DECEMBER 2024 - 3 Years Old child, Type1 Diabetes, Insulin Hypoglycemia, Intermittent, Bloating 1 Month
PATIENT DATA LOG OF DECEMBER - 2024
01/12/24
Patient Advocate: 1.12.24
7.30am blood sugar 69
7.30am nuts
7.45am milk
9.30am 3.5u lispro insulin
9.35am rice with pulses, brinjal, tomato, long beans, radish, chayote, green banana, beans, egg and salad
12.00noon orange
1.30pm blood sugar 154
1.30pm 3u lispro insulin
1.35am lunch with previous dish except egg and include paneer
PaJR PHR Moderator: 👆 lantus not mentioned here?
Patient Advocate: 8.30pm 5u lantus
PaJR PHR Moderator: Yesterday?
And today?
Patient Advocate: 7.00pm mixed of milk puffed rice and banana
8.45pm 5u lantus
9.45pm blood sugar 254
9.45pm 2.5u lispro insulin
9.50pm dinner with as same as lunch dish except paneer and include egg
02/12/24
PaJR PHR Moderator: Today's fasting?
Patient Advocate: 2.12.24
7.45am blood sugar 160
7.45am nuts
8.00am payesh( milk, coun rice, dates and raisins)
9.45am 3.5u lispro insulin
9.50am rice with pulses, brinjal, tomato, long beans, radish, chayote, green banana, pumpkin, egg, and salad
12.00noon orange
1.30pm blood suger 309
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg and include paneer
Patient Advocate: 3.12.24
7.30am blood sugar 68
7.30am nuts
7.45am milk
PaJR PHR Moderator: 5U lantus is a bit dicey with the fasting sugars dangerously veering toward hypo on one day and normalised on another day!
4.5U with a ordinary insulin syringe would be safer
Patient Advocate: 9.30am 3.5u lispro insulin
9.35am rice with pulses, pointed gourd, chayote green banana, brinjal, tomato, long beans, egg and salad
12.00noon apple
1.30pm blood sugar 243
1.30pm 3.5u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
7.00pm banana
9.00pm 5u lantus insulin
9.30pm blood sugar 230
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish
Patient Advocate: 7.30am blood sugar 58
7.30am nuts
7.45am milk
PaJR PHR Moderator: Switch back lantus to 4U! Should not have given more than 4 if 4.5U wasn't possible
Patient Advocate: Due to some problems I can't update here
PaJR PHR Moderator: What problems?
Patient Advocate: 7.12.24
7.500am fasting blood sugar 238
7.30am milk
9.45am 3.5u lispro insulin
9.50am rice with pulses, brinjal, tomato, long beans, beans, radish, chayote, papaya, cauliflower, spinach and egg
1.45pm blood suger 368
1.45pm 4u lispro insulin
1.50pm lunch with same previous dish except egg
Patient Advocate: No problem with the patient
PaJR PHR Moderator: 👆On 4/12/24 there was hypoglycemia with 5U lantus
PaJR PHR Moderator: I'm assuming on 6/12/24 she received 4U and developed hyperglycemia. Although we need to confirm by taking a 3:00 AM blood sugar but it's likely that her blood sugar fluctuations are because of very small changes in her lantus dose (again assuming other factors such as carb intake and exercise are constant but then that data isn't well captured and shared here)
Patient Advocate: Yes Sir 4u lantus at 8.30pm
Patient Advocate: 7.00pm oats
9.30pm blood sugar 338
9.30pm 2.5u lispro insulin
9.35pm rice with pulses, carrot, cauliflower, beans, pakoda and salad
Patient Advocate: 8.45pm 4u lantus
11.45pm blood sugar 453
PaJR PHR Moderator: After checking the fasting today the morning insulin lispro will need to be increased
This needs to be made 4.5U using a plain syringe as shown in 30F's PaJR
Patient Advocate: 8.12.24
7.45am fasting blood sugar 238
7.45am milk
9.30am 5u lispro insulin
9.40am rice with pulses, brinjal, tomato, long beans, radish, chayote, papaya, beans, cabbage spinach, egg and salad
11=45am orange
1.30pm blood sugar 238
1.30pm 4u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
Lantus ki aaj ke 1u bariye debo?
PaJR PHR Moderator: Lantus ta jodi sokaler deeke dewa jai breakfast er por ebong lunch er aage tahole hoito 1U barano jete pare kenoki tahole shara diner barti sugar taake komabe kintu bortoman jemon raate dewa hocche taate abar early morning hypoglycemia te chole jabar sombhabona royeche. Tabe 4.5U dewa jete pare ordinary syringe er shahajje jemon @Participant unar patient ke dicchen
PaJR PHR Moderator: 👆@Narmeen Shah can we check with AI if this was the highest recorded blood sugar till date in this patient?
Patient Advocate: 7.00pm Meggie
8.30pm 5u lantus insulin
9.30pm blood sugar 243
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish
Narmeen Shah: The highest recorded blood sugar for this patient was 445. This measurement was taken at 9:30 pm on November 30, 2024, right before dinner. The patient had nuts at 7:30 am, followed by milk at 7:45 am. The patient had a meal of rice, pulses, brinjal, tomato, chayote, beans, radish, tomato, egg, and salad at 9:35 am, followed by an apple at 11:45 am. For lunch at 1:35 pm, they had the same dish as their morning meal but with paneer instead of egg. They had a banana at 7:00 pm and popcorn at 7:30 pm. Their dinner at 9:35 pm consisted of the same lunch dish with the addition of pakoda. The patient received 4 units of lispro insulin before their 9:35 am meal, 4 units before lunch, and 4.5 units before dinner. They also had 5 units of lantus insulin at 8:30 pm.
Narmeen Shah: Yes sir. 453 is the highest crossing the last highest recorded blood sugar of 445.
PaJR PHR Moderator: Can AI share all the highest recordings since the PaJR began and all the lowest in one graph?
PaJR PHR Moderator: Today's fasting?
Narmeen Shah: Ok sir let me check.
Patient Advocate: 9.12.24
7.50 am fasting blood sugar 176
7.50am milk
9.30am 4.5u lispro insulin
9.40am rice with pulses, papaya, chayote, long beans, radish, beans, cabbage, cauliflower, egg and salad
11.45am orange
1.30pm blood sugar 291
1.30pm 4u lispro insulin
1.40pm lunch with same previous dish except egg and include paneer
7.00pm oats
8.30pm 5u lantus insulin
9.30pm blood sugar 210
9.30pm 1.5u lispro insulin
9.35pm dinner with as same as lunch dish
PaJR PHR Moderator: Fasting?
Patient Advocate: 10.12.24
8.00am fasting blood sugar 213
8.00am nuts
8.15am milk
9.30am 5u lispro insulin 9.32am rice with pulses papaya, chayote, spinach, carrot, cauliflower, cabbage and salad
11.45am orange
1.30pm blood sugar 327
1.30pm 5u lispro insulin
1.35pm lunch with same previous dish and egg
Patient Advocate: 7.00pm oats
8.30pm 5u lantus insulin
9.30pm blood sugar 250
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish except egg
Patient Advocate: 11.12.24
7.45am fasting blood sugar 58
7.45am nuts and dates
8.00am milk
9.30am 3.5u lispro insulin
9.35am rice with pulses, brinjal, tomato, long beans, bitter gourd, beans, radish, chayote, papaya and salad
PaJR PHR Moderator: 5U lantus is dangerous for her.
If we can't make it 4.5 lets keep it at 4
Patient Advocate: 11.45am apple
1.30pm blood sugar 236
1.30pm 3.5u lispro insulin
1.35pm dinner with same previous dish and chicken
7.00pm Meggie
8.45 pm 5u lantus insulin
9.30pm blood sugar 154
9.30pm 1u lispro insulin
9.35 pm dinner with as same as lunch dish
Patient Advocate: 11.45pm blood suger 161
Then 5grm suger (chini)
Patient Advocate: 12.12.24
7.45am blood suger 218
7.45am nuts
8.00am milk
PaJR PHR Moderator: 5U lantus is dangerous for her. 👆
PaJR PHR Moderator: If we review her current cycles with 5U lantus her fasting sugars appear unaffected by it for 2-3 days and then she suddenly goes into hypoglycemia with the same dose? @Narmeen Shah please confirm
Patient Advocate: 9.50am 4.5u lispro insulin
9.55am rice with papaya, chayote, bitter gourd, tomato, long beans, radish, beans, cauliflower, cabbage, paneer and salad
Narmeen Shah: Yes sir
Patient Advocate: 12.00noon orange
1.45pm blood sugar 360
1.45pm 5u lispro insulin
1.50pm lunch with same previous dish except paneer and include egg
7.00pm Meggie
8.45pm 5u lantus insulin।
9.45pm blood sugar 145
9.45pm 0.5u lispro insulin
9.50pm dinner with as same as lunch dish
PaJR PHR Moderator: Thanks
Any way we can also add the dates to each value?
Patient Advocate: 7.45am blood sugar 179
7.45am nuts
8.00am milk
9.45am 4.5u lispro insulin
9.50am rice with pulses, brinjal, bottle gourd, tomato, long beans, , papaya, cauliflower, spinach, carrot, egg and salad
12.00noon apple
1.45pm blood sugar 255
1.45pm 4u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
Narmeen Shah: Sir some of these values were repeated on other days as well so that's y didn't mention the single date to avoid error.
PaJR PHR Moderator: Yes we need the values from all dates.
The LLMs can often cause errors when given numerical based tasks
Narmeen Shah: Ok sir.
Yes sir that's why I recheck it manually.
14/12/24
Patient Advocate: 7.00pm oats
8.30pm 5u lantus insulin
9.30pm blood sugar 138
9.30pm 0.50u lispro insulin
9.35pm dinner with as same as lunch dish and include butter
PaJR PHR Moderaor: Fasting?
Can you share a graph for this showing the lantus dose in y axis and glucose change with time in x axis?
Let's also check out today's fasting
Narmeen Shah: Sir for a month?
PaJR PHR Moderator: I guess we noticed this bug (that we are trying to feature)particularly this week but then I can recall it having been there earlier as well over the last few months.
But let's just check the last two weeks
Patient Advocate: 7.45am fasting blood sugar 73
7.45am nuts
8.00am milk
PaJR PHR Moderator: Let's update the data here https://narmeenshah.blogspot.com/2024/07/3-year-old-child-type1-diabetes-insulin.html?m=1 from 9/12/2024 to today. I need that to share the recent milestone
Narmeen Shah: Done sir ✅
PaJR PHR Moderator:
[14/12, 09:36] Pediatric Endocrinologist NJ: Shouldn’t the Lantus dose (independent variable) be on the x axis and the glucose values (dependent/responsive variable) be on the y axis?
[14/12, 09:38] PaJR moderator: I guessed the x axis will need to be time with the dependent and glucose values changing with time labeled in the x axis while the y axis would label the 1U change in the lantus dose
[14/12, 09:41]Pediatric Endocrinologist NJ: You’re taking about a 3 D graph with 3 variables - time, Lantus dose, and glucose x, y, and z axes.
With a more traditional 2D XY graph, Lantus on X and glucose on Y - glucose should be FPG
[14/12, 09:42] PaJR moderator: Yes let's try out all 2D and 3D options
[14/12, 09:42] Pediatric Endocrinologist NJ: Do you have the software to create a 3D graph?
[14/12, 09:52] PaJR moderator: AI has everything
Patient Advocate: 10.00am 3.5y lispro insulin
10.05am rice with pulses, brinjal, tomato, chayote, cauliflower,, radish , beans papaya and salad
Narmeen Shah:
16/12/24
Patient Advocate: 16/12/24
7.45am blood sugar 207
7.45am nuts
8.00am milk
PaJR PHR Moderator: @Narmeen Shah check if we are in the crest of the lantus 4-5 unit blood sugar "yo yo crest and trough" cycle that you have recently documented and archived for this patient
Patient Advocate: 9.45am 6u lispro insulin
17/12/24
PaJR PHR Moderator: 👍
Today's fasting?
Patient Advocate: 17.12.24
7.45am fasting blood suger 106
7.45am nuts
8.00am milk
9.45am 4.5u lispro insulin
9.50am rice with pulses, brinjal, bottle gourd, cauliflower, carrot, spinach, cabbage, egg and salad
PaJR PHR Moderator: @Narmeen Shah it's still in the trough before it falls into the hypoglycemia pit and then the dose is reduced to lift up the sugars again and the cycle continues till we can disrupt this cycle with 4.5U of lantus at night
Narmeen Shah: Sir lantus was not given on sunday or that 8:45pm 5U lispro is actually lantus mistyped as lispro?
Patient Advocate: Yes Sir it was mistyped
Narmeen Shah: Ok thank you 🙏
Patient Advocate: 12.00noon apple
1.45pm blood sugar 210
1.45pm 3.5u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm one biscuit
7.00pm oats
8.30pm 5u lantus insulin
9.30pm blood sugar 266
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish
Patient Advocate: 18.12.24
7.45am blood sugar 124
7.45am nuts
8.00am milk
PaJR PHR Moderator: 👆@Narmeen Shah the 5U is producing optimal fasting instead of getting into hypos for how many days now?
Narmeen Shah: Sir since 3 days.
Sir last hypoglycemia episode was on 14dec with 5U.
After that 4U was given which rises the fasting sugar level to 264.
5U was given after that, which kept the sugar readings 207, 106, 124 since 3 days.
PaJR PHR Moderator: Can we get the graph a few days prior to 14 December to check if the 4U to 5U hyper hypo yo yo pattern is visible from earlier?
Narmeen Shah: Sir the last graph is starting from 30Nov to 17dec.
Should i create before 30Nov?
PaJR PHR Moderator: 👆Hypos on 1, 4, 11, 14!
Let's look from before 1st
PaJR PHR Moderator: Yes let's check before 30th November as far as we can spot the 4U to 5U changes
Narmeen Shah: Ok sir.
Patient Advocate: 9.15am 5u lispro insulin
9.50am rice with pulses brinjal, spinach, cabbage, cauliflower, radish, papaya, beans, ghee and salad
12.00noon mosambi
1.30pm blood sugar 169
1.30pm one park chocolate
1.40pm 4u lispro insulin
1.45pm lunch with same previous dish and fish
7.00pm oats
8.45pm 5u lantus insulin
9.30pm blood sugar 287
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish
Narmeen Shah:
19/12/24
PaJR PHR Moderator: From our pediatric endocrinologist:
Based on this, 4 units seems ok, except for an occasional breakthrough. The parents and even the physicians should not be responding to spikes on a daily basis, but to patterns (typically requires at least a week’s data). The exception is hypoglycaemia, especially severe hypoglycaemia (defined as hypoglycaemia requiring assistance). “Requiring” means the patient could not have treated the hypo themselves. Tough to determine in kids <5 or 6.
@Narmeen Shah thanks to your graphs for these insights!
PaJR PHR Moderator: 👆The hyperglycemia breakthroughs are so well visible in this graph as if mountains tearing through the clouds of the 4U lantus line!
What is concerning though is the number of hypoglycemia dig throughs that remain slightly unnoticed perhaps due to the absence of a baseline. @Narmeen Shah can you also draw a "line of control" LOC to suggest fair control with a line cutting the y axis at 175 and another cutting the y at 70?
Patient Advocate: 19.12.24
7.45am blood suger 223
7.45am nuts
8.00am milk
9.30am 6.5u lispro insulin
9.35am rice with pulses, papaya, beans, cabbage, cauliflower, radish, spinach, ghee and salad
12.00noon apple
1.30pm blood sugar 157
1.30pm 3.5u lispro insulin
1.35pm lunch with same previous dish and include egg
PaJR PHR Moderator: From 4.5U morning lispro on 17/12/24 to 5U on 18/12/24 yesterday to 6.5U Today 19/12/24 all decisions made by the patient's immediate caregiver @Narmeen Shah
Narmeen Shah: Sure sir 👍
Narmeen Shah:
Patient Advocate: 6.30pm one biscuit
7.00pm oats
8.30pm 5u lantus
9.30pm blood suger 304
9.30pm 2.5u lispro e
9.35pm dinner with as same as lunch dish
Patient Advocate: 20.12.24
7.45am fasting blood sugar 120
7.45am nuts
8.00am milk
PaJR PHR Moderator: 👏👏
Put this graph at the top here 👇
https://narmeenshah.blogspot.com/2024/12/december-2024-3-years-old-child-type1.html?m=1
Patient Advocate: 9.30am 5u lispro insulin
9.35am rice with pulses, brinjal, spinach, cabbage, cauliflower, carrot, radish, butter and salad
11.45am orange
1.30pm blood sugar 246
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except butter and include fish
Patient Advocate: 7.00pm oats
8.30pm 5u lantus
9.30pm blood sugar 216
9.30pm 1.5u lispro insulin
9.35pm dinner with as same as lunch dish
PaJR PHR Moderator: Fasting?
Patient Advocate: 21.12.24
7.45am fasting blood sugar 190
7.45am nuts
8.00am milk
9.30an 5u lispro insulin
9.35am rice with pulses, brinjal, tomato, long beans, beans, radish, cabbage, cauliflower, egg and salad
12.00noon orange
1.30pm blood sugar 225
1.30 pm 4u lispro insulin
1.35pm lunch with same previous dish except egg
7.00pm oats
8.30pm 5u lantus insulin
9.30pm blood sugar 289
9.30pm 2.5u lispro insulin
9.35pm dinner with as same as lunch dish and papad
Patient Advocate: 22.12.24
7.45am fasting blood sugar 87
7.45am nuts
8.00am milk
PaJR PHR Moderator: Tonight reduce lantus dose
Patient Advocate: Ok Sir
Patient Advocate: 9.45am 4u lispro insulin
9.50am rice with pulses, brinjal, tomato, long beans, radish, beans, cabbage, carrot, egg and salad
12.00noon orange
1.45pm blood sugar 241
1.45pm 5u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 114
7.00pm oats
7.30pm one biscuit
8.30am 5u lantus insulin
9.30pm blood sugar 214
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish
PaJR PHR Moderator: Today's fasting?
Patient Advocate: 7.45am fasting blood sugar 183
7.45am nuts
8.00am milk
PaJR PHR Moderator: Interestingly no hypoglycemia yet inspite of being on continued lantus 5 even as the fasting went down to 87 yesterday
@Narmeen Shah can you figure out with @Meta AI as to how this can be represented in the graph and what are the possible data points missing that somehow salvaged the fasting sugars inspite of the prior patterns predicting otherwise
Meta AI: To better understand the situation and represent it graphically, let's break down the key points:
# Key Points
1. Continued Lantus 5: You're consistently taking 5 units of Lantus (long-acting insulin) as part of your diabetes management.
2. Fasting glucose dropped to 87: Despite being on the same dose of Lantus, your fasting blood glucose level decreased to 87 mg/dL.
3. No hypoglycemia: You haven't experienced any episodes of low blood sugar (hypoglycemia) despite the decrease in fasting glucose.
# Possible Factors Influencing Fasting Glucose
Several factors could be contributing to the decrease in fasting glucose without hypoglycemia:
1. Improved insulin sensitivity: Your body might be becoming more responsive to insulin, allowing glucose to enter cells more efficiently.
2. Changes in diet or physical activity: Alterations in your diet or exercise routine could be influencing your glucose levels.
3. Hormonal fluctuations: Hormonal changes, such as those experienced during the menstrual cycle or due to other endocrine conditions, might be affecting glucose metabolism.
4. Other medications or supplements: Certain medications or supplements could be interacting with your diabetes medications or influencing glucose levels.
# Graphical Representation
To visualize this data, you could use a line graph or a scatter plot to track your fasting glucose levels over time. The x-axis would represent time (e.g., days or weeks), and the y-axis would represent fasting glucose levels.
# Data Points to Consider Adding
To better understand the situation and identify potential patterns, consider adding the following data points:
1. Time of day: Record the time of day when you take your fasting glucose measurements.
2. Food intake and timing: Log your food intake, including the timing and amount of carbohydrates, protein, and fat.
3. Physical activity: Record your physical activity levels, including the type, duration, and intensity.
4. Other medications and supplements: List any other medications or supplements you're taking, including dosages and timing.
5. Sleep patterns: Track your sleep patterns, including duration and quality.
# Example Graph
Here's an example of what the graph could look like:
Fasting Glucose Levels Over Time
| Time (Days) | Fasting Glucose (mg/dL) |
| --- | --- |
| 1 | 120 |
| 2 | 115 |
| 3 | 110 |
| 4 | 105 |
| 5 | 100 |
| 6 | 95 |
| 7 | 90 |
| 8 | 87 |
This graph shows a general downward trend in fasting glucose levels over time, with some fluctuations.
By analyzing this data and considering the additional factors mentioned earlier, you can work with your healthcare provider to adjust your treatment plan and optimize your glucose control.
Patient Advocate: 9.45am 5u lispro insulin
9.50am rice with pulses, paneer butter beans radish long beans brinjal and salad
12.30pm apple
1.45pm blood sugar 196
1.45pm 3u lispro insulin
1.50pm lunch with same previous dish except egg and include paneer
7.00pm oats
9.30pm blood suger 303
9.38pm 2.5u Lispro insulin
9.45pm dinner with as same as lunch dish and pakoda
Patient Advocate: 24.12.24
7.45am blood suger 129
7.45am nuts
8.00am milk
9.45am 4u lispro insulin
9.50am rice with pulses, butter, beans, radish, long beans, brinjal, carrot, cauliflower, egg and salad
12.00noon apple and orange
1.40pm blood sugar 140
1.40pm 2u lispro insulin
1.50pm lunch with same previous dish except egg, butter and include fish
7.00pm aata roti two pcs
9.30pm blood sugar 278
8.30pm 5u lantus insulin 9.30pm 1.5u lispro insulin
9.35pm dinner with as same as lunch dish
Patient Advocate: 7.45am fasting blood sugar 59
7.45am nuts
8.00am milk
9.00am one kinder Joy chocolate
9.45am 3.5u lispro insulin
9.50am rice with pulses butter, beans, long beans, radish, cabbage, cauliflower, carrot, spinach, egg and salad
PaJR PHR Moderator: @Narmeen Shah can we see the graph as to how this hypoglycemia arrived after how many days?
Unfortunately this was expected and inspite of informing above the patient's primary caregiver insisted on continuing the same dose of lantus.
👆
Patient Advocate: 12.00noon orange
1.30pm blood sugar 195
1.30am 3u lispro insulin
1.35pm lunch with same previous dish except egg and butter and include paneer
PaJR PHR Moderator: Any symptoms of hypoglycemia and anything administered for that?
Patient Advocate: No Sir
Narmeen Shah: Sure sir.
Participant 20: Upto 2 Hypos per week are generally accepted in Type 1. Perhaps we may not need to address each and every hypo (notwithstanding age of the child) ?
PaJR PHR Moderator: And these are asymptomatic!
And these episodes of hypoglycemia unawareness have never been documented in 3 year old toddlers so much so that this term is not used for them rather the term asymptomatic hypoglycemia appears to be favoured
Patient Advocate: 6.30pm 15grm cake
7.00pm oats
8.30pm 4u lantus insulin
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish and egg
Participant 20: Only time will tell! Thanks to PaJR (the only resource in the world which can do it live) we'll see the evolution of these events in the flesh
Patient Advocate: 11.45pm blood sugar 238
Patient Advocate: 26.12.24
7.45am fasting blood sugar 171
7.45am milk
9.30am 4.5u lispro insulin
9.35am rice with pulses, ghee, beans, radish, cauliflower, spinach, carrot, cabbage, egg and salad
11.45am blood suger 178
12.00noon orange
1.45pm one lolypop
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
7.00pm oats
8.30pm 4u lantus insulin
9.30pm blood sugar 218
9.30pm 1u lispro insulin
9.35pm dinner with as same as lunch dish
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