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

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PATIENT DATA LOG OF JANUARY - 2025




01/01/25

Patient Advocate: 1.1.25
8.00am milk 
9.45am 3u lispro 
9.50am rice with pulses, ghee, beans, radish, spinach, tomato, carrot brocolli, fish and salad 
12.00noon orange 
1.30pm lunch with same previous dish

PaJR PHR Moderator: No fasting sugar today?

Patient Advocate: সকালে স্ট্রিপ ছিল না
1.25pm 3u lispro insulin 
3.45pm blood sugar 180
7.00pm aara roti
8.30pm 4u lantus insulin 
9.30pm blood sugar 342
9.30pm 2.5u lispro insulin
9.35pm dinner with as same as lunch dish

02/01/25

Patient Advocate: 2.1.25
7.45am fasting blood sugar 89
7.45am milk 
9.45am 3u lispro insulin 
9.50am rice with pulses , brinjal spinach, cabbage,,  carrot , beans,, papaya, egg and salad

PaJR PHR Moderator: @Participant 20 her pre dinner is 342 and her long acting lantus cannot be increased more than 4U as her fasting is 89 and her pre lunch lispro of 3U is serving well for 2 hours as a post lunch of 180!

Stalemate!  

The only way out is to split the lantus or maybe wait for another day to see how this plays out

Participant 20: I agree.
One hypothesis could be that in a growing child Insulin requirements can vary each day and would it be possible that on some days there is some endogenous production?
Something along these lines @PaJR PHR Moderator?

Participant 20: Fascinating that PaJR is enabling Child and Adolescent Live Diabetes Clinics!

03/01/25

PaJR PHR Moderator: The japs beat us to it here too!

Although our patient here is different in the sense that her type 1 was very acute and hit last year March with a wham and this is one of those PaJRs where the journey has been documented since that period by @Narmeen Shah

Patient Advocate: 12.00noon orange 
1.30pm blood sugar 165
1.30pm 3u lispro insulin 
1.35pm lunch with same previous dish except egg and include fish 
7.00pm oats 
8.30pm 4u lantus insulin 
9.30pm 2u lispro insulin 
9.35pm dinner with rice, pulses,, beans, carrot, cauliflower (khichdi), egg and salad 
11.45pm blood sugar 133 and ate 5grm chocolate

Patient Advocate: 3.01.25
7.45am fasting blood sugar 122.
7.45am milk 
9.45am 3.5u lispro insulin 
9.50am rice with pulses, papaya, beans, brocolli, carrot, cauliflower, spinach, butter, egg and salad

PaJR PHR Moderator: 👍
Please share her last road to health growth chart image

Participant 20: There is also a passing mention of Fulminant Type 1. Will review some literature on that.

Patient Advocate: I will share at evening Sir.

04/01/25

Patient Advocate: 11.55am blood suger 153
12.00noon pomegranate 
1.30pm 3u lispro insulin 
1.35pm lunch with same previous dish except egg and include fish 
7.00pm oats
9.30pm blood suger 221
9.30pm 1u lispro insulin 
9.35pm dinner with as same as lunch dish

Patient Advocate: 4.01.25
7.45am fasting blood sugar 170
7.45am nuts 
8.00am payesh ( rice, coconut, dates raisin)
9.45am 4.5u lispro insulin 
9.50am rice with pulses, papaya, beans, cabbage, cauliflower, carrot, spinach, radish, egg and salad

PaJR PHR Moderator: 👆 lantus dose yesterday?

Patient Advocate: 8.45am 4u lantus insulin

PaJR PHR Moderator: AM or PM?

Patient Advocate: Sorry Sir ota pm

Patient Advocate: 12.00noon pomegranate 
1.30pm blood sugar 273
1.30pm 4u lispro insulin 
1.35pm lunch with same previous dish except egg and include paneer
6.30pm payesh
8.30pm 4u lantus 
9.30pm blood sugar 398
9.30pm 3u lispro insulin 
9.35pm dinner with as same as lunch dish and papad

05/01/25

Patient Advocate: 5.01.25
7.45am fasting blood sugar 135
7.45am nuts 
8.00am milk 
9.45am 3.5u lispro insulin 
9.50am rice with papaya, beans, carrot, cabbage, cauliflower, radish, tomato, butter and salad

PaJR PHR Moderator: 398 effect of payesh
273 at 1:30PM effect of payesh at 8:00 AM

Patient Advocate: 12.00noon blood sugar 396
12..00noon apple 
1.30pm 5u lispro insulin 
1.30pm lunch with same previous dish except butter and include egg
স্যার আজকে তো পায়েস খায়নি আজকে তাহলে এমন টা কি করে হলো কিছুই বোঝা যাচ্ছে না l

PaJR PHR Moderator: 👆Any sugar in the milk at 8:00AM?

Would be better if the meal plate images are shared to guage the quantity and quality

06/01/25

Patient Advocate: 7.30pm oats 
8.30pm 4u lantus insulin 
10.00pm blood sugar 200
10.00pm 1u lispro insulin 
10.05pm rice with pulses, cabbage, brinjal, tomato, egg
8.00am milk was without sugar

Patient Advocate: 6.01.25
7.45am 253
7.45am milk

PaJR PHR Moderator: Where is the milk obtained from? From locale cow or is it packaged? Does it taste sweet?
Now the lantus needs to be raised preferably to 4.5 or else if 5 then we will need to anticipate the next hypo trough @Narmeen Shah

Patient Advocate: Local cow
9.45am 5u lispro insulin 
9.50am rice with pulses, butter ,brinjal, tomato, beans , kidney beans, brocolli, cauliflower, papaya, egg and salad



PaJR PHR Moderator: Pre cooking?

Patient Advocate: Yes Sir
1.30pm blood suger 210
1.30pm 3.5u lispro insulin 
1.35pm lunch with same previous dish except egg and include paneer 
7.00pm oats
8.30pm 5u lispro insulin 
9.30pm blood sugar 228
9.35pm 1.5u lispro insulin 
9.40pm dinner with as same as lunch dish and papad


07/01/25

PaJR PHR Moderator: Share every plate image just before eating

Patient Advocate: 7.1.25
7.45am fasting blood sugar 121
7.45am nuts 
8.00am milk 
9.45am  3.5u lispro insulin 
9.55am rice with pulses , egg and salad


Nuts

Milk

PaJR PHR Moderator: 👍
Nuts in milk?
Groundnuts?

Patient Advocate: Only nuts pest ( Almond, walnut, piasta, cashew and chickpea )

PaJR PHR Moderator: Does she enjoy eating that paste more than if you would have given her the same whole unpasted?

Patient Advocate: She takes so much time to eat unpast nuts approx 1 hour

Patient Advocate: 12.00noon apple 
1.45pm 3u lispro insulin 
1.50pm rice with papaya,  kidney beans, brocolli, cauliflower, carrot spinach, beans, fish and salad

08/01/25

4.00pm blood suger 208
6.30pm oats
8.30pm 5u lantus insulin 
9.30pm blood sugar 303
9.30pm 2u lispro insulin 
9.35pm dinner with as same as lunch dish

Patient Advocate: 08.01.25
7.45am blood sugar 90
7.45am milk 
9.30am 3u lispro insulin 
9.35am rice with pulses, butter, beans, kidney beans, brocolli, carrot, spinach, carrot, brinjal and salad 
12.45pm 3u lispro insulin 
12.50pm lunch with same previous dish

PaJR PHR Moderator: Now that you have increased the lantus to 5U be careful about the early morning asymptomatic hypoglycemia

Patient Advocate: Ok Sir
5.00pm boil egg
6.30pm mixed of chickpea with  onion, tomato, coriander
স্যার আমরা একটু আন্দামান ঘুরতে যাচ্ছি তাই খাওয়ার এবং সময়ের পরিবর্তন হবে আর একটু গাইড করবেন ওকে বাইরের খাওয়ার খেতে হবে সেই ব্যাপারে l
8.30pm 4u lantus insulin 
8.30pm blood sugar 81 and no lispro insulin 
8.35pm rice with pulses, egg and salad

09/01/25

Patient Advocate: 9.01.25
6.45am blood sugar 199
6.45am roti(aata), boil egg, banana,
 6.45am 3u lispro insulin 10.00am orange 
12.30pm blood sugar 395
12.30pm 5u lispro insulin
12.35pm rice with pulses, cauliflower, tomato, banana flower, fish 
3.15pm lasyi ( sour curd, lemon and salt) without sugar 
4.00pm apple 1/3 and guava 1/4
5.15pm bar

PaJR PHR Moderator: 10:00AM Orange or orange juice?

Patient Advocate: Orange
5.15pm banana 
8.15pm blood sugar 113
8.15pm 0.5u lispro insulin 
8.20pm rice with pulses cabbage, spinach, fish 
9.00pm 5u lantus insulin

10/01/25

Patient Advocate: 10.01.25
8.15am blood sugar 148.
8.15am 2u lispro insulin 
8.20am  breakfast with idle (2pcs),  sambar and egg
11.30am orange 
1.00pm blood sugar 53
1.00pm 2u lispro insulin 
1.05 lunch with rice, pulses, mixed vegetable (remove potatos) and fish 
3.15pm coconut water 
3.45pm orange 1/2
5.15pm orange 1/2
7.15pm bread pakoda remove potatos

11/01/25

Patient Advocate: 8.45pm 5u lantus insulin 
8.50pm blood sugar 412
9.00pm 3.5u lispro insulin 
9.05pm fried rice,  chichen and salad

Patient Advocate: 11.01.25
7.00am blood suger 177
7.00am bread with butter, boil egg and banana 
1.05pm blood sugar 263
1.05pm 4u lispro insulin 
1.10pm rice with pulses, bottle gourd, green peas, tomato and fish

12/01/25

Patient Advocate: 3.30pm coconut water 1/2
6.00pm blood sugar 123
6.15pm mixed fruit 1/2 plate
8.15pm blood sugar 208
8.20pm 1.5u lispro 
8.25pm dinner rice, pulses, mixed vegetable, fish and fish 
9.00pm 5u lantus insulin

Patient Advocate: 12.01.25
8.00am blood suger 293
8.00am 4u lispro insulin 
8.08am breakfast with idle and sambar
12.00noon 1/4 glass soft drinks
1.45pm blood sugar 31
No symptoms 
1.45pm one bar of chocolate 
1.50pm rice with pulses, mixed vegetable and egg
2.10pm 1.5u lispro insulin ( সুগার কম থাকার জন্য ইনসুলিন টা পড়ে দেওয়া হরেছে )
4.30pm 1/2 orange 
5.15pm 2 pcs chocolate biscuit 
6.10pm 1/2 bread pakoda 
8.15pm blood sugar 300
8.15pm 2.5u lispro insulin 
8.20pm rice with pulses, mixed vegetable and children 
8.40pm 5u lantus insulin 
8.50pm vomiting 
9.00pm 4pcs chocolate biscuit 
9.30pm vomiting 
9.45pm lanzol junior tablets and 1/2 ondem tablet 
10.00pm 1 cup ors
Tablets গুলি দিতাম না যেহেতু বাইরে আছি তাই দিলাম l

13/01/25

Patient Advocate: 13.01.25
8.00am blood 186
10.00am coconut water 1/2
11.15am coconut water 1/2
11.45am little quantity of puffed rice 
12.15pm blood sugar 218
3.00pm blood sugar 250
3.00pm 4u lispro insulin 
3.05pm rice and mixed vegetable, pulses, fish
7.00pm maggie 2-3 teaspoon 
8.30pm 5u lantus insulin 
9.00pm blood sugar 57
9.00pm rice with pulses, mixed vegetable, paneer and salad 
No lispro at night

14/01/25


PaJR PHR Moderator: 👆Done by our pediatric endocrinologist with this accompanying note: 

I finally found time to arrange the data from the young girl with T1D in the format our nurses (and software packages when we download the data from the glucose machines) presented to us in the clinic… based on this, I have captured what I would discuss with the family if I were seeing them in my clinic in a text box at the bottom of the page. *1) The family is in urgent need of professional dietary advice, 2) if this exercise was repeated every 2 weeks, advice to the family can be more streamlined (than reacting to individual or daily values)*.

Patient Advocate: 14.01.25
8.15am boil egg and banana 
8.45am blood sugar 193
9.05am banana 
11.45am coconut water 
1.00pm blood sugar 203
1.05pm 4u lispro insulin 
1.10pm lunch with rice, carrot, bottle gourd, beans, cabbage, chickpea, paneer, fish

15/01/25

Patient Advocate: 4.30pm 5pcs (not packet) of chips
8.00pm blood sugar 73
8.00pm 0.5u lispro insulin 
8.05pm dinner with rice, pulses, cabbage, carrot, long beans, egg and salad 
8.30pm 5ml metrozil SYP.
8.45pm 5u lantus insulin

PaJR PHR Moderator: Why metrogyl syrup?

Patient Advocate: 15.01.25
7.45am blood suger 
193
7.45am some puffed rice 
8.15am 3.5u lispro insulin 
8.20am idle 2pcs and one teaspoon suji
[6:46 pm, 15/01/2025] Patient Advocate: 1.00pm blood sugar 53
1.00pm 1.5u lispro insulin 
1.05pm lunch with rice long beans, pulses and fish ( eat less then other normal day) 
1.30pm 6pcs of jems chocolate 
4.00pm blood sugar 58
4.00pm Cadbury chocolate 3bar

16/01/25

Patient Advocate: 7.00pm momo 2pcs
8.30pm 5u lantus insulin 
9.00pm blood sugar 177
9.00pm 1u lispro insulin 
9.05pm dinner with rice, cauliflower, pulses, long beans, egg, and salad

Patient Advocate: She had dysentery

Patient Advocate: 16.01.25
7.45am blood sugar 149
7.45am 3.5u lispro insulin 
7.50am puri, vegetable 
12.45pm coconut water

17/01/25

Patient Advocate: 1.30pm blood sugar 54
1.30pm 1u lispro insulin 
1.35pm lunch with rice, pulses, mixed vegetable,fish  and salad 
6.30pm 1/3 bread pakoda
8.45pm 5u lantus insulin 
8.45pm blood sugar 116
8.45pm 0.5u lispro insulin 
8.50pm dinner with rice, pulses, mixed vegetable, egg, and salad

PaJR PHR Moderator: Morning lispro dose was decided after counting anticipated carb consumption? @Participant 20 @Participant @Narmeen Shah (AI ask) how much would be the estimated lispro dose for an anticipated puri vegetables that a 3 year old can eat?

Patient Advocate: 17.01.25
7.45pm blood sugar 307
7.45am 5u lispro insulin 
7.50am idle 2pcs

PaJR PHR Moderator: @Meta AI how much would be the estimated lispro dose from carb counting for an anticipated puri vegetables that a 3 year old can eat?

Meta AI: To estimate the lispro dose for a 3-year-old eating a serving of pureed vegetables, we'll need to consider a few factors:

1. Carb content of pureed vegetables: The carb content varies depending on the vegetable. Here are approximate carb counts for some common pureed vegetables:
    - Peas: 5-6 grams per 1/4 cup serving
    - Carrots: 6-7 grams per 1/4 cup serving
    - Green beans: 3-4 grams per 1/4 cup serving
    - Sweet potatoes: 10-12 grams per 1/4 cup serving
2. Insulin-to-carb ratio (ICR): This ratio varies depending on the individual, their insulin sensitivity, and the time of day. A common starting point for children is 1 unit of insulin for every 15-20 grams of carbs. However, this ratio may need to be adjusted based on the child's specific needs.
3. Assumed serving size: Let's assume a serving size of 1/4 cup (about 50-60g) of pureed vegetables.

Based on these factors, here are some estimated lispro doses for a 3-year-old eating a serving of pureed vegetables:

- Peas: 5-6 grams of carbs x (1 unit / 15-20 grams) = 0.25-0.4 units of lispro
- Carrots: 6-7 grams of carbs x (1 unit / 15-20 grams) = 0.3-0.5 units of lispro
- Green beans: 3-4 grams of carbs x (1 unit / 15-20 grams) = 0.15-0.25 units of lispro
- Sweet potatoes: 10-12 grams of carbs x (1 unit / 15-20 grams) = 0.5-0.8 units of lispro

Keep in mind that these are rough estimates and may need to be adjusted based on the child's individual needs and insulin sensitivity. It's always best to consult with a healthcare professional or registered dietitian for personalized guidance on insulin dosing and carb counting.

PaJR PHR Moderator: @Meta AI its not pureed vegetables
It's a few pieces of puri (circular fried dough Indian style) with vegetables that a 3 year old may eat

Meta AI: To estimate the lispro dose for a 3-year-old eating a few pieces of puri with vegetables, we'll need to consider the carb content of the puri and vegetables together.

Here's an approximate carb count:

- 1-2 puris (depending on size): 15-30 grams of carbs
- Vegetables (assuming a small serving): 5-10 grams of carbs

Total estimated carb count: 20-40 grams

Using the insulin-to-carb ratio (ICR) of 1 unit of insulin for every 15-20 grams of carbs, the estimated lispro dose would be:

- 20-40 grams of carbs x (1 unit / 15-20 grams) = 1-2 units of lispro

Please note that this is a rough estimate and may vary depending on individual factors, such as insulin sensitivity and the child's specific needs. Consult with a healthcare professional or registered dietitian for personalized guidance on insulin dosing and carb counting.

PaJR PHR Moderator: 👆this is fasting at 7:45 AM?

PaJR PHR Moderator: 👆Why is the patient advocate repeatedly giving high dose of lispro since 15/1/25 despite the child getting hypoglycemia by 1:00PM since 15/1/25?

PaJR PHR Moderator: 👆 morning lispro skipped on 14/1/25?

PaJR PHR Moderator: 👆 morning lispro skipped on 13/1/25?

PaJR PHR Moderator: 👆 morning lispro taken on 12/1/25
Severe hypoglycemia of 31 at 1:45 PM! Albeit asymptomatic

PaJR PHR Moderator: 👆 morning lispro skipped on 11/1/25

PaJR PHR Moderator: 👆 morning 2U lispro producing hypoglycemia at 1:00 PM on 10/12/25!

PaJR PHR Moderator: 👆on 9/1/25 morning lispro of 3U producing 395 at 12:30 PM!

Patient Advocate: আজকে আবার পোস্ট ব্রেকফাস্ট সুগার টা দেখছি l

Participant 20: I assume the pediatric endocrinologist specifically recommended seeing a dietician, exactly for this issue?

Patient Advocate: 10.40am blood suger 40
10.40am chocolate 3 bar
11.00am butter biscuit 2pcs
12.30pm lemon juice 1/6 glass at the airport 
5.10pm blood sugar 146
6.00pm chowmin 
6.45pm lassi without sugar 
8.15pm 0.5u lispro insulin 
8.20pm rice with pulses, mixed vegetable and fish 
8.45pm 4u lantus insulin

PaJR PHR Moderator: The hypoglycemia documented at 10:40 AM was expected with such a jump of the lispro dose

18/01/25

Patient Advocate: 18.01.25
7.30am blood sugar 237
7.30am 2u lispro insulin 
7.35am bread one pc with butter, egg, boil vegetable ( green peas, carrot and beans)
12.00noon aata roti 1/2, rice 3-4 teaspoon, pulses and sour curd 
6.15pm two biscuit and little quantity of puffed rice 
8.30pm 5u lantus insulin 
8.45pm blood sugar 342
8.50pm dinner with rice, pulses, brinjal, tomato, carrot, beans, papaya and salad

Patient Advocate: স্যার আমরা আজকে সারাদিন তিন চারটে গাড়ি পাল্টে বাড়িতে ফিরছি l তাই আজ খাওয়ার আর ইনসুলিন ঠিক ঠাক দেওয়া হয়নি l এরজন্য দুপুরের খাওয়ার আগে ইনসুলিন দাওয়া হয়নি l আগামী কাল থেকে সব কিছু ঠিকঠাক হয়ে যাবে l🙏🏾

19/01/25

Patient Advocate: 19.01.25
7.45am blood sugar 63
7.42am milk with puffed rice 
9.50am 3.5u lispro insulin 
9.55am rice with pulses, brinjal, spinach, carrot, chayote, kidney beans, cauliflower, turnip, egg and salad 
12.00noon orange

20/01/25

Patient Advocate: 1.30pm blood sugar 110
1.30pm 3u lispro insulin 
1.35pm lunch with same previous dish except egg and include fish 
7.00pm oats 
8.30pm 5u lantus insulin 
9.45pm blood sugar 143
9.45pm 0.5u lispro insulin 
9.50pm dinner with as same as lunch dish 
12.00night blood suger 193
12.00night 1.5 teaspoon payesh ( milk, cown rice and suger)

PaJR PHR Moderator: Beware of the sudden chaotic morning hypo with 1U lantus increments that generally come after a few days in this child

Patient Advocate: Ok Sir 🙏🏾

Patient Advocate: 7.45am blood sugar 195
7.45am payesh (milk, cown rice, dates and raisins) without sugar
9.45am 3.5u lispro insulin 
9.50am rice with pulses, brinjal, tomato, spinach, cabbage, cauliflower, carrot, kidney beans, turnip, butter, egg and salad 
12.00noon blood sugar 228
12.00noon orange
1.30pm 3.5u lispro insulin 
1.35pm lunch with same previous dish except egg and include paneer 
7.00pm oats 
8.45pm 5u lantus insulin 
9.30pm blood sugar 214
9.30pm 1u lispro insulin 
9.35on dinner with as same as lunch dish and papad

21/01/25

Patient Advocate: 21.01.25
7.45am blood sugar 141
7.45am nuts 
8.00am milk
9.45am 3.5u lispro insulin 
9.50am rice with pulses, brinjal, tomato, kidney beans, brocolli, carrot, beatroot, beans, cauliflower, spinach, egg and salad 
12.00noon pomegranate,
1.45pm blood sugar 297
1.50pm 4.5u lispro insulin 
1.55pm lunch with same previous dish except egg and include fish

22/01/25

Patient Advocate: 4.00pm blood sugar 106
7.00pm oats
9.30pm 0.5u lispro insulin 
9.35pm dinner with as same as lunch dish

PaJR PHR Moderator: Yesterday's lantus?

Patient Advocate: 8.30pm 5u lantus

Patient Advocate: 22.01.25
7.45am blood sugar 238
7.45am nuts 
8.00am milk

PaJR PHR Moderator: This hints at a sizeable contribution of even the lispro dose to the morning fasting? @Participant 20

Patient Advocate: 9.45am 4.5u lispro insulin 
9.50am rice with pulses, carrot, cauliflower, spinach, brocolli, beatroot, beans, kidney beans, brinjal,tomato, egg and salad

Participant 20: Yes to an extent.

Patient Advocate: 12.00noon pomegranate 
1.45pm blood sugar 331
1.45pm 5u lispro insulin 
1.50pm lunch with same previous dish except egg and include fish
6.45pm one patty (making with rice flour, butter) without sugar
7.00pm oats
8.30pm 5u lantus insulin 
9.45pm blood sugar 435
9.45pm 5u lispro insulin 
9.50pm dinner with as same as lunch dish

23/01/25

Patient Advocate: 11.55, pm blood sugar 171
Then 1/2 teaspoon of payesh ( milk, rice and suger)

PaJR PHR Moderator: Why 1/2 tea spoon of payesh?

PaJR PHR Moderator: Since Tuesday she appears to have entered the hyperglycemic phase of her blood glucose cycle with the afternoon pre lunches increasing progressively inspite of the increasing lispro dose, which off course true to their short acting nature may not be expected to cover till pre lunch, which can only be tackled by huddling the meal times closer or increasing lantus further only if the fasting also keeps progressively rising (again the danger here is that she may suddenly go into the hypoglycemia phase of her cycle where higher long acting doses would be unsafe)? @Participant 20 @Participant

Patient Advocate: 23.01.24
7.45am blood sugar 71
7.45am nuts 
8.00am payesh (milk, rice, dates and raisins) without sugar

PaJR PHR Moderator: As suspected lantus is already threatening to cause hypoglycemia by tomorrow
PaJR PHR Moderator: In anticipation 4.5U lantus tonight

Patient Advocate: Sir, it was 238 of sugar level on same lantus dose even before lunch and dinner it was also above 300
Lantus pen nsulin doesn't support 0.5u

PaJR PHR Moderator: Yes it may not act on the meals
Hence we only keep looking at fasting as a lantus action marker of both it's efficacy and harm

PaJR PHR Moderator: We know that and discussed it here earlier and the proposed solution was to get an ordinary syringe for it just like the other type 1 diabetes patient but I guess that would have been inconvenient in which case we already previously once settled for reducing the dose to 4U

PaJR PHR Moderator: It's action on the meals is very subtle as part of an overall basal effect, which interestingly is sufficient to cater to 30F patient's 24 hour requirements and she's doing fairly well in terms of sugar control with 8U of lantus alone once a day as you may have noticed. Let's hope we can achieve that level of convenience for 3F also someday

Participant: Could site of administration be causing this prolonged/additive effect of lantus?

Patient Advocate: Next month I will discuss with my local endocrinolgist about the ordinary syringe. Without prescription how can I use this ? Then my local doctor will be angry .

PaJR PHR Moderator: Would be grateful for some papers pointing to the same

PaJR PHR Moderator: @30f Diabetes PA please share how your patient managed to transition from her pen to syringe without making her local doctor angry

Participant: Ok Sir. Will post. I was reading that abdomen has a near constant release of lantus. Arm and thigh have variable release and can delay the peak of action. Also areas of low blood supply can have variable release.

PaJR PHR Moderator: Yes that's text book established information.
@Patient Advocate please share what are the regular sites on her body where your patient is being injected

Patient Advocate: 9.45am 3.5u lispro insulin 
9.50am rice with pulses, brinjal, spinach, cabbage, cauliflower carrot, beans, kidney beans, brocolli, turnip, butter,  paneer, brinjal fry one pc and salad ( only cucumber)


Patient Advocate: Thigh and around the navel

Participant: Maybe if you can document the site of each lantus dose in a journal..the data can be analysed after a few days/weeks.

Patient Advocate: Lantus always pulshes in thigh and  lispro some time in thigh and some time in around navel

Participant: ok. if possible please do document the sites of administration for each including left or right, up or down, as much detail as you can about the site.

PaJR PHR Moderator: Any particular reason for this choice?

Patient Advocate: No Sir, She doesn't want to take all time in belly

Patient Advocate: 11.55pm blood sugar 404
12.00noon orange 
1.45pm 5u lispro insulin
1.50pm lunch with same previous dish except paneer, brinjal fry and include fish

30f Diabetes PA: Sir, pen refill was not available, so I used syringe instead of pen after taking permission from the doctor.

24/01/25

Patient Advocate: 7.45pm milk
8.45pm 5u lantus 
9.30pm blood sugar 70
9.35pm dinner with as same as lunch dish 
* No lispro at night*

Patient Advocate: 24.01.25
7.45am blood suger 193
7.45am milk
9.45am 4.5u lispro insulin 
9.50am rice with pulses, brinjal, spinach, carrot, cauliflower, brocolli, turnip, beans, kidney beans, egg and salad
Patient Advocate: 12.00noon orange

PaJR PHR Moderator: No fasting sugar values today?

25/01/25

Patient Advocate: It was fasting

Patient Advocate: 1.30pm blood 263
1.30pm 4u lispro insulin 
1.35pm lunch with same previous dish except egg and include paneer 
7.00pm oats 
8.45pm 5u lantus insulin 
9.30pm blood sugar 335
9.30pm 3.5u lispro insulin 
9.35pm dinner with as same as lunch dish except egg and include fish

Patient Advocate: 25.01.25
7.45am fasting blood sugar 235
7.45am nuts
8.00am milk

PaJR PHR Moderator: Yesterday's insulin

Lispro 4.5U+4U+3.5U

Lantus 5U

Glucose dependent variable Outcomes: 

193+263+335+235/4

256.5 (mean from scant 4 samples)

Patient Advocate: Absolutely Sir
9.30am 5.5u lispro insulin 
9.35am rice with pulses, brinjal, tomato, beans, kidney beans, brocolli, cauliflower, papaya chayote, cabbage, butter and salad
11.45am blood sugar 384
12.00noon orange 
1.30pm 6u lispro insulin 
1.35pm lunch with same previous dish
6.30pm oats 
8.45pm 5u lantus insulin 
9.45pm blood sugar 205
9.45pm 2u lispro insulin 
9.50pm dinner with as same as lunch dish

26/01/25

Patient Advocate: 26.01.25
7.45am fasting blood suger 88
7.45am nuts 
8.00am milk 
9.45am 4u lispro insulin 
9.50am rice with pulses, brinjal, chayote, beans,  carrot, beatroot, turnip brocolli, egg and salad
12.00noon orange 
1.30pm blood sugar 297
1.30pm 5u lispro insulin 
1.35pm lunch with same previous dish except egg and include chicken
6.30pm oats 
8.45pm 5u lantus insulin 
9.45pm blood sugar 309
9.45pm 3.5,u lispro insulin 
9.50pm dinner with as same as lunch dish and 1/2 puri
স্যার কাল থেকে কি lantus 6u করে দিব?

PaJR PHR Moderator: Na already fasting 88
Lantus barano jabe na
Shudhu lispro tai barano jabe

PaJR PHR Moderator: 👆 gotokal 1:30 PM lispro 6U a 9:45 PM a 205 hoyechilo
Aajke 1;30 PM 5U a 9:45PM a 309

27/01/25

Patient Advocate: 27.01.25
7.45am blood sugar 213
7.45am nuts 
8.00am milk
 9.45am 6.5u lispro insulin 
9.50am rice with pulses, brinjal, tomato, beans, kidney beans, brocolli, carrot, cabbage, beatroot, turnip, butter and salad
12.00noon orange 
12.00noon blood sugar 314
স্যার সুগার নামছেই না l কি করব এখন ?

PaJR PHR Moderator: Aajke lantus ta +1 barano jete pare ebong lispro dose guno o gotokaaler tulonai +1 barano jete pare
CGM device ta lagiye nite parle khub bhalo hoi

28/01/25

Patient Advocate: 1.30pm 6u lispro insulin 
1.35pm lunch with same previous dish 
6.15pm oats 
9.30pm 6u lantus insulin 
9.30pm blood sugar 178
9.35pm 0.5u lispro insulin 
9.40pm dinner with same previous dish and one pakoda

Patient Advocate: 28.01.25
7.45am fasting blood sugar 264
7.45am milk

PaJR PHR Moderator: 6U lantus tao ektu somoi nebe

Patient Advocate: 9.30am 5u lispro 
9.35am rice with pulses, brinjal, spinach, carrot, cauliflower, cabbage, tomato, beatroot, beans kidney beans, brocolli, butter and salad
11.45am pomegranate 
1.30pm blood sugar 167
1.30pm 3u lispro insulin 
1.35pm lunch with same previous dish except butter and include fish 
3.50pm blood sugar 178
6.30pm oats 
8.15pm one pc momo 
9.30pm 6u lantus insulin 
9.45pm blood sugar 346
9.45pm 5u lispro insulin 
9.50pm dinner with as same as lunch dish

29/01/25

PaJR PHR Moderator: Today's fasting?

Patient Advocate: 7.45am fasting blood sugar 44
7.45am nuts and dates 
8.00am milk with 1/4 teaspoon sugar 
9.30am 3pcs biscuit 
11.15am 4u lispro insulin 
11.20am rice with pulses, tomato, brinjal, spinach, carrot, chayote, kidney beans, beans, brocolli, bitter, beatroot, butter and salad 
12.45pm pomegranate 
2.00pm blood sugar 244
2.00pm 3.5u lispro insulin 
2.05pm lunch with same previous dish except butter and include fish 
7.00pm oats
স্যার মেয়ে আজ থেকে স্কুল যাচ্ছে তাই সময় গুলি একটু আগে পরে হচ্ছে

PaJR PHR Moderator: Reduce lantus dose today

30/01/25

Patient Advocate: 9.00pm 5u lantus
9.30pm blood sugar 266
9.30pm 2u lispro insulin 
9.35pm dinner with as same as lunch dish

PaJR PHR Moderator: Fasting today?

Patient Advocate: 30.01.25
7.45am fasting blood sugar 130
7.45am nuts 
8.00am milk 
9.45am 4.5u lispro insulin 
9.50am rice with pulses, brinjal, pumpkin, beans, kidney beans, brocolli, carrot, beatroot,  egg and salad

31/01/25

Patient Advocate: 11.00am normal sandesh (stolenly ate)
11.45am pomegranate 
1.30pm blood sugar 342
1.30pm 5.5u lispro insulin 
1.35pm lunch with same previous dish except egg and include fish 
6.30pm oats 
9.00pm 5u lantus insulin 
9.30pm blood sugar 241
9.30pm 2u lispro insulin 
9.35pm dinner with as same as lunch dish

PaJR PHR Moderator: Stolen sweet 342!
I guess sweets are not good for anyone and should not be kept at home to prevent someone from stealing them?

Patient Advocate: Ok Sir

Patient Advocate: 31.01.25
7.45am blood sugar 97
7.45am milk with one biscuit 
9.45am 2pcs biscuit
10.45am 4.5u lispro insulin 
10.50am rice with pulses, bitter gourd, chayote, beans brocolli carrot beatroot, tomato kidney beans pumpkin egg and salad 
12.15pm pomegranate 
1.45pm blood sugar 266
1.45pm 4.5u lispro insulin 
1.50pm lunch with same previous dish except egg and include fish 
7.00pm oats 
9.00pm 5u lantus insulin 
9.45pm blood sugar 146
9.45pm  0.5u  lispro insulin 
9.50pm dinner with as same as lunch dish

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