JULY 2024 - 3 Years Old child, Type1 Diabetes, Insulin Hypoglycemia, Intermittent, Bloating 1 Month

PATIENT DATA LOG OF JULY - 2024


01/08/24

Patient Advocate: 01/07/24

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

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

11.50am blood suger 161

12.00noon mango 

1.45pm 2u lispro insulin 

1.50pm lunch with same as previous dish and egg

6.00pm sour curd with salt

7.00pm maggi 

9.45pm blood sugar 81

9.50pm 2u lispro insulin 

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

10.40pm 3u lantus insulin


2/7/24

Patient Advocate: 12.00night blood suger 91


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

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


Patient Advocate: কোন গুলোর ছাবি স্যার ?


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

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

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


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

7.45am blood sugar 108

7.45am milk and puffed rice 

9.45am  2u lispro insulin 

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

12.00noon mango 

2.00pm 2u lispro insulin 

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

4.15pm blood sugar 147

6.15pm sour curd 

7.15pm maggi

9.45pm blood sugar 95

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch with and salad 

10.40pm 3u lantus insulin


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


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


Patient Advocate 2F Diabetes1: 01/07/24

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

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

11.50am blood suger 161

12.00noon mango 

1.45pm 2u lispro insulin 

1.50pm lunch with same as previous dish and egg

6.00pm sour curd with salt

7.00pm maggi 

9.45pm blood sugar 81

9.50pm 2u lispro insulin 

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

10.40pm 3u lantus insulin


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


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

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


Patient Advocate 2F Diabetes1: কোন গুলোর ছাবি স্যার ?


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


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

Baki shudhu text guno copy paste korle habe

👆Ekhane jebhabe dekhano sheibhabe text hishebe pathan Patient Advocate 

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

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


Patient Advocate: Ok


PaJR PHR Moderator: Aei chart tar kotha bolchilam

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


Patient Advocate:








PaJR PHR Moderator: Well done Patient Advocate 👏👏


2/07/24

Patient Advocate:

7.40am milk with puffed rice 

9.45am 2u lispro insulin 

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

12.00noon sagu with mango and banana 

1.45pm blood suger  90

1.45pm  2u lispro insulin 

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

5.30pm sour curd with salt 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.45am 3u lantus insulin


03/07/24

Patient Advocate: 02/04/24

12.00midnight blood suger 63

Then 1/3 teaspoon sugar

03/07/24

7.45am milk with puffed rice 

9.45am 2u lispro insulin 

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

12.00noo blood sugar 47

Than 1/2 teaspoon sugar 

One mango 

1.30pm 1u lispro insulin 

1.40pm lunch with same previous dish and egg

5.30pm sour curd with salad

7.00pm oats

9.30pm blood sugar 184

9.40pm 2u lispro insulin 

9.50pm dinner with as same as lunch dish 

10.45pm 3u lantus insulin


04/07/24

PaJR PHR Moderator: Needed to reduce night lantus too?

What's today's fasting?


Patient Advocate: 04/07/24

7.45am blood sugar 86

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm 2u lispro insulin 

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

4.00pm blood sugar 73

5.30pm sour curd with salt 

7.00pm oats 

9.30pm 2u lispro insulin 

9.40pm dinner with as same as lunch dish 

10.30pm 2u lantus insulin


05/07/24

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


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


Patient Advocate: Yes

05/07/24

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon blood sugar 108

12.00noon  mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish 

5.30pm sour curd 

7.00pm oats 

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

9.30pm blood suger 366

9.40pm 2u lispro insulin 

9.50pm dinner with as same as lunch dish 

10.30pm 3u lantus insulin


06/07/24

PaJR PHR Moderator: The sweety payesh!


07/07/24

Patient Advocate: 06/07/24

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon 1/2 mango

1.45pm blood suger 266

1.50pm 2u lispro insulin 

2.00pm lunch with same previous dish and paneer

5.30pm sour curd 

7.15pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish and salad 

10.40pm 3u lantus insulin 

12.00night blood suger 111


07/07/24

7.45am blood sugar 181

7.45am milk and puffed rice

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


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

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


08/07/24

Patient Advocate: 07/07/24

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and fish 

4.00pm blood suger 233

5.30pm sour curd  

7.00pm oats

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.30pm 4u kantu insulin

Kantu> lantus


08/07/24

7.45am blood sugar 90

9.45am 2u lispro insulin 

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

11.55am blood suger 263

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and paneer 

5.30pm sour curd 

7.30pm oats

9.45pm blood suger 154

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin


10/07/24

Patient Advocate: 9.07.24

7.30am milk with puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm blood suger 183

1.50pm 2u lispro insulin 

2.00pm lunch with same as previous dish and egg 

5.30pm sour curd 

7.00pm oats 

8.30pm two teaspoons prasad ( khichudi)

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish except egg 

10.30pm 4u lantus insulin 

12.00night blood sugar 122


10/07/24

7.45am blood sugar 99

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm 2u lispro insulin

1.55pm lunch with same previous dish and egg 

4.00pm blood suger after lunch 123

5.30pm sour curd 

7.30pm one banana and grist ( two teaspoons)

9.30pm 2u lispro insulin 

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

10.30pm 4u lantus insulin


11/07/24

Patient Advocate:

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon blood suger 137

12.00noon mango 

1.45pm 2u lispro insulin 

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

6.00pm sour curd 

7.15pm aata roti one pc with ghee and salt

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4U lantus insulin


13/07/24

Patient Advocate: 12/07/24

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon blood suger 223

12.00noon mango 

1.45pm 2u lispro insulin 

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

5.30pm sour curd 

7.15pm banana 

9.45pm blood suger 44

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin 

12.00night blood suger 212

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


13/07/24

7.45am blood sugar 142

7.45am milk with puffed rice


PaJR PHR Moderator:

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

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

 7.45am blood sugar 99

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm 2u lispro insulin

1.55pm lunch with same previous dish and egg 

4.00pm blood suger after lunch 123

5.30pm sour curd 

7.30pm one banana and grist ( two teaspoons)

9.30pm 2u lispro insulin 

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

10.30pm 4u lantus insulin

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

9.45am 2u lispro insulin 

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

12.00noon blood suger 137

12.00noon mango 

1.45pm 2u lispro insulin 

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

6.00pm sour curd 

7.15pm aata roti one pc with ghee and salt

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4U lantus insulin

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

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon blood suger 223

12.00noon mango 

1.45pm 2u lispro insulin 

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

5.30pm sour curd 

7.15pm banana 

9.45pm blood suger 44

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin 

12.00night blood suger 212

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

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

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

13/07/24

7.45am blood sugar 142

7.45am milk with puffed rice


Meta AI:

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

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

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

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

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

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


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


Patient Advocate: No symptoms 

She was in normal activities like reading, dancing and playing


PaJR PHR Moderator: This is problematic!

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

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

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

Full text link 👇

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

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

Unquote

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

Impaired awareness of hypoglycemia (IAH) therapies

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

Unquote

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


14/07/24

Patient Advocate: 13.07.24

9.45am 2u lispro insulin 

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

12.00noon guava 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and paneer 

4.00pm blood suger 169

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 3u lantus insulin


14/07/24

7.30am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon blood sugar 99

12.00noon mango 

1.45pm 2u lispro insulin 

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

5.30pm sour curd 

7.00pm oats 

8.00pm jackfruit 

9.45pm Blood suger 308

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.45pm 4u lantus insulin


15/07/24

Patient Advocate:

Quantity of Jackfruit

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


Patient Advocate: Yes Sir


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


Patient Advocate: It was without added sugar


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


Patient Advocate: Ok Sir


16/07/24

Patient Advocate: 15/07/24

7.30am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm blood sugar 224

1.50pm 2u lispro insulin 

2.00pm lunch with same previous dish and paneer 

5.30 pm sour curd 

7.00pm one  banana and sweet (sandesh)

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

12.00night blood suger 180


17/07/24

Patient Advocate: 16/07/24

7.30am blood sugar 135

7.30am milk and puffed rice 

9.45am 2u lispro insulin 

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

12..00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and fish 

4.00pm blood sugar 64

5.30pm sour curd 

7.00pm pineapple 

7.30pm payesh (with diabexy sugar)

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin 

12.00night blood suger 79

Sour curd


Payesh making with milk, kaun  rice and diabexy sugar


PaJR PHR Moderator: 👍

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


Patient Advocate: Ok thank you Sir

17/07/24

7.45am nuts and dates 

8.00am milk and puffed rice 

9.50am 2u lispro insulin 

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

12.00noon mango and sago mixed without sugar 

1.50pm 2u lispro insulin 

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

4.00pm blood suger 249

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

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

10.30pm 4u lantus insulin


18/07/24

PaJR PHR Moderator: 👍


Patient Advocate: 18/07/24

7.30am nuts and dates 

8.00am milk and puffed rice


19/07/24

Patient Advocate: 18.07/24

9.45am 2u lispro insulin 

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

12.00nonn blood suger 186

12.05pm mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and include fish 

5.30pm one egg

7.00pm oats

9.30pm blood sugar 70

9.30pm one small piece of creamy cake 

9.45pm 2u lispro insulin 

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

10.40pm 4u lantus insulin


19/07/24

7.30am nuts

7.45am milk and puffed rice 

9.45am 2u lispro insulin

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

12.00noon mango 

1.45pm blood sugar 114

1.45pm 2u lispro insulin 

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

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as previous dish 

10.45pm 4u lantus insulin


20/07/24

Patient Advocate: 12.00night blood suger 168


PaJR PHR Moderator: 👍


Patient Advocate: 20/07/24

7.30am blood sugar 173

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45am 2u lispro insulin 

1.45pm lunch with same previous dish and paneer 

4.00pm blood sugar 286

5.30pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin


21/07/24

Patient Advocate: 21/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon blood suger 250

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and fish 

5.30pm sour curd 

7.00pm oats 

8.30pm banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin


22/07/24

Patient Advocate: 12.00night blood sugar 135


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


Patient Advocate: No Sir

22/07/24

7.30am nuts and dates 

7.45am milk and puffed 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm 2u lispro insulin 

1.55pm lunch with same previous dish and paneer 

4.00pm blood suger 214

5.30pm sour curd 

7.00pm oats 

9.30pm blood sugar 279

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm lantus insulin 4u


23/07/24

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


Patient Advocate:



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

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


Narmeen Shah: Thank you sir.

Patient Advocate: 23/07/24

7.30am blood sugar 122

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm 2u lispro insulin 

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

4.00pm blood sugar 230

5.30pm sour curd

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


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


24/07/24

Patient Advocate: 23/07/24

7.00pm oats 

9.30pm blood sugar 259

9.45pm  3u lispro insulin 

9.55dinner with as same as lunch dish 

10.40pm 4u lantus insulin

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

12.00night blood sugar 185


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

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


Patient Advocate: Yes Sir

24/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon blood suger 285

12.00noon mango 

1.45pm 2u lispro insulin 

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

5.30pm sour curd 

7.15pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin


25/07/24

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

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

Always remember hypoglycemia is more dangerous than hyperglycemia.


Patient Advocate: 24/07/24

9.45pm blood sugar before dinner 248

25/07/27

7.30am blood sugar 124

Sir 

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


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


Patient Advocate: 25/07/24

7.30am blood suger 124

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am  2u lispro insulin 

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

12.00noon mango 

1.45pm blood sugar 104

1.45pm 2u lispro insulin

1.55pm lunch with same previous dish and egg 

5.30pm sour curd 

7.00pm oats 

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

10.40pm 5u lantus insulin


27/07/24

Patient Advocate: 26/07/24

7.30am blood suger 74

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

2.30pm 2u lispro insulin 

2.40pm lunch with as same as previous dish and fish 

4.50pm blood sugar 211

5.30pm sour curd 

7.30pm banana 

9.30pm 25ml sugar free icecream 

10.10pm 2u lispro insulin 

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

11.00pm 5u lantus insulin


27/07/24

7.30am nuts and dates 

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

10.00am 2u lispro insulin 

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

12.15pm blood sugar 242

12.15pm mango 

2.00pm 2u lispro insulin 

2.10pm lunch with same previous dish and paneer 

6.00pm sour curd 

7.00pm sugar free icecream 

7.30pm oats 

10.00pm 2u lispro insulin 

10.10pm dinner with as same as previous dish 

10.45pm 5u lantus insulin

10.00pm blood sugar before dinner 183


28/07/24

PaJR PHR Moderator: 👍


Patient Advocate: Good evening Sir 

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

28/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm 2u lispro insulin 

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

4.00pm blood suger 232

5.45pm sour curd 

7.00pm oats 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin


29/07/24

PaJR PHR Moderator: ENT dekhano dorkar

Chobio share korun





30/07/24

Patient Advocate: 29/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango

1.45pm blood sugar 207

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish except egg 

4.00pm blood sugar 83

5.30pm sour curd 

7.38pm banana 2pcs

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 5u lantus insulin


PaJR PHR Moderator: Increasing the lispro by 1 unit before lunch nearly went close to a hypo!


31/07/24

Patient Advocate: 30/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin

9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pointed gourd, bitter gourd, pumpkin, egg and salad 

12.00noon mango 

1.45pm blood sugar 275

1.45pm 3u lispro insulin 

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

4.00pm blood sugar 237

5.30pm sour curd 

7.00pm oats

9.45pm blood suger 93

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin


31/07/24

7.30am nuts and dates 

7.45am milk and puffed rice 

9.45am 2u lispro insulin 

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

12.00noon mango 

1.45pm 3u lispro insulin 

1.55pm lunch with same previous dish and paneer 

4.00pm blood suger 101

5.30pm sour curd 

8.00pm 2pcs banana 

9.45pm 2u lispro insulin 

9.55pm dinner with as same as lunch dish 

10.40pm 4u lantus insulin


01/08/24

Patient Advocate: 31/07/24

12.00night blood suger after dinner 166


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