After my initial reluctance to trust the meter I decided to inject what it suggested and see how I went, after all, I would be going to a follow up meeting with the DSN and presumably she would be looking at my results. I also started to notice that when I overrode the suggestions I was getting hypos. This was somewhat curious because previously I had been injecting much larger doses for the same meals. I mean significantly higher doses. Anyway, my BGs seemed to be OKish. In other words, I was in the “target range” before the next meal, but the “target range” was set at 5.5 – 8.5. Nowhere near as tight control as I am used to.
A week into the experiment I decided to tweak the meter settings. I discovered I could set Carb ratios by time of day so I firstly altered my Carbohydrate ratio to 1:6 at breakfast and 1:8 at lunch and dinner as I did feel 1:9 wasn’t quite right for me. I then changed my correction dose to a single target of 5. I changed insulin duration to 4hrs 30. The dose suggestions were still way lower than I had been injecting but I persisted with following the meter’s suggestions for dosing. I began to weigh all food and religiously test at the 2 hour mark.
The meter has a convenient alarm feature which lets you set alarms either for a certain time every day (useful for reminding you to do basal) or for a one off alarm. Since my mealtimes are by no means set in stone, but vary each day, this merely meant setting a one off when I injected to remind me to test at 2 hours. The first time I did this I had a cake in the oven and thought it was the oven timer and at the same time thought “arghhh there’s something gone wrong with it, it’s very quiet”. I then realised it was the meter alarm. The two hour readings were actually no worse than they had been when I had been injecting approx 2/3rds more insulin. I couldn’t quite believe it.
I did run a few tests in parallel with my old meter from the same drop of blood and it would appear that the new meter reads approx 1u lower around the 8 mark ( reading of 8.4 on the new meter would be 9.5 on the old) but down at the lower end the 2 meters read identically. From 1 drop of blood I had 4.6 from both meters. Not sure what to think of that – who knows which is the most accurate at the higher end? Will definitely be hanging onto my Optium Xceed though since I have current Ketone strips and would not want to lose the ability to check blood ketones.
So as the week wore on I realised that my insulin needs weren’t anywhere near what I had been injecting. Plus I hadn’t been dosing anything for protein. Not only that, but once I had tweaked the meter lo and behold my 5 hour numbers were back in the 5 range. I do still note that I can’t eat protein between meals with impunity, though the rise is minimal e.g. 4.6 to 5.4. Of course I have have heard that often lowering insulin doses, whilst being counter-intuitive does work, it’s hard to actually believe it when it’s happening to you, but believe it I must, because the meter is telling me so. So, in conclusion regarding the doses I have cut my total daily bolus from around 30u to around 11u.
This leads me to question the amount of basal I am using as it is now seriously out of balance with the 11u of Bolus since I am taking 14u Levemir at night and 12u in the morning, a total of 26u which is more than twice my bolus. I am thinking of reducing it by 1u tonight and 1u tomorrow, but that begs the question of whether I should at the same time increase insulin:carb ratios. I’ve always had to sort this kind of thing out for myself, but with an appointment with the specialist carb counting dietiitian tomorrow and an appointment with the DSN in early December I am wondering whether (and hoping that) on this occasion I can have some real support. I do recall that at my one appointment with the Endo in May he said that I was on “too much” insulin. It also makes me wonder whether I might finally be able to shed some weight!
The meter has a USB cable and when you plug it into your computer it installs the Freestyle software for you. The software can show you a lot of reports. I still have to digest these a little better, but initial understanding shows a clear pattern of hypos in the late afternoon at 5 – 6 pm. I am currently pondering why? It’s at the tail end of my lunchtime Humalog if it lasts 5 hours, but out of the range if it’s 4 hrs 30. I really don’t know, it could be the peak of the Levemir at 9 hours according to the Levemir profile graph here since I am on approx 0.4u per kilo of body weight which would appear to have a 10 hour peak action before tailing off and out. In any case starting last night I have reduced the Levemir to 12 in the evening and 11 in the morning. I may have to tweak up my bolus ratios a touch, but I am confident I shall get there in time and that the Insulinx is one of the best things that has happened to me (apart from being correctly diagnosed at long last) since diagnosis.
I will write a proper review of the meter and it’s capabilities but for now I am uploading here some screenshots of the graphs available when you plug your meter into the computer. Certainly I am now spotting patterns that I wouldn’t otherwise have caught.
The first picture is a “Snapshot” of the past two weeks:
Snapshot
Bear in mind that I was newly getting used to the meter and there were times when I hadn’t tapped the right places on the screen to actually record the insulin dose, plus there was a gap when I ran out of the 30 strips I was given and had to wait to have a prescription sorted out.
Next one sees the Modal day:
The statistics under the graph are where I noticed the run of hypos.
When we get to the daily statistics it seems to publish 2 days to a page. This is the page that covers 17 November:
And after each of 2 days, the daily statistic summary:
I need more time to digest these reports, but I can already see how immensely useful they are going to be. The final chart is the Meal Event averages and it’s currently a bit of a mystery to me! Presumably the DSN will be able to advise when I go on 29th November to see her for a double length appointment.
Sorry I haven’t been able to capture full charts, they were done as “print screen” from my 22″ monitor and the “window” which the software opens doesn’t seem to be resizable to show a full chart even though it doesn’t fill my monitor.
My conclusion so far is that I am very pleased and amazed with the potential of the meter and it’s affect on my control, which I am sure will get tighter and tighter.