SEPTEMBER 2024 - 3 Years Old child, Type1 Diabetes, Insulin Hypoglycemia, Intermittent, Bloating 1 Month
PATIENT DATA LOG OF SEPTEMBER - 2024
01/09/24
Patient Advocate: 1.09.24
7.30am blood suger 80
7.30am nuts and dates
7.45am milk and puffed
02/09/24
Patient Advocate: 9.45am 2u lispro insulin
9.55am rice with papaya, chayote, green banana, long beans, Spiny guard, pumpkin, egg and salad
12.00noon mosambi, apple
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 228
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
PaJR PHR Moderator: (Gotokal er fasting dekhe uporer montobbo korechilam.
Aajker fasting ta jaante parle bhalo hoto) đ
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 jaiāĨ¤
Abar air ta barkore diye tarpor push korle takhon sugar level thik thak asheāĨ¤
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 jaiāĨ¤
Abar air ta barkore diye tarpor push korle takhon sugar level thik thak asheāĨ¤
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: đ@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 jaiāĨ¤
Abar air ta barkore diye tarpor push korle takhon sugar level thik thak asheāĨ¤
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 đ
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:
Iâm 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 airâĻ 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!
Hereâs one, but if you have something in a local language, itâll 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?
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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 đ
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. đ
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 đ
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 đ
Keep adding these to her online case report too
Narmeen Shah: Ok sir đ
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 đ
06/09/24
Patient Advocate: 5.09.24
7.30am nuts and dates
7.45am milk
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, green banana, papaya, long beans, bitter gourd, egg and salad
12.00noon blood sugar 249
12.00noon mosambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 71
5.30pm sour curd
7.00pm banana
9.30pm pizza
9.45pm 2u lispro insulin
9.55pm rice with as same as lunch dish
10.40pm 4u lantus insulin
PaJR PHR Moderator: 2 unit of lispro appears less and 3 units appears dangerously close to hypoglycemia!
If only we could procure 2.5
Check fasting sugars to decide the suitability of the current lantus dose
Participant 20: Why not Actrapid? Slightly lesser peak than Lispro and a couple hours more duration of action.
https://drive.google.com/file/d/1_WP94jHW5P8t620REGJGX0rEmHYxdig5/view?usp=sharing
This is a document on "Dose adjustment for normal eating (DAFNE)" which allows for precise calculation of carbohydrate portion and adjust insulin doses accordingly.
The standard recommendation for 1 CP is 1 unit Lispro (Humalog). But I would advise to start with 1/2 (half) unit for each CP to see how the child responds.
16/09/24
PaJR PHR Moderator:
"Dyadic conversational inputs around this patient that would be useful for the entire team of learners here:
Pediatric Endocrinologist: Very useful! Thank you. If the stated assumptions are true (can it be checked?).
Moderator: @Narmeen Shah please see if you can verify the stated assumption/conclusion from your graph as in numbered the lines below:
1)...then, the fasting (pre-bf) is a tad too low.
The lid pro insulin at bf is not enough (bolts insulin has two jobs - to bring the pre-meal blood sugar down, if itâs high, and to cover the carbs + protein eaten at the meal).
2) In this case, the pre-bf values is on the lower end, and the post bf is very high.
So she needs more insulin at breakfast, not unexpected (âfirst meal effectâ). The lid pro at lunch is good to cover her lunch (pre- and post-lunch are very similar, so if pre-lunch is decreased, post-lunch will also be lower).
Her dinner list spro is too much. So, I think if her breakfast lispro is increased, and dinner lispro is decreased, her sugars will even out.
This graph should be repeated every 2 weeks and adjustments need to be made.
PaJR moderator: Very valuable inputs for this patient. I guess the catch is in the dose increments and decrements as we are unable to increase it by 0.5U that would be safer?
Pediatric Endocrinologist: True, but I would reduce dinner lispro by 1 unit and increase breakfast lispro by 1
PaJR moderator: I guess that may have been done in the past if we could wade through the entire case report events documented till date since months and hence we were hung on titrating with 0.5."
Patient Advocate: 7.00,pm banana
9.45pm blood sugar 289
9.45pm 3u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
7.30am blood sugar 90
7.30am nuts and dates
7.42am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, long beans, Spiny guard, ribbed gourd, egg and salad
12.00noon blood suger 297
12.00noon mosambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm banana
17/09/24
PaJR PHR Moderator:
"Query:
Why it is happening that sugar levels are that much low in pre breakfast and high in post breakfast and low at night. Check the above daily routine again from sep 1 - sept 13 and analyze the keen aspect.
ChatGPT said:
The pattern of blood sugar levels being low in pre-breakfast and high in post-breakfast, followed by low at night, can be analyzed in the context of the provided daily routine and insulin doses. Hereâs a detailed look at the possible reasons behind this pattern:
1. Pre-Breakfast Low Blood Sugars:
- - Lantus (long-acting insulin) is administered at 10:40 pm, which peaks during the night, potentially contributing to low blood sugar in the morning (pre-breakfast).
- - The fasting blood sugars are quite low on several days (e.g., 72 on 11/09, 53 on 12/09). This suggests the night dose of Lantus (4 units) might be slightly too high, as indicated by the PaJR PHR Moderator's recommendation to reduce Lantus to 3 units.
- - Overnight hypoglycemia (unnoticed due to lack of symptoms) may occur, leading to low morning fasting levels.
- - The low pre-breakfast levels may also be due to prolonged fasting (i.e., the time gap between dinner and breakfast).
2. Post-Breakfast High Blood Sugars:
- - The Lispro dose given at breakfast (2 units) appears insufficient to handle the carbohydrates and protein in the breakfast meal.
- - On many days, the post-breakfast sugars spike (e.g., 267 on 03/09, 282 on 13/09), indicating that the insulin-to-carbohydrate ratio at breakfast is inadequate.
- - The phenomenon of "dawn phenomenon" or "first meal effect" could also be at play, where insulin resistance is typically higher in the morning, requiring more insulin at breakfast.
- - The meal composition (e.g., puffed rice, nuts, dates) likely contains high glycemic index (GI) carbs that cause rapid spikes in blood sugar, and 2 units of Lispro may not be enough to manage this.
3. Low Nighttime Blood Sugars:
- - After dinner, the pre-bedtime sugar levels (e.g., 57 on 13/09) are quite low, which suggests that the dinner Lispro dose (2 units) may be too high relative to the amount of carbs consumed at dinner.
- - The insulin sensitivity increases at night, which means the same dose of insulin might have a stronger effect, leading to low blood sugars before bed or overnight hypoglycemia.
- - The combination of long-acting Lantus and short-acting Lispro at night could be causing excessive lowering of blood sugars during the night, especially if the evening meal has fewer carbohydrates or if there is less activity.
Key Analysis Points:
1. Breakfast Lispro Dose Insufficient:
- - The post-breakfast blood sugars are significantly higher than pre-breakfast levels. The 2-unit Lispro given at breakfast may not be covering the amount of carbs/protein in breakfast or dealing with the "dawn phenomenon."
- - Increasing the Lispro dose at breakfast (e.g., from 2 units to 3 units) might help better manage these spikes.
2. Lantus Dose Too High at Night:
- - The low pre-breakfast blood sugars suggest the Lantus dose needs to be reduced at night. Reducing it from 4 units to 3 units might prevent nighttime hypoglycemia.
- - The PaJR PHR Moderator suggested this adjustment to optimize the nighttime glucose levels.
3. Dinner Lispro Needs Adjustment:
- - The 2 units of Lispro at dinner may be too much, especially if the evening meal is low in carbs. Reducing this dose to 1 or 1.5 units might prevent low post-dinner and pre-bedtime sugar levels.
4. Monitoring and Adjustments:
- - Continuous Glucose Monitoring (CGM) or frequent blood sugar checks might be necessary to track fluctuations throughout the day, especially overnight.
- - Adjusting both meal composition and insulin doses for different times of day is key to preventing these high-low swings.
Suggested Next Steps:
- - Increase Lispro dose at breakfast to 3 units to manage the morning spike.
- - Reduce Lantus to 3 units at night to prevent pre-breakfast lows.
- - Reduce Lispro at dinner (possibly to 1.5 units) to avoid low nighttime sugars.
This should help smooth out the extremes and stabilize blood sugar levels throughout the day.
Disclaimer:
The information provided in this analysis is intended for experimental and informational purposes only. It is not meant to replace professional medical advice, diagnosis, or treatment. Do not use this analysis as medical advice, as it could lead to unintended consequences or complications. Always seek the guidance of a healthcare professional before making any adjustments to your diabetes management plan.
PaJR PHR Moderator: Done by @Narmeen Shah. Please share the image showing your method too here
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āĻŽā§āĻ˛ āĻŦāĻŋāĻļā§āĻ˛ā§āĻˇāĻŖā§āĻ° āĻŦāĻŋāĻˇāĻ¯āĻŧ:
ā§§. āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§ āĻĄā§āĻ āĻ āĻĒāĻ°ā§āĻ¯āĻžāĻĒā§āĻ¤:
- āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻĒāĻ°ā§ āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻž āĻĒā§āĻ°āĻžāĻ-āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ° āĻŽāĻžāĻ¤ā§āĻ°āĻžāĻ° āĻ¤ā§āĻ˛āĻ¨āĻžāĻ¯āĻŧ āĻāĻ˛ā§āĻ˛ā§āĻāĻ¯ā§āĻā§āĻ¯āĻāĻžāĻŦā§ āĻŦā§āĻļāĻŋāĨ¤ āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻ¸āĻŽāĻ¯āĻŧ āĻĻā§āĻāĻ¯āĻŧāĻž 2-āĻāĻāĻ¨āĻŋāĻ āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§ āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻāĻžāĻ°ā§āĻŦā§āĻšāĻžāĻāĻĄā§āĻ°ā§āĻ/āĻĒā§āĻ°ā§āĻāĻŋāĻ¨ā§āĻ° āĻĒāĻ°āĻŋāĻŽāĻžāĻŖāĻā§ āĻāĻāĻžāĻ° āĻāĻ°ā§ āĻ¨āĻž āĻŦāĻž "āĻā§āĻ°ā§āĻ° āĻāĻāĻ¨āĻž" āĻ¨āĻŋāĻ¯āĻŧā§ āĻāĻžāĻ āĻāĻ°āĻ¤ā§ āĻĒāĻžāĻ°ā§ āĻ¨āĻžāĨ¤
- āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻ¸āĻŽāĻ¯āĻŧ Lispro āĻĄā§āĻ āĻŦāĻžāĻĄāĻŧāĻžāĻ¨ā§ (āĻ¯ā§āĻŽāĻ¨, 2 āĻāĻāĻ¨āĻŋāĻ āĻĨā§āĻā§ 3 āĻāĻāĻ¨āĻŋāĻ) āĻāĻ āĻ¸ā§āĻĒāĻžāĻāĻāĻā§āĻ˛āĻŋāĻā§ āĻāĻ°āĻ āĻāĻžāĻ˛āĻāĻžāĻŦā§ āĻĒāĻ°āĻŋāĻāĻžāĻ˛āĻ¨āĻž āĻāĻ°āĻ¤ā§ āĻ¸āĻšāĻžāĻ¯āĻŧāĻ¤āĻž āĻāĻ°āĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤
āĻĒā§āĻ°āĻļā§āĻ¨*
āĻā§āĻ¨ āĻāĻŽāĻ¨ āĻšāĻā§āĻā§ āĻ¯ā§ āĻ¸āĻāĻžāĻ˛ā§āĻ° āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ¯āĻŧ āĻāĻŋāĻ¨āĻŋāĻ° āĻŽāĻžāĻ¤ā§āĻ°āĻž āĻ āĻ¨ā§āĻ āĻāĻŽ āĻāĻŦāĻ āĻ¸āĻāĻžāĻ˛ā§āĻ° āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ¯āĻŧ āĻŦā§āĻļāĻŋ āĻāĻŦāĻ āĻ°āĻžāĻ¤ā§ āĻāĻŽāĨ¤ 1 āĻ¸ā§āĻĒā§āĻā§āĻŽā§āĻŦāĻ° āĻĨā§āĻā§ 13 āĻ¸ā§āĻĒā§āĻā§āĻŽā§āĻŦāĻ° āĻĒāĻ°ā§āĻ¯āĻ¨ā§āĻ¤ āĻāĻĒāĻ°ā§āĻ° āĻĻā§āĻ¨āĻŋāĻ āĻ°ā§āĻāĻŋāĻ¨āĻāĻŋ āĻāĻŦāĻžāĻ° āĻĒāĻ°ā§āĻā§āĻˇāĻž āĻāĻ°ā§āĻ¨ āĻāĻŦāĻ āĻĒā§āĻ°āĻāĻ° āĻĻāĻŋāĻāĻāĻŋ āĻŦāĻŋāĻļā§āĻ˛ā§āĻˇāĻŖ āĻāĻ°ā§āĻ¨āĨ¤
āĻā§āĻ¯āĻžāĻāĻāĻŋāĻĒāĻŋāĻāĻŋ āĻŦāĻ˛ā§āĻā§āĻ¨:
āĻĒā§āĻ°āĻžāĻ-āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ¯āĻŧ āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻŽāĻžāĻ¤ā§āĻ°āĻž āĻāĻŽ āĻāĻŦāĻ āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻĒāĻ°ā§ āĻāĻā§āĻāĻ¤āĻ° āĻšāĻāĻ¯āĻŧāĻžāĻ° āĻ§āĻ°āĻŖ, āĻ°āĻžāĻ¤ā§ āĻāĻŽ āĻšāĻāĻ¯āĻŧāĻžāĻ° āĻĒāĻ°, āĻĒā§āĻ°āĻĻāĻ¤ā§āĻ¤ āĻĻā§āĻ¨āĻŋāĻ āĻ°ā§āĻāĻŋāĻ¨ āĻāĻŦāĻ āĻāĻ¨āĻ¸ā§āĻ˛āĻŋāĻ¨ā§āĻ° āĻŽāĻžāĻ¤ā§āĻ°āĻžāĻ° āĻĒāĻ°āĻŋāĻĒā§āĻ°ā§āĻā§āĻˇāĻŋāĻ¤ā§ āĻŦāĻŋāĻļā§āĻ˛ā§āĻˇāĻŖ āĻāĻ°āĻž āĻ¯ā§āĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤ āĻāĻāĻžāĻ¨ā§ āĻāĻ āĻĒā§āĻ¯āĻžāĻāĻžāĻ°ā§āĻ¨ā§āĻ° āĻĒāĻŋāĻāĻ¨ā§ āĻ¸āĻŽā§āĻāĻžāĻŦā§āĻ¯ āĻāĻžāĻ°āĻŖāĻā§āĻ˛āĻŋāĻ° āĻāĻāĻāĻŋ āĻŦāĻŋāĻļāĻĻ āĻā§āĻšāĻžāĻ°āĻž āĻ°āĻ¯āĻŧā§āĻā§:
ā§§. āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻ˛ā§ āĻŦā§āĻ˛āĻžāĻĄ āĻ¸ā§āĻāĻžāĻ°:
- āĻ˛ā§āĻ¯āĻžāĻ¨ā§āĻāĻžāĻ¸ (āĻĻā§āĻ°ā§āĻ-āĻ āĻāĻŋāĻ¨āĻ¯āĻŧ āĻāĻ¨āĻ¸ā§āĻ˛āĻŋāĻ¨) āĻ°āĻžāĻ¤ā§āĻ°āĻŋ 10:40 āĻāĻžāĻ¯āĻŧ āĻĒāĻ°āĻŋāĻāĻžāĻ˛āĻŋāĻ¤ āĻšāĻ¯āĻŧ, āĻ¯āĻž āĻ°āĻžāĻ¤ā§āĻ° āĻŽāĻ§ā§āĻ¯ā§ āĻ¸āĻ°ā§āĻŦā§āĻā§āĻ āĻĒāĻ°ā§āĻ¯āĻžāĻ¯āĻŧā§ āĻĒā§āĻāĻāĻžāĻ¯āĻŧ, āĻ¸āĻŽā§āĻāĻžāĻŦā§āĻ¯āĻāĻžāĻŦā§ āĻ¸āĻāĻžāĻ˛ā§ (āĻĒā§āĻ°āĻžāĻ-āĻāĻžāĻāĻ¯āĻŧāĻž) āĻāĻŽ āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻā§āĻˇā§āĻ¤ā§āĻ°ā§ āĻ āĻŦāĻĻāĻžāĻ¨ āĻ°āĻžāĻā§āĨ¤
- āĻāĻĒāĻŦāĻžāĻ¸ā§āĻ° āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻĒāĻ°āĻŋāĻŽāĻžāĻŖ āĻŦā§āĻļ āĻāĻ¯āĻŧā§āĻāĻĻāĻŋāĻ¨ā§ āĻāĻŽ āĻĨāĻžāĻā§ (āĻ¯ā§āĻŽāĻ¨, 11/09 āĻ¤āĻžāĻ°āĻŋāĻā§ 72, 12/09 āĻ¤āĻžāĻ°āĻŋāĻā§ 53)āĨ¤ āĻāĻāĻŋ āĻĒāĻ°āĻžāĻŽāĻ°ā§āĻļ āĻĻā§āĻ¯āĻŧ āĻ¯ā§ āĻ˛ā§āĻ¯āĻžāĻ¨ā§āĻāĻžāĻ¸ (4 āĻāĻāĻ¨āĻŋāĻ) āĻāĻ° āĻ°āĻžāĻ¤ā§āĻ° āĻĄā§āĻ āĻāĻŋāĻā§āĻāĻž āĻŦā§āĻļāĻŋ āĻšāĻ¤ā§ āĻĒāĻžāĻ°ā§, āĻ¯ā§āĻŽāĻ¨āĻāĻŋ āĻ˛ā§āĻ¯āĻžāĻ¨ā§āĻāĻžāĻ¸āĻā§ 3 āĻāĻāĻ¨āĻŋāĻā§ āĻāĻŽāĻžāĻ¨ā§āĻ° āĻāĻ¨ā§āĻ¯ PaJR PHR āĻŽāĻĄāĻžāĻ°ā§āĻāĻ°ā§āĻ° āĻ¸ā§āĻĒāĻžāĻ°āĻŋāĻļ āĻĻā§āĻŦāĻžāĻ°āĻž āĻ¨āĻŋāĻ°ā§āĻĻā§āĻļāĻŋāĻ¤ āĻšāĻ¯āĻŧā§āĻā§āĨ¤
- āĻ°āĻžāĻ¤āĻžāĻ°āĻžāĻ¤āĻŋ āĻšāĻžāĻāĻĒā§āĻā§āĻ˛āĻžāĻāĻ¸ā§āĻŽāĻŋāĻ¯āĻŧāĻž (āĻ˛āĻā§āĻˇāĻŖā§āĻ° āĻ āĻāĻžāĻŦā§āĻ° āĻāĻžāĻ°āĻŖā§ āĻ āĻ˛āĻā§āĻˇāĻŋāĻ¤) āĻāĻāĻ¤ā§ āĻĒāĻžāĻ°ā§, āĻ¯āĻžāĻ° āĻĢāĻ˛ā§ āĻ¸āĻāĻžāĻ˛ā§āĻ° āĻāĻĒāĻŦāĻžāĻ¸ā§āĻ° āĻŽāĻžāĻ¤ā§āĻ°āĻž āĻāĻŽ āĻšāĻ¯āĻŧāĨ¤
- āĻĒā§āĻ°āĻžāĻ-āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ° āĻāĻŽ āĻŽāĻžāĻ¤ā§āĻ°āĻž āĻĻā§āĻ°ā§āĻāĻžāĻ¯āĻŧāĻŋāĻ¤
āĻāĻĒāĻŦāĻžāĻ¸ā§āĻ° āĻāĻžāĻ°āĻŖā§āĻ āĻšāĻ¤ā§ āĻĒāĻžāĻ°ā§
(āĻ āĻ°ā§āĻĨāĻžā§, āĻ°āĻžāĻ¤ā§āĻ° āĻāĻžāĻŦāĻžāĻ° āĻāĻŦāĻ
āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻŽāĻ§ā§āĻ¯ā§ āĻ¸āĻŽāĻ¯āĻŧā§āĻ° āĻŦā§āĻ¯āĻŦāĻ§āĻžāĻ¨)
2. āĻ¸āĻāĻžāĻ˛ā§āĻ° āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ° āĻĒāĻ°ā§ āĻāĻā§āĻ āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻž:*
- āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§ āĻĻā§āĻāĻ¯āĻŧāĻž āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§ āĻĄā§āĻ (2 āĻāĻāĻ¨āĻŋāĻ) āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻāĻžāĻŦāĻžāĻ°ā§ āĻāĻžāĻ°ā§āĻŦā§āĻšāĻžāĻāĻĄā§āĻ°ā§āĻ āĻāĻŦāĻ āĻĒā§āĻ°ā§āĻāĻŋāĻ¨ āĻĒāĻ°āĻŋāĻāĻžāĻ˛āĻ¨āĻž āĻāĻ°āĻžāĻ° āĻāĻ¨ā§āĻ¯ āĻ āĻĒāĻ°ā§āĻ¯āĻžāĻĒā§āĻ¤ āĻŦāĻ˛ā§ āĻŽāĻ¨ā§ āĻšāĻ¯āĻŧāĨ¤
- āĻ āĻ¨ā§āĻ āĻĻāĻŋāĻ¨, āĻ¸āĻāĻžāĻ˛ā§āĻ° āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ° āĻĒāĻ° āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻĒāĻ°āĻŋāĻŽāĻžāĻŖ āĻŦā§āĻĄāĻŧā§ āĻ¯āĻžāĻ¯āĻŧ (āĻ¯ā§āĻŽāĻ¨, 03/09 āĻ¤āĻžāĻ°āĻŋāĻā§ 267, 13/09 āĻ¤āĻžāĻ°āĻŋāĻā§ 282), āĻāĻā§āĻāĻŋāĻ¤ āĻāĻ°ā§ āĻ¯ā§ āĻ¸āĻāĻžāĻ˛ā§āĻ° āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ¯āĻŧ āĻāĻ¨āĻ¸ā§āĻ˛āĻŋāĻ¨-āĻĨā§āĻā§-āĻāĻžāĻ°ā§āĻŦā§āĻšāĻžāĻāĻĄā§āĻ°ā§āĻ āĻ āĻ¨ā§āĻĒāĻžāĻ¤ āĻ āĻĒāĻ°ā§āĻ¯āĻžāĻĒā§āĻ¤āĨ¤
- "āĻā§āĻ°ā§āĻ° āĻāĻāĻ¨āĻž" āĻŦāĻž "āĻĒā§āĻ°āĻĨāĻŽ āĻāĻžāĻŦāĻžāĻ°ā§āĻ° āĻĒā§āĻ°āĻāĻžāĻŦ" āĻāĻ° āĻāĻāĻ¨āĻžāĻāĻŋāĻ āĻā§āĻ˛āĻ¤ā§ āĻĒāĻžāĻ°ā§, āĻ¯ā§āĻāĻžāĻ¨ā§ āĻāĻ¨āĻ¸ā§āĻ˛āĻŋāĻ¨ āĻĒā§āĻ°āĻ¤āĻŋāĻ°ā§āĻ§ āĻ¸āĻžāĻ§āĻžāĻ°āĻŖāĻ¤ āĻ¸āĻāĻžāĻ˛ā§ āĻŦā§āĻļāĻŋ āĻšāĻ¯āĻŧ, āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻ¸āĻŽāĻ¯āĻŧ āĻāĻ°āĻ āĻāĻ¨āĻ¸ā§āĻ˛āĻŋāĻ¨ā§āĻ° āĻĒā§āĻ°āĻ¯āĻŧā§āĻāĻ¨ āĻšāĻ¯āĻŧāĨ¤
- āĻāĻžāĻŦāĻžāĻ°ā§āĻ° āĻ¸āĻāĻŽāĻŋāĻļā§āĻ°āĻŖā§ (āĻ¯ā§āĻŽāĻ¨, āĻĒāĻžāĻĢ āĻāĻ°āĻž āĻāĻžāĻ¤, āĻŦāĻžāĻĻāĻžāĻŽ, āĻā§āĻā§āĻ°) āĻ¸āĻŽā§āĻāĻŦāĻ¤ āĻāĻā§āĻ āĻā§āĻ˛āĻžāĻāĻ¸ā§āĻŽāĻŋāĻ āĻāĻ¨āĻĄā§āĻā§āĻ¸ (GI) āĻāĻžāĻ°ā§āĻŦā§āĻšāĻžāĻāĻĄā§āĻ°ā§āĻ āĻ°āĻ¯āĻŧā§āĻā§ āĻ¯āĻž āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻĻā§āĻ°ā§āĻ¤ āĻŦā§āĻĻā§āĻ§āĻŋ āĻāĻāĻžāĻ¯āĻŧ āĻāĻŦāĻ āĻāĻāĻŋ āĻĒāĻ°āĻŋāĻāĻžāĻ˛āĻ¨āĻž āĻāĻ°āĻžāĻ° āĻāĻ¨ā§āĻ¯ āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§āĻ° 2 āĻāĻāĻ¨āĻŋāĻ āĻ¯āĻĨā§āĻˇā§āĻ āĻ¨āĻžāĻ āĻšāĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤
3. āĻāĻŽ āĻ°āĻžāĻ¤ā§āĻ° āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻž:*
- āĻ°āĻžāĻ¤ā§āĻ° āĻāĻžāĻŦāĻžāĻ°ā§āĻ° āĻĒāĻ°ā§, āĻā§āĻŽāĻžāĻ¨ā§āĻ° āĻāĻā§ āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻŽāĻžāĻ¤ā§āĻ°āĻž (āĻ¯ā§āĻŽāĻ¨, 13/09 āĻ¤āĻžāĻ°āĻŋāĻā§ 57) āĻŦā§āĻļ āĻāĻŽ, āĻ¯āĻž āĻĒāĻ°āĻžāĻŽāĻ°ā§āĻļ āĻĻā§āĻ¯āĻŧ āĻ¯ā§ āĻ°āĻžāĻ¤ā§āĻ° āĻāĻžāĻŦāĻžāĻ°ā§ āĻāĻžāĻāĻ¯āĻŧāĻž āĻāĻžāĻ°ā§āĻŦā§āĻšāĻžāĻāĻĄā§āĻ°ā§āĻā§āĻ° āĻĒāĻ°āĻŋāĻŽāĻžāĻŖā§āĻ° āĻ¤ā§āĻ˛āĻ¨āĻžāĻ¯āĻŧ āĻĄāĻŋāĻ¨āĻžāĻ° āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§ āĻĄā§āĻ (2 āĻāĻāĻ¨āĻŋāĻ) āĻā§āĻŦ āĻŦā§āĻļāĻŋ āĻšāĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤
- āĻ°āĻžāĻ¤ā§ āĻāĻ¨āĻ¸ā§āĻ˛āĻŋāĻ¨ā§āĻ° āĻ¸āĻāĻŦā§āĻĻāĻ¨āĻļā§āĻ˛āĻ¤āĻž āĻŦā§āĻĻā§āĻ§āĻŋ āĻĒāĻžāĻ¯āĻŧ, āĻ¯āĻžāĻ° āĻ āĻ°ā§āĻĨ āĻāĻ¨āĻ¸ā§āĻ˛āĻŋāĻ¨ā§āĻ° āĻāĻāĻ āĻĄā§āĻ āĻāĻ°āĻ āĻļāĻā§āĻ¤āĻŋāĻļāĻžāĻ˛ā§ āĻĒā§āĻ°āĻāĻžāĻŦ āĻĢā§āĻ˛āĻ¤ā§ āĻĒāĻžāĻ°ā§, āĻ¯āĻžāĻ° āĻĢāĻ˛ā§ āĻļā§āĻŦāĻžāĻ° āĻāĻā§ āĻŦāĻž āĻ°āĻžāĻ¤āĻžāĻ°āĻžāĻ¤āĻŋ āĻšāĻžāĻāĻĒā§āĻā§āĻ˛āĻžāĻāĻ¸ā§āĻŽāĻŋāĻ¯āĻŧāĻž āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻĒāĻ°āĻŋāĻŽāĻžāĻŖ āĻāĻŽ āĻšāĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤
- āĻ°āĻžāĻ¤ā§ āĻĻā§āĻ°ā§āĻ-āĻ āĻāĻŋāĻ¨āĻ¯āĻŧāĻāĻžāĻ°ā§ āĻ˛ā§āĻ¯āĻžāĻ¨ā§āĻāĻžāĻ¸ āĻāĻŦāĻ āĻ¸ā§āĻŦāĻ˛ā§āĻĒ-āĻ āĻāĻŋāĻ¨āĻ¯āĻŧ āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§āĻ° āĻ¸āĻāĻŽāĻŋāĻļā§āĻ°āĻŖ āĻ°āĻžāĻ¤ā§āĻ° āĻŦā§āĻ˛āĻž āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻ āĻ¤ā§āĻ¯āĻ§āĻŋāĻ āĻšā§āĻ°āĻžāĻ¸ āĻāĻāĻžāĻ¤ā§ āĻĒāĻžāĻ°ā§, āĻŦāĻŋāĻļā§āĻˇ āĻāĻ°ā§ āĻ¯āĻĻāĻŋ āĻ¸āĻ¨ā§āĻ§ā§āĻ¯āĻžāĻ° āĻāĻžāĻŦāĻžāĻ°ā§ āĻāĻŽ āĻāĻžāĻ°ā§āĻŦā§āĻšāĻžāĻāĻĄā§āĻ°ā§āĻ āĻĨāĻžāĻā§ āĻŦāĻž āĻ¯āĻĻāĻŋ āĻāĻŽ āĻāĻžāĻ°ā§āĻ¯āĻāĻ˛āĻžāĻĒ āĻĨāĻžāĻā§āĨ¤
āĻŽā§āĻ˛ āĻŦāĻŋāĻļā§āĻ˛ā§āĻˇāĻŖā§āĻ° āĻŦāĻŋāĻˇāĻ¯āĻŧ:
ā§§. āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§ āĻĄā§āĻ āĻ āĻĒāĻ°ā§āĻ¯āĻžāĻĒā§āĻ¤:
- āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻĒāĻ°ā§ āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻž āĻĒā§āĻ°āĻžāĻ-āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ° āĻŽāĻžāĻ¤ā§āĻ°āĻžāĻ° āĻ¤ā§āĻ˛āĻ¨āĻžāĻ¯āĻŧ āĻāĻ˛ā§āĻ˛ā§āĻāĻ¯ā§āĻā§āĻ¯āĻāĻžāĻŦā§ āĻŦā§āĻļāĻŋāĨ¤ āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻ¸āĻŽāĻ¯āĻŧ āĻĻā§āĻāĻ¯āĻŧāĻž 2-āĻāĻāĻ¨āĻŋāĻ āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§ āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻāĻžāĻ°ā§āĻŦā§āĻšāĻžāĻāĻĄā§āĻ°ā§āĻ/āĻĒā§āĻ°ā§āĻāĻŋāĻ¨ā§āĻ° āĻĒāĻ°āĻŋāĻŽāĻžāĻŖāĻā§ āĻāĻāĻžāĻ° āĻāĻ°ā§ āĻ¨āĻž āĻŦāĻž "āĻā§āĻ°ā§āĻ° āĻāĻāĻ¨āĻž" āĻ¨āĻŋāĻ¯āĻŧā§ āĻāĻžāĻ āĻāĻ°āĻ¤ā§ āĻĒāĻžāĻ°ā§ āĻ¨āĻžāĨ¤
- āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻ¸āĻŽāĻ¯āĻŧ Lispro āĻĄā§āĻ āĻŦāĻžāĻĄāĻŧāĻžāĻ¨ā§ (āĻ¯ā§āĻŽāĻ¨, 2 āĻāĻāĻ¨āĻŋāĻ āĻĨā§āĻā§ 3 āĻāĻāĻ¨āĻŋāĻ) āĻāĻ āĻ¸ā§āĻĒāĻžāĻāĻāĻā§āĻ˛āĻŋāĻā§ āĻāĻ°āĻ āĻāĻžāĻ˛āĻāĻžāĻŦā§ āĻĒāĻ°āĻŋāĻāĻžāĻ˛āĻ¨āĻž āĻāĻ°āĻ¤ā§ āĻ¸āĻšāĻžāĻ¯āĻŧāĻ¤āĻž āĻāĻ°āĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤
ā§¨āĨ¤ āĻ˛ā§āĻ¯āĻžāĻ¨ā§āĻāĻžāĻ¸ āĻĄā§āĻ āĻ°āĻžāĻ¤ā§ āĻā§āĻŦ āĻŦā§āĻļāĻŋ:
- āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻāĻŽ āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻž āĻĒāĻ°āĻžāĻŽāĻ°ā§āĻļ āĻĻā§āĻ¯āĻŧ āĻ¯ā§ āĻ˛ā§āĻ¯āĻžāĻ¨ā§āĻāĻžāĻ¸ āĻĄā§āĻ āĻ°āĻžāĻ¤ā§ āĻāĻŽāĻžāĻ¤ā§ āĻšāĻŦā§āĨ¤ āĻāĻāĻŋ 4 āĻāĻāĻ¨āĻŋāĻ āĻĨā§āĻā§ 3 āĻāĻāĻ¨āĻŋāĻā§ āĻāĻŽāĻŋāĻ¯āĻŧā§ āĻ°āĻžāĻ¤ā§āĻ° āĻšāĻžāĻāĻĒā§āĻā§āĻ˛āĻžāĻāĻ¸ā§āĻŽāĻŋāĻ¯āĻŧāĻž āĻĒā§āĻ°āĻ¤āĻŋāĻ°ā§āĻ§ āĻāĻ°āĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤
- PaJR PHR āĻŽāĻĄāĻžāĻ°ā§āĻāĻ° āĻ°āĻžāĻ¤ā§āĻ° āĻā§āĻ˛ā§āĻā§āĻ āĻŽāĻžāĻ¤ā§āĻ°āĻž āĻ āĻĒā§āĻāĻŋāĻŽāĻžāĻāĻ āĻāĻ°āĻžāĻ° āĻāĻ¨ā§āĻ¯ āĻāĻ āĻ¸āĻŽāĻ¨ā§āĻŦāĻ¯āĻŧā§āĻ° āĻĒāĻ°āĻžāĻŽāĻ°ā§āĻļ āĻĻāĻŋāĻ¯āĻŧā§āĻā§āĻ¨āĨ¤
ā§Š. āĻĄāĻŋāĻ¨āĻžāĻ° āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§āĻ° āĻ¸āĻžāĻŽāĻā§āĻāĻ¸ā§āĻ¯ āĻĒā§āĻ°āĻ¯āĻŧā§āĻāĻ¨:
- āĻ°āĻžāĻ¤ā§āĻ° āĻāĻžāĻŦāĻžāĻ°ā§ āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§āĻ° 2 āĻāĻāĻ¨āĻŋāĻ āĻā§āĻŦ āĻŦā§āĻļāĻŋ āĻšāĻ¤ā§ āĻĒāĻžāĻ°ā§, āĻŦāĻŋāĻļā§āĻˇ āĻāĻ°ā§ āĻ¯āĻĻāĻŋ āĻ¸āĻ¨ā§āĻ§ā§āĻ¯āĻžāĻ° āĻāĻžāĻŦāĻžāĻ°ā§ āĻāĻžāĻ°ā§āĻŦā§āĻšāĻžāĻāĻĄā§āĻ°ā§āĻ āĻāĻŽ āĻĨāĻžāĻā§āĨ¤ āĻāĻ āĻĄā§āĻāĻāĻŋ 1 āĻŦāĻž 1.5 āĻāĻāĻ¨āĻŋāĻā§ āĻāĻŽāĻŋāĻ¯āĻŧā§ āĻ°āĻžāĻ¤ā§āĻ° āĻāĻžāĻŦāĻžāĻ°ā§āĻ° āĻĒāĻ°ā§ āĻāĻŦāĻ āĻā§āĻŽāĻžāĻ¨ā§āĻ° āĻāĻā§ āĻāĻŋāĻ¨āĻŋāĻ° āĻŽāĻžāĻ¤ā§āĻ°āĻž āĻāĻŽ āĻšāĻāĻ¯āĻŧāĻž āĻĒā§āĻ°āĻ¤āĻŋāĻ°ā§āĻ§ āĻāĻ°āĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤
4. āĻĒāĻ°ā§āĻ¯āĻŦā§āĻā§āĻˇāĻŖ āĻāĻŦāĻ āĻ¸āĻŽāĻ¨ā§āĻŦāĻ¯āĻŧ:
- āĻā§āĻ°āĻŽāĻžāĻāĻ¤ āĻā§āĻ˛ā§āĻā§āĻ āĻŽāĻ¨āĻŋāĻāĻ°āĻŋāĻ (CGM) āĻŦāĻž āĻāĻ¨ āĻāĻ¨ āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻĒāĻ°ā§āĻā§āĻˇāĻž āĻ¸āĻžāĻ°āĻž āĻĻāĻŋāĻ¨, āĻŦāĻŋāĻļā§āĻˇ āĻāĻ°ā§ āĻ°āĻžāĻ¤āĻžāĻ°āĻžāĻ¤āĻŋ āĻāĻ āĻžāĻ¨āĻžāĻŽāĻž āĻā§āĻ°ā§āĻ¯āĻžāĻ āĻāĻ°āĻžāĻ° āĻāĻ¨ā§āĻ¯ āĻĒā§āĻ°āĻ¯āĻŧā§āĻāĻ¨ āĻšāĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤
- āĻĻāĻŋāĻ¨ā§āĻ° āĻŦāĻŋāĻāĻŋāĻ¨ā§āĻ¨ āĻ¸āĻŽāĻ¯āĻŧā§āĻ° āĻāĻ¨ā§āĻ¯ āĻāĻžāĻŦāĻžāĻ°ā§āĻ° āĻ¸āĻāĻŽāĻŋāĻļā§āĻ°āĻŖ āĻāĻŦāĻ āĻāĻ¨āĻ¸ā§āĻ˛āĻŋāĻ¨ā§āĻ° āĻĄā§āĻ āĻāĻāĻ¯āĻŧāĻ āĻ¸āĻžāĻŽāĻā§āĻāĻ¸ā§āĻ¯ āĻāĻ°āĻž āĻāĻ āĻāĻā§āĻ-āĻ¨āĻŋāĻŽā§āĻ¨ āĻĻā§āĻ˛ āĻ°ā§āĻ§ āĻāĻ°āĻžāĻ° āĻŽā§āĻ˛ āĻāĻžāĻŦāĻŋāĻāĻžāĻ āĻŋāĨ¤
āĻĒā§āĻ°āĻ¸ā§āĻ¤āĻžāĻŦāĻŋāĻ¤ āĻĒāĻ°āĻŦāĻ°ā§āĻ¤ā§ āĻĒāĻĻāĻā§āĻˇā§āĻĒ:
- āĻ¸āĻāĻžāĻ˛ā§āĻ° āĻ¸ā§āĻĒāĻžāĻāĻ āĻĒāĻ°āĻŋāĻāĻžāĻ˛āĻ¨āĻž āĻāĻ°āĻ¤ā§ āĻ¸āĻāĻžāĻ˛ā§āĻ° āĻ¨āĻžāĻ¸ā§āĻ¤āĻžāĻ¯āĻŧ āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§āĻ° āĻĄā§āĻ 3 āĻāĻāĻ¨āĻŋāĻā§ āĻŦā§āĻĻā§āĻ§āĻŋ āĻāĻ°ā§āĻ¨āĨ¤
- āĻĒā§āĻ°āĻžāĻ¤āĻāĻ°āĻžāĻļā§āĻ° āĻāĻŽ āĻšāĻāĻ¯āĻŧāĻž āĻ°ā§āĻ§ āĻāĻ°āĻ¤ā§ āĻ°āĻžāĻ¤ā§ āĻ˛ā§āĻ¯āĻžāĻ¨ā§āĻāĻžāĻ¸āĻā§ 3 āĻāĻāĻ¨āĻŋāĻā§ āĻāĻŽāĻŋāĻ¯āĻŧā§ āĻĻāĻŋāĻ¨āĨ¤
- āĻ°āĻžāĻ¤ā§ āĻāĻŽ āĻļāĻ°ā§āĻāĻ°āĻž āĻāĻĄāĻŧāĻžāĻ¤ā§ āĻ°āĻžāĻ¤ā§āĻ° āĻāĻžāĻŦāĻžāĻ°ā§ āĻ˛āĻŋāĻ¸āĻĒā§āĻ°ā§ āĻāĻŽāĻŋāĻ¯āĻŧā§ āĻĻāĻŋāĻ¨ (āĻ¸āĻŽā§āĻāĻŦāĻ¤ 1.5 āĻāĻāĻ¨āĻŋāĻ)āĨ¤
āĻāĻāĻŋ āĻāĻ°āĻŽāĻā§āĻ˛āĻŋāĻā§ āĻŽāĻ¸ā§āĻŖ āĻāĻ°āĻ¤ā§ āĻāĻŦāĻ āĻ¸āĻžāĻ°āĻž āĻĻāĻŋāĻ¨ āĻ°āĻā§āĻ¤ā§ āĻļāĻ°ā§āĻāĻ°āĻžāĻ° āĻŽāĻžāĻ¤ā§āĻ°āĻž āĻ¸ā§āĻĨāĻŋāĻ¤āĻŋāĻļā§āĻ˛ āĻāĻ°āĻ¤ā§ āĻ¸āĻšāĻžāĻ¯āĻŧāĻ¤āĻž āĻāĻ°āĻŦā§"
Narmeen Shah: Sir
1. I first copy pasted the complete data of the case report from sept 1 - sept 13.
2. Excel data that I created to calculate the pre- post- mean blood sugar values for the graph.
3. Wrote my two assumptions and ask to verify the stated assumptions.
- Post and Pre meal times don't mean that nothing is fed between these intervals.
- Insulin has been given either after the meal or before the meal so the sugar levels are not independent of interventions.
4. Chatgpt broke down the assumptions and reponded about it in four points.
5. After that I gave the query/prompt:
- - Why it is happening that sugar levels are that much low in pre breakfast and high in post breakfast and low at night. Check the above daily routine again from sep 1 - sept 13 and analyze the keen aspect.
Lispro - action starts by 30 minutes, peaks 1-2 hours, gone by 3 hours; Regular - action starts by 60 minutes, peaks 3-5 hours, gone by 8 hours - etc. Lantus - pretty flat with repeated use, especially if dose is >10 units. Hypos less with Lantus and degludec.
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