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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3/20/24
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.
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
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:
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
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:
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
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
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
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
Good
ReplyDeleteThank you sir.
Delete