1 teaspoon sugar was given

PaJR PHR Moderator: No symptoms?

She needs CGM to prevent such episodes

Patient Advocate: 8.09.24

7.30am blood sugar 101

7.30am nuts and dates 

7.45am milk and puffed

09/09/24

Patient Advocate: 9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, green banana, papaya, long beans, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 129

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin

10/09/24

Patient Advocate: 9.09/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with chayote, green banana, papaya, long beans, pointed gourd, egg and salad 

12.00noon mosambi 

1.45pm blood sugar 280

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg 

4.00pm blood sugar 285

5.30pm sour curd 

7.00pm banana 

9.45pm blood sugar 297

9.45 3u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

PaJR PHR Moderator: Slightly high today due to x factors!

Patient Advocate: 10/09/24

7.30am nuts and dates 

7.45am milk with palm (tal)

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, bitter gourd, long beans, green banana, and salad 

12.00noon blood sugar 218

12.00noon mosambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm milk with palm and banana 

9.45pm blood sugar 208

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish

11/09/24

Patient Advocate: 10.40pm 4u lantus insulin

11/09/24

7.30am fasting blood suger 72

7.30am nuts and dates 

7.45am milk with puffed rice

PaJR PHR Moderator: Low fasting reflects the need for optimizing dose of lantus

Higher post meal sugars means the lispro needs to be optimised but again due to x factors as well as known factors such as diet and exercise, this is difficult as the sugar levels keep varying till we able to monitor it more meticulously

12/09/24

Patient Advocate: 9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, bitter gourd, spiny gourd, ribbed gourd, tomato, egg and salad 

12.00noon mosambi 

1.45pm blood sugar 89

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin 

12.00night blood suger 93

PaJR PHR Moderator: The lispro should have been 1 unit yesterday at least starting from before lunch and dinner

The lantus needs to be reduced to 3

Patient Advocate: Ok Sir

Sir ekhane ekta jinish lakshya kara jachhe lantus ta use korte korte kichhu din por por pen er madhya haoa(air) dhuke jachche sei samay lantus ja deoa hoy puro ta dhoke na takhon sugar level bere jai।

Abar air ta barkore diye tarpor push korle takhon sugar level thik thak ashe।

Kintu air ta jadi alpo thake tahole bar korte asubidha hay

PaJR PHR Moderator: @Meta AI please translate this for our other group members

Meta AI: I'd be happy to help! Please share the text you'd like me to translate, and let me know which language you'd like it to be translated into.

PaJR PHR Moderator: @Meta AI Sir ekhane ekta jinish lakshya kara jachhe lantus ta use korte korte kichhu din por por pen er madhya haoa(air) dhuke jachche sei samay lantus ja deoa hoy puro ta dhoke na takhon sugar level bere jai।
Abar air ta barkore diye tarpor push korle takhon sugar level thik thak ashe।
Kintu air ta jadi alpo thake tahole bar korte asubidha hay

Meta AI: I can translate that for you. Here's the translation:

"When using Lantus, after a few days, air enters the pen, and if the full dose is not administered at that time, the sugar level rises. If air is removed by tapping and then injecting, the sugar level remains under control. However, if there is less air, it is difficult to administer the dose."

Please note that this text appears to be discussing the use of an insulin pen, specifically Lantus, and the importance of removing air from the pen to ensure accurate dosing and blood sugar control. If you have any further questions or need additional assistance, feel free to ask!

PaJR PHR Moderator: 👆@Participant 19 @Participant 20 @Participant 21 would you like to comment on this?

Sir ekhane ekta jinish lakshya kara jachhe lantus ta use korte korte kichhu din por por pen er madhya haoa(air) dhuke jachche sei samay lantus ja deoa hoy puro ta dhoke na takhon sugar level bere jai।

Abar air ta barkore diye tarpor push korle takhon sugar level thik thak ashe।

Kintu air ta jadi alpo thake tahole bar korte asubidha hay

@Meta AI please translate this for our other group members

I can translate that for you. Here's the translation:

"When using Lantus, after a few days, air enters the pen, and if the full dose is not administered at that time, the sugar level rises. If air is removed by tapping and then injecting, the sugar level remains under control. However, if there is less air, it is difficult to administer the dose."

Please note that this text appears to be discussing the use of an insulin pen, specifically Lantus, and the importance of removing air from the pen to ensure accurate dosing and blood sugar control. If you have any further questions or need additional assistance, feel free to ask!

Participant 20: Will need a trend to make any reasonable conclusion.

Please also consider Thyroid and Adrenal insufficiency as he could be at high risk for Autoimmune polyglandular syndromes.

Patient Advocate: Same problem was seen first time also in lispro pen

PaJR PHR Moderator: Here's the trend since last 6 months 👇

https://narmeenshah.blogspot.com/2024/07/3-year-old-child-type1-diabetes-insulin.html?m=1

@Narmeen Shah @Participant 22 can you put it in an LLM and see if you can share it graphically since last one month and separately for last one week?

Narmeen Shah: Ok sir

PaJR PHR Moderator: Inputs from our pediatric endocrinologist in NJ:

I’m not sure I understand the question correctly: air bubbles have to be removed from pens at first use, and from syringes at every use. Typically, if the technique is correct, then after the first expulsion of air from a cartridge, there should be no way for air to enter the cartridge.  Now, they will have to waste some insulin at the start to get rid of air… sometimes they have to do it a few times, because some cartridges can have more air. 

Has someone watched the technique of injection? 

My mother has been using Basalog Pens for at least 10 years now. And she had this issue initially, until we made her watch some instructional videos. She was loath to waste even small amounts of insulin initially, because of the cost, so she was skipping the step of removing air bubbles! 

Here’s one, but if you have something in a local language, it’ll be better. 

https://youtu.be/ZcfKG0Mp3kI?si=cW7ggTLgBJxlytmq

PaJR PHR Moderator: Please share a video of how you use the pen today keeping the patient deidentified

I think he may have shared a similar video earlier. Is it in her case report link?

Patient Advocate: এই কলমটির বর্তমান অবস্থা পর্যন্ত দুবার বাতাস( air) বার করা হয়ে গেছে, আর সেটা শুরু তে নয় দুবারই ব্যবহারের মাঝখানে l

12/09/24

7.30am blood sugar 53

7.30am nuts, chocolate 

and dates

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, bitter gourd, spiny gourd, tomato, pumpkin, egg and salad 

12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood suger 128

5.30pm sour curd 

7.00pm banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as previous dish 

10.40pm 3u lantus insulin

13/09/24

PaJR PHR Moderator: The hypoglycemia is the effect of 4U of lantus on 11/9/2024!

Did she have any symptoms of hypoglycemia?

Patient Advocate: No Sir

13.09.24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, green banana, long beans, ribbed gourd, bitter gourd, pumpkin egg and salad 

12.00noon blood sugar 282

12.00noon apple

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish

5.30pm sour curd 

7.00pm banana 

9.45pm blood suger 57

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin

14/09/24

PaJR PHR Moderator: Let's start with the trends of fluctuations for this week.

Also @Patient Advocate can you share an image of the paper based charts that you keep for this and last month? 

The case report contains some paper based charts from few months back I guess

Because we don't have CGM here we are unable to keep track of the number of asymptomatic hypoglycemia events this patient is having @Participant 20

@Participant 23 had promised to find out some monitoring equipment developed by his IIT colleagues but I guess that didn't materialize? 

We also looked for CGM monitors suitable for 3 years old children and found some but perhaps we gave up earlier due to logistics.

Any idea what they may use for monitoring for 3 years old diabetics in UK and US?

Narmeen Shah: Greetings sir 🙏

Sir I tried my best for two days to plot the data into graph using llm, python coding and spss software as well as manually but wasn't able to get the desired output and unable to merge both the graphs with respect to time. Beyond my expertise. 🙏

Below are the visualizations for what I was able to do so far.

(For the whole month of August 2024)

PaJR PHR Moderator: Well done 👏

The fluctuations are standing out

Was her lantus ever increased to 5?

Would be nice to see what has been brewing in September till now

Do update her case report with the above images that you generated

Narmeen Shah: Yes sir. Here's the data I extracted.

https://docs.google.com/spreadsheets/d/18DeTEzBh_cm27WhVqF3dLloLw6JnEBGNl5Uj1gPv4wY/edit?usp=sharing

Here's the input & output.

https://colab.research.google.com/drive/1rh2STRsbpcS4Cxihgnf0mGf75Cu7MiwT?usp=sharing

PaJR PHR Moderator: Let's archive all the above into her case report

Narmeen Shah: Ok sir

Participant 20: I'm aware that Abbott Freestyle Libre has been discussed. What's the progress on that front?

PaJR PHR Moderator: Can you share if it can be ordered on Amazon for a three year old child?

Patient Adavocate: 14/09/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, bitter gourd, spiny gourd, tomato, long beans,  pumpkin, egg and salad 

12.00noon pieces of mixed fruit ( prasad)

1.45pm blood suger 226

1.45pm 3u lispro insulin

1.55pm lunch with same previous dish except egg 

4.00pm blood sugar 74

5.30pm sour curd 

7.00pm banana

Narmeen Shah:

PaJR PHR Moderator: Parents described benefits of CGM use: decreased worry about glucose excursions, improved sleep, increased sense of safety with children who cannot recognize or express symptoms of hypo- or hyperglycemia, and greater comfort with other caregivers, especially using remote monitoring functionality when away from children. Challenges included painful insertions, wearing multiple devices on small bodies, disruptive alerts, data gaps due to lost signals, skin/adhesive problems, and difficulty interpreting the amount of information generated by CGM.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708264/

PaJR PHR Moderator: Inputs from global pediatric endocrinologist:

Instead of daily excursions, can we get a graph of mean daily values (pre- and post/breakfast, pre- and post-lunch, pre- and post-dinner etc): values may not be available for each time point everyday. Grouping the timings around meals is better than calendar times, and allows an assessment of responses in the fed and post-absorptive states.

15/09/24

Patient Advocate: 9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin

15/09/24

7.30am blood sugar 270

7.30am nuts and dates 

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, long beans, pumpkin, egg and salad

Paticipant 20: My analysis is that the 2U lispro is not sufficing for both breakfast and Lunch.

Lispro for dinner appears okay.

Lantus 4U seems perfect at bedtime. However there are occasional low sugar events in the morning.

Ideally we need 2 am or 3 am blood sugars too to check if there is any nocturnal high or low blood sugars.

Narmeen Shah:

Assumptions

1. Post and Pre meal times don't mean that nothing is fed between these intervals.

2. Insulin has been given either after the meal or before the meal so the sugar levels are not independent of interventions.

https://docs.google.com/spreadsheets/d/18DeTEzBh_cm27WhVqF3dLloLw6JnEBGNl5Uj1gPv4wY/edit?usp=sharing

https://colab.research.google.com/drive/1rh2STRsbpcS4Cxihgnf0mGf75Cu7MiwT?usp=sharing

PaJR PHR Moderator: Well done 👏

Keep adding these to her online case report too

Narmeen Shah: Ok sir 🙏

Patient Advocate: 12.00noon mosambi 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 298

5.30pm sour curd

PaJR PHR Moderator: Quoting from the case report our notes on 👇

06/09/24

Patient Advocate: 5.09.24

7.30am nuts and dates 

7.45am milk

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, green banana, papaya, long beans, bitter gourd, egg and salad 

12.00noon blood sugar 249

12.00noon mosambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

4.00pm blood sugar 71

5.30pm sour curd 

7.00pm banana 

9.30pm pizza

9.45pm 2u lispro insulin 

9.55pm rice with as same as lunch dish 

10.40pm 4u lantus insulin

PaJR PHR Moderator: 2 unit of lispro appears less and 3 units appears dangerously close to hypoglycemia!

If only we could procure 2.5

Check fasting sugars to decide the suitability of the current lantus dose

Participant 20: Why not Actrapid? Slightly lesser peak than Lispro and a couple hours more duration of action.

https://drive.google.com/file/d/1_WP94jHW5P8t620REGJGX0rEmHYxdig5/view?usp=sharing

This is a document on "Dose adjustment for normal eating (DAFNE)" which allows for precise calculation of carbohydrate portion and adjust insulin doses accordingly.

The standard recommendation for 1 CP is 1 unit Lispro (Humalog). But I would advise to start with 1/2 (half) unit for each CP to see how the child responds.

16/09/24

PaJR PHR Moderator:

"Dyadic conversational inputs around this patient that would be useful for the entire team of learners here:

Pediatric Endocrinologist: Very useful! Thank you. If the stated assumptions are true (can it be checked?). 

Moderator: @Narmeen Shah please see if you can verify the stated assumption/conclusion from your graph as in numbered the lines below:

1)...then, the fasting (pre-bf) is a tad too low. 

The lid pro insulin at bf is not enough (bolts insulin has two jobs - to bring the pre-meal blood sugar down, if it’s high, and to cover the carbs + protein eaten at the meal). 

2) In this case, the pre-bf values is on the lower end, and the post bf is very high. 

So she needs more insulin at breakfast, not unexpected (“first meal effect”). The lid pro at lunch is good to cover her lunch (pre- and post-lunch are very similar, so if pre-lunch is decreased, post-lunch will also be lower). 

Her dinner list spro is too much. So, I think if her breakfast lispro is increased, and dinner lispro is decreased, her sugars will even out. 

This graph should be repeated every 2 weeks and adjustments need to be made.

PaJR moderator: Very valuable inputs for this patient. I guess the catch is in the dose increments and decrements as we are unable to increase it by 0.5U that would be safer?

Pediatric Endocrinologist: True, but I would reduce dinner lispro by 1 unit and increase breakfast lispro by 1

PaJR moderator: I guess that may have been done in the past if we could wade through the entire case report events documented till date since months and hence we were hung on titrating with 0.5."

Patient Advocate: 7.00,pm banana 

9.45pm blood sugar 289

9.45pm 3u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

7.30am blood sugar 90

7.30am nuts and dates 

7.42am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, long beans, Spiny guard, ribbed gourd, egg and salad 

12.00noon blood suger 297

12.00noon mosambi

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg 

5.30pm sour curd 

7.00pm banana

17/09/24

PaJR PHR Moderator: 

"Query:

Why it is happening that sugar levels are that much low in pre breakfast and high in post breakfast and low at night. Check the above daily routine again from sep 1 - sept 13 and analyze the keen aspect.

ChatGPT said:

The pattern of blood sugar levels being low in pre-breakfast and high in post-breakfast, followed by low at night, can be analyzed in the context of the provided daily routine and insulin doses. Here’s a detailed look at the possible reasons behind this pattern:

1. Pre-Breakfast Low Blood Sugars:

• - Lantus (long-acting insulin) is administered at 10:40 pm, which peaks during the night, potentially contributing to low blood sugar in the morning (pre-breakfast).
• - The fasting blood sugars are quite low on several days (e.g., 72 on 11/09, 53 on 12/09). This suggests the night dose of Lantus (4 units) might be slightly too high, as indicated by the PaJR PHR Moderator's recommendation to reduce Lantus to 3 units.
• - Overnight hypoglycemia (unnoticed due to lack of symptoms) may occur, leading to low morning fasting levels.
• - The low pre-breakfast levels may also be due to prolonged fasting (i.e., the time gap between dinner and breakfast).

2. Post-Breakfast High Blood Sugars:

• - The Lispro dose given at breakfast (2 units) appears insufficient to handle the carbohydrates and protein in the breakfast meal.
• - On many days, the post-breakfast sugars spike (e.g., 267 on 03/09, 282 on 13/09), indicating that the insulin-to-carbohydrate ratio at breakfast is inadequate.
• - The phenomenon of "dawn phenomenon" or "first meal effect" could also be at play, where insulin resistance is typically higher in the morning, requiring more insulin at breakfast.
• - The meal composition (e.g., puffed rice, nuts, dates) likely contains high glycemic index (GI) carbs that cause rapid spikes in blood sugar, and 2 units of Lispro may not be enough to manage this.

3. Low Nighttime Blood Sugars:

• - After dinner, the pre-bedtime sugar levels (e.g., 57 on 13/09) are quite low, which suggests that the dinner Lispro dose (2 units) may be too high relative to the amount of carbs consumed at dinner.
• - The insulin sensitivity increases at night, which means the same dose of insulin might have a stronger effect, leading to low blood sugars before bed or overnight hypoglycemia.
• - The combination of long-acting Lantus and short-acting Lispro at night could be causing excessive lowering of blood sugars during the night, especially if the evening meal has fewer carbohydrates or if there is less activity.

Key Analysis Points:

1. Breakfast Lispro Dose Insufficient:

• - The post-breakfast blood sugars are significantly higher than pre-breakfast levels. The 2-unit Lispro given at breakfast may not be covering the amount of carbs/protein in breakfast or dealing with the "dawn phenomenon."
• - Increasing the Lispro dose at breakfast (e.g., from 2 units to 3 units) might help better manage these spikes.

2. Lantus Dose Too High at Night:

• - The low pre-breakfast blood sugars suggest the Lantus dose needs to be reduced at night. Reducing it from 4 units to 3 units might prevent nighttime hypoglycemia.
• - The PaJR PHR Moderator suggested this adjustment to optimize the nighttime glucose levels.

3. Dinner Lispro Needs Adjustment:

• - The 2 units of Lispro at dinner may be too much, especially if the evening meal is low in carbs. Reducing this dose to 1 or 1.5 units might prevent low post-dinner and pre-bedtime sugar levels.

4. Monitoring and Adjustments:

• - Continuous Glucose Monitoring (CGM) or frequent blood sugar checks might be necessary to track fluctuations throughout the day, especially overnight.
• - Adjusting both meal composition and insulin doses for different times of day is key to preventing these high-low swings.

Suggested Next Steps:

• - Increase Lispro dose at breakfast to 3 units to manage the morning spike.
• - Reduce Lantus to 3 units at night to prevent pre-breakfast lows.
• - Reduce Lispro at dinner (possibly to 1.5 units) to avoid low nighttime sugars.

This should help smooth out the extremes and stabilize blood sugar levels throughout the day.

Disclaimer:

The information provided in this analysis is intended for experimental and informational purposes only. It is not meant to replace professional medical advice, diagnosis, or treatment. Do not use this analysis as medical advice, as it could lead to unintended consequences or complications. Always seek the guidance of a healthcare professional before making any adjustments to your diabetes management plan.

PaJR PHR Moderator: Done by @Narmeen Shah. Please share the image showing your method too here

থাকে।

মূল বিশ্লেষণের বিষয়:

১. প্রাতঃরাশের লিসপ্রো ডোজ অপর্যাপ্ত:

- প্রাতঃরাশের পরে রক্তে শর্করা প্রাক-নাস্তার মাত্রার তুলনায় উল্লেখযোগ্যভাবে বেশি। প্রাতঃরাশের সময় দেওয়া 2-ইউনিট লিসপ্রো প্রাতঃরাশের কার্বোহাইড্রেট/প্রোটিনের পরিমাণকে কভার করে না বা "ভোরের ঘটনা" নিয়ে কাজ করতে পারে না।

- প্রাতঃরাশের সময় Lispro ডোজ বাড়ানো (যেমন, 2 ইউনিট থেকে 3 ইউনিট) এই স্পাইকগুলিকে আরও ভালভাবে পরিচালনা করতে সহায়তা করতে পারে।

প্রশ্ন*

কেন এমন হচ্ছে যে সকালের নাস্তায় চিনির মাত্রা অনেক কম এবং সকালের নাস্তায় বেশি এবং রাতে কম। 1 সেপ্টেম্বর থেকে 13 সেপ্টেম্বর পর্যন্ত উপরের দৈনিক রুটিনটি আবার পরীক্ষা করুন এবং প্রখর দিকটি বিশ্লেষণ করুন।

চ্যাটজিপিটি বলেছেন:

প্রাক-নাস্তায় রক্তে শর্করার মাত্রা কম এবং প্রাতঃরাশের পরে উচ্চতর হওয়ার ধরণ, রাতে কম হওয়ার পর, প্রদত্ত দৈনিক রুটিন এবং ইনসুলিনের মাত্রার পরিপ্রেক্ষিতে বিশ্লেষণ করা যেতে পারে। এখানে এই প্যাটার্নের পিছনে সম্ভাব্য কারণগুলির একটি বিশদ চেহারা রয়েছে:

১. প্রাতঃরাশের লো ব্লাড সুগার:

- ল্যান্টাস (দীর্ঘ-অভিনয় ইনসুলিন) রাত্রি 10:40 টায় পরিচালিত হয়, যা রাতের মধ্যে সর্বোচ্চ পর্যায়ে পৌঁছায়, সম্ভাব্যভাবে সকালে (প্রাক-খাওয়া) কম রক্তে শর্করার ক্ষেত্রে অবদান রাখে।

- উপবাসের রক্তে শর্করার পরিমাণ বেশ কয়েকদিনে কম থাকে (যেমন, 11/09 তারিখে 72, 12/09 তারিখে 53)। এটি পরামর্শ দেয় যে ল্যান্টাস (4 ইউনিট) এর রাতের ডোজ কিছুটা বেশি হতে পারে, যেমনটি ল্যান্টাসকে 3 ইউনিটে কমানোর জন্য PaJR PHR মডারেটরের সুপারিশ দ্বারা নির্দেশিত হয়েছে।

- রাতারাতি হাইপোগ্লাইসেমিয়া (লক্ষণের অভাবের কারণে অলক্ষিত) ঘটতে পারে, যার ফলে সকালের উপবাসের মাত্রা কম হয়।

- প্রাক-নাস্তার কম মাত্রা দীর্ঘায়িত 

উপবাসের কারণেও হতে পারে 

(অর্থাৎ, রাতের খাবার এবং 

প্রাতঃরাশের মধ্যে সময়ের ব্যবধান)

2. সকালের নাস্তার পরে উচ্চ রক্তে শর্করা:*

- প্রাতঃরাশে দেওয়া লিসপ্রো ডোজ (2 ইউনিট) প্রাতঃরাশের খাবারে কার্বোহাইড্রেট এবং প্রোটিন পরিচালনা করার জন্য অপর্যাপ্ত বলে মনে হয়।

- অনেক দিন, সকালের নাস্তার পর শর্করার পরিমাণ বেড়ে যায় (যেমন, 03/09 তারিখে 267, 13/09 তারিখে 282), ইঙ্গিত করে যে সকালের নাস্তায় ইনসুলিন-থেকে-কার্বোহাইড্রেট অনুপাত অপর্যাপ্ত।

- "ভোরের ঘটনা" বা "প্রথম খাবারের প্রভাব" এর ঘটনাটিও খেলতে পারে, যেখানে ইনসুলিন প্রতিরোধ সাধারণত সকালে বেশি হয়, প্রাতঃরাশের সময় আরও ইনসুলিনের প্রয়োজন হয়।

- খাবারের সংমিশ্রণে (যেমন, পাফ করা ভাত, বাদাম, খেজুর) সম্ভবত উচ্চ গ্লাইসেমিক ইনডেক্স (GI) কার্বোহাইড্রেট রয়েছে যা রক্তে শর্করার দ্রুত বৃদ্ধি ঘটায় এবং এটি পরিচালনা করার জন্য লিসপ্রোর 2 ইউনিট যথেষ্ট নাও হতে পারে।

3. কম রাতের রক্তে শর্করা:*

- রাতের খাবারের পরে, ঘুমানোর আগে শর্করার মাত্রা (যেমন, 13/09 তারিখে 57) বেশ কম, যা পরামর্শ দেয় যে রাতের খাবারে খাওয়া কার্বোহাইড্রেটের পরিমাণের তুলনায় ডিনার লিসপ্রো ডোজ (2 ইউনিট) খুব বেশি হতে পারে।

- রাতে ইনসুলিনের সংবেদনশীলতা বৃদ্ধি পায়, যার অর্থ ইনসুলিনের একই ডোজ আরও শক্তিশালী প্রভাব ফেলতে পারে, যার ফলে শোবার আগে বা রাতারাতি হাইপোগ্লাইসেমিয়া রক্তে শর্করার পরিমাণ কম হতে পারে।

- রাতে দীর্ঘ-অভিনয়কারী ল্যান্টাস এবং স্বল্প-অভিনয় লিসপ্রোর সংমিশ্রণ রাতের বেলা রক্তে শর্করার অত্যধিক হ্রাস ঘটাতে পারে, বিশেষ করে যদি সন্ধ্যার খাবারে কম কার্বোহাইড্রেট থাকে বা যদি কম কার্যকলাপ থাকে।

মূল বিশ্লেষণের বিষয়:

১. প্রাতঃরাশের লিসপ্রো ডোজ অপর্যাপ্ত:

- প্রাতঃরাশের পরে রক্তে শর্করা প্রাক-নাস্তার মাত্রার তুলনায় উল্লেখযোগ্যভাবে বেশি। প্রাতঃরাশের সময় দেওয়া 2-ইউনিট লিসপ্রো প্রাতঃরাশের কার্বোহাইড্রেট/প্রোটিনের পরিমাণকে কভার করে না বা "ভোরের ঘটনা" নিয়ে কাজ করতে পারে না।

- প্রাতঃরাশের সময় Lispro ডোজ বাড়ানো (যেমন, 2 ইউনিট থেকে 3 ইউনিট) এই স্পাইকগুলিকে আরও ভালভাবে পরিচালনা করতে সহায়তা করতে পারে।

২। ল্যান্টাস ডোজ রাতে খুব বেশি:

- প্রাতঃরাশের কম রক্তে শর্করা পরামর্শ দেয় যে ল্যান্টাস ডোজ রাতে কমাতে হবে। এটি 4 ইউনিট থেকে 3 ইউনিটে কমিয়ে রাতের হাইপোগ্লাইসেমিয়া প্রতিরোধ করতে পারে।

- PaJR PHR মডারেটর রাতের গ্লুকোজ মাত্রা অপ্টিমাইজ করার জন্য এই সমন্বয়ের পরামর্শ দিয়েছেন।

৩. ডিনার লিসপ্রোর সামঞ্জস্য প্রয়োজন:

- রাতের খাবারে লিসপ্রোর 2 ইউনিট খুব বেশি হতে পারে, বিশেষ করে যদি সন্ধ্যার খাবারে কার্বোহাইড্রেট কম থাকে। এই ডোজটি 1 বা 1.5 ইউনিটে কমিয়ে রাতের খাবারের পরে এবং ঘুমানোর আগে চিনির মাত্রা কম হওয়া প্রতিরোধ করতে পারে।

4. পর্যবেক্ষণ এবং সমন্বয়:

- ক্রমাগত গ্লুকোজ মনিটরিং (CGM) বা ঘন ঘন রক্তে শর্করার পরীক্ষা সারা দিন, বিশেষ করে রাতারাতি ওঠানামা ট্র্যাক করার জন্য প্রয়োজন হতে পারে।

- দিনের বিভিন্ন সময়ের জন্য খাবারের সংমিশ্রণ এবং ইনসুলিনের ডোজ উভয়ই সামঞ্জস্য করা এই উচ্চ-নিম্ন দোল রোধ করার মূল চাবিকাঠি।

প্রস্তাবিত পরবর্তী পদক্ষেপ:

- সকালের স্পাইক পরিচালনা করতে সকালের নাস্তায় লিসপ্রোর ডোজ 3 ইউনিটে বৃদ্ধি করুন।

- প্রাতঃরাশের কম হওয়া রোধ করতে রাতে ল্যান্টাসকে 3 ইউনিটে কমিয়ে দিন।

- রাতে কম শর্করা এড়াতে রাতের খাবারে লিসপ্রো কমিয়ে দিন (সম্ভবত 1.5 ইউনিট)।

এটি চরমগুলিকে মসৃণ করতে এবং সারা দিন রক্তে শর্করার মাত্রা স্থিতিশীল করতে সহায়তা করবে"

Narmeen Shah: Sir

1. I first copy pasted the complete data of the case report from sept 1 - sept 13.

2. Excel data that I created to calculate the pre- post- mean blood sugar values for the graph.

3. Wrote my two assumptions and ask to verify the stated assumptions.

- Post and Pre meal times don't mean that nothing is fed between these intervals.

- Insulin has been given either after the meal or before the meal so the sugar levels are not independent of interventions.

4. Chatgpt broke down the assumptions and reponded about it in four points.

5. After that I gave the query/prompt:

• - Why it is happening that sugar levels are that much low in pre breakfast and high in post breakfast and low at night. Check the above daily routine again from sep 1 - sept 13 and analyze the keen aspect.

PaJR PHR Moderator: Thanks!

Update all to the case report too

Narmeen Shah: Ok sir. Thank you 🙏🙏

Patient Advocate: 9.45pm blood sugar 160

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin 

12.00night blood suger 273

17/09/24

7.30am  nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, chayote, papaya, long beans, bitter gourd, ribbed gourd, egg and salad 

12.00noon mosambi 

1.45pm blood sugar 266

5.30pm sour curd

PaJR PHR Moderator: Feedback to this from our pediatric endocrinologist:

ChatGPT’s medical algorithms are not perfect. 

Would not recommend using it for medical decision making. 

I would recommend reducing the lispro at dinner first. Reducing Lantus will mean the blood glucose during the day - lunch/pre-dinner blood glucose levels will become higher. 

You can ask the person to give the Lantus earlier - 10:40 is way, way too late. Why not earlier - at 7 or 8 pm. 

The post-dinner blood glucose levels are low - in a 3-year old, we typically run it around 120-150.

PaJR PHR Moderator: 👆@Patient Advocate lantus ta aekhon 7-8PM er modhye diye nile bhalo hoi

Patient Advocate: Sir আমার একটা কথা বলার ছিল, আমি জানিনা তাই একটা কথা জানার জন্য প্রশ্ন করছি l 

ডিনার এর আগে lispro ফাস্ট একশন ইনসুলিন দেওয়া হয় l আবার  শুনেছি ( কিন্তু আমি সঠিক জানি না ) Lantus দেওয়ার 6 ঘণ্টা পর থেকে কাজ করে তো সে ক্ষেত্রে শেষ রাতে মোটামুটি 2am এর পর suger level ta একটু বেশি কমার চান্স থাকবে না কি ?

PaJR PHR Moderator: Lispro'r action majhraat obdhi thakar kotha noi. Khawar du ghonta baade shesh hoye jawar kotha

Patient Advocate: Lispro যদি রাতের খাবার এর সুগার টা সঠিক জায়গায় নিয়ে আসে আমি তারপর শেষ রাতে Lantus এর action এর ব্যাপারে বলছিলাম। Sir l

PaJR PHR Moderator: Lantus kokhonoi hypoglycemia korar kotha noi karon ota just sugar take baseline a maintain korte sahajjo kore

Patient Advocate: এখন বুঝলাম স্যার

PaJR PHR Moderator: Kintu jehetu lantus er slow action ta overall sugar take komiye aane tai overall hypoglycemic event a lantus er ekta direct obodan na thakleo indirect obodan thakte pare oi jonyei lantus er dose tao shei bhabe titrate kora dorkar tabe overall evening 7-8 PM nilei bhalo

Lispro - action starts by 30 minutes, peaks 1-2 hours, gone by 3 hours; Regular - action starts by 60 minutes, peaks 3-5 hours, gone by 8 hours - etc. Lantus - pretty flat with repeated use, especially if dose is >10 units. Hypos less with Lantus and degludec.

18/09/24

Patient Advocate: 1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00 pm banana 

9.45pm blood sugar 220

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

Thik achhe Sir

Participant 20: As advised by pediatric endocrinologist, please give the Lantus injection earlier and please consider changing meal times to earlier slots for better optimisation.

Patient Advocate: What should mealtime be ?

PaJR PHR Moderator: Early dinner at 9:00 PM

Participant 20: From my newbie learnings here - Detemir (Levemir brand) can be considered if Hypos are concerning.

Twice a day; lesser risk of Hypos and more agency for dose titration? @PaJR PHR Moderator

Patient Advocate: 18/09/24

7.30am nuts and dates 7.45am milk with palm 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, bitter gourd, spiny gourd, ribbed gourd, long beans, egg and salad 

12.00noon blood suger 230

12.00noon mosambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm palm with milk

9.45pm blood sugar 228

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin

Kal theke 7-8pm e lantus dibo

19/09/24

Patient Advocate:

PaJR PHR Moderator: Ingredients?

Patient Advocate: It is palm(tal) which was taken yesterday day in two times

19/09/24

7.30am nuts and dates 

7.45am  milk and puffed rice 

9.45am 2u lispro insulin 

9.55am rice with papaya, chayote, green banana, long beans, bitter gourd, spiny gourd, ribbed gourd, egg and salad 

12.00noon mosambi 

1.45pm blood sugar 360

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

5.30pm sour curd

PaJR PHR Moderator: Pre Breakfast lispro needs to be increased to 3U

Patient Advocate: Ok Sir

7.00pm banana 

9.00pm 4u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

20/09/24

Patient Advocate: 20/09/24

7.30am blood suger 183

7.30am nuts and dates 

7.45am payesh( milk, kaun rice, dates and raisins)

9.30am 3u lispro insulin 

9.40am rice with chayote, green banana, long beans, bitter gourd, spiny gourd, ribbed gourd, egg and salad 

11.30am apple

1.30pm 3u lispro insulin 1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd

21/09/24

Patient Advocate: 7.00pm banana 

7.45pm 5u lantus insulin 

9.30pm blood sugar 163

9.40pm dinner with as same as lunch dish

21/09/24

7.30am blood sugar 124

7.30am nuts and dates 

7.45am milk and puffed rice

9.30am 2u lispro insulin 

9.40am rice with papaya, chayote, green banana, long beans, sponge gourd, tomato, spiny guard, egg and salad 

11.30am apple 

1.30pm blood sugar 334

1.30pm 4u lispro insulin 

1.40pm lunch with same previous dish except egg

What is the reason of high sugar where lantus was given 5u in last night?

PaJR PHR Moderator: Why did we reduce the lispro today? That's the reason.

Lantus is a long acting drug that acts and builds up in the system very slowly over days and will cause an overall reduction of the basal blood sugar and not address anything specifically such as post meal sugars

Patient Advocate: There was 124 suger level in fasting

PaJR PHR Moderator: The action of lantus is best perceived in the fasting sugar values.

However in other patients with type 1 diabetes like 30F who's group you are also following and is fully archived here👇

https://chat.whatsapp.com/Jdzf1ol80dB78Ip6B3k3xb

you may have noticed how we could slowly bring her total insulin requirements down to 3-4 units of lantus only per day. 

It's possible that at some point even 3F's requirements could fall to that

👆So increasing lantus from 4 to 5U here reduced the fasting from 183 to 124

22/09/24

Patient Advocate: 5.30pm sour curd 

7.00am banana 

7.30pm 4u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

11.50pm blood sugar 163

22/09/24

7.30am blood sugar 133

7.45am  milk

9.30am 2u lispro insulin 

9.48am rice with papaya, chayote, bitter gourd, spiny gourd, sponge gourd, tomato, long beans and salad 

11.30am apple 

1.30pm blood sugar 173

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish and fish 

5.00pm sour curd

7.00pm oats 

8.00pm 4u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

23/09/24

Patient Advocate: 11.45pm blood sugar 138

23/09/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.30am 2u lispro insulin 

9.40am rice with spiny gourd, ribbed gourd, tomato, papaya, chayote, sponge gourd, long beans, egg and salad 

11.40am blood sugar 254

12.00noon mosambi 

1.30pm 3u lispro insulin

1.40pm lunch with same previous dish except egg 

5.30pm sour curd 

7.00pm oats 

8.00pm 5u lantus insulin 

9.30pm blood sugar 140

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

24/09/24

PaJR PHR Moderator: The post breakfast high is because of the lower dose of lispro before breakfast compared to those before lunch and dinner.

Always measure fasting blood sugars the day after you have increased lantus dose. Yesterday it was increased so today's fasting is important

Patient Advocate: 24/06/24

7.30am fasting blood suger 151

7.30am nuts and dates 

7.45am milk and puffed rice 

9.30am 3u lispro insulin 

9.40am rice with long beans, papaya, chayote, sponge gourd, tomato, spiny guard, pumpkin, egg and salad 

11.30am mosambi 

1.30pm blood sugar 100

1.40pm lunch with same previous dish except egg 

5.30pm sour curd 

7.00pm banana 

8.30pm 4u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish and include egg

25/09/24

Patient Advocate: 11.45pm blood sugar 94

PaJR PHR Moderator: 👆This fasting was an effect of the lantus 5U day before yesterday

The 1:30PM pre lunch blood sugar yesterday is an effect of the morning lispro 3U as well as day before yesterday's lantus 5U basal effect and same basal effect of lantus 5U day before yesterday is partly reducing the 11:40PM post dinner other than the pre dinner lispro of 2U 

That is how the basal lantus unit has a synergistic symmetric effect on the overall basal sugar levels so while we increase lantus we can always decrease the short acting pre meal lispro.

In @⁨30F Diabetes1 10 years Madhya Pradesh PaJR⁩ 's patient we managed to stop the short acting insulin altogether and her patient is currently only on lantus insulin alone once daily

Patient Advocate: 7.30am fasting blood sugar 75

7.30am nuts 

7.40am milk, puffed rice and dates

PaJR PHR Moderator: My hypothesis for this fasting value is that this is the residual effect of your 5U of lantus day before yesterday and 4U of lantus yesterday.

Share her post breakfast blood sugar and remain vigilant for hypoglycemia

Patient Advocate: 9.30am 2u lispro insulin 

9.40am rice with papaya, chayote, pointed gourd, bitter gourd, tomato, spiny guard, long beans, egg and salad 

11.30am apple 

1.30pm blood sugar 174

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm banana 

8.30pm 4u lantus insulin

26/09/24

Patient Advocate: 9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

26/09/24

7.30am blood sugar 81

7.30am nuts 

7.40am milk, puffed rice and dates 

9.30am 2u lispro insulin 

9.40am rice with papaya, long beans, bitter gourd, pumpkin, chayote, pointed gourd, egg and salad 

11.30am apple 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm banana 

8.30pm 4u lantus 

9.30pm blood sugar 247

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

27/09/24

Patient Advocate: 11.45pm blood sugar 66

Plain suger 0.5 teaspoon 

No symptoms

PaJR PHR Moderator: She needed 2.5

How about trying the insulin syringe instead of pen to get 2.5 just like @⁨30F Diabetes1 10 years Madhya Pradesh PaJR⁩ 's patient is using?

28/09/24

Patient Advocate: 27/09/24

7.30am nuts 

7.45am milk, dates and puffed rice 

9..30am 2u lispro insulin 

9.40am rice with papaya, chayote, sponge gourd, tomato, spiny guard, pumpkin, pointed gourd, egg and salad 

11.45am mosambi 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg 

4.00pm blood suger 94

5.30pm sour curd 

7.00pm banana 

8.30pm 4u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch with and include egg

29/09/24

Patient Advocate: 28/09/24

7.30am nuts 

7.40am milk, puffed rice and dates 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, chayote, bitter gourd, spiny gourd, long beans, egg and salad 

11.50am blood sugar 200

11.50am apple

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg 

5.30pm sour curd 

7.00pm banana 

8.30pm 4u lantus insulin 

9.30pm blood sugar 220

9.40pm gf dinner with as same as lunch dish and papad

29/09/24

7.30am blood suger 127

7.38am nuts 

7.45am milk, puffed rice and dates 

9.30am rice with chayote, bitter gourd, spiny gourd, sponge gourd, long beans, egg and salad 

11.30am mosambi 

1.30am pm blood sugar 124

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish 

5.30pm sour curd 

7.00pm oats 

8.30am 4u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with rice, pulses, mutton and salad

30/09/24

Patient Advocate: 11.45pm blood suger 156

PaJR PHR Moderator: How much lispro before breakfast yesterday?

Patient Advocate: Lispro before breakfast 2u

Patient Advocate: 30/09/24

7.30am blood suger 145

7.30am  payesh (milk, dates, rice, and nuts)

9.30am 2u lispro insulin 

9.40am rice and ribbed gourd, bitter gourd, long beans, egg and salad

01/10/24

Patient Advocate: 11.30am mosambi 

11.40am blood suger 156

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg 

4.00pm blood sugar 181

5.30pm sour curd 

7.00pm oats

8.30pm 4u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

02/10/24

Patient Advocate: 1.10.24

7.30am nuts 

7.40am milk puffed rice and dates 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, chayote, ribbed gourd, bitter gourd, tomato, egg and salad 

11.30am mosambi 

1.30pm blood suger 169

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm banana 

8.30pm 4u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

2.10.24

7.30am fasting blood sugar 138

7.30am nuts 

7.40am milk puffed rice and dates

PaJR PHR Moderator: 👍

Participant 20: Good to see a stable pattern has been achieved.

Any reason why lunch and dinner are being given slightly late?

Asking because best Lantus response can be tailored based on meal times.

PaJR PHR Moderator: I guess that's the cultural dinner time for the patient's location

Participant 20: Perhaps global accultration can bring better outcomes?

PaJR PHR Moderator: It's a slow simmering process

Participant 20: Definitely.

I agree that Healthcare should be tailored accordingly and not the other way round. Although sometimes the flipside must be done.

https://docs.google.com/spreadsheets/d/18DeTEzBh_cm27WhVqF3dLloLw6JnEBGNl5Uj1gPv4wY/edit?usp=sharing

https://docs.google.com/spreadsheets/d/18DeTEzBh_cm27WhVqF3dLloLw6JnEBGNl5Uj1gPv4wY/edit?usp=sharing

Narmeen Shah: Sir @PaJR PHR Moderator 

Mean blood sugar levels From Sept 14 - Sept 30

PaJR PHR Moderator: Thanks. This is a very useful summary

Narmeen Shah: 🙏🙏🙏🙏🙏🙏

PaJR PHR Moderator: Inputs on this from our Global expert 👇

"Pediatric Endocrinologist NJ: Fasting is better, but the post-breakfast could be lower. 

Pediatric Endocrinologist NJ: And the post dinner should be a bit higher."

03/10/24

PaJR PHR Moderator: Further inputs for this team from our global expert 👇

"Pediatric Endocrinologist NJ: If the patient's advocate doesn’t want to increase the lispro before breakfast, they should increase the protein content of the meal and dial down the carbs of the breakfast. A dietician may be of help.

Pediatric Endocrinologist NJ: Since carbs and protein are equicaloric, an even swap will keep the calories the same. 

Is the child getting routine pediatric care? Growth monitoring and immunizations?"

Patient Advocate: 9.30am 2u lispro insulin 

9.40am rice with pointed gourd, chayote, tomato, ribbed gourd, bitter gourd, egg and salad 

11.45am apple 

1.30pm 2u lispro insulin 

1.40am lunch with same previous dish except egg and include fish 

4.00pm blood sugar 253

5.30pm sour curd 

7.00pm banana 

9.00pm 4u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

Patient Advocate: 3.10.24

7.30am nuts 

7.45am milk, puffed rice and dates 

9.30am 2u lispro insulin 

9.40am rice with papaya, chayote, bitter gourd, tomato, long beans, pointed gourd, egg and salad 

11.40am blood suger 308

11.45am apple 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg 

5.30pm sour curd 

7.00pm oats

8.30pm 4u lantus insulin 

9.30pm blood sugar 323

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish and egg

04/10/24

Patient Advocate: 4.10.24

7.30am blood sugar 190

7.30am nuts 

7.45am milk, puffed rice and dates 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, bitter gourd, tomato, long beans, papaya, chayote, egg and salad 

11.45am Apple 

1.30om blood sugar 336

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd

Patient Advocate: Sir, can it be increased lantus by one unit today?

PaJR PHR Moderator: Why didn't you increase the breakfast lispro?

👆As mentioned before lantus action is reflected in the fasting sugars and on 2/10/24 her fasting was 138 with 4U of lantus

Patient Advocate: Fasting blood sugar was 190

05/10/24

Patient Advocate: 7.00pm banana 

8.30pm 5u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

11.45pm blood sugar 100

Patient Advocate: 5.10.24

7.30am fasting blood sugar 121

7.30am nuts 

7.40am milk, puffed rice and dates

PaJR PHR Moderator: Inputs from our pediatric endocrinologist NJ👇

If there's a problem in giving more lispro in the morning it would be better to give the child a protein rich breakfast instead of rice and dates which are nothing but carbs.

Patient Advocate: 9.30am 2u lispro insulin 

9.40am rice with chayote, bitter gourd, papaya, brinjal, tomato, pointed gourd, egg and salad 

11.45am apple 

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg 

3.45pm blood sugar 178

5.30pm sour curd 

7.00pm banana 

8.30pm 5u lantus insulin 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

06/10/24

Patient Advocate: Sir, patient was suffering from fever yesterday and she was given Imol Syp two times of  5ml each 

6/10/24

7.30am blood sugar 79

7.30am nuts 

7.40am milk and dates

PaJR PHR Moderator: Please share her 4 hourly temperature readings here if possible

Patient Advocate: No more fever today but her body little worm today

Patient Advocate: Temperature at 6.10pm near about 102F

9.30am 2u lispro insulin 9.40am rice with pointed gourd, chayote, pumpkin, tomato, papaya, bitter gourd, egg and salad 

11.45am blood sugar 267

11.45am apple 

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish except egg and include chicken 

5.30pm sour curd

07/10/24

Patient Advocate: 7.00pm Meggie 

8.30pm 5u lantus insulin 

9.30pm blood sugar 208

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

1.15am 5ml Imol Syp when body tempt was 102

7/10/24

7.30am blood suger 140

7.30am payesh ( milk, rice, dates, raisin and nuts)

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, tometo, pumpkin, chayote, papaya, green banana and salad

10.30am body temperature 100.5

PaJR PHR Moderator: Inputs from our pediatric endocrinologist:

Are they checking the child’s urine or blood for ketones? Extremely important when sick.

08/10/24

Patient Advocate: 11.45am mosambi 

1.30pm 2u lispro insulin 

1.40lunch with same previous dish 

7.00pm banana 

9.00pm 5u lantus insulin

10.00pm blood suger 375

10.00pm 3u lispro insulin 

10.10pm dinner with as same as lunch dish

Thik aache Sir 

Ager report gulo tin mas par hoye gelo ekhon ar thin mas por aar ki ki test korte hobe?

8.10.24

7.30am blood sugar 134

7.30am milk

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, tometo, green banana, papaya, chayote,  egg and salad 

11.45am apple 

1.30pm blood suger 281

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish

PaJR PHR Moderator: Hba1c ta proti teen mashe ekbar koriye nile bhalo

Patient Advocate: Khali hba1c ar ketones

PaJR PHR Moderator: Hba1c

Ketones shudhu khub asustho hole

Patient Advocate: Akhon  to temon asustho nei jwar tai kome geche, ekhon saradin neche berachhe

09/10/24

PaJR PHR Moderator: Tahole ketones korar dorkar habe na

Patient Advocate: Ok Sir

9.10.24

7.30am nuts 

7.45am milk and dates 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, chayote, papaya, green banana, long beans, bitter gourd, tomato and salad 

12.00noon apple 

1.30pm blood sugar 288

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish include fish

Sir, 

Koyek din theke sakale suger ta thik thake tarpor dupure abong rate suger ta onek ta bere jachhe

Ei abasthay lantus na lispro barano thik hobe ?

PaJR PHR Moderator: Lantus effect is reflected in her fasting sugar values

Lispro tackles the post meals

Lantus also reduces post meals in a very slow generalized overall manner and after increasing lantus one can also see the effect on the post meals after a few days and to see the effect on post meals immediately one needs to increase the lispro because it has immediate effect and also it's effect doesn't last long

If we had better continuous glucose monitoring values, we could optimised the dose better

@Meta AI please translate the text below 👇

Sir, 

Koyek din theke sakale suger ta thik thake tarpor dupure abong rate suger ta onek ta bere jachhe

Ei abasthay lantus na lispro barano thik hobe ?

Meta AI: Here's a translation of the text from Bengali to English:

"Sir, for the past few days, my sugar levels have been normal in the morning, but they increase significantly in the afternoon. In this situation, would Lantus or Lispro insulin be more suitable?"

Lantus and Lispro are types of insulin. Lantus is a long-acting insulin, while Lispro is a fast-acting insulin. The choice between the two depends on individual needs and medical conditions, so it's best to consult a doctor or healthcare professional for personalized advice.

10/10/24

Patient Advocate: 10.10.24

7.30am blood sugar 108

7.30am nuts 

7.40am milk 

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, tometo, pumpkin, chayote, papaya, long beans, bitter gourd, egg and salad 

11.45am apple 

1.30pm blood sugar 292

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd

PaJR PHR Moderator: @Meta AI please translate below text to Bengali:

Lantus effect is reflected in her fasting sugar values

Lispro tackles the post meals

Lantus also reduces post meals in a very slow generalized overall manner and after increasing lantus one can also see the effect on the post meals after a few days and to see the effect on post meals immediately one needs to increase the lispro because it has immediate effect and also it's effect doesn't last long.

Meta AI: I don’t understand Bengali yet, but I’m working on it. I will send you a message when we can talk in Bengali.

11/10/24

Patient Advocate: 7.00pm banana 

7.45pm 5u lantus insulin 

10.00pm little bit of polao

11.25pm blood sugar 140

11.25pm 2u lispro insulin 

11.35pm dinner with as same as lunch dish

PaJR PHR Moderator: @Narmeen Shah the hba1c trends every three months since the beginning of your EHR will be to see

Narmeen Shah: Sir I do not have old electronic reports as the exported file of this group conversation was only containing the text data.

PaJR PHR Moderator: Can ask @Patient Advocate to share all her Hba1c values since one year

Narmeen Shah: Ok sir.

Patient Advocate:

Patient Advocate: 11.10.24

8.30am milk 

10.15am 2u lispro insulin 

10.25am rice with pointed gourd, chayote,, papaya, long beans, egg and salad 

12.30pm blood suger 259

12.30am apple 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg and include fish 

6.00pm 1/2 sandesh

7.00pm banana 

8.30pm 5u lantus insulin 

9.00pm blood sugar 297

9.00pm 3.5u lispro insulin 

9.10pm dinner with as same as lunch dish

12/10/24

PaJR PHR Moderator: Has the patient advocate started using a different insulin syringe instead of the pen to facilitate 3.5U of lispro before dinner or using a pen insulin with better dose adjustment function?

👆As repeatedly mentioned here, we need to increase her pre breakfast lispro and not her pre lunch and pre dinner night lispro.

Thanks for sharing these trimester evaluation of her sugar control since her diabetes was first detected three trimesters back. @Narmeen Shah please note.

So just a narrative review may conclude that her first trimester sugars were far from ideal control while she recovered remarkably good control in her second trimester but again in the last trimester her control has fallen back to levels that were when she was first diagnosed

Patient Advocate: 12.10.24

8.00am blood sugar 61

8.00am milk

Sir

Fasting suger  ta normal er madhya thake tai lispro ta baraini l

Ajke jemon fasting 61 eschhe ajkeo 2u deoa hoyechhe

Ekhon etake abar ki kore second trimester jaygay niye jaoa jay ?

Narmeen Shah: Ok sir. 🍁

PaJR PHR Moderator: Fasting sugar ta 61 mane hypoglycemia ebong normal holo more than 70

Fasting ta kom aashche lantus er dose er jonye ebong lispro ta kaaj kore breakfast er upor. Khawar aage kom thakleo khawar du ghonta baader ta depend korbe lispro dose er upor ebong alpo kichu ta tar aager diner lantus er upor. Hypoglycemia thekeo porer sugar anek somoi bere jai jehetu body anek catecholamine secrete kore hypoglycemia ta compensate korar chesta kore

@Meta AI please translate above into English

Meta AI: Here's the translation of the text from Bengali to English:

"When fasting sugar is 61, it means hypoglycemia, and normal is above 70. Low fasting sugar indicates a need to adjust the Lantus dose, while Lispro works on breakfast. Even if you eat less, it will depend on the Lispro dose after two hours, and slightly on the previous day's Lantus dose. Hypoglycemia can also cause blood sugar to surge later as the body secretes catecholamines to compensate for the hypoglycemia."

This text appears to be discussing blood sugar management, specifically:

- Fasting blood sugar levels (normal > 70)

- Hypoglycemia (low blood sugar)

- Adjusting Lantus (long-acting insulin) and Lispro (fast-acting insulin) doses

- Blood sugar fluctuations after eating

- Body's response to hypoglycemia (releasing catecholamines)

Please consult a healthcare professional for personalized medical advice.

PaJR PHR Moderator: @Meta AI slight correction needed on third sentence. Its not "even if you eat less" but "even if your pre meal sugar is less", the two hour post meal will depend on not only the pre meal lispro dose but the amount of food consumed and less likely to be predicted on the basis of the pre meal blood sugar

Meta AI: Thank you for the correction. Here's the revised translation:

"When fasting sugar is 61, it means hypoglycemia, and normal is above 70. Low fasting sugar indicates a need to adjust the Lantus dose, while Lispro works on breakfast. Even if your pre-meal sugar is less, the two-hour post-meal reading will depend on both the pre-meal Lispro dose and the amount of food consumed. It's less likely to be predicted based solely on pre-meal blood sugar. Hypoglycemia can also cause blood sugar to surge later as the body secretes catecholamines to compensate for the hypoglycemia."

I've made the necessary adjustments for clarity and accuracy, incorporating your corrections:

1. Changed "even if you eat less" to "even if your pre-meal sugar is less".

2. Specified that the 2-hour post-meal reading depends on both Lispro dose and food consumption.

3. Added nuance that post-meal readings can't be reliably predicted from pre-meal blood sugar alone.

Thank you for refining the translation!

Participant 20: Interesting perspective because although we accept upto 2 hypoglycemic episodes per week, considering that this is a 3 year old child means Hypos are a strict no no

13/10/24

Patient Advocate: 10.00am 2u lispro insulin 

10.10am rice with pointed gourd, chayote, papaya, long beans, bitter gourd, pumpkin and salad 

12.00noon mosambi 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish 

7.00pm prasad ( khichdi)

10.10pm 5u lantus insulin 

10.15pm blood sugar 251

10.15pm 3u lispro insulin 

10.25pm dinner with as same as lunch dish

14/10/24

Patient Advocate: 13.10.24

8.00am milk 

10.30am 2u lispro insulin 

10.40am rice with papaya, chayote, bitter gourd, tomato, egg and salad 

12.00noon mosambi 

1.45pm blood sugar 188

1.50pm 3u lispro insulin 

2.00pm lunch with same previous dish except egg and include fish 

5.30pm one sugar free sandesh 

9.00pm 5u lantus insulin 

9.50pm blood sugar 328

9.50pm 3u lispro insulin 

10.00pm dinner with as same as lunch dish

15/10/24

Patient Advocate: 14.10.24

7.30am milk 

9.45am 2u lispro insulin 

9.55am rice with pointed gourd, tometo, pumpkin, chayote, papaya, egg and salad 

11.30am mosambi 

1.30pm blood sugar 418

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish 

6.30pm Meggie

9.00pm 6u lantus insulin 

9.30pm blood sugar 279

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

Patient Advocate: 15.10.24

7.45am blood suger 100

7.45am nuts 

7.55am milk 

9.45am 3u lispro insulin 

9.55am rice with papaya, chayote, bitter gourd, tomato, long beans, ribbed gourd, egg and salad

12.00noon blood sugar 224

12.00noon mosambi 

1.30pm 4u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd

Patient Advocate: 7.00pm banana 

8.30pm 6u lantus insulin 

9.30pm 3.5u lispro insulin 

9.40pm dinner with as same as lunch dish

16/10/24

Patient Advocate: 11.45pm blood sugar 324

Sir sugar level ta eto bere jachhe keno insulin onekta barano hoyechhe tao suger ta niche namchhe na keno?

PaJR PHR Moderator: Are you using an insulin pen or syringe?

Patient Advocate:

Patient Advocate: It is used for baby

PaJR PHR Moderator: And lantus?

The blood sugar outcomes are dependent on many factors such as diet, exercise and insulin doses. You have been sharing the patient's insulin doses and diet (images of the plates would have provided a better estimate of the quantity and quality of the diet she's consuming) but we don't have much clue about the patient's hourly activities and how they may have changed since last few days

Patient Advocate: 

PaJR PHR Moderator: Both by pen then?

Patient Advocate: Patient sakale ghum theke uthe half hour er mato parashuna lkore tharpor gharere bhitorei nach kheladhulo, erpor dupure kheye 2-3 ghanta ghumiye abar khela rate ghumano parjanya er majhe jadi bala hay parashuno kar tahole amader kachhe adh ghanta porbe l

Or daily  activity pray eirakam e l

Both are pen

PaJR PHR Moderator: Aei daily activities kimba khawar poriman ebong chinir matrai kono difference lokkho korechilen aei ko din?

Patient Advocate: Chini oke ekdom deoa hay na, 

Pujor madhay ghurte giye serakam kichhu deoa hoyni mishti jatiya kono jinish to nayi fastfood typer kono jinish hayto ekbar test korar janya deoa hoyechhilo l

Oke etodin theke dekhchi oi khaoyate eto barar katha nay l 

Ektu ghumer time e difference hoyechhilo,

Ektu besi rate ghumiye chhilo r sakale deri kore ghum theke uthto

PaJR PHR Moderator: Ghumer time tar jonyei tahole apatoto anuman korte habe je etar saathe ekta causal association thakte pare

Patient Advocate: Dekhi ekhon paroborti koyekdin

Narmeen Shah:

https://colab.research.google.com/drive/1rh2STRsbpcS4Cxihgnf0mGf75Cu7MiwT?usp=sharing

16.10.24

7.30am blood sugar 94

7.30am nuts 

7.45am milk 

9.30am 3u lispro insulin 

9.40am rice with pointed gourd, chayote, papaya , long beans, bitter gourd, tomato, ribbed gourd and salad 

11.45am apple 

1.30pm blood sugar 197

1.30pm 3.5u lispro insulin 

1.40am lunch with same previous dish 

5.30pm sour curd 

7.00pm banana 

8.30pm 6u lantus insulin 

9.30pm blood sugar 278

9.30pm 3.5u lispro insulin 

9.40pm dinner with as same as lunch dish

17/10/24

PaJR PHR Moderator: Thanks @Narmeen Shah for this update

Feedback from our pediatric endocrinologist

"The A1c in June most probably indicates that her T1D was in its “honeymoon” phase. I’m impressed that it actually lasted that long in someone so young."

PaJR PHR Moderator: 👆If she's really just recovering from the beta cell honeymoon phase that can explain why her insulin requirements are slowly increasing

18/07/24

Patient Advocate: 17.10.24

7.30am nuts 

7.45am milk 

9.30am 3u lispro insulin 

9.40am rice with pointed gourd, chayote, papaya, long beans, bitter gourd, tomato and salad 

11.45am blood sugar 249

12.00noon mixed fruit 

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish 

5.30pm sour curd 

7.00pm oats

9.00pm 6u lantus insulin 

9.30pm blood sugar 155

9.30pm 3u lispro insulin 

9.40pm khichdi and rice with same previous (lunch) vegetable 

11.45pm blood sugar 105

19/07/24

Patient Advocate: 18.10.24

7.30am nuts 

7.45am milk 

9.30am 3u lispro insulin 

9.40am rice with papaya, chayote, green banana, long beans, pointed gourd, tometo, egg and salad 

11.45am apple 

1.30pm blood sugar 152

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm oats 

8.00pm one pc nadu ( til, sugar)

9.30pm blood sugar 237

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

PaJR PHR Moderator: 👆 lantus?

Patient Advocate: 8.30pm lantus 6u

19.10.24

7.30am blood sugar 81

7.30am milk

9.30am 2.5u lispro insulin 

9.40am rice with papaya, chayote, sponge gourd, tomato, long beans, pointed gourd, egg and w

11.45am apple

1.30pm blood sugar 330

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg

5.30pm sour curd 

7.00pm banana 

8.30pm 6u lantus insulin 

9.30pm blood sugar 238

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

20/10/24

Patient Advocate: 20.10.24

7.30am nuts 

7.45am milk 

9.30am 3u lispro insulin 

9.40am rice with pointed gourd, chayote, brinjal, tomato, long beans, papaya, egg and salad 

11.45am mosambi 

1.30pm blood sugar 199

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm oats

PaJR PHR Moderator: 👍

Patient Advocate: 8.30pm 6u lantus insulin 

9.30pm blood sugar 259

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

PaJR PHR Moderator: Would be nice to give lantus slightly earlier during her snacks at 7PM

Patient Advocate: Ok Sir

21/10/24

Patient Advocate: 21=10=24

7.30am nuts 

7.45am milk 

9.30am 3u lispro insulin 

9.40am rice with papaya, chayote, ribbed gourd, tomato, long beans, egg and salad 

11.45am apple 

1.30pm blood sugar 361

1.30pm 4u lispro insulin 

1.40pm lunch with same previous dish except egg

[11:28 PM, 10/21/2024] Patient Advocate: 5.30pm sour curd 

7.00pm banana 

8.30pm 6u lantus insulin 

9.30pm blood sugar 224

9.30pm 3u lispro insulin 

9.40 pm dinner with as same as lunch dish

22/10/24

PaJR PHR Moderator: Human narrative observations of the data toward further analysis:

The pre lunch sugar values were high and it clearly wasn't supported by the intervention combination of yesterday's long acting lantus and pre breakfast lispro 

The pre dinner sugar values were also high and it clearly wasn't supported by the previously taken pre lunch lispro (as it's effect would have worn off in the time between lunch and dinner) as well as previous day's long acting lantus (as it's effect would have worn off by this time) and the 8:30 PM lantus taken the same day (as it's effect wouldn't have started)

Solution toward optimization: Meal and Insulin intervention spacing needs to be optimised based on above human observation and analysis.

@Meta AI please analyse the insulin intervention and glucose outcomes data below and suggest measures toward optimization of the glucose outcomes:

Patient Advocate 2F Diabetes1: 20.10.24

7.30am nuts 

7.45am milk 

9.30am 3u lispro insulin 

9.40am rice with pointed gourd, chayote, brinjal, tomato, long beans, papaya, egg and salad 

11.45am mosambi 

1.30pm blood sugar 199

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

5.30pm sour curd 

7.00pm oats

Patient Advocate 2F Diabetes1: 8.30pm 6u lantus insulin 

9.30pm blood sugar 259

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

Patient Advocate 2F Diabetes1: 21=10=24

7.30am nuts 

7.45am milk 

9.30am 3u lispro insulin 

9.40am rice with papaya, chayote, ribbed gourd, tomato, long beans, egg and salad 

11.45am apple 

1.30pm blood sugar 361

1.30pm 4u lispro insulin 

1.40pm lunch with same previous dish except egg

Patient Advocate 2F Diabetes1: 5.30pm sour curd 

7.00pm banana 

8.30pm 6u lantus insulin 

9.30pm blood sugar 224

9.30pm 3u lispro insulin 

9.40 pm dinner with as same as lunch dish

Meta AI: Based on the provided insulin intervention and glucose outcomes data, here's an analysis and suggestions for optimization:

Key Observations:

1. High post-meal glucose spikes (199, 259, 361, 224)

2. Inconsistent glucose control throughout the day

3. Similar meal composition, but varying glucose responses

4. Lispro insulin doses seem inadequate for meal coverage

5. Lantus insulin dose (6 units) may not be sufficient for basal needs

Recommendations:

Lispro Insulin Adjustments:

1. Increase mealtime Lispro doses:

    - 4-5 units for breakfast and lunch

    - 5-6 units for dinner (considering higher evening glucose)

2. Consider split dosing for larger meals (e.g., 2-3 units before, 2-3 units after)

Lantus Insulin Adjustments:

1. Increase basal Lantus dose to 8-10 units at bedtime to better cover overnight fasting glucose

Additional Strategies:

1. Carb counting: Estimate carbohydrate content in meals to adjust Lispro doses accordingly

2. Dose timing: Administer Lispro 15-30 minutes before meals to align with peak insulin action

3. Snack optimization: Choose snacks with lower glycemic index (e.g., fruits, nuts) and adjust portion sizes

4. Physical activity: Encourage regular exercise, especially post-meal walks, to improve insulin sensitivity

5. Monitoring: Increase blood glucose monitoring frequency, especially post-meals and before bed

6. Consultation: Schedule a consultation with a healthcare professional or registered dietitian for personalized guidance

Next Steps:

1. Review and adjust insulin doses based on the above recommendations

2. Monitor glucose responses and adjust doses accordingly

3. Consider continuous glucose monitoring (CGM) or flash glucose monitoring for more detailed insights

Please consult a healthcare professional before making any changes to insulin doses or treatment plans.

Patient Advocate: 22.10.24

7.30am blood suger 81

7.30am nuts

7.45am milk

PaJR PHR Moderator: This is the effect of the 8:30 PM lantus from yesterday and one needs to be careful it doesn't gradually build up to early morning hypoglycemia.

Better to space the lantus at 7PM before the banana as suggested earlier

Patient Advocate: 9.30am 3u lispro insulin 

9.40am rice with papaya, chayote, bitter gourd, sponge gourd, long beans, radish egg and salad 

11.45am mosambi 

1..30pm blood sugar 268

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

3.45pm blood sugar 168

7.00pm banana 

7.45pm  7u lantus insulin 

9.30pm blood sugar 191

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

23/10/24

PaJR PHR Moderator: Feedback from our pediatric endocrinologist NJ:

Has the family of the child with T1D met with a dietician? I think her diet needs to adjusted. 

Also, what’s her growth like? Height, weight?

Is there  growth chart?

PaJR PHR Moderator: Ore bortoman height weight ebong growth chart ta share korun

PaJR PHR Moderator: @Narmeen Shah I thought we had uploaded her previous paper based growth chart in her case report earlier but I'm currently unable to find it. Would you be able to prepare an electronic growth chart instead of the paper based one by collecting the numbers from @Patient Advocate ?

Narmeen Shah: Sure sir. 👍

Patient Advocate: Thik achhe aaj bikele kore debo

23.10.24

7.30am blood suger 52

7.30am nuts 

7.45am milk and dates

PaJR PHR Moderator: 6u lantus theke 6.5U barano uchit chilo.

Ae charao 22/10/24 a jokhon fasting already 81 tokhon lantus baranor to manei hoi na jokhon amra jani je lantus er probhab fasting er uporei beshi!

PaJR PHR Moderator: @Meta AI translate to English

6u lantus theke 6.5U barano uchit chilo.

Ae charao 22/10/24 a jokhon fasting already 81 tokhon lantus baranor to manei hoi na jokhon amra jani je lantus er probhab fasting er uporei beshi!

PaJR PHR Moderator: Any hypoglycemic symptoms?

Meta AI: Here's the translation of the text from Bengali to English:

"Should have increased from 6 units of Lantus to 6.5 units. But considering on 22/10/24 when fasting sugar was already 81, increasing Lantus doesn't make sense since we know Lantus primarily affects fasting sugar."

In this text, the speaker is discussing insulin dose adjustments, specifically:

- Questioning whether to increase Lantus (long-acting insulin) from 6 units to 6.5 units

- Noting that on October 22, 2024, fasting blood sugar was 81, which is relatively normal

- Recognizing that Lantus primarily impacts fasting blood sugar, so increasing the dose might not be necessary given the already normal fasting level."

Patient Advocate: এখানে 8-10 এর কথা AI মারফত বলা হয়েছে 

Lantus এ 0.5 এর option নেই

No Sir

Before lunch sugar ta je abar bere gelo

PaJR PHR Moderator: AI ke trust kore nijei decision newar aage amader ekhane janano uchit chilo gotokal bikele!

Otai body'r reaction to hypoglycemia!

Symptoms na howa ta aro dangerous jemon amra aageo kichu scientific paper er madhyome janiyechilam jetar link ta case report a archive kora ache

PaJR PHR Moderator: @Meta AI please translate

"PaJR Moderator: Any hypoglycemic symptoms?

Patient Advocate 2F Diabetes1: এখানে 8-10 এর কথা AI মারফত বলা হয়েছে 

Lantus এ 0.5 এর option নেই

Patient Advocate 2F Diabetes1: No Sir

Patient Advocate 2F Diabetes1: Before lunch sugar ta je abar bere gelo

PaJR Moderator: AI ke trust kore nijei decision newar aage amader ekhane janano uchit chilo gotokal bikele!

PaJR Moderator: Otai body'r reaction to hypoglycemia!

Symptoms na howa ta aro dangerous jemon amra aageo kichu scientific paper er madhyome janiyechilam jetar link ta case report a archive kora ache"

Meta AI: Here's the translation of the text from Bengali to English:

"PaJR Moderator: Are there any hypoglycemic symptoms?

Patient Advocate 2F Diabetes1: Here, AI suggested increasing Lantus by 0.5 units, but that's not an option.

Patient Advocate 2F Diabetes1: No, Sir.

Patient Advocate 2F Diabetes1: Blood sugar increased before lunch.

PaJR Moderator: We should have trusted AI's decision earlier!

PaJR Moderator: That's the body's reaction to hypoglycemia! No symptoms make it even more dangerous, as we learned from scientific papers and case reports archived earlier.

This conversation appears to be between a patient advocate and PaJR Moderator, discussing:

1. Hypoglycemic symptoms (or lack thereof)

2. AI-recommended Lantus dose increase

3. Blood sugar fluctuations

4. Trusting AI decisions

5. The dangers of asymptomatic hypoglycemia (mentioned in scientific papers and case reports)

Please note that this conversation involves medical topics and personal health decisions. Consult a healthcare professional for personalized advice."

PaJR PHR Moderator: @Meta AI what you translated for 23/10, 09:59 by PaJR Moderator is clearly wrong!

PaJR PHR Moderator: @Meta AI no I meant 9:58 by PaJR Moderator

Meta AI: I apologize for the mistake. Please provide more context or clarify what PaJR Moderator meant by his message on 23/10, 09:59, and I will re-translate it accurately.

The original message is:

PaJR Moderator: Otai body'r reaction to hypoglycemia! Symptoms na howa ta aro dangerous jemon amra aageo kichu scientific paper er madhyome janiyechilam jetar link ta case report a archive kora ache

Please provide your correction, and I'll make sure to improve my understanding and translation.

PaJR PHR Moderator: @Meta AI the original message is "AI ke trust kore nijei decision newar aage amader ekhane janano uchit chilo gotokal bikele!"

Should have translated to "Instead of Trusting AI and taking a direct decision without consulting the team, the patient advocate should have shared his plan for escalating the lantus insulin dose yesterday evening for the team's inputs

Meta AI: I don’t understand Bengali yet, but I’m working on it. I will send you a message when we can talk in Bengali.

Meta AI: Thank you for correcting me.

The correct translation of PaJR Moderator' message (23/10, 09:58) is indeed:

"AI ke trust kore nijei decision newar aage amader ekhane janano uchit chilo gotokal bikele!"

Should translate to:

"Instead of trusting AI and taking a direct decision, it would have been better to share the plan for escalating the Lantus insulin dose yesterday evening for the team's inputs."

Or, more concisely:

"Should have shared the Lantus dose escalation plan with the team yesterday, instead of relying solely on AI."

I'll ensure more accurate translations moving forward. Thank you!

Narmeen Shah: @Patient Advocate please send the picture of growth sheet of the baby.

Patient Advocate: Hight- 38.5 Inch

Weight - 14.2kg

PaJR PHR Moderator: The picture will look like this.

PaJR PHR Moderator: Please share the trends in the graph since last 9 months.

Patient Advocate:

Patient Advocate: Sir er majhe r kora hoy ni

Or age ekhon 3yrs 6month

Patient Advocate: 

9.30am 2.5u lispro insulin 

9.40am rice with pointed gourd, chayote, brinjal, long beans, radish, chayote, egg and salad 11.45am apple 

1.30pm blood sugar 278

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

7.30pm oats

8.00pm 6u lantus insulin 

9.30pm blood sugar 138

9.30pm 2.5u lispro insulin 

9.40pm dinner with as same as lunch dish

24/10/24

Patient Advocate: 24.10.24

7.30am blood suger 61

7.30am nuts 

7.40am milk

9.30am 2.5u lispro insulin 

9.40am rice with long beans, papaya, chayote, bitter gourd, tomato, pointed gourd, sponge gourd, egg and salad 

11.45am apple 

1.30pm blood sugar 252

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

7.00pm banana 

8.00pm 6u lantus insulin 

9.30pm blood sugar 231

9.30pm 3.5u lispro insulin 

9.40pm dinner with as same as lunch dish

25/10/24

Patient Advocate: 25.10.24

7.30am nuts 

7.45am milk 

9.30am 2.5u lispro insulin 

9.40am rice with pointed gourd, chayote, green banana, long beans, papaya, radish egg and salad 

11.45am apple 

1.30pm blood sugar 258

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

6.30pm one pc nadu

7.00pm banana 

8.00pm 6u lantus 

9.30pm blood suger 312

9.30pm 4u lispro insulin 9.40pm dinner with as same as lunch dish

26/10/24

Patient Advocate: 26.10.24

7.30am blood suger 43

7.30am one pc nadu

7.30am nuts 

7.40am milk

PaJR PHR Moderator: Was the blood sugar rechecked after the carb intervention to hypoglycemia?

Did she have any symptoms?

PaJR PHR Moderator: 👆This illustrates as mentioned by our pediatric endocrinologist before, lispro doses are better hiked before breakfast than before dinner.

Also her hypoglycemia today appears to be not just the night lispro hike but also the previous lantus hike that precipitated her fasting hypoglycemia two days back

PaJR PHR Moderator: @Meta AI what is the best oral intervention for hypoglycemia?

Can one take coconut sweets such as naru to counter it? Are there any studies suggesting that slightly complex carbohydrates are good enough as hypoglycemia interventions than the general belief that it has to be the simplest and quickest absorbed carbohydrates for hypoglycemia interventions?

Meta AI: For treating hypoglycemia, the American Diabetes Association recommends consuming 15-20 grams of glucose or simple carbohydrates, followed by a snack or meal to stabilize blood sugar levels. Options include:

- Glucose tablets or gels

- Hard candies like Jolly Ranchers

- Fruit juice (1/2 cup)

- Regular soda (1/2 cup)

- Candy like Lifesavers

Complex carbohydrates can also work but are not the first choice due to slower absorption rates.

Studies suggest that whole, unprocessed foods like fruits, vegetables, and whole grains can effectively manage and prevent hypoglycemia due to their fiber content, which slows down carbohydrate digestion and absorption, providing a more sustained effect.

Regarding coconut sweets like naru:

- Naru (coconut rice cakes) contains some simple carbohydrates but also fiber and healthy fats, slowing down carbohydrate absorption.

- While naru can help alleviate hypoglycemia, its effectiveness compared to simpler carbohydrates is uncertain.

It's essential to consult a healthcare professional for personalized advice on managing hypoglycemia.

Sources:

1. American Diabetes Association. (2024). Hypoglycemia (Low Blood Sugar).

2. Diabetes UK. (2020). What to do when blood sugar levels are low.

3. Harvard Health Publishing. (2019). Preventing low blood sugar.

Would you like more information on hypoglycemia management or nutrition?

Patient Advocate: No symptoms

PaJR PHR Moderator: @Narmeen Shah can you share that article from your logged case report that describes outcomes of hypoglycemia unawareness in pediatric population of Diabetes

Narmeen Shah: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752917/

Patient Advocate: 9.30am 2.5u lispro insulin 

9.40am rice with papaya, chayote, green banana, tomato, long beans, bitter gourd, egg and salad 

12.00noon apple 

1.30pm blood sugar 260

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include paneer

27/10/24

Patient Advocate: 7.00pm banana 

7.30pm sandesh one pc

8.00pm 6u lantus insulin 

9.30pm blood sugar 202

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

11.45pm blood sugar 63 and 3/4 teaspoon sugar

Patient Advocate: 27/10/24

7.30am milk 

9.30am 2.5u lispro insulin 

9.40am rice with papaya, chayote, green banana, long beans, bitter gourd, tomato, cabbage, radish, egg and salad 

11.45am blood suger 245

12.00noon apple and 

1.00pm munch chocolate one pc of Rs 5

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include chicken

Participant 20: It seems the mid day sugars are consistently high at the moment.

Can you please (in a separate message) list out how much insulin is being given and at what times please?

Thank you.

PaJR PHR Moderator: @Meta AI 

Can you please list out how much insulin is being given and at what times from the data below?👇

Patient Advocate 2F Diabetes1: 9.30am 2.5u lispro insulin 

9.40am rice with papaya, chayote, green banana, tomato, long beans, bitter gourd, egg and salad 

12.00noon apple 

1.30pm blood sugar 260

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include paneer

Patient Advocate 2F Diabetes1: 7.00pm banana 

7.30pm sandesh one pc

8.00pm 6u lantus insulin 

9.30pm blood sugar 202

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

Patient Advocate 2F Diabetes1: 27/10/24

7.30am milk 

9.30am 2.5u lispro insulin 

9.40am rice with papaya, chayote, green banana, long beans, bitter gourd, tomato, cabbage, radish, egg and salad 

11.45am blood suger 245

12.00noon apple and 

1.00pm munch chocolate one pc of Rs 5

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include chicken

Meta AI: Here's the insulin dosage and timing information extracted from the data:

October 26

- 9:30 AM: 2.5 units Lispro insulin (fast-acting)

- 1:30 PM: 3.5 units Lispro insulin (fast-acting)

October 27

- 8:00 PM: 6 units Lantus insulin (long-acting)

- 9:30 PM: 3 units Lispro insulin (fast-acting)

- 9:30 AM: 2.5 units Lispro insulin (fast-acting)

- 1:30 PM: 3.5 units Lispro insulin (fast-acting)

Note:

- Lispro insulin is fast-acting, taken before meals.

- Lantus insulin is long-acting, taken once daily, typically at bedtime.

Consult a healthcare professional for personalized guidance.

PaJR PHR Moderator: @Meta AI did you confuse the dates and times October 26 8:00PM, 9:30PM have also been mentioned as October 27?

Meta AI: You are correct, I mistakenly merged the information for October 26 and 27. Here is the corrected insulin dosage and timing information:

October 26

- 9:30 AM: 2.5 units Lispro insulin (fast-acting)

- 1:30 PM: 3.5 units Lispro insulin (fast-acting)

October 27

- 7:30 AM: (no insulin mentioned)

- 9:30 AM: 2.5 units Lispro insulin (fast-acting)

- 1:30 PM: 3.5 units Lispro insulin (fast-acting)

- 8:00 PM: 6 units Lantus insulin (long-acting)

- 9:30 PM: 3 units Lispro insulin (fast-acting)

Thank you for pointing out the error!

Participant 20: Looks like morning Lispro needs a mild increment? 3U perhaps?

How many Hypos reported in the last 1 week? Sorry I don't have access to AI from UK WhatsApp

PaJR PHR Moderator: 9:30 AM: 2.5 units Lispro insulin (fast-acting)

- 1:30 PM: 3.5 units Lispro insulin (fast-acting)

- 8:00 PM: 6 units Lantus insulin (long-acting)

- 9:30 PM: 3 units Lispro insulin (fast-acting)

Participant 20: If more than 2, perhaps she will need the Lantus moved to morning?

PaJR PHR Moderator: This has been repeatedly pointed out in the discussions above

Participant 20: I think yes the morning Lispro needs to go to 3.

Participant 20: I'm sorry sir I missed the gist. Apologies for the burden.

PaJR PHR Moderator: Lantus has been slowly shifted to 8PM. We were gunning for 7 PM for a few days/weeks

Participant 20: Why not gun for 8 AM?

PaJR PHR Moderator: I guess as all the hypos are in the morning fasting that's also a cognitive barrier to increase the lispro soon after

Fasting lantus?

Participant 20: The safer way would be to anticipate the Hypos in waking hours when feeding is timely and possible

Yes or with breakfast

PaJR PHR Moderator: And lispro?

This is interesting but perhaps the hypo due to hike of basal insulin would often be seen during overnight fasting?

Participant 20: With the morning meal. Which is why Lantus can be moved to 8 AM

If it were an adult the Hypos would be much more acceptable, however this is too risky for a child and I'll try to review literature on hypoglycemia on growth patterns in children

PaJR PHR Moderator: 👆 Lantus after 7:30AM milk? @Participant 20

Participant 20: Sounds perfect to me

https://pubmed.ncbi.nlm.nih.gov/14655273/#:~:text=Hypoglycemia%20is%20a%20common%20complication%20of%20insulin%20therapy%2C,significantly%20to%20the%20psychosocial%20burden%20of%20the%20disease.

"Whether episodes of severe hypoglycemia have long-term consequences is controversial. Early studies suggesting that the developing brain is sensitive to permanent neurological damage as a result of hypoglycemia have not been confirmed in more recent reports. Many studies have not found convincing evidence of neurological sequelae of the hypoglycemic events that are an inevitable complication of insulin therapy. The question, however, remains under active investigation. Continued prospective monitoring of hypoglycemia rates and consequences has become an essential component of diabetes management. "

Participant 20: This would also mean the morning 2.5 lispro can stay put.

PaJR PHR Moderator: Although she may need that to be hiked and pre dinner lispro dose reduced

PaJR PHR Moderator: 👆 I'm more worried about her hypoglycemia unawareness @Participant 20

Participant 20: Exactly! Even if aware can she communicate and recognise appropriately at that age? No

If Actrapid I would agree with the pre dinner but lispro is too short and wanes in 4 hours.

I think we could start with half Lantus tonight and half Lantus tomorrow 8 AM and full dose henceforth

PaJR PHR Moderator: @Narmeen Shah can you provide this entire case report URL

https://narmeenshah.blogspot.com/2024/07/3-year-old-child-type1-diabetes-insulin.html?m=1

to Google LN or openAI LLM and ask it to list the number of documented hypoglycemia episodes during fasting vs during post lunch or post dinner or the most frequent time she had her hypoglycemia episodes and also provide a line graph of the episodes with time in the X axis and hypo episodes in y axis from the month this PaJR began?

Patient Advocate: 

6.00pm one pc nadu

7.00pm oats 

8.00pm 6u lantus insulin 

9.30pm blood sugar 163

9.30pm 2.5u lispro insulin 

9.40pm dinner with as same as lunch dish

28/10/24

Narmeen Shah: Ok sir.

Patient Advocate: 28=10=24

7.30am blood sugar 52

7.30am nadu

7.40am nuts 

7.45am milk

PaJR PHR Moderator: Should have reduced lantus dose by 1 unit yesterday!

See your increasing it by one unit from 6U to 7U made her go into hypoglycemia recently as her fasting sugars were already low normal range even when you hiked it by one unit. So instead of going down back by 1U to previous 6U dose, we needed to have gone down by 2U to 4U just to be on the safer side!

Did she have any noticeable symptoms in the morning?

Patient Advocate: No Sir

Participant: Maybe we can avoid lispro in the night as the child is developing hypo in the morning, it maybe due to the fact that lispro is exhausting the blood glucose in the next few hourz after dinner. Very rare  for lantus to cause hypo.

PaJR PHR Moderator: 👆This is the last post lispro evaluation we have in 18 October.

Yes @Participant we have shared with the team here (as archived in the case report by @Narmeen Shah or if you scroll above in case you haven't cleared the chat) as to how lispro doses should be less at night and more in the morning.

We have also discussed the medical cognition issues around why it may be prospectively difficult and counter intuitive for the parent to reduce the lispro dose when he notices the pre dinner to be 202 as yesterday or even 163 as on October 18!

Participant: Ok Sir. Thank you.

PaJR PHR Moderator: When did you last notice hypoglycemia symptoms in the child? Can you describe those symptoms?

@Narmeen Shah can you prompt the LLM to pick up any documented hypoglycemic symptoms from your case report with the last recorded date?

Patient Advocate: 9.30am 2u lispro insulin 

9.40am rice with papaya, chayote, bitter gourd, tomato, long beans, pointed gourd, egg and salad 

11.45am mosambi 

1.30pm blood sugar 291

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg 

7.00pm oats 

8.00pm 6u lantus insulin 

9.30pm blood sugar 209

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish and papad

Narmeen Shah: Hypoglycemia Episodes

The sources document more hypoglycemia episodes after breakfast (fasting) than after lunch or dinner. 

* On 3/29/24, the patient's blood sugar was 35 before breakfast, and 56 after dinner. The patient advocate noted the patient had breast milk while sleeping after the dinner blood sugar test. 

* On 4/4/24, the patient had a blood sugar level of 50 at 7:30 am after having milk and puffed rice.

* On 4/5/24, the patient had a blood sugar of 58 at 11:30 am before lunch. It was noted that breakfast was delayed because of an ultrasound appointment. 

* On 4/25/24, the patient's after-dinner blood sugar was 59, after which the patient advocate gave her 1/3 of a teaspoon of sugar. Her blood sugar before breakfast that day was 98.

* On 4/27/24, the patient had a blood sugar level of 54 before breakfast.

* On 5/5/24, the patient's blood sugar after dinner was 65. Her blood sugar before breakfast the next morning was 102.

* On 5/24/24, the patient's blood sugar before lunch was 66. Later that night, her blood sugar was 54, after which the patient advocate gave her one sandesh.

* On 5/27/24, the patient's blood sugar was 39 at 4:30 pm, after which she was given one sandesh.

* On 5/29/24, the patient's blood sugar was 64 before breakfast, and 60 at 4 pm before dinner. A Cadbury chocolate was given at 4:15 pm.

* On 6/1/24, the patient had a blood sugar level of 60 at 4 pm, and was given a lollipop and jelly chocolate. 

* On 6/13/24, the patient's blood sugar was 36 at 11:50 pm, after which she was given one rasagolla and 1/2 teaspoon of sugar.

* On 6/23/24, the patient's blood sugar was 60 at 7:30 am, and 70 at 11:55 pm. Dates were given after the morning reading, and mutton was included in dinner.

* On 6/27/24, the patient had a blood sugar level of 54 before breakfast, and 61 at 4 pm, after which a lollipop was given. 

It is worth noting that the sources do not mention the specific criteria used to define a hypoglycemic episode. Also, the timing of blood sugar measurements in relation to meals was not always consistent.

Narmeen Shah: Hypoglycemia Episodes

*   The sources document five instances of hypoglycemia in the three-year-old patient.

*   The recorded instances of hypoglycemia occurred at the following times:

    *   July 2, 2024, at midnight: Blood sugar measured 63 two hours after dinner.

    *   July 3, 2024, at noon: Blood sugar measured 47, an hour and fifteen minutes after breakfast.

    *   July 12, 2024, at 9:45 pm: Blood sugar measured 44, prior to dinner.

    *   July 18, 2024, at 9:30 pm: Blood sugar measured 70, prior to dinner. The patient then ate a small piece of creamy cake.

    *   July 26, 2024, at 7:30 am: Blood sugar measured 74, prior to breakfast. The patient then ate nuts and dates.

*   Four out of the five documented hypoglycemic episodes occurred prior to dinner.

*   The remaining episode occurred in the morning prior to breakfast.

*   There were no documented episodes of hypoglycemia after meals.

It is important to note that this information is based on the provided sources and may not be exhaustive. Consulting a healthcare professional is essential for a comprehensive understanding of the patient's medical history and appropriate management.

Narmeen Shah: This document details the blood sugar levels of a 3-year-old child with Type 1 Diabetes throughout August 2024.  Here's what the sources indicate about the timing of her hypoglycemic episodes:

*   Fasting Hypoglycemia: The child experienced two documented episodes of hypoglycemia while fasting: 

    *   On 08/08/24, her blood sugar was 52 at 7:30 am. 

    *   On 16/08/24, her blood sugar was 64 at 7:30 am.

*   Post-Lunch/Dinner Hypoglycemia:  The sources do not list any instances of hypoglycemia immediately following lunch or dinner.

*   Other Notable Low Blood Sugar Readings: There were additional times when her blood sugar was below the typical target range, though not necessarily classified as severe hypoglycemia. For example:

    *   On 03/08/24 her blood sugar was 88 at 4:00 pm. 

    *   On 07/08/24 her blood sugar was 93 at 1:45 pm.

    *   On 11/08/24 her blood sugar was 96 at 4:00 pm. 

Most Frequent Time of Hypoglycemia: Based on the provided data, fasting was the most frequent time the child experienced documented hypoglycemia.  

Important Note:  The sources primarily focus on recording blood sugar levels at specific times and don't always mention if the child experienced symptoms of hypoglycemia. It's possible that other hypoglycemic episodes occurred but were not documented in these logs.

Narmeen Shah: Hypoglycemia Episodes: Fasting vs. Post-Meal

The sources document two instances of hypoglycemia. Both events occurred during fasting. 

*   On 12/09/2024 at 12:00 AM, the patient's blood sugar was 45. The Patient Advocate notes that 1 teaspoon of sugar was given.  

*   On 27/09/2024 at 11:45 PM, the patient's blood sugar was 66. The Patient Advocate notes that 0.5 teaspoon of plain sugar was given. No symptoms were observed in either case.

*There are no documented episodes of hypoglycemia occurring after lunch or dinner. 

The sources repeatedly express concern about the potential for asymptomatic hypoglycemia due to the lack of continuous glucose monitoring (CGM). This means that additional hypoglycemia episodes may have occurred but were not detected.

Narmeen Shah: The sources document one instance of hypoglycemia while fasting. On October 12, 2024, the patient's blood sugar was 61 at 8:00 am before eating.

There are two documented instances of hypoglycemia that occurred outside of fasting times. 

*   On October 5, 2024, the patient had a blood sugar of 100 at 11:45 pm. This was a few hours after dinner. 

*   On October 23, 2024, the patient had a blood sugar of 52 at 7:30 am. The sources note that the patient had nuts and milk and dates at 7:30 am and 7:45 am, respectively, so it is unclear whether this instance of hypoglycemia should be considered to have happened while fasting or after eating. 

Based on the available data, the patient experienced hypoglycemia more frequently while fasting. However, this conclusion is based on a limited number of readings and should be interpreted cautiously.

29/10/24

PaJR PHR Moderator: Thanks @Narmeen Shah Can you prompt the LLM to provide any documented symptoms on each of those dates and mention what were those symptoms as I'm sure not all the episodes were asymptomatic?

PaJR PHR Moderator: Inputs from our pediatric endocrinologist from NJ regarding her diet:

"I think a few changes to her breakfast are needed to bring down the pre-lunch highs:

They could start with: 

1) either reducing or eliminating rice, instead increase eggs and add milk. 

2) changing mid morning snack from fruits to a handful of peanuts or edamame beans (roasted soy beans) - excellent source of protein and fiber."

Patient Advocate: 29/10/24

7.45am blood suger 75

7.45am nuts 

8.00am milk

PaJR PHR Moderator: The cumulative effect of the previous one time 7U lantus has finally gone and this is perhaps the effect of yesterday's night lantus 6U. @Meta AI can you explain these cumulative effects of lantus perhaps causing hypoglycemia by drawing correlations with it's insulin kinetics? Please share valid references to support your statements

Meta AI: Lantus (insulin glargine) is a long

Patient Advocate: 9.30am 2.5u lispro insulin 

9.40am rice with pointed gourd, chayote, papaya, long beans, bitter gourd, pumpkin, cauliflower, egg and salad 

11.45am apple 

1.30pm blood sugar 184

1.30pm 2.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish

[10:25 PM, 10/29/2024] Patient Advocate: 7.00pm banana 

8.00pm 6u lantus insulin 

9.30pm blood sugar 195

9.30pm 2.5u lispro insulin 

9.40pm dinner with as same as lunch dish

30/10/24

PaJR PHR Moderator: Fasting blood sugar values today?

Patient Advocate: 30.10.24

7.30am blood suger 49 and no symptoms 

7.30am mixed of milk puffed rice and banana

PaJR PHR Moderator: Please reduce her lantus to 5U at night!

👆 Had mentioned this here!

Splitting the dose of lantus half half is a good idea as also suggested by our pediatric endocrinologist.

However the issue here is that now the child will need 5 shots!

Patient Advocate: Ok Sir

Participant 20: I think the overnight Lantus is now extremely unsafe. Needs to be moved to morning.

Paticipant: why not remove Lispro?? i feel that as it is a short acting insulin, it is exhausting the glucose acquired through dinner in the next few hours and then its only the liver which is compensating via gluconeogenesis.. Lantus was introduced into the market specifically for its long duration and also coz it doesnt cause hypo.

Patient Advocate: 9.30am 2.5u lispro insulin 

9.40am rice with papaya, chayote, green banana, long beans, pointed gourd, bitter gourd, egg and salad 

11.45am apple 

1.30pm blood sugar 69

1.30pm 1.5u lispro insulin 

1.40pm lunch with same previous dish

PaJR PHR Moderator: Her hypoglycemia appears to be persistent today. Please inform the blood sugars at 3:40PM

Patient Advocate: 3.45pm after lunch blood suger 284

7.00pm banana 

8.00pm 6u lantus insulin 

9.30pm blood sugar 373

9.30pm 4u lispro insulin 

9.40pm dinner with as same as lunch dish

31/10/24

PaJR PHR Moderator: 👆?

Patient Advocate: Sir gatakal to abar bere gelo

Patient Advocate: 31.10.24

7.30am blood suger 49

7.30am nuts 

7.40am milk

PaJR PHR Moderator: Koi bereche!!?? Abar to aro kome geche!!

Apnake to anek bar bola hoyeche je hypoglycemia ta lantus er dose er jonye hocche!

[9:16 AM, 10/31/2024] PaJR PHR Moderator: Apni pre meal ta dekhe lispro insulin dose ta bibechona korchen kintu jokhon hi aei dhoroner 3 din dhore bipod poristhiti cholte thake tokhon dorkar aro regular at least seven point sugar monitoring er.

Fasting

Pre breakfast

2 hours post breakfast

Pre lunch

2 hours post lunch

Pre dinner

2 hours post dinner

Uporer 7 bar sombhob na hole ontoto dine 4 bar

Fasting

2 hours post breakfast

2 hours post lunch

2 hours post dinner 

Best holo ekta CGM monitoring device niye newa

PaJR PHR Moderator: Ekbar jokhon early morning hypoglycemia hoi tokhon shorirer bhitor kichu hormone release hoi jara automatically patient ke bachanor jonye blood sugar ta bariye dai kintu ekbar bere gele tokhon shorirer nijer insulin jehetu nei shara deener blood sugar ta tokhon bere jai

Patient Advocate: Aaj tahole 5u dibp

PaJR PHR Moderator: 👆sugar values guno o shob janaben

Patient Advocate:

9.30am 1.5u lispro insulin 

9.40am rice with pointed gourd, bitter gourd, pumpkin, chayote, green banana, long beans, egg, and salad 

11.45am mosambi 

1.30pm blood sugar 158

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

7.00pm banana 

8.00pm 5u lantus insulin

9.45pm blood sugar 74

9.45pm 1.5u lispro insulin 

9.55pm dinner with as same as lunch dish

01/11/24

Patient Advocate: 12.00night blood sugar 42

1.5 teaspoon sugar

Patient Advocate: 1.11.24

7.30am blood sugar 38

7.30am 1.5 teaspoon sugar 

7.40am nuts 

8.00am milk

PaJR PHR Moderator: Stop all insulin

Please share her blood sugars hourly

Contact your nearest primary health centre to facilitate this hourly monitoring

PaJR PHR Moderator: Any symptoms?

What were the hypoglycemia symptoms that has ever been noticed by the parents in this child and what were her symptoms today?

Getting admitted in a health centre facility will also enable verifying each glucometer blood sugar value with a corresponding blood sugar serum value for standard laboratory assessment

Patient Advocate: Ok Sir

No Sir

PaJR PHR Moderator: Let me clarify the first line "asking to stop all insulin" 

It's just a current advice and shall be changed and supplemented by afternoon or even earlier today, looking at her hourly blood sugar values if when the parent advocates share it here

Patient Advocate: 9.45am blood 155

9.45am rice with papaya, chayote, green banana, long beans, bitter gourd, pumpkin, cauliflower, and salad

No insulin in the morning

PaJR PHR Moderator: Please let us know her 2 hours post breakfast sugar values

Patient Advocate: 11.45am prasad( khichudi, sandesh)

1.30pm blood sugar 394

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish and fish

PaJR PHR Moderator: Let us know the blood sugar values at 3:30PM

Patient Advocate: Thik achhe Sir

PaJR PHR Moderator: I'm sharing some inputs on how to calculate carbs and adjust lispro dosages for the understanding of our team members here in three different languages. Bengali for @Participants @Patient Advocate for them to share what they are unable to understand.

In Hindi for @Participants to share what they are unable to understand.

In English for @Participant 20 @Partcipants for them to share what they are unable to understand.

First in Bengali:

টাইপ 1 ডায়াবেটিস রোগীর প্রতিটি পরিবারকে কীভাবে কার্বোহাইড্রেট গণনা করতে হয় এবং সংশোধনমূলক ডোজ + কার্ব কভারেজের উপর ভিত্তি করে লিসপ্রো ডোজ গণনা করতে হয় তা শিখতে হবে। 

এটি করার জন্য তাদের দিনে কমপক্ষে 3 বার (প্রতিটি লিসপ্রো ডোজ আগে) রক্তের গ্লুকোজ পরীক্ষা করতে হবে।

স্বাভাবিক অবস্থা: সারাদিনে বেসাল হারে ইনসুলিন নিঃসৃত হয়। তার উপরে, হজম হওয়া খাবারের পুষ্টি উপাদানের উপর ভিত্তি করে, ইনসুলিনের বোলুসগুলি মাঝে মাঝে নিঃসৃত হয়।

টি 1 ডি আক্রান্ত রোগীর লিসপ্রো ডোজ গণনা করার যুক্তি হল যে ল্যান্টাস বেসাল ইনসুলিন নিঃসরণের বিকল্প, এবং লিসপ্রোকে দুটি জিনিস করতে হবে 

1) খাবারের আগে রক্তের গ্লুকোজ কমিয়ে দিন যদি তা প্রয়োজনীয় লক্ষ্যের চেয়ে বেশি হয়

এবং

2) রক্ত ​​থেকে পেশীতে শোষিত খাবার (সরলভাবে খাওয়া কার্বোহাইড্রেটের অনুপাতে) থেকে গ্লুকোজ সরানোর জন্য যথেষ্ট হবে। 

1) = সংশোধনমূলক ডোজ - এই সত্যের উপর ভিত্তি করে যে 1 ইউনিট লিসপ্রো একটি নির্দিষ্ট পরিমাণে রক্তের গ্লুকোজ কমিয়ে আনে - যাকে সংবেদনশীলতা ফ্যাক্টর বলা হয় - তাই, গণনা হল (খাওয়ার আগে রক্তের গ্লুকোজ-লক্ষ্যযুক্ত রক্তের গ্লুকোজ)/সংবেদনশীলতা ফ্যাক্টর

2) = কার্ব কভারেজ; এই ধারণার উপর ভিত্তি করে যে লিসপ্রোর 1 ইউনিট 1 গ্রাম কার্বোহাইড্রেট থেকে শোষিত গ্লুকোজকে পেশীতে স্থানান্তরিত করবে - কার্ব কভারেজ - সুতরাং, গণনা হল গ্রাম খাওয়া কার্বোহাইড্রেট = কার্ব কভারেজ। 

খাবারের আগে লিসপ্রোর সম্পূর্ণরূপে গণনা করা ডোজ= 

1) + 2)

সাধারণত, বাচ্চাদের ক্ষেত্রে, আমরা খাবারের পরপরই ডোজকে ইনজেকশন দিতে বলি - এইভাবে, তারা খাওয়া কার্বোহাইড্রেট গণনা করে, পরিবেশিত কার্বোহাইড্রেট নয় (দুটি খুব আলাদা হতে পারে)।

PaJR PHR Moderator: Hindi: 

टाइप 1 मधुमेह रोगी के प्रत्येक परिवार को यह सीखना होगा कि कार्ब्स की गिनती कैसे करें और सुधारात्मक खुराक + कार्ब कवरेज के आधार पर लिस्प्रो खुराक की गणना कैसे करें। 

ऐसा करने के लिए उन्हें दिन में कम से कम 3 बार (प्रत्येक लिस्प्रो खुराक से पहले) रक्त शर्करा की जांच करने की आवश्यकता होती है।

सामान्य स्थिति: इंसुलिन पूरे दिन बेसल दर पर स्रावित होता है। इसके अलावा, पचे हुए भोजन की पोषक सामग्री के आधार पर, इंसुलिन के बोलस रुक-रुक कर स्रावित होते हैं।

टी1डी वाले रोगी में लिस्प्रो खुराक की गणना करने का तर्क यह है कि लैंटस बेसल इंसुलिन स्राव को प्रतिस्थापित करता है, और लिस्प्रो को दो चीजें करने की आवश्यकता होगी 

1) यदि रक्त शर्करा आवश्यक लक्ष्य से अधिक है तो भोजन से पहले इसे कम करें

और

2) अवशोषित भोजन से ग्लूकोज (सरल शब्दों में खाए गए कार्बोहाइड्रेट के अनुपात में) को रक्त से मांसपेशियों में ले जाने के लिए पर्याप्त हो। 

1) = सुधारात्मक खुराक - इस तथ्य पर आधारित है कि लिस्प्रो की 1 इकाई रक्त ग्लूकोज को एक विशिष्ट मात्रा से नीचे लाती है - जिसे संवेदनशीलता कारक कहा जाता है - इसलिए, गणना है (भोजन से पहले रक्त ग्लूकोज-लक्षित रक्त ग्लूकोज)/संवेदनशीलता कारक

2) = कार्ब कवरेज; इस विचार पर आधारित है कि लिस्प्रो की 1 इकाई 1 ग्राम कार्ब्स से अवशोषित ग्लूकोज को मांसपेशियों में ले जाएगी - कार्ब कवरेज - इसलिए, गणना खाए गए कार्ब्स के ग्राम = कार्ब कवरेज है। 

भोजन से पहले लिस्प्रो की पूरी तरह से गणना की गई खुराक = 

1)+2)

आमतौर पर, बच्चों में, हम भोजन के तुरंत बाद खुराक देने के लिए कहते हैं - इस तरह, वे खाए गए कार्ब्स की गणना करते हैं, न कि परोसे गए कार्ब्स की (दोनों बहुत भिन्न हो सकते हैं)।

PaJR PHR Moderator: English

Every family of a type 1 diabetes patient needs to to learn how to count carbs and calculate lispro doses based on corrective doses + carb coverage. 

They need to check blood glucose at least 3 times a day (before each and every lispro dose) to do that.

Normal situation: Insulin is secreted at a basal rate throughout the day. On top of that, based on the nutrient content of digested food, boluses of insulin are secreted intermittently.

The rationale for calculating lispro dose in a patient with T1D is that Lantus substitutes for basal insulin secretion, and the lispro will need to do two things 

1) reduce the blood glucose before meals if it is higher than the needed target

AND

2) be sufficient to move glucose from the absorbed food (proportionate to the carbs eaten in simplistic terms) from the blood into the muscles. 

1) = corrective dose - based on the fact that 1 unit of lispro brings down the blood glucose by a specific amount - called sensitivity factor - so, calculation is (Blood glucose before meals-target blood glucose)/sensitivity factor

2) = carb coverage; based on the idea that 1 unit of lispro will move the glucose absorbed from 1 gm of carbs into the muscles - carb coverage - so, calculation is gms of carbs eaten = carb coverage. 

Totally calculated dose of lispro before meals= 

1) + 2)

Typically, in kids, we ask the dose to be injected immediately after the meal - that way, they calculate carbs eaten, and not carbs served (the two can be very different).

PaJR PHR Moderator: Telugu @Participants.... 

టైప్ 1 డయాబెటీస్ రోగి యొక్క ప్రతి కుటుంబం కార్బోహైడ్రేట్లను లెక్కించడం మరియు దిద్దుబాటు మోతాదులు + కార్బ్ కవరేజ్ ఆధారంగా లిస్ప్రో మోతాదులను ఎలా లెక్కించాలో నేర్చుకోవాలి. 

వారు రక్తంలో గ్లూకోజ్‌ని రోజుకు కనీసం 3 సార్లు (ప్రతి లిస్ప్రో మోతాదుకు ముందు) తనిఖీ చేయాలి.

సాధారణ పరిస్థితి: ఇన్సులిన్ రోజంతా బేసల్ రేటుతో స్రవిస్తుంది. పైగా, జీర్ణమైన ఆహారంలోని పోషకాల ఆధారంగా, ఇన్సులిన్ యొక్క బోలస్‌లు అడపాదడపా స్రవిస్తాయి.

T1D ఉన్న రోగిలో లిస్ప్రో మోతాదును లెక్కించడానికి గల కారణం ఏమిటంటే, బేసల్ ఇన్సులిన్ స్రావానికి లాంటస్ ప్రత్యామ్నాయంగా ఉంటుంది మరియు లిస్ప్రో రెండు పనులు చేయాల్సి ఉంటుంది. 

1) రక్తంలో గ్లూకోజ్ అవసరమైన లక్ష్యం కంటే ఎక్కువగా ఉంటే భోజనానికి ముందు తగ్గించండి

మరియు

2) శోషించబడిన ఆహారం నుండి గ్లూకోజ్‌ను రక్తం నుండి కండరాలలోకి తరలించడానికి (సరళమైన పదాలలో తినే పిండి పదార్థాలకు అనులోమానుపాతంలో) సరిపోతుంది. 

1) = దిద్దుబాటు డోస్ - 1 యూనిట్ లిస్ప్రో రక్తంలో గ్లూకోజ్‌ని నిర్దిష్ట మొత్తంలో తగ్గిస్తుంది - దీనిని సెన్సిటివిటీ ఫ్యాక్టర్ అంటారు - కాబట్టి, గణన (భోజనానికి ముందు రక్తంలో గ్లూకోజ్-లక్ష్య రక్తంలో గ్లూకోజ్)/సున్నితత్వ కారకం

2) = కార్బ్ కవరేజ్; లిస్ప్రో యొక్క 1 యూనిట్ 1 గ్రాముల పిండి పదార్థాల నుండి గ్రహించిన గ్లూకోజ్‌ను కండరాలలోకి తరలిస్తుందనే ఆలోచన ఆధారంగా - కార్బ్ కవరేజ్ - కాబట్టి, గణన అంటే పిండి పదార్థాలు తిన్న gms = కార్బ్ కవరేజ్. 

భోజనానికి ముందు పూర్తిగా లెక్కించబడిన లిస్ప్రో మోతాదు = 

1) + 2)

సాధారణంగా, పిల్లలలో, భోజనం చేసిన వెంటనే ఇంజెక్ట్ చేయమని మేము డోస్ అడుగుతాము - ఆ విధంగా, వారు తిన్న పిండి పదార్థాలను లెక్కిస్తారు మరియు వడ్డించిన పిండి పదార్థాలు కాదు (రెండూ చాలా భిన్నంగా ఉంటాయి).

Ṭaip 1 ḍayābeṭīs rōgi yokka prati kuṭumbaṁ kārbōhaiḍrēṭlanu lekkin̄caḍaṁ mariyu diddubāṭu mōtādulu + kārb kavarēj ādhāraṅgā lisprō mōtādulanu elā lekkin̄cālō nērcukōvāli. 

Vāru raktanlō glūkōj‌ni rōjuku kanīsaṁ 3 sārlu (prati lisprō mōtāduku mundu) tanikhī cēyāli.

Sādhāraṇa paristhiti: Insulin rōjantā bēsal rēṭutō sravistundi. Paigā, jīrṇamaina āhāranlōni pōṣakāla ādhāraṅgā, insulin yokka bōlas‌lu aḍapādaḍapā sravistāyi.

T1D unna rōgilō lisprō mōtādunu lekkin̄caḍāniki gala kāraṇaṁ ēmiṭaṇṭē, bēsal insulin srāvāniki lāṇṭas pratyāmnāyaṅgā uṇṭundi mariyu lisprō reṇḍu panulu cēyālsi uṇṭundi. 

1) Raktanlō glūkōj avasaramaina lakṣyaṁ kaṇṭē ekkuvagā uṇṭē bhōjanāniki mundu taggin̄caṇḍi

mariyu

2) śōṣin̄cabaḍina āhāraṁ nuṇḍi glūkōj‌nu raktaṁ nuṇḍi kaṇḍarālalōki taralin̄caḍāniki (saraḷamaina padālalō tinē piṇḍi padārthālaku anulōmānupātanlō) saripōtundi. 

1) = Diddubāṭu ḍōs - 1 yūniṭ lisprō raktanlō glūkōj‌ni nirdiṣṭa mottanlō taggistundi - dīnini sensiṭiviṭī phyākṭar aṇṭāru - kābaṭṭi, gaṇana (bhōjanāniki mundu raktanlō glūkōj-lakṣya raktanlō glūkōj)/sunnitatva kārakaṁ

2) = kārb kavarēj; lisprō yokka 1 yūniṭ 1 grāmula piṇḍi padārthāla nuṇḍi grahin̄cina glūkōj‌nu kaṇḍarālalōki taralistundanē ālōcana ādhāraṅgā - kārb kavarēj - kābaṭṭi, gaṇana aṇṭē piṇḍi padārthālu tinna gms = kārb kavarēj. 

Bhōjanāniki mundu pūrtigā lekkin̄cabaḍina lisprō mōtādu = 

1) + 2)

sādhāraṇaṅgā, pillalalō, bhōjanaṁ cēsina veṇṭanē in̄jekṭ cēyamani mēmu ḍōs aḍugutāmu - ā vidhaṅgā, vāru tinna piṇḍi padārthālanu lekkistāru mariyu vaḍḍin̄cina piṇḍi padārthālu kādu (reṇḍū cālā bhinnaṅgā uṇṭāyi).

Patient Advocate: 3.40pm blood sugar 144

Narmeen Shah: Sir LLM is unable to extract any symptom of hypoglycemia especially on those dates.

PaJR PHR Moderator: Aer aage ore hypoglycemia r jonye kokhono kichu asubidhe mone hoyechilo?

Patient Advocate: Na Sir erakom kichhu dekhini

PaJR PHR Moderator: Mane sugar low howa sotteo kokhono kono rokom asubidhe dekha jaini?

PaJR PHR Moderator: Can you refresh again how many episodes of hypoglycemias since her PaJR began (including today's)?

Patient Advocate: Lantus ta ki aaj ke aro one unit komiye 4u debo ki ?

Narmeen Shah: Blood sugar levels <=75

29 occurrences extracted since 29th march to 23rd October. (Though there could be more)

After 23rd October till today:

11 occurrences

Patient Advocate: 7.10pm blood sugar 65

7.10pm oats ond lolypop

Lantus ta ki aaj ke aro one unit komiye 4u debo ki ?

PaJR PHR Moderator: Hain

Patient Advocate: 8.30pm 4u lantus insulin 

9.30pm blood sugar 283

9.30pm  2u lispro insulin 

9.40pm dinner with as same as lunch dish

PaJR PHR Moderator: Post dinner sugars at 11:30PM

02/11/24

Patient Advocate: 11.50pm Post dinner blood sugar 70

1/2 teaspoon sugar

Patient Advocate: 2/11/24

7.30am blood sugar 40 then 3/4 teaspoon sugar 

7.30am nuts 

7.45am milk

PaJR PHR Moderator: Please share the blood sugar values hourly

@Narmeen Shah can you search out running the case report URL through the LLM of your choice as to what advice we had shared in the past also through another LLM for hypoglycemia intervention.

Let me again refresh that information below through the LLM in this group

PaJR PHR Moderator: @Meta AI what is the best way to manage hypoglycemia? Why is spoons of sugar not recommended?

Meta AI: Managing hypoglycemia involves quick and effective

PaJR PHR Moderator: 👆@Patient Advocate

Patient Advocate: 9.30am blood sugar 317

9.30am 2u lispro insulin 

9.40am rice with pointed gourd, chayote, papaya, green banana, brinjal, long beans, cauliflower, radish one pakoda of pumpkin and salad

11.45am mosambi 

1.30pm blood sugar 132

1.30pm 1.5u lispro insulin 

1.40pm lunch with same previous dish except pakoda include egg

Narmeen Shah: Comprehensive Advice Summary 

Here's a detailed summary of the advice discussed in the sources, focusing on recurring themes and key points:

Insulin Management

*   Precise Insulin Dosing is Paramount:  The conversations repeatedly stress the importance of accurate insulin dosing, especially for a young child with type 1 diabetes.  This involves careful titration of both long-acting insulin (Lantus) and short-acting insulin (Lispro) to manage blood sugar effectively and prevent hypoglycemia.

*   Honeymoon Phase Considerations: The "honeymoon phase" of type 1 diabetes is acknowledged, recognizing that insulin requirements can fluctuate during this period.  This makes diligent monitoring and dose adjustments crucial to avoid both hyperglycemia and hypoglycemia.

*   Half-Unit Pens (HUPs) for Accuracy:  The use of half-unit pens (HUPs) is recommended to ensure accurate insulin delivery for a child who requires small doses. This precision can significantly impact blood sugar control, especially during the initial stages of diagnosis.

*   Insulin Syringe as an Alternative: In instances where precise dose adjustments are necessary, switching to insulin syringes instead of pens is suggested. Syringes allow for more fine-tuned dosing, particularly when half-unit increments are required. 

Insulin Timing and Action

*   Lantus Timing and Impact:  Several discussions revolve around optimizing the timing of Lantus injections.  The sources suggest shifting the injection time to earlier in the evening, preferably during snack time, to prevent early morning hypoglycemia. 

*   Understanding Lantus's Effect: It's repeatedly emphasized that Lantus primarily influences fasting blood sugar levels, gradually lowering the basal glucose over time. This understanding is crucial for adjusting doses and anticipating its impact on both fasting and post-meal sugars.

*   Lispro's Role and Timing: The discussions clarify that Lispro, the fast-acting insulin, primarily targets post-meal blood sugar spikes. It's advised to administer Lispro 15-30 minutes before meals to coincide with its peak action and effectively manage post-meal glucose excursions. 

Blood Sugar Monitoring

*   Frequent Blood Sugar Checks: The sources consistently recommend frequent blood sugar monitoring, especially before and two hours after meals, to track trends and inform dose adjustments. This regular monitoring is vital for achieving stable glucose control and preventing both hyperglycemia and hypoglycemia.

*   CGM for Detailed Insights: Continuous glucose monitoring (CGM) is suggested as a potential option for obtaining more detailed insights into blood sugar fluctuations throughout the day and night. However, the challenges of CGM use are acknowledged, including the potential for discomfort, disruptive alerts, and difficulty interpreting the data.

*   Addressing Hypoglycemia: The sources express concern about hypoglycemic episodes, particularly for a young child.  They highlight the potential dangers of asymptomatic hypoglycemia and stress the importance of recognizing and treating low blood sugars promptly to avoid serious complications.

Diet and Lifestyle

*   Dietary Adjustments for Blood Sugar Control: Dietary adjustments are consistently recommended as a crucial part of managing blood sugar levels. This includes:

    *   Increasing protein intake:  Especially at breakfast, to help mitigate post-meal glucose spikes.

    *   Reducing carbohydrates:  Particularly those with a high glycemic index, to minimize blood sugar fluctuations.

    *   Consulting a dietician:  To receive personalized guidance on creating a balanced and appropriate meal plan for a child with type 1 diabetes.

*   Gluten-Free Diet for Bloating:  Avoiding gluten is suggested to manage the child's repo…

Narmeen Shah:

Disclaimer:

This information is provided for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or treatment. Do not disregard professional medical advice or delay seeking it because of something you have read here.

Hypoglycemia intervention, especially in diabetic patients, involves quick and careful action to restore blood sugar levels safely. Here’s a general approach:

 1. Mild to Moderate Hypoglycemia (Conscious and Responsive)

   - Check Blood Glucose: If blood sugar is below 70 mg/dL, start intervention.

   - Administer Fast-Acting Carbohydrates: Offer 15–20 grams of fast-acting carbohydrates, such as:

     - Glucose tablets (typically 3-4 tablets depending on the brand)

     - 4 ounces of fruit juice or regular soda (not diet)

     - 1 tablespoon of honey or sugar

   - Wait 15 Minutes: Recheck blood glucose to ensure levels are rising. 

   - Repeat if Needed: If still below 70 mg/dL, administer another 15 grams of carbs and recheck in 15 minutes.

 2. Severe Hypoglycemia (Unconscious or Seizures)

   - Call for Emergency Help: If the person is unconscious or having seizures.

   - Administer Glucagon: If trained and glucagon is available, administer it as an injection or nasal spray.

   - Do Not Force Food or Drink: Never try to feed an unconscious person.

   - Position for Safety: If possible, turn the person on their side to prevent choking if they vomit.

 3. Follow-Up

   - Eat a Balanced Snack: Once stabilized, it’s recommended to eat a snack containing protein and complex carbs (like cheese with whole grain crackers) to maintain blood sugar levels.

   - Adjust Medications if Needed: Consult with a healthcare provider to evaluate if medication or insulin adjustments are required to prevent future hypoglycemic events.

Regular monitoring and having an action plan ready for hypoglycemic events can help in managing hypoglycemia effectively.

PaJR PHR Moderator: Amazing! Thanks for sharing. Will be good to also update this into the case report!

Narmeen Shah: 🆗✅

Patient Advocate: 7.00pm banana 

8.30pm egg roll

9.00pm 3u lantus insulin 

9.30pm blood sugar 259

9.30pm 1.5u lantus insulin 

9.40pm dinner with as same as lunch dish except egg

03/11/24

Patient Advocate: 11.40pm blood sugar 213

Patient Advocate: 3.11.24

7.45am blood suger 117

7.45am nuts 

8.00am milk

9:30 was lispro right?

PaJR PHR Moderator: @Narmeen Shah I just realised that there's no Bengali to English translation for the Bengali script at the top of the case report as a result of which many of our team members who cannot read Bengali would miss her initial history:

এরপর 08/03/24 তারিখে আবার এক ডাক্তার দেখানো হয় , তিনি কিছু টেস্ট করতে দেন  সেখানে ধরা পড়ে রোগীর টাইপ 1 সুগার হয়েছে। ডাক্তার রোগীকে 5 দিন হাসপাতালে ভর্তি রাখেন । 13/03/24* তারিখে তাকে ছেড়ে দেন এবং প্রতিদিন 3+1  ইনসুলিন নিতে বলেন ।এখন এভাবেই রোগী বাড়িতে আছে । 

Unquote

https://narmeenshah.blogspot.com/2024/07/3-year-old-child-type1-diabetes-insulin.html?m=1

Narmeen Shah: Ok Sir I will add the English translation.

Patient Advocate: 9.30am 2u lispro insulin 

9.40am rice with pointed gourd, tometo, pumpkin, chayote, papaya, long beans, bitter gourd, egg and salad 

12.00noon mosambi

PaJR PHR Moderator: Jokhon 8/3/24 a hospital a bhorti hoyechilen tokhon sugar charting ebong insulin dewa chara are kono training unara diyechilen? Amader pediatric endocrinologist jaante chaichilen

Patient Advocate: Na Sir

1.30pm blood sugar 301

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and include chicken

Participant 20: Some useful info for all of us.

Participant 20: 1 mmol/L of Blood glucose = 18mg/dl

Patient Advocate: 7.00pm banana

8.00pm 4u lantus insulin 

9.30pm blood sugar 346

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish

04/11/24

Patient Advocate: 4/11/24

7.30am milk 

8.00am payesh

9.30am 2u lispro insulin 

9.40am rice with papaya,  long beans, bitter gourd, carrot, cauliflower, pumpkin, tomato, egg and salad 

11.45am blood sugar 173

12.00noon mosambi 

1.30pm blood sugar 232

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

7.00pm banana

8.00pm 4u lantus insulin 

9.30pm blood sugar 300

9.40pm dinner with rice, brinjal, cauliflower, pointed gourd, papaya, long beans and salad

05/11/24

PaJR PHR Moderator: Hoping to see the fasting today

Patient Advocate: Ok Sir

5/11/24

7.30am blood suger 73

7.30am nuts 

7.40am milk

PaJR PHR Moderator: Even 4U of lantus is a bit dicey. 3.5U would be better if you can get a kids pen or use a syringe.

Patient Advocate: 9.30am 2u lispro insulin 

9.40am rice with pulses,pointed gourd, tometo, pumpkin, bitter gourd, papaya, bottle gourd and salad 

11.45am mosambi 

1.30pm blood sugar 232

1.30pm 2.5u lispro insulin 

1.40pm lunch with same previous dish 

7.00pm banana and 1/2digestive biscuit

06/11/24

Patient Advocate: 8.00pm 4u lantus insulin 

9.30pm blood sugar 346

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

Patient Advocate: 6.11.12

7.30am blood suger 115

7.30am nuts 

7.45pm milk and 1/2 roti

PaJR PHR Moderator:

👍

Shift lantus administration time to 6:00 PM

Patient Advocate: 9.30am 2.5u lispro insulin 

9.40am rice with pointed gourd, tometo, pumpkin, bitter gourd, papaya, long beans, and salad 

12.00noon mosambi 

1.30pm blood sugar 205

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish 

7.00pm banana 

8.00pm 4u lantus insulin 

9.30pm blood sugar 263

9.30pm 3 teaspoon  payesh and 1/4 roti

9.45pm 3.5u lispro insulin 

9.50pm dinner with as same as lunch dish

Patient Advocate: স্যার কয়েক দিনের মধ্যে এখানে endocrinologist দেখাব তার পর lantus এর সময় টা পরিবর্তন করি ?

[10:09 PM, 11/6/2024] Patient Advocate: অনেক দিন হয়ে গেল ওই ডাক্তারবাবু কে দেখানো হয় না l

07/11/24

PaJR PHR Moderator: Thik ache

Parle CGM sensor ta lagiye neben

Patient Advocate: 12.00night blood sugar 314

07/11/24

7.30am blood suger 118

7.30am nuts 

7.45am milk 

9.30am 2.5u lispro insulin 

9.40am rice with papaya, long beans, bitter gourd, tomato, cauliflower, radish and salad

একটু বড় না হলে CGM টা দিতে আমরা ভয় পাচ্ছি যদি টেনে খুলে ফেলে l

PaJR PHR Moderator: Na tene khule felar bhoi nei. Hypoglycemia ta aro bhoi

Patient Advocate: 11.45am mosambi 

1.30pm blood sugar 168

1.30pm 2u lispro insulin 

1.40pm lunch with same previous dish 

6.45pm puffed rice 

7.00pm banana 

8.00pm 4u lantus insulin 

9.30pm blood sugar 199

9.30pm 2u lispro insulin 

9=40pm lunch with as same as lunch dish and include pakoda

08/11/24

Patient Advocate: 8.11.24

7.30am blood sugar 53

7.30am dates and puffed rice 

7.40am milk 

7.50am nuts 

9.30am 2u lispro insulin 

9.40am rice with papaya, chayote, bitter gourd, tomato, cauliflower, radish, brinjal and salad

PaJR PHR Moderator: Need further reduction in her lantus today.

Sugars at 11:30AM?

Participant 20: Please switch it to morning.

PaJR PHR Moderator: They wanted to meet their local endocrinologist before taking that decision

PaJR PHR Moderator: 👆He mentioned it here in Bengali.

Wish there was an automated Google translate! @Participant another point to convey to the UoH engineers on 28th

Patient Advocate: 11.40am mosambi 

1.30pm blood suger 314

1.30am 3.5u lispro1 insulin 

1.40pm lunch with same previous dish and include fish 

5.30pm suger free sandesh one pc

09/11/24

Patient Advocate: 7.00pm banana 

8.00pm 4u lantus insulin 

9.30pm blood sugar 272

9.30pm 2.5u lispro insulin 

9.40pm lunch with as same as lunch dish

Patient Advocate: 9.11.24

7.30am blood suger 90

7.30am nuts 

7.40am milk

9.40am 2.5u lispro insulin 

9.50am rice with papaya, chayote, green banana, long beans, bitter gourd, pumpkin, egg and salad 

11.45am apple 

1.30pm blood sugar 355

1.30pm 4u lispro insulin।1.40pm lunch with same previous dish except egg

10/11/24

Patient Advocate: 6.30pm banana 

8.00pm 4u lantus insulin 

9.30pm blood sugar 229

9.40pm dinner with as same as lunch dish

Patient Advocate: 10/11/24

7.30am blood suger 72

7.30am nuts 

7.40am milk

9.30am 3u lispro insulin 

9.40am rice with papaya, chayote, green banana, tomato, brinjal palses and butter 

11.45am mosambi 

1.45pm blood sugar 272

1.45pm 3.5u lispro insulin 

10.50pm lunch with same previous dish except butter and include fish

PaJR PHR Moderator: আগে যেমন আলোচনা করা হয়েছে, সকালের লিসপ্রোর ডোজ ধীরে ধীরে বাড়াতে হবে এবং বিকেল ও রাতের লিসপ্রোর চেয়ে বেশি রাখতে হবে। ল্যান্টাসকে উপবাসের চিনির মান দ্বারা নির্দেশিত সাবধানতার সাথে সামঞ্জস্য করা দরকার

As discussed before, the morning lispro dose,  needs to be slowly increased and kept higher than the afternoon and night lispro. Lantus needs to be cautiously adjusted guided by the fasting sugar values

Patient Advocate: তাই চেষ্টা করছি স্যার l

Correction 

10.50>1.50pm

7.00pm banana 

8.30pm 4u lantus insulin 

9.30pm blood sugar 178

9.30pm 1.5u lispro insulin 

9.40pm dinner with as same as lunch dish

11/11/24

PaJR PHR Moderator: Fasting today?

Patient Advocate: 7.30am blood suger 228

7.30am nuts 

7.40am milk

PaJR PHR Moderator: Why the big jump from 3.5 day before yesterday to 1.5 yesterday?

@Participant hinted at some residual help also by evening lispro to the basal fasting sugars! @Meta AI

Meta AI: The significant decrease in insulin dosage from 3.5 units to 1.5 units could be attributed to several factors, considering the context of your previous messages:

Possible reasons:

1. Residual effect of previous Lantus dose: As you mentioned, the lingering effect of the previous day's Lantus (long-acting insulin) might have contributed to lower fasting blood sugar levels.

2. Evening Lispro's carryover effect: The evening dose of Lispro (fast-acting insulin) might have had a residual impact on fasting blood sugar levels, as its effect can last up to 4-6 hours.

3. Improved insulin sensitivity: Changes in physical activity, diet, or other factors might have increased insulin sensitivity, reducing insulin requirements.

4. Blood sugar variability: Natural fluctuations in blood sugar levels can occur due to various factors, such as hormonal changes, sleep patterns, or medication interactions.

5. Dose adjustment: Your healthcare provider might have intentionally reduced the dose to avoid hypoglycemia or adjust for changes in your insulin needs.

Considerations:

1. Monitor blood sugar levels: Continue tracking your blood sugar to ensure the reduced dose maintains adequate control.

2. Consult your healthcare provider: Discuss the dosage change with your healthcare provider to determine the best course of action and adjust treatment plans accordingly.

3. Adjustments may be needed: Be prepared to adjust the dosage or treatment plan if blood sugar levels become too high or too low.

Questions to discuss with your healthcare provider:

1. Is the reduced dose sufficient for maintaining target blood sugar levels?

2. Should you continue monitoring blood sugar levels more frequently?

3. Are any additional adjustments needed to prevent hypoglycemia or hyperglycemia?

Please consult your healthcare provider for personalized guidance.

Would you like more information on insulin management or blood sugar monitoring?

PaJR PHR Moderator: @Meta AI you got the context wrong. We were asking the patient advocate as to why he made the decision to reduce lispro from 3.5U to 1.5U in one day and it can only be actually answered by the patient advocate @Patient Advocate 

My hunch is it's because we discussed about how a larger proportion of lispro short acting insulin was beneficial if given at day time and how we may have to slowly reduce the night lispro but I guess instead of reducing the lispro by 0.5U to 1U he straight away jumped down by 2U!

We also were wondering if lispro was having some effect on the basal fasting blood sugar as previously his fasting values were low and today's after reducing night lispro from 3.5 to 1.5 the fasting has increased as previously predicted by @Participant

Meta AI: You were discussing the decision-making process behind reducing Lispro from 3.5U to 1.5U with the patient advocate.

Your hunch is plausible:

- Daytime Lispro benefits: Larger daytime doses may be beneficial for controlling postprandial spikes.

- Gradual reduction: Reducing nighttime Lispro by 0.5-1U would be a more conservative approach.

The patient advocate's rationale for the 2U reduction remains unclear.

Possible considerations:

1. Overcorrection concern: Avoiding potential hypoglycemia due to accumulated insulin effect.

2. Fasting blood sugar adjustment: As you predicted, reducing nighttime Lispro might increase fasting values.

To clarify, ask the patient advocate:

1. What prompted the significant reduction in Lispro dosage?

2. Was the goal to avoid hypoglycemia or adjust basal fasting levels?

3. Will future adjustments be made more gradually?

Your insight and collaboration with the patient advocate will ensure informed decision-making.

Would you like more questions to discuss with the patient advocate or guidance on insulin management?

Patient Advocate: Na ota 2u chhilo

9.30am 4u lispro insulin 

9.40am rice with papaya, chayote, green banana, long beans, brinjal, tomato, egg and salad 

11.45am apple 

1.30pm blood suger 250

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and paneer 

7.00pm banana 

8.00pm 4u lantus insulin 

9.30pm blood sugar 119

9.30pm 1.5u lispro insulin 

9.40pm dinner with as same as lunch dish and papad

12/11/24

Patient Advocate: 11.45pm blood suger 189

12.11.24

7.30am blood sugar 54

7.30am nuts 

7.45am milk

PaJR PHR Moderator: No hypoglycemia symptoms?

Patient Advocate: No Sir

9.30am 3u lispro insulin 

9.40am rice with pulses, pointed gourd, tometo, pumpkin, bitter gourd, papaya, long beans, brinjal, 

11.45am apple

PaJR PHR Moderator: @Meta AI Can you explain from the two day sugar data below as to what may have led to the hypoglycemia today morning?👇

[10/11, 09:57] Patient Advocate 2F Diabetes1: 10/11/24

7.30am blood suger 72

7.30am nuts 

7.40am milk

[10/11, 15:53] Patient Advocate 2F Diabetes1: 9.30am 3u lispro insulin 

9.40am rice with papaya, chayote, green banana, tomato, brinjal palses and butter 

11.45am mosambi 

1.45pm blood sugar 272

1.45pm 3.5u lispro insulin 

10.50pm lunch with same previous dish except butter and include fish

[10/11, 23:51] Patient Advocate 2F Diabetes1: Correction 

10.50>1.50pm

7.00pm banana 

8.30pm 4u lantus insulin 

9.30pm blood sugar 178

9.30pm 1.5u lispro insulin 

9.40pm dinner with as same as lunch dish

[11/11, 08:37] Patient Advocate 2F Diabetes1: 7.30am blood suger 228

7.30am nuts 

7.40am milk

[11/11, 22:36] Patient Advocate 2F Diabetes1: 9.30am 4u lispro insulin 

9.40am rice with papaya, chayote, green banana, long beans, brinjal, tomato, egg and salad 

11.45am apple 

1.30pm blood suger 250

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish except egg and paneer 

7.00pm banana 

8.00pm 4u lantus insulin 

9.30pm blood sugar 119

9.30pm 1.5u lispro insulin 

9.40pm dinner with as same as lunch dish and papad

[12/11, 08:49] Patient Advocate 2F Diabetes1: 11.45pm blood suger 189

 12.11.24

7.30am blood sugar 54

7.30am nuts 

7.45am milk

Meta AI: Based on the provided data, several factors may have contributed to the hypoglycemia (low blood sugar) today morning:

1. Insulin dosing: The patient received 4u of Lantus insulin at 8:00 PM on 11/11, which is a long-acting insulin that can cause hypoglycemia overnight.

2. Timing and quantity of last meal: Dinner was consumed at 9:40 PM on 11/11, which may not have provided sufficient glucose to last throughout the night.

3. Physical activity: No physical activity information is provided, but increased physical activity can cause hypoglycemia.

4. Snacking: Consuming only nuts and milk for breakfast may not provide sufficient glucose.

5. Insulin sensitivity: Individual variability in insulin sensitivity can lead to unpredictable glucose fluctuations.

To better understand the cause, consider consulting a healthcare professional for personalized guidance.

Please note: This analysis is based on limited data and should not replace medical advice.

PaJR PHR Moderator: @Meta AI 

Regarding your point 1:

Same Lantus dose was given on the night before the hyperglycemia as well as hypoglycemia

Point 2: The timing and quantity of last meal at night appear to be same from what data was shared by the patient's advocate

Regarding 3 @Patient Advocate can you share if her physical activities were significantly different on the night before the morning hyperglycemia vs the night before the morning hypoglycemia today?

Meta AI: You're right; the Lantus dose and dinner timing/quantity seem consistent across both nights.

Regarding physical activity, unfortunately, there's no data provided to compare the patient's physical activities on the two nights. To investigate further:

1. Ask the patient's advocate if there were any changes in physical activity or stress levels on 11/11 compared to 10/11.

2. Consider other factors:

    - Sleep quality/patterns

    - Hormonal changes

    - Other medications or supplements

    - Menstrual cycle (if applicable)

3. Review more detailed medical history and medication regimen.

4. Consult a healthcare professional for personalized guidance.

Additional data or context would help identify the specific factors contributing to the hypoglycemia.

Patient Advocate: 1.30pm blood suger 230

1.30pm 3.5u lispro insulin 

1.40pm lunch with same previous dish, salad and fish

7.15pm banana 

8.30pm 4u lantus insulin 

9.30pm blood sugar 193

9.30pm 1.5u lispro insulin 

9.40pm dinner with as same as lunch dish

13/11/24

PaJR PHR Moderator: Today's fasting?

Patient Advocate: 13.11.24

7.30am fasting 97

7.30am nuts 

7.40am milk

9.30am 3.5u lispro insulin 

9.40am rice with papaya, long beans, bitter gourd, tomato, pointed gourd, brinjal, palses, egg and salad

11.45am mosambi 

1.30pm blood sugar 252

1.30pm  3.5u lispro insulin 

1.40pm lunch with rice with pulses, pointed gourd, carrot, chayote, papaya, long beans,  tomato, fish and salad 

6.00pm one biscuit 

7.00pm Meggie 

8.30pm 4u lantus insulin 

9.30pm blood sugar 243

9.30pm 2u lispro insulin 

9.40pm dinner with rice, brinjal, tomato, long beans, papaya, pointed gourd, mutton and salad

14/11/24

Participant: Happy Childrens Day to our star patient and wishing her the best😄💐

Participant: Today is World Diabetes Day as well.

Patient Advocate: 14/11/24

7.30am blood sugar 88

7.30am nuts 

7.40am milk

Thank you Sir

9.50am 3.5u lispro insulin 

10.00am rice with pulses, pointed gourd, chayote, papaya, long beans, bitter gourd, tomato, spinach, egg and salad 

12.00noon apple

[11:28 PM, 11/14/2024] Patient Advocate: 1.30pm blood sugar 213

1.30pm 3u lispro insulin 

1.40pm lunch with same previous dish except egg and include fish 

7.00pm banana 

8.00pm milk

8.30pm 4u lantus insulin 

9.30pm blood sugar 322

9.30pm 3u lispro insulin 

9.40pm dinner with as same as lunch dish

15/11/24

Patient Advocate: 15.11.24

7.30am blood sugar 152

7.30am nuts 

7.45am milk

9.500am 4u lispro insulin 

10.00am rice with pulses, pointed gourd, chayote, papaya, long beans, bitter gourd, beans, brinjal tomato and salad 

12.00noon mosambi and sugarcane 

1.45pm blood sugar 211

1.45pm 3.5u lispro insulin 

1.50pm lunch with same previous dish and fish

7.00pm banana 

8.15pm 6-7 teaspoon khichdi 

8.30pm 4u lantus insulin 

9.30pm blood suger 342

9.30pm 3.5u lispro insulin 

9.40pm dinner with as same as lunch dish

16/11/24

Patient Advocate: 11.45pm post dinner blood sugar 105

16.11.24

7.30am blood sugar 75

7.30am nuts 

7.45am milk

PaJR PHR Moderator: 👍the night lispro could have been lower although I'm aware it was designed to cater to the pre meal

Patient Advocate: 9.30am 3.5u lispro insulin 

9.40am rice with pointed gourd, tometo, long beans, bitter gourd, papaya 

12.00noon mosambi 

1.45pm blood sugar 206

1.45pm 3u lispro insulin 

1.50pm lunch with same previous dish 

6.50pm banana

8=30pm 4u lispro insulin 

10.00pm blood sugar 57

10.00pm Cadbury chocolate ( two bar)

10.10pm 0.5u lispro insulin 

10.15pm dinner with as same as lunch dish

17/11/24

Patient Advocate: 12.15am post dinner blood sugar 246

PaJR PHR Moderator: 👆We suggested lowering the night lispro but you increased it!! 😳

Any symptoms?

👆 no lantus yesterday?

Patient Advocate: ড্যান্স করছিল করতে করতে বলছিল আমার আর নাচতে ইচ্ছে করছে না

8.30pm ওটা lispro হবে না ওটা lantus হবে

17.11.24

7.30এম blood suger 110

7.30am nuts 

7.45am milk with aata roti

PaJR PHR Moderator: Etai ki prothom ore HYPOGLYCEMIA jorito ekta symptom jeta prothom amra jante parlam?

Patient Advocate: 9.30am 4u lispro insulin 

9.40am rice with papaya, long beans, pulses pointed gourd bitter gourd, tomato, beans and salad

হ্যাঁ স্যার বাড়িতে বিয়ে তো তাই খুব নাচা নাচি করছিল গতকাল প্রায় 2.5-3 ঘণ্টা নেচেছিল

PaJR PHR Moderator: @Meta AI please translate below:

হ্যাঁ স্যার বাড়িতে বিয়ে তো তাই খুব নাচা নাচি করছিল গতকাল প্রায় 2.5-3 ঘণ্টা নেচেছিল

Meta AI: Here's the translation:

"Yes, sir, there was a wedding at home, so I danced a lot yesterday, approximately for 2.5-3 hours."

This information suggests that the patient engaged in significant physical activity (dancing) on the night before the morning hypoglycemia, which could be a contributing factor to the low blood sugar.

Patient Advocate: 12.00noon pear

1.30pm blood sugar 58

1.30pm 1.5u lispro insulin 

1.40pm lunch with same previous dish and fish 

4.00pm blood sugar 68

Gems

4.00pm gem

5pcs gems chocolate

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