FEBRUARY 2025 - 3 Years Old child, Type1 Diabetes, Insulin Hypoglycemia, Intermittent, Bloating 1 Month

PATIENT DATA LOG OF FEBRUARY - 2025

01/02/25

Patient Advocate: 01.02.25

7.45am fasting blood sugar 192

7.45am nuts 

8.00am milk

9.45am 5.5u lispro insulin 

9.50am rice with pulses, brinjal, tomato, beans, bitter gourd, cauliflower, carrot, beetroot, spinach, cabbage, papad and salad

PaJR PHR Moderator: 👍

Patient Advocate: 12.00noon grapes

2.00pm blood sugar 64

2.00pm 2.5u lispro insulin 

2.05pm lunch with same previous dish 

7.00pm maggie 

9.00pm 5u lispro insulin 

9.30pm blood sugar 137

9.30pm 0.5u lispro insulin 

9.35pm dinner with as same as lunch dish except papad and include pakoda

02/02/25

Patient Advocate: 2.02.25

7.45am fasting blood sugar 63

7.45am nuts 

8.00am milk 

9.45am 3.5u lispro insulin 

9.50am rice with pulses, brinjal, tomato, beans, bitter gourd, chayote, spinach, brocolli, cauliflower, beetroot and salad 

12.00noon blood sugar 216

1.30pm 3.5u lispro insulin 

1.35pm lunch with same previous dish and fish

PaJR PHR Moderator: 👆 with the hyperglycemic phase ending in Friday, @Participant 20 @Narmeen Shah , the patient appears to have entered a normo to hypoglycemic phase since yesterday!

Participant 20: We should publish this widely.

PaJR PHR Moderator: Share the published link widely

Participant 20: Will need to present this in an easily digestible manner.

Patient Advocate: 6.30pm oats 

7.00pm chocos 1/3 packet 

9.15pm 5u lantus insulin 

9.35pm blood sugar 165

9.35pm 1u lispro insulin 

9.40pm dinner with as same as lunch dish

03/02/25

Patient Advocate: 03.02.25

7.45am fasting blood sugar 53

7.45am milk with 2/3 packet of chocos

8.15am nuts 

9.45am mixed fruits and 1/4 of sandesh (prasad)

1.15pm blood sugar 365

1.15pm 6u lispro insulin 

1.20pm khichudi, brinjal fry one pc, cabbage (ghonto)

PaJR PHR Moderator: Time to reduce lantus to 4U tonight

04/02/25

Patient Advocate: 6.45pm oats 

9.15pm 5u lantus 

9.30pm blood sugar 211

9.30pm 1u lispro insulin 

9.35pm dinner with rice, brinjal, cabbage, geen peas, butter , 1/2 pc pakoda (mashroom) and salad

এটা পরে দেখেছি স্যার

PaJR PHR Moderator: Fasting sugars today?

Patient Advocate: 7.45am fasting blood sugar 228

7.45am nuts 

8.00am milk 

9.45am 5.5u lispro insulin 

9.50am rice with pulses, brinjal, tomato, beans, bitter gourd, chayote, green peas, carrot, cauliflower, cabbage, egg and salad

11.45am orange 

1.30pm blood sugar 130

1.30pm 1u lispro insulin 

1.35pm rice with pulses, brinjal, spinach, carrot, cauliflower, fish and salad 

6.00pm 1/4 of samosha (  except potato)

6.45pm banana 2pcs

9.15pm 5u lantus insulin 

9.45pm blood sugar 397

9.45pm 3.5u lispro insulin 

9.50pm dinner with as same as morning dish

05/02/25

Patient Advocate: 5./02/25

7.45am fasting blood sugar 249

7.45am nuts 

8.00am milk

06/02/25

Patient Advocate: 9.45am 2pcs chocolate biscuit 

10.45am 6u lispro insulin 

10.50am rice with pulses brinjal, tomato, pumpkin, carrot, cauliflower, cabbage, beetroot, beans, chayote, green peas, butter and salad  

11.30am lays 1/2 of small packet 

12.00noon pomegranate 

1.45.pm blood sugar 316

1.45pm 5.5u lispro insulin 

1.50pm lunch with same previous dish except butter and include fish 

4.00pm blood suger 

182

7.00pm oata

9.15pm 5u lantus insulin 

9.45pm blood sugar 259

9.50pm dinner with as same as lunch dish

PaJR PHR Moderator: What drove the point of hypoglycemia to a sharp and sustained rise of hyperglycemia inspite of other parameters perhaps remaining constant? Off coupon one of the issues here is that we don't know if those parameters were actually constant

Patient Advocate: 6.02.25

7.45am fasting blood sugar 169

7.45am nuts 

8.00am milk 

9.45am two pcs chocolate biscuit

10.45am 5.5u lispro insulin 

10.50pm rice with pulses, cauliflower, carrot, beans, tomato, chayote, beetroot, carrot, cabbage, egg and salad 

12.00noon grapes 

1.45pm blood sugar 285

1.45pm 5.5u lispro insulin 

1.50pm lunch with same previous dish except egg and include fish 

6.45pm oats 

9.15pm 5u lantus insulin 

9.45pm blood sugar 212

9.45pm 1u lispro insulin 

9.50pm dinner with as same as lunch dish

07/02/25

Patient Advocate: 7.02.25

7.45am fasting blood sugar 205

7.45am nuts 

8.00am milk 

9.30am chocolate biscuit 2pcs 

10.45am 6u lispro insulin 

10.50am rice with pulses, brinjal, tomato, beans, cabbage, carrot, brocolli, beetroot, chayote, bitter gourd, butter and salad

12.15pm  grapes 

1.45pm blood sugar 319

1.45pm 6u lispro insulin 

1.50pm lunch with same previous dish except butter and include egg 

6.45pm oats

স্যার এখন lantus না lispro বাড়ানো যায় ?

PaJR PHR Moderator: Lantus barano ta depend kore fasting sugar er upor

Aajke 205 chilo gotokaler 5 lantus er por tai sabdhane 5.5 kora jete pare 

Lispro ta aager diner two hour post meal sugar er upor dependent kore jodi aager dino motamuti aeki khabar calorie theke thake. Aeki calorie rakha oi jonyei subidhe. Jodi aager diner shei shomoikar sugar value na thake kimba calorie consumption aager diner tulonai khub bhinno hoi tahole shei aandaje lispro ta adjust korar kotha

Participant 20: Possibly this child will need switching to Humalog Mix 75. 3 injections and enough long acting.

 Lantus is far too hypoglycemic for this child?

Or even Humalog Mix 50

Patient Advocate: 9.15pm 5u lantus insulin 

9.45pm blood sugar 103

No lispro at night 

9.45pm dinner with as same as lunch dish

08/02/25

PaJR PHR Moderator: Also influenced by our learning from the other PaJR type 1 diabetes patient

Patient Advocate: 8.02.25

7.45am fasting blood sugar 196

7.45am nuts 

8.00am milk with 1/2 aata roti

9.45am 6u lispro insulin 

9.50am rice with pulses, cauliflower, carrot, beans, tomato, chayote, kidney beans, brocolli, beetroot, egg and salad 

12.00noon mixed fruit 

1.40pm blood sugar 409

1.40pm 6.5u lispro insulin 

1.45pm lunch with same previous dish except egg, chutney ( tomato and jujube except sugar)

PaJR PHR Moderator: Would be nice to see the picture of the food plates

Patient Advocate: 4.05pm blood sugar 212

7.00pm oats

9.15pm 5u lispro insulin 

9.45pm blood sugar 158

9.45pm 1u lispro insulin 

9.50pm dinner with as same as lunch dish

09/02/25

Patient Advocate: 9.02.25

7.45am fasting blood sugar 195

7.45am nuts 

8.00am milk

Nuts

Patient Advocate: 9.45am 6u lispro insulin 

9.50am rice with pulses, brinjal, tomato, beans, kidney beans, brocolli, carrot, beatroot, cauliflower, chayote, pakoda (onion), and salad

PaJR PHR Moderator: 👍

Patient Advocate: 12.00noon blood sugar 243

12.00noon pomegranate 

1.45pm 4.5u lispro insulin 

1.50pm lunch with same previous dish except pakoda and include egg

PaJR PHR Moderator: What is the liquid being used to mix the powdered nuts?

Does she enjoy the nuts in this way?

What nuts are these?

Patient Advocate: No powder, it is whole nuts . Patient does not chwe the whole nuts so its make pest in mixture.

PaJR PHR Moderator: You mean the liquid in the paste is coming out from the nuts themselves?

What nuts are these?

Does she enjoy eating the nuts in this paste form or thinks it to be more of a medicine?

Patient Advocate: Cashew, piasta, wallnut, almond and chickpea

7.00pm oats 

9.15pm 5u lantus insulin 

9.45pm blood sugar 145

9.45pm 1u lispro insulin 

9.50pm  dinner with as same as lunch dish

10/02/25

Patient Advocate: 10.02.25

7.45am fasting blood sugar 174

7.45am milk 

9.45am chocolate biscuit 2pcs 

10.45am 5.5u lispro insulin 

10.50am rice with pulses, brinjal, tomato, beans, bitter gourd, pumpkin, carrot, cauliflower, beetroot, egg and salad 

12.00noob pomegranate 

1.30pm blood sugar 205

1.30pm 4.5u lispro insulin 

1.35pm lunch with same previous dish except egg

6.45pm oats 

9.15pm 5u lispro insulin 

9.45pm blood sugar 67

No lispro at night 

9.50pm dinner with as same as lunch dish

11/02/25

Patient Advocate: 11.02.25

7.45am fasting blood sugar 243

7.45am nuts 

8.00am milk 

9.45am chocolate biscuit 2pcs 

10.45am 6.5u lispro insulin 

10.50am rice with pulses, brinjal, tomato, beans, bitter gourd, chayote, carrot, beetroot, brocolli, egg 1/2 and salad

PaJR PHR Moderator: You mean no lantus at night?

Why the sudden jump in her lispro from 1U day before yesterday to 5U yesterday? Or was it 5U lispro or lantus taken at 9:15PM?

Patient Advocate: No lispro, lantus was   given 5u

PaJR PHR Moderator: Alright

Patient Advocate: 12.00noon pomegranate 

1.45pm blood sugar 157

1.45pm 3.5u lispro insulin 

1.50pm lunch with same previous dish

4.10pm blood sugar after lunch 112

12/02/25

Patient Advocate: 7.00pm oats 

9.15pm 5u lantus insulin 

9.45pm blood sugar 144

9.45pm 0.5u lispro insulin 

9.50pm dinner with as same as lunch dish 

10.20pm 7-8 drops of iron syrup

Patient Advocate: 12.02.25

7.45am fasting blood sugar 220

7.45am nuts 

8.00am milk

9.45am chocolate biscuit 2pcs 

10.45am 6.5u lispro insulin

10.50am rice with pulses, brinjal, spinach, carrot, cauliflower, beans , kidney beans, brocolli, beetroot, egg and salad 

12.15pm orange 

12.50pm blood sugar 291

1.30pm 5.5u lispro insulin 

1.35pm lunch with same previous dish except egg and include fish

Participant: Hi. I'm going to bhopal in March. I remember we were discussing about a pt in bhopal who would have helped with personalised medical approach.

Is this the same Pt?

PaJR PHR Moderator: No will tag you there

Patient Advocate: 6.30pm banana 

9.15pm 5u lantus insulin 

9.45pm blood sugar 146

9.45pm 1u lispro insulin 

9.50pm dinner with as same as lunch dish

13/02/25

Patient Advocate: 13.02.25

7.45am fasting blood sugar 191

7.45am nuts 

8.00am milk 

9.45am 6u lispro insulin 

9.50am rice with pulses, cauliflower, tomato, brocolli, spinach, carrot, chayote, beetroot, beans,  egg and salad

12.00noon normal sandesh 

1.00pm egg (omlette)

1.30pm blood sugar 98

1.30pm 2.5u lispro insulin 

1.35pm lunch with same previous dish except egg and include fish

[11:33 pm, 13/02/2025] Patient Advocate: 7.00pm oats 

9.15pm 5u lantus insulin 

9.30pm blood sugar 300

9.30pm 3.5u lispro insulin 

9.35pm dinner with as same as lunch dish

14/02/25

Patient Advocate: 14.02.25

7.45am fasting blood sugar 75

7.45am milk, aata roti and banana 

9.45am 4.5u lispro insulin 

9.50am rice with pulses brinjal tomato beans beetroot, carrot, cauliflower, spinach brocolli egg and salad 

12.00noon orange

15/02/25

Patient Advocate: 15.02.25

7.45am fasting blood sugar 220

7.45am milk 

9.45am 5.5u lispro insulin 

9.50am rice with pulses, brinjal, tomato, beans, chayote, cauliflower, carrot, beetroot, brocolli, spinach, egg and salad 

12.00noon orange 

1.45pm blood sugar 245

1.45pm 4.5u lispro insulin 

1.50pm lunch with same previous dish except egg

PaJR PHR Moderator: 👆 Yesterday's lantus?

Patient Advocate: 9.20pm 5u lantus insulin

6.30pm banana 

9.15pm 5u lantus insulin 

9.45pm blood sugar 231

9.45pm 2u lispro insulin 

9.50pm dinner with as same as lunch dish and papad

16/02/25

PaJR PHR Moderator: Yesterday's total lispro was:

5.5U+4.5U+2U?

Patient Advocate: Yes

17/02/25

Patient Advocate: 16.2.25

7.45am fasting blood sugar 123

7.45am milk

9.45am 4.5u lispro insulin 

9.50am rice with pulses, cauliflower, carrot, spinach, cabbage, beetroot, beans, egg and salad 

12.00noon orange 

1.45pm blood sugar 237

1.45pm 4.5u lispro insulin 

1.50pm lunch with same previous dish except egg 

4.00pm blood sugar 72

6.30pm banana 

9.15pm 5u lantus insulin 

9.45pm mutton one pc, chips 3-4pcs,

10.30pm blood sugar 229

10.30pm 2u lispro insulin 

10.35pm dinner with as same as lunch dish and include egg

PaJR PHR Moderator: Pre lunch insulin and food same except egg and yet the difference is between 237 and 72 but we also need to take into account that the post meal time after which these were tested is different

Patient Advocate: There was pre dinner mutton and  chips in marriage reception party

18/02/25

Patient Advocate: 17.02.25

7.45am fasting blood sugar 238

7.45am milk 

9.45am 5.5u lispro insulin 

9.50am rice with pulses, cauliflower, carrot, tomato, beans, chayote, beetroot, brocolli, egg and salad।

12.00noon orange 

1.30pm blood sugar 60

1.35pm 2.5u lispro insulin 

1.40pm lunch with same previous dish except egg and include paneer 

6.30pm banana 

9.15pm 5u lantus 

9.45pm blood sugar 185

9.45pm 2.5u lispro insulin 

9.50pm dinner with as same as lunch dish

19/02/25

Patient Advocate: 18.02.25

7.45am fasting blood sugar 124

7.45am milk 

9.45am 4.5u lispro insulin 

9.50am rice with pulses, cauliflower, carrot spinach, cabbage, beetroot brocolli egg and salad 

12.00noon orange 

1.30pm blood sugar 272

1.30pm 5u lispro insulin 

1.50pm lunch with same previous dish except egg 

6.30pm oats 

9.15pm 5u lantus insulin 

9.45pm  blood suger 197

9.50pm 1.5u lispro insulin 

9.55pm dinner with as same as lunch dish and include egg

Patient Advocate: 19.02.25

7.45am fasting blood sugar 171

7.45am milk

9.15am 2pcs cream biscuit (orio)

10.45am 6u lispro insulin 

10.50am rice with pulses, brinjal, tomato, beans, chayote, cabbage, beetroot, brocolli, carrot, egg and salad 

12.30pm orange 

1.00pm blood sugar 301

1.00pm one pc sandesh

2.00pm 6.5u lispro insulin 

7.00pm oats and 1/2 aata roti

20/02/25

Patient Advocate: 2.05pm lunch with same previous dish except egg and include fish 

9.15pm 5u lantus insulin 

9.45pm blood sugar 282

9.45pm 2.5u lispro insulin 

9.50pm dinner with as same as lunch dish

Patient Advocate: 20.02.25

7.45am fasting blood sugar 131

7.45am nuts 

8.00am milk

9.45am 2pcs chocolate biscuit.

10.45am 5.5u lispro e

10.50am rice with pulses, brinjal, carrot, tomato, beans, kidney beans, brocolli, cauliflower, beetroot, egg and salad

12.30pm pomegranate 

1.45pm blood sugar 200

1.45pm 4u lispro insulin 

1.50pm lunch with same previous dish except egg and include fish

6.30pm oats 

9.15pm 5u lantus insulin 

9.30pm blood sugar 181

9.30pm 1.5u lispro insulin 

9.35pm dinner with as same as lunch dish

21/02/25

Patient Advocate: 21.2.25

7.45am fasting blood sugar 105

7.45am nuts 

8.00am milk 

9.45am chocolate biscuit 2pcs 

10.45am 4.5u lispro insulin 

10.50am rice with pulses cauliflower, tomato, pumpkin, carrot, beetroot, spinach, cabbage brinjal, egg and salad 

12.15pm orange

22/02/25

Patient Advocate: 1.55pm blood sugar 193

2.00pm 4.u lispro insulin 2.05pm Lunch with same previous dish except egg and include fish 

7.00pm oats 

9.15pm 5u lantus insulin 

9.45pm blood sugar 127

9.50pm 0.5u lispro insulin 

9.55pm dinner with as same as lunch dish

22.02.25

7.45am fasting blood sugar 244

7.45am nuts 

8.00am milk

PaJR PHR Moderator: Her dinners are still quite late. It may be better to prepone the dinner time for the entire family and finish it by evening.

I myself eat daily by 6PM

Patient Advocate: Ok Sir

Patient Advocate: 9.45am 6u lispro insulin 

9.58am rice with pulses, cauliflower, tomato,  pumpkin, carrot, beetroot, chayote bitter gourd, egg and salad 

12.00noon grapes 

1.30pm blood sugar 292

1.30pm 5.5u lispro insulin 

1.35pm lunch with same previous dish except egg and include paneer 

6.00pm banana

23/02/25

Patient Advocate: 9.00pm 5u lantus insulin 

9.00pm blood sugar 58

9.05pm sandesh one pc 

9.10pm dinner with as same as lunch dish and papad 

No lispro at night

Patient Advocate: 23.2.25

7.45am fasting blood sugar 54

7.45am milk with sour

9.30am 3.5u lispro insulin 

9.35am rice with pulses, brinjal tomato, beans, kidney beans, pumpkin, chayote, carrot, beetroot,  egg and salad

PaJR PHR Moderator: Blood sugar was checked immediately after taking the lantus injection or before taking the lantus?

Patient Advocate: No Sir

Patient Advocate: 12.00noon grapes 

1.30pm blood sugar 275

1.30pm 5u lispro insulin 

1.35pm lunch with same previous dish except egg and include fish

PaJR PHR Moderator: When was the 9PM blood sugar checked?

After taking the lantus or before taking the lantus?

Patient Advocate: Befire

PaJR PHR Moderator: If before then that may have been a signal to also reduce the lantus dose by 1U?

24/02/25

Patient Advocate: 6.30pm banana 

9.00pm 4u lantus insulin 

9.15pm blood sugar 117

9.15pm 0.5u lispro insulin 

9.20pm dinner with as same as lunch dish

Patient Advocate: 24.02.25

7.30am fasting blood sugar 249

7.30am nuts 

7.45am milk

9.45am chocolate biscuit 2pcs 

10.45am 7u lispro insulin 

10.50am rice with pulses, cauliflower, tomato, pumpkin, carrot, beetroot, chayote, beans, kidney beans, egg and salad

12.15pm grapes 

12.50pm blood sugar 310

1.45pm 5.5u lispro insulin 

1.50pm lunch with same previous dish except egg and paneer 

6.30pm oats 

9.00pm 4u lantus insulin 

9.15pm blood sugar 164

9.15pm 1u lispro insulin 

9.20pm dinner with as same as lunch dish

25/02/25

The pre lunch has been consistently high regardless of the pre breakfast lispro dose @Narmeen Shah? Can we get AI to reason out why?

@Participant 20 we can try to incorporate this case's experience from author Narmeen into the current publishable commentary

Patient Advocate: 25.02.25

7.45am fasting blood sugar 133

7.45am nuts

8.00am milk

Narmeen Shah: The consistently high pre-lunch blood sugar levels despite varying pre-breakfast lispro doses could be due to multiple factors, including:

1. Delayed or Insufficient Insulin Action in the Morning

Basal insulin (Lantus) might be insufficient overnight, leading to higher fasting levels, which carry over into the pre-lunch period.

The morning lispro dose might not be fully compensating for breakfast intake, causing a gradual rise in blood sugar until lunch.

2. Breakfast Composition & Glycemic Impact

The morning meal often contains high-carb items like rice, biscuits, milk, and nuts (paste form), which may cause a delayed glucose release.

The fat content from nuts, butter, and eggs could be slowing down digestion, leading to prolonged glucose absorption and a gradual rise before lunch.

3. Insulin Timing & Action Mismatch

Lispro is rapid-acting but has a peak effect in 1-2 hours and lasts around 4 hours.

If breakfast is high-carb or protein-heavy, a single lispro dose may not be sufficient to control the entire morning glucose rise.

This suggests the morning insulin dose might need adjustment (either timing or an additional correction dose mid-morning).

4. Post-Breakfast Snacks & Blood Sugar Spikes

There are mid-morning snacks (e.g., biscuits, fruits, pomegranate, grapes) that might be adding to glucose levels but are not always covered by additional insulin.

This contributes to high pre-lunch readings, as the previous lispro dose may have worn off by then.

5. Liver’s Role in Glucose Regulation

The dawn phenomenon (morning liver glucose release) may still be influencing late-morning levels, especially if basal insulin (Lantus) is not strong enough overnight.

Liver glycogen breakdown between meals (especially if breakfast insulin is insufficient) could be pushing pre-lunch glucose up.

6. Gastrointestinal Factors & Nutrient Absorption

Certain high-fiber vegetables (e.g., bitter gourd, beans, cabbage, chayote) may slow down glucose absorption, leading to a delayed rise in glucose before lunch.

If there’s delayed gastric emptying (gastroparesis), the glucose from breakfast might be getting absorbed later than expected, leading to a pre-lunch spike.

Narmeen Shah: Sir @PaJR PHR Moderator AI mostly focuses on diet whenever asked about high readings through out the day except for fasting sugar.

PaJR PHR Moderator: Once we supply more patient data into the query, the LLM may be able to process a more focused and shorter answer?

Ideally we should be able to ask the LLM to go through the entire patient record (earlier we could do it by supplying the entire URL but that feature has been moved to premium I guess)

Narmeen Shah: Sir, above was generated by ChatGpt from one month's data. 

For feeding entire case report via link, that feature work freely in Google NotebookLM.

Below is the response from NotebookLM of entire case report.

Narmeen Shah: Based on the information provided in the sources, here are some possible reasons why the pre-lunch blood sugar levels have been consistently high, despite variations in the pre-breakfast Lispro dose:

*   *Dawn phenomenon or first meal effect* Insulin resistance is typically higher in the morning, requiring more insulin at breakfast. The 2-unit Lispro given at breakfast may not be covering the amount of carbs/protein in breakfast or dealing with the "dawn phenomenon".

*   *Insufficient Lispro dose at breakfast* The Lispro dose given at breakfast (2 units) appears insufficient to handle the carbohydrates and protein in the breakfast meal. The post-breakfast blood sugars are significantly higher than pre-breakfast levels.

*   *High Glycemic Index (GI) of breakfast foods* 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.

*   *Lantus Dosage and Timing*  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 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.

*   *Inconsistent spacing of meal and insulin intervention* Meal and Insulin intervention spacing needs to be optimised based on human observation and analysis.

*   *Dietary Factors* Meals appear to be high in carbohydrates, which can impact blood sugar levels. Inconsistent fiber intake: Fiber-rich foods like vegetables and fruits are present, but the quantity varies. Protein and fat intake: Protein sources like eggs, fish, and paneer are included, but fat intake is not clearly documented.

PaJR PHR Moderator: Thanks!

Looking at the one month data driven response as well the entire year's response there are some interesting general knowledge points the LLM has made. It's not that those weren't at the back of our minds but it's good to get some reiteration and commiseration perhaps

Patient Advocate: 9.45 am chocolate biscuit 2pcs 

10.45am 5.5u lispro insulin 

10.50am rice with pulses, brinjal, tomato, beans, kidney beans, pumpkin, chayote, carrot, beetroot, egg and salad 

12.15pm grapes 

12.50pm blood sugar 266

1.45pm 5u lispro insulin 

1.50pm lunch with same previous dish except egg and include paneer 

6.15pm oats

9.00pm 4u lantus insulin 

9.15pm blood sugar 189

9.15pm 1.5u lispro insulin 

9.20pm dinner with as same as lunch dish

26/02/25

Patient Advocate: 26.02.25

7.45am fasting blood sugar 150

7.45am milk

PaJR PHR Moderator: 👍

27/02/25

Patient Advocate: 9.45am 4.5u lispro insulin 

9.50am rice with pulses, cabbage, carrot, beans, tomato, chayote, beetroot, ghee and salad 

12.00,noon pomegranate 

1.30pm blood sugar 117

1.30pm 3u lispro insulin 1.35pm lunch with same previous dish except ghee and include paneer 

6.30pm banana 

9.00pm 4u lantus insulin 

9.15pm blood sugar 254

9.15pm 1u lispro insulin 

9.20pm dinner with 1/2 as same as lunch dish and 1/2 khichdi

Patient Advocate: 27.2.25

7.45am fasting blood sugar 140

7.45am milk

PaJR PHR Moderator: 👍

28/02/25

Patient Advocate: 9.45am chocolate biscuit 2pcs 

10.45am 5.5u lispro insulin 

10.50am rice with pulses brinjal, tomato, beans, bitter gourd, chayote, carrot, beetroot, brocolli, ghee and salad 

12.15pm grapes 

1.45pm blood sugar 102

1.45pm 2.5u lispro insulin 

1.50pm lunch with same previous dish except ghee and include paneer 

6.30pm banana 

7.00pm khichdi (prasad)

9.00pm 4u lantus insulin 

9.15pm blood sugar 284

9.15pm 2u lispro insulin 

9.20pm dinner with as same as lunch dish

PaJR PHR Moderator: @Participant 20 lantus appears to lose it's steam here by dinner time the next day and the lispro is well short acting enough to not cover till then?

On the other hand for those who can't afford lantus in India twice daily NPH covers better other than the fact that even plain insulin is longer acting than lispro and while that has it's disadvantages, the longer coverage of plain insulin can also be useful if the doses are optimised judiciously! No wonder that plain insulin and NPH ruled for a good many decades before it's position was usurped by lispro and lantus? @Narmeen Shah would it be possible to prompt your LLM to look at this patient's entire case URL and do a thematic analysis to extract this theme of poor insulin coverage by lantus and lispro from the daily data of lantus lispro insulin interventions and corresponding blood sugar outcomes?

Patient Advocate: 7.45am fasting blood sugar 135

7.45am milk 

9.45am chocolate biscuit 2pcs

10.45am 5u lispro insulin 

10.50am rice with pulses, carrot, broccoli, cauliflower, beetroot, brinjal, tomato, peas and salad 

12.18pm pomegranate

Narmeen Shah: Yes sir. I will do it.

Patient Advocate: 1.45pm blood sugar 172

1.45pm 4u lispro insulin 

1.50pm lunch with same previous dish and egg

6.30pm oats

9.00pm 4u lantus insulin 

9.15pm blood sugar 222

9.15pm 1.5u lispro insulin 

9.20pm dinner with as same as lunch dish

Narmeen Shah: Based on the sources provided, a thematic analysis reveals a recurring issue of poor insulin coverage by Lantus and Lispro, evidenced by fluctuating blood sugar levels despite adjustments in insulin dosages and dietary considerations. Several factors contribute to this theme: 

 *   *Inconsistent Blood Sugar Control:* High post-meal glucose spikes and inconsistent glucose control throughout the day are frequently observed. For example, on multiple occasions, blood sugar levels are high despite pre-meal Lispro injections. 

 *   *Inadequate Lispro Dosage:* Lispro insulin doses sometimes appear insufficient to cover mealtime carbohydrate intake, leading to hyperglycemia. The need for increased Lispro doses at breakfast, lunch, and dinner is mentioned, with suggestions to consider split dosing for larger meals. 

 *   *Lantus Dosage and Timing Challenges:* The effectiveness of Lantus is questioned, with instances of both hypoglycemia and hyperglycemia occurring, indicating difficulties in establishing a stable basal insulin level. Adjustments to the Lantus dose are frequently discussed, with the timing of Lantus injections being a key consideration to prevent early morning hypoglycemia. There are suggestions to split the Lantus dose or move it to the morning. 

 *   *Impact of Dietary Factors:* Dietary variations, including carbohydrate quantity and meal composition, significantly impact blood sugar levels. The need for consistent carbohydrate intake and consulting a dietitian is emphasized. 

 *   *Influence of Lifestyle Factors:* The absence of consistent data regarding physical activity and other lifestyle factors, such as stress and sleep, makes it difficult to fully assess their impact on blood sugar control. 

 *   *Hypoglycemia Unawareness:* There are concerns about hypoglycemia unawareness, which is particularly dangerous in a young child. The lack of continuous glucose monitoring (CGM) may contribute to undetected hypoglycemic episodes. 

 *   *"Yo-yo" Effect:* A pattern of blood sugar fluctuations related to Lantus dosage adjustments is noted, where dose reductions lead to hyperglycemia and dose increases result in hypoglycemia. 

 *   *Practical Issues with Insulin Administration:* Air entering the Lantus pen and difficulties in administering precise doses with pens (as opposed to syringes) are mentioned as potential factors affecting blood sugar control. The need for half-unit pens is also highlighted.

 *   *Need for Frequent Monitoring and Adjustments:* The necessity for frequent blood sugar monitoring and insulin dose adjustments based on trends and individual responses is consistently emphasized. 

 Several recommendations are made to address these issues: 

 *   Adjusting Lispro and Lantus doses based on blood sugar trends. 

 *   Optimizing the timing of insulin injections. 

 *   Implementing carb counting to better match insulin doses to carbohydrate intake. 

 *   Considering the use of insulin syringes for more precise dose adjustments. 

 *   Consulting with a healthcare professional and a registered dietitian for personalized guidance.

---

Access Complete Patient Record:

• Complete Patient Data

Access Monthly Records - 2024:

• March to June
• July
• August
• September
• October
• November
• December

Access Monthly Records - 2025:

• January
  
• February
• March