NOVEMBER 2024 - 3 Years Old child, Type1 Diabetes, Insulin Hypoglycemia, Intermittent, Bloating 1 Month
PATIENT DATA LOG OF NOVEMBER - 2024
01/11/24
Patient Advocate: 1.11.24
7.30am blood sugar 38
7.30am 1.5 teaspoon sugar
7.40am nuts
8.00am milk
PaJR PHR Moderator: Stop all insulin
Please share her blood sugars hourly
Contact your nearest primary health centre to facilitate this hourly monitoring
PaJR PHR Moderator: Any symptoms?
What were the hypoglycemia symptoms that has ever been noticed by the parents in this child and what were her symptoms today?
Getting admitted in a health centre facility will also enable verifying each glucometer blood sugar value with a corresponding blood sugar serum value for standard laboratory assessment
Patient Advocate: Ok Sir
No Sir
PaJR PHR Moderator: Let me clarify the first line "asking to stop all insulin"
It's just a current advice and shall be changed and supplemented by afternoon or even earlier today, looking at her hourly blood sugar values if when the parent advocates share it here
Patient Advocate: 9.45am blood 155
9.45am rice with papaya, chayote, green banana, long beans, bitter gourd, pumpkin, cauliflower, and salad
No insulin in the morning
PaJR PHR Moderator: Please let us know her 2 hours post breakfast sugar values
Patient Advocate: 11.45am prasad( khichudi, sandesh)
1.30pm blood sugar 394
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish and fish
PaJR PHR Moderator: Let us know the blood sugar values at 3:30PM
Patient Advocate: Thik achhe Sir
PaJR PHR Moderator: I'm sharing some inputs on how to calculate carbs and adjust lispro dosages for the understanding of our team members here in three different languages. Bengali for @Participants @Patient Advocate for them to share what they are unable to understand.
In Hindi for @Participants to share what they are unable to understand.
In English for @Participant 20 @Partcipants for them to share what they are unable to understand.
First in Bengali:
টাইপ 1 ডায়াবেটিস রোগীর প্রতিটি পরিবারকে কীভাবে কার্বোহাইড্রেট গণনা করতে হয় এবং সংশোধনমূলক ডোজ + কার্ব কভারেজের উপর ভিত্তি করে লিসপ্রো ডোজ গণনা করতে হয় তা শিখতে হবে।
এটি করার জন্য তাদের দিনে কমপক্ষে 3 বার (প্রতিটি লিসপ্রো ডোজ আগে) রক্তের গ্লুকোজ পরীক্ষা করতে হবে।
স্বাভাবিক অবস্থা: সারাদিনে বেসাল হারে ইনসুলিন নিঃসৃত হয়। তার উপরে, হজম হওয়া খাবারের পুষ্টি উপাদানের উপর ভিত্তি করে, ইনসুলিনের বোলুসগুলি মাঝে মাঝে নিঃসৃত হয়।
টি 1 ডি আক্রান্ত রোগীর লিসপ্রো ডোজ গণনা করার যুক্তি হল যে ল্যান্টাস বেসাল ইনসুলিন নিঃসরণের বিকল্প, এবং লিসপ্রোকে দুটি জিনিস করতে হবে
1) খাবারের আগে রক্তের গ্লুকোজ কমিয়ে দিন যদি তা প্রয়োজনীয় লক্ষ্যের চেয়ে বেশি হয়
এবং
2) রক্ত থেকে পেশীতে শোষিত খাবার (সরলভাবে খাওয়া কার্বোহাইড্রেটের অনুপাতে) থেকে গ্লুকোজ সরানোর জন্য যথেষ্ট হবে।
1) = সংশোধনমূলক ডোজ - এই সত্যের উপর ভিত্তি করে যে 1 ইউনিট লিসপ্রো একটি নির্দিষ্ট পরিমাণে রক্তের গ্লুকোজ কমিয়ে আনে - যাকে সংবেদনশীলতা ফ্যাক্টর বলা হয় - তাই, গণনা হল (খাওয়ার আগে রক্তের গ্লুকোজ-লক্ষ্যযুক্ত রক্তের গ্লুকোজ)/সংবেদনশীলতা ফ্যাক্টর
2) = কার্ব কভারেজ; এই ধারণার উপর ভিত্তি করে যে লিসপ্রোর 1 ইউনিট 1 গ্রাম কার্বোহাইড্রেট থেকে শোষিত গ্লুকোজকে পেশীতে স্থানান্তরিত করবে - কার্ব কভারেজ - সুতরাং, গণনা হল গ্রাম খাওয়া কার্বোহাইড্রেট = কার্ব কভারেজ।
খাবারের আগে লিসপ্রোর সম্পূর্ণরূপে গণনা করা ডোজ=
1) + 2)
সাধারণত, বাচ্চাদের ক্ষেত্রে, আমরা খাবারের পরপরই ডোজকে ইনজেকশন দিতে বলি - এইভাবে, তারা খাওয়া কার্বোহাইড্রেট গণনা করে, পরিবেশিত কার্বোহাইড্রেট নয় (দুটি খুব আলাদা হতে পারে)।
PaJR PHR Moderator: Hindi:
टाइप 1 मधुमेह रोगी के प्रत्येक परिवार को यह सीखना होगा कि कार्ब्स की गिनती कैसे करें और सुधारात्मक खुराक + कार्ब कवरेज के आधार पर लिस्प्रो खुराक की गणना कैसे करें।
ऐसा करने के लिए उन्हें दिन में कम से कम 3 बार (प्रत्येक लिस्प्रो खुराक से पहले) रक्त शर्करा की जांच करने की आवश्यकता होती है।
सामान्य स्थिति: इंसुलिन पूरे दिन बेसल दर पर स्रावित होता है। इसके अलावा, पचे हुए भोजन की पोषक सामग्री के आधार पर, इंसुलिन के बोलस रुक-रुक कर स्रावित होते हैं।
टी1डी वाले रोगी में लिस्प्रो खुराक की गणना करने का तर्क यह है कि लैंटस बेसल इंसुलिन स्राव को प्रतिस्थापित करता है, और लिस्प्रो को दो चीजें करने की आवश्यकता होगी
1) यदि रक्त शर्करा आवश्यक लक्ष्य से अधिक है तो भोजन से पहले इसे कम करें
और
2) अवशोषित भोजन से ग्लूकोज (सरल शब्दों में खाए गए कार्बोहाइड्रेट के अनुपात में) को रक्त से मांसपेशियों में ले जाने के लिए पर्याप्त हो।
1) = सुधारात्मक खुराक - इस तथ्य पर आधारित है कि लिस्प्रो की 1 इकाई रक्त ग्लूकोज को एक विशिष्ट मात्रा से नीचे लाती है - जिसे संवेदनशीलता कारक कहा जाता है - इसलिए, गणना है (भोजन से पहले रक्त ग्लूकोज-लक्षित रक्त ग्लूकोज)/संवेदनशीलता कारक
2) = कार्ब कवरेज; इस विचार पर आधारित है कि लिस्प्रो की 1 इकाई 1 ग्राम कार्ब्स से अवशोषित ग्लूकोज को मांसपेशियों में ले जाएगी - कार्ब कवरेज - इसलिए, गणना खाए गए कार्ब्स के ग्राम = कार्ब कवरेज है।
भोजन से पहले लिस्प्रो की पूरी तरह से गणना की गई खुराक =
1)+2)
आमतौर पर, बच्चों में, हम भोजन के तुरंत बाद खुराक देने के लिए कहते हैं - इस तरह, वे खाए गए कार्ब्स की गणना करते हैं, न कि परोसे गए कार्ब्स की (दोनों बहुत भिन्न हो सकते हैं)।
PaJR PHR Moderator: English
Every family of a type 1 diabetes patient needs to to learn how to count carbs and calculate lispro doses based on corrective doses + carb coverage.
They need to check blood glucose at least 3 times a day (before each and every lispro dose) to do that.
Normal situation: Insulin is secreted at a basal rate throughout the day. On top of that, based on the nutrient content of digested food, boluses of insulin are secreted intermittently.
The rationale for calculating lispro dose in a patient with T1D is that Lantus substitutes for basal insulin secretion, and the lispro will need to do two things
1) reduce the blood glucose before meals if it is higher than the needed target
AND
2) be sufficient to move glucose from the absorbed food (proportionate to the carbs eaten in simplistic terms) from the blood into the muscles.
1) = corrective dose - based on the fact that 1 unit of lispro brings down the blood glucose by a specific amount - called sensitivity factor - so, calculation is (Blood glucose before meals-target blood glucose)/sensitivity factor
2) = carb coverage; based on the idea that 1 unit of lispro will move the glucose absorbed from 1 gm of carbs into the muscles - carb coverage - so, calculation is gms of carbs eaten = carb coverage.
Totally calculated dose of lispro before meals=
1) + 2)
Typically, in kids, we ask the dose to be injected immediately after the meal - that way, they calculate carbs eaten, and not carbs served (the two can be very different).
PaJR PHR Moderator: Telugu @Participants....
టైప్ 1 డయాబెటీస్ రోగి యొక్క ప్రతి కుటుంబం కార్బోహైడ్రేట్లను లెక్కించడం మరియు దిద్దుబాటు మోతాదులు + కార్బ్ కవరేజ్ ఆధారంగా లిస్ప్రో మోతాదులను ఎలా లెక్కించాలో నేర్చుకోవాలి.
వారు రక్తంలో గ్లూకోజ్ని రోజుకు కనీసం 3 సార్లు (ప్రతి లిస్ప్రో మోతాదుకు ముందు) తనిఖీ చేయాలి.
సాధారణ పరిస్థితి: ఇన్సులిన్ రోజంతా బేసల్ రేటుతో స్రవిస్తుంది. పైగా, జీర్ణమైన ఆహారంలోని పోషకాల ఆధారంగా, ఇన్సులిన్ యొక్క బోలస్లు అడపాదడపా స్రవిస్తాయి.
T1D ఉన్న రోగిలో లిస్ప్రో మోతాదును లెక్కించడానికి గల కారణం ఏమిటంటే, బేసల్ ఇన్సులిన్ స్రావానికి లాంటస్ ప్రత్యామ్నాయంగా ఉంటుంది మరియు లిస్ప్రో రెండు పనులు చేయాల్సి ఉంటుంది.
1) రక్తంలో గ్లూకోజ్ అవసరమైన లక్ష్యం కంటే ఎక్కువగా ఉంటే భోజనానికి ముందు తగ్గించండి
మరియు
2) శోషించబడిన ఆహారం నుండి గ్లూకోజ్ను రక్తం నుండి కండరాలలోకి తరలించడానికి (సరళమైన పదాలలో తినే పిండి పదార్థాలకు అనులోమానుపాతంలో) సరిపోతుంది.
1) = దిద్దుబాటు డోస్ - 1 యూనిట్ లిస్ప్రో రక్తంలో గ్లూకోజ్ని నిర్దిష్ట మొత్తంలో తగ్గిస్తుంది - దీనిని సెన్సిటివిటీ ఫ్యాక్టర్ అంటారు - కాబట్టి, గణన (భోజనానికి ముందు రక్తంలో గ్లూకోజ్-లక్ష్య రక్తంలో గ్లూకోజ్)/సున్నితత్వ కారకం
2) = కార్బ్ కవరేజ్; లిస్ప్రో యొక్క 1 యూనిట్ 1 గ్రాముల పిండి పదార్థాల నుండి గ్రహించిన గ్లూకోజ్ను కండరాలలోకి తరలిస్తుందనే ఆలోచన ఆధారంగా - కార్బ్ కవరేజ్ - కాబట్టి, గణన అంటే పిండి పదార్థాలు తిన్న gms = కార్బ్ కవరేజ్.
భోజనానికి ముందు పూర్తిగా లెక్కించబడిన లిస్ప్రో మోతాదు =
1) + 2)
సాధారణంగా, పిల్లలలో, భోజనం చేసిన వెంటనే ఇంజెక్ట్ చేయమని మేము డోస్ అడుగుతాము - ఆ విధంగా, వారు తిన్న పిండి పదార్థాలను లెక్కిస్తారు మరియు వడ్డించిన పిండి పదార్థాలు కాదు (రెండూ చాలా భిన్నంగా ఉంటాయి).
Ṭaip 1 ḍayābeṭīs rōgi yokka prati kuṭumbaṁ kārbōhaiḍrēṭlanu lekkin̄caḍaṁ mariyu diddubāṭu mōtādulu + kārb kavarēj ādhāraṅgā lisprō mōtādulanu elā lekkin̄cālō nērcukōvāli.
Vāru raktanlō glūkōjni rōjuku kanīsaṁ 3 sārlu (prati lisprō mōtāduku mundu) tanikhī cēyāli.
Sādhāraṇa paristhiti: Insulin rōjantā bēsal rēṭutō sravistundi. Paigā, jīrṇamaina āhāranlōni pōṣakāla ādhāraṅgā, insulin yokka bōlaslu aḍapādaḍapā sravistāyi.
T1D unna rōgilō lisprō mōtādunu lekkin̄caḍāniki gala kāraṇaṁ ēmiṭaṇṭē, bēsal insulin srāvāniki lāṇṭas pratyāmnāyaṅgā uṇṭundi mariyu lisprō reṇḍu panulu cēyālsi uṇṭundi.
1) Raktanlō glūkōj avasaramaina lakṣyaṁ kaṇṭē ekkuvagā uṇṭē bhōjanāniki mundu taggin̄caṇḍi
mariyu
2) śōṣin̄cabaḍina āhāraṁ nuṇḍi glūkōjnu raktaṁ nuṇḍi kaṇḍarālalōki taralin̄caḍāniki (saraḷamaina padālalō tinē piṇḍi padārthālaku anulōmānupātanlō) saripōtundi.
1) = Diddubāṭu ḍōs - 1 yūniṭ lisprō raktanlō glūkōjni nirdiṣṭa mottanlō taggistundi - dīnini sensiṭiviṭī phyākṭar aṇṭāru - kābaṭṭi, gaṇana (bhōjanāniki mundu raktanlō glūkōj-lakṣya raktanlō glūkōj)/sunnitatva kārakaṁ
2) = kārb kavarēj; lisprō yokka 1 yūniṭ 1 grāmula piṇḍi padārthāla nuṇḍi grahin̄cina glūkōjnu kaṇḍarālalōki taralistundanē ālōcana ādhāraṅgā - kārb kavarēj - kābaṭṭi, gaṇana aṇṭē piṇḍi padārthālu tinna gms = kārb kavarēj.
Bhōjanāniki mundu pūrtigā lekkin̄cabaḍina lisprō mōtādu =
1) + 2)
sādhāraṇaṅgā, pillalalō, bhōjanaṁ cēsina veṇṭanē in̄jekṭ cēyamani mēmu ḍōs aḍugutāmu - ā vidhaṅgā, vāru tinna piṇḍi padārthālanu lekkistāru mariyu vaḍḍin̄cina piṇḍi padārthālu kādu (reṇḍū cālā bhinnaṅgā uṇṭāyi).
Patient Advocate: 3.40pm blood sugar 144
Narmeen Shah: Sir LLM is unable to extract any symptom of hypoglycemia especially on those dates.
PaJR PHR Moderator: Aer aage ore hypoglycemia r jonye kokhono kichu asubidhe mone hoyechilo?
Patient Advocate: Na Sir erakom kichhu dekhini
PaJR PHR Moderator: Mane sugar low howa sotteo kokhono kono rokom asubidhe dekha jaini?
PaJR PHR Moderator: Can you refresh again how many episodes of hypoglycemias since her PaJR began (including today's)?
Patient Advocate: Lantus ta ki aaj ke aro one unit komiye 4u debo ki ?
Narmeen Shah: Blood sugar levels <=75
29 occurrences extracted since 29th march to 23rd October. (Though there could be more)
After 23rd October till today:
11 occurrences
Patient Advocate: 7.10pm blood sugar 65
7.10pm oats ond lolypop
Lantus ta ki aaj ke aro one unit komiye 4u debo ki ?
PaJR PHR Moderator: Hain
Patient Advocate: 8.30pm 4u lantus insulin
9.30pm blood sugar 283
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
PaJR PHR Moderator: Post dinner sugars at 11:30PM
02/11/24
Patient Advocate: 11.50pm Post dinner blood sugar 70
1/2 teaspoon sugar
Patient Advocate: 2/11/24
7.30am blood sugar 40 then 3/4 teaspoon sugar
7.30am nuts
7.45am milk
PaJR PHR Moderator: Please share the blood sugar values hourly
@Narmeen Shah can you search out running the case report URL through the LLM of your choice as to what advice we had shared in the past also through another LLM for hypoglycemia intervention.
Let me again refresh that information below through the LLM in this group
PaJR PHR Moderator: @Meta AI what is the best way to manage hypoglycemia? Why is spoons of sugar not recommended?
Meta AI: Managing hypoglycemia involves quick and effective
PaJR PHR Moderator: 👆@Patient Advocate
Patient Advocate: 9.30am blood sugar 317
9.30am 2u lispro insulin
9.40am rice with pointed gourd, chayote, papaya, green banana, brinjal, long beans, cauliflower, radish one pakoda of pumpkin and salad
11.45am mosambi
1.30pm blood sugar 132
1.30pm 1.5u lispro insulin
1.40pm lunch with same previous dish except pakoda include egg
Narmeen Shah: Comprehensive Advice Summary
Here's a detailed summary of the advice discussed in the sources, focusing on recurring themes and key points:
Insulin Management
* Precise Insulin Dosing is Paramount: The conversations repeatedly stress the importance of accurate insulin dosing, especially for a young child with type 1 diabetes. This involves careful titration of both long-acting insulin (Lantus) and short-acting insulin (Lispro) to manage blood sugar effectively and prevent hypoglycemia.
* Honeymoon Phase Considerations: The "honeymoon phase" of type 1 diabetes is acknowledged, recognizing that insulin requirements can fluctuate during this period. This makes diligent monitoring and dose adjustments crucial to avoid both hyperglycemia and hypoglycemia.
* Half-Unit Pens (HUPs) for Accuracy: The use of half-unit pens (HUPs) is recommended to ensure accurate insulin delivery for a child who requires small doses. This precision can significantly impact blood sugar control, especially during the initial stages of diagnosis.
* Insulin Syringe as an Alternative: In instances where precise dose adjustments are necessary, switching to insulin syringes instead of pens is suggested. Syringes allow for more fine-tuned dosing, particularly when half-unit increments are required.
Insulin Timing and Action
* Lantus Timing and Impact: Several discussions revolve around optimizing the timing of Lantus injections. The sources suggest shifting the injection time to earlier in the evening, preferably during snack time, to prevent early morning hypoglycemia.
* Understanding Lantus's Effect: It's repeatedly emphasized that Lantus primarily influences fasting blood sugar levels, gradually lowering the basal glucose over time. This understanding is crucial for adjusting doses and anticipating its impact on both fasting and post-meal sugars.
* Lispro's Role and Timing: The discussions clarify that Lispro, the fast-acting insulin, primarily targets post-meal blood sugar spikes. It's advised to administer Lispro 15-30 minutes before meals to coincide with its peak action and effectively manage post-meal glucose excursions.
Blood Sugar Monitoring
* Frequent Blood Sugar Checks: The sources consistently recommend frequent blood sugar monitoring, especially before and two hours after meals, to track trends and inform dose adjustments. This regular monitoring is vital for achieving stable glucose control and preventing both hyperglycemia and hypoglycemia.
* CGM for Detailed Insights: Continuous glucose monitoring (CGM) is suggested as a potential option for obtaining more detailed insights into blood sugar fluctuations throughout the day and night. However, the challenges of CGM use are acknowledged, including the potential for discomfort, disruptive alerts, and difficulty interpreting the data.
* Addressing Hypoglycemia: The sources express concern about hypoglycemic episodes, particularly for a young child. They highlight the potential dangers of asymptomatic hypoglycemia and stress the importance of recognizing and treating low blood sugars promptly to avoid serious complications.
Diet and Lifestyle
* Dietary Adjustments for Blood Sugar Control: Dietary adjustments are consistently recommended as a crucial part of managing blood sugar levels. This includes:
* Increasing protein intake: Especially at breakfast, to help mitigate post-meal glucose spikes.
* Reducing carbohydrates: Particularly those with a high glycemic index, to minimize blood sugar fluctuations.
* Consulting a dietician: To receive personalized guidance on creating a balanced and appropriate meal plan for a child with type 1 diabetes.
* Gluten-Free Diet for Bloating: Avoiding gluten is suggested to manage the child's repo…
Narmeen Shah:
Disclaimer:
This information is provided for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or treatment. Do not disregard professional medical advice or delay seeking it because of something you have read here.
Hypoglycemia intervention, especially in diabetic patients, involves quick and careful action to restore blood sugar levels safely. Here’s a general approach:
1. Mild to Moderate Hypoglycemia (Conscious and Responsive)
- Check Blood Glucose: If blood sugar is below 70 mg/dL, start intervention.
- Administer Fast-Acting Carbohydrates: Offer 15–20 grams of fast-acting carbohydrates, such as:
- Glucose tablets (typically 3-4 tablets depending on the brand)
- 4 ounces of fruit juice or regular soda (not diet)
- 1 tablespoon of honey or sugar
- Wait 15 Minutes: Recheck blood glucose to ensure levels are rising.
- Repeat if Needed: If still below 70 mg/dL, administer another 15 grams of carbs and recheck in 15 minutes.
2. Severe Hypoglycemia (Unconscious or Seizures)
- Call for Emergency Help: If the person is unconscious or having seizures.
- Administer Glucagon: If trained and glucagon is available, administer it as an injection or nasal spray.
- Do Not Force Food or Drink: Never try to feed an unconscious person.
- Position for Safety: If possible, turn the person on their side to prevent choking if they vomit.
3. Follow-Up
- Eat a Balanced Snack: Once stabilized, it’s recommended to eat a snack containing protein and complex carbs (like cheese with whole grain crackers) to maintain blood sugar levels.
- Adjust Medications if Needed: Consult with a healthcare provider to evaluate if medication or insulin adjustments are required to prevent future hypoglycemic events.
Regular monitoring and having an action plan ready for hypoglycemic events can help in managing hypoglycemia effectively.
PaJR PHR Moderator: Amazing! Thanks for sharing. Will be good to also update this into the case report!
Narmeen Shah: 🆗✅
Patient Advocate: 7.00pm banana
8.30pm egg roll
9.00pm 3u lantus insulin
9.30pm blood sugar 259
9.30pm 1.5u lantus insulin
9.40pm dinner with as same as lunch dish except egg
03/11/24
Patient Advocate: 11.40pm blood sugar 213
Patient Advocate: 3.11.24
7.45am blood suger 117
7.45am nuts
8.00am milk
9:30 was lispro right?
PaJR PHR Moderator: @Narmeen Shah I just realised that there's no Bengali to English translation for the Bengali script at the top of the case report as a result of which many of our team members who cannot read Bengali would miss her initial history:
এরপর 08/03/24 তারিখে আবার এক ডাক্তার দেখানো হয় , তিনি কিছু টেস্ট করতে দেন সেখানে ধরা পড়ে রোগীর টাইপ 1 সুগার হয়েছে। ডাক্তার রোগীকে 5 দিন হাসপাতালে ভর্তি রাখেন । 13/03/24* তারিখে তাকে ছেড়ে দেন এবং প্রতিদিন 3+1 ইনসুলিন নিতে বলেন ।এখন এভাবেই রোগী বাড়িতে আছে ।
Unquote
Narmeen Shah: Ok Sir I will add the English translation.
Patient Advocate: 9.30am 2u lispro insulin
9.40am rice with pointed gourd, tometo, pumpkin, chayote, papaya, long beans, bitter gourd, egg and salad
12.00noon mosambi
PaJR PHR Moderator: Jokhon 8/3/24 a hospital a bhorti hoyechilen tokhon sugar charting ebong insulin dewa chara are kono training unara diyechilen? Amader pediatric endocrinologist jaante chaichilen
Patient Advocate: Na Sir
1.30pm blood sugar 301
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and include chicken
Participant 20: Some useful info for all of us.
Participant 20: 1 mmol/L of Blood glucose = 18mg/dl
Patient Advocate: 7.00pm banana
8.00pm 4u lantus insulin
9.30pm blood sugar 346
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
04/11/24
Patient Advocate: 4/11/24
7.30am milk
8.00am payesh
9.30am 2u lispro insulin
9.40am rice with papaya, long beans, bitter gourd, carrot, cauliflower, pumpkin, tomato, egg and salad
11.45am blood sugar 173
12.00noon mosambi
1.30pm blood sugar 232
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
7.00pm banana
8.00pm 4u lantus insulin
9.30pm blood sugar 300
9.40pm dinner with rice, brinjal, cauliflower, pointed gourd, papaya, long beans and salad
05/11/24
PaJR PHR Moderator: Hoping to see the fasting today
Patient Advocate: Ok Sir
5/11/24
7.30am blood suger 73
7.30am nuts
7.40am milk
PaJR PHR Moderator: Even 4U of lantus is a bit dicey. 3.5U would be better if you can get a kids pen or use a syringe.
Patient Advocate: 9.30am 2u lispro insulin
9.40am rice with pulses,pointed gourd, tometo, pumpkin, bitter gourd, papaya, bottle gourd and salad
11.45am mosambi
1.30pm blood sugar 232
1.30pm 2.5u lispro insulin
1.40pm lunch with same previous dish
7.00pm banana and 1/2digestive biscuit
06/11/24
Patient Advocate: 8.00pm 4u lantus insulin
9.30pm blood sugar 346
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
Patient Advocate: 6.11.12
7.30am blood suger 115
7.30am nuts
7.45pm milk and 1/2 roti
PaJR PHR Moderator:
PaJR PHR Moderator:
👍
Shift lantus administration time to 6:00 PM
Patient Advocate: 9.30am 2.5u lispro insulin
9.40am rice with pointed gourd, tometo, pumpkin, bitter gourd, papaya, long beans, and salad
12.00noon mosambi
1.30pm blood sugar 205
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish
7.00pm banana
8.00pm 4u lantus insulin
9.30pm blood sugar 263
9.30pm 3 teaspoon payesh and 1/4 roti
9.45pm 3.5u lispro insulin
9.50pm dinner with as same as lunch dish
Patient Advocate: স্যার কয়েক দিনের মধ্যে এখানে endocrinologist দেখাব তার পর lantus এর সময় টা পরিবর্তন করি ?
[10:09 PM, 11/6/2024] Patient Advocate: অনেক দিন হয়ে গেল ওই ডাক্তারবাবু কে দেখানো হয় না l
07/11/24
PaJR PHR Moderator: Thik ache
Parle CGM sensor ta lagiye neben
Patient Advocate: 12.00night blood sugar 314
07/11/24
7.30am blood suger 118
7.30am nuts
7.45am milk
9.30am 2.5u lispro insulin
9.40am rice with papaya, long beans, bitter gourd, tomato, cauliflower, radish and salad
একটু বড় না হলে CGM টা দিতে আমরা ভয় পাচ্ছি যদি টেনে খুলে ফেলে l
PaJR PHR Moderator: Na tene khule felar bhoi nei. Hypoglycemia ta aro bhoi
Patient Advocate: 11.45am mosambi
1.30pm blood sugar 168
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish
6.45pm puffed rice
7.00pm banana
8.00pm 4u lantus insulin
9.30pm blood sugar 199
9.30pm 2u lispro insulin
9=40pm lunch with as same as lunch dish and include pakoda
08/11/24
Patient Advocate: 8.11.24
7.30am blood sugar 53
7.30am dates and puffed rice
7.40am milk
7.50am nuts
9.30am 2u lispro insulin
9.40am rice with papaya, chayote, bitter gourd, tomato, cauliflower, radish, brinjal and salad
PaJR PHR Moderator: Need further reduction in her lantus today.
Sugars at 11:30AM?
Participant 20: Please switch it to morning.
PaJR PHR Moderator: They wanted to meet their local endocrinologist before taking that decision
PaJR PHR Moderator: 👆He mentioned it here in Bengali.
Wish there was an automated Google translate! @Participant another point to convey to the UoH engineers on 28th
Patient Advocate: 11.40am mosambi
1.30pm blood suger 314
1.30am 3.5u lispro1 insulin
1.40pm lunch with same previous dish and include fish
5.30pm suger free sandesh one pc
09/11/24
Patient Advocate: 7.00pm banana
8.00pm 4u lantus insulin
9.30pm blood sugar 272
9.30pm 2.5u lispro insulin
9.40pm lunch with as same as lunch dish
Patient Advocate: 9.11.24
7.30am blood suger 90
7.30am nuts
7.40am milk
9.40am 2.5u lispro insulin
9.50am rice with papaya, chayote, green banana, long beans, bitter gourd, pumpkin, egg and salad
11.45am apple
1.30pm blood sugar 355
1.30pm 4u lispro insulin।1.40pm lunch with same previous dish except egg
10/11/24
Patient Advocate: 6.30pm banana
8.00pm 4u lantus insulin
9.30pm blood sugar 229
9.40pm dinner with as same as lunch dish
Patient Advocate: 10/11/24
7.30am blood suger 72
7.30am nuts
7.40am milk
9.30am 3u lispro insulin
9.40am rice with papaya, chayote, green banana, tomato, brinjal palses and butter
11.45am mosambi
1.45pm blood sugar 272
1.45pm 3.5u lispro insulin
10.50pm lunch with same previous dish except butter and include fish
PaJR PHR Moderator: আগে যেমন আলোচনা করা হয়েছে, সকালের লিসপ্রোর ডোজ ধীরে ধীরে বাড়াতে হবে এবং বিকেল ও রাতের লিসপ্রোর চেয়ে বেশি রাখতে হবে। ল্যান্টাসকে উপবাসের চিনির মান দ্বারা নির্দেশিত সাবধানতার সাথে সামঞ্জস্য করা দরকার
As discussed before, the morning lispro dose, needs to be slowly increased and kept higher than the afternoon and night lispro. Lantus needs to be cautiously adjusted guided by the fasting sugar values
Patient Advocate: তাই চেষ্টা করছি স্যার l
Correction
10.50>1.50pm
7.00pm banana
8.30pm 4u lantus insulin
9.30pm blood sugar 178
9.30pm 1.5u lispro insulin
9.40pm dinner with as same as lunch dish
11/11/24
PaJR PHR Moderator: Fasting today?
Patient Advocate: 7.30am blood suger 228
7.30am nuts
7.40am milk
PaJR PHR Moderator: Why the big jump from 3.5 day before yesterday to 1.5 yesterday?
@Participant hinted at some residual help also by evening lispro to the basal fasting sugars! @Meta AI
Meta AI: The significant decrease in insulin dosage from 3.5 units to 1.5 units could be attributed to several factors, considering the context of your previous messages:
Possible reasons:
1. Residual effect of previous Lantus dose: As you mentioned, the lingering effect of the previous day's Lantus (long-acting insulin) might have contributed to lower fasting blood sugar levels.
2. Evening Lispro's carryover effect: The evening dose of Lispro (fast-acting insulin) might have had a residual impact on fasting blood sugar levels, as its effect can last up to 4-6 hours.
3. Improved insulin sensitivity: Changes in physical activity, diet, or other factors might have increased insulin sensitivity, reducing insulin requirements.
4. Blood sugar variability: Natural fluctuations in blood sugar levels can occur due to various factors, such as hormonal changes, sleep patterns, or medication interactions.
5. Dose adjustment: Your healthcare provider might have intentionally reduced the dose to avoid hypoglycemia or adjust for changes in your insulin needs.
Considerations:
1. Monitor blood sugar levels: Continue tracking your blood sugar to ensure the reduced dose maintains adequate control.
2. Consult your healthcare provider: Discuss the dosage change with your healthcare provider to determine the best course of action and adjust treatment plans accordingly.
3. Adjustments may be needed: Be prepared to adjust the dosage or treatment plan if blood sugar levels become too high or too low.
Questions to discuss with your healthcare provider:
1. Is the reduced dose sufficient for maintaining target blood sugar levels?
2. Should you continue monitoring blood sugar levels more frequently?
3. Are any additional adjustments needed to prevent hypoglycemia or hyperglycemia?
Please consult your healthcare provider for personalized guidance.
Would you like more information on insulin management or blood sugar monitoring?
PaJR PHR Moderator: @Meta AI you got the context wrong. We were asking the patient advocate as to why he made the decision to reduce lispro from 3.5U to 1.5U in one day and it can only be actually answered by the patient advocate @Patient Advocate
My hunch is it's because we discussed about how a larger proportion of lispro short acting insulin was beneficial if given at day time and how we may have to slowly reduce the night lispro but I guess instead of reducing the lispro by 0.5U to 1U he straight away jumped down by 2U!
We also were wondering if lispro was having some effect on the basal fasting blood sugar as previously his fasting values were low and today's after reducing night lispro from 3.5 to 1.5 the fasting has increased as previously predicted by @Participant
Meta AI: You were discussing the decision-making process behind reducing Lispro from 3.5U to 1.5U with the patient advocate.
Your hunch is plausible:
- Daytime Lispro benefits: Larger daytime doses may be beneficial for controlling postprandial spikes.
- Gradual reduction: Reducing nighttime Lispro by 0.5-1U would be a more conservative approach.
The patient advocate's rationale for the 2U reduction remains unclear.
Possible considerations:
1. Overcorrection concern: Avoiding potential hypoglycemia due to accumulated insulin effect.
2. Fasting blood sugar adjustment: As you predicted, reducing nighttime Lispro might increase fasting values.
To clarify, ask the patient advocate:
1. What prompted the significant reduction in Lispro dosage?
2. Was the goal to avoid hypoglycemia or adjust basal fasting levels?
3. Will future adjustments be made more gradually?
Your insight and collaboration with the patient advocate will ensure informed decision-making.
Would you like more questions to discuss with the patient advocate or guidance on insulin management?
Patient Advocate: Na ota 2u chhilo
9.30am 4u lispro insulin
9.40am rice with papaya, chayote, green banana, long beans, brinjal, tomato, egg and salad
11.45am apple
1.30pm blood suger 250
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and paneer
7.00pm banana
8.00pm 4u lantus insulin
9.30pm blood sugar 119
9.30pm 1.5u lispro insulin
9.40pm dinner with as same as lunch dish and papad
12/11/24
Patient Advocate: 11.45pm blood suger 189
12.11.24
7.30am blood sugar 54
7.30am nuts
7.45am milk
PaJR PHR Moderator: No hypoglycemia symptoms?
Patient Advocate: No Sir
9.30am 3u lispro insulin
9.40am rice with pulses, pointed gourd, tometo, pumpkin, bitter gourd, papaya, long beans, brinjal,
11.45am apple
PaJR PHR Moderator: @Meta AI Can you explain from the two day sugar data below as to what may have led to the hypoglycemia today morning?👇
[10/11, 09:57] Patient Advocate 2F Diabetes1: 10/11/24
7.30am blood suger 72
7.30am nuts
7.40am milk
[10/11, 15:53] Patient Advocate 2F Diabetes1: 9.30am 3u lispro insulin
9.40am rice with papaya, chayote, green banana, tomato, brinjal palses and butter
11.45am mosambi
1.45pm blood sugar 272
1.45pm 3.5u lispro insulin
10.50pm lunch with same previous dish except butter and include fish
[10/11, 23:51] Patient Advocate 2F Diabetes1: Correction
10.50>1.50pm
7.00pm banana
8.30pm 4u lantus insulin
9.30pm blood sugar 178
9.30pm 1.5u lispro insulin
9.40pm dinner with as same as lunch dish
[11/11, 08:37] Patient Advocate 2F Diabetes1: 7.30am blood suger 228
7.30am nuts
7.40am milk
[11/11, 22:36] Patient Advocate 2F Diabetes1: 9.30am 4u lispro insulin
9.40am rice with papaya, chayote, green banana, long beans, brinjal, tomato, egg and salad
11.45am apple
1.30pm blood suger 250
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and paneer
7.00pm banana
8.00pm 4u lantus insulin
9.30pm blood sugar 119
9.30pm 1.5u lispro insulin
9.40pm dinner with as same as lunch dish and papad
[12/11, 08:49] Patient Advocate 2F Diabetes1: 11.45pm blood suger 189
12.11.24
7.30am blood sugar 54
7.30am nuts
7.45am milk
Meta AI: Based on the provided data, several factors may have contributed to the hypoglycemia (low blood sugar) today morning:
1. Insulin dosing: The patient received 4u of Lantus insulin at 8:00 PM on 11/11, which is a long-acting insulin that can cause hypoglycemia overnight.
2. Timing and quantity of last meal: Dinner was consumed at 9:40 PM on 11/11, which may not have provided sufficient glucose to last throughout the night.
3. Physical activity: No physical activity information is provided, but increased physical activity can cause hypoglycemia.
4. Snacking: Consuming only nuts and milk for breakfast may not provide sufficient glucose.
5. Insulin sensitivity: Individual variability in insulin sensitivity can lead to unpredictable glucose fluctuations.
To better understand the cause, consider consulting a healthcare professional for personalized guidance.
Please note: This analysis is based on limited data and should not replace medical advice.
PaJR PHR Moderator: @Meta AI
Regarding your point 1:
Same Lantus dose was given on the night before the hyperglycemia as well as hypoglycemia
Point 2: The timing and quantity of last meal at night appear to be same from what data was shared by the patient's advocate
Regarding 3 @Patient Advocate can you share if her physical activities were significantly different on the night before the morning hyperglycemia vs the night before the morning hypoglycemia today?
Meta AI: You're right; the Lantus dose and dinner timing/quantity seem consistent across both nights.
Regarding physical activity, unfortunately, there's no data provided to compare the patient's physical activities on the two nights. To investigate further:
1. Ask the patient's advocate if there were any changes in physical activity or stress levels on 11/11 compared to 10/11.
2. Consider other factors:
- Sleep quality/patterns
- Hormonal changes
- Other medications or supplements
- Menstrual cycle (if applicable)
3. Review more detailed medical history and medication regimen.
4. Consult a healthcare professional for personalized guidance.
Additional data or context would help identify the specific factors contributing to the hypoglycemia.
Patient Advocate: 1.30pm blood suger 230
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish, salad and fish
7.15pm banana
8.30pm 4u lantus insulin
9.30pm blood sugar 193
9.30pm 1.5u lispro insulin
9.40pm dinner with as same as lunch dish
13/11/24
PaJR PHR Moderator: Today's fasting?
Patient Advocate: 13.11.24
7.30am fasting 97
7.30am nuts
7.40am milk
9.30am 3.5u lispro insulin
9.40am rice with papaya, long beans, bitter gourd, tomato, pointed gourd, brinjal, palses, egg and salad
11.45am mosambi
1.30pm blood sugar 252
1.30pm 3.5u lispro insulin
1.40pm lunch with rice with pulses, pointed gourd, carrot, chayote, papaya, long beans, tomato, fish and salad
6.00pm one biscuit
7.00pm Meggie
8.30pm 4u lantus insulin
9.30pm blood sugar 243
9.30pm 2u lispro insulin
9.40pm dinner with rice, brinjal, tomato, long beans, papaya, pointed gourd, mutton and salad
14/11/24
Participant: Happy Childrens Day to our star patient and wishing her the best😄💐
Participant: Today is World Diabetes Day as well.
Patient Advocate: 14/11/24
7.30am blood sugar 88
7.30am nuts
7.40am milk
Thank you Sir
9.50am 3.5u lispro insulin
10.00am rice with pulses, pointed gourd, chayote, papaya, long beans, bitter gourd, tomato, spinach, egg and salad
12.00noon apple
[11:28 PM, 11/14/2024] Patient Advocate: 1.30pm blood sugar 213
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
7.00pm banana
8.00pm milk
8.30pm 4u lantus insulin
9.30pm blood sugar 322
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
15/11/24
Patient Advocate: 15.11.24
7.30am blood sugar 152
7.30am nuts
7.45am milk
9.500am 4u lispro insulin
10.00am rice with pulses, pointed gourd, chayote, papaya, long beans, bitter gourd, beans, brinjal tomato and salad
12.00noon mosambi and sugarcane
1.45pm blood sugar 211
1.45pm 3.5u lispro insulin
1.50pm lunch with same previous dish and fish
7.00pm banana
8.15pm 6-7 teaspoon khichdi
8.30pm 4u lantus insulin
9.30pm blood suger 342
9.30pm 3.5u lispro insulin
9.40pm dinner with as same as lunch dish
16/11/24
Patient Advocate: 11.45pm post dinner blood sugar 105
16.11.24
7.30am blood sugar 75
7.30am nuts
7.45am milk
PaJR PHR Moderator: 👍the night lispro could have been lower although I'm aware it was designed to cater to the pre meal
Patient Advocate: 9.30am 3.5u lispro insulin
9.40am rice with pointed gourd, tometo, long beans, bitter gourd, papaya
12.00noon mosambi
1.45pm blood sugar 206
1.45pm 3u lispro insulin
1.50pm lunch with same previous dish
6.50pm banana
8=30pm 4u lispro insulin
10.00pm blood sugar 57
10.00pm Cadbury chocolate ( two bar)
10.10pm 0.5u lispro insulin
10.15pm dinner with as same as lunch dish
17/11/24
Patient Advocate: 12.15am post dinner blood sugar 246
PaJR PHR Moderator: 👆We suggested lowering the night lispro but you increased it!! 😳
Any symptoms?
👆 no lantus yesterday?
Patient Advocate: ড্যান্স করছিল করতে করতে বলছিল আমার আর নাচতে ইচ্ছে করছে না
8.30pm ওটা lispro হবে না ওটা lantus হবে
17.11.24
7.30এম blood suger 110
7.30am nuts
7.45am milk with aata roti
PaJR PHR Moderator: Etai ki prothom ore HYPOGLYCEMIA jorito ekta symptom jeta prothom amra jante parlam?
Patient Advocate: 9.30am 4u lispro insulin
9.40am rice with papaya, long beans, pulses pointed gourd bitter gourd, tomato, beans and salad
হ্যাঁ স্যার বাড়িতে বিয়ে তো তাই খুব নাচা নাচি করছিল গতকাল প্রায় 2.5-3 ঘণ্টা নেচেছিল
PaJR PHR Moderator: @Meta AI please translate below:
হ্যাঁ স্যার বাড়িতে বিয়ে তো তাই খুব নাচা নাচি করছিল গতকাল প্রায় 2.5-3 ঘণ্টা নেচেছিল
Meta AI: Here's the translation:
"Yes, sir, there was a wedding at home, so I danced a lot yesterday, approximately for 2.5-3 hours."
This information suggests that the patient engaged in significant physical activity (dancing) on the night before the morning hypoglycemia, which could be a contributing factor to the low blood sugar.
Patient Advocate: 12.00noon pear
1.30pm blood sugar 58
1.30pm 1.5u lispro insulin
1.40pm lunch with same previous dish and fish
4.00pm blood sugar 68
Gems
4.00pm gem
5pcs gems chocolate
Access Complete Patient Record:
Comments
Post a Comment