05-07-2024
This is an Online E Log Book to discuss our patient's de-identified health data shared after taking her guardian's consent. Here we discuss our individual patient's problems through a series of inputs from the available global online community of experts with the aim to solve those patient's clinical problems with the collective current best evidence based input.
INITIAL HISTORY IN ENGLISH
Patient Advocate: Respected Sir,
I am a patient advocate. My patient was born on 30/04/2021, with a birth weight of 2.8 kg. On 25/02/24, the patient experienced a fever for one evening. Since then, her body has gradually become weaker, though her appetite has significantly increased. However, there has been no improvement in her physical condition, and she is drinking a lot of water, to the point that two diapers were not sufficient overnight. After observing this for a few days, we consulted a doctor on 03/03/24. The doctor prescribed some medication and advised some tests. However, the medication did not seem to work.
On 08/03/24, we consulted another doctor, who also advised further tests. These revealed that the patient has Type 1 diabetes. The doctor admitted the patient to the hospital for 5 days, and on 13/03/24, they were discharged with instructions to administer insulin 3+1 times daily.
The patient is now at home and follows the following diet:
- 7:30 am: Wakes up and eats two cream cracker biscuits
- 9:30 am: Eats a bowl of oats
- 11:30 am: Has a fruit (orange, sweet lime, guava, apple, or pomegranate)
- 1:00 pm: Eats rice with dal, vegetables, or vegetables with egg/fish
- 4:30 pm: Eats two biscuits
- 5:00 pm: Has fruit or puffed rice
- 9:00 pm: Eats dalia (broken wheat) with vegetables
PaJR PHR Moderator: Bhalo hoye jabe. Chinta nei
Roj unar ghontai ghontai Ki Ki activities korchen ebong roj Ki Ki khacchen shetar plate er chobi please ekhane janaben. Khawar aage koto dose insulin load korlen tar chobio janaben
Ektu describe kore deben
Bhaat are daal are doi?
Patient Advocate: Ghum theke 8am uthe duto suger free biscuit kehechhe. 9.45am Gajar,beet, squash,beans,Pepe diye bhat sathe dim kusum bad diye, sange gajar r aashar salat l
Breakfast er age
PaJR PHR Moderator: Sugar free kimba Jekono biscuit avoid kora dorkar.
Oguno simply moida
Tar theke Lal muri kimba Lal Khoi jeguno dhaan theke banano would be better
Patient Advocate: 19/3/24
Before lunch 101
After dinner 233
Ekhaner doctor boleche dine duto time korte
Sir o to onek chhoto oke manano khub kasto , ek bar kanna shuru korle r thame na jatakshan na oi jinish ta oke deoa hay ।
PaJR PHR Moderator: Hain kintu kone jinish?
Bhalo Khabar o bhalo lagbe nishchoi. Jeguno khotikarok sheguno amra bhabi sushshadhoo kintu ashole oguno hoito ekkebarei sushshadhoo noi kintu onyo der dekhe ore shei dharona hocche. Dui bhai boner ebong barir shobar aeK hi khabar khawa uchit
Patient Advocate: Sakal 11.30am mosambi 1pc medium size
1.45pm insuline 3mg
2.00pm lunch sakal 9.30am Tai repeat
Sorry Sir sakale 9.15am 3mg insulin deoa hoyechhilo
Patient Advocate: Ok
Luncher dui (2) ghanta por 36 ,sathe sathe duto biscuits abong ekta 15grm er lojence dilam
5.30pm ekata chaler guror plain pithe(পিঠে)
Sir, insulin ki bandho hobe seta ki sambhab?
Sir muri ki dite parbo, murir glycemic index bole 80-90, please suggest me sir
PaJR PHR Moderator: Hain Jekono khawar plate a ekta proportion kore dewa jete pare.
Niche details share korchi
Sabdhane dite habe. Sugar high howar theke low hoye jawa ta beshi khoti karoK bishesh Kore baronto bacchader khetre.
Aer aage eto ta kom kokhono hoyechilo?
36 howar aage kimba pore Kono koshto lokkho korechilen?
Patient Advocate: Chart madhya ekdin same time 28hoyechhilo।
Kashto bolte hat pa kanpa
PaJR PHR Moderator: Aekhon theke before lunch insulin ta bondho rakhun
Lunch er aage insulin na niye du ghonta bade janaben kalke
Aekhon theke ore ebong barir sobar khawar thala guno aeibhabe sajano habe 👇
https://medicinedepartment.blogspot.com/2023/09/the-healthy-plate-diet-in-bengali-telegu.html?m=0
Patient Advocate: 9.30pm e gajar, beans, squash diye dalia
Dinner er age 2unit abar ghumanor samay 4unit insulin deoa hoyechhe
21-03-2024
Patient Advocate: Good morning Sir
AJ sakal 7.35am ghum theke uthe alpo muri kheyechhe, 9.45am bhat chholar Dall, Lao dogar sabji, 25grm machh r gajar , sasha r salat
PaJR PHR Moderator: Ajke blood glucose dekhen ni? Insulin koto niyechilen breakfast er aage?
Lunch aer aage insulin bondho rekhe lunch er du ghonta baade blood sugar ta koto thake janaben (dorkar hole aeK hi sample lab aeo pathate paren lunch er du ghonta bade)
Apnar local daktar keo janiye rakhben
Apnar local daktar keo amader sompoorno kothopkothon ta janiye rakhben
Patient Advocate: Ajke breakfast er por test korbo, insulin breakfast er age neoa hoyechhe l
Agami 23 March doctor er check up achhe l
Suger test er sampurna data record ache local doctor ke dekhabo l
Breakfast er du ghanta por suger leve 72
Dupur 12tay apple r Kamala mile 100grm
PaJR PHR Moderator: Hain kintu ore bortoman record dekhe bojha jacche je lunch aer proti du ghanta bade 3U insulin nile khub dangerous bhabe ore sugar ta fall Kore jacche tai ore lunch aer aager insulin ta bortoman a bondho rakha proyojon ebong bondho rekhe ajke lunch aer du ghonta bade sugar ta kemon thakche sheta janaben
Patient Advocate: Thik achhe sir
1.30pm gajar, squash, Pepe r sabji diye bhat sathe 25grm machh
4 tay suger 147
PaJR PHR Moderator: Dinner er aageo sugar ta Kore janale bhalo hoto.
Aer aage proti din oi somai ta beshi dekhacchilo jehetu lunch aer por hypoglycemia howai abar beshi Kore sugar khete dite hocchilo
Patient Advocate: 5pm khub kanna korchhilo pray 1 ghanta tarpor ekta suger free biscuit dilam r 1/2 bati muri ।
7pm 70% dark chocolate tar 15 minutes por 1/2 atta roti
9.15pm suger 132
Dinner gajar,Pepe,beans, squash diye dalia songe 1/3 chamach ghee
22-03-2024
PaJR PHR Moderator: Thik ache. Dinner er aage sugar ta dekhe mone hocche bikeler biscuit, muri are dark chocolate a kono khoti hoini
Patient Advocate: AJ sakal 7.15am ghum theke uthe 1PC biscuit alpo muri
9.30am gajar, squash,tometo,Pepe diye bhat sathe 1/2 dim kusum chhara abong salat
Before lunch
PaJR PHR Moderator: Kono insulin neben na lunch er aage
Patient Advocate: Na
Lunch e gajar, beans, squash, tometo diye bhat sange 1/2 dim, 15gmr machh abong salat
Ghum theke uthe bikel 5pm muri 10grm dark chocolate
23-03-2024
Patient Advocate: Yesterday rat 9.30pm gajar, squash, Pepe diye dalia songe ghee r salat
After dinner
AJ sakale 8.00am ghum theke uthe gajar squash Pepe sedho diye ghee bhat kheyechhe, insulin nebar por
PaJR PHR Moderator: 👍
Patient Advocate: 1.00pm sasha gajar kacha
2.15pm gajar, squash chhola dal diye bhat
Ajke Siliguri te doctor dekhate jachhi Tai sabkichhur time ulot palot hoye gelo
AJ ekhaner doctor ke dekhalam onake ei grouper khatopokathan balam ebong ekhon je luncher ager insulin ta bondho kore deoa hoyechhe seta bolechhe, uni bollen je Ami sadharon eisab patient ektu stable hole baire giye dekhiye ante boli l
Tobe je doctor er suggestion amra nichhi tar field ta janle oner Mone ekta satisfaction asto
Ei doctor bollen luncher ager ta ekebare bondho na kore tin Bela 2u kore nite bollen
Luncher por suger level👇👇👇
6.15pm 1pc biscuit ektu muri
8pm atar ruti 1/2
PaJR PHR Moderator: Eta Ki ajke luncher aage insulin 2U newar 2 ghonta por?
Patient Advocate: Na ajke lunch aage kono insulin neoa hay ni
PaJR PHR Moderator: Amader field ta diabetes
Patient Advocate: Thank you Sir
PaJR PHR Moderator: Bhalo korechen
Aekhon ota lunch aer aage bondho reKhe lunch er 2 ghonta baade majhe majhe blood sugar ta Kore janaben
Soptahe eK din fasting, breakfast er du ghonta baade, lunch er du ghonta baade, dinner aer du ghonta baade ta Kore janaben
Patient Advocate: Ok
PaJR PHR Moderator: Unake apnar Chart er shuru theke lunch aer 2 ghonta baader blood sugar guno dangerously fall Kore jawa ta dekhiye bojhano gechilo?
Patient Advocate: Ekdom Sir
Er janya dose er poriman komiye 3u theke 2u kore dilo tin belai
9.45pm gajar,Pepe matarsuti diye dalia
Aaj dinner er age 2u insulin deoa holo
PaJR PHR Moderator: Kintu uni etao dekhechen je bortomane lunch er aage 0U niyeo blood sugars normal aashche. Tahole keno 2U newa habe? Hoito amra je bhabe ekhane roj follow up korte parchi sheta okhane sombhob habe na bole?
Parle plate aer chobi guno share korben
Patient Advocate: Suger test er plate ta ki Sir?
PaJR PHR Moderator: Khawar plate guno
24-03-2024
Patient Advocate: AJ sakal 7.30am ghum theke uthe alpo muri tarpor 9.45am gajar,Pepe, squash,beans diye bhat
Sorry ota 9.45hobe na 8.45 hobe
3.15pm gajar, beans, squash,dim (kusum bade) diye bhat sange gajar r sasha salat
6.15pm muri
Aajo barite back karar janya time ulot palot hoye gelo
PaJR PHR Moderator: Ajke 5:15 PM (lunch er du ghonta bade) sugar ta kemon chilo jante parle bhalo hoto kintu bujhte parchi oi somoi hoito apnara gari te chilen
Patient Advocate: Aaj sakale 2u, lunch er aage kono insulin neoa hay ni, eiabasthay dinner er age suger level 180
Aaj 7.45pm 1/2 roti
10.00pm gajar tometo beans squash diye dalia
Dinner er age 2u insulin deoa hoyechhe
25-03-2024
PaJR PHR Moderator: Dinner er aage ektu beshi gotokaaler traveling er jonye hoito
Patient Advocate: Hote pare
Sakal 7.45am ghum theke uthe ektu muri
9.30am gajar, Pepe, beans, squash diye bhat sange salad
PaJR PHR Moderator: Description er saathe chobi o share korle bhalo hoi
Patient Advocate: Thik achhe Sir
1.45pm gajar, beet, beans, squash, Pepe , mung dal diya bhat sange salad
PaJR PHR Moderator: Insulin newa hoini bodh hoi?
Patient Advocate: Sakal e hayechhe 2u breakfast er age
Bikel 4.30pm 1/2 sandrsh
7pm muri khehechhe
9.45pm beans, squash, Pepe diye dalia songe salat.
26-03-2024
PaJR PHR Moderator: Before dinner Insulin?
Patient Advocate: 2u
Sakal 8am ghum theke uthe muri kheyechhe
Before breakfast
2u insulin
PaJR PHR Moderator: Breakfast er du ghonta bade?
Patient Advocate: Murir sange olpo garur dudh
PaJR PHR Moderator: Kotai?
Post breakfast sugar ta kotai newa?
Patient Advocate: Breakfast karlo to 9.50am
PaJR PHR Moderator: O accha tahole sugar value ta fasting sugar chilo?
Naki sugar ta muri khawar por?
Jekono khabar jeta sokale prothom khawa hoi bigyan bhitti te shetai breakfast
Patient Advocate: Muri khabar por
PaJR PHR Moderator: Kotokkhon por?
Patient Advocate: Muri kheyechhe 8.00am blood test hoyechhe 9.15am
PaJR PHR Moderator: Test always fasting kimba Jekono khawar du ghonta bade korben nahole confusion habe
Patient Advocate: Ok
11.30am 50grm paka bell
1.45pm Pepe, beans, squash, beet diye bhat sange two pcs chicken abong salat
Luncher du ghanta por
Luncher age kono insulin neoa hoy ni
PaJR PHR Moderator: 👆Breakfast a Ki kheye chilo?
Patient Advocate: Murir sange olpo garur dudh
PaJR PHR Moderator: Kintu muri to 8"00 AM a kheyechilo
9:50 AM a Ki kheyechilo?
Patient Advocate: Muri kheyechhe 8am
9.30am gajar Pepe beans diye beet diye bhat sange salad
PaJR PHR Moderator: 9:30 AM a 2U insulin niyechilo?
Patient Advocate: Yes Sir
Sir or krimi hoyechhe Noworm syrup ki deoa jabe?
Tobe ajke dibo na l
PaJR PHR Moderator: পুনর্বিবেচনা:
8:00 AM মুড়ি গরুর দুধ (চিনি দিয়ে?)
সকাল ৯:৪৭ ব্লাড সুগার ৬৭ সকাল
9:50 AM 2U ইনসুলিনের পরে সকালের নাস্তায় গাজর, মটরশুটি, বীট, ভাত, সালাদ
1:45 PM দুপুরের খাবারের পর ইনসুলিন নেই পেঁপে, মটরশুটি, স্কোয়াশ, বিট, চিকেন, ভাত, সালাদ
4:44 PM রক্তে শর্করা 269 আমাদের অজান্তেই সে কি অন্য কোন মিষ্টি খেতে পারে?
Revision:
8:00 AM Muri cows milk (with sugar?)
9:47Am blood sugar 67
9:50AM 2U insulin followed by breakfast carrot, beans, beet, rice, salad
1:45 PM No insulin followed by Lunch
Papaya, beans, squash, beet, chicken, rice, salad
4:44 PM blood sugar 269
Could he have consumed any other sweets he may have consumed without our knowing?
Jekono syrup dile ore blood sugar bere jete pare
Patient Advocate: Dudh e kono suger chhilo na
11.30am paka bell 50grm
O ajke sarakshan Amar sange chhilo uporer baire kono khabar khay ni
Bell er theke ki suger level bere jete pare ?
PaJR PHR Moderator: Ote Chini dewa hoyechilo?
Patient Advocate: Na, halka noon
PaJR PHR Moderator: Goto kaal lunch aer aage shara din Ki Ki niyechilen ektu time soho list Kore Dekhte habe
Goto kaal lunch aer du ghonta bade blood sugar koto chilo?
Patient Advocate: Gato kaal before lunch chhilo 66, r dinner er du ghanta por chhilo 150
Sakal e muri
9.30am gajar, Pepe, beans, squash diye bhat sange salad
11.45 am 1PC Kamala (orange )
1.45pm gajar, beet, beans, squash, mung dal diye bhat sange salad
PaJR PHR Moderator: Before naki lunch aer du ghonta por?
Patient Advocate: 150 chhilo dinner er du ghanta por
PaJR PHR Moderator: O tahole lunch aer du ghonta bade goto Kal newa hoini?
Always khawar du ghonta bade neben. Before newa shob somoi proyojon nei jodi na insulin newar por hypoglycemia 'r ashonka thake
Patient Advocate: Thik achhe Sir
5.30pm alpo muri
7.45pm roti 1/2
9.45pm squash,Pepe diye dalia sange sasha r salat
Er age 2u insulin
Shoyar age 4u insulin
27-03-2024
4U insulin lantus
উপরের পদ্ধতিতে তাদের নামও দিলে ভালো হবে
Patient Advocate: Ok
7.30am ghum theke uthe alpo muri aar cha
8.50am 2u insulin
9.00am Pepe, squash barite banano paneer (without fat) diye bhat sange salad
PaJR PHR Moderator: 9:00 AM 2U insulin before breakfast
11:00 AM blood sugar 56?
Patient Advocate: Yes Sir
PaJR PHR Moderator: Any symptoms?
Given her anything to eat after seeing the report?
Patient Advocate: No Sir
One Guava and 50grm ripe papaya
PaJR PHR Moderator: Kotai? Blood sugar ta dekhar por ?
কোন উপসর্গ?
রক্তে শর্করার পরিমাণ কম দেখে আপনি কি তাকে কিছু খেতে দিয়েছেন?
Patient Advocate: Hay Sir blood suger dekhar por
PaJR PHR Moderator: আপনি যদি আজ দুপুরের খাবারের আগে তার শর্করা পরীক্ষা করতে পারেন এবং আমাদের জানাতে পারেন তবে ভাল হবে
Patient Advocate: ঠিক আছে
কোনো রকমের symptom নেই suger level কমার পড়ে খাবার রুচি পায়খানা প্রসাব সব ঠিক আছে
Before lunch
PaJR PHR Moderator: Thik ache.
Aekhon lunch aer aage insulin newar dorkar nei
Patient Advocate: Luncher age insulin to apni bolar por theke neoa hoy na
PaJR PHR Moderator: Hain goto kaal jodio lunch aer du ghonta baader sugar ta dekhe mone hoyechilo abar shuru korte hote pare.
Ajke lunch aer du ghonta baader sugar ta janaben
Patient Advocate: আজকে দুপুরের খাবারের পর sugur leve ছিল 117
বিকেলে ঘুম থেকে উঠে 5.30pm মুড়ি, 6.45pm 1pc সুগার ফ্রি বিস্কুট, 7.45pm 1/2 pc আটার রুটি খেয়েছে l
PaJR PHR Moderator: 👍
Patient Advocate: 10pm gajar, squash, beans, badbati abong soyabean diye dalia sanga salat
Khaoar age 2u
Khaoar por 4u insulin
28-03-2024
PaJR PHR Moderator: Bhalo
Insulin ta janabar somoi always aei bhabe complete information ta janaben :
2U lispro (aspart) khawar aage
4U lantus (glargine) khawar por
Patient Advocate: Thik achhe
Sakal 7.45am 50ml dudh(swar bar karar por) abong 15 to 20grm muri
PaJR PHR Moderator: Ajke breakfast er aage kichu insulin newa hoyechilo?
Kono fasting kimba pre breakfast blood sugar value kora hoyeche?
Patient Advocate: Sakal 9.45am insulin 2u
10.05am beans, badbati, squash, gajar, mung dal diye bhat, sange salat.
Ajke fasting test hoyni, Lunch er age karbo
Sir আপনি কয়েক দিন ধরে রোগী সম্বেন্ধে বুঝলেন, একবার যদি সামনে থেকে দেখে আর কিছু টেস্ট করতে হলে করে দেখে যদি কোনো সলিউশন থাকে তাহলে আমরা সেইভাবেই এগিয়ে যেতাম । তাই স্যার আপনি যদি মে মাসে কোনো ডেট দিতেন তাহলে খুবই উপকৃত হতাম l এত আগে ডেট চাইলাম কারণ আমাদের ট্রেনের টিকিট কাটতে হবে তাই l
11.30am 1/2 মৌসুম্বি 7-8 pcs আঙুর
Before lunch
PaJR PHR Moderator: Jekono somai aaste paren
Patient Advocate: Ok thank you Sir
PaJR PHR Moderator: Ajke lunch aer du ghonta baader ta ektu beshi habe mone hocche
Patient Advocate: Lunch 2.00pm beans, badbati, gajar, squash,mung dal diye bhat sange machh ar salad
Amar o Mone hochhe Tai , test kore dekhbo
PaJR PHR Moderator: যদি আমরা অনুমান করতে পারি যে এটি উচ্চতর হতে চলেছে আমরা এই ধরনের অনুষ্ঠানে দুপুরের খাবারের আগে 1U যোগ করতে পারি
If we can anticipate that it's going to be high we may add 1U before lunch on such occasions
Patient Advocate: ঠিক আছে
Return ticket ta koy din pore katbo Sir?
PaJR PHR Moderator: 1 week
Patient Advocate: Ok, thank you Sir
5.30pm oats and sasha
9.45pm 2u insulin
10am gajar, squash, beans, badbati diye dalia songe machh ar salad
10.30pm 4u insulin
Sir amra 19th May train e chapbo 20th May apnar sathe dekha karbo
29-03-2024
Patient Advocate: Dinner er por suger level 56
Aaj sakale breakfast er age suger level 35
Ok ki ekhon theke tin(৩) belai 1u kore insulin deoa jabe
Dinner du ghanta por suger test karar por ghumiye ghumiye breastmilk kheyechhilo
7.45am muri dudh duto(2) khejur, 6-7ta kishmish deoa hoyechhe
PaJR PHR Moderator: Aei breakfast aer aage insulin daen ni asha korchi?!
Patient Advocate: Na deoa hoy ni
Suger level ta eirakam thakle ki ajke sakale insulin deoa jabe?
PaJR PHR Moderator: Na ekdom na
4U lantus to o roj raatei nito tai na? Koto din holo aei dose ta shuru kora hoyechilo?
2U lispro o to aek hi bhabe tokhon thekei nicchilo tai na?
Patient Advocate: 13/03/24 tarikh theke 4u lantus deoa hoyechhe
13/03/24 tarikh theke 3u kore dine tinbar , 21/03/24 tarikh theke 3u kore du bar
24/03/24 tarikh theke 2u kore du bar
PaJR PHR Moderator: Aaste aaste mone hocche ore insulin requirement ta kome aashche.
Aekhon aei somoi insulin dewar aage khub sabdhanota obolombon korte habe
Koyek din blood ta insulin newar aage ebong newar du ghonta bade test kore dekhle bhalo habe
Test aer jonye bar bar prick korle o Ki sojjo korte pare naki somosya hoi. Aajkal prick na Kore continuous glucose monitoring aer jonye machine pawa jai.
https://www.freestyle.abbott/us-en/products/freestyle-libre-cgm-kids.html#:~:text=Patients%20ages%204%2D17%20are,through%20their%20parent%20or%20guardian.
Patient Advocate: Ekhon Mone 10.00 am suger level 192
10.00am 2u insulin
10.15am beans, badbati, squash, gajar, ichchhe diye bhat sange dimer sada portion, salad
Etar price Kato Sir?
PaJR PHR Moderator: Aekhon sugar ta dekhe janaben
https://www.amazon.in/FreeStyle-Libre-Sensor-Glucose-Monitoring/dp/B0849WHJQN/ref=sr_1_1?crid=1WHGF3XVLRI0U&keywords=freestyle%2Blibre&qid=1700466622&sprefix=freestyle%2Blibr%2Caps%2C228&sr=8-1&th=1&gclid=Cj0KCQjwzZmwBhD8ARIsAH4v1gUvlwR9uh17mfs36QD3kIkPrLYQqx-_HV-kHUAuvBtkqZMdMiVXx3YaAqrLEALw_wcB
Aekhono 4 bochor er theke choto bacchader upor temon proyog hoini
Patient Advocate: Er to three hote one month baki
Luncher age
6.00pm 6grm of dark chocolate
6.45pm oats and salad
PaJR PHR Moderator: Luncher du ghonta por bodh hoi aajke are kora hoini?
Patient Advocate: Na Sir
Participant 1: Who's the patient primary caretaker ?
PaJR PHR Moderator: Not them
Participant 1: Hellos Patient Advocate,
Given this is Type 1 case , I contacted a founder of the NGO who are helping kids and adults with type 1 diabetes.
The NGO name is blue circle diabetes foundation run by Nupur Lalwani and team.
For using CGM they have requested to connect with you.
If you are okay with, I will share your contact details with her.
Please let me know.
PaJR PHR Moderator: Also translate this into Bengali with google translate for smoother communication
Participant 2: দেবুকে জানাই,
টাইপ ১ ডায়াবেটিস নিয়ে কাজ করা একটি এনজিও'র (অলাভজনক সংগঠন) প্রতিষ্ঠাতার সাথে যোগাযোগ করেছিলাম। এই এনজিও'র নাম হলো ব্লু সার্কেল ডায়াবেটিস ফাউন্ডেশন, এটি নুপুর লালwani ও তাঁর টিমের দ্বারা পরিচালিত হয়।
এটি যেহেতু টাইপ ১ এর ক্ষেত্রে, তাই কন্টিনিউয়াস গ্লুকোজ মনিটরিং (CGM) সম্পর্কে জানতে তাঁদের সাথে যোগাযোগ করা হয়েছিল। তারা আগ্রহী হয়েছেন এবং এ বিষয়ে আরও আলোচনা করার জন্য আপনার সাথে যোগাযোগ করতে চান।
আপনি যদি সম্মত হন, তাহলে কি আমি আপনার যোগাযোগের তথ্য নুপুর লালwani ও তাঁর টিমের সাথে শেয়ার করতে পারি?
Patient Advocate: Parents
You can
Participant 1: Okay.,
I am assuming they will be able to understand English or Hindi
ঠিক আছে.,
আমি ভুল হলে আমাকে সংশোধন করুন @~দেবুর অভিভাবক এবং আমি এই নম্বরটি শেয়ার করছি।
আমি ধরে নিচ্ছি তারা ইংরেজি বা হিন্দি বুঝতে সক্ষম হবে
Patient Advocate: হ্যাঁ স্যার
Er por aro ekta list achhe
PaJR PHR Moderator: Otao please share korun
Patient Advocate: Ok , korchhi
PaJR PHR Moderator: 👆March 20 r aei value lunch aer por, after lunch AL jeta 36 aeshchilo shetao chart a enter kore din
March 21 after lunch ta 147 apnar Chart a add Kore din
Chart a parle insulin aer dose tao mention korben
Patient Advocate: 13/03/24 tarikh theke 4u lantus deoa hoyechhe
13/03/24 tarikh theke 3u kore dine tinbar , 21/03/24 tarikh theke 3u kore du bar
24/03/24 tarikh theke 2u kore du bar
PaJR PHR Moderator: Ekhane dekhun shudhu March 20 r apnar entry ta Participant 3 AI er madhyome kibhabe shajiyechen 👇
March 20 table of 2F's sugars with the insulin doses added:
| Time | Insulin | Sugar Level |
|------|---------|-------------|
| 7:35 AM | - | - |
| 9:45 AM | 2U aspart | - |
| After breakfast | - | 72 (2 hours after breakfast) |
| 12:00 PM | - | - |
| 1:30 PM | 2U aspart (withheld) | - |
| 4:00 PM | - | 147 (2 hours after lunch) |
| 5:00 PM | - | - |
| 7:00 PM | - | - |
| 9:15 PM | 2U aspart | 132 (pre-dinner) |
| After 9:15 PM | 4U glargine | - |
Note: The insulin dose of 2U aspart was withheld before lunch due to the dangerous hypoglycemia mentioned in the conversation.
Aajke dinner aer por dekhe dorkar hole lantus ta komiye dewa jete pare nahole abar aaj sokaler moton kalkeo fasting kome na jai
Dinner kotai Kore?
Patient Advocate: 10.00pm
PaJR PHR Moderator: Lantus ta ajke kom neben 2U
Patient Advocate: ঠিক আছে
30-03-2024
PaJR PHR Moderator: 👏👏
Aaste aaste aekhon insulin requirement ta komche. Shurur deeKe type 1 Diabetes a aerokom aaste aaste insulin requirement kome aasha ta anek khetre dekha jai jetake bola hoi "honeymoon" phase
Patient Advocate: AJ sakal 8am 50ml dudh ar muri khai niye 15-20grm
তাহলে কি insulin টা বন্ধ হতে পারে ?
PaJR PHR Moderator: Na eta ekta samoyik phase. Kichu din bondho hoye giye abar dorkar hote shuru korbe. Tai jonye etar naam "honeymoon."
Aei jonye aei phase tai monitoring aro beshi joroori hoye othe keno Ki kokhon abar insulin dorkar hote shuru korbe bola mushkil.
Patient Advocate: 9.45am insulin 2u
10.00am gajar, broccoli, squash, badbati, beans, paneer diye bhat sange salad
PaJR PHR Moderator: Post breakfast sugar?
Patient Advocate: 12.00 noon ae karbo
Post breakfast
11.30am one apple
1.30pm gajar, broccoli, squash, badbati, beans diye bhat sange salad
5.30pm dark chocolate 8grm
6.30pm masala oats & salad
9.45pm insulin 2u
10.00pm gajar, squash, beans, badbati, tometo diye bhat sange salad
10.30pm insulin 2u
31-03-2024
Patient Advocate: 7.30
7.30am ghum theke uthe dudh muri khai kheyechhe
9.30am 2u insulin
9.45am gajar , Pepe, squash, beans, badbati, kancha kala, tometo diye bhat
Post breakfast sugar level 148
12.00noon 8-10pcs grapes, one pc mousambi
Participant 1: I believe Nupur has spoken with the parent about type 1 and CGM.
We can take the next step.
PaJR PHR Moderator: What would be the next step?
Participant 1: Who has the CGM that we sent last time , I will try to arrange the reader
If parent approves for CGM we can plan something’s here
PaJR PHR Moderator: We have a departmental patient fund group where all resources that we receive to take care of our patients are logged and archived 👇
Patient Advocate: 1.30pm Pepe, beans, squash, tometo, kancha kala, badbati diye bhat sange machh and salad
5.30 pm dark chocolate 10grm
6.30pm masala oats and salad
9.45pm 2u insulin
10.00pm beans, squash, tometo, gajar, badbati diye dalia sange machh and salad
PaJR PHR Moderator: 👍
01-04-2024
Patient Advocate: Post dinner suger level 250
PaJR PHR Moderator: Aer modhye kichu mishti chilo?
Barir sobai 10:00 PM dinner na kore Ki 8 PM kore 10:00 ghumote parben?
Bacchar pokkhe 12:00 AM abar blood sugar korano mushkil hote pare naki ota ghumer modhyei kore fela jai?
Dark chocolate tar chobi pathaben. Koto % dark?
3:30 PM lunch aer por asha kori sugar ta thik chilo?
Patient Advocate: Na kichhu mishti chhilo na
10.00pm ghumano ektu muskil hoye jabe
Blood test ta ghumer madhya kore fela jay
Lunch 1.30pm kore chhilo
Lunch er por test Kora hoy ni
Test Kora hoyechhilo breakfast er du ghanta por je ta chhilo 148
PaJR PHR Moderator: Raate insulin lantus koto niyechilen?
Kotai?
Patient Advocate: Lantus 2u
PaJR PHR Moderator: Aro komano jete pare
Kotai?
Patient Advocate: Sir, balchhilam je rate to duto insulin deoa hay ar Sara rat onek ta gap hoye Jay ar pray sakale sugar level niche thake, sei karonei or sakal er insulin ta lunch er aage deoa jabe ki ?
9.30am beans, squash, tometo, gajar, badbati, Pepe, paneer diye bhat sange salad
PaJR PHR Moderator: এই প্রশ্নের উত্তর বোঝার জন্য আমাদের স্বাভাবিক ইনসুলিন নিঃসরণের শারীরবৃত্তীয়তা বুঝতে হবে।
সাধারণত ইনসুলিন যে কোনও খাবারের পরে শরীরের অভ্যন্তরে নিঃসৃত হয় এবং তাই যৌক্তিকভাবে আমাদের প্রতিটি khawar পরে ইনসুলিন নিতে হবে যা বর্তমানে তার মধ্যে ইনসুলিন লিসপ্রো দিয়ে প্রতিস্থাপিত হচ্ছে।
এছাড়াও অল্প পরিমাণে ইনসুলিন নিঃসরণ হয় যা সাধারণত না খেয়েও সব সময় ঘটে এবং এটি ইনসুলিন ল্যান্টাস দ্বারা প্রতিস্থাপিত হচ্ছে।
আবার যেমন আমরা দেখেছি যে ইনসুলিনের প্রয়োজনীয়তা বর্তমানে ওঠানামা করছে কারণ এটি দেখা যাচ্ছে যে দুপুরের খাবারের আগে সম্ভবত তার শরীর থেকে কিছু ইনসুলিন নিঃসৃত হয় যে ক্ষেত্রে আমরা বাইরে থেকে কিছু দিতে পারি না অন্যথায় সে হাইপোগ্লাইসেমিয়াতে যেতে পারে।
বর্তমানে প্রাতঃরাশের 2U ইনসুলিন হাইপোগ্লাইসেমিয়া তৈরি করছে না যা bujhiye দেয় যে সকালের নাস্তার আগে শরীরের ইনসুলিন নিঃসরণ কম হয়।
To understand the answer to this question we may need to understand the physiology of normal insulin secretion.
Generally insulin is normally secreted inside the body after any meal and hence logically we need to take insulin after every mean which is currently being replaced in her with the insulin lispro.
Also there is a small amount of Insulin secretion that happens all the time normally even without eating and that is being replaced by insulin lantus.
Again as we have seen the Insulin requirement is currently fluctuating as it appears that before lunch there is possibly some insulin being secreted by her body in which case we can't give any from outside or else she may go into hypoglycemia.
Currently the breakfast 2U insulin is not producing hypoglycemia suggesting that the body's insulin secretion is less before breakfast.
Patient Advocate: Ok thank you Sir
11.30am mousamu one pc and 4-5 pcs grapes
12.45pm beans, squash, tometo, gajar, badbati, Pepe, paneer soyabean diye bhat sange salad
Participant 1: I will try to arrange a reader for CGM.
Patient Advocate can you share model number of you phone ? Which mobile phone are you using
Perfect , it has NFC.
We start with CGM
Patient Advocate: Two hours later of lunch suger level 259
5.30pm dark chocolate 8grm
6.30pm oats and salad
PaJR PHR Moderator: Eta dekhe mone hocche ajke lunch aer aage 2U lispro newa jeto
Patient Advocate: 9.30pm 2u insulin
9.45pm gajar, squash, Pepe, broccoli , patal diye dalia songe salad
12.45pm beans, squash, tometo, gajar, badbati, Pepe, paneer soyabean diye bhat sange salad
10.30pm insulin 2u
02-04-2024
PaJR PHR Moderator: Aajke lunch aer aage sugar dekhe dorkar mone hole 1U lispro
Patient Advocate: 👍
8.00am khai diye dudh
9.15am 2u insulin
9.30am gajar, Pepe, beans, squash, uchchhe, patal, tometo diye bhat sange dim ar salad
Two hours later of breakfast sugar level 150
PaJR PHR Moderator: 2U before breakfast was ideal for her today
Patient Advocate: 11.30am apple one pc
1.15pm 1u insulin
1.30pm gajar, Pepe, beans, squash, uchchhe, patal, tometo, soyabean diye bhat sange salad
PaJR PHR Moderator: 3:30 Pm blood sugar?
Patient Advocate: Ektu barir baire chhilam Tai Kora hoy ni
5.30pm dark chocolate 8grm
6.30pm oats and salad
Before dinner sugar level 204
9.40pm insulin 2u
9.50pm pepe, beans, badbati, squash, patal diye dalia sanga salad
03-04-2024
Patient Advocate: 8.00am muri diye dudh
9.20 am 2u insulin
9.40am gajar,pepe,beans,squash,uchche,patol, tomato diye Bhat sange dim ar salad
11.40am one Apple
Lunch er age sugar level 165
Lunch gajar, pepe, beans, squash, patal, tomato soyabean ar sing mach diye bhat sange salad
PaJR PHR Moderator: Lunch kotai?
Lunch er aage insulin 1U niyechilen?
Patient Advocate: Lunch koreche 1.45pm
Lunch er aage 1 U insulin deowa hoyeche
04-04-2024
Patient Advocate: Yesterday 4.30pm Tak dai
6.45pm oats and salad
9.50pm 2u insulin
10.00pm gajar, pepe, beans, badbati, squash diye dalia sanga salad
10.30pm 2u insulin
AJ sakal 7.30am sugar level 50
7.30am khai muri diye dudh
PaJR PHR Moderator: Tar por du ghonta baade blood sugar?
Patient Advocate: 9.30am Pepe, squash, beet, kancha kala, badbati, tometo diye bhat sange salad and dim
Er aage 2u insulin
PaJR PHR Moderator: Raate Lantus ta aro komiye 1U kora jete pare
11:30 AM sugar Ki jana jabe
Patient Advocate: Before lunch sugar level 194
1.30pm Pepe, beans, squash, tometo, badbati, kancha kala diye bhat sange salad ar machh
PaJR PHR Moderator: 1U diyechen?
Lunch er 2 ghonta baader ta obosyoi janaben
Patient Advocate: 1u insulin deoa hoyechhe befor lunch
Lunch du ghanta por suger level 216
5.30pm Tak dai 4-5 chamach
7.00pm pasta and salad
Before dinner 2u insulin
9.45pm squash, Pepe, beans, matarsuti diye dalia songe machh ar salad
Potty r poriman ta tulonamulok Kom chhilo ahke
05-04-2024
PaJR PHR Moderator: Pete jol jomeche kina ultrasound Kore dekha dorkar
Patient Advocate: Jal jamar Karan ta ki ?
Ultrasound korar por sei jal ta ki abar test korte hobe jodi korte hoy Tobe ki test korte hobe?
PaJR PHR Moderator: Aage jol ache kina dekha jaak.
Patient Advocate: Ok jachhi sir ultrasound korte
7.30am dudh khai, 1/2 aata roti
11.30 am sugar level 58
11.30am insulin 1u
11.40am gajar pepe, beans, squash, sajna data diye bhat sange e
Ultrasound korate jaoyar janya khaoate deri hoye gelo
PaJR PHR Moderator: Ultrasound aer report a kichu janalen?
Ultrasound a confirm kore bojha jacche ota just gas aer jonye.
Eta dekhe amra sobai aashostto holam!
Patient Advocate: Gas er janyo Lanzol Junior deoa jabe ki Sir?
PaJR PHR Moderator: Na dewai bhalo kenoki o kono osubidhe feel korchena. Lanzol ta sudhu matro samoyik relief dewar jonye ebong otar alhada side effects o ache
Aaste aaste kome jabe.
Patient Advocate: Thik achhe Sir
2.30pm gajar, Pepe, beans, squash , sajna data diye dalia sanga dim ar salad
6.00pm Tak dai 50ml
7.00pm pasta and salad
9.30pm 2u insulin
9.45 pm beans, squash, pepe diye dalia sanga salad
10.30pm 2u insulin
06-04-2024
PHR Moderator: Goto kaal lunch kotai ebong Ki kheyechilen ebong koto unit insulin niyechilen?
Patient Advocate: Gata kaal er lunch
Luncher age insulin neoa hoy ni
Dinner er age sugar level 235
AJ sakal 7.15 am dudh diye khai
PaJR PHR Moderator: 👍
Patient Advocate: Sir khaoar jinisher madhya kono kichhu add ba less korte hobe jate or shashir fit and strong thake r gas ba onyo kono samasya na hay ?
PaJR PHR Moderator: Dudh ta komale gas ta kichu ta komte pare
Baki gas er jonye chintar kono karon nei
Patient Advocate: 9.30am 2u insulin
9.45am pepe , squash, badbati, ichchha diye bhat sange salad
11.30am alpo bedana r alpo tormuj (watermelon) kheyechhe
Egulo chulkochhe
1.30pm insulin 2u
1.40pm pepe, squash, badbati,uchchhe, paneer diye bhat sange salad
Luncher age sugar level 230
Sir patient fan chhara ghumote chay na ar edike or sharir ta khuboi garam
PaJR PHR Moderator: Fan chaliye ghumote pare
Aeguno allergy theke hocche
Patient Advocate: Egulor suger er sathe kono samparko aachhe
PaJR PHR Moderator: 11:30 AM a bodh hoi sugar dekha hoini?
Patient Advocate: Na Sir
PaJR PHR Moderator: Generally noi
Oshudh aer reaction thekeo anek somoi aei dhoroner allergy hote pare
Patient Advocate: ekhon insulin chhara onno kono oshudh to nichchhe na
PaJR PHR Moderator: 3:40 PM a lunch er du ghonta bade o na?
Patient Advocate: Kono ki Skin Specialist ke dekhabi ki?
Lunch er pore ki Nebo?
PaJR PHR Moderator: Hain local daktar Ke Jekono notun kono somosya hole oti obosoyee janiye rakhben
Blood sugar?
Patient Advocate: Hay Sir
PaJR PHR Moderator: Mane amra besh kichu Din dhore dekhchilam lunch aer du ghonta por sugar ta khub low hoye jacchilo tai aekhon lunch aer du ghonta bade kemon ache sheta bojhar jonye
Eta lunch er teen ghonta bade?
Patient Advocate: Hm.
Sharir ta garam kisher theke Sir ?
PaJR PHR Moderator: Ore temperature ta proti char ghontai mepe mepe ekhane janaben
Patient Advocate: Thik achhe
PaJR PHR Moderator: Eta jokhon dekhlen tokhon kono koshto chilo jemon kampuni?
Patient Advocate: Na kono kapuni chhilo na ulte aro fan na chalale kanna kati shuru kore day
Ekhono garam achhe
PaJR PHR Moderator: Gorom a fan na chalaleo shorir gorom hote pare
Temperature ta mepe janale bhalo hoi
Patient Advocate: Or garam dekhe fan ta bandho kore dei kintu o kanna kati kore pore abar chaliye dei
Ektu pore janachhi, ekhon ekjon Skin specialist dekhate niye jachhi
5.50pm temperature 101F
Sir Doctor ei ousudh gulo dilo r tin saptaha por abar dekhate ballo
Ar ballo ei alargee ta sabar kshetrei hay sugar er patient er ektu basi hay
To Sir ei ousudh gulo ki ekhon khaote parbo?
Eta ki Sir insulin theke hochchhe?
9.30pm insulin
9.45pm beans squash Pepe diye dalia songe salad
10.10pm temperature 101F
07-04-2024
Patient Advocate: Sakal 7.30am sugar level 97
Aaj sakale Khali khai
7.30am temperature 99F
Ei Doctor er madhya sir Ami confidence Kom dekhla Tai sir pore ekjon Physician MD ke dekhalam uni nicher medicine gulo dilo egulo khaoano jabe ki ?
Laveta M syrup 5 ml at HS
ATAREX lotion to apply locally
9.45am insulin 2u
10.00am beans, badbati, squash, Pepe, tometo, soyabean diye bhat sange salad
11.45am paka pepe 25g and tormuj 50grm
12.00noon temperature 98.5F
PaJR PHR Moderator: Hain khawano jabe
11:45 AM a Ki blood sugar dekha hoyechilo?
Asha korchi CGM device ta pele bar bar needle prick Kore test korar koshto ta kombe
Patient Advocate: Na dekha hoyni
1.30pm insulin 2u
1.45pm beans, badbati, squash, Pepe, tometo diye bhat sange machh and salad
PaJR PHR Moderator: 3:45 PM a asha korchi dekha jabe
Patient Advocate: Hobe SIR
4.00pm sugar level 165
5.10pm temperature 98F
5.15pm Tak dai
5.45pm almond 2pcs
6.45 pm pasta and salad
9.30pm insulin 2u
9.45pm beans, badbati, squash Pepe, tometo diye dalia songe machh and salad.
08-04-2024
Patient Advocate: 10.20pm 2u insulin and
Syrup 5ml
PaJR PHR Moderator: Gas er jonye hoye thakle kono chinta nei
Patient Advocate: Ki kore bujhbo eta kiser theke hochchhe?
PaJR PHR Moderator: Ultrasound Kore onyo kono chinta jonok bishoi theke hocchena sheta bojha jacche
Gas ta normally intestine aer movement ta shothik na howar jonye hoi
Patient Advocate: Eta thik ki kore Kara jay?
খাওয়া দাওয়া কোনো কিছু পরিবর্তন করতে হবে কি না কোনো ঔসধ দিতে হবে ?
PaJR PHR Moderator: Eta khawa ebong activities er upor depend Kore.
Roj Kar khawar chobi ebong roj Kar ghontai ghontai activities share korle bola jabe bishesh Kore Jei Din guno hocche ebong Jei Din guno hocchena shediner khawa ebong activities compare Kore.
http://userdrivenhealthcare.blogspot.com/2024/02/pajr-daily-activities-sharing-guide-in.html?m=1
Patient Advocate: Thik er por theke activity guno share karbo
7.30am ghum theke uthe 5-6pcs nuts alpo khai
8.30am adha ghanta hatahati koreche
9.30am 2u insulin
9.45am squash, badbati, beans soyabean and paneer diye bhat sange salad
12.00noon mousambi
12.15 ektu nachanachi korechhe
After breakfast
PaJR PHR Moderator: 11:30 AM?
Patient Advocate: Hay Sir
1.30pm insulin 1u
1.45pm squash, badbati, beans, paneer diye bhat sange salad
2.30pm to 5.30pm ghum
5.30pm dai
6.00pm to 7.00pm হেঁটেছে
7.00pm oats
7.30pm to 8.00pm হেঁটেছে
9.30pm 2u insulin
9.45pm squash, patal,e, pepe, beans diye dalia songe salad
10.30 pm 2u insulin
Before dinner sugar level 290
Sir patient er protidin sakale pet fola thake na kintu bikal theke onek ta fola thake er janya khete chay na
Er janya ki karbo Sir?
09-04-2024
Patient Advocate: Sakal 7.30am ghum theke uthe 1/2 pc ata ruti, alpo khai
PaJR PHR Moderator: Goto kaaler moton bikele doi deben ebong haanthaben. Amar mone hoi ote kichu ta better habe.
Eta ekta diurnal variation jeta khub sombhoboto enteric neural autonomy'r karone
Patient Advocate: Thik achhe
Oki Sir pre dinner e pasta/cornflakes dudh diye/ oats khete parbe ?
9.30am 2u insulin
9.45am gajar, pepe, beans, squash, tometo, paneer diye bhat sange salad
PaJR PHR Moderator: Eguno jodio processed food ebong temone healthy noi tao majhe modhye khete pare
Patient Advocate: 👍
10.15am to 11.30 kheladhula
11.30 am paka pepe kheyechhe
12.00noon to 1.00pm kheladhula
1.20pm 1u insulin
1.30pm gajar, pepe, beans, squash, Tometo, machh diye bhat sange salad kheyechhe
2.30pm to 5.15pm ghum
5.30pm dai
5.45pm to 6.30pm khelDulo
6.30pm pasta and salad
7.00pm to 8.00pm hatahati
9.30pm 2u insulin
9.45pm beans, squash, badbati, patal diye dalia songe machh and e
10.15pm 2u insulin
10-04-2024
Patient Advocate: After dinner sugar level 123
Sakal 8.00am sugar level 92
8.00am ভেজা বাদাম আর অল্প খৈ
8.30am to 9.15am একটু বই নিয়ে নাড়া চাড়া করা
9.15am to 9.45am hatahati
9.45am 2u insulin
10.00am gajar, pepe beans, squash, tometo, soyabean diye bhat sange dim ar salad
10.30am to 12.00noon হালকা খেলাধুলা করা ,
12.00noon একটা বেদানা
আবার একটু খেলাধুলা করা
1.15pm 1u insulin
1.30pm gajar, squash, Pepe, tometo, soyabean ar alpo dim diye bhat sange salad
এরপর 2.00pm থেকে ঘুম
3.45pm sugar level 130
5.00pm টক দই
5.30pm 6.30 pm hatahati
6.30pm pasta
7.00pm to 9.30pm hatahati , বাই নিয়ে হাতাহাতি করা এবং ঘরে খেলাধুলা, নাচানাচি
9.30pm 2u insulin
9.45pm beans, squash, tometo, gajar, pepe diye dalia songe salad
11-04-2024
Patient Advocate: সকাল 7.30am ঘুম থেকে উঠে খৈ
7.30 am suger level 91
9.45am insulin 2u
9.30am gajar, Pepe, squash, badbati, patal, paneer, soyabean diye bhat sange salad
11.45am mousamu 1pc
1.15pm insulin 2u
1.30pm pepe, squash, badbati, patal, gajar, machh diye bhat sange salad
5.30pm 1/2 সন্দেশ, দই
7.00pm pasta
9.30pm 2u insulin
9.45pm beans, badbati, squash, gajar and machh diye dalia songe salad
Dinner er age suger level 188
10.15pm insulin 2u
12-04-2024
Patient Advocate: Aaj sakal 7.30am ghum theke uthe 5-6pcs nuts and alpo khai
9.30am 2u insulin
9.45am beans, badbati, tometo, squash, Pepe, soyabean diye bhat sange salad
11.45am 1pc mousambi
1.15 pm 2u insulin
1.45pm beans, badbati, tometo, squash, Pepe, paneer diye bhat sange salad
Before lunch
PaJR PHR Moderator: At 1:10 PM before the insulin?
Can you share the blood sugars at 3:45 PM 2 hours after lunch?
11:45 AM mousambi with sugar?
Patient Advocate: Insulin er age neoa
Khali mousambi, sugar deoa hoy na
After lunch
PaJR PHR Moderator: At 3:45 PM?
Patient Advocate: Na 4.20
পেট টা এখন খুব ফল ওর পটি তে খুব গন্ধ হচ্ছে লোকে কি কোনো ঔষধ দেবেন কি?
পেট ফোলা টা যে একেবারে কমছে না l
PaJR PHR Moderator: 👆Aei din pet fola lokkho korechilen?
O kono koshto bolche?
Patient Advocate: হ্যাঁ স্যার প্রতিদিনই ফোলে, খালি সকলের দিকটা ফোলা টা থাকে না l
PaJR PHR Moderator: Ote ore kono koshto hoi?
Patient Advocate: Na kastor Katha bole na kintu potty ta shakta ar gandho hay
ওর খেলাধুলা চলাফেরা মোটামুটি কার্যকলাপ প্রতিদিন একই রকম
PaJR PHR Moderator: Oguno jodi thik thake tahole ojotha onyo oshudh na khawai bhalo
Patient Advocate: Bikel hole je pet ta fule Jay, saijanya bolchhilam
PaJR PHR Moderator: Taate ore kono osubidhe hocchena.
Ota intestine aer movement ta bikeler deeke slow hoye jawar jonye
13-04-2024
Patient Advocate: Or potty te je khub durgandha hochhe
5.30pm টক দই
7.00pm pasta with salad
9.30pm আজ একটা অনুষ্ঠান বাড়ীতে গিয়ে কোলে বসে একটু মাছ মাংস মুখে দিয়েছে
10.15pm 3u insulin যেহেতু আজকে একটু বাইরের জিনিস খেয়েছে
10.30pm gajar, squash, beans, badbati, tometo diye dalia songe salad
11.15pm 2u insulin
PaJR PHR Moderator: Bairer jinish khelei beshi insulin dorkar habe eta hoito bhaba uchit hobe na. Shothik bhabe blood sugar dekhe insulin aer dose ta bibechona kora uchit habe jar jonye khawar aage ebong khawar du ghonta porer blood sugar dutoi important
Ore Potty'r chobi ta pathaben
Potty te jedin beshi durgondho habe eta lokkho korte habe je taar aager din o gom er toiri podartho beshi kheyechilo kina. Gluten sensitivity theke eta hote pare
Bojha jacche je oi bhabe 1U bariye dewa ta dangerous hote parto!
Patient Advocate: 9.45am 2u insulin
10.00am দই, 1/2 কালা দিয়ে অল্প ছাতু তারপর অল্প ভাত পেঁপে কুয়াশ, গাজর টমেটো, করলা, পানির, সয়াবিন দিয়ে salad
12.00noo mousambi
1.30pm 1u insulin
1.40pm gajar, Pepe, squash, tometo, Karla, sajna, paneer, soyabean diye bhat sange salad
Bikal 6.00pm টক দই
6.30pm one pc biscuit
7.30pm বাড়িতে বানানো আটার পাস্তা সঙ্গে স্যালাড
9.45pm 2u insulin
10.00pm pere, squash, gajar, Karla diye dalia songe salad.
14-04-2024
Patient Advocate: Dinner ege sugar level 349
Sakal 7.30am ghum theke uthe 5-6pcs nuts and khai
9.40am 2u insulin
9.45am alpo khichuri aar gajar, Pepe, squash, tometo diye bhat sange salad
PaJR PHR Moderator: Checked at 9:40 PM?
Paticipant 1 Any update on getting her a CGM?
Participant 1: I am arranging a reading next week , but when is the patient expected to come to hospital ?
PaJR PHR Moderator: How about letting them start using it even before they come taking help of their local doctor?
Participant 1: The sensor needs to be activated with reader
Where does the patient stays ?
Okay , is there any doctor that can use reader
PaJR PHR Moderator: Would it be possible to have a call with Patient Advocate to assess if he can handle the logistics along with the local doctor?
Participant 1: We can try , I will have to arrange a reader and CGM in his area
Can you confirm the city ?
Patient Advocate: 11.45am after breakfast sugar level 305
Ajke lucher age ki 1u e insulin dibo Sir
PaJR PHR Moderator: Lunch kotai?
Participant 1: Oh , let me check how can we get sensor and reader there
Will be able to confirm tomorrow as the courier service are close today
Patient Advocate: We will came by 20th may.
1.30pm e lunch
Participant 1: Let me confirm the sensor expiry working with Abbott
Patient Advocate: Sir sab kichhu to ekoi rakam chhilo tahole hatat kore eto bere gelo Keno suger ta?
1.30pm 2u insulin
1.40pm gajar, Pepe, squash, tometo, paneer and 1pc chicken diye bhat sange salad
PaJR PHR Moderator: Sugar কেন বাড়ছে এবং কমছে তা বোঝার জন্য আমাদের প্রতিদিন চিনির মানগুলির আরও ডেটা থাকতে হবে যেমন প্রতি খাবারের আগে এবং দুই ঘন্টা পরে। একবার আমরা একাধিক সূঁচের কাঁটা এড়াতে তার শরীরে CGM ডিভাইসটি সংযুক্ত করতে পারলে, তার চিনির বৃদ্ধি এবং হ্রাসের কারণগুলি আরও ভালভাবে বোধগম্য হবে।
To be able to decipher why the sugars are rising and falling we need to have more data of sugar values everyday such as before and two hour after every meal. Once we can connect the CGM device to her body to avoid multiple needle pricks, the reasons for her sugar rise and fall would become better understandable
তার রাতের খাবারের আগে আমাদের কাছে যা কিছু তথ্য আছে তা থেকে, রাতের খাবারের আগে তার উচ্চ শর্করার জন্য দায়ী করা যেতে পারে উচ্চ ক্যালোরিজেনিক খাবারের জন্য যা সে রাতের খাবারের আগে খেয়েছিল।
[4/13, 10:33 PM] Patient Advocate 2F Diabetes1: Bikal 6.00pm টক দই
6.30pm one pc biscuit
7.30pm বাড়িতে বানানো আটার পাস্তা সঙ্গে স্যালাড
[4/14, 9:30 AM] Patient Advocate 2F Diabetes1: Dinner ege sugar level 349
From whatever data we have before her dinner, her higher sugars before dinner can be attributed to the higher calorigenic foods she appears to have consumed before dinner.
Patient Advocate: এগুলো আগেও খেয়েছিল
আগে এতত বাড়ে নি l
PaJR PHR Moderator: Aage upore ae khabar guno blood sugar ebong insulin dose sohith onyo date a lekha thakle share korun
👆Ae charao aer aager honeymoon phase tao kete jabar jonye eta hote pare
Patient Advocate: Lunch er dui ghanta por suger level 300
আর পেট ফোলা টা কিন্তু কিছুতেই কমছে না l
Insulin dose gulo ki revise korben ?
15-04-2024
Patient Advocate: Bikel 5.30pm Tak dai
7.00pm barite banano lal attar pasta sange salad
9.30pm 3u insulin
9.45pm squash, Pepe, tometo, patal, diye dalia songe one pc chicken and salad
Bed time 3u insulin
Sakale 6.45am sugar level 73
sakale 7.30am nuts and 1/2 আটার রুটি
PaJR PHR Moderator: উপরে যেমন আগে বলা হয়েছে, ইনসুলিনকে সুনির্দিষ্টভাবে সামঞ্জস্য করতে সক্ষম হওয়ার জন্য, খাবারের দুই ঘন্টা পরে এবং আগে রক্তে শর্করার মানগুলি যত্ন সহকারে সংগ্রহ করা প্রয়োজন। আমরা এটি পেতে অক্ষম ছিলাম কারণ এটি আরও শিশুর চাপ সৃষ্টি করবে এবং তাই আমরা CGM ডিভাইসের জন্য অপেক্ষা করছিলাম।
ক্ষণস্থায়ী হাইপোগ্লাইসেমিয়া ক্ষণস্থায়ী হাইপারগ্লাইসেমিয়ার চেয়ে বেশি বিপজ্জনক। অনুগ্রহ করে আপনার স্থানীয় ডাক্তারের সাথে সর্বদা আমাদের সমস্ত পরামর্শ শেয়ার করুন কারণ তিনিই আপনার সন্তানের অবস্থার সর্বোত্তম বিচারক কারণ তার কাছে সরাসরি তাৎক্ষণিক প্রবেশাধিকার রয়েছে।
As told above earlier, to be able to adjust the insulin precisely, one needs meticulous collection of blood sugar values two hours after and before meals. We were unable to obtain that as that would cause further child stress and hence we were waiting for the CGM device.
Transient hypoglycemia is more dangerous than transient hyperglycemia.
Please share all our suggestions with your local doctor always as she is the best judge of your child's condition as she has direct immediate access to the child.
16-04-2024
Patient Advocate: Good morning Sir
গত কাল সারাদিন বিডিও অফিসে এ ইলেকশন এর কাজে ব্যস্ত থাকার জন্য কালকের আপডেট দিতে পারি নি l গতকাল তিন বার Lispro 2u করে এবং রাতে। Lantus 3u দেওয়া হয়েছে l
কাল লাঞ্চের দু ঘন্টা পর BS ছিল 303
আজ সকাল 7.30am 4-5pcs nuts এবং 10-12grm খৈ
9.45am BS 100
10.00am gajar, sajna, paneer, squash, tometo, patal, Pepe diye bhat sange dim ar salad
আজ সকাল 9.50am insulin 2u
Sir আমি শিলিগুড়িতে যে endocrinologist দেখাতাম উনি ফোন রিপ্লাই দেয় না l আর আমাদের এখান থেকে শিলিগুড়ি গিয়ে ডাক্তার বাবুকে দেখিয়ে ফিরে আসতে দুদিন লেগে যায় কারণ একদিন এত লং জার্নি বাচ্চা কে নিয়ে করা যায় না l
তাই আজকে আমাদের কুচবিহার এ একজন MD কে দেখাবো l
PaJR PHR Moderator: Hain MD Ke dekhalei jotheshto
Patient Advocate: ঠিক আছে, ধন্যবাদ স্যার
11.30am mousambi
12.10pm suger level 103
1.15pm insulin 1u
1.30 pm gajar, sajna, squash, tometo,patal, Pepe, diye bhat sange chingri machh ar salad.
17-04-2024
Patient Advocate: 5.30 pm Tak dai
7.00pm pasta and salad
9.30pm 2u insulin
9.45pm badbati, squash gajar, pepe, patal diye dalia sanga chingri machh ar salad
10.30pm 3u insulin
Dinner er du ghanta por BS 303
AJ sakal 7.45am nuts and khai
9.45am Blood suger 113
10.10am gajar,sajna , squash, Pepe, tometo, soyabean diye bhat sange paneer and salad
11.30am বেদানা
1.15pm blood suger 208
1.25pm insulin 2u
1.40pm gajar, Pepe, squash, sajna, tomato diye bhat sange machh and salad
20-04-2024
Patient Advocate: গতকাল ডিনার এর পর BS ছিল 63
তখন ওকে 1/2 চামচ চিনি দেওয়া হয়েছে
আজ সকাল 7.40am ঘুম থেকে উঠে nuts এবং খৈ
9.30am 2u insulin
9.45am Pepe, Tometo, squash, sajna, soyabean , diye bhat sange dim ar salad
গত দু দিন ইলেকশন ডিউটি থাকার কারণে কোনো আপডেট দিতে পারি নি l
11.45am mousambi
Before lunch BS 237
1.45pm Pepe, squash, tometo, sajna, soyabean diye bhat sange salad
PaJR PHR Moderator: Dinner er 2 ghonta por?
Patient Advocate: Hay dinner er du ghanta por
PaJR PHR Moderator: Insulin Lispro 2U niyechilo? Sugar test Korar kotokkhon aage Lantus ta niyechilo?
Patient Advocate: Lispro 2u deoa hoyechhilo
Suger test korar 1.15 hours age
PaJR PHR Moderator: Dinner ta lispro'r kotokkhon baade kora hoyechilo?
Patient Advocate: 15 minutes por
PaJR PHR Moderator: Na lispro newar 15 minutes aer beshi deri kora jai na
Tar aagei kheye newa uchit nahole blood sugar ta aeibhabe fall korte pare
Patient Advocate: 10-15 minutes er madhya khaono hay
Sir khaoar porer samay to dharbo khakhon theke, khaoar shurur samay theke na shesher samay theke Karan or khete 30 minutes samay lage
PaJR PHR Moderator: Thala niye boshben ebong insulin newar saathe saathei khawa shuru
Ae chara shedin shara dine are kichu osadharon lokkho korechilen jar jonye eta hoye thakte pare?
Shuru
Dinner a Ki kheyechilo?
Patient Advocate: Regular ja khay sabji r singi machh
Bikel 5.30pm টক দই
7.00pm পাস্তা সঙ্গে স্যালাড
9.30pm blood suger 264
9.30pm insulin 2u
9.40pm beans, badbati, squash, Pepe diye dalia songe salad
10.30pm 3u insulin
4/21/24
Patient Advocate: Sakal 7.45am nuts and khai
9.30am 2u insulin
9.40am gajar Pepe squash beans badbati paneer diye bhat sange dim ar salad
Sakal ghum theke uthe khai khaoar age blood suger chhilo 86
11.30am alpo paka Bel r tarmuj
1.30pm 2u insulin
1.45pm Pepe, squash, beans, badbati, sajna, soyabean, paneer diye bhat sange salad
PaJR PHR Moderator: 👍
Patient Advocate: 4.00pm blood sugar 91
5.00pm Tak dai
6.45pm pasta and salad
4/22/24
Patient Advocate: 9.30pm 2u insulin
9.45pm beans, squash, Pepe, tometo soyabean diye dalia songe salad
10.30pm 2u insulin
11.45pm blood suger 259
Sakal 7.45am ghum theke uthe 5-6pcs nuts and khai
PaJR PHR Moderator: 👍
Patient Advocate: Sir kono din rate kono din bikele suger te bere jachhe l eta kirakam hochhe or activity abong khaoa daoa ekoi rakam aachhe to bayar ta bujhtei parchhi na l
PaJR PHR Moderator: Asha korchi aage jemone prokash korechilam, ore protyek ta khawar aage ebong du ghonta por jedin blood sugar ta jana jabe shedin amra ore insulin dose ta shothik titrate korte parbo blood sugar ta protyek khawar er aage pore shothik aanar jonye.
Tar jonye amra bhabchilam apni ekhane ashar aagei jodi CGM device ta pahunche jeto tahole khub bhalo hoto. Ekhane ashar por abar kothai pawa jabe shekhane giye nite hote pare.
Participant 3 Any idea where they can obtain a CGM device that can be delivered to them for this 3 year old child.
Paticipant 1 has already initiated the process but I'm worried the patient may reach us before the CGM reaches them and we may have to get another one here.
Paticipant 1 Any update on if your team is sending it to them to their address before May?
Patient Advocate: Thik achhe Sir apnara Jodi ekhon pathanor byabostha korte paren tahole ami upokrito hobo abong apnader prati kritagya thakbo
Participant 2: Will find and update sir
PaJR PHR Moderator: Aeki proshner uttor apnar korar aagei ami likhte shuru korechilam ebong share korlam upore.
Amader eta bujhte habe je tottho gunor ektao jodi missing hoi tahole bujhte asubidhe habe.
Ki Ki tottho lagbe :
Jeta apni janacchen :
Khabar chobi time
Insulin dose time
Jeta janano jacchena :
Proti ta khawar aager blood sugar ebong insulin are khawar du ghonta baader sugar
Jeta arektu sonkhepe ontoto soptahe ekbar janano jete pare :
Khali pet fasting ebong proti ta khawar du ghonta baade dine ontoto char bar o jodi koriye janate paren soptahe jekono aeK din tahole byapar ta ektu bojha jai
Paticipant 1 er saathe apnar phone a kotha hoyeche?
Patient Advocate: Na Sir kono kotha hobe ni l
9.45am 2u insulin
9.55am gajar, Pepe, squash, tometo, uchche, soyabean diye bhat sange salad
সকালে খাওয়ার দু ঘন্টা পর ☝🏻
Eta kintu bhat khaoar por
PaJR PHR Moderator: 11:55 AM?
Patient Advocate: Hay Sir
12.00noon ekta bedana
1.40pm 2u insulin
1.50pm gajar, Pepe, squash, uchche, paneer diye bhat sange salad
4.00pm blood suger 259
Bikel 5.30pm Tak dai
8.00pm oats and salad
9.45pm 2u insulin
9.55pm pepe, beans, squash, gajar, soyabean diye dalia sanga salad
Ajke doctor er kachhe niye giechhilam . Oi doctor Babu dupurer insulin ta 1u bariye 3u dite bollen ebong proti disher por test kore pathate bollen
4/23/24
Patient Advocate: 10.45pm insulin 3u
Dinner er du ghanta por blood suger 314
Sakal blood suger 113 7.15am nuts and 1/2 aata roti
9.35am 2u insulin
9.45am pepe, squash, badbati, patal paneer soyabean diye bhat sange dim ar salad
Ei khabarer du ghanta por blood suger 100
PaJR PHR Moderator: Dinner er du ghonta bade mane 11:55?
Patient Advocate: Gatakale dinner er du ghanta por
PaJR PHR Moderator: Tahole 11:45 PM?
Patient Advocate: 11.45pm ei 314
11.45am one mousambi
1.30pm 2u insulin
1.40pm Pepe,, squash, badbati, patal, machh diye bhat sange salad
3.40pm blood suger 239
5.30pm Tak dai
7.00pm oats and salad
4/24/24
Patient Advocate: Rate khaoar age 2u insulin
Khaoar por shoyar samay 3u insulin
Dinner er du ghanta por Mane 11.50pm blood suger 273
PaJR PHR Moderator: Lunch ebong dinner er aage blood sugar check kore insulin lispro (aspart) ta 0.5U barano jete pare ( jetuku bortoman tottho saamne ache tar bhittite)
Patient Advocate: Sakal e ghum theke uthe blood suger 154
0.5u baranor options nei one u kore barano kamano jay
7.30pm nuts and 1/2 roti
Gata 22/04 doctor ke dekhanor por lunch er aage 1u insulin barate bolechhilen to aj theke lispro 2-3-2 u kore deoa shuru korlam Sir?
PaJR PHR Moderator: Jedin barano komano habe shedin ontoto sugar guno khawar du ghonta bade check kora dorkar
Participant 3, Paticipant 1
Interesting issue in this patient's context :
"Most of the available pens in the market deliver insulin in 1 U increments, a few deliver in half-units (0.5 U). Half-unit pens (HUPs), compared to 1 U pens, can further improve the accuracy and precision in insulin therapyCitation13. Young people and elderly, who need very small insulin dosages, are much benefited by the use of HUPs. Carbohydrate counting improves glycemic control and reduces glycemic variability. Half unit insulin delivery can more effectively match the insulin to carbohydrate ratio in people using carbohydrate counting to calculate insulin doseCitation9,Citation13. The main purpose of HUPs is to provide accurate insulin administration to an insulin-sensitive patient. HUPs improve treatment adherence leading to better clinical outcome and quality of lifeCitation13. HUPs that are available in the market are HumaPen Luxura HDFootnotei, NovoPen EchoFootnoteii, JuniorSTARFootnoteiii, Humalog Junior KwikpenFootnoteiv, and InPen."
https://www.tandfonline.com/doi/full/10.1080/03007995.2021.1898356
Ekhane ache 👇
https://m.indiamart.com/proddetail/humalog-junior-kwikpen-2850841647288.html
Patient Advocate: 9.40am insulin 2u 9.50am Badbadi, beans, squash, gajar, tometo, misti kumro, karla, soyabean, paneer diye bhat sange salad
Participant 1: Correct
Patient Advocate: 12.15pm mousambi
1.40pm 3u insulin
1.50pm badbati, beans, squash, tometo, gajar, misti kumro, Karla, soyabean diye bhat sange salad
4.00pm blood suger 81
5.30pm Tak dai
7.00pm aatar pasta and salad
9.30pm 2u insulin
9.40pm gajar, squash, beans, badbati, tometo, mishti kumro diye dalia songe machh and salad
10.40pm 3u insulin
4/25/24
Patient Advocate: 11.50pm after dinner blood suger 59
Eta dekhar por 1/3 chhoto chamach er chini khaiye diyechi
Aaj sakale 7.45am ghum theke blood suger 98
7.50am nuts and 1/2 aata roti
PaJR PHR Moderator: 👆4:00 PM er blood sugar ta dekhe sotorko hoye 9:30 PM er aage ekbar blood sugar Kore temon bojha gele 1-1.5U dewa jeto
Patient Advocate: 9.45am 2u insulin
9.50am gajar, squash, beans, badbati, tometo, diye bhat sange salad
12.00noon blood suger 102
12.00noon mousambi
1.30pm 2u insulin
1.40pm gajar, squash, beans, badbati, tometo diye bhat sange chicken and salad
3.55pm blood suger 67
PaJR PHR Moderator: Abar sugar komte shuru koreche
Aebar abar 0.5U nahole 1U kore komiye dewa uchit
Patient Advocate: Tahole Aaj rate lispro ki 1u aar lantus 3u dibo ?
Jekhane gatokaal raate lispro diye chhilam 2u aar lantus 3u.
PaJR PHR Moderator: Hain
Patient Advocate: 5.00pm one candy
5.30pm Tak dai
7.00pm oats and salad
9.30pm 1u lispro
9.40pm beans, badbati, squash, Karla, chicken diye dalia songe salad
11.45pm lantus 3u
4/26/24
PaJR PHR Moderator: মার্কিন যুক্তরাষ্ট্রের পেডিয়াট্রিক এন্ডোক্রিনোলজিস্ট ডাঃ রবি শঙ্কর এই দলে যোগ দিয়েছেন এবং পরামর্শ দিয়েছেন যে শিশুর পেট ফুলে যাওয়া সিলিয়াক রোগের কারণে হতে পারে। আমাদের পক্ষে কি এখানে গ্রুপে আলোচনা করা সম্ভব হবে যে কীভাবে আমরা শিশুকে গ্লুটেন মুক্ত খাবার দিতে পারি এবং তবুও তাকে খুশি রাখতে পারি?
Participant 5 a pediatric endocrinologist from USA has joined the group and has suggested that the child's abdominal bloating could be due to coeliac disease. Would it be possible for us to discuss here in the group as to how we may offer the child a gluten free diet and yet keep her happy? Paticipant 1 Participant 6 Patient Advocate Participant 3
Participant 1: Let me check if I have any nutritionist who have works with patient or this age group
Patient Advocate: 11.55pm after dinner
blood suger 332
PaJR PHR Moderator: Raate 0.5 komate parle bhalo hoto.
Anyways blood sugar kome jawa ta aro beshi chinta jonok
Ore aer aage HbA1c test ta kora hoyechilo?
Ektu oi report ta share korte parben?
Participant 7 Can you put all the content in this PaJR into a case report EMR in your online-learning portfolio and share the link. It would be essential for those who joined late to understand what has already transpired
Or Participant 8 can do it but then she herself joined late
Thanks
Patient Advocate: Sakal e ghum theke uthe blood suger 117
7.30am nuts and 1/2 aata roti
9.35am insulin 2u
Sir, patient ke protidin jerakam khaoa khaoano hay apatata sairakami dibo ki na kichhu paribartan karte hobe ?
PaJR PHR Moderator: March 10, 2024 Hba1c 8.3 around the time of her type 1 diabetes diagnosis I guess.
Not sure if it was the HPLC method as the lab report doesn't mention it. Many labs in India use latex agglutination for hba1c and we have found here over a period of two years of testing that the values with latex hardlyParticipant 5
Patient Advocate: তাহলে কি আবার HBA1C টেস্ট করবো?
পুরোনো রিপোর্ট গুলি আবার পাঠাবো?
PaJR PHR Moderator: Na ota teen mashe ekbar koralei habe kintu koranor aage ekbar jene neben ora HPLC method use korche kina
Dekhi jara Ekhane shuru te chilen tara shob kichu joro korte paren kina are nahole ekbar shob kichu Participant 8 kimba Ke pathano jete pare
Patient Advocate: 9.45am gajar, squash, beans, badbati, tometo soyabean, paneer diye bhat sange salad
Participant 1: Have spoken to a nutritionist, she will be available on Sunday.
She would need a brief about the patient.
And what is expected result
Patient Advocate: 12.00noon blood suger 91
12.00noon mousambi
1.30pm insulin 1u dilam Sir Karan ager sugar ta 91 esechhe
1.40pm gajar, squash, beans, badbati, tometo, soyabean, machh diye bhat sange salad
PaJR PHR Moderator: 👆Gotokal 2U newar por 67 aeshechilo aeijonyeo aro 1U diyechen
Patient Advocate: গত কাল breakfast er por blood suger ছিল 102 আবার dinner আগে 2u নেওয়ার পর এসেছিল 67 ।কিন্তু আজকে breakfast পর 91 তাই আজকে 1u দেওয়া হল
PaJR PHR Moderator: Dinner na lunch?
Patient Advocate: Sorry sir lunch
PaJR PHR Moderator: Ajke 3:40PM a insulin 1U newar por koto?
Patient Advocate: 1u insulin নেওয়ার পরেই 147
PaJR PHR Moderator: Ajke eta apni bhalo manage korechen 👏
Patient Advocate: একটু অন্য মন ছিল তাই একটু গণ্ডগোল হয়ে গিয়েছিল l
PaJR PHR Moderator: Na eta to gondogol hoini. Bhaloi hoyeche
Patient Advocate: আমি একটু অন্যমনস্ক ছিলাম
PaJR PHR Moderator: Oh accha lunch are dinner er terminology ta? Sheta temon kichu gondogol noi
Patient Advocate: Hay sir
Bikel 5.30pm টক দই
7.00pm pasta and salad
9.40pm lispro 2u
9.50pm beans, badbati, squash, gajar,patal, tometo, mishti kumro and machh diye bhat sange salad
10.30pm lantus 3u
4/27/24
Patient Advocate: কয়েক থেকে lantus টা পেটে পুষ করে সুজটা যখন বাইরে বের করছি বাইরে দুই তিন ফোটে পরে যাচ্ছে এতে ওর সুগার টা সকালেও বেশি থাকছে l এই lentus এর পেন টার কি সমস্যা কোনো না অন্য কিছু?
11.50pm blood suger 238
সকালে ঘুম থেকে blood suger 138
7.45am nuts and khai
9.45am lispro 2u
9.50am gajar, squash, beans badbati, tometo patal, ghinga, soyabean, paneer diye bhat sange salad
PaJR PHR Moderator: Google translated for the other members 👇
"After pushing a few lantus in the stomach, when I take out the suja, two or three drops are left, so his sugar is more in the morning. Is there any problem with the pen Participant 5 Participant 3
Patient Advocate: 11.50am blood suger 154
12.00noon one mousambi
1.30pm lispro 2u
1.40Pm gajar, squash, beans, badbati, tometo, patal, jhinga, soyabean diye dalia sanga salat
3.55pm blood sugar 188
5.30pm টক দই
7.00pm pasta and salad
9.30pm lispro 2u
9.40pm beans, badbati, tometo, squash, patal diye dalia songe salad
11.20pm lantus 3u
4/28/24
PaJR PHR Moderator: Thanks for sharing this
Patient Advocate: Gatakal 11.50pm after dinner blood suger 155
Sakal 7.45 am ghum theke uthe blood suger 137
7.45am nuts and khai
PaJR PHR Moderator: Insulin naam ebong dose tao mention korben jaate proti ta text aei puro data ta standalone fute uthte pare
Patient Advocate: 9.50am lispro 2u
10.00am gajar, squash, beans, badbati, tometo diye bhat sange dim ar salad
Sir insulin lantus টা কি করব?
PaJR PHR Moderator: Janacchi.
Patient Advocate: 12.00noon তরমুজ
1.30pm lispro 2u
1.40pm gajar, squash, beans, badbati, tometo, diye bhat sange dim ar salad
4.00pm blood sugar 127
PaJR PHR Moderator: আমাদের বিশেষজ্ঞ ডাঃ রবিশঙ্করের পরামর্শ: ইনসুলিনের ফোঁটা সবসময় দেখা যায়... এবং এইরকম একটি ছোট ডোজ দিয়ে কারো মধ্যে পার্থক্য হতে পারে। সুপারিশ হল সুইটি বের করার আগে 10 সেকেন্ডের জন্য কলমটি জায়গায় রাখুন। ল্যান্টাস (সানোফি অ্যাভেন্টিস দ্বারা তৈরি ইনসুলিন গ্লারজিনের ব্র্যান্ড নাম) এবং বাসাগলার (এলি লিলি দ্বারা তৈরি বায়োসিমিলার) এবং বাসালগ (ভারতে তৈরি বায়োসিমিলার) এর শক্তি হল U 100। যার মানে হল 100 ইউনিট/mL - যার মানে হল 3 ইউনিট 30 মাইক্রোলিটার। তাই সঠিক কৌশল ব্যবহার করা খুবই গুরুত্বপূর্ণ। সেই সাথে কম ডোজ (<10 ইউনিট) এর অর্ধেক জীবন ওঠানামা হতে পারে।
Suggestions from our expert Participant 18:
Drops of insulin are always seen… and may make a difference in someone with such a small dose.
The recommendation is to keep the pen in place for a count of 10 seconds before pulling the needle out.
The strength of Lantus (the brand name of insulin glargine manufactured by Sanofi Aventis) and Basaglar (biosimilar made by Eli Lilly) AND Basalog (biosimilar made in India) is U 100. Which means there’s 100 units/mL - which means 3 units is 30 microliters.
So very important to use proper technique. That plus the short half life of low doses (<10 units) can result in fluctuations.
ল্যান্টাস ডোজ সম্পর্কে ডাঃ রবি শঙ্করের পরামর্শ: ল্যান্টাসের কম ডোজ (<10 ইউনিট) এ, কর্মের সময়কাল প্রায় 12-14 ঘন্টা এবং 24 ঘন্টা নয়। আমি তাকে 2 ইউনিট বিআইডিতে শুরু করব।
Participant 18's suggestions about lantus dose :
At such low doses (<10 units) of Lantus, the duration of action is about 12-14 hours and not 24 hours. I would start her on 2 units BID.
এর মানে হল আমরা তার স্থানীয় ডাক্তারের সাথে পরামর্শ করার পরে তার দৈনিক লিসপ্রোতে পরিবর্তন করতে পারি 1U-1U-1U এবং তার glargine দিতে সকালের নাস্তার সাথে 2U- দুপুরের খাবারে 0- রাতের খাবারের পর 2U
This means we can after consulting her local doctor, change her daily lispro to
1U-1U-1U and
give her glargine
2U with breakfast-
0 at lunch-
2U after dinner
4/29/24
Patient Advocate: Gatakal luncher du ghanta por blood suger 127
5.30pm Tak dai
7.00pm oats and salad
9.30pm insulin lispro 2u
9.40pm beans, badbati, squash, gajar, patal diye dalia songe salad
10.30pm insulin lantus 3u
11.50pm blood sugar 94
Aj sakal 7.30am blood suger 123
7.30am nuts and muri
Lantus company r ek bhadra lokke phone Kara hoyechhilo tarpor kalrate ar samsya hoyni l
9.45am insulin lispro 2u
9.50am gajar squash beans badbati tometo diye bhat sange soyabean and salad
12.00noon mousambi
1.30pm insulin lispro 2u
1.40pm gajar squash, beans badbati tometo soyabean diye bhat sange salad
4/30/24
Patient Advocate: Gatakal 29/04/24, 3.50pm luncher du ghanta por blood suger 116
9.30pm 2u lispro
10.30pm 3u lantus insulin
11.40pm dinner er du ghanta por blood suger 90
Aj sakal 7.30am ghum theke uthe blood suger 65
7.30am nuts and chocolate biscuit 2 pcs
PaJR PHR Moderator: Lantus ta 1U raate komiye 1U sokale breakfast er por shuru kora jete pare?
Patient Advocate: আর Lispro টা?
PaJR PHR Moderator: 1U to 2U depending on the pre meal sugars
👆Ekhane aage janano hoyechilo dekhun
Patient Advocate: 9.30am Lispro 2u insulin
9.40am gajar, squash patal, tomato, soyabean diye bhat sange salad
5/1/24
Patient Advocate: Gatakal 1.30pm lispro 2u
1.40pm gajar, squash patal, tomato, chicken diye bhat sange salad
3.55pm blood sugar 121
5.30pm টক দই
7.00pm oats and salad
9.30pm 2u lispro insulin
9.40pm beans, badbati, tometo, squash, chicken diye dalia songe salad
11.00pm 3u lantus insulin
Aj sakal 8.00am blood suger 91
8.00am nuts and muri
9.45am 2u lispro insulin
9.55am payesh muri
11.45am mousambi
1.30pm lispro insulin 2u
1.40pm gajar pepe beans badbati squash machh diye bhat sange salad
4.00pm blood sugar 128
5.15pm Tak dai
6.45pm oats and salad
9.30pm lispro insulin 2u
9.40pm beans squash tometo patal Pepe machh diye dalia songe salad
10.30pm lantus insulin 3u
5/2/24
Patient Advocate: Sakal 7.30am ghum theke uthe 5-6pcs nuts and aata roti
9.30am 2u lispro insulin
9.40am gajar Pepe Badbadi mishti kumro Lauer data soyabean paneer diye bhat sange salad
12.00noon mousambi
1.35pm 2u lispro insulin
1.45pm gajar Pepe Badbadi mishti kumro Lauer data diye bhat sange dim ar salad
After lunch
PaJR PHR Moderator: At 3:45PM after 2U of lispro at 1:35PM?
Patient Advocate: হ্যা স্যার
5/3/24
Patient Advocate: Aj sakal 7.30am ghum theke uthe 5-6pcs nuts and aata roti
9.30am lispro insulin 2u
9.40am gajar Pepe squash badbati uchchhe patal paneer diye bhat sange salad
11.40am blood sugar 168
12.00noon bedana
1.40pm lispro insulin 2u
1.45pm gajar pepe squash badbati uchchhe patal dim diye bhat sange salad
5.00pm Tak dai
7.00pm aatar pasta and salad
9.30pm blood sugar 180
9.30pm lispro insulin 2u
9.40pm gajar Karla badbati Pepe soyabean diye dalia songe salad
10.35pm lantus insulin 3u
5/4/24
Patient Advocate: Sakal 7.45 ghum theke uthe 5-6pcs nuts and aata roti
9.55am lispro insulin 2u
10.05am gajar Pepe squash badbati patal paneer soyabean diye bhat sange salad
1.45pm blood sugar 116
1.50pm lispro insulin 2u
2.05pm gajar squash Pepe tometo patal Badbadi soyabean diye bhat sange salad
5.30pm টক দই
7.00pm pasta and salad
9.30pm lispro insulin 2u
9.40pm squash badbati uchchhe patal tometo soyabean diye dalia songe salad
10.30pm lantus insulin 3u
5/5/24
PaJR PHR Moderator: Summarizing these parental diet and insulin updates (again activity updates of energy expenditure missing) for benefit of being able to display those that stand out in a thematic manner (with constructive criticism for the patient data collectors and patient data communicator) :
Friday Morning data shared by the parent above in a multilingual format 👇
7:45 AM Wakes
Breakfast 5-6 nuts (no image as to which nuts) + wheat Roti (again no image as to how many)
First insulin before the second meal of the day :
Lispro 2U at 9:55 AM
Second meal (second breakfast) of papaya, squash, carrot, String beans, pointed gourd, paneer, soybean (again no image and no estimate on quantity and quality)
1:45 PM : Post breakfast glucose assessment on efficacy of the 9"55 AM 2U lispro comes as 116 mg/dl
1:50 PM Pre lunch lispro 2U
2:05 PM Lunch with almost similar stuff as in the second texted breakfast (again no images to suggest quantity and quality)
5.30pm sour yoghurt
7.00pm pasta and salad
9.30pm lispro insulin 2u
9.40pm dinner with similar stuff as breakfast and lunch (squash badbati uchchhe patal tometo soyabean diye dalia songe salad) again no image to assess quantity and quality
10.30pm lantus insulin 3u
Patient Advocate: গতকাল ডিনার এর পর ব্লাড সুগার 65
Sakal 7.30am ghum theke uthe 5-6pcs nuts☝🏻
10-15grm khai
এই পরিমাণ বাদাম রাতে ভিজিয়ে সকালে দেওয়া হয়
এখানে ঝিঙে মিষ্টিকুমড়া বরবটি সজনা গাজর কুয়াশ টমেটো আছে
PaJR PHR Moderator: Eta Ki barir sobai khae naki sudhu o khai?
Patient Advocate: Na eta sudhu patient e khai .
PaJR PHR Moderator: Jemone amra aageo share korechilam, amra barir sobai jodi eta cheshta korte pari je jei poushtik aahar patient Ke dewa hocche sheta jodi sobai khai tahole
1) Barir sobai poushtik aahar pabe
2) Patient o barir sobar theke nijeke alhada mone korbe na
আপনি কখনও কখনও খাবারের আগে এবং কখনও কখনও খাবারের দুই ঘন্টা পরে চিনির পরীক্ষা করতে বেছে নেওয়ার কারণ কী হতে পারে তা আমরা জানতে আগ্রহী ছিলাম। শুক্রবার আপনি কি মনে করতে পারেন কেন আপনি তার দুপুরের খাবারের আগে চিনি পরীক্ষা করেছিলেন?
We were curious to know what could be the reason you sometimes choose to do the sugar test before meals and sometimes two hours after meals. On Friday can you recall why you did the sugar test before her lunch?
Patient Advocate: ওর এই রোগটা ধরা পরার আগেও ওর জন্য আলাদা খাবার তৈরি করা হতো কারণ ওর একটুকু লঙ্কা খেতে পারেন আর ওর সবজিগুলি একদম নরম করা হয় l আর একটু বড় হলে ওর খাবার আমাদের সাথেই তৈরি করা হবে l
দিনে 6 বার টেস্ট করা একটু অসুবিধা হয় যায়, তাই এখানকার ডাক্তার বলেছিল সকাল, দুপুর আর রাত মিলিয়ে দিনে একবার খাবারের আগে এবং পরবর্তী খাবারের পরে এমন করে পরিবর্তন করে টেস্ট করলে তিনদিনে সবগুলো সময়ই টেস্ট করা হয়ে যাবে l
Sakal 7.25am blood suger 83
9.30am lispro insulin 2u
9.40am opre dekhano sabji gulo diye bhat sange salad
11.30am one mousambi
1.30pm lispro insulin 2u
1.40pm jhinge misti kumro badbati sajna gajar squash tometo soyabean paneer diye bhat sange salad
5/6/24
Patient Advocate: Aj sakal 7.30am ghum theke uthe 5-6pcs nuts and aata roti
9.30am lispro insulin 2u
9.40am gajar squash patal tomato jhinga badbati soyabean paneer diye bhat sange salad
11.00am blood suger 238
11.45am mousambi
1.30pm 2u lispro insulin
1.40pm gajar squash Pepe tometo patal jhinga badbati soyabean diye bhat sange salad
5/7/24
Patient Advocate: Gatakal 5.30pm tak dai
7.00pm oats and salad
9.30pm blood sugar 118
9.30pm 2u lispro insulin
9.40pm badbati squash patal tomato soyabean diye dalia songe salad
10.30pm 2u Lantus insulin
Aaj 7.30am ghum theke uthe 5-6pcs nuts and aata roti
9.30am 2u lispro insulin
9.40am jhinga badbati tometo squash patal soyabean paneer diye bhat sange salad
11.45am mousambi
1.30pm blood sugar 132
1.30pm 2u lispro insulin
1.40pm beans squash tometo patal jhinga soyabean chingri machh diye bhat sange salad
5.30pm Tak dai
7.08pm aatar pasta and salad
9.30pm 2u lispro insulin
9.40pm gajar squash Pepe tometo soyabean diye bhat sange chingri machh and salad
5/8/24
Patient Advocate: 10.30pm 2u Lantus insulin 2u
12.00mid night blood sugar 108
Sakal 7.30am ghum theke uthe blood sugar 119
Sakale 👇 nuts gulo r aatar roti kheyechhe
9.30am lispro insulin 2u
9.40am gajar squash patal tomato badbati soyabean paneer diye bhat sange salad
11.45am apple
1.30pninsulin lispro 2u
1.40pm gajar squash patal tomato sajna soyabean machh diye bhat sange salad
3.50pm blood sugar 124
5.30pm tak dai
7.30pm oats and salad
9.40pm lispro insulin 2u
9.50pm badbati squash patal tomato soyabean diye dalia sanga salad
10.30pm lantus insulin 3u
5/9/24
Patient Advocate: Sakal 7.15am ghum theke uthe 5-6pcs nuts and aata roti
9.30am lispro insulin 2u
9.40am gajar Pepe Badbadi mishti kumro soyabean paneer diye bhat sange salad
11.45am blood suger 209
12.00noon mousambi
1.45pm 2u lispro insulin
1.55pm gajar Pepe Badbadi mishti kumro soyabean paneer diye bhat sange salad
5.30pm Tak dai
7.00pm oats and salad
9.45pm lispro insulin 2u
9.50 misti kumro badbati tometo squash patal diye dalia songe machher dim ar salad
10.40pm lantus insulin 3u
5/10/24
Patient Advocate: 11.50pm after dinner blood sugar 81
Aaj sakale 7.25am ghum theke uthe 5-6pcs nuts and aata roti 1pc
PaJR PHR Moderator: আমাদের এখানে আগে পরিকল্পনা অনুযায়ী তার গ্লুটেন মুক্ত খাদ্য ব্যবস্থাপনা শুরু করতে হবে।
Āmādēra ēkhānē āgē parikalpanā anuyāẏī tāra gluṭēna mukta khādya byabasthāpanā śuru karatē habē.
We need to start her gluten free diet management as plannParticipant 5 Paticipant 1 Participant 4 Participant 6 We need your help with this by guiding Patient Advocate about the gluten free diet options for his three year old patient to prevent her abdominal bloating
Participant 1: Did connect with the nutritionist, she is out again till next Friday
I think we will have to find options
Patient Advocate: 9.30am lispro insulin 2u
9.40am gajar squash patal tomato soyabean paneer diye bhat sange salad
11.50am blood suger 148
1.30pm lispro insulin 2u
1.40pm gajar squash patal tomato soyabean machh diye bhat sange salad
5.30pm tak dai
7.30pm oats and salad
8.30pm 25grm vanilla ice-cream
9.30pm blood suger 294
9.40pm squash badbati uchchhe mishti kumro machh diye dalia songe salad
10.30pm lantus insulin 3u
PaJR PHR Moderator: Before dinner lispro?
Participant 4: Diagnosed of gluten sensitivity sir ? Couldn't understand the description.. will try Google translate
PaJR PHR Moderator: Diagnosis : Bloating and type 1 diabetes could be gluten sensitivity
Patient Advocate: Ota likhte bhule giyechhi
Before dinner lispro insulin 2u
5/11/24
PaJR PHR Moderator: Will be grateful for your guidance on gluten free diet for this child
Patient Advocate: Aj sakal e 7.45am blood suger 84
7.45am 5-6 pcs nuts and khai
Participant 4: Will be on it sir... Shall share soon
As of now is the patient advocate already avoiding gluten sources ? Or is it yet to be started sir ? because in the description I see some biscuits and also oats (possible gluten contamination)
PaJR PHR Moderator: He hasn't started gluten restricted diet yet
Patient Advocate: 9.45am 2u lispro insulin
9.55an misti kumro badbati tometo squash Karla soyabean paneer diye bhat sange salad
11.30am mousambi
1.45pm 2u lispro insulin
1.55pm misti kumro badbati tometo squash Karla soyabean diye bhat sange salad
4.10pm blood sugar 126
Participant 4: Ok sir.
Sir Can the patient advocate communicate in English with us or shall we frame diet plan and share after translating it
5/12/24
Patient Advocate: 4.30pm boil egg
7.00pm oats and salad
9.30pm 2u lispro insulin
9.40pm long beans, bitter gourd, pointed gourd, tometo, dalia with salad
10.30pm lantus insulin 3u
Participant 4: Items to be avoided ❌
Wheat/ maida
Bread
Barley
Sooji/ Semolina
Instant noodles like Maggi/ Pasta
Daliya
Vermicelli / Bambino
Biscuits
Wafers
Few packaged snacks as kids may tend to eat (like Lays Chips/Kurkure)
Asafoetida/Hing
Cakes / Pastries
I see that oats is often given.... Have to purchase oats only with a *gluten free* tag as there is chance for potential contamination
PaJR PHR Moderator: Thanks. Great beginning.
We can also share the Bengali google translated version below the English version.
তার ফোলা সম্ভাবনা কমাতে নীচে তালিকাভুক্ত আইটেমগুলি এড়ানো উচিত👇
❌ নিবেন না
গম/ময়দা
রুটি যব সুজি/ সুজি ম্যাগি/
পাস্তার মতো ইনস্ট্যান্ট নুডলস
ডালিয়া ভার্মিসেলি / ব্যাম্বিনো
বিস্কুট ওয়েফারস অল্প কিছু প্যাকেজ করা স্ন্যাকস যেমন বাচ্চাদের খাওয়ার প্রবণতা থাকতে পারে (যেমন লেস চিপস/কুরকুরে)
হিং/হিং
কেক/পেস্ট্রি
The items listed below are to be avoided to reduce the chances of her bloating
Don't take ❌
Wheat/ maida
Bread
Barley
Sooji/ Semolina
Instant noodles like Maggi/ Pasta
Daliya
Vermicelli / Bambino
Biscuits
Wafers
Few packaged snacks as kids may tend to eat (like Lays Chips/Kurkure)
Asafoetida/Hing
Cakes / Pastries
কোনো প্যাকেটজাত খাবার কেনার সময় অনুগ্রহ করে দেখে নিন এতে *গ্লুটেন ফ্রি* ট্যাগ আছে কি না, অন্যথায় তার খাবারের গ্লুটেন দ্বারা সম্ভাব্য দূষণের সম্ভাবনা সবসময় থাকে।
If purchasing any packaged food please check if it has a *gluten free* tag as otherwise there is always a chance for potential contamination of her food with gluten
Patient Advocate: Ok Sir
Morning 7.30an 5-6pcs nuts and puffed rice
9.45am pointed gourd, bitter gourd, pumpkin, papaya, chayote, soya chunk, egg and rice with salad
11.55am blood sugar 106
12.15pm watermelon and apple
1.35pm 2u lispro insulin
1.45pm rice with pointed gourd, bitter gourd, pumpkin, papaya, chayote, soya chunk, fish and salad
5.45pm sour curd
7.00pm oats and salad
9.30pm blood sugar 347
9.30pm 2u lispro insulin
9.40pm rice with chayot, papaya, bitter gourd, pointed gourd, fish and salad
5/13/24
Patient Advocate: Morning 7.30am blood suger 135
7.35am 5-6pcs nuts and puffed rice
PaJR PHR Moderator: Not taken lantus yesterday?
Patient Advocate: Yes Sir neoa hoyechilo 3u lantus insulin
9.30am 2u lispro insulin
9.40am rice with pointed gourd, bitter gourd, tomato, long beans papaya, soyabean and salad
11.45am home made mango milk shake
1.30pm 2u lispro insulin
1.40pm rice with pointed gourd, bitter gourd, tomato, long beans, papaya, soyabean and salad
4.00pm blood sugar 111
5.30pm sour curd
7.00pm oats and salad
PaJR PHR Moderator: 👍
9.45pm 2u lispro insulin
9.50pm rice with carrots, papaya, chayote, bitter gourd and salad
10.40pm lantus insulin 3u
5/14/24
Patient Advocate: Morning 7.45am puffed rice
9.45am 2u lispro insulin
9.55am rice with ☝🏻☝🏻chayot, papaya, rubbed gourd , long beans, soya chunk and salad
12.00noon mousambi, grapes
1.00pm 25grm icecream
1.30pm blood suger 183
1.35pm 2u lispro insulin
1.45pm rice with chayot, papaya, rubbed gourd, long beans, soya chunk and salad
5.30pm milk and puffed rice
9.40pm 2u lispro insulin
9.50pm rice with pointed gourd, tometo, long beans, papaya, chicken and salad
5/15/24
Patient Advocate: Yesterday 10.40pm lantus insulin 3u
12.00midnight blood sugar 75
Morning 7.30am puffed rice with milk
PaJR PHR Moderator: 👍
Patient Advocate: 9.30am 2u lispro insulin
9.40am rice with chayote, bitter gourd, tomato, long beans, papaya, fish and salad
11.40am blood sugar 118
12.00noon mousambi grapes
1.30pm 2u lispro insulin
1.40pm rice with chayote, bitter gourd, tomato, long beans, papaya, fish and salad
7.00pm cheese flavour biscuit one pc
7.30pm oats and salad
Participant 2: Not advisable
Patient Advocate: We try to keep this away but when the child is very stubborn , comfort is to given with one
Participant 2: Did you try slapping the baby when stubborn?
I mean,docs may not advise but quite a few parents do
Patient Advocate: No Sir
Participant 2: Good
Patient Advocate: Thank you
Participant 2: How are parents doing?
It should be really tough and beautiful struggle
Patient Advocate: 9.50pm 2u lispro insulin
10pm rice with chayote, papaya, pointed gourd, tometo, soyabean and salad
10.30pm 3u lantus insulin
5/16/24
Patient Advocate: Morning 7.45am blood suger 92
7.45am nuts and puffed rice with milk
9.30am 2u lispro insulin
9.40am rice with chayote, papaya, pointed gourd, tometo, long beans, soyabean and salad
11.45am mousambi and apple
1.30pm 2u lispro insulin
1.40pm same as previous dish and fish
4.00pm blood suger 120
5.00pm sour curd
6.30pm oats and salad
7.38pm 30grm suger free icecream
9.45pm 2u lispro insulin
9.55pm rice with chayote, papaya, pointed gourd, spiny guard, fish and salad
5/17/24
PaJR PHR Moderator: 👍
The child is visting us soon on 20th may. Participant 3 Participant 9 Paticipant 1 Can you suggest the best way we may procure the child friendly CGM earlier discussed here above to apply it on her to free her from daily pricks?
Participant 2: Paticipant 1 there's Freestyle Libre pro 3 available for kids and teens right?
Can we get them for this patient?
Participant 1: Abbott has Libre pro , Libre 14 days , Libre 2 and Libre 3.
Unfortunately we only have pro and 14 days available in India
PaJR PHR Moderator: Should we order it once they arrive here through your local pharmacy contacts?
Participant 2: Let me find out and update
Participant 1: We can order prior , it make take Color of days and also they have expire till sept 24.
PaJR PHR Moderator: Also need to check if they are compatible with his mobile
Participant 1: We can arrange one for this case , I belief the caretaker has NFC phone
Patient Advocate: Morning 7.30am nuts and puffed rice
9.30am 2u lispro insulin
9.40am rice with carrots, papaya, chayote, bitter gourd, pumpkin, long beans, paneer and salad
11.45am apple
1.30pm blood suger 189
130pm 2u lispro insulin
1.40pm same as previous dish
5/18/24
Patient Advocate: Morning 10.00am blood sugar 212
10.00am 2u lispro insulin
10.10am rice with bitter gourd, tomato, long beans, soyabean and salad
1.30pm 2u lispro insulin
1.40pm rice with bitter gourd, tomato, long beans, soyabean and salad
5.00pm lemon water
6.30pm 1/2 glass lassy
9.30pm blood sugar 72
9.30pm 2u lispro insulin
9.40pm rice with long beans, papaya, chayote, bitter gourd, tomato, soyabean and salad
10.30pm 3u lantus insulin
5/19/24
PaJR PHR Moderator: Is she currently on the train from your place to our hospital? How many kms?
Patient Advocate:
Train not start yet
Train will start at 8.35am
8.45am one pc idli
10.00am 2u lispro insulin
10.10am rice with bitter gourd, tomato, long beans, chayote and salad
2.15pm 2u lispro insulin
2.25pm rice with chayote, bitter gourd, tomato, long beans, paneer
Train e test Kara hochhe ne sir
PaJR PHR Moderator: Train kothai pahuncheche?
Patient Advocate: Bhubaneswar
PaJR PHR Moderator: 👆they are reaching tomorrow
Participant 2: Paticipant 1
Can you send the name of sensor which is compatible?
Freestyle libre pro 3-kids?
PaJR PHR Moderator: This one 👇
https://www.freestyle.abbott/us-en/products/freestyle-libre-cgm-kids.html
Participant 2: Yes sir..there's Libre pro 3 too,just wanted to confirm which one is compatible to app
PaJR PHR Moderator: Patient Advocate's mobile phone needs to be compatible. He will know
Participant 1: Libre 3
Participant 2: What about the compatibility of phone?
Participant 1: App compatibility can not be confirmed, as they are not available in India
Participant 2: Not available bro
Participant 1: Any phone with NFC will do ,
Yes they are not
We will have to go with Libre
Or Libre pro
Participant 2: Adult ones?
Paticipant 1 these are available
PaJR PHR Moderator: Is the pediatric version for this 3 year old girl available?
Participant 2: No..this is regular size
Participant 1: Yes. This is Libre 14 days
PaJR PHR Moderator: We need pediatric size for a 3 year old
Participant 2: It's not available in India sir.
We will have to go through Abbott company directly..
Let me give it a shot.
Can't guarantee.
Paticipant 1 Can you try it as well?
Maybe CSR?
PaJR PHR Moderator: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444498/
Participant 2: What's the babies latest hba1c?
PaJR PHR Moderator: Check this one if available 👇
https://www.dexcom.com/en-CA/pediatrics
Participant 2: Wait sir
Participant 1: I have spoken to them , I belief it’s not yet tested and approved in India
PaJR PHR Moderator: March 10, 2024 Hba1c 8.3 around the time of her type 1 diabetes diagnosis I guess.
Not sure if it was the HPLC method as the lab report doesn't mention it. Many labs in India use latex agglutination for hba1c and we have found here over a period of two years of testing that the values with latex hardly ever cross 8-9!
Participant 2: Any family history of t1dm?
5/20/24
Patient Advocate: Good morning Sir, we have reached the Nalgonda Station
PaJR PHR Moderator: Please come to our OPD.
Participant 9 Please admit one of the parents in the Special ward asap
Participant 9: Okay Sir
Participant 7: Sir they want to admit the child
Shall I admit both parent and child or just child
PaJR PHR Moderator: You are in OPD?
Participant 7: Yes sir
PaJR PHR Moderator: Admit the parent now. Child if necessary after they show her to the pediatrician with some bridging by Participant 15 like with the other 7M guided by Participant 10
Participant 7: Okay sir
Participant 10: The patient will be admitted to GM Unit 5 sir
PaJR PHR Moderator: What about her road to health card to be made from pediatrics by Participant 16 and Participant 17?
Patient Advocate: Sir apnar jinish tar Katha Mone rakhben 🙏🏾
Participant 1: Are we using 0.5 dose insulin pen , or is not required.
PaJR PHR Moderator: Oh ekkhuni dekhlam!
Kalke niye nebo tahole
Yes we did discuss this earlier when we trying to optimize and titrate her insulin requirements but recently we forgot about it as the sugars appear to have become optimized
Participant 1: Okay
Patient Advocate: Thik achhe
Sir, tahole HBA1C ekhan theke ekbar kore neben?
PaJR PHR Moderator: 3 mash a ekbar korano hoi
Ota aage abar kore temon labh nei
Patient Advocate: 10.50am blood sugar 73
12.50pm 2u lispro insulin
1.00pm breakfast and lunch with the dish of hospital
6.40pm one and half idli
8.50pm 2u lispro insulin
9.00pm dinner with hospital dish
11.15pm after dinner blood suger 212
5/21/24
PaJR PHR Moderator: Hospital dinner? Any sweets?
Patient Advocate: No Sir
Participant 2: Any other associated deficiencies?(like vitamins/protein/calorie?)
Patient Advocate: Sir our discharge?
Participant 2: Why hurry?
PaJR PHR Moderator: The road to health is normal Participant 11
Please share some review of literature around it with particular emphasis on "normal" is decided
Participant 11: https://www.webmd.com/parenting/baby/features/baby-growth-charts-what-influences-your-babys-growth
This is our patient’s growth chart
PaJR PHR Moderator: Yes Participant 12 Participant 7 We have evaluated and planned her further management and she can be discharged. Please prepare it and share the draft with me asap
Participant 13 Please help them get the device before they leave Hyderabad this Saturday.
Participant 3 Please suggest some good locations for them to stay and visit in Hyderabad
Participant 2: Sure sir..
Any specific places they like to visit in Hyd?
PaJR PHR Moderator: What area do you think the two kids 3 and 6 would enjoy?
Participant 2: I'd suggest them to take a room somewhere around JNTU.
Will meet the kid and take him to nice places nearby(a mall etc) and my home too..
When are they returning?
PaJR PHR Moderator: Saturday
Participant 2: Okk..
Patient Advocate: Even though we don't have any specific place, but we need a good place from where we can visit easily the sight scene of Hyderabad
Participant 2: Nice..
Just install OYO app..You can book rooms for reasonable prices there.
And book a room closer to what you want to visit.
Just ping me wherever you stay,I'll try to catch up.
And maybe we can meet for a lunch one day at my home
Patient Advocate: Ok thank you Sir
Morning 7.30am puffed rice
9.15am 2u lispro insulin
9.25am 2pcs idli and cucumber
12.30pm mousambi
1.40pm blood sugar 175
1.50pm lunch with hospital dish
6.00pm puffed rice
9.10pm 2u lispro insulin
9.20pm dinner with hospital dish and cucumber
5/22/24
PaJR PHR Moderator: Yesterday's last mile to first mile PaJR shared decision makings followed by today's journal club :
Yesterday morning parents asked about
1) the 3 year old's prognosis and
2) her future options toward receiving a needle free existence through either biological stem cell transplantation (for which we explained preliminaries and ticketed the need for a journal club shared below) or receiving a AI driven insulin pump (we had already had a journal club around that the link to which can be found in the description box of this PaJR)
3) We also offered them to test a non invasive video game like device developed by IIT Hyderabad to be supported by Participant 13 in addition to the standard monitoring devices she's already on.
4) Her yellowing with normal bilirubin initially explained as hyper carotenemia is still uncertain as the yellowing appears to have been noticed even before she began her carrot diet
UDLCO Journal club initiated by elective 2019 student :
Participant 16:
Transplantation of ESCs or iPSCs in T1DM can regenerate the islet β-cells and increase β-cell mass through differentiating to insulin-producing cells (IPCs), pancreatic progenitors, islet organoids, and interspecific pancreatic chimeras, which benefited the treatment of T1DM
iPSCs can be generated from the skin fibroblasts of T1DM patients. These iPSCs can differentiate into pancreatic cell lineages and generate T1DM SC β-cells, making autologous stem cell-derived pancreatic progeny transplantation for T1DM possible
Patient was presented at age 3 in diabetic ketoacidosis requiring hospitalization
Fibroblasts obtained from skin biopsies were cultured and infected with a combination of retroviruses encoding the transcription factors OCT4, SOX2, and KLF4.
4 weeks after infections, colonies were picked based on their morphological resemblance to human ES cell colonies and expanded.
DiPS lines from both patients could respond to WNT3A and Activin A treatment to differentiate into definitive endoderm.
Further differentiation toward gut tube endoderm, and pancreatic progenitors was achieved by supplying FGF10 and cyclopamine, and FGF10, cyclopamine, retinoic acid, and (−)-Indolactam V.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735559/
PaJR PHR Moderator: What did you learn from this?
Which questions that we raised yesterday with the parents were answered in this article?
1)The follow up of a 3 year old child with type 1? However there's limited data here only around one patient who was 21 years of age after being diagnosed at age of 3.
How about searching for more type 1 patient data where we have many more 3 year olds followed till they were 50-60-70?
2) The question around the current status of stem cell therapy is also not adequately answered here as it's a 2009 report although it nevertheless talks about an exciting advance in developing functional beta cells from diseased individuals.
Participant 16: Sir we had discussed about _how_ a stem cell can be made to differentiate specifically into a pancreatic beta cell, which is explained here.
Also, another interesting point is that they have used skin fibroblasts here which is less invasive than using stem cells from the bone marrow.
PaJR PHR Moderator: It is still a hypothesis as it's still not been trialled or it's ineffective?
What about point 1 regarding prognosis of a type 1 detected at age of 3?
Participant 16: Not been trialled on humans sir. There are some limitations to it being experimented on humans.
The second point I'm still looking it up sir
Patient Advocate: Sir,
Khali Patient Advocate De ke discharge korechhe, Kakali De Das ke discharge koreni l
PaJR PHR Moderator: Participant 12 Participant 7 Participant 14 Discharge both the parents asap!
Participant 13: Can some one add him in the group
He is ceo of blue semi non invasive glucose monitoring device
PaJR PHR Moderator: Share the group invite link with him
Patient Advocate: Yesterday blood sugar after dinner 164
7.45am puffed rice
9.45am 2u lispro insulin
9.55am idli and cucumber
12.00noon blood sugar 105
আমরা বের হচ্ছি স্যার l🙏🏾🙏🏾🙏🏾
12.15pm mousambi
1.30pm 2u lispro insulin
1.40pm hospital dish
8.00pm boil egg
9.15pm blood suger 108
9.15pm 2u lispro insulin
9.25pm dinner
5/23/24
Patient Advocate: Before breakfast blood sugar 124
9.45am 2u lispro insuplin
9.50am breakfast
1.30pm 2u lispro insulin
1.40pm lunch
7.00pm chicken and papad
10.00pm blood sugar 104
10.10pm dinner
10.30pm 3u lantus insulin
5/25/24
Patient Advocate: Sir gatakal kichhu update dite parini, kal sakal theke rat parjyanta ghora ghuri kore rate eshe ghumiyuporichhi
24/05/24
7.30am muri
9.30am 2u lispro insulin
9.40am breakfast
1.45pm before lunch blood sugar 66
1.45pm 2u lispro insulin
1.50pm lunch
3.00pm one cornetto butter squch icecream
4.00pm watermelon and cucumber
10.00pm blood sugar 54
10.00pm one sandesh
10.10pm 2u lispro insulin
10.20pm biriyani
10.45pm 3u lantus insulin
Today i.e. 25/05/23
6.30am muri
8.30one dark fantasy creak biscuit two pcs
9.55am blood sugar 155
9.55am 2u lispro insulin
10.05am breakfast
Aaj sakal 8.30am train e amra firchhi Sir 👋🏻👋🏻
5/26/24
Patient Advocate: 25/05/24
1.45pm 2u lispro insulin
1.55pm lunch
6.00pm two cream biscuit
7.00pm puffed rice
9.45pm 2u lispro insulin
9.55pm dinner
10.30pm 3u lantus insulin
5/27/24
Patient Advocate: 26/0524
8.00am puffed rice
9.10am boil egg
1.00pm one 5rs Cadbury chocolate
4.30pm blood sugar 39
4.30am one sandesh
4.40pm 1u lispro insulin
4.50pm lunch
9.30pm blood sugar 204
9.40pm dinner
11.30pm 3u lantus insulin
Train e khaoar kichhu na paoay khaoate parini
27/05/24
8.00am puffed rice
10.15am 1/2 pattis
11.00am boil egg
3.00pm barite dhuke blood sugar 133
3.05pm 2u lispro insulin
3.15pm rice with long beans, pointed gourd, bitter gourd, tomato, spiny guard, lady finger, rubbed gourd, brinjal, soyabean and salad
7.15pm oats
9.30pm 2u lispro insulin
9.40pm dinner with as same as recipe of lunch
10.30pm 3u lantus insulin
5/28/24
PaJR PHR Moderator: Participant 13 I guess they couldn't get the hand held IIT Hyderabad device to test parallely along with standard care they are sharing?
Patient Advocate: Sir ,
Sattis sir er sathe jogajog hayni jadi sambhab hay courier e pathiye dile Ami upi e payment kore dibo l
PaJR PHR Moderator: Ekhane unake tag kore jogajog koriye dilam
Patient Advocate: 7.30am milk And puffed rice
9.45am 2u lispro insulin
9.55am rice with pumpkin, long beans, pointed gourd, tometo, bitter gourd, spiny guard, soyabean amd salad
12.00noon mango
1.30pm 2u lispro insulin
1.40pm same as previous dish
4.00pm blood suger 63
4.05 one lolypop and sandesh
PaJR PHR Moderator: Any hypoglycemia symptoms at 4:00 PM or was the lollipop given as a precaution?
Patient Advocate: No sir
5/29/24
Patient Advocate: 28/05/24
7.00pm oats and salad
9.30pm blood sugar 155
9.30pm 2u lispro insulin
9.40pm rice with pumpkin, long beans, pointed gourd, spiny guard, soyabean, fish and salad
10.15pm 3u lantus insulin
29.05.24
7.45am blood sugar 64
7.45am milk and puffed rice
9.30am 2u lispro insulin
9.40am rice with pointed gourd, bitter gourd, pumpkin, long beans, tomato, spiny guard, soyabean paneer and salad
11.30am one pomegranate
1.30pm 2u lispro insulin
1.40pm rice with pointed gourd, bitter gourd, pumpkin, long beans, tomato, spiny guard, soyabean, fish and salad
4.00pm blood sugar 60
4.15pm one Cadbury normal chocolate
7.00pm oats
9.30pm blood sugar 212
9.35pm 2u lispro insulin
9.45pm rice with tomato, pumpkin, long beans, green banana, fish and salad
10.30pm 3u lantus insulin
5/30/24
Patient Advocate: 7.45am puffed rice
9.30am 2u lispro insulin
9.40am rice with pointed gourd, tometo, spiny guard, pumpkin leaf, soyabean, paneer and salad
12.00noon lichi 3pcs
1.30pm blood suger 88
1.30pm 2u lispro insulin
1.40pm rice with pointed gourd, tometo, spiny guard, pumpkin leaf, soyabean, fish and salad
5.30pm jackfruit with puffed rice
9.30pm 2u lispro insulin
9.40pm rice with pointed gourd, tometo, spiny guard, pumpkin leaf, fish and salad
10.30pm 3u lantus insulin
5/31/24
PaJR PHR Moderator: 👍
6/1/24
Patient Advocate: 31/05/24
7.30am blood sugar 85
7.30am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, pumpkin, pumpkin leaf, brinjal, spiny guard, ribbed guard, soyabean, paneer and salad
12.00 noon mango
1.30pm 2u lispro insulin
1.40pm same as previous dish and fish
4.00pm blood suger 60
4.05pm lolypop and jelly chocolate
5.00pm jackfruit with puffed rice
7.00pm oats
9.45pm 2u lispro insulin
9.55pm as same as the dish of the lunch
12.00midnight blood suger 111
PaJR PHR Moderator: 1:30 PM lispro dose can be reduced. How much was it today?
Patient Advocate: 2u
PaJR PHR Moderator: 3:30 PM sugar?
Patient Advocate: 83
01/06/24
7.45am milk and puffed rice
9.30am 2u lispro insulin
9.40am rice with zucchini, long beans, pumpkin, brinjal, pointed gourd, green banana, soyabean and salad
11.50am Blood suger 111
12.00noon mango
1.30pm 2u lispro insulin
1.40pm as same as previous dish and paneer
4.00pm blood sugar 83
6.30pm jackfruit with puffed rice and milk
9.30pm 2u lispro insulin
9.40pm as same as the dish of lunch
10.30pm 3u lantus insulin
6/2/24
Patient Advocate: 2/06/24
7.30am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with tomato, pumpkin, long beans, pointed gourd, ribbed gourd, snake gourd, soyabean paneer and salad
11.45am ripe papaya
1.30pm blood sugar 214
1.30pn 2u lispro insulin
1.40pm as same as previous dish and fish
5.30pm sour curd
7.00pm ripe jackfruit with milk and puffed rice
9.30pm 2u lispro insulin
9.40pm same as lunch dish
10.30pm 3u lantus insulin
6/3/24
Patient Advocate: 02/06/24
Blood sugar after two hours of dinner 112
Participant 2: Good
6/4/24
Patient Advocate: 03/06/24
7.30am milk with puffed rice
9.50am 2u lispro insulin
10.00am rice with pointed gourd, bitter gourd, tomato, spiny guard, pumpkin, soyabean and salad
12.00noon blood suger 90
12.00noon mango
1.45pm 2u lispro insulin
1.55pm as same as previous dish
5.00pm sour curd
7.00pm wheat flour chapati
9.45pm blood sugar 145
9.55ok as same as previous dish
10.40pm 3u lantus insulin
PaJR PHR Moderator: Check out the difference in the data with the food on two subsequent days with the same insulin dose :
[6/2] Patient Advocate 2F Diabetes1: 2/06/24
9.45am 2u lispro insulin
9.55am rice with tomato, pumpkin, long beans, pointed gourd, ribbed gourd, snake gourd, soyabean paneer and salad
11.45am ripe papaya
1.30pm blood sugar 214
[6/4] Patient Advocate 2F Diabetes1: 03/06/24
9.50am 2u lispro insulin
10.00am rice with pointed gourd, bitter gourd, tomato, spiny guard, pumpkin, soyabean and salad
12.00noon blood suger 90
The only difference in ingredients here is "bitter gourd?"
Patient Advocate: 04/06/24
7.30am blood suger 138
7.30am milk with puffed rice
10.00am 2u lispro insulin
10.10am rice with pointed gourd, long beans, tomato, bitter gourd, sponge gourd, chayote, green banana, egg and salad
12.00noon mango
1.30pm 2u lispro insulin
1.40pm as same as previous dish and fish
3.50pm blood suger 164
5.30pm sour curd
7.00pm oats
9.30pm 2u lispro insulin
9.40pm as same as lunch dish
10.30pm 3u lantus insulin
6/6/24
Patient Advocate: 05/06/24
7.45am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, green banana, chayote, soyabean, egg and salad
12.00noon mango
2.00pm blood suger 90
2.00pm 2u lispro insulin
2.10pm lunch with as same as previous dish
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with the same dish of lunch except egg
10.45pm 3u lantus insulin
06/06/24
7.30am blood sugar 101
7.35pm milk with puffed rice
PaJR PHR Moderator: 👍
Patient Advocate: 9.45am 2u lispro insulin
9.55am rice with chayote, spiny gourd, pointed gourd, long beans, tomato, soyabean, egg and salad
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch
1.55pm lunch with same previous dish except egg and fish
4.00pm blood sugar 125
5.30pm sour curd
7.00pm milk with puffed rice
9.30pm 2u lispro insulin
9.40pm dinner as same as lunch
10.30pm 3u lantus insulin
6/7/24
PaJR PHR Moderator: 👍
6/8/24
Patient Advocate: 07/06/24
7.30am milk with puffed rice
9.30am 2u lispro insulin।
9.40am rice with long beans, chayote, spiny gourd, pointed gourd, green banana, soyabean, egg and salad.
11.55am blood suger 94
12.00noon mango
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.00pm 10grm dark chocolate
6.00pm sour curd
7.00pm oats
9.30pm blood sugar 212
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
10.30pm 3u lantus insulin
08/06/24
7.30am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, spiny guard, tomato, chayote, soyabean, egg and salad
12.15pm mango
1.45pm blood suger 81
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg
5.00pm sour curd
7.00am payesh with banana
10.00pm 2u lispro insulin
10.10pm dinner with same as lunch dish
10.40pm 3u lantus insulin
6/9/24
Patient Advocate: 8/06/24
12.15am blood sugar after dinner 62
Then 3/4 teaspoon sugar (chini)
9/06/24
7.30am milk with puffed rice
10.00am 2u lispro insulin
10.10am rice with tomato, spiny gourd, pointed gourd, papaya, soyabean , egg and salad
12.00noon ripe jackfruit
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and soyabean added chicken
3.50pm blood sugar 165
5.30pm sour curd
7.00pm aata meggi
9.40pm blood sugar 162
9.50pm dinner with same as lunch dish
10.30pm 3u lantus insulin
6/10/24
Patient Advocate: 10/06/24
7.30am milk with puffed rice
9.45am 2u lispro insulin
9.50am rice with papaya chayote, bitter gourd, tomato, pointed gourd, spiny gourd, egg and salad
12.00noon blood sugar 78
12.00noon mango
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and added soyabean
5.00pm sour curd
7.00pm oats
9.15pm one dark fantasy biscuit
9.45pm blood sugar 278
9.45pm 2u lispro insulin
9.50pm dinner with same lunch dish
10.30pm 3u lantus insulin
6/11/24
PaJR PHR Moderator: Post dark fantasy glucose outcomes in this patient is a stark reminder of the sugar and maida in children's favorite biscuits? Participant 3 Participant 13
Participant 2: Tattoo and poster presentation for improved outcomes
Patient Advocate: 11/06/24
7.30am blood sugar 110
7.30am milk with puffed rice
9.45am 2u insulin
9.55am rice with papaya, pointed gourd, spiny gourd, chayote, soyabean, egg and salad
12.00noon mango
1.40pm 2u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 75
5.00pm sour curd
6.30pm oats
9.30pm 2u lispro insulin
9.40pm dinner with same as lunch dish
10.30pm 3u lantus insulin
6/13/24
Patient Advocate: 12/06/24
7.30am milk and puffed rice
10.00am 2u lispro insulin
10.10am sweet curd, puffed rice, mango and banana
1.30pm blood sugar 300
1.30pm 2u lispro insulin
1.40pm rice with pointed gourd, chayote, pumpkin, papaya, carrot, fish, one pc chicken and salad
5.30pm sour curd
7.00pm chapati of aata
9.30pm blood sugar 350
9.30pm 3u lispro insulin
9.40pm rice with pointed gourd, tometo, pumpkin, papaya chayote, fish, one pc chicken and salad
10.30pm 3u lantus insulin
11.50pm blood suger 36
11.50pm one rasagolla and 1/2 teaspoon sugar
13/06/24
7.45am blood sugar 104
7.45am milk and puffed rice
9.30am rice with pointed gourd, tometo, spiny guard, pumpkin, papaya chayote, soyabean, egg and salad
PaJR PHR Moderator: The sudden one unit increase in the pre dinner 9:30 P M lispro (to combat her hyperglycemia due to the sweet curd and aata) appears to have resulted in the 11:50 pm hypParticipant 5
Patient Advocate what were the symptoms?
Patient Advocate: No symptoms has been found
6/14/24
Patient Advocate: 12.00noon mango
1.30pm 2u lispro insulin
1.30pm rice with same previous dish except egg and include fish
5.00pm sour curd
7.00pm oats
9.30pm 2u lispro insulin
9.40pm dinner with same as lunch dish
10.30pm 3u lantus insulin
11.50pm blood suger 105
14/06/24
7.45am milk with puffed rice
9.30am rice with carrots, papaya, chayote, bitter gourd, pointed gourd, tometo, egg and salad
11.15am ripe jackfruit
11.45am blood suger 307
1.45pm 2u lispro insulin
PaJR PHR Moderator: No lispro in the morning?
One needs to be very careful about hypoglycemia unawareness.
More about it here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499525/
6/16/24
Patient Advocate: Yes given
15/06/24
7.30am milk and puffed rice
9.30am 2u lispro insulin
9.40am rice with pointed gourd, tometo, spiny guard, carrots, chayote, papaya, soyabean, egg and salad
11.35am mango
1.30pm blood sugar 146
1.30pm 2u lispro insulin
1.40am lunch with same previous dish except egg and include fish
5.30pm sour curd
7.30pm oats
9.30pm 2u lispro insulin
9.40pm rice with chayote, papaya, bitter gourd, tomato, spiny guard, fish and salad
10.30pm 3u lantus insulin
Blood suger after dinner 77
6/17/24
Patient Advocate: 16/06/24
7.30am milk and puffed rice
9.30am 2u lispro insulin
9.40am rice with papaya, chayote, bitter gourd, pumpkin, pointed gourd, spiny guard, soyabean, egg and salad
11.40am blood sugar 102
11.45am mango
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm roti of rice flour
9.45pm blood suger 377
9.50pm 2u lispro insulin
10.00pm dinner with same as lunch dish
10.40pm 3u lantus insulin
12.00night blood suger 114
PaJR PHR Moderator: 9:45PM obdhi aager diner lantus er action kome aashche?
Is the previous day's lantus action coming down by 9:4 Participant 5
Patient Advocate: Tahole ki ajke lantus ta aro 1u bariye 4u kore debo Karan ager din o dinner er age sugar 300 opore chhilo
PaJR PHR Moderator: Ekhane duration of action er issue mone hocche. Dose er noi
Kintu dinner er pore 77 hoye gechilo
Amar notun phone theke aager shob WhatsApp message guno delete hoye geche.
Ore body weight ebong last hba1c ta kabe koto chilo janate parben?
Patient Advocate: Parbo Sir
HBA1C report on 10/03/24 was 8.3
Body weight last three month same position 13kg
6/18/24
PaJR PHR Moderator: When we plotted it on the road to health card her growth appeared to be in the right direction within the expected standard!
Please share the image of the road to health card again and have you plotted her recent weight in it?
Participant 6 Can we find an online pediatric growth plotting app similar to the paper based road to health card?
Also Patient Advocate 10/3/24 was also the date her diabetes was diagnosed for the first time?
Was the hba1c repeated on 10/6/24 as discussed earlier that it needs to be repeated every 3 months?
Patient Advocate: 10/03/24 was first date of diagnosis
I
On 10/06/24 HBA1C has not been done because they're not our house, they are in their mama,s house
On returning it will be done
PaJR PHR Moderator: We salute our PaJR patients parents for their inspiring dedication and let's celebrate this day as PaJR parents day:
Check out this article as a food for thought to celebrate this day (Bengali translation below):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151965/
Abstract:
Introduction:
The management of childhood type 1 diabetes requires the active participation of parents. The aim of the present study was to describe the main characteristics of parents of children with type 1 diabetes, including objective burden regarding time spent on diabetes care, emotional distress (exhaustion, need for respite, quality of life), and symptoms of depression as well as anxiety.
আমরা আমাদের PaJR রোগীর পিতামাতাদের তাদের অনুপ্রেরণামূলক উত্সর্গের জন্য অভিনন্দন জানাই এবং আসুন এই দিনটিকে PaJR পিতামাতা দিবস হিসাবে উদযাপন করি:
এই দিনটি উদযাপনের চিন্তার খোরাক হিসাবে এই নিবন্ধটি দেখুন:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151965/
বিমূর্ত:
ভূমিকা:
শৈশব টাইপ 1 ডায়াবেটিস পরিচালনার জন্য পিতামাতার সক্রিয় অংশগ্রহণ প্রয়োজন। বর্তমান অধ্যয়নের লক্ষ্য ছিল টাইপ 1 ডায়াবেটিস আক্রান্ত শিশুদের পিতামাতার প্রধান বৈশিষ্ট্যগুলি বর্ণনা করা, যার মধ্যে ডায়াবেটিসের যত্নে ব্যয় করা সময়, মানসিক যন্ত্রণা (ক্লান্তি, অবকাশের প্রয়োজন, জীবনের মান) এবং বিষণ্নতার লক্ষণগুলি সহ পাশাপাশি উদ্বেগ।
Patient Advocate: 17/06/24
7.45am blood suger 121
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, bitter gourd, tomato, ribbed guard, egg and salad
12.00noon ripe jackfruit
1.45pm 2u lispro insulin
1.50pm lunch with same as previous dish except egg and include fish
5.30pm sour curd
7.00pm mild and roti of rice flour
9.30pm 2u lispro insulin
9.40pm rice with jackfruit seed, pointed gourd, tometo, long beans, papaya, fish and salad
10.30pm 3u Lantus insulin
11.55pm blood suger 235
6/20/24
Patient Advocate: 18/06/24
7.45am milk and puffed
9.30am 2u lispro insulin
9.40am rice with pointed gourd, bitter gourd, tomato, papaya, egg and salad
11.45am blood sugar 236
1.30pm 2u lispro insulin
1.40pm lunch with same as previous dish except egg and include fish
5.30pm sour curd
7.00pm oats
9.30pm blood sugar 304
9.30pm 2u lispro insulin
9.40pm rice with chayote, papaya, pointed gourd, tometo, fish and salad
10.30pm 4u lantus insulin
19/06/24
8.00am blood sugar 98
8.00am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with chayote, papaya, bitter gourd, pumpkin, long beans, egg and salad
1.30pm 2u lispro insulin
1.40pm lunch with same as previous dish except egg and include fish
3.50pm blood sugar 90
5.00pm sour curd
7.00pm chowmin
9.30pm 2u lispro insulin
9.40pm rice with green banana, pointed gourd, papaya, long beans
10.30pm 4u lantus insulin
PaJR PHR Moderator: Lantus 1 unit baranote, post meal guno o ektu beshi kome jacche.
Hypoglycemia hote sabdhane thakte habe
Dorkar hole lispro dose ta komano jete pare
Patient Advocate: Ok
6/21/24
Patient Advocate: 20/06/24
7.30am only puffed rice because digestive problems and seems to be dysentery
9.30am 2u lispro insulin
9.40am rice with pointed gourd, papaya, green banana, long beans, bitter gourd, soyabean, egg and salad
11.50am blood suger 78
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm oats
9.30pm blood sugar 267
9.30 pm 2u lispro insulin
9.40pm rice with as same as lunch dish
10.30pm 4u lantus insulin
6/22/24
Patient Advocate: 21/06/24
7.30am only puffed rice
9.30am 2u lispro insulin
9.40am rice with chayote, papaya, pointed gourd, green banana soyabean and salad
11.50am mousambi
1.30pm blood suger 152
1.40pm 2u lispro insulin
1.50pm lunch with same previous dish and fish
5.30pm sour curd
7.15pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
PaJR PHR Moderator: Please check for urine ketones with a ketostix.
Any acute illness in a type1 diabetic, one must check for ketones, even if the BG is low or normal
Patient Advocate: Monday will be done
PaJR PHR Moderator: Urine ketones are done to prevent emergencies
Patient Advocate: কিভাবে ?
PaJR PHR Moderator: Ketone positive thakle diabetic ketoacidosis er jonye emergency treatment shuru korte hote pare
Diabetic ketoacidosis jekono infection er fole precipitate hote pare
Patient Advocate: Ketone ki sugar level bariya dey ki ?
PaJR PHR Moderator: Na onyo bhabe khoti korte pare bishesh kore acid level bariye
Tabe hain generally sugar barle ketones o barte pare tabe khub rarely sugar na barleo ketones bere giye khoti hote pare.
Urine Ketones barle next step hishebe amra immediately arterial blood gas kore, blood a acid er matra ta dekhe ni
Patient Advocate: Agami kal to Sunday, r aj sakale or to first urin kore felechhe ekhon Monday chhara ro hobe na,
Bairer theke ke ketones barar kono lakshan dekhe bojhar upai acche?
Ar Sir ketones control karar upai ki?
PaJR PHR Moderator: Emergency treatment of diabetic ketoacidosis involves iv fluids and iv insulin
First urine is not necessary for testing urine ketones
Patient Advocate: 21/06/24
Blood suger after dinner 212
22/06/24
7.30am puffed rice
9.30am 2u lispro insulin
9.40am rice with chayote, papaya, long beans, pointed gourd, green banana, soyabean, paneer and salad
11.50am blood suger 162
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with same previous dish
10.45pm 4u lantus insulin
6/23/24
Patient Advocate: 22/06/24
Blood suger before dinner 174
6/24/24
Patient Advocate: 23/06/24
7.30am blood suger 60
7.30am puffed rice and dates 2pcs
9.30am 2u lispro insulin
9.40am rice with chayote, papaya, pointed gourd, green banana, soyabean, paneer and salad
12.00noon mango
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish and fish
3.45pm blood sugar 77
5.30pm sour curd
7.00pm oats
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish and one pc mutton
10.30pm 4u lantus insulin
11.55pm blood sugar 70
Sir, Patient ke 21/06/24 tarikhe child specialist dekhano hoyechhilo karon o besh kayek dine theke 3-4 times potty korchhilo ar pottyr poriman ta 3--4 time i onek ta poriman hochhilo tai doctor er kache niye giyechhilam । Kintu medicine guli ekhono deoa hoy ni Karan apni ketone test korte bollen tai ajke urine ketone test korar por seta apnake dekhiye apni jadi bolen tahole oi medicine guli dibo
PaJR Participant 5 medicines by the local pediatrician for the child's diarrhoea
PaJR PHR Moderator: Aekhon emnitei kome jaini?
Ore stools er chobi ta amake pm kore share korte parben?
Patient Advocate: Kal kore dibo
6/25/24
Patient Advocate: 24/06/24
7.30am milk with puffed rice
9.30am 2u lispro insulin
9.40am chayote, papaya, pointed gourd, pumpkin, soyabean and salad
11.50am blood suger 106
12.00noon mango
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish and paneer
5.30pm sour curd
7.00pm oats
7.30pm banana, mango, jackfruit and sago mixed 40grm
9.30pm blood suger 267
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
10.30pm 4u lantus insulin
PaJR PHR Moderator: 👆 Congratulations to the patient's parents. From 8.3 to 6.6 in three months 👏👏
Patient Advocate: Phosphorus, Potassium and AST : ALT Ratio normal korar upay ta ki Sir ?
PaJR PHR Moderator: Oguno borderline.
Arek din repeat korle normal dekhate pare
Patient Advocate: Ok, thank you Sir
6/26/24
Patient Advocate: 25/06/24
7.30am medicine prescribe pediatrician
7.40am milk with puffed rice
9.30am 2u lispro insulin
9.40am rice with chayote, bitter gourd, pumpkin, papaya, pointed gourd, paneer and salad
12.00noon mango
1.30pm blood suger 120
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except paneer and include fish
5.30pm sour curd
7.00pm oats
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
10.30pm 4u lantus insulin
11.40pm blood sugar 72
25/06/24
There were also two times medicine after lunch and dinner
26/06/24
7.30am medicine prescribe by pediatrician
7.40am milk with puffed rice
9.30am 2u lispro insulin
9.40am rice with chayote bitter gourd, pumpkin, soyabean and salad
11.50am blood sugar 106
12.00noon mango
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish
5.30pm sour curd
8.30pm milk and puffed rice
9.50pm blood suger 71
10pm 2u lispro insulin
10.10pm dinner with as same as lunch dish
10.45pm 4u lantus insulin
Two times medicine after lunch and dinner
6/27/24
PaJR PHR Moderator: The sugar values are coming borderline and it would be nice to reduce lispro Participant 5 ?
Bortoman a apni pen use korchen naki syringe?
Patient Advocate: Pen
27/06/24
7.45am blood sugar 54
7.45am two pcs dates and milk with puffed rice
9.45am 2u lispro insulin
9.50am rice with pointed gourd, pumpkin, papaya, chayote, bitter gourd , soyabean, and egg
12.00noon mango
1.30pm blood sugar
1.35pm 2u lispro insulin
1.45pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 61
4.05pm one lolipop candy
5.00pm sour curd
6.30pm oats
7.30pm ripe jackfruit
9.55pm 2u lispro insulin
10.05pm dinner with as same as lunch dish and salad
10.45pm 3u lantus insulin
6/28/24
PaJR PHR Moderator: Reduce lispro dose asap.
If you can't procure the Humalog Junior Kwikpen 100iu Pre Filled Pen Of 3ml Solution For Injection to reduce the dose by 0.5 then currently reduce it by 1U
More about how to procure the junior kwikpen here👇 https://pharmeasy.in/online-medicine-order/humalog-junior-kwikpen-100iu-pre-filled-pen-of-3ml-solution-for-in Participant 5 Could you come across a similar page from India providing the same functionality through syringes instead of pen?
What was 1:30 PM blood sugar?
Patient Advocate: Ei lekhata bhulbasata hoye geche, oi samay test kora jay ni
6/29/24
Patient Advocate: 28/06/24
7.45am puffed rice and milk
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, pointed gourd, bitter gourd , soyabean and egg
12.00noon blood sugar 81
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish and paneer
5.00pm sour curd
6.45pm fuse chocolate
8.45pm milk and puffed rice
10.10pm blood sugar 173
10.20pm dinner with as same as lunch dish
11.00pm 3u lantus insulin
6/30/24
Patient Advocate: 29/06/24
7.45am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, bitter gourd, papaya, green banana, spiny gourd, and soyabean
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and paneer
5.30pm sour curd
7.00pm oats
9.45pm blood sugar 264
9.50pm 2u lispro insulin
10.00pm dinner with as same as lunch dish and salad
10.40pm 3u lantus insulin
PaJR PHR Moderator: Added sugar in sour curd?
Patient Advocate: Sour curd with sald not little bit of sugar
PaJR PHR Moderator: Check the sugar content in the oats. Is it a commercial packaged oats?
Patient Advocate:
PaJR PHR Moderator: 200 mg of sugar per serving
Patient Advocate: Ei oats ta daily khay, kintu sugar ta ei rakam majhe madhye bere jaoar Karan ta ki Sir ?
PaJR PHR Moderator: Jotodur anuman korchi ore pancreas thekeo majhe majhe kichu insulin beruchchhe jeta sugar ta kokhono kokhono fall koracche abar majhe majhe pancreas theke ekkebarei kichu beruchchhena jar jonye sugar ta bere jacche
Amader 30F er group aeo anketa aek dhoroner byapar dekha jacche
Patient Advocate: 30/06/24
7.45am blood sugar 108
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.50am rice with papaya, spiny gourd, long beans, pointed gourd, ribbed gourd, bitter gourd, soyabean and egg
12.00noon mango
2.00pm 2u lispro insulin
2.10pm lunch with same previous dish except egg and include fish
4.15pm blood sugar 147
6.15pm sour curd
7.15pm maggi
9.45pm blood sugar 95
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch with and salad
10.40pm 3u lantus insulin
Patient Advocate: It is for three times
1/7/24 (Day/Month/Year)
PaJR PHR Moderator: Children may appreciate a variation in their daily diet
Patient Advocate: 01/07/24
7.45am milk with puffed rice
9.45am 2u lispro insulin
9.50am rice with pointed gourd, bitter gourd, chayote, papaya, long beans, spiny guard, soyabean and salad
11.50am blood suger 161
12.00noon mango
1.45pm 2u lispro insulin
1.50pm lunch with same as previous dish and egg
6.00pm sour curd with salt
7.00pm maggi
9.45pm blood sugar 81
9.50pm 2u lispro insulin
10.00pm dinner with as same as lunch dish except egg and a small size papad
10.40pm 3u lantus insulin
2/7/24
Patient Advocate: 12.00night blood suger 91
PaJR PHR Moderator: Aeguno shob apnar local daktar jei dhoroner chart diyechilen shei dhoroner chart aeo shajacchen?
Otao ekhane share korte parben aager moton jemon otar chobi share korechilen?
Patient Advocate: কোন গুলোর ছাবি স্যার ?
PaJR PHR Moderator: Ekdom shuru te jei chart ta share korechilen jeta dekhe amra prothom ore hypoglycemia r kotha janai ebong insulin dose komate boli
Amar mone hoi shei chart guno apni nishchoi parallel bhabe toiri rekhechen apnar local pediatrician ke dekhanor jonye?
Aekhono porjyonto aei group a ja kothopokothon hoyeche aei group a oguno shob select kore, ebong tarpor copy kore ekhane abar paste korte parben jaate protyek ta kothopokothon er saathe date o thake jemon ami kichu ta niche kore dekhalam 👇
[30/06] Patient Advocate 2F Diabetes1: 30/06/24
7.45am blood sugar 108
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.50am rice with papaya, spiny gourd, long beans, pointed gourd, ribbed gourd, bitter gourd, soyabean and egg
12.00noon mango
2.00pm 2u lispro insulin
2.10pm lunch with same previous dish except egg and include fish
4.15pm blood sugar 147
6.15pm sour curd
7.15pm maggi
9.45pm blood sugar 95
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch with and salad
10.40pm 3u lantus insulin
[01/07] Patient Advocate 2F Diabetes1: It is for three times
PaJR PHR Moderator: Children may appreciate a variation in their daily diet
Patient Advocate 2F Diabetes1: 01/07/24
7.45am milk with puffed rice
9.45am 2u lispro insulin
9.50am rice with pointed gourd, bitter gourd, chayote, papaya, long beans, spiny guard, soyabean and salad
11.50am blood suger 161
12.00noon mango
1.45pm 2u lispro insulin
1.50pm lunch with same as previous dish and egg
6.00pm sour curd with salt
7.00pm maggi
9.45pm blood sugar 81
9.50pm 2u lispro insulin
10.00pm dinner with as same as lunch dish except egg and a small size papad
10.40pm 3u lantus insulin
[02/07] Patient Advocate 2F Diabetes1: 12.00night blood suger 91
PaJR PHR Moderator: Aeguno shob apnar local daktar jei dhoroner chart diyechilen shei dhoroner chart aeo shajacchen?
Otao ekhane share korte parben aager moton jemon otar chobi share korechilen?
Patient Advocate 2F Diabetes1: কোন গুলোর ছাবি স্যার ?
Patient Advocate: Thik achhe ami kore debo ektu samay niye Karan Sai March mas theke, onek gulo chhabi hobe l
PaJR PHR Moderator: Apatoto shudhu oi prothom chart ta ebong last chart ta share korun
Baki shudhu text guno copy paste korle habe
👆Ekhane jebhabe dekhano sheibhabe text hishebe pathan Patient Advocate
Text guno ke chobi hishebe dile oguno ke amra case report a paste korte parbona.
Chobi shudu jeguno apnar paper a banano ore blood sugar chart er shudhu sheguno pathalei habe
Patient Advocate: Ok
PaJR PHR Moderator: Aei chart tar kotha bolchilam
PaJR PHR Moderator: 👆 Eta aekhono apnar local daktar er jonye maintain korchen asha kori
Patient Advocate:
PaJR PHR Moderator: Well done Patient Advocate 👏👏
2/07/24
Patient Advocate:
7.40am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with chayote, bitter gourd, ribbed gourd, long beans, pointed gourd, soyabean, egg and salad
12.00noon sagu with mango and banana
1.45pm blood suger 90
1.45pm 2u lispro insulin
1.55pm lunch with same as previous dish except egg and include fish
5.30pm sour curd with salt
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.45am 3u lantus insulin
03/07/24
Patient Advocate: 02/04/24
12.00midnight blood suger 63
Then 1/3 teaspoon sugar
03/07/24
7.45am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, green banana, chayote, bitter gourd, ribbed gourd, soyabean
12.00noo blood sugar 47
Than 1/2 teaspoon sugar
One mango
1.30pm 1u lispro insulin
1.40pm lunch with same previous dish and egg
5.30pm sour curd with salad
7.00pm oats
9.30pm blood sugar 184
9.40pm 2u lispro insulin
9.50pm dinner with as same as lunch dish
10.45pm 3u lantus insulin
04/07/24
PaJR PHR Moderator: Needed to reduce night lantus too?
What's today's fasting?
Patient Advocate: 04/07/24
7.45am blood sugar 86
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.45am rice with pointed gourd, chayote, brinjal, soyabean, egg and salad
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 73
5.30pm sour curd with salt
7.00pm oats
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
10.30pm 2u lantus insulin
05/07/24
Patient Advocate: 04/07/24 blood sugar two hours later 78
PaJR PHR Moderator: 2 hours later in 4/7/24 was 11:30PM, two hours after dinner?
Patient Advocate: Yes
05/07/24
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, bitter gourd, long beans, pumpkin , spiny gourd, soyabean, paneer and salad
12.00noon blood sugar 108
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish
5.30pm sour curd
7.00pm oats
8.30pm 1/2 bowl khichudi prasad in which 1.5 teaspoon of sweety payesh also
9.30pm blood suger 366
9.40pm 2u lispro insulin
9.50pm dinner with as same as lunch dish
10.30pm 3u lantus insulin
06/07/24
PaJR PHR Moderator: The sweety payesh!
07/07/24
Patient Advocate: 06/07/24
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am chayote, bitter gourd, pumpkin, long beans, pointed gourd, soyabean
12.00noon 1/2 mango
1.45pm blood suger 266
1.50pm 2u lispro insulin
2.00pm lunch with same previous dish and paneer
5.30pm sour curd
7.15pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish and salad
10.40pm 3u lantus insulin
12.00night blood suger 111
07/07/24
7.45am blood sugar 181
7.45am milk and puffed rice
Sir blood suger after dinner esechhilo 111 kintu sara raat ghumiye kichhu na kheye bede 181 hoyegelo kibhabe?
PaJR PHR Moderator:: Amader shorirer physiology te aemon bhabe kichu mechanism ache jaate overnight fasting holeo amader Liver theke glucose beriye rokte chole aashe ebong shei bhabe sugar taake fall hote dei na.
Kintu diabetics der khetre aei mechanism guno shothik kaaj kore na tai jonye proyojon er beshi sugar liver nijer store theke blood a pathiye dai
08/07/24
Patient Advocate: 07/07/24
9.45am 2u lispro insulin
9.55am rice with spiny guard, chayote, green banana, long beans, pointed gourd, egg and salad
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and fish
4.00pm blood suger 233
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.30pm 4u kantu insulin
Kantu> lantus
08/07/24
7.45am blood sugar 90
9.45am 2u lispro insulin
9.55am rice with papaya, spiny guard, pumpkin, green banana, chayote, long beans, bitter gourd, tomato, soyabean and ghee
11.55am blood suger 263
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and paneer
5.30pm sour curd
7.30pm oats
9.45pm blood suger 154
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
10/07/24
Patient Advocate: 9.07.24
7.30am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, green banana, chayote, bitter gourd, tomato, spiny guard, pumpkin, soyabean and salad
12.00noon mango
1.45pm blood suger 183
1.50pm 2u lispro insulin
2.00pm lunch with same as previous dish and egg
5.30pm sour curd
7.00pm oats
8.30pm two teaspoons prasad ( khichudi)
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish except egg
10.30pm 4u lantus insulin
12.00night blood sugar 122
10/07/24
7.45am blood sugar 99
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pumpkin, soyabean and salad
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and egg
4.00pm blood suger after lunch 123
5.30pm sour curd
7.30pm one banana and grist ( two teaspoons)
9.30pm 2u lispro insulin
9.40pm dinner with as same as previous dish except egg and include fish
10.30pm 4u lantus insulin
11/07/24
Patient Advocate:
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with Spiny guard, chayote, papaya, long beans, sponge gourd, green banana , soyabean, egg and salad
12.00noon blood suger 137
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
6.00pm sour curd
7.15pm aata roti one pc with ghee and salt
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4U lantus insulin
13/07/24
Patient Advocate: 12/07/24
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, green banana, chayote, long beans, sponge gourd, soyabean, egg and salad
12.00noon blood suger 223
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.15pm banana
9.45pm blood suger 44
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 3u lantus insulin
12.00night blood suger 212
After suger level 44, 1/4 teaspoon jam was given
13/07/24
7.45am blood sugar 142
7.45am milk with puffed rice
PaJR PHR Moderator:
@Meta AI can you make out from the transcripts below as to what may have precipitated this child's hypoglycemia at 9:45PM on 12/7/24
[10/07, 23:42] Patient Advocate 2F Diabetes1:
7.45am blood sugar 99
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pumpkin, soyabean and salad
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and egg
4.00pm blood suger after lunch 123
5.30pm sour curd
7.30pm one banana and grist ( two teaspoons)
9.30pm 2u lispro insulin
9.40pm dinner with as same as previous dish except egg and include fish
10.30pm 4u lantus insulin
[11/07, 23:37] Patient Advocate 2F Diabetes1: 7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with Spiny guard, chayote, papaya, long beans, sponge gourd, green banana , soyabean, egg and salad
12.00noon blood suger 137
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
6.00pm sour curd
7.15pm aata roti one pc with ghee and salt
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4U lantus insulin
[13/07, 08:36] Patient Advocate 2F Diabetes1: 12/07/24
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, green banana, chayote, long beans, sponge gourd, soyabean, egg and salad
12.00noon blood suger 223
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.15pm banana
9.45pm blood suger 44
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 3u lantus insulin
12.00night blood suger 212
[13/07, 08:38] Patient Advocate 2F Diabetes1:
After suger level 44, 1/4 teaspoon jam was given
[13/07, 08:39] Patient Advocate 2F Diabetes1:
13/07/24
7.45am blood sugar 142
7.45am milk with puffed rice
Meta AI:
Based on the transcripts, it appears that the child's hypoglycemia (blood sugar level of 44) at 9:45 PM on December 7, 2024, may have been precipitated by a combination of factors, including:
1. Insulin doses: The child received multiple doses of lispro insulin throughout the day, including 2 units at 9:45 AM, 1:45 PM, and 9:45 PM.
2. Meals and snacks: The child had a relatively consistent diet throughout the day, with a mix of carbohydrates, protein, and vegetables. However, the dinner at 9:55 PM may have been digested quickly, causing a rapid drop in blood sugar.
3. Physical activity: There is no mention of physical activity in the transcripts, but it is possible that the child engaged in some physical activity during the day that may have contributed to the hypoglycemia.
4. Insulin sensitivity: The child may have been more sensitive to insulin than usual, which could have caused the blood sugar to drop more rapidly than expected.
The fact that the child's blood sugar level was 223 at 12:00 PM and then dropped to 44 at 9:45 PM suggests that there may have been a rapid decline in blood sugar levels in the evening. The administration of 1/4 teaspoon of jam after the hypoglycemic episode suggests that the child's caregivers were attempting to quickly raise the child's blood sugar levels.
PaJR PHR Moderator: Did she have any symptoms before or at 9:45PM yesterday?
Patient Advocate: No symptoms
She was in normal activities like reading, dancing and playing
PaJR PHR Moderator: This is problematic!
@Narmeen Shah did we share this before here and is it archived in your case report EHR link but anyways I'm resharing some literature review around this in the links below:
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-019-0441-9
ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes
Full text link 👇
https://onlinelibrary.wiley.com/doi/full/10.1111/pedi.13443
Among patients aged <6 years (n = 46), 59% of care providers reported impaired awareness of hypoglycemia, and the rate of severe hypoglycemia was significantly higher in those reporting impaired awareness (33.3 vs. 52 episodes per 100 patient-years, P = 0.02). More patients with recurrent hypoglycemia reported impaired awareness of hypoglycemia (47 vs. 28%, P = 0.03).
Unquote
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752917/
Impaired awareness of hypoglycemia (IAH) therapies
Mistimed or imprecise dosing of insulin increases the likelihood of hypoglycemic events and recurrent episodes of hypoglycemia lead to the development of IAH (Cryer, 1993; Davis et al., 2000; Geddes et al., 2008; van Meijel et al., 2020; Muneer, 2021).
Unquote
https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1271814/full
14/07/24
Patient Advocate: 13.07.24
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, sponge gourd, long beans, chayote, pumpkin, soyabean and salad
12.00noon guava
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and paneer
4.00pm blood suger 169
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 3u lantus insulin
14/07/24
7.30am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with chayote, bitter gourd, tomato, long beans, papaya, pumpkin, soyabean, egg and salad
12.00noon blood sugar 99
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include chicken
5.30pm sour curd
7.00pm oats
8.00pm jackfruit
9.45pm Blood suger 308
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.45pm 4u lantus insulin
15/07/24
Patient Advocate:
PaJR PHR Moderator: Consumed yesterday at 8:00 PM?
Patient Advocate: Yes Sir
PaJR PHR Moderator: Luckily you were able to capture it's effect on the blood sugar inspite of, I presume, having no added sugar
Patient Advocate: It was without added sugar
PaJR PHR Moderator: Try giving her a piece of whole jackfruit to eat without making it into juice and then check the blood sugar after two hours
Patient Advocate: Ok Sir
Patient Advocate: 15/07/24
7.30am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, sponge gourd, chayote, bitter gourd, tomato, long beans, soyabean and salad
12.00noon mango
1.45pm blood sugar 224
1.50pm 2u lispro insulin
2.00pm lunch with same previous dish and paneer
5.30 pm sour curd
7.00pm one banana and sweet (sandesh)
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
12.00night blood suger 180
17/07/24
Patient Advocate: 16/07/24
7.30am blood sugar 135
7.30am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, bitter gourd, pumpkin, long beans, sponge gourd, soyabean, egg and salad
12..00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and fish
4.00pm blood sugar 64
5.30pm sour curd
7.00pm pineapple
7.30pm payesh (with diabexy sugar)
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
12.00night blood suger 79
Sour curd
Payesh making with milk, kaun rice and diabexy sugar
PaJR PHR Moderator: 👍
Making it with dates or raisins may have been healthier than adding artificial sweeteners
Patient Advocate: Ok thank you Sir
17/07/24
7.45am nuts and dates
8.00am milk and puffed rice
9.50am 2u lispro insulin
10.00am rice with papaya, pointed gourd, bitter gourd, pumpkin, long beans, egg and salad
12.00noon mango and sago mixed without sugar
1.50pm 2u lispro insulin
2.00pm lunch with same previous dish except egg and include roe
4.00pm blood suger 249
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish and include one smal piece chicken
10.30pm 4u lantus insulin
18/07/24
PaJR PHR Moderator: 👍
Patient Advocate: 18/07/24
7.30am nuts and dates
8.00am milk and puffed rice
19/07/24
Patient Advocate: 18.07/24
9.45am 2u lispro insulin
9.55am rice with pointed gourd, bitter gourd, pumpkin, papaya, chayote, sponge gourd, soyabean and salad
12.00nonn blood suger 186
12.05pm mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and include fish
5.30pm one egg
7.00pm oats
9.30pm blood sugar 70
9.30pm one small piece of creamy cake
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch with except fish and include papad
10.40pm 4u lantus insulin
19/07/24
7.30am nuts
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, sponge gourd, long beans, paneer and salad
12.00noon mango
1.45pm blood sugar 114
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except paneer and include fish
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as previous dish
10.45pm 4u lantus insulin
20/07/24
Patient Advocate: 12.00night blood suger 168
PaJR PHR Moderator: 👍
Patient Advocate: 20/07/24
7.30am blood sugar 173
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, sponge gourd, tomato, spiny guard, pointed gourd, soyabean and salad
12.00noon mango
1.45am 2u lispro insulin
1.45pm lunch with same previous dish and paneer
4.00pm blood sugar 286
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
21/07/24
Patient Advocate: 21/07/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, green banana, Spiny guard , soyabean and salad
12.00noon blood suger 250
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and fish
5.30pm sour curd
7.00pm oats
8.30pm banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
22/07/24
Patient Advocate: 12.00night blood sugar 135
PaJR PHR Moderator: Any sugary foods or drinks taken yesterday morning?
Patient Advocate: No Sir
22/07/24
7.30am nuts and dates
7.45am milk and puffed
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, sponge gourd, tometo, spiny guard, soyabean and salad
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and paneer
4.00pm blood suger 214
5.30pm sour curd
7.00pm oats
9.30pm blood sugar 279
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm lantus insulin 4u
23/07/24
PaJR PHR Moderator: Please share the picture of her sugar chart for the entire last week
Patient Advocate:
PaJR PHR Moderator: @Narmeen Shah thanks for updating the logs here regularly onto her EHR case report.
Nice to find it's already updated till 19/7/24
Narmeen Shah: Thank you sir.
Patient Advocate: 23/07/24
7.30am blood sugar 122
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, sponge gourd, chayote, green banana, Spiny guard soyabean, and salad
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 230
5.30pm sour curd
Can lantus be increased by one unit? That is 4 to 5
PaJR PHR Moderator: But she's already having hypoglycemia. You may have to reduce the lispro
24/07/24
Patient Advocate: 23/07/24
7.00pm oats
9.30pm blood sugar 259
9.45pm 3u lispro insulin
9.55dinner with as same as lunch dish
10.40pm 4u lantus insulin
Sorry Sir apnar ei message ta ami age dekheni, dinner er pore dekhechhi ।
12.00night blood sugar 185
PaJR PHR Moderator: If you are following the discussions in our 30F type 1 diabetes group managed by patient advocate you may have seen how that patient's regular insulin had to be completely stopped because of her hypoglycemia episodes and how currently she is doing well only on slow dose increments of lantus alone?
আপনি যদি রোগীর উকিল দ্বারা পরিচালিত আমাদের 30F টাইপ 1 ডায়াবেটিস গ্রুপের আলোচনাগুলি অনুসরণ করেন, আপনি হয়তো দেখেছেন যে কীভাবে তার patient er হাইপোগ্লাইসেমিয়া পর্বের কারণে তার নিয়মিত ইনসুলিন সম্পূর্ণরূপে বন্ধ করে দেওয়া হয়েছিল এবং বর্তমানে সে কীভাবে কেবল ল্যান্টাসের ধীর ডোজ বৃদ্ধিতে ভাল করছে?
Patient Advocate: Yes Sir
24/07/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, bitter gourd, tomato, long beans, papaya, chayote, sponge gourd, egg and salad
12.00noon blood suger 285
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.15pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 5u lantus insulin
25/07/24
PaJR PHR Moderator: Increasing lantus without decreasing lispro could be problematic and drive episodes of hypoglycemia
Whenever dose changes need to be made we would need to get more blood sugar values pre and post two hours after meals
Always remember hypoglycemia is more dangerous than hyperglycemia.
Patient Advocate: 24/07/24
9.45pm blood sugar before dinner 248
25/07/27
7.30am blood sugar 124
Sir
কয়েক দিন থেকে ব্লাড সুগার টা বেশি যাচ্ছে তাই গতকাল রাতে খাওয়ার আগে টেস্ট করেছিলাম এবং সকালে ঘুম থেকে উঠে টেস্ট করে দেখলাম l
PaJR PHR Moderator: Thik ache lantus ek unit bariye ki hoi dekha jak
Patient Advocate: 25/07/24
7.30am blood suger 124
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, long beans, bitter gourd, sponge gourd, chayote, papaya, soyabean and salad
12.00noon mango
1.45pm blood sugar 104
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and egg
5.30pm sour curd
7.00pm oats
9.45pm dinner with as same as previous dish except egg and include fish
10.40pm 5u lantus insulin
27/07/24
Patient Advocate: 26/07/24
7.30am blood suger 74
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, bitter gourd, tomato, long beans, papaya, chayote, and salad
12.00noon mango
2.30pm 2u lispro insulin
2.40pm lunch with as same as previous dish and fish
4.50pm blood sugar 211
5.30pm sour curd
7.30pm banana
9.30pm 25ml sugar free icecream
10.10pm 2u lispro insulin
10.20pm dinner with as same as lunch dish and one pc chicken
11.00pm 5u lantus insulin
27/07/24
7.30am nuts and dates
7.45am payesh( milk, rice, raisins and dates)
10.00am 2u lispro insulin
10.10am rice with papaya, chayote, bitter gourd, tomato, long beans, green banana soyabean and salad
12.15pm blood sugar 242
12.15pm mango
2.00pm 2u lispro insulin
2.10pm lunch with same previous dish and paneer
6.00pm sour curd
7.00pm sugar free icecream
7.30pm oats
10.00pm 2u lispro insulin
10.10pm dinner with as same as previous dish
10.45pm 5u lantus insulin
10.00pm blood sugar before dinner 183
28/07/24
PaJR PHR Moderator: 👍
Patient Advocate: Good evening Sir
Sir patient er dan kaner (right ear) niche halka fulechhe aar byatha korchhe. Eta kisher theke aar etar janya ki karbo ? Or kintu ektu sardi legechhe .
28/07/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, sponge gourd, long beans, pointed, green banana, egg and salad
12.00noon mango
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood suger 232
5.45pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 5u lantus insulin
29/07/24
PaJR PHR Moderator: ENT dekhano dorkar
Chobio share korun
30/07/24
Patient Advocate: 29/07/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, pumpkin, long beans, papaya, chayote, green banana egg and salad
12.00noon mango
1.45pm blood sugar 207
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg
4.00pm blood sugar 83
5.30pm sour curd
7.38pm banana 2pcs
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 5u lantus insulin
PaJR PHR Moderator: Increasing the lispro by 1 unit before lunch nearly went close to a hypo!
31/07/24
Patient Advocate: 30/07/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pointed gourd, bitter gourd, pumpkin, egg and salad
12.00noon mango
1.45pm blood sugar 275
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 237
5.30pm sour curd
7.00pm oats
9.45pm blood suger 93
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
31/07/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pumpkin, soyabean and salad
12.00noon mango
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish and paneer
4.00pm blood suger 101
5.30pm sour curd
8.00pm 2pcs banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
01/08/24
Patient Advocate: 31/07/24
12.00night blood suger after dinner 166
Patient Advocate: 01/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, pumpkin, long beans, pointed gourd, tometo, paneer and salad
1.45pm blood suger 259
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish
5.45pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish and include fish
03/08/24
Patient Advocate: 02/08/24
7.30am blood suger 94
7.30am nuts and e
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, pumpkin, chayote, green banana, pointed gourd, egg and salad
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include paneer
4.00pm blood suger 88
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish except paneer and include fish
10.40pm 4u lantus insulin
04/08/24
Patient Advocate: 3/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, pumpkin, papaya, sponge gourd, ribbed gourd, bitter gourd and salad
12.00noon mousambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish and paneer
4.00pm blood sugar, 243
5.30pm sour curd
7.00pm banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10..40pm 5u lantus insulin
9.45pm blood sugar before dinner 199
05/08/24
Patient Advocate: 4/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, sponge gourd, bitter gourd, tomato, pointed gourd, and salad
12.00noon blood suger 247
12.00noon mousambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish and fish
5.30pm sour curd
7.00pm banana
9.45pm blood sugar 163
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 5u lantus insulin
06/08/24
Patient Advocate: 05/08/24
7.30am blood suger 98
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, bitter gourd, pumpkin, papaya, chayote, green banana,
12.00noon mousambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish and paneer
4.00pm blood sugar 126
5.30pm sour curd
7.45pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 5u lantus insulin
6/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, green banana, pointed gourd, bitter gourd, tomato, egg and salad
12.00noon blood sugar 137
12.00noon mousambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm oats
9.45pm blood suger 233
9.45pm 3u lispro insulin
9.55pm dinner with as same as previous
10.40pm 5u lantus insulin
07/08/24
Patient Advocate: 12.00night blood sugar two hours later of dinner 99
PaJR PHR Moderator: 👍
Patient Advocate: 07/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, green banana, sponge gourd, tomato egg and salad
12.00noon mousambi
1.45pm blood sugar 93
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30om sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as previous dish
10.40pm 5u lantus insulin
08/08/24
Patient Advocate: 12.10am blood suger after dinner 213
8/08/24
7.30am blood suger 52
No symptoms at all
7.30am nuts, dates and 1/2 cream roll biscuit
7.45am milk
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, ribbed gourd, tomato, green banana, egg and salad
12.00noon mousambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm banana
9.45pm blood suger 120
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
09/08/24
Patient Advoacte: 09/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, green banana, chayote, papaya, ribbed gourd, egg and salad
12.00noon mousambi
1.45pm blood sugar 190
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.15pm banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
10/08/24
Patient Advocate: 12.00night blood suger after dinner 150
10/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, bitter gourd, tomato, pointed gourd, green banana, egg and salad
12.00noon mousambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg
5.38pm sour curd
7.00pm banana
9.45pm blood suger 258
9.45pm 2u lispro insulin
9.55pm dinner with as same as previous dish
10.40pm 5u lantus insulin
11/08/24
Patient Advocate: 11/08/24
7.30am blood suger 136
7.30am nuts
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, green banana, tomato, egg and salad ( cucumber and lemon)
12.00noon moumita l
12.00noon mousambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg
4.00pm blood suger 96
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 5u lantus insulin
12/08/24
PaJR PHR Moderator: 👍
Patient Advocate: 12/08/24
7.30am nuts
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, bitter gourd, tomato, chayote, papaya, green banana, egg and salad
12.00noon blood suger 176
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm banana
9.45pm blood sugar 134
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 5u lantus insulin
13/08/24
Patient Advocate: 13/08/24
7.30am nuts
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, green banana, bitter truth, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55am lunch with same previous dish
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish except egg
10.40pm 5u lantus insulin
PaJR PHR Moderator: Any symptoms at 6:30AM?
Patiet Advocate: No Sir
16/08/24
Patient Advocate: 15/08/24
7.30am nuts
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, brinjal Spiny guard, long beans, papaya, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 5u lantus insulin
16.08.24
7.30am blood suger 64
7.30am nuts
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, long beans, papaya,, chayote , green banana, bitter gourd, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 113
5.30pm sour curd
7.00pm banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch with
10.40pm 5u lantus insulin
17/08/24
PaJR PHR Moderator: Reduce lantus dose to 3U
Patient Advocate: Ok sir
18/08/24
Patient Advocate: 17/08/24
7.30am blood suger 67
7.30am nuts
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, bitter gourd, tomato, long beans, papaya, chayote, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm oats
7.15pm 1pc sweet (sandesh)
9.45pm blood sugar 290
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus
Dinner er age sugar onek ta high chhilo tai 2u na kamiye 1u kamano hoyechhe
PaJR PHR Moderator: The sugar before dinner gets worked on primarily by the lispro she's given while the lantus works on the basal sugar levels as reflected in her fasting levels which was still hypoglycemic as lantus wasn't reduced well enough!
রাতের খাবারের আগে চিনিটি প্রাথমিকভাবে তার দেওয়া লিসপ্রো দ্বারা কাজ করে.
ল্যান্টাস বেসাল চিনির মাত্রায় কাজ করে যা তার উপবাসের মাত্রায় প্রতিফলিত হয় যা তখনও হাইপোগ্লাইসেমিক ছিল কারণ ল্যান্টাস যথেষ্ট পরিমাণে হ্রাস পায়নি!
Patient Advocate: 18/08/24
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, green banana, pointed gourd, tometo, long beans, egg and salad
12.00noon blood sugar 105
12.00noon mosambi
1.45pm 2u lispro insulin
155pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm banana
9.45pm blood sugar 167
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 3u lantus insulin
20/08/24
Patient Advocate: 19/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, long beans, papaya, chayote, green banana, bitter gourd, egg and salad
12.00noon mosambi
1.45pm blood sugar 302
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as previous dish
10.40pm 3u lantus insulin
20/08/24
7.30am fasting blood sugar 180
7.30am nuts and dates
7.45am milk with puffed rice
PaJR PHR Moderator: Increase lantus today to 4U
Patient Advocate: Ok Sir, I also think that
PaJR PHR Moderator: Wish we had the 0.5U kids pens easily available (link was shared earlier and is it archived in @Narmeen Shah 's case report?)to make the process of pediatrics insulin dose titration easier and better controlled
Patient Advocate: Eta pray shesher dike, porer Lantus ta 0.5u kids pen khoj karbo
Narmeen Shah: https://m.indiamart.com/proddetail/humalog-junior-kwikpen-2850841647288.html
https://pharmeasy.in/online-medicine-order/humalog-junior-kwikpen-100iu-pre-filled-pen-of-3ml-solution-for-in
Sir these links? Yes, they are archived in the case report.
Patient Advocate: 9.45am 2u lispro insulin
9.55am rice with papaya, chayote, green banana, long beans, sponge gourd, pumpkin, egg and salad
12.00noon mosambi
2.30pm 2u lispro insulin
2.45pm lunch with same previous dish except egg and include fish
5.00pm blood sugar 216
6.30pm sour curd
7.30pm oats
9.45pm blood sugar 276
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.45pm 4u lantus insulin
22/08/24
Patient Advocate: 21/08/24
7.30am nuts and dates
7.45am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, sponge gourd, long beans, pointed gourd, bitter gourd, tomato, green banana , egg and salad
12.00noon blood sugar 176
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish
5.30pm sour curd
7.00pm oats
9.45pm blood suger 175
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish except egg
10.40pm 4u lantus insulin
23/08/24
Patient Advocate: 22/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, spiny gourd, sponge gourd long beans, pumpkin, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
12.. 00night blood suger 114
23/08/24
7.30am blood sugar 144
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, green banana, long beans, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood suger 248
5.30pm sour curd
Sir Aaj ke ki lantus 1u barano jabe ?
PaJR PHR Moderator: Lantus barano komano tar jonye either amader puro diner 7 point sugar profile dorkar 2-3 days jabot are nahole at least 2-3 diner por por fasting ta dekha proyojon
4PM er sugar ta depend korche 1:45 PM a newa lispro r upore
Patient Advocate: Thik achhe
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
24/08/24
Patient Advocate: 24/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, green banana, long beans, sponge gourd, egg and salad
12.00noon apple and guava
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg
4.00pm blood sugar 244
5.30pm sour curd
7.00pm banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
26/08/24
Patient Advocate: 25/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, green banana, bitter gourd, tomato and salad
12.00noon blood sugar 217
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish and fish
5.30pm sour curd
7.00pm banana
8.30pk one pc cream cake
9.45pm blood sugar 379
9.45pm lispro insulin 3u
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
12.00night blood sugar 201
PaJR PHR Moderator: Today's fasting sugars?
Patient Advocate: Fasting 95
PaJR PHR Moderator: Better not increase lantus now
Yesterday's higher post meal sugars may need dose titration of her short acting lispro insulin just before her meals
27/08/24
Patient Advocate: 26/08/24
7.45am blood sugar 95
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, brinjal, tomato, spiny guard, pumpkin, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm banana
9.45pm blood suger 157
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish except fish
10.40pm lantus insulin 4u
PaJR PHR Moderator: The above data driven fact that her high post meal blood sugars since two days resolved without any changes of insulin dose suggests that diet and activities factors are involved in the previous highs and current lows.
@Patient Advocate can you share details about her diet and or activities that you feel may have made a difference to her sugars?
@Narmeen Shah thanks for updating her EHR case report till 23/8/24!
29/08/24
Patient Advocate: 27/08/24
Ei din amra barir baire thakar janya test Kara hoy ni
Insulin lispro 3 times before meal by 2u each
Aar lantus 4u at night
28/0824
7.30am blood suger 69
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, green banana, papaya, spiny guard, bitter gourd, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 119
5.30pm sour curd
7.00pm oats
8.15pm amul kool 3/4 bottle
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
PaJR PHR Moderator: Lantus aabar 3U kore dewa bhalo keno ki ota abar dangerous hypoglycemia r pothe niye choleche.
0.5U dose titration korte parle bhalo hoto
Patient Advocate: Ok Sir, ajke sugar level ta dekhe apnake janabo
PaJR PHR Moderator: Gotokal er fasting dekhe uporer montobbo korechilam.
Aajker fasting ta jaante parle bhalo hoto
Patient Advocate: 29/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, green banana, long beans, egg and salad
12.00noon blood sugar 319
12.00noon mosambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 199
30/08/24
Patient Advocate: 5.30pm sour curd
7.00pm banana
9.45pm blood sugar 210
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
PaJR PHR Moderator: Lispro should have been 3 units before breakfast yesterday and 2 units before lunch
Lantus should have been 3 units
Patient Advocate: 30/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, long beans, tomato and salad
12.00noon mosambi
1.45pm blood suger 275
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish
5.30pm sour curd
7.45pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
31/08/24
Patient Advocate: 12.00night blood suger 210
01/09/24
Patient Advocate: 31/08/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, pumpkin, chayote, papaya, long beans, and salad
12.00noon mosambi
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish and paneer
5.00pm prasad (fruits and mix of flour, milk, banana palm fruit, raisins)
7.00pm blood suger 253
7.30pm sugar free icecream
9.45pm 2u lispro insulin
9.55pm khichudi and previous vegetable
10.40pm 4u lantus insulin
Patient Advocate: 1.09.24
7.30am blood suger 80
7.30am nuts and dates
7.45am milk and puffed
02/09/24
Patient Advocate: 9.45am 2u lispro insulin
9.55am rice with papaya, chayote, green banana, long beans, Spiny guard, pumpkin, egg and salad
12.00noon mosambi, apple
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 228
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
PaJR PHR Moderator: (Gotokal er fasting dekhe uporer montobbo korechilam.
Aajker fasting ta jaante parle bhalo hoto) 👆
03/09/24
Patient Advocate: 2.09.24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, sponge gourd, long beans, green banana, soyabean and salad
12.00noon blood suger 267
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish
5.30pm sour curd
7.00pm banana
9.45pm blood sugar 107
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
04/09/24
Patient Advocate: 03.09.24
7.30am nuts and dates
7.45am milk
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, papaya, long beans, bitter gourd, spiny gourd, egg and salad
12.00noon mosambi
1.45pm blood sugar 257
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 140
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
12.00night blood sugar 179
04/09/24
7.30am blood sugar 174
7.30am nuts and dates
7.45am milk
05/09/24
Patient Advocate: 9.45am 2u lispro insulin
9.55am rice with pointed gourd, ribbed gourd, long beans, bitter gourd, spiny gourd, tomato, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 211
5.30pm sour curd
7.00pm little bit of dosa and banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pn 4u lantus insulin
06/09/24
Patient Advocate: 5.09.24
7.30am nuts and dates
7.45am milk
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, green banana, papaya, long beans, bitter gourd, egg and salad
12.00noon blood sugar 249
12.00noon mosambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 71
5.30pm sour curd
7.00pm banana
9.30pm pizza
9.45pm 2u lispro insulin
9.55pm rice with as same as lunch dish
10.40pm 4u lantus insulin
PaJR PHR Moderator: 2 unit of lispro appears less and 3 units appears dangerously close to hypoglycemia!
If only we could procure 2.5
Check fasting sugars to decide the suitability of the current lantus dose
Patient Advocate: Ok Sir
6.09.24
7.30am blood sugar 135
7.30am milk and puffed rice
07/09/24
Patient Advocate: 9.45am 2u lispro insulin
9.55am rice with chayote, green banana, papaya, long beans, pointed gourd, tomato, bitter gourd,spiny gourd and salad
12.00noon mosambi
1.45pm blood sugar 174
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish include fish
5.30pm sour curd
7.00pm banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
08/09/24
Patient Advocate: 7/09/24
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd chayote brinjal tomato fish and salad
12.00noon mosambi
1.45pm blood sugar 148
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish
5.38pm sour curd
7.00pm banana
9.45pm 2u lispro insulin
9.55pm khichdi
10.40pm 4u lantus insulin
12.00noon blood sugar 45
PaJR PHR Moderator: 12:00 AM hypoglycemia!? Any symptoms?
Patient Advocate: No Sir
1 teaspoon sugar was given
PaJR PHR Moderator: No symptoms?
She needs CGM to prevent such episodes
Patient Advocate: 8.09.24
7.30am blood sugar 101
7.30am nuts and dates
7.45am milk and puffed
09/09/24
Patient Advocate: 9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, green banana, papaya, long beans, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 129
5.30pm sour curd
7.00pm oats
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 3u lantus insulin
10/09/24
Patient Advocate: 9.09/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with chayote, green banana, papaya, long beans, pointed gourd, egg and salad
12.00noon mosambi
1.45pm blood sugar 280
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg
4.00pm blood sugar 285
5.30pm sour curd
7.00pm banana
9.45pm blood sugar 297
9.45 3u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
PaJR PHR Moderator: Slightly high today due to x factors!
Patient Advocate: 10/09/24
7.30am nuts and dates
7.45am milk with palm (tal)
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, bitter gourd, long beans, green banana, and salad
12.00noon blood sugar 218
12.00noon mosambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm milk with palm and banana
9.45pm blood sugar 208
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
11/09/24
Patient Advocate: 10.40pm 4u lantus insulin
11/09/24
7.30am fasting blood suger 72
7.30am nuts and dates
7.45am milk with puffed rice
PaJR PHR Moderator: Low fasting reflects the need for optimizing dose of lantus
Higher post meal sugars means the lispro needs to be optimised but again due to x factors as well as known factors such as diet and exercise, this is difficult as the sugar levels keep varying till we able to monitor it more meticulously
12/09/24
Patient Advocate: 9.45am 2u lispro insulin
9.55am rice with papaya, chayote, bitter gourd, spiny gourd, ribbed gourd, tomato, egg and salad
12.00noon mosambi
1.45pm blood sugar 89
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
12.00night blood suger 93
PaJR PHR Moderator: The lispro should have been 1 unit yesterday at least starting from before lunch and dinner
The lantus needs to be reduced to 3
Patient Advocate: Ok Sir
Sir ekhane ekta jinish lakshya kara jachhe lantus ta use korte korte kichhu din por por pen er madhya haoa(air) dhuke jachche sei samay lantus ja deoa hoy puro ta dhoke na takhon sugar level bere jai।
Abar air ta barkore diye tarpor push korle takhon sugar level thik thak ashe।
Kintu air ta jadi alpo thake tahole bar korte asubidha hay
PaJR PHR Moderator: @Meta AI please translate this for our other group members
Meta AI: I'd be happy to help! Please share the text you'd like me to translate, and let me know which language you'd like it to be translated into.
PaJR PHR Moderator: @Meta AI Sir ekhane ekta jinish lakshya kara jachhe lantus ta use korte korte kichhu din por por pen er madhya haoa(air) dhuke jachche sei samay lantus ja deoa hoy puro ta dhoke na takhon sugar level bere jai।
Abar air ta barkore diye tarpor push korle takhon sugar level thik thak ashe।
Kintu air ta jadi alpo thake tahole bar korte asubidha hay
Meta AI: I can translate that for you. Here's the translation:
"When using Lantus, after a few days, air enters the pen, and if the full dose is not administered at that time, the sugar level rises. If air is removed by tapping and then injecting, the sugar level remains under control. However, if there is less air, it is difficult to administer the dose."
Please note that this text appears to be discussing the use of an insulin pen, specifically Lantus, and the importance of removing air from the pen to ensure accurate dosing and blood sugar control. If you have any further questions or need additional assistance, feel free to ask!
PaJR PHR Moderator: 👆@Participant 19 @Participant 20 @Participant 21 would you like to comment on this?
Sir ekhane ekta jinish lakshya kara jachhe lantus ta use korte korte kichhu din por por pen er madhya haoa(air) dhuke jachche sei samay lantus ja deoa hoy puro ta dhoke na takhon sugar level bere jai।
Abar air ta barkore diye tarpor push korle takhon sugar level thik thak ashe।
Kintu air ta jadi alpo thake tahole bar korte asubidha hay
@Meta AI please translate this for our other group members
I can translate that for you. Here's the translation:
"When using Lantus, after a few days, air enters the pen, and if the full dose is not administered at that time, the sugar level rises. If air is removed by tapping and then injecting, the sugar level remains under control. However, if there is less air, it is difficult to administer the dose."
Please note that this text appears to be discussing the use of an insulin pen, specifically Lantus, and the importance of removing air from the pen to ensure accurate dosing and blood sugar control. If you have any further questions or need additional assistance, feel free to ask!
Participant 20: Will need a trend to make any reasonable conclusion.
Please also consider Thyroid and Adrenal insufficiency as he could be at high risk for Autoimmune polyglandular syndromes.
Patient Advocate: Same problem was seen first time also in lispro pen
PaJR PHR Moderator: Here's the trend since last 6 months 👇
https://narmeenshah.blogspot.com/2024/07/3-year-old-child-type1-diabetes-insulin.html?m=1
@Narmeen Shah @Participant 22 can you put it in an LLM and see if you can share it graphically since last one month and separately for last one week?
Narmeen Shah: Ok sir
PaJR PHR Moderator: Inputs from our pediatric endocrinologist in NJ:
I’m not sure I understand the question correctly: air bubbles have to be removed from pens at first use, and from syringes at every use. Typically, if the technique is correct, then after the first expulsion of air from a cartridge, there should be no way for air to enter the cartridge. Now, they will have to waste some insulin at the start to get rid of air… sometimes they have to do it a few times, because some cartridges can have more air.
Has someone watched the technique of injection?
My mother has been using Basalog Pens for at least 10 years now. And she had this issue initially, until we made her watch some instructional videos. She was loath to waste even small amounts of insulin initially, because of the cost, so she was skipping the step of removing air bubbles!
Here’s one, but if you have something in a local language, it’ll be better.
https://youtu.be/ZcfKG0Mp3kI?si=cW7ggTLgBJxlytmq
PaJR PHR Moderator: Please share a video of how you use the pen today keeping the patient deidentified
I think he may have shared a similar video earlier. Is it in her case report link?
Patient Advocate: এই কলমটির বর্তমান অবস্থা পর্যন্ত দুবার বাতাস( air) বার করা হয়ে গেছে, আর সেটা শুরু তে নয় দুবারই ব্যবহারের মাঝখানে l
12/09/24
7.30am blood sugar 53
7.30am nuts, chocolate
and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, bitter gourd, spiny gourd, tomato, pumpkin, egg and salad
12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood suger 128
5.30pm sour curd
7.00pm banana
9.45pm 2u lispro insulin
9.55pm dinner with as same as previous dish
10.40pm 3u lantus insulin
13/09/24
PaJR PHR Moderator: The hypoglycemia is the effect of 4U of lantus on 11/9/2024!
Did she have any symptoms of hypoglycemia?
Patient Advocate: No Sir
13.09.24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, green banana, long beans, ribbed gourd, bitter gourd, pumpkin egg and salad
12.00noon blood sugar 282
12.00noon apple
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm banana
9.45pm blood suger 57
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 3u lantus insulin
14/09/24
PaJR PHR Moderator: Let's start with the trends of fluctuations for this week.
Also @Patient Advocate can you share an image of the paper based charts that you keep for this and last month?
The case report contains some paper based charts from few months back I guess
Because we don't have CGM here we are unable to keep track of the number of asymptomatic hypoglycemia events this patient is having @Participant 20
@Participant 23 had promised to find out some monitoring equipment developed by his IIT colleagues but I guess that didn't materialize?
We also looked for CGM monitors suitable for 3 years old children and found some but perhaps we gave up earlier due to logistics.
Any idea what they may use for monitoring for 3 years old diabetics in UK and US?
Narmeen Shah: Greetings sir 🙏
Sir I tried my best for two days to plot the data into graph using llm, python coding and spss software as well as manually but wasn't able to get the desired output and unable to merge both the graphs with respect to time. Beyond my expertise. 🙏
Below are the visualizations for what I was able to do so far.
(For the whole month of August 2024)
PaJR PHR Moderator: Well done 👏
The fluctuations are standing out
Was her lantus ever increased to 5?
Would be nice to see what has been brewing in September till now
Do update her case report with the above images that you generated
Narmeen Shah: Yes sir. Here's the data I extracted.
https://docs.google.com/spreadsheets/d/18DeTEzBh_cm27WhVqF3dLloLw6JnEBGNl5Uj1gPv4wY/edit?usp=sharing
Here's the input & output.
https://colab.research.google.com/drive/1rh2STRsbpcS4Cxihgnf0mGf75Cu7MiwT?usp=sharing
PaJR PHR Moderator: Let's archive all the above into her case report
Narmeen Shah: Ok sir
Participant 20: I'm aware that Abbott Freestyle Libre has been discussed. What's the progress on that front?
PaJR PHR Moderator: Can you share if it can be ordered on Amazon for a three year old child?
Patient Adavocate: 14/09/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, bitter gourd, spiny gourd, tomato, long beans, pumpkin, egg and salad
12.00noon pieces of mixed fruit ( prasad)
1.45pm blood suger 226
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg
4.00pm blood sugar 74
5.30pm sour curd
7.00pm banana
Narmeen Shah:
PaJR PHR Moderator: Parents described benefits of CGM use: decreased worry about glucose excursions, improved sleep, increased sense of safety with children who cannot recognize or express symptoms of hypo- or hyperglycemia, and greater comfort with other caregivers, especially using remote monitoring functionality when away from children. Challenges included painful insertions, wearing multiple devices on small bodies, disruptive alerts, data gaps due to lost signals, skin/adhesive problems, and difficulty interpreting the amount of information generated by CGM.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708264/
PaJR PHR Moderator: Inputs from global pediatric endocrinologist:
Instead of daily excursions, can we get a graph of mean daily values (pre- and post/breakfast, pre- and post-lunch, pre- and post-dinner etc): values may not be available for each time point everyday. Grouping the timings around meals is better than calendar times, and allows an assessment of responses in the fed and post-absorptive states.
15/09/24
Patient Advocate: 9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 3u lantus insulin
15/09/24
7.30am blood sugar 270
7.30am nuts and dates
7.45am milk with puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, long beans, pumpkin, egg and salad
Paticipant 20: My analysis is that the 2U lispro is not sufficing for both breakfast and Lunch.
Lispro for dinner appears okay.
Lantus 4U seems perfect at bedtime. However there are occasional low sugar events in the morning.
Ideally we need 2 am or 3 am blood sugars too to check if there is any nocturnal high or low blood sugars.
Narmeen Shah:
Assumptions
1. Post and Pre meal times don't mean that nothing is fed between these intervals.
2. Insulin has been given either after the meal or before the meal so the sugar levels are not independent of interventions.
https://docs.google.com/spreadsheets/d/18DeTEzBh_cm27WhVqF3dLloLw6JnEBGNl5Uj1gPv4wY/edit?usp=sharing
https://colab.research.google.com/drive/1rh2STRsbpcS4Cxihgnf0mGf75Cu7MiwT?usp=sharing
PaJR PHR Moderator: Well done 👏
Keep adding these to her online case report too
Narmeen Shah: Ok sir 🙏
Patient Advocate: 12.00noon mosambi
1.45pm 2u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 298
5.30pm sour curd
PaJR PHR Moderator: Quoting from the case report our notes on 👇
06/09/24
Patient Advocate: 5.09.24
7.30am nuts and dates
7.45am milk
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, green banana, papaya, long beans, bitter gourd, egg and salad
12.00noon blood sugar 249
12.00noon mosambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
4.00pm blood sugar 71
5.30pm sour curd
7.00pm banana
9.30pm pizza
9.45pm 2u lispro insulin
9.55pm rice with as same as lunch dish
10.40pm 4u lantus insulin
PaJR PHR Moderator: 2 unit of lispro appears less and 3 units appears dangerously close to hypoglycemia!
If only we could procure 2.5
Check fasting sugars to decide the suitability of the current lantus dose
Participant 20: Why not Actrapid? Slightly lesser peak than Lispro and a couple hours more duration of action.
https://drive.google.com/file/d/1_WP94jHW5P8t620REGJGX0rEmHYxdig5/view?usp=sharing
This is a document on "Dose adjustment for normal eating (DAFNE)" which allows for precise calculation of carbohydrate portion and adjust insulin doses accordingly.
The standard recommendation for 1 CP is 1 unit Lispro (Humalog). But I would advise to start with 1/2 (half) unit for each CP to see how the child responds.
16/09/24
PaJR PHR Moderator:
"Dyadic conversational inputs around this patient that would be useful for the entire team of learners here:
Pediatric Endocrinologist: Very useful! Thank you. If the stated assumptions are true (can it be checked?).
Moderator: @Narmeen Shah please see if you can verify the stated assumption/conclusion from your graph as in numbered the lines below:
1)...then, the fasting (pre-bf) is a tad too low.
The lid pro insulin at bf is not enough (bolts insulin has two jobs - to bring the pre-meal blood sugar down, if it’s high, and to cover the carbs + protein eaten at the meal).
2) In this case, the pre-bf values is on the lower end, and the post bf is very high.
So she needs more insulin at breakfast, not unexpected (“first meal effect”). The lid pro at lunch is good to cover her lunch (pre- and post-lunch are very similar, so if pre-lunch is decreased, post-lunch will also be lower).
Her dinner list spro is too much. So, I think if her breakfast lispro is increased, and dinner lispro is decreased, her sugars will even out.
This graph should be repeated every 2 weeks and adjustments need to be made.
PaJR moderator: Very valuable inputs for this patient. I guess the catch is in the dose increments and decrements as we are unable to increase it by 0.5U that would be safer?
Pediatric Endocrinologist: True, but I would reduce dinner lispro by 1 unit and increase breakfast lispro by 1
PaJR moderator: I guess that may have been done in the past if we could wade through the entire case report events documented till date since months and hence we were hung on titrating with 0.5."
Patient Advocate: 7.00,pm banana
9.45pm blood sugar 289
9.45pm 3u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
7.30am blood sugar 90
7.30am nuts and dates
7.42am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, long beans, Spiny guard, ribbed gourd, egg and salad
12.00noon blood suger 297
12.00noon mosambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm banana
17/09/24
PaJR PHR Moderator:
"Query:
Why it is happening that sugar levels are that much low in pre breakfast and high in post breakfast and low at night. Check the above daily routine again from sep 1 - sept 13 and analyze the keen aspect.
ChatGPT said:
The pattern of blood sugar levels being low in pre-breakfast and high in post-breakfast, followed by low at night, can be analyzed in the context of the provided daily routine and insulin doses. Here’s a detailed look at the possible reasons behind this pattern:
1. Pre-Breakfast Low Blood Sugars:
- - 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 fasting blood sugars are quite low on several days (e.g., 72 on 11/09, 53 on 12/09). This suggests the night dose of Lantus (4 units) might be slightly too high, as indicated by the PaJR PHR Moderator's recommendation to reduce Lantus to 3 units.
- - Overnight hypoglycemia (unnoticed due to lack of symptoms) may occur, leading to low morning fasting levels.
- - The low pre-breakfast levels may also be due to prolonged fasting (i.e., the time gap between dinner and breakfast).
2. Post-Breakfast High Blood Sugars:
- - The Lispro dose given at breakfast (2 units) appears insufficient to handle the carbohydrates and protein in the breakfast meal.
- - On many days, the post-breakfast sugars spike (e.g., 267 on 03/09, 282 on 13/09), indicating that the insulin-to-carbohydrate ratio at breakfast is inadequate.
- - The phenomenon of "dawn phenomenon" or "first meal effect" could also be at play, where insulin resistance is typically higher in the morning, requiring more insulin at breakfast.
- - 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.
3. Low Nighttime Blood Sugars:
- - After dinner, the pre-bedtime sugar levels (e.g., 57 on 13/09) are quite low, which suggests that the dinner Lispro dose (2 units) may be too high relative to the amount of carbs consumed at dinner.
- - The insulin sensitivity increases at night, which means the same dose of insulin might have a stronger effect, leading to low blood sugars before bed or overnight hypoglycemia.
- - The combination of long-acting Lantus and short-acting Lispro at night could be causing excessive lowering of blood sugars during the night, especially if the evening meal has fewer carbohydrates or if there is less activity.
Key Analysis Points:
1. Breakfast Lispro Dose Insufficient:
- - The post-breakfast blood sugars are significantly higher than pre-breakfast levels. The 2-unit Lispro given at breakfast may not be covering the amount of carbs/protein in breakfast or dealing with the "dawn phenomenon."
- - Increasing the Lispro dose at breakfast (e.g., from 2 units to 3 units) might help better manage these spikes.
2. Lantus Dose Too High at Night:
- - 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.
- - The PaJR PHR Moderator suggested this adjustment to optimize the nighttime glucose levels.
3. Dinner Lispro Needs Adjustment:
- - The 2 units of Lispro at dinner may be too much, especially if the evening meal is low in carbs. Reducing this dose to 1 or 1.5 units might prevent low post-dinner and pre-bedtime sugar levels.
4. Monitoring and Adjustments:
- - Continuous Glucose Monitoring (CGM) or frequent blood sugar checks might be necessary to track fluctuations throughout the day, especially overnight.
- - Adjusting both meal composition and insulin doses for different times of day is key to preventing these high-low swings.
Suggested Next Steps:
- - Increase Lispro dose at breakfast to 3 units to manage the morning spike.
- - Reduce Lantus to 3 units at night to prevent pre-breakfast lows.
- - Reduce Lispro at dinner (possibly to 1.5 units) to avoid low nighttime sugars.
This should help smooth out the extremes and stabilize blood sugar levels throughout the day.
Disclaimer:
The information provided in this analysis is intended for experimental and informational purposes only. It is not meant to replace professional medical advice, diagnosis, or treatment. Do not use this analysis as medical advice, as it could lead to unintended consequences or complications. Always seek the guidance of a healthcare professional before making any adjustments to your diabetes management plan.
PaJR PHR Moderator: Done by @Narmeen Shah. Please share the image showing your method too here
থাকে।
মূল বিশ্লেষণের বিষয়:
১. প্রাতঃরাশের লিসপ্রো ডোজ অপর্যাপ্ত:
- প্রাতঃরাশের পরে রক্তে শর্করা প্রাক-নাস্তার মাত্রার তুলনায় উল্লেখযোগ্যভাবে বেশি। প্রাতঃরাশের সময় দেওয়া 2-ইউনিট লিসপ্রো প্রাতঃরাশের কার্বোহাইড্রেট/প্রোটিনের পরিমাণকে কভার করে না বা "ভোরের ঘটনা" নিয়ে কাজ করতে পারে না।
- প্রাতঃরাশের সময় Lispro ডোজ বাড়ানো (যেমন, 2 ইউনিট থেকে 3 ইউনিট) এই স্পাইকগুলিকে আরও ভালভাবে পরিচালনা করতে সহায়তা করতে পারে।
প্রশ্ন*
কেন এমন হচ্ছে যে সকালের নাস্তায় চিনির মাত্রা অনেক কম এবং সকালের নাস্তায় বেশি এবং রাতে কম। 1 সেপ্টেম্বর থেকে 13 সেপ্টেম্বর পর্যন্ত উপরের দৈনিক রুটিনটি আবার পরীক্ষা করুন এবং প্রখর দিকটি বিশ্লেষণ করুন।
চ্যাটজিপিটি বলেছেন:
প্রাক-নাস্তায় রক্তে শর্করার মাত্রা কম এবং প্রাতঃরাশের পরে উচ্চতর হওয়ার ধরণ, রাতে কম হওয়ার পর, প্রদত্ত দৈনিক রুটিন এবং ইনসুলিনের মাত্রার পরিপ্রেক্ষিতে বিশ্লেষণ করা যেতে পারে। এখানে এই প্যাটার্নের পিছনে সম্ভাব্য কারণগুলির একটি বিশদ চেহারা রয়েছে:
১. প্রাতঃরাশের লো ব্লাড সুগার:
- ল্যান্টাস (দীর্ঘ-অভিনয় ইনসুলিন) রাত্রি 10:40 টায় পরিচালিত হয়, যা রাতের মধ্যে সর্বোচ্চ পর্যায়ে পৌঁছায়, সম্ভাব্যভাবে সকালে (প্রাক-খাওয়া) কম রক্তে শর্করার ক্ষেত্রে অবদান রাখে।
- উপবাসের রক্তে শর্করার পরিমাণ বেশ কয়েকদিনে কম থাকে (যেমন, 11/09 তারিখে 72, 12/09 তারিখে 53)। এটি পরামর্শ দেয় যে ল্যান্টাস (4 ইউনিট) এর রাতের ডোজ কিছুটা বেশি হতে পারে, যেমনটি ল্যান্টাসকে 3 ইউনিটে কমানোর জন্য PaJR PHR মডারেটরের সুপারিশ দ্বারা নির্দেশিত হয়েছে।
- রাতারাতি হাইপোগ্লাইসেমিয়া (লক্ষণের অভাবের কারণে অলক্ষিত) ঘটতে পারে, যার ফলে সকালের উপবাসের মাত্রা কম হয়।
- প্রাক-নাস্তার কম মাত্রা দীর্ঘায়িত
উপবাসের কারণেও হতে পারে
(অর্থাৎ, রাতের খাবার এবং
প্রাতঃরাশের মধ্যে সময়ের ব্যবধান)
2. সকালের নাস্তার পরে উচ্চ রক্তে শর্করা:*
- প্রাতঃরাশে দেওয়া লিসপ্রো ডোজ (2 ইউনিট) প্রাতঃরাশের খাবারে কার্বোহাইড্রেট এবং প্রোটিন পরিচালনা করার জন্য অপর্যাপ্ত বলে মনে হয়।
- অনেক দিন, সকালের নাস্তার পর শর্করার পরিমাণ বেড়ে যায় (যেমন, 03/09 তারিখে 267, 13/09 তারিখে 282), ইঙ্গিত করে যে সকালের নাস্তায় ইনসুলিন-থেকে-কার্বোহাইড্রেট অনুপাত অপর্যাপ্ত।
- "ভোরের ঘটনা" বা "প্রথম খাবারের প্রভাব" এর ঘটনাটিও খেলতে পারে, যেখানে ইনসুলিন প্রতিরোধ সাধারণত সকালে বেশি হয়, প্রাতঃরাশের সময় আরও ইনসুলিনের প্রয়োজন হয়।
- খাবারের সংমিশ্রণে (যেমন, পাফ করা ভাত, বাদাম, খেজুর) সম্ভবত উচ্চ গ্লাইসেমিক ইনডেক্স (GI) কার্বোহাইড্রেট রয়েছে যা রক্তে শর্করার দ্রুত বৃদ্ধি ঘটায় এবং এটি পরিচালনা করার জন্য লিসপ্রোর 2 ইউনিট যথেষ্ট নাও হতে পারে।
3. কম রাতের রক্তে শর্করা:*
- রাতের খাবারের পরে, ঘুমানোর আগে শর্করার মাত্রা (যেমন, 13/09 তারিখে 57) বেশ কম, যা পরামর্শ দেয় যে রাতের খাবারে খাওয়া কার্বোহাইড্রেটের পরিমাণের তুলনায় ডিনার লিসপ্রো ডোজ (2 ইউনিট) খুব বেশি হতে পারে।
- রাতে ইনসুলিনের সংবেদনশীলতা বৃদ্ধি পায়, যার অর্থ ইনসুলিনের একই ডোজ আরও শক্তিশালী প্রভাব ফেলতে পারে, যার ফলে শোবার আগে বা রাতারাতি হাইপোগ্লাইসেমিয়া রক্তে শর্করার পরিমাণ কম হতে পারে।
- রাতে দীর্ঘ-অভিনয়কারী ল্যান্টাস এবং স্বল্প-অভিনয় লিসপ্রোর সংমিশ্রণ রাতের বেলা রক্তে শর্করার অত্যধিক হ্রাস ঘটাতে পারে, বিশেষ করে যদি সন্ধ্যার খাবারে কম কার্বোহাইড্রেট থাকে বা যদি কম কার্যকলাপ থাকে।
মূল বিশ্লেষণের বিষয়:
১. প্রাতঃরাশের লিসপ্রো ডোজ অপর্যাপ্ত:
- প্রাতঃরাশের পরে রক্তে শর্করা প্রাক-নাস্তার মাত্রার তুলনায় উল্লেখযোগ্যভাবে বেশি। প্রাতঃরাশের সময় দেওয়া 2-ইউনিট লিসপ্রো প্রাতঃরাশের কার্বোহাইড্রেট/প্রোটিনের পরিমাণকে কভার করে না বা "ভোরের ঘটনা" নিয়ে কাজ করতে পারে না।
- প্রাতঃরাশের সময় Lispro ডোজ বাড়ানো (যেমন, 2 ইউনিট থেকে 3 ইউনিট) এই স্পাইকগুলিকে আরও ভালভাবে পরিচালনা করতে সহায়তা করতে পারে।
২। ল্যান্টাস ডোজ রাতে খুব বেশি:
- প্রাতঃরাশের কম রক্তে শর্করা পরামর্শ দেয় যে ল্যান্টাস ডোজ রাতে কমাতে হবে। এটি 4 ইউনিট থেকে 3 ইউনিটে কমিয়ে রাতের হাইপোগ্লাইসেমিয়া প্রতিরোধ করতে পারে।
- PaJR PHR মডারেটর রাতের গ্লুকোজ মাত্রা অপ্টিমাইজ করার জন্য এই সমন্বয়ের পরামর্শ দিয়েছেন।
৩. ডিনার লিসপ্রোর সামঞ্জস্য প্রয়োজন:
- রাতের খাবারে লিসপ্রোর 2 ইউনিট খুব বেশি হতে পারে, বিশেষ করে যদি সন্ধ্যার খাবারে কার্বোহাইড্রেট কম থাকে। এই ডোজটি 1 বা 1.5 ইউনিটে কমিয়ে রাতের খাবারের পরে এবং ঘুমানোর আগে চিনির মাত্রা কম হওয়া প্রতিরোধ করতে পারে।
4. পর্যবেক্ষণ এবং সমন্বয়:
- ক্রমাগত গ্লুকোজ মনিটরিং (CGM) বা ঘন ঘন রক্তে শর্করার পরীক্ষা সারা দিন, বিশেষ করে রাতারাতি ওঠানামা ট্র্যাক করার জন্য প্রয়োজন হতে পারে।
- দিনের বিভিন্ন সময়ের জন্য খাবারের সংমিশ্রণ এবং ইনসুলিনের ডোজ উভয়ই সামঞ্জস্য করা এই উচ্চ-নিম্ন দোল রোধ করার মূল চাবিকাঠি।
প্রস্তাবিত পরবর্তী পদক্ষেপ:
- সকালের স্পাইক পরিচালনা করতে সকালের নাস্তায় লিসপ্রোর ডোজ 3 ইউনিটে বৃদ্ধি করুন।
- প্রাতঃরাশের কম হওয়া রোধ করতে রাতে ল্যান্টাসকে 3 ইউনিটে কমিয়ে দিন।
- রাতে কম শর্করা এড়াতে রাতের খাবারে লিসপ্রো কমিয়ে দিন (সম্ভবত 1.5 ইউনিট)।
এটি চরমগুলিকে মসৃণ করতে এবং সারা দিন রক্তে শর্করার মাত্রা স্থিতিশীল করতে সহায়তা করবে"
Narmeen Shah: Sir
1. I first copy pasted the complete data of the case report from sept 1 - sept 13.
2. Excel data that I created to calculate the pre- post- mean blood sugar values for the graph.
3. Wrote my two assumptions and ask to verify the stated assumptions.
- Post and Pre meal times don't mean that nothing is fed between these intervals.
- Insulin has been given either after the meal or before the meal so the sugar levels are not independent of interventions.
4. Chatgpt broke down the assumptions and reponded about it in four points.
5. After that I gave the query/prompt:
- - Why it is happening that sugar levels are that much low in pre breakfast and high in post breakfast and low at night. Check the above daily routine again from sep 1 - sept 13 and analyze the keen aspect.
PaJR PHR Moderator: Thanks!
Update all to the case report too
Narmeen Shah: Ok sir. Thank you 🙏🙏
Patient Advocate: 9.45pm blood sugar 160
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
12.00night blood suger 273
17/09/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with pointed gourd, chayote, papaya, long beans, bitter gourd, ribbed gourd, egg and salad
12.00noon mosambi
1.45pm blood sugar 266
5.30pm sour curd
PaJR PHR Moderator: Feedback to this from our pediatric endocrinologist:
ChatGPT’s medical algorithms are not perfect.
Would not recommend using it for medical decision making.
I would recommend reducing the lispro at dinner first. Reducing Lantus will mean the blood glucose during the day - lunch/pre-dinner blood glucose levels will become higher.
You can ask the person to give the Lantus earlier - 10:40 is way, way too late. Why not earlier - at 7 or 8 pm.
The post-dinner blood glucose levels are low - in a 3-year old, we typically run it around 120-150.
PaJR PHR Moderator: 👆@Patient Advocate lantus ta aekhon 7-8PM er modhye diye nile bhalo hoi
Patient Advocate: Sir আমার একটা কথা বলার ছিল, আমি জানিনা তাই একটা কথা জানার জন্য প্রশ্ন করছি l
ডিনার এর আগে lispro ফাস্ট একশন ইনসুলিন দেওয়া হয় l আবার শুনেছি ( কিন্তু আমি সঠিক জানি না ) Lantus দেওয়ার 6 ঘণ্টা পর থেকে কাজ করে তো সে ক্ষেত্রে শেষ রাতে মোটামুটি 2am এর পর suger level ta একটু বেশি কমার চান্স থাকবে না কি ?
PaJR PHR Moderator: Lispro'r action majhraat obdhi thakar kotha noi. Khawar du ghonta baade shesh hoye jawar kotha
Patient Advocate: Lispro যদি রাতের খাবার এর সুগার টা সঠিক জায়গায় নিয়ে আসে আমি তারপর শেষ রাতে Lantus এর action এর ব্যাপারে বলছিলাম। Sir l
PaJR PHR Moderator: Lantus kokhonoi hypoglycemia korar kotha noi karon ota just sugar take baseline a maintain korte sahajjo kore
Patient Advocate: এখন বুঝলাম স্যার
PaJR PHR Moderator: Kintu jehetu lantus er slow action ta overall sugar take komiye aane tai overall hypoglycemic event a lantus er ekta direct obodan na thakleo indirect obodan thakte pare oi jonyei lantus er dose tao shei bhabe titrate kora dorkar tabe overall evening 7-8 PM nilei bhalo
Lispro - action starts by 30 minutes, peaks 1-2 hours, gone by 3 hours; Regular - action starts by 60 minutes, peaks 3-5 hours, gone by 8 hours - etc. Lantus - pretty flat with repeated use, especially if dose is >10 units. Hypos less with Lantus and degludec.
18/09/24
Patient Advocate: 1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00 pm banana
9.45pm blood sugar 220
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
Thik achhe Sir
Participant 20: As advised by pediatric endocrinologist, please give the Lantus injection earlier and please consider changing meal times to earlier slots for better optimisation.
Patient Advocate: What should mealtime be ?
PaJR PHR Moderator: Early dinner at 9:00 PM
Participant 20: From my newbie learnings here - Detemir (Levemir brand) can be considered if Hypos are concerning.
Twice a day; lesser risk of Hypos and more agency for dose titration? @PaJR PHR Moderator
Patient Advocate: 18/09/24
7.30am nuts and dates 7.45am milk with palm
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, bitter gourd, spiny gourd, ribbed gourd, long beans, egg and salad
12.00noon blood suger 230
12.00noon mosambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm palm with milk
9.45pm blood sugar 228
9.45pm 2u lispro insulin
9.55pm dinner with as same as lunch dish
10.40pm 4u lantus insulin
Kal theke 7-8pm e lantus dibo
19/09/24
Patient Advocate:
PaJR PHR Moderator: Ingredients?
Patient Advocate: It is palm(tal) which was taken yesterday day in two times
19/09/24
7.30am nuts and dates
7.45am milk and puffed rice
9.45am 2u lispro insulin
9.55am rice with papaya, chayote, green banana, long beans, bitter gourd, spiny gourd, ribbed gourd, egg and salad
12.00noon mosambi
1.45pm blood sugar 360
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
5.30pm sour curd
PaJR PHR Moderator: Pre Breakfast lispro needs to be increased to 3U
Patient Advocate: Ok Sir
7.00pm banana
9.00pm 4u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
20/09/24
Patient Advocate: 20/09/24
7.30am blood suger 183
7.30am nuts and dates
7.45am payesh( milk, kaun rice, dates and raisins)
9.30am 3u lispro insulin
9.40am rice with chayote, green banana, long beans, bitter gourd, spiny gourd, ribbed gourd, egg and salad
11.30am apple
1.30pm 3u lispro insulin 1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
21/09/24
Patient Advocate: 7.00pm banana
7.45pm 5u lantus insulin
9.30pm blood sugar 163
9.40pm dinner with as same as lunch dish
21/09/24
7.30am blood sugar 124
7.30am nuts and dates
7.45am milk and puffed rice
9.30am 2u lispro insulin
9.40am rice with papaya, chayote, green banana, long beans, sponge gourd, tomato, spiny guard, egg and salad
11.30am apple
1.30pm blood sugar 334
1.30pm 4u lispro insulin
1.40pm lunch with same previous dish except egg
What is the reason of high sugar where lantus was given 5u in last night?
PaJR PHR Moderator: Why did we reduce the lispro today? That's the reason.
Lantus is a long acting drug that acts and builds up in the system very slowly over days and will cause an overall reduction of the basal blood sugar and not address anything specifically such as post meal sugars
Patient Advocate: There was 124 suger level in fasting
PaJR PHR Moderator: The action of lantus is best perceived in the fasting sugar values.
However in other patients with type 1 diabetes like 30F who's group you are also following and is fully archived here👇
you may have noticed how we could slowly bring her total insulin requirements down to 3-4 units of lantus only per day.
It's possible that at some point even 3F's requirements could fall to that
👆So increasing lantus from 4 to 5U here reduced the fasting from 183 to 124
22/09/24
Patient Advocate: 5.30pm sour curd
7.00am banana
7.30pm 4u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
11.50pm blood sugar 163
22/09/24
7.30am blood sugar 133
7.45am milk
9.30am 2u lispro insulin
9.48am rice with papaya, chayote, bitter gourd, spiny gourd, sponge gourd, tomato, long beans and salad
11.30am apple
1.30pm blood sugar 173
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish and fish
5.00pm sour curd
7.00pm oats
8.00pm 4u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
23/09/24
Patient Advocate: 11.45pm blood sugar 138
23/09/24
7.30am nuts and dates
7.45am milk and puffed rice
9.30am 2u lispro insulin
9.40am rice with spiny gourd, ribbed gourd, tomato, papaya, chayote, sponge gourd, long beans, egg and salad
11.40am blood sugar 254
12.00noon mosambi
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm oats
8.00pm 5u lantus insulin
9.30pm blood sugar 140
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
24/09/24
PaJR PHR Moderator: The post breakfast high is because of the lower dose of lispro before breakfast compared to those before lunch and dinner.
Always measure fasting blood sugars the day after you have increased lantus dose. Yesterday it was increased so today's fasting is important
Patient Advocate: 24/06/24
7.30am fasting blood suger 151
7.30am nuts and dates
7.45am milk and puffed rice
9.30am 3u lispro insulin
9.40am rice with long beans, papaya, chayote, sponge gourd, tomato, spiny guard, pumpkin, egg and salad
11.30am mosambi
1.30pm blood sugar 100
1.40pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm banana
8.30pm 4u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish and include egg
25/09/24
Patient Advocate: 11.45pm blood sugar 94
PaJR PHR Moderator: 👆This fasting was an effect of the lantus 5U day before yesterday
The 1:30PM pre lunch blood sugar yesterday is an effect of the morning lispro 3U as well as day before yesterday's lantus 5U basal effect and same basal effect of lantus 5U day before yesterday is partly reducing the 11:40PM post dinner other than the pre dinner lispro of 2U
That is how the basal lantus unit has a synergistic symmetric effect on the overall basal sugar levels so while we increase lantus we can always decrease the short acting pre meal lispro.
In @30F Diabetes1 10 years Madhya Pradesh PaJR 's patient we managed to stop the short acting insulin altogether and her patient is currently only on lantus insulin alone once daily
Patient Advocate: 7.30am fasting blood sugar 75
7.30am nuts
7.40am milk, puffed rice and dates
PaJR PHR Moderator: My hypothesis for this fasting value is that this is the residual effect of your 5U of lantus day before yesterday and 4U of lantus yesterday.
Share her post breakfast blood sugar and remain vigilant for hypoglycemia
Patient Advocate: 9.30am 2u lispro insulin
9.40am rice with papaya, chayote, pointed gourd, bitter gourd, tomato, spiny guard, long beans, egg and salad
11.30am apple
1.30pm blood sugar 174
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm banana
8.30pm 4u lantus insulin
26/09/24
Patient Advocate: 9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
26/09/24
7.30am blood sugar 81
7.30am nuts
7.40am milk, puffed rice and dates
9.30am 2u lispro insulin
9.40am rice with papaya, long beans, bitter gourd, pumpkin, chayote, pointed gourd, egg and salad
11.30am apple
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm banana
8.30pm 4u lantus
9.30pm blood sugar 247
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
27/09/24
Patient Advocate: 11.45pm blood sugar 66
Plain suger 0.5 teaspoon
No symptoms
PaJR PHR Moderator: She needed 2.5
How about trying the insulin syringe instead of pen to get 2.5 just like @30F Diabetes1 10 years Madhya Pradesh PaJR 's patient is using?
28/09/24
Patient Advocate: 27/09/24
7.30am nuts
7.45am milk, dates and puffed rice
9..30am 2u lispro insulin
9.40am rice with papaya, chayote, sponge gourd, tomato, spiny guard, pumpkin, pointed gourd, egg and salad
11.45am mosambi
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg
4.00pm blood suger 94
5.30pm sour curd
7.00pm banana
8.30pm 4u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch with and include egg
29/09/24
Patient Advocate: 28/09/24
7.30am nuts
7.40am milk, puffed rice and dates
9.30am 2u lispro insulin
9.40am rice with pointed gourd, chayote, bitter gourd, spiny gourd, long beans, egg and salad
11.50am blood sugar 200
11.50am apple
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm banana
8.30pm 4u lantus insulin
9.30pm blood sugar 220
9.40pm gf dinner with as same as lunch dish and papad
29/09/24
7.30am blood suger 127
7.38am nuts
7.45am milk, puffed rice and dates
9.30am rice with chayote, bitter gourd, spiny gourd, sponge gourd, long beans, egg and salad
11.30am mosambi
1.30am pm blood sugar 124
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish
5.30pm sour curd
7.00pm oats
8.30am 4u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with rice, pulses, mutton and salad
30/09/24
Patient Advocate: 11.45pm blood suger 156
PaJR PHR Moderator: How much lispro before breakfast yesterday?
Patient Advocate: Lispro before breakfast 2u
Patient Advocate: 30/09/24
7.30am blood suger 145
7.30am payesh (milk, dates, rice, and nuts)
9.30am 2u lispro insulin
9.40am rice and ribbed gourd, bitter gourd, long beans, egg and salad
01/10/24
Patient Advocate: 11.30am mosambi
11.40am blood suger 156
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg
4.00pm blood sugar 181
5.30pm sour curd
7.00pm oats
8.30pm 4u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
02/10/24
Patient Advocate: 1.10.24
7.30am nuts
7.40am milk puffed rice and dates
9.30am 2u lispro insulin
9.40am rice with pointed gourd, chayote, ribbed gourd, bitter gourd, tomato, egg and salad
11.30am mosambi
1.30pm blood suger 169
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm banana
8.30pm 4u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
2.10.24
7.30am fasting blood sugar 138
7.30am nuts
7.40am milk puffed rice and dates
PaJR PHR Moderator: 👍
Participant 20: Good to see a stable pattern has been achieved.
Any reason why lunch and dinner are being given slightly late?
Asking because best Lantus response can be tailored based on meal times.
PaJR PHR Moderator: I guess that's the cultural dinner time for the patient's location
Participant 20: Perhaps global accultration can bring better outcomes?
PaJR PHR Moderator: It's a slow simmering process
Participant 20: Definitely.
I agree that Healthcare should be tailored accordingly and not the other way round. Although sometimes the flipside must be done.
Narmeen Shah: Sir @PaJR PHR Moderator
Mean blood sugar levels From Sept 14 - Sept 30
PaJR PHR Moderator: Thanks. This is a very useful summary
Narmeen Shah: 🙏🙏🙏🙏🙏🙏
PaJR PHR Moderator: Inputs on this from our Global expert 👇
"Pediatric Endocrinologist NJ: Fasting is better, but the post-breakfast could be lower.
Pediatric Endocrinologist NJ: And the post dinner should be a bit higher."
03/10/24
PaJR PHR Moderator: Further inputs for this team from our global expert 👇
"Pediatric Endocrinologist NJ: If the patient's advocate doesn’t want to increase the lispro before breakfast, they should increase the protein content of the meal and dial down the carbs of the breakfast. A dietician may be of help.
Pediatric Endocrinologist NJ: Since carbs and protein are equicaloric, an even swap will keep the calories the same.
Is the child getting routine pediatric care? Growth monitoring and immunizations?"
Patient Advocate: 9.30am 2u lispro insulin
9.40am rice with pointed gourd, chayote, tomato, ribbed gourd, bitter gourd, egg and salad
11.45am apple
1.30pm 2u lispro insulin
1.40am lunch with same previous dish except egg and include fish
4.00pm blood sugar 253
5.30pm sour curd
7.00pm banana
9.00pm 4u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
Patient Advocate: 3.10.24
7.30am nuts
7.45am milk, puffed rice and dates
9.30am 2u lispro insulin
9.40am rice with papaya, chayote, bitter gourd, tomato, long beans, pointed gourd, egg and salad
11.40am blood suger 308
11.45am apple
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm oats
8.30pm 4u lantus insulin
9.30pm blood sugar 323
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish and egg
04/10/24
Patient Advocate: 4.10.24
7.30am blood sugar 190
7.30am nuts
7.45am milk, puffed rice and dates
9.30am 2u lispro insulin
9.40am rice with pointed gourd, bitter gourd, tomato, long beans, papaya, chayote, egg and salad
11.45am Apple
1.30om blood sugar 336
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
Patient Advocate: Sir, can it be increased lantus by one unit today?
PaJR PHR Moderator: Why didn't you increase the breakfast lispro?
👆As mentioned before lantus action is reflected in the fasting sugars and on 2/10/24 her fasting was 138 with 4U of lantus
Patient Advocate: Fasting blood sugar was 190
05/10/24
Patient Advocate: 7.00pm banana
8.30pm 5u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
11.45pm blood sugar 100
Patient Advocate: 5.10.24
7.30am fasting blood sugar 121
7.30am nuts
7.40am milk, puffed rice and dates
PaJR PHR Moderator: Inputs from our pediatric endocrinologist NJ👇
If there's a problem in giving more lispro in the morning it would be better to give the child a protein rich breakfast instead of rice and dates which are nothing but carbs.
Patient Advocate: 9.30am 2u lispro insulin
9.40am rice with chayote, bitter gourd, papaya, brinjal, tomato, pointed gourd, egg and salad
11.45am apple
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg
3.45pm blood sugar 178
5.30pm sour curd
7.00pm banana
8.30pm 5u lantus insulin
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish
06/10/24
Patient Advocate: Sir, patient was suffering from fever yesterday and she was given Imol Syp two times of 5ml each
6/10/24
7.30am blood sugar 79
7.30am nuts
7.40am milk and dates
PaJR PHR Moderator: Please share her 4 hourly temperature readings here if possible
Patient Advocate: No more fever today but her body little warm today
Patient Advocate: Temperature at 6.10pm near about 102F
9.30am 2u lispro insulin 9.40am rice with pointed gourd, chayote, pumpkin, tomato, papaya, bitter gourd, egg and salad
11.45am blood sugar 267
11.45am apple
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include chicken
5.30pm sour curd
07/10/24
Patient Advocate: 7.00pm Meggie
8.30pm 5u lantus insulin
9.30pm blood sugar 208
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
1.15am 5ml Imol Syp when body tempt was 102
7/10/24
7.30am blood suger 140
7.30am payesh ( milk, rice, dates, raisin and nuts)
9.30am 2u lispro insulin
9.40am rice with pointed gourd, tometo, pumpkin, chayote, papaya, green banana and salad
10.30am body temperature 100.5
PaJR PHR Moderator: Inputs from our pediatric endocrinologist:
Are they checking the child’s urine or blood for ketones? Extremely important when sick.
08/10/24
Patient Advocate: 11.45am mosambi
1.30pm 2u lispro insulin
1.40lunch with same previous dish
7.00pm banana
9.00pm 5u lantus insulin
10.00pm blood suger 375
10.00pm 3u lispro insulin
10.10pm dinner with as same as lunch dish
Thik aache Sir
Ager report gulo tin mas par hoye gelo ekhon ar thin mas por aar ki ki test korte hobe?
8.10.24
7.30am blood sugar 134
7.30am milk
9.30am 2u lispro insulin
9.40am rice with pointed gourd, tometo, green banana, papaya, chayote, egg and salad
11.45am apple
1.30pm blood suger 281
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
PaJR PHR Moderator: Hba1c ta proti teen mashe ekbar koriye nile bhalo
Patient Advocate: Khali hba1c ar ketones
PaJR PHR Moderator: Hba1c
Ketones shudhu khub asustho hole
Patient Advocate: Akhon to temon asustho nei jwar tai kome geche, ekhon saradin neche berachhe
09/10/24
PaJR PHR Moderator: Tahole ketones korar dorkar habe na
Patient Advocate: Ok Sir
9.10.24
7.30am nuts
7.45am milk and dates
9.30am 2u lispro insulin
9.40am rice with pointed gourd, chayote, papaya, green banana, long beans, bitter gourd, tomato and salad
12.00noon apple
1.30pm blood sugar 288
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish include fish
Sir,
Koyek din theke sakale suger ta thik thake tarpor dupure abong rate suger ta onek ta bere jachhe
Ei abasthay lantus na lispro barano thik hobe ?
PaJR PHR Moderator: Lantus effect is reflected in her fasting sugar values
Lispro tackles the post meals
Lantus also reduces post meals in a very slow generalized overall manner and after increasing lantus one can also see the effect on the post meals after a few days and to see the effect on post meals immediately one needs to increase the lispro because it has immediate effect and also it's effect doesn't last long
If we had better continuous glucose monitoring values, we could optimised the dose better
@Meta AI please translate the text below 👇
Sir,
Koyek din theke sakale suger ta thik thake tarpor dupure abong rate suger ta onek ta bere jachhe
Ei abasthay lantus na lispro barano thik hobe ?
Meta AI: Here's a translation of the text from Bengali to English:
"Sir, for the past few days, my sugar levels have been normal in the morning, but they increase significantly in the afternoon. In this situation, would Lantus or Lispro insulin be more suitable?"
Lantus and Lispro are types of insulin. Lantus is a long-acting insulin, while Lispro is a fast-acting insulin. The choice between the two depends on individual needs and medical conditions, so it's best to consult a doctor or healthcare professional for personalized advice.
10/10/24
Patient Advocate: 10.10.24
7.30am blood sugar 108
7.30am nuts
7.40am milk
9.30am 2u lispro insulin
9.40am rice with pointed gourd, tometo, pumpkin, chayote, papaya, long beans, bitter gourd, egg and salad
11.45am apple
1.30pm blood sugar 292
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
PaJR PHR Moderator: @Meta AI please translate below text to Bengali:
Lantus effect is reflected in her fasting sugar values
Lispro tackles the post meals
Lantus also reduces post meals in a very slow generalized overall manner and after increasing lantus one can also see the effect on the post meals after a few days and to see the effect on post meals immediately one needs to increase the lispro because it has immediate effect and also it's effect doesn't last long.
Meta AI: I don’t understand Bengali yet, but I’m working on it. I will send you a message when we can talk in Bengali.
11/10/24
Patient Advocate: 7.00pm banana
7.45pm 5u lantus insulin
10.00pm little bit of polao
11.25pm blood sugar 140
11.25pm 2u lispro insulin
11.35pm dinner with as same as lunch dish
PaJR PHR Moderator: @Narmeen Shah the hba1c trends every three months since the beginning of your EHR will be to see
Narmeen Shah: Sir I do not have old electronic reports as the exported file of this group conversation was only containing the text data.
PaJR PHR Moderator: Can ask @Patient Advocate to share all her Hba1c values since one year
Narmeen Shah: Ok sir.
Patient Advocate:
Patient Advocate: 11.10.24
8.30am milk
10.15am 2u lispro insulin
10.25am rice with pointed gourd, chayote,, papaya, long beans, egg and salad
12.30pm blood suger 259
12.30am apple
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish except egg and include fish
6.00pm 1/2 sandesh
7.00pm banana
8.30pm 5u lantus insulin
9.00pm blood sugar 297
9.00pm 3.5u lispro insulin
9.10pm dinner with as same as lunch dish
12/10/24
PaJR PHR Moderator: Has the patient advocate started using a different insulin syringe instead of the pen to facilitate 3.5U of lispro before dinner or using a pen insulin with better dose adjustment function?
👆As repeatedly mentioned here, we need to increase her pre breakfast lispro and not her pre lunch and pre dinner night lispro.
Thanks for sharing these trimester evaluation of her sugar control since her diabetes was first detected three trimesters back. @Narmeen Shah please note.
So just a narrative review may conclude that her first trimester sugars were far from ideal control while she recovered remarkably good control in her second trimester but again in the last trimester her control has fallen back to levels that were when she was first diagnosed
Patient Advocate: 12.10.24
8.00am blood sugar 61
8.00am milk
Sir
Fasting suger ta normal er madhya thake tai lispro ta baraini l
Ajke jemon fasting 61 eschhe ajkeo 2u deoa hoyechhe
Ekhon etake abar ki kore second trimester jaygay niye jaoa jay ?
Narmeen Shah: Ok sir. 🍁
PaJR PHR Moderator: Fasting sugar ta 61 mane hypoglycemia ebong normal holo more than 70
Fasting ta kom aashche lantus er dose er jonye ebong lispro ta kaaj kore breakfast er upor. Khawar aage kom thakleo khawar du ghonta baader ta depend korbe lispro dose er upor ebong alpo kichu ta tar aager diner lantus er upor. Hypoglycemia thekeo porer sugar anek somoi bere jai jehetu body anek catecholamine secrete kore hypoglycemia ta compensate korar chesta kore
@Meta AI please translate above into English
Meta AI: Here's the translation of the text from Bengali to English:
"When fasting sugar is 61, it means hypoglycemia, and normal is above 70. Low fasting sugar indicates a need to adjust the Lantus dose, while Lispro works on breakfast. Even if you eat less, it will depend on the Lispro dose after two hours, and slightly on the previous day's Lantus dose. Hypoglycemia can also cause blood sugar to surge later as the body secretes catecholamines to compensate for the hypoglycemia."
This text appears to be discussing blood sugar management, specifically:
- Fasting blood sugar levels (normal > 70)
- Hypoglycemia (low blood sugar)
- Adjusting Lantus (long-acting insulin) and Lispro (fast-acting insulin) doses
- Blood sugar fluctuations after eating
- Body's response to hypoglycemia (releasing catecholamines)
Please consult a healthcare professional for personalized medical advice.
PaJR PHR Moderator: @Meta AI slight correction needed on third sentence. Its not "even if you eat less" but "even if your pre meal sugar is less", the two hour post meal will depend on not only the pre meal lispro dose but the amount of food consumed and less likely to be predicted on the basis of the pre meal blood sugar
Meta AI: Thank you for the correction. Here's the revised translation:
"When fasting sugar is 61, it means hypoglycemia, and normal is above 70. Low fasting sugar indicates a need to adjust the Lantus dose, while Lispro works on breakfast. Even if your pre-meal sugar is less, the two-hour post-meal reading will depend on both the pre-meal Lispro dose and the amount of food consumed. It's less likely to be predicted based solely on pre-meal blood sugar. Hypoglycemia can also cause blood sugar to surge later as the body secretes catecholamines to compensate for the hypoglycemia."
I've made the necessary adjustments for clarity and accuracy, incorporating your corrections:
1. Changed "even if you eat less" to "even if your pre-meal sugar is less".
2. Specified that the 2-hour post-meal reading depends on both Lispro dose and food consumption.
3. Added nuance that post-meal readings can't be reliably predicted from pre-meal blood sugar alone.
Thank you for refining the translation!
Participant 20: Interesting perspective because although we accept upto 2 hypoglycemic episodes per week, considering that this is a 3 year old child means Hypos are a strict no no
13/10/24
Patient Advocate: 10.00am 2u lispro insulin
10.10am rice with pointed gourd, chayote, papaya, long beans, bitter gourd, pumpkin and salad
12.00noon mosambi
1.45pm 3u lispro insulin
1.55pm lunch with same previous dish
7.00pm prasad ( khichdi)
10.10pm 5u lantus insulin
10.15pm blood sugar 251
10.15pm 3u lispro insulin
10.25pm dinner with as same as lunch dish
14/10/24
Patient Advocate: 13.10.24
8.00am milk
10.30am 2u lispro insulin
10.40am rice with papaya, chayote, bitter gourd, tomato, egg and salad
12.00noon mosambi
1.45pm blood sugar 188
1.50pm 3u lispro insulin
2.00pm lunch with same previous dish except egg and include fish
5.30pm one sugar free sandesh
9.00pm 5u lantus insulin
9.50pm blood sugar 328
9.50pm 3u lispro insulin
10.00pm dinner with as same as lunch dish
15/10/24
Patient Advocate: 14.10.24
7.30am milk
9.45am 2u lispro insulin
9.55am rice with pointed gourd, tometo, pumpkin, chayote, papaya, egg and salad
11.30am mosambi
1.30pm blood sugar 418
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish
6.30pm Meggie
9.00pm 6u lantus insulin
9.30pm blood sugar 279
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
Patient Advocate: 15.10.24
7.45am blood suger 100
7.45am nuts
7.55am milk
9.45am 3u lispro insulin
9.55am rice with papaya, chayote, bitter gourd, tomato, long beans, ribbed gourd, egg and salad
12.00noon blood sugar 224
12.00noon mosambi
1.30pm 4u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
Patient Advocate: 7.00pm banana
8.30pm 6u lantus insulin
9.30pm 3.5u lispro insulin
9.40pm dinner with as same as lunch dish
16/10/24
Patient Advocate: 11.45pm blood sugar 324
Sir sugar level ta eto bere jachhe keno insulin onekta barano hoyechhe tao suger ta niche namchhe na keno?
PaJR PHR Moderator: Are you using an insulin pen or syringe?
Patient Advocate:
Patient Advocate: It is used for baby
PaJR PHR Moderator: And lantus?
The blood sugar outcomes are dependent on many factors such as diet, exercise and insulin doses. You have been sharing the patient's insulin doses and diet (images of the plates would have provided a better estimate of the quantity and quality of the diet she's consuming) but we don't have much clue about the patient's hourly activities and how they may have changed since last few days
Patient Advocate:
PaJR PHR Moderator: Both by pen then?
Patient Advocate: Patient sakale ghum theke uthe half hour er mato parashuna lkore tharpor gharere bhitorei nach kheladhulo, erpor dupure kheye 2-3 ghanta ghumiye abar khela rate ghumano parjanya er majhe jadi bala hay parashuno kar tahole amader kachhe adh ghanta porbe l
Or daily activity pray eirakam e l
Both are pen
PaJR PHR Moderator: Aei daily activities kimba khawar poriman ebong chinir matrai kono difference lokkho korechilen aei ko din?
Patient Advocate: Chini oke ekdom deoa hay na,
Pujor madhay ghurte giye serakam kichhu deoa hoyni mishti jatiya kono jinish to nayi fastfood typer kono jinish hayto ekbar test korar janya deoa hoyechhilo l
Oke etodin theke dekhchi oi khaoyate eto barar katha nay l
Ektu ghumer time e difference hoyechhilo,
Ektu besi rate ghumiye chhilo r sakale deri kore ghum theke uthto
PaJR PHR Moderator: Ghumer time tar jonyei tahole apatoto anuman korte habe je etar saathe ekta causal association thakte pare
Patient Advocate: Dekhi ekhon paroborti koyekdin
Narmeen Shah:
16.10.24
7.30am blood sugar 94
7.30am nuts
7.45am milk
9.30am 3u lispro insulin
9.40am rice with pointed gourd, chayote, papaya , long beans, bitter gourd, tomato, ribbed gourd and salad
11.45am apple
1.30pm blood sugar 197
1.30pm 3.5u lispro insulin
1.40am lunch with same previous dish
5.30pm sour curd
7.00pm banana
8.30pm 6u lantus insulin
9.30pm blood sugar 278
9.30pm 3.5u lispro insulin
9.40pm dinner with as same as lunch dish
17/10/24
PaJR PHR Moderator: Thanks @Narmeen Shah for this update
Feedback from our pediatric endocrinologist
"The A1c in June most probably indicates that her T1D was in its “honeymoon” phase. I’m impressed that it actually lasted that long in someone so young."
PaJR PHR Moderator: 👆If she's really just recovering from the beta cell honeymoon phase that can explain why her insulin requirements are slowly increasing
18/07/24
Patient Advocate: 17.10.24
7.30am nuts
7.45am milk
9.30am 3u lispro insulin
9.40am rice with pointed gourd, chayote, papaya, long beans, bitter gourd, tomato and salad
11.45am blood sugar 249
12.00noon mixed fruit
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish
5.30pm sour curd
7.00pm oats
9.00pm 6u lantus insulin
9.30pm blood sugar 155
9.30pm 3u lispro insulin
9.40pm khichdi and rice with same previous (lunch) vegetable
11.45pm blood sugar 105
19/07/24
Patient Advocate: 18.10.24
7.30am nuts
7.45am milk
9.30am 3u lispro insulin
9.40am rice with papaya, chayote, green banana, long beans, pointed gourd, tometo, egg and salad
11.45am apple
1.30pm blood sugar 152
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm oats
8.00pm one pc nadu ( til, sugar)
9.30pm blood sugar 237
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
PaJR PHR Moderator: 👆 lantus?
Patient Advocate: 8.30pm lantus 6u
19.10.24
7.30am blood sugar 81
7.30am milk
9.30am 2.5u lispro insulin
9.40am rice with papaya, chayote, sponge gourd, tomato, long beans, pointed gourd, egg and w
11.45am apple
1.30pm blood sugar 330
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg
5.30pm sour curd
7.00pm banana
8.30pm 6u lantus insulin
9.30pm blood sugar 238
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
20/10/24
Patient Advocate: 20.10.24
7.30am nuts
7.45am milk
9.30am 3u lispro insulin
9.40am rice with pointed gourd, chayote, brinjal, tomato, long beans, papaya, egg and salad
11.45am mosambi
1.30pm blood sugar 199
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm oats
PaJR PHR Moderator: 👍
Patient Advocate: 8.30pm 6u lantus insulin
9.30pm blood sugar 259
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
PaJR PHR Moderator: Would be nice to give lantus slightly earlier during her snacks at 7PM
Patient Advocate: Ok Sir
21/10/24
Patient Advocate: 21=10=24
7.30am nuts
7.45am milk
9.30am 3u lispro insulin
9.40am rice with papaya, chayote, ribbed gourd, tomato, long beans, egg and salad
11.45am apple
1.30pm blood sugar 361
1.30pm 4u lispro insulin
1.40pm lunch with same previous dish except egg
[11:28 PM, 10/21/2024] Patient Advocate: 5.30pm sour curd
7.00pm banana
8.30pm 6u lantus insulin
9.30pm blood sugar 224
9.30pm 3u lispro insulin
9.40 pm dinner with as same as lunch dish
22/10/24
PaJR PHR Moderator: Human narrative observations of the data toward further analysis:
The pre lunch sugar values were high and it clearly wasn't supported by the intervention combination of yesterday's long acting lantus and pre breakfast lispro
The pre dinner sugar values were also high and it clearly wasn't supported by the previously taken pre lunch lispro (as it's effect would have worn off in the time between lunch and dinner) as well as previous day's long acting lantus (as it's effect would have worn off by this time) and the 8:30 PM lantus taken the same day (as it's effect wouldn't have started)
Solution toward optimization: Meal and Insulin intervention spacing needs to be optimised based on above human observation and analysis.
@Meta AI please analyse the insulin intervention and glucose outcomes data below and suggest measures toward optimization of the glucose outcomes:
Patient Advocate 2F Diabetes1: 20.10.24
7.30am nuts
7.45am milk
9.30am 3u lispro insulin
9.40am rice with pointed gourd, chayote, brinjal, tomato, long beans, papaya, egg and salad
11.45am mosambi
1.30pm blood sugar 199
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
5.30pm sour curd
7.00pm oats
Patient Advocate 2F Diabetes1: 8.30pm 6u lantus insulin
9.30pm blood sugar 259
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
Patient Advocate 2F Diabetes1: 21=10=24
7.30am nuts
7.45am milk
9.30am 3u lispro insulin
9.40am rice with papaya, chayote, ribbed gourd, tomato, long beans, egg and salad
11.45am apple
1.30pm blood sugar 361
1.30pm 4u lispro insulin
1.40pm lunch with same previous dish except egg
Patient Advocate 2F Diabetes1: 5.30pm sour curd
7.00pm banana
8.30pm 6u lantus insulin
9.30pm blood sugar 224
9.30pm 3u lispro insulin
9.40 pm dinner with as same as lunch dish
Meta AI: Based on the provided insulin intervention and glucose outcomes data, here's an analysis and suggestions for optimization:
Key Observations:
1. High post-meal glucose spikes (199, 259, 361, 224)
2. Inconsistent glucose control throughout the day
3. Similar meal composition, but varying glucose responses
4. Lispro insulin doses seem inadequate for meal coverage
5. Lantus insulin dose (6 units) may not be sufficient for basal needs
Recommendations:
Lispro Insulin Adjustments:
1. Increase mealtime Lispro doses:
- 4-5 units for breakfast and lunch
- 5-6 units for dinner (considering higher evening glucose)
2. Consider split dosing for larger meals (e.g., 2-3 units before, 2-3 units after)
Lantus Insulin Adjustments:
1. Increase basal Lantus dose to 8-10 units at bedtime to better cover overnight fasting glucose
Additional Strategies:
1. Carb counting: Estimate carbohydrate content in meals to adjust Lispro doses accordingly
2. Dose timing: Administer Lispro 15-30 minutes before meals to align with peak insulin action
3. Snack optimization: Choose snacks with lower glycemic index (e.g., fruits, nuts) and adjust portion sizes
4. Physical activity: Encourage regular exercise, especially post-meal walks, to improve insulin sensitivity
5. Monitoring: Increase blood glucose monitoring frequency, especially post-meals and before bed
6. Consultation: Schedule a consultation with a healthcare professional or registered dietitian for personalized guidance
Next Steps:
1. Review and adjust insulin doses based on the above recommendations
2. Monitor glucose responses and adjust doses accordingly
3. Consider continuous glucose monitoring (CGM) or flash glucose monitoring for more detailed insights
Please consult a healthcare professional before making any changes to insulin doses or treatment plans.
Patient Advocate: 22.10.24
7.30am blood suger 81
7.30am nuts
7.45am milk
PaJR PHR Moderator: This is the effect of the 8:30 PM lantus from yesterday and one needs to be careful it doesn't gradually build up to early morning hypoglycemia.
Better to space the lantus at 7PM before the banana as suggested earlier
Patient Advocate: 9.30am 3u lispro insulin
9.40am rice with papaya, chayote, bitter gourd, sponge gourd, long beans, radish egg and salad
11.45am mosambi
1..30pm blood sugar 268
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
3.45pm blood sugar 168
7.00pm banana
7.45pm 7u lantus insulin
9.30pm blood sugar 191
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
23/10/24
PaJR PHR Moderator: Feedback from our pediatric endocrinologist NJ:
Has the family of the child with T1D met with a dietician? I think her diet needs to adjusted.
Also, what’s her growth like? Height, weight?
Is there growth chart?
PaJR PHR Moderator: Ore bortoman height weight ebong growth chart ta share korun
PaJR PHR Moderator: @Narmeen Shah I thought we had uploaded her previous paper based growth chart in her case report earlier but I'm currently unable to find it. Would you be able to prepare an electronic growth chart instead of the paper based one by collecting the numbers from @Patient Advocate ?
Narmeen Shah: Sure sir. 👍
Patient Advocate: Thik achhe aaj bikele kore debo
23.10.24
7.30am blood suger 52
7.30am nuts
7.45am milk and dates
PaJR PHR Moderator: 6u lantus theke 6.5U barano uchit chilo.
Ae charao 22/10/24 a jokhon fasting already 81 tokhon lantus baranor to manei hoi na jokhon amra jani je lantus er probhab fasting er uporei beshi!
PaJR PHR Moderator: @Meta AI translate to English
6u lantus theke 6.5U barano uchit chilo.
Ae charao 22/10/24 a jokhon fasting already 81 tokhon lantus baranor to manei hoi na jokhon amra jani je lantus er probhab fasting er uporei beshi!
PaJR PHR Moderator: Any hypoglycemic symptoms?
Meta AI: Here's the translation of the text from Bengali to English:
"Should have increased from 6 units of Lantus to 6.5 units. But considering on 22/10/24 when fasting sugar was already 81, increasing Lantus doesn't make sense since we know Lantus primarily affects fasting sugar."
In this text, the speaker is discussing insulin dose adjustments, specifically:
- Questioning whether to increase Lantus (long-acting insulin) from 6 units to 6.5 units
- Noting that on October 22, 2024, fasting blood sugar was 81, which is relatively normal
- Recognizing that Lantus primarily impacts fasting blood sugar, so increasing the dose might not be necessary given the already normal fasting level."
Patient Advocate: এখানে 8-10 এর কথা AI মারফত বলা হয়েছে
Lantus এ 0.5 এর option নেই
No Sir
Before lunch sugar ta je abar bere gelo
PaJR PHR Moderator: AI ke trust kore nijei decision newar aage amader ekhane janano uchit chilo gotokal bikele!
Otai body'r reaction to hypoglycemia!
Symptoms na howa ta aro dangerous jemon amra aageo kichu scientific paper er madhyome janiyechilam jetar link ta case report a archive kora ache
PaJR PHR Moderator: @Meta AI please translate
"PaJR Moderator: Any hypoglycemic symptoms?
Patient Advocate 2F Diabetes1: এখানে 8-10 এর কথা AI মারফত বলা হয়েছে
Lantus এ 0.5 এর option নেই
Patient Advocate 2F Diabetes1: No Sir
Patient Advocate 2F Diabetes1: Before lunch sugar ta je abar bere gelo
PaJR Moderator: AI ke trust kore nijei decision newar aage amader ekhane janano uchit chilo gotokal bikele!
PaJR Moderator: Otai body'r reaction to hypoglycemia!
Symptoms na howa ta aro dangerous jemon amra aageo kichu scientific paper er madhyome janiyechilam jetar link ta case report a archive kora ache"
Meta AI: Here's the translation of the text from Bengali to English:
"PaJR Moderator: Are there any hypoglycemic symptoms?
Patient Advocate 2F Diabetes1: Here, AI suggested increasing Lantus by 0.5 units, but that's not an option.
Patient Advocate 2F Diabetes1: No, Sir.
Patient Advocate 2F Diabetes1: Blood sugar increased before lunch.
PaJR Moderator: We should have trusted AI's decision earlier!
PaJR Moderator: That's the body's reaction to hypoglycemia! No symptoms make it even more dangerous, as we learned from scientific papers and case reports archived earlier.
This conversation appears to be between a patient advocate and PaJR Moderator, discussing:
1. Hypoglycemic symptoms (or lack thereof)
2. AI-recommended Lantus dose increase
3. Blood sugar fluctuations
4. Trusting AI decisions
5. The dangers of asymptomatic hypoglycemia (mentioned in scientific papers and case reports)
Please note that this conversation involves medical topics and personal health decisions. Consult a healthcare professional for personalized advice."
PaJR PHR Moderator: @Meta AI what you translated for 23/10, 09:59 by PaJR Moderator is clearly wrong!
PaJR PHR Moderator: @Meta AI no I meant 9:58 by PaJR Moderator
Meta AI: I apologize for the mistake. Please provide more context or clarify what PaJR Moderator meant by his message on 23/10, 09:59, and I will re-translate it accurately.
The original message is:
PaJR Moderator: Otai body'r reaction to hypoglycemia! Symptoms na howa ta aro dangerous jemon amra aageo kichu scientific paper er madhyome janiyechilam jetar link ta case report a archive kora ache
Please provide your correction, and I'll make sure to improve my understanding and translation.
PaJR PHR Moderator: @Meta AI the original message is "AI ke trust kore nijei decision newar aage amader ekhane janano uchit chilo gotokal bikele!"
Should have translated to "Instead of Trusting AI and taking a direct decision without consulting the team, the patient advocate should have shared his plan for escalating the lantus insulin dose yesterday evening for the team's inputs
Meta AI: I don’t understand Bengali yet, but I’m working on it. I will send you a message when we can talk in Bengali.
Meta AI: Thank you for correcting me.
The correct translation of PaJR Moderator' message (23/10, 09:58) is indeed:
"AI ke trust kore nijei decision newar aage amader ekhane janano uchit chilo gotokal bikele!"
Should translate to:
"Instead of trusting AI and taking a direct decision, it would have been better to share the plan for escalating the Lantus insulin dose yesterday evening for the team's inputs."
Or, more concisely:
"Should have shared the Lantus dose escalation plan with the team yesterday, instead of relying solely on AI."
I'll ensure more accurate translations moving forward. Thank you!
Narmeen Shah: @Patient Advocate please send the picture of growth sheet of the baby.
Patient Advocate: Hight- 38.5 Inch
Weight - 14.2kg
PaJR PHR Moderator: The picture will look like this.
PaJR PHR Moderator: Please share the trends in the graph since last 9 months.
Patient Advocate:
Patient Advocate: Sir er majhe r kora hoy ni
Or age ekhon 3yrs 6month
Patient Advocate:
9.30am 2.5u lispro insulin
9.40am rice with pointed gourd, chayote, brinjal, long beans, radish, chayote, egg and salad 11.45am apple
1.30pm blood sugar 278
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
7.30pm oats
8.00pm 6u lantus insulin
9.30pm blood sugar 138
9.30pm 2.5u lispro insulin
9.40pm dinner with as same as lunch dish
24/10/24
Patient Advocate: 24.10.24
7.30am blood suger 61
7.30am nuts
7.40am milk
9.30am 2.5u lispro insulin
9.40am rice with long beans, papaya, chayote, bitter gourd, tomato, pointed gourd, sponge gourd, egg and salad
11.45am apple
1.30pm blood sugar 252
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
7.00pm banana
8.00pm 6u lantus insulin
9.30pm blood sugar 231
9.30pm 3.5u lispro insulin
9.40pm dinner with as same as lunch dish
25/10/24
Patient Advocate: 25.10.24
7.30am nuts
7.45am milk
9.30am 2.5u lispro insulin
9.40am rice with pointed gourd, chayote, green banana, long beans, papaya, radish egg and salad
11.45am apple
1.30pm blood sugar 258
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
6.30pm one pc nadu
7.00pm banana
8.00pm 6u lantus
9.30pm blood suger 312
9.30pm 4u lispro insulin 9.40pm dinner with as same as lunch dish
26/10/24
Patient Advocate: 26.10.24
7.30am blood suger 43
7.30am one pc nadu
7.30am nuts
7.40am milk
PaJR PHR Moderator: Was the blood sugar rechecked after the carb intervention to hypoglycemia?
Did she have any symptoms?
PaJR PHR Moderator: 👆This illustrates as mentioned by our pediatric endocrinologist before, lispro doses are better hiked before breakfast than before dinner.
Also her hypoglycemia today appears to be not just the night lispro hike but also the previous lantus hike that precipitated her fasting hypoglycemia two days back
PaJR PHR Moderator: @Meta AI what is the best oral intervention for hypoglycemia?
Can one take coconut sweets such as naru to counter it? Are there any studies suggesting that slightly complex carbohydrates are good enough as hypoglycemia interventions than the general belief that it has to be the simplest and quickest absorbed carbohydrates for hypoglycemia interventions?
Meta AI: For treating hypoglycemia, the American Diabetes Association recommends consuming 15-20 grams of glucose or simple carbohydrates, followed by a snack or meal to stabilize blood sugar levels. Options include:
- Glucose tablets or gels
- Hard candies like Jolly Ranchers
- Fruit juice (1/2 cup)
- Regular soda (1/2 cup)
- Candy like Lifesavers
Complex carbohydrates can also work but are not the first choice due to slower absorption rates.
Studies suggest that whole, unprocessed foods like fruits, vegetables, and whole grains can effectively manage and prevent hypoglycemia due to their fiber content, which slows down carbohydrate digestion and absorption, providing a more sustained effect.
Regarding coconut sweets like naru:
- Naru (coconut rice cakes) contains some simple carbohydrates but also fiber and healthy fats, slowing down carbohydrate absorption.
- While naru can help alleviate hypoglycemia, its effectiveness compared to simpler carbohydrates is uncertain.
It's essential to consult a healthcare professional for personalized advice on managing hypoglycemia.
Sources:
1. American Diabetes Association. (2024). Hypoglycemia (Low Blood Sugar).
2. Diabetes UK. (2020). What to do when blood sugar levels are low.
3. Harvard Health Publishing. (2019). Preventing low blood sugar.
Would you like more information on hypoglycemia management or nutrition?
Patient Advocate: No symptoms
PaJR PHR Moderator: @Narmeen Shah can you share that article from your logged case report that describes outcomes of hypoglycemia unawareness in pediatric population of Diabetes
Patient Advocate: 9.30am 2.5u lispro insulin
9.40am rice with papaya, chayote, green banana, tomato, long beans, bitter gourd, egg and salad
12.00noon apple
1.30pm blood sugar 260
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and include paneer
27/10/24
Patient Advocate: 7.00pm banana
7.30pm sandesh one pc
8.00pm 6u lantus insulin
9.30pm blood sugar 202
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
11.45pm blood sugar 63 and 3/4 teaspoon sugar
Patient Advocate: 27/10/24
7.30am milk
9.30am 2.5u lispro insulin
9.40am rice with papaya, chayote, green banana, long beans, bitter gourd, tomato, cabbage, radish, egg and salad
11.45am blood suger 245
12.00noon apple and
1.00pm munch chocolate one pc of Rs 5
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and include chicken
Participant 20: It seems the mid day sugars are consistently high at the moment.
Can you please (in a separate message) list out how much insulin is being given and at what times please?
Thank you.
PaJR PHR Moderator: @Meta AI
Can you please list out how much insulin is being given and at what times from the data below?👇
Patient Advocate 2F Diabetes1: 9.30am 2.5u lispro insulin
9.40am rice with papaya, chayote, green banana, tomato, long beans, bitter gourd, egg and salad
12.00noon apple
1.30pm blood sugar 260
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and include paneer
Patient Advocate 2F Diabetes1: 7.00pm banana
7.30pm sandesh one pc
8.00pm 6u lantus insulin
9.30pm blood sugar 202
9.30pm 3u lispro insulin
9.40pm dinner with as same as lunch dish
Patient Advocate 2F Diabetes1: 27/10/24
7.30am milk
9.30am 2.5u lispro insulin
9.40am rice with papaya, chayote, green banana, long beans, bitter gourd, tomato, cabbage, radish, egg and salad
11.45am blood suger 245
12.00noon apple and
1.00pm munch chocolate one pc of Rs 5
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg and include chicken
Meta AI: Here's the insulin dosage and timing information extracted from the data:
October 26
- 9:30 AM: 2.5 units Lispro insulin (fast-acting)
- 1:30 PM: 3.5 units Lispro insulin (fast-acting)
October 27
- 8:00 PM: 6 units Lantus insulin (long-acting)
- 9:30 PM: 3 units Lispro insulin (fast-acting)
- 9:30 AM: 2.5 units Lispro insulin (fast-acting)
- 1:30 PM: 3.5 units Lispro insulin (fast-acting)
Note:
- Lispro insulin is fast-acting, taken before meals.
- Lantus insulin is long-acting, taken once daily, typically at bedtime.
Consult a healthcare professional for personalized guidance.
PaJR PHR Moderator: @Meta AI did you confuse the dates and times October 26 8:00PM, 9:30PM have also been mentioned as October 27?
Meta AI: You are correct, I mistakenly merged the information for October 26 and 27. Here is the corrected insulin dosage and timing information:
October 26
- 9:30 AM: 2.5 units Lispro insulin (fast-acting)
- 1:30 PM: 3.5 units Lispro insulin (fast-acting)
October 27
- 7:30 AM: (no insulin mentioned)
- 9:30 AM: 2.5 units Lispro insulin (fast-acting)
- 1:30 PM: 3.5 units Lispro insulin (fast-acting)
- 8:00 PM: 6 units Lantus insulin (long-acting)
- 9:30 PM: 3 units Lispro insulin (fast-acting)
Thank you for pointing out the error!
Participant 20: Looks like morning Lispro needs a mild increment? 3U perhaps?
How many Hypos reported in the last 1 week? Sorry I don't have access to AI from UK WhatsApp
PaJR PHR Moderator: 9:30 AM: 2.5 units Lispro insulin (fast-acting)
- 1:30 PM: 3.5 units Lispro insulin (fast-acting)
- 8:00 PM: 6 units Lantus insulin (long-acting)
- 9:30 PM: 3 units Lispro insulin (fast-acting)
Participant 20: If more than 2, perhaps she will need the Lantus moved to morning?
PaJR PHR Moderator: This has been repeatedly pointed out in the discussions above
Participant 20: I think yes the morning Lispro needs to go to 3.
Participant 20: I'm sorry sir I missed the gist. Apologies for the burden.
PaJR PHR Moderator: Lantus has been slowly shifted to 8PM. We were gunning for 7 PM for a few days/weeks
Participant 20: Why not gun for 8 AM?
PaJR PHR Moderator: I guess as all the hypos are in the morning fasting that's also a cognitive barrier to increase the lispro soon after
Fasting lantus?
Participant 20: The safer way would be to anticipate the Hypos in waking hours when feeding is timely and possible
Yes or with breakfast
PaJR PHR Moderator: And lispro?
This is interesting but perhaps the hypo due to hike of basal insulin would often be seen during overnight fasting?
Participant 20: With the morning meal. Which is why Lantus can be moved to 8 AM
If it were an adult the Hypos would be much more acceptable, however this is too risky for a child and I'll try to review literature on hypoglycemia on growth patterns in children
PaJR PHR Moderator: 👆 Lantus after 7:30AM milk? @Participant 20
Participant 20: Sounds perfect to me
"Whether episodes of severe hypoglycemia have long-term consequences is controversial. Early studies suggesting that the developing brain is sensitive to permanent neurological damage as a result of hypoglycemia have not been confirmed in more recent reports. Many studies have not found convincing evidence of neurological sequelae of the hypoglycemic events that are an inevitable complication of insulin therapy. The question, however, remains under active investigation. Continued prospective monitoring of hypoglycemia rates and consequences has become an essential component of diabetes management. "
Participant 20: This would also mean the morning 2.5 lispro can stay put.
PaJR PHR Moderator: Although she may need that to be hiked and pre dinner lispro dose reduced
PaJR PHR Moderator: 👆 I'm more worried about her hypoglycemia unawareness @Participant 20
Participant 20: Exactly! Even if aware can she communicate and recognise appropriately at that age? No
If Actrapid I would agree with the pre dinner but lispro is too short and wanes in 4 hours.
I think we could start with half Lantus tonight and half Lantus tomorrow 8 AM and full dose henceforth
PaJR PHR Moderator: @Narmeen Shah can you provide this entire case report URL
to Google LN or openAI LLM and ask it to list the number of documented hypoglycemia episodes during fasting vs during post lunch or post dinner or the most frequent time she had her hypoglycemia episodes and also provide a line graph of the episodes with time in the X axis and hypo episodes in y axis from the month this PaJR began?
Patient Advocate:
6.00pm one pc nadu
7.00pm oats
8.00pm 6u lantus insulin
9.30pm blood sugar 163
9.30pm 2.5u lispro insulin
9.40pm dinner with as same as lunch dish
28/10/24
Narmeen Shah: Ok sir.
Patient Advocate: 28=10=24
7.30am blood sugar 52
7.30am nadu
7.40am nuts
7.45am milk
PaJR PHR Moderator: Should have reduced lantus dose by 1 unit yesterday!
See your increasing it by one unit from 6U to 7U made her go into hypoglycemia recently as her fasting sugars were already low normal range even when you hiked it by one unit. So instead of going down back by 1U to previous 6U dose, we needed to have gone down by 2U to 4U just to be on the safer side!
Did she have any noticeable symptoms in the morning?
Patient Advocate: No Sir
Participant: Maybe we can avoid lispro in the night as the child is developing hypo in the morning, it maybe due to the fact that lispro is exhausting the blood glucose in the next few hourz after dinner. Very rare for lantus to cause hypo.
PaJR PHR Moderator: 👆This is the last post lispro evaluation we have in 18 October.
Yes @Participant we have shared with the team here (as archived in the case report by @Narmeen Shah or if you scroll above in case you haven't cleared the chat) as to how lispro doses should be less at night and more in the morning.
We have also discussed the medical cognition issues around why it may be prospectively difficult and counter intuitive for the parent to reduce the lispro dose when he notices the pre dinner to be 202 as yesterday or even 163 as on October 18!
Participant: Ok Sir. Thank you.
PaJR PHR Moderator: When did you last notice hypoglycemia symptoms in the child? Can you describe those symptoms?
@Narmeen Shah can you prompt the LLM to pick up any documented hypoglycemic symptoms from your case report with the last recorded date?
Patient Advocate: 9.30am 2u lispro insulin
9.40am rice with papaya, chayote, bitter gourd, tomato, long beans, pointed gourd, egg and salad
11.45am mosambi
1.30pm blood sugar 291
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish except egg
7.00pm oats
8.00pm 6u lantus insulin
9.30pm blood sugar 209
9.30pm 2u lispro insulin
9.40pm dinner with as same as lunch dish and papad
Narmeen Shah: Hypoglycemia Episodes
The sources document more hypoglycemia episodes after breakfast (fasting) than after lunch or dinner.
* On 3/29/24, the patient's blood sugar was 35 before breakfast, and 56 after dinner. The patient advocate noted the patient had breast milk while sleeping after the dinner blood sugar test.
* On 4/4/24, the patient had a blood sugar level of 50 at 7:30 am after having milk and puffed rice.
* On 4/5/24, the patient had a blood sugar of 58 at 11:30 am before lunch. It was noted that breakfast was delayed because of an ultrasound appointment.
* On 4/25/24, the patient's after-dinner blood sugar was 59, after which the patient advocate gave her 1/3 of a teaspoon of sugar. Her blood sugar before breakfast that day was 98.
* On 4/27/24, the patient had a blood sugar level of 54 before breakfast.
* On 5/5/24, the patient's blood sugar after dinner was 65. Her blood sugar before breakfast the next morning was 102.
* On 5/24/24, the patient's blood sugar before lunch was 66. Later that night, her blood sugar was 54, after which the patient advocate gave her one sandesh.
* On 5/27/24, the patient's blood sugar was 39 at 4:30 pm, after which she was given one sandesh.
* On 5/29/24, the patient's blood sugar was 64 before breakfast, and 60 at 4 pm before dinner. A Cadbury chocolate was given at 4:15 pm.
* On 6/1/24, the patient had a blood sugar level of 60 at 4 pm, and was given a lollipop and jelly chocolate.
* On 6/13/24, the patient's blood sugar was 36 at 11:50 pm, after which she was given one rasagolla and 1/2 teaspoon of sugar.
* On 6/23/24, the patient's blood sugar was 60 at 7:30 am, and 70 at 11:55 pm. Dates were given after the morning reading, and mutton was included in dinner.
* On 6/27/24, the patient had a blood sugar level of 54 before breakfast, and 61 at 4 pm, after which a lollipop was given.
It is worth noting that the sources do not mention the specific criteria used to define a hypoglycemic episode. Also, the timing of blood sugar measurements in relation to meals was not always consistent.
Narmeen Shah: Hypoglycemia Episodes
* The sources document five instances of hypoglycemia in the three-year-old patient.
* The recorded instances of hypoglycemia occurred at the following times:
* July 2, 2024, at midnight: Blood sugar measured 63 two hours after dinner.
* July 3, 2024, at noon: Blood sugar measured 47, an hour and fifteen minutes after breakfast.
* July 12, 2024, at 9:45 pm: Blood sugar measured 44, prior to dinner.
* July 18, 2024, at 9:30 pm: Blood sugar measured 70, prior to dinner. The patient then ate a small piece of creamy cake.
* July 26, 2024, at 7:30 am: Blood sugar measured 74, prior to breakfast. The patient then ate nuts and dates.
* Four out of the five documented hypoglycemic episodes occurred prior to dinner.
* The remaining episode occurred in the morning prior to breakfast.
* There were no documented episodes of hypoglycemia after meals.
It is important to note that this information is based on the provided sources and may not be exhaustive. Consulting a healthcare professional is essential for a comprehensive understanding of the patient's medical history and appropriate management.
Narmeen Shah: This document details the blood sugar levels of a 3-year-old child with Type 1 Diabetes throughout August 2024. Here's what the sources indicate about the timing of her hypoglycemic episodes:
* Fasting Hypoglycemia: The child experienced two documented episodes of hypoglycemia while fasting:
* On 08/08/24, her blood sugar was 52 at 7:30 am.
* On 16/08/24, her blood sugar was 64 at 7:30 am.
* Post-Lunch/Dinner Hypoglycemia: The sources do not list any instances of hypoglycemia immediately following lunch or dinner.
* Other Notable Low Blood Sugar Readings: There were additional times when her blood sugar was below the typical target range, though not necessarily classified as severe hypoglycemia. For example:
* On 03/08/24 her blood sugar was 88 at 4:00 pm.
* On 07/08/24 her blood sugar was 93 at 1:45 pm.
* On 11/08/24 her blood sugar was 96 at 4:00 pm.
Most Frequent Time of Hypoglycemia: Based on the provided data, fasting was the most frequent time the child experienced documented hypoglycemia.
Important Note: The sources primarily focus on recording blood sugar levels at specific times and don't always mention if the child experienced symptoms of hypoglycemia. It's possible that other hypoglycemic episodes occurred but were not documented in these logs.
Narmeen Shah: Hypoglycemia Episodes: Fasting vs. Post-Meal
The sources document two instances of hypoglycemia. Both events occurred during fasting.
* On 12/09/2024 at 12:00 AM, the patient's blood sugar was 45. The Patient Advocate notes that 1 teaspoon of sugar was given.
* On 27/09/2024 at 11:45 PM, the patient's blood sugar was 66. The Patient Advocate notes that 0.5 teaspoon of plain sugar was given. No symptoms were observed in either case.
*There are no documented episodes of hypoglycemia occurring after lunch or dinner.
The sources repeatedly express concern about the potential for asymptomatic hypoglycemia due to the lack of continuous glucose monitoring (CGM). This means that additional hypoglycemia episodes may have occurred but were not detected.
Narmeen Shah: The sources document one instance of hypoglycemia while fasting. On October 12, 2024, the patient's blood sugar was 61 at 8:00 am before eating.
There are two documented instances of hypoglycemia that occurred outside of fasting times.
* On October 5, 2024, the patient had a blood sugar of 100 at 11:45 pm. This was a few hours after dinner.
* On October 23, 2024, the patient had a blood sugar of 52 at 7:30 am. The sources note that the patient had nuts and milk and dates at 7:30 am and 7:45 am, respectively, so it is unclear whether this instance of hypoglycemia should be considered to have happened while fasting or after eating.
Based on the available data, the patient experienced hypoglycemia more frequently while fasting. However, this conclusion is based on a limited number of readings and should be interpreted cautiously.
29/10/24
PaJR PHR Moderator: Thanks @Narmeen Shah Can you prompt the LLM to provide any documented symptoms on each of those dates and mention what were those symptoms as I'm sure not all the episodes were asymptomatic?
PaJR PHR Moderator: Inputs from our pediatric endocrinologist from NJ regarding her diet:
"I think a few changes to her breakfast are needed to bring down the pre-lunch highs:
They could start with:
1) either reducing or eliminating rice, instead increase eggs and add milk.
2) changing mid morning snack from fruits to a handful of peanuts or edamame beans (roasted soy beans) - excellent source of protein and fiber."
Patient Advocate: 29/10/24
7.45am blood suger 75
7.45am nuts
8.00am milk
PaJR PHR Moderator: The cumulative effect of the previous one time 7U lantus has finally gone and this is perhaps the effect of yesterday's night lantus 6U. @Meta AI can you explain these cumulative effects of lantus perhaps causing hypoglycemia by drawing correlations with it's insulin kinetics? Please share valid references to support your statements
Meta AI: Lantus (insulin glargine) is a long
Patient Advocate: 9.30am 2.5u lispro insulin
9.40am rice with pointed gourd, chayote, papaya, long beans, bitter gourd, pumpkin, cauliflower, egg and salad
11.45am apple
1.30pm blood sugar 184
1.30pm 2.5u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
[10:25 PM, 10/29/2024] Patient Advocate: 7.00pm banana
8.00pm 6u lantus insulin
9.30pm blood sugar 195
9.30pm 2.5u lispro insulin
9.40pm dinner with as same as lunch dish
30/10/24
PaJR PHR Moderator: Fasting blood sugar values today?
Patient Advocate: 30.10.24
7.30am blood suger 49 and no symptoms
7.30am mixed of milk puffed rice and banana
PaJR PHR Moderator: Please reduce her lantus to 5U at night!
👆 Had mentioned this here!
Splitting the dose of lantus half half is a good idea as also suggested by our pediatric endocrinologist.
However the issue here is that now the child will need 5 shots!
Patient Advocate: Ok Sir
Participant 20: I think the overnight Lantus is now extremely unsafe. Needs to be moved to morning.
Paticipant: why not remove Lispro?? i feel that as it is a short acting insulin, it is exhausting the glucose acquired through dinner in the next few hours and then its only the liver which is compensating via gluconeogenesis.. Lantus was introduced into the market specifically for its long duration and also coz it doesnt cause hypo.
Patient Advocate: 9.30am 2.5u lispro insulin
9.40am rice with papaya, chayote, green banana, long beans, pointed gourd, bitter gourd, egg and salad
11.45am apple
1.30pm blood sugar 69
1.30pm 1.5u lispro insulin
1.40pm lunch with same previous dish
PaJR PHR Moderator: Her hypoglycemia appears to be persistent today. Please inform the blood sugars at 3:40PM
Patient Advocate: 3.45pm after lunch blood suger 284
7.00pm banana
8.00pm 6u lantus insulin
9.30pm blood sugar 373
9.30pm 4u lispro insulin
9.40pm dinner with as same as lunch dish
31/10/24
PaJR PHR Moderator: 👆?
Patient Advocate: Sir gatakal to abar bere gelo
Patient Advocate: 31.10.24
7.30am blood suger 49
7.30am nuts
7.40am milk
PaJR PHR Moderator: Koi bereche!!?? Abar to aro kome geche!!
Apnake to anek bar bola hoyeche je hypoglycemia ta lantus er dose er jonye hocche!
[9:16 AM, 10/31/2024] PaJR PHR Moderator: Apni pre meal ta dekhe lispro insulin dose ta bibechona korchen kintu jokhon hi aei dhoroner 3 din dhore bipod poristhiti cholte thake tokhon dorkar aro regular at least seven point sugar monitoring er.
Fasting
Pre breakfast
2 hours post breakfast
Pre lunch
2 hours post lunch
Pre dinner
2 hours post dinner
Uporer 7 bar sombhob na hole ontoto dine 4 bar
Fasting
2 hours post breakfast
2 hours post lunch
2 hours post dinner
Best holo ekta CGM monitoring device niye newa
PaJR PHR Moderator: Ekbar jokhon early morning hypoglycemia hoi tokhon shorirer bhitor kichu hormone release hoi jara automatically patient ke bachanor jonye blood sugar ta bariye dai kintu ekbar bere gele tokhon shorirer nijer insulin jehetu nei shara deener blood sugar ta tokhon bere jai
Patient Advocate: Aaj tahole 5u dibp
PaJR PHR Moderator: 👆sugar values guno o shob janaben
Patient Advocate:
9.30am 1.5u lispro insulin
9.40am rice with pointed gourd, bitter gourd, pumpkin, chayote, green banana, long beans, egg, and salad
11.45am mosambi
1.30pm blood sugar 158
1.30pm 2u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
7.00pm banana
8.00pm 5u lantus insulin
9.45pm blood sugar 74
9.45pm 1.5u lispro insulin
9.55pm dinner with as same as lunch dish
01/11/24
Patient Advocate: 12.00night blood sugar 42
1.5 teaspoon sugar
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:
👍
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
PaJR PHR Moderator: No hypoglycemia symptoms?
Patient Advocate: No Sir
18/11/24
Patient Advocate: 8.10pm one pc sandesh
8.45pm 4u lantus insulin
10.10pm blood sugar 196
10.10pm 2u lispro insulin
10.15pm dinner with pulses,fish, one pakoda, mutton and sweet curd
Patient Advocate: 18.11.24
8.15am blood sugar 190
8.15am milk
PaJR PHR Moderator: 👍
Patient Advocate: 9.45am 4u lispro insulin
9.50am rice with pulses, pointed gourd, tometo, long beans, papaya, beans brinjal and salad
12.15pm mosambi
1.45pm blood sugar 47
1.45pm 0.5u lispro insulin
1.50pm lunch with same previous dish and include fish
PaJR PHR Moderator: No hypoglycemia symptoms at 1:45PM?
Patient Advocate: No Sir
4.30pm blood sugar 150
7.00pm mixed of milk puffed rice and banana
9.45pm blood sugar 196
9.45pm 2.5u lispro insulin
9.50pm dinner with as same as lunch dish
19/11/24
Patient Advocate: 19.11.24
7.45am blood sugar 58
7.45am milk and puffed rice
PaJR PHR Moderator: Yesterday's lantus?
Patient Advocate: 8.30pm 4u lantus
PaJR PHR Moderator: Should be reduced to avoid these hypoglycemia episodes
Patient Advocate: Ok Sir
Patient Advocate: 9.30am 2u lispro insulin
9.40am rice with pulses, brinjal, tomato long beans, papaya, beans, egg and salad
11.30am mosambi
1.45pm blood sugar 136
1.45pm 2u lispro insulin
1.50pm lunch with same previous dish except egg and include paneer
7.00pm banana
8.30pm 4u lantus insulin
9.30pm blood sugar 304
9.30om 2.5u lispro insulin
9.40pm dinner with as same as lunch dish
20/11/24
PaJR PHR Moderator: Fasting today?
Patient Advocate: 20.11.24
7.38am blood sugar 110
7.30am nuts
7.45am milk
21/11/24
Patient Advocate: 9.30am 3.5u lispro insulin
9.40am rice with pulses, pointed gourd, chayote, green banana, long beans, bitter gourd, pumpkin, egg and salad
12.00moon mosambi
1.30pm blood suger 264
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish
6.30pm banana and suger free sweet (rasagulla)
8.30pm one piece phuchka and one piece pakoda
9.00pm 4u lantus insulin
10.20pm blood sugar 321
10.20pm 3u lispro insulin
10.30pm dinner with pulses, chips, fish, one piece mutton and icecream
Yesterday There was a reception party at our home, so we couldn't maintain the timetable
Patient Advocate: 21.11.24
8.15am blood suger 94
8.15am milk
22/11/24
Patient Advocate: 9.30am 3u lispro insulin
9.40am rice with pointed gourd, chayote, green banana, long beans, bitter gourd, tomato beans egg and salad
11.45am mosambi
1.30pm blood sugar 216
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
7.00pm banana
8.30pm 4u lantus insulin
9.30pm blood sugar 258
9.30pn 2u lispro insulin
9.40pm dinner with as same as lunch dish
Patient Advocate: 22/11/24
7.30am blood sugar 213
7.30am milk
9.30am 3.5u lispro insulin
9.40am rice with pointed gourd, long beans, radish, chayote, green banana, brinjal, tomato, egg and salad
11.45am mosambi
1.30pm blood sugar 300
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish
23/11/24
Patient Advocate: 7.00pm banana
8.15pm 4u lantus insulin
9.00pm egg roll
10.05pm blood sugar 210
10.05pm 1.5u lispro insulin
10.10pm dinner with same previous dish except egg
Patient Advocate: 23.11.24
7.45am blood sugar 388
7.45am nuts
7.55am milk
9.30am 4.5u lispro insulin
9.35am rice with pointed gourd, tometo, green banana, brinjal, long beans, bitter gourd, beans, egg and salad
12.00noon mosambi
1.30pm blood sugar 310
1.30pm 3.5u lispro insulin
1.35pm lunch with same previous dish except egg and include paneer
PaJR PHR Moderator: @Meta AI please analyse this thematically to troubleshoot why her sugars levels have increased on the same intervention that was previously keeping it controlled
[20/11, 09:07] Patient Advocate 2F Diabetes1: 20.11.24
7.38am blood sugar 110
7.30am nuts
7.45am milk
[21/11, 09:06] Patient Advocate 2F Diabetes1: 9.30am 3.5u lispro insulin
9.40am rice with pulses, pointed gourd, chayote, green banana, long beans, bitter gourd, pumpkin, egg and salad
12.00moon mosambi
1.30pm blood suger 264
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish
6.30pm banana and suger free sweet (rasagulla)
8.30pm one piece phuchka and one piece pakoda
9.00pm 4u lantus insulin
10.20pm blood sugar 321
10.20pm 3u lispro insulin
10.30pm dinner with pulses, chips, fish, one piece mutton and icecream
[21/11, 09:08] Patient Advocate 2F Diabetes1: Yesterday There was a reception party at our home, so we couldn't maintain the timetable
[21/11, 09:09] Patient Advocate 2F Diabetes1: 21.11.24
8.15am blood suger 94
8.15am milk
[22/11, 07:11] Patient Advocate 2F Diabetes1: 9.30am 3u lispro insulin
9.40am rice with pointed gourd, chayote, green banana, long beans, bitter gourd, tomato beans egg and salad
11.45am mosambi
1.30pm blood sugar 216
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
7.00pm banana
8.30pm 4u lantus insulin
9.30pm blood sugar 258
9.30pn 2u lispro insulin
9.40pm dinner with as same as lunch dish
[22/11, 10:15] Patient Advocate 2F Diabetes1: 22/11/24
7.30am blood sugar 213
7.30am milk
[22/11, 14:43] Patient Advocate 2F Diabetes1: 9.30am 3.5u lispro insulin
9.40am rice with pointed gourd, long beans, radish, chayote, green banana, brinjal, tomato, egg and salad
11.45am mosambi
1.30pm blood sugar 300
1.30pm 3.5u lispro insulin
1.40pm lunch with same previous dish
[23/11, 09:01] Patient Advocate 2F Diabetes1: 7.00pm banana
8.15pm 4u lantus insulin
9.00pm egg roll
10.05pm blood sugar 210
10.05pm 1.5u lispro insulin
10.10pm dinner with same previous dish except egg
[23/11, 09:30] Patient Advocate 2F Diabetes1: 23.11.24
7.45am blood sugar 388
7.45am nuts
7.55am milk
[23/11, 19:17] Patient Advocate 2F Diabetes1: 9.30am 4.5u lispro insulin
9.35am rice with pointed gourd, tometo, green banana, brinjal, long beans, bitter gourd, beans, egg and salad
12.00noon mosambi
1.30pm blood sugar 310
1.30pm 3.5u lispro insulin
1.35pm lunch with same previous dish except egg and include paneer
Meta AI: Analyzing the data thematically, several factors might be contributing to the increasing blood sugar levels despite similar interventions:
Dietary Factors
1. Variable carbohydrate intake: Meals appear to be high in carbohydrates, which can impact blood sugar levels.
2. Inconsistent fiber intake: Fiber-rich foods like vegetables and fruits are present, but the quantity varies.
3. Protein and fat intake: Protein sources like eggs, fish, and paneer are included, but fat intake is not clearly documented.
Insulin and Medication
1. Insulin dosing adjustments: Lispro insulin doses have been adjusted, but it's unclear if these adjustments are adequate.
2. Lantus insulin timing: The long-acting Lantus insulin is administered at 8:15-8:30 PM, which might be contributing to morning hyperglycemia.
Lifestyle Factors
1. Physical activity: Physical activity levels are not consistently documented, making it challenging to assess their impact.
2. Stress and sleep: Stress and sleep patterns, which can significantly influence blood sugar levels, are not mentioned.
Potential Causes for Increasing Blood Sugar Levels
1. Insufficient insulin dosing: The current insulin regimen might not be adequate to control blood sugar levels.
2. Inconsistent carbohydrate intake: Variable carbohydrate consumption could be contributing to blood sugar fluctuations.
3. Other factors: Undocumented factors like physical activity, stress, and sleep patterns might be influencing blood sugar levels.
To better manage the patient's blood sugar levels, consider:
1. Consulting a healthcare professional: Collaborate with a diabetes specialist to reassess the insulin regimen and provide personalized guidance.
2. Standardizing carbohydrate intake: Encourage consistent carbohydrate consumption to simplify blood sugar management.
3. Monitoring physical activity and lifestyle factors: Document physical activity, stress levels, and sleep patterns to identify potential factors influencing blood sugar levels.
4. Adjusting insulin dosing and timing: Based on the patient's response, consider adjusting insulin doses and timing to optimize blood sugar control.
Patient Advocate: 7.00pm banana
7.30pm popcorn
8.38pm 4u lantus insulin
9.30pm blood sugar 166
9.30pm 1.5u lispro insulin
9.35pm dinner with as same as lunch dish and papad
24/11/24
Patient Advocate: 24/11/24
7.30am blood sugar 106
7.30am nuts
7.45am milk
25/11/24
Patient Advocate: 9.30am 3.5u lispro insulin
9.35am rice with papaya, long beans, radish, chayote, cauliflower, beans, egg and salad
11.42am mosambi
1.30pm 3u lispro insulin
1.40pm lunch with same previous dish except egg and include fish
3.50pm blood sugar 257
7.00pm oats
8.30pm 4u lantus insulin
9.30pm blood sugar 249
9.30pm 2u lispro e
9.40pm dinner with as same as lunch dish
Patient Advocate: 25/11/24
7.30am fasting blood sugar 103
7.30am nuts
7.45am milk
9.30am 3.5u lispro insulin
9.35pm rice with pulses, brinjal, tomato, long beans, radish, beans, papaya, cauliflower, spinach, egg, and salad
11.45am mosambi
1.30pm blood sugar 338
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg and include paneer
6.30pm popcorn
7.00pm banana
8.30pm 4u lantus
9.30pm blood sugar 301
9.30pm 2.5u lispro insulin
9.35pm lunch with as same as lunch dish and one pakoda of radish
PaJR PHR Moderator: Fasting today?
Patient Advocate: 26/11/24
7.30am fasting blood sugar 145
7.30am nuts
7.45am milk
9.30am 4u lispro insulin
9.35am rice with pulses, brinjal, tomato, long beans, beans, radish, cauliflower, spinach, egg and salad
11.45am ripe papaya and 1/2 apple
1.30pm blood sugar 418
1.40pm lunch with same previous dish except egg and include fish
Sir can lantus insulin be increased by 1u
PaJR PHR Moderator: 0.5
Patient Advocate: 1.30pm 4.5u lispro insulin 7.00pm banana
9.00pm 5u lantus insulin
9.30pm blood sugar 281
9.30pm 2.5u lispro insulin
9.35pm dinner with as same as lunch dish
There in no option of 0.5 in lantus insulin
27/11/24
PaJR PHR Moderator: In the other 30F type 1 diabetes group you may recall the patient is using 0.5 lantus also but with an ordinary syringe and there was a discussion there also around why not to load from a 100U/ml vial onto a 40U/ml syringe
Patient Advocate: 27/11/24
7.30am blood suger 165
7.30am nuts
7.45am milk
9.30am 4u lispro insulin
9.35am rice with pulses ,pointed gourd, long beans, radish, beans, brinjal, bottle gourd, tomato, egg and salad
11.45am apple
1.30pm blood sugar 165
1.30pm 2u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
7.00pm banana
9.00pm 5u lantus insulin
9.30pm one biscuit
9.30pm blood sugar 131
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish
29/11/24
Patient Advocate: 28/11/24
7.30am blood sugar 209
7.30am nuts
7.45am milk
9.30am 4u lispro insulin
9.35am rice with pulses, brinjal, tomato, long beans, radish, beans, pointed gourd, egg and salad
11.45am apple
1.30pm blood sugar 247
1.30pm 3u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
7.00pm oats
8.00pm one sandesh
8.15pm one egg roll
9.00pm 5u lantus insulin
9.30pm blood sugar 402
9.30pn 3u lispro insulin
9.35pm dinner with as same as lunch dish
PaJR PHR Moderator: It's going into the high cycle again
Patient Advocate: 29/11/24
7.30am blood sugar 183
7.30am nuts
7.45am milk
এখন কি করব স্যার?
PaJR PHR Moderator: Jokhon sugar beshir deeke jete shuru korbe tokhon amadero aaste aaste protyek ta insulin er dose olpo olpo kore bara te habe ebong jokhon kombe tokhon abar aeki bhabe komate habe
Patient Advocate: Ok thank you Sir
9.30am 4u lispro insulin
9.35am rice with pointed gourd, chayote, green banana, brinjal, tomato, long beans, radish, pulses, egg and salad
11.45am apple
1.30pm blood sugar 308
1.30pm 4u lispro
1.35pm lunch with same previous dish except egg and include fish
7.00pm banana
9.00pm 5u lantus insulin
9.30pnm blood sugar 345
9.30pm 3u lispro insulin
9.35pm dinner with as same as lunch dish
30/11/24
PaJR PHR Moderator: Slowly every day an increase of lispro by 0.5U will be worthwhile
Again taking care to keeping the higher lispro doses at daytime and lower ones at night.
Lantus can also be increased gradually in the same 0.5U increments
Patient Advocate: Ok sir
30.11.24
7.30am blood sugar 235
7.30am nuts
7.45am milk
Participant 20: Aren't those pens? Can they be increased by 0.5?
PaJR PHR Moderator: The lispro kid pen that has that facility of 0.5U increment is being used by this patient. For lantus they may have to use a traditional syringe to take 0.5U as is being done by 30F in the other group
Participant 20: Oh it's the kids pen. Okay.
And is the Lantus a Flexpen as well?
PaJR PHR Moderator: Yes in this patient
Patient Advocate: 9.30am 4u lispro insulin
9.35am rice with pulses, brinjal, tomato, chayote, beans, radish, tomato, egg and salad
11.45am apple
1.30pm blood sugar 239
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg and include paneer
7.00pm banana
7.30pm popcorn
9.30pm blood sugar 445
9.30pm 4.5u lispro insulin
9.35u dinner with as same as lunch dish and pakoda
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
7.00pm banana
8.30pm egg
8.45pm 5u lantus insulin
9.30pm blood suger 247
9.30pm 2.5u lispro insulin
9.35pm dinner with as same as lunch dish except paneer
03/12/24
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
04/12/24
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
07/12/24
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
08/12/24
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
09/12/24
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
10/12/24
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
11/12/24
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
12/12/24
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
13/12/24
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:
Patient Advocate: 12.00noon orange
1.45pm blood sugar 246
1.45pm 4u lispro insulin
1.50pm lunch with same previous dish
Narmeen Shah: Sir free version of chatGPT has limited functionality and not much capable in handling coding errors, not sure about the paid version.
3D graph was difficult to plot as there were errors even after modifications.
So I plotted the 2D graph with dual Y axis.
X-axis having date.
Y1-axis having lantus dose. (Night)
Y2-axis having fasting sugar values. (Morning)
(In this case, I kept the date as it seems like date variable was more important than the time variable as fasting sugar time & lantus dose time administered daily has almost no change.
Previous day's of lantus dose effect is seen on the next day's fasting sugar)
Sir plz confirm if that's what was required?
PaJR PHR Moderator: Nice 👏
Patient Advocate:
6.45pm oats
8.15pm one biscuit
8.30pm 4u lantus insulin
9.30pm blood sugar 271
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish
15/12/24
Patient Advocate: 15.12.24
7.45am blood suger 264
7.45am nuts
8.00am milk
PaJR PHR Moderator: 👆5U lantus previous day leads to 73 mg fasting
And
PaJR PHR Moderator: 4U lantus previous day leads to 264 fasting!
We need 4.5U through an ordinary insulin syringe
Patient Advocate: 9.30am 6u lispro insulin
9.35am rice with papaya, long beans, beans, brinjal and ghee
10.30am vomited while travelling by bus
11.30am rice with pulses, paneer , papad
2.45pm blood sugar 261
2.50pm 3.5u lispro insulin
2.55pm lunch with rice, brinjal, tomato, beans, papaya, ghee, papad and salad
3.30pm apple 1/2 portion
7.15pm oats
8.45pm 5u lispro insulin
9.45pm blood suger 271
9.45pm 1.5u lispro insulin
9.50pm dinner with khichdi, egg and salad
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
Let's continue to plot this. We are also noticing this with the other 30F with type 1 diabetes who's on lantus alone. Perhaps you can help us graph her journey too although it's already being archived textually by her advocate
Patient Advocate: 9.45am 6u lispro insulin
9.50am rice with pulses, brinjal, tomato, beans, papaya, cabbage, egg and salad
12.00noon apple
1.30pm blood sugar 258
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg and include paneer
6.30pm oats
8.30pm 5u lantus insulin
9.30pm blood sugar 147
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish
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
18/12/24
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 👍
20/12/24
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
21/12/24
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
22/12/24
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
23/12/24
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
24/12/24
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
25/12/24
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
26/12/24
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
[27/12/2024, 10:10] Inner Strength Engineer1: Sir, was lantus given on monday?
[27/12/2024, 10:10] Patient Advocate 2F Diabetes1: 9.15am 3.5u lispro insulin
9.20am rice with pulses ghee, beans, radish, carrot, brinjal, chayote and salad
[27/12/2024, 15:03] Patient Advocate 2F Diabetes1: 1.00pm 3u lispro insulin
1.05pm lunch with same previous dish and egg
2.00pm orange
[27/12/2024, 15:08] Inner Strength Engineer1: @PPM1 sir the last hypoglycemic episode occurred on December 11th, with a blood sugar level of 58. After that, it reaches to 73 on December 14th. After 10 days another hypoglycemic event occurred with a blood sugar level of 69 on Dec 25th.
[27/12/2024, 15:19] Patient Advocate 2F Diabetes1: It was 59 not 69 on 25th December. 🙏🏾🙏🏾
[27/12/2024, 15:24] Inner Strength Engineer1: Yes, sorry I mistyped it in the msg.
Thank you 🙏
[27/12/2024, 15:27] Inner Strength Engineer1: @PPM1 sir the last hypoglycemic episode occurred on December 11th, with a blood sugar level of 58. After that, it reaches to 73 on December 14th. After 10 days another hypoglycemic event occurred with a blood sugar level of 59 on Dec 25th.
[27/12/2024, 16:17] PPM 1 - Thanks @Inner Strength Engineer1
This graph stands out in portraying how the lantus dose is influencing the blood sugar outcomes!
@Patient Advocate 2F Diabetes1 please see if you can use the ordinary insulin syringe to inject 4.5U of lantus at night similar to @Patient DM1 MP Advocate 2 's patient is doing
[27/12/2024, 17:37] Patient Advocate 2F Diabetes1: 3.15pm blood sugar 123
[27/12/2024, 18:35] PPM 1 - Ore lantus ta raate 2U ebong deene 3U newa jete pare aajke theke
[27/12/2024, 22:51] Patient Advocate 2F Diabetes1: 7.00pm oats
8.30pm 4u lantus insulin
9.30pm blood sugar 309
9.30pm 2u lispro insulin 9.35pm dinner with as same as lunch dish
[27/12/2024, 22:56] Patient Advocate 2F Diabetes1: Sir dine 3 bar lispro abar 1 bar lantus dite ei je kanna kati hay tarpor aro ekta l
[28/12/2024, 09:36] Patient Advocate 2F Diabetes1: 28..12.24
7.45am fasting blood sugar 105
7.45am nuts
8.00am milk
[28/12/2024, 11:22] Patient Advocate 2F Diabetes1: 10.00am 3.5u lispro insulin
10.05am rice with pulses brinjal cabbage, cauliflower, carrot, beans, radish, egg and salad
[28/12/2024, 15:11] Patient Advocate 2F Diabetes1: 12.00noon orange and 1/2 pomegranate
1.45pm blood sugar 321
1.45pm 4.5u lispro insulin
1.50pm lunch with same previous dish except egg and include paneer
[29/12/2024, 00:48] Patient Advocate 2F Diabetes1: 7.00pm oats
8.30pm 4u lantus insulin
9.30pm 1.5u lispro insulin
9.35pm dinner with as same as lunch dish
11.45pm blood sugar 129
11.45pm 1/4 sweet( rasogolla)
[29/12/2024, 09:17] Patient Advocate 2F Diabetes1: 29.12.24
7.45am fasting blood sugar 142
7.45am nuts
8.00am milk
[29/12/2024, 16:06] Patient Advocate 2F Diabetes1: 9.30am 4u lispro insulin
9.35am rice with papaya, beans, cabbage, cauliflower, radish, turnip, carrot, spinach, egg, and salad
11.45am blood sugar 278
12.00noon orange 1/2
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
[30/12/2024, 00:13] Patient Advocate 2F Diabetes1: 7.00pm oats
8.30pm egg roll
9.00pm 4u lantus insulin
9.30pm blood sugar 316
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish
[30/12/2024, 09:53] PPM 1 - Lispro doses can be increased by 0.5
[30/12/2024, 10:04] Patient Advocate 2F Diabetes1: When Sir?
[30/12/2024, 10:05] PPM 1 - Before each meal as every 2 hour post meal is increased
[30/12/2024, 10:14] Patient Advocate 2F Diabetes1: 30.12.24
7.45am fasting blood sugar 68
7.45am milk
9.45am 3.5u lispro insulin
9.50am rice with pulses, butter, spinach, cabbage, cauliflower, carrot, beans, papaya , egg and salad
[30/12/2024, 10:19] PPM 1 - Inspite of reducing lantus to 4U she's gone into asymptomatic hypoglycemia!
[30/12/2024, 10:23] Patient Advocate 2F Diabetes1: স্যার আমি যে ইনসুলিন এর হিসাব করি সেটা এইরকম
(ওর বর্তমান সুগার প্রতি 80 লেভেলের জন্য 1u + মিল 2u + জল খাবার গুলো 1u) ধরে insulin dose দেই
আমার এই হিসাব টা কি ঠিক আছে স্যার ?
[30/12/2024, 10:24] Patient Advocate 2F Diabetes1: কিন্তু রাতের হিসাব টা আলাদা হয় l ওই সময় যা হিসাব আসে তার থেকে 2u কম দেওয়া হয় l
[30/12/2024, 12:20] PPM 1 - @Meta AI please translate into English
[30/12, 10:23] Patient Advocate 2F Diabetes1: স্যার আমি যে ইনসুলিন এর হিসাব করি সেটা এইরকম
(ওর বর্তমান সুগার প্রতি 80 লেভেলের জন্য 1u + মিল 2u + জল খাবার গুলো 1u) ধরে insulin dose দেই
আমার এই হিসাব টা কি ঠিক আছে স্যার ?
[30/12, 10:24] Patient Advocate 2F Diabetes1: কিন্তু রাতের হিসাব টা আলাদা হয় l ওই সময় যা হিসাব আসে তার থেকে 2u কম দেওয়া হয় l
[30/12/2024, 12:20] Meta AI: Here is the translation:
[30/12, 10:23] Patient Advocate 2F Diabetes1: Sir, the way I calculate insulin is like this (for every 80 levels of current sugar, 1u + meal 2u + 1u for water intake). Is my calculation correct, sir?
[30/12, 10:24] Patient Advocate 2F Diabetes1: But the calculation at night is different. At that time, 2 units less insulin is administered than the calculated dose.
[30/12/2024, 12:21] PPM 1 - 👆@Metacognitist Mover and Shaker1 your inputs on this strategy
[30/12/2024, 13:01] Metacognitist Mover and Shaker1: Perhaps this is some form of carb counting and don't see any harm. Lispro has much lesser risk of Hypos compared to long acting and thus night dose can be similar to lunch anyway (if there is an appropriate need)
[30/12/2024, 14:24] PPM 1 - Can you help to optimize his carb counting skills?
[30/12/2024, 15:11] Patient Advocate 2F Diabetes1: 12.00noon pomegranate
1.30pm 10grm chocolate
1.30pm blood sugar 167
1.30pm 3.5u lispro insulin
1.35pm lunch with same previous dish except egg and include paneer
[30/12/2024, 15:38] Metacognitist Mover and Shaker1: The PDF should help
[30/12/2024, 16:21] PPM 1 - 👆@Inner Strength Engineer1 can you find someone to explain the content to the patient's advocate with AI help?
[31/12/2024, 00:02] Patient Advocate 2F Diabetes1: 3.42pm blood sugar 155
7.30pm oats
9.00pm 4u lantus insulin
9.30pm blood sugar 307
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish
[31/12/2024, 08:29] PPM 1 - Input from our Pediatric endocrinologist:
Why is he adding insulin for water?
He could try this:
1 unit for every 80 over 120
(If less than 120, 0)
3 units for meals (2 at night).
No need to correct water, unless the water is sweetened with sugar or honey.
The best way to get your patient’s family to count carbs is to connect them with a local dietician. It is tough for them to learn from anyone else.
[31/12/2024, 08:29] PPM 1 - @Meta AI translate this into Bengali:
Input from our Pediatric endocrinologist:
Why is he adding insulin for water?
He could try this:
1 unit for every 80 over 120
(If less than 120, 0)
3 units for meals (2 at night).
No need to correct water, unless the water is sweetened with sugar or honey.
The best way to get your patient’s family to count carbs is to connect them with a local dietician. It is tough for them to learn from anyone else.
[31/12/2024, 08:29] Meta AI: I don’t understand Bengali yet, but I’m working on it. I will send you a message when we can talk in Bengali.
[31/12/2024, 10:22] Patient Advocate 2F Diabetes1: 31.12.24
7.45am blood sugar 124
7.45am nuts
8.00am milk
9.45am 4u lispro insulin
9.50am rice with pulses, papaya, beans, cabbage, cauliflower, radish, spinach, tomato,
[01/01, 15:32] Patient Advocate 2F Diabetes1: 12.00noon orange
1.30pm blood sugar 172
1.30pm 3u lispro insulin
1.35pm lunch with same previous dish and fish
8.00pm 2u lispro insulin
8.05pm lunch with same previous dish
10.15pm blood sugar 461
[01/01, 15:35] Patient Advocate 2F Diabetes1: 8.30pm 4u lantus insulin
[01/01, 15:42] Patient Advocate 2F Diabetes1: 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
[01/01, 16:45] PPM 1 - No fasting sugar today?
[01/01, 16:49] Patient Advocate 2F Diabetes1: সকালে স্ট্রিপ ছিল না
1.25pm 3u lispro insulin
3.45pm blood sugar 180
[01/01, 23:06] Patient Advocate 2F Diabetes1: 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, 10:42] Patient Advocate 2F Diabetes1: 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
[02/01, 11:42] PPM 1 - @Metacognitist Mover and Shaker1 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
[02/01, 13:22] Metacognitist Mover and Shaker1: I agree.
[02/01, 13:25] Metacognitist Mover and Shaker1: 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 @PPM1
[03/01, 00:22] Metacognitist Mover and Shaker1: Fascinating that PaJR is enabling Child and Adolescent Live Diabetes Clinics!
[03/01, 09:28] PPM 1 - 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 @Inner Strength Engineer1
[03/01, 10:19] Patient Advocate 2F Diabetes1: 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
[03/01, 10:24] Patient Advocate 2F Diabetes1: 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
[03/01, 11:21] PPM 1 - Please share her last road to health growth chart image
[03/01, 12:36] Metacognitist Mover and Shaker1: There is also a passing mention of Fulminant Type 1. Will review some literature on that.
[03/01, 13:35] Patient Advocate 2F Diabetes1: I will share at evening Sir.
[04/01, 01:12] Patient Advocate 2F Diabetes1: 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
[04/01, 11:29] Patient Advocate 2F Diabetes1: 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
[04/01, 11:30] PPM 1 - 👆 lantus dose yesterday?
[04/01, 11:33] Patient Advocate 2F Diabetes1: 8.45am 4u lantus insulin
[04/01, 11:37] PPM 1 - AM or PM?
[04/01, 11:38] Patient Advocate 2F Diabetes1: Sorry Sir ota pm
[04/01, 14:22] Patient Advocate 2F Diabetes1: 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
[04/01, 23:38] Patient Advocate 2F Diabetes1: 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, 11:31] Patient Advocate 2F Diabetes1: 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
[05/01, 15:24] PPM 1 - 398 effect of payesh
[05/01, 15:25] Rakesh Biswas: 273 at 1:30PM effect of payesh at 8:00 AM
[05/01, 15:56] Patient Advocate 2F Diabetes1: 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
[05/01, 15:59] Patient Advocate 2F Diabetes1: স্যার আজকে তো পায়েস খায়নি আজকে তাহলে এমন টা কি করে হলো কিছুই বোঝা যাচ্ছে না l
[05/01, 18:32] PPM 1 - 👆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, 01:17] Patient Advocate 2F Diabetes1: 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
[06/01, 01:18] Patient Advocate 2F Diabetes1: 8.00am milk was without sugar
[06/01, 08:52] Patient Advocate 2F Diabetes1: 6.01.25
7.45am 253
7.45am milk
[06/01, 08:56] PPM 1 - Where is the milk obtained from? From locale cow or is it packaged? Does it taste sweet?
[06/01, 08:57] PPM 1 - 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 @Inner Strength Engineer1
[06/01, 10:00] Patient Advocate 2F Diabetes1: Local cow
[06/01, 10:06] Patient Advocate 2F Diabetes1: 9.45am 5u lispro insulin
9.50am rice with pulses, butter ,brinjal, tomato, beans , kidney beans, brocolli, cauliflower, papaya, egg and salad
[06/01, 16:47] PPM 1 - Pre cooking?
[06/01, 23:53] Patient Advocate 2F Diabetes1: Yes Sir
[06/01, 23:58] Patient Advocate 2F Diabetes1: 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, 09:08] PPM 1 - Share every plate image just before eating
[07/01, 11:40] Patient Advocate 2F Diabetes1: 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।
[07/01, 11:42] Patient Advocate 2F Diabetes1: Nuts
[07/01, 11:42] Patient Advocate 2F Diabetes1: Milk
[07/01, 12:14] PPM 1 - Nuts in milk?
Groundnuts?
[07/01, 12:28] Patient Advocate 2F Diabetes1: Only nuts pest ( Almond, walnut, piasta, cashew and chickpea )
[07/01, 13:14] PPM 1 - Does she enjoy eating that paste more than if you would have given her the same whole unpasted?
[07/01, 14:30] Patient Advocate 2F Diabetes1: She takes so much time to eat unpast nuts approx 1 hour
[07/01, 15:53] Patient Advocate 2F Diabetes1: 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, 15:08] Patient Advocate 2F Diabetes1: 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
[08/01, 15:11] Patient Advocate 2F Diabetes1: 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
[08/01, 17:02] PPM 1 - Now that you have increased the lantus to 5U be careful about the early morning asymptomatic hypoglycemia
[08/01, 17:23] Patient Advocate 2F Diabetes1: Ok Sir
[08/01, 18:59] Patient Advocate 2F Diabetes1: 5.00pm boil egg
6.30pm mixed of chickpea with onion, tomato, coriander
[08/01, 19:02] Patient Advocate 2F Diabetes1: স্যার আমরা একটু আন্দামান ঘুরতে যাচ্ছি তাই খাওয়ার এবং সময়ের পরিবর্তন হবে আর একটু গাইড করবেন ওকে বাইরের খাওয়ার খেতে হবে সেই ব্যাপারে l
[08/01, 22:08] Patient Advocate 2F Diabetes1: 8.30pm 4u lantus insulin
8.30pm blood sugar 81 and no lispro insulin
8.35pm rice with pulses, egg and salad
[09/01, 10:57] Patient Advocate 2F Diabetes1: 9.01.25
6.45am blood sugar 199
6.45am roti(aata), boil egg, banana,
[09/01, 18:25] Patient Advocate 2F Diabetes1: 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
[09/01, 20:53] PPM 1 - 10:00AM Orange or orange juice?
[09/01, 21:35] Patient Advocate 2F Diabetes1: Orange
[09/01, 21:38] Patient Advocate 2F Diabetes1: 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, 20:59] Patient Advocate 2F Diabetes1: 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, 06:08] Patient Advocate 2F Diabetes1: 8.45pm 5u lantus insulin
8.50pm blood sugar 412
9.00pm 3.5u lispro insulin
9.05pm fried rice, chichen and salad
[11/01, 16:01] Patient Advocate 2F Diabetes1: 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, 08:43] Patient Advocate 2F Diabetes1: 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
[12/01, 08:47] Patient Advocate 2F Diabetes1: 12.01.25
8.00am blood suger 293
8.00am 4u lispro insulin
8.08am breakfast with idle and sambar
[12/01, 23:42] Patient Advocate 2F Diabetes1: 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
[12/01, 23:43] Patient Advocate 2F Diabetes1: Tablets গুলি দিতাম না যেহেতু বাইরে আছি তাই দিলাম l
[13/01, 16:13] Patient Advocate 2F Diabetes1: 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
[13/01, 22:41] Patient Advocate 2F Diabetes1: 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, 08:12] PPM 1 - Another analysis and inference of this patient's first two weeks of data in January 2025
[14/01, 08:13] PPM 1 - 👆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)*.
[14/01, 13:27] Patient Advocate 2F Diabetes1: 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, 09:40] Patient Advocate 2F Diabetes1: 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
[15/01, 09:42] PPM 1 - Why metrogyl syrup?
[15/01, 09:42] Patient Advocate 2F Diabetes1: 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
[15/01, 19:16] Patient Advocate 2F Diabetes1: 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
[15/01, 19:18] Patient Advocate 2F Diabetes1: 4.00pm Cadbury chocolate 3bar
[16/01, 08:49] Patient Advocate 2F Diabetes1: 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
[16/01, 13:57] Patient Advocate 2F Diabetes1: She had dysentery
[16/01, 14:06] Patient Advocate 2F Diabetes1: 16.01.25
7.45am blood sugar 149
7.45am 3.5u lispro insulin
7.50am puri, vegetable
12.45pm coconut water
[17/01, 08:59] Patient Advocate 2F Diabetes1: 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
[17/01, 09:14] PPM 1 - Morning lispro dose was decided after counting anticipated carb consumption? @Metacognitist Mover and Shaker1 @PPM3 SR Medicine @Inner Strength Engineer1 (AI ask) how much would be the estimated lispro dose for an anticipated puri vegetables that a 3 year old can eat?
[17/01, 09:15] Patient Advocate 2F Diabetes1: 17.01.25
7.45pm blood sugar 307
7.45am 5u lispro insulin
7.50am idle 2pcs
[17/01, 09:15] PPM 1 - @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?
[17/01, 09:15] 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.
[17/01, 09:16] Rakesh Biswas: @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
[17/01, 09:16] 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.
[17/01, 09:18] PPM 1 - 👆this is fasting at 7:45 AM?
[17/01, 09:21] PPM 1 - 👆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?
[17/01, 09:22] PPM 1 - 👆 morning lispro skipped on 14/1/25?
[17/01, 09:22] PPM 1 - 👆 morning lispro skipped on 13/1/25?
[17/01, 09:24] PPM 1 - 👆 morning lispro taken on 12/1/25
Severe hypoglycemia of 31 at 1:45 PM! Albeit asymptomatic
[17/01, 09:25] PPM 1 -👆 morning lispro skipped on 11/1/25
[17/01, 09:26] PPM 1 - 👆 morning 2U lispro producing hypoglycemia at 1:00 PM on 10/12/25!
[17/01, 09:28] PPM 1 - 👆on 9/1/25 morning lispro of 3U producing 395 at 12:30 PM!
[17/01, 09:42] Patient Advocate 2F Diabetes1: আজকে আবার পোস্ট ব্রেকফাস্ট সুগার টা দেখছি l
[17/01, 09:48] Metacognitist Mover and Shaker1: I assume the pediatric endocrinologist specifically recommended seeing a dietician, exactly for this issue?
[17/01, 21:30] Patient Advocate 2F Diabetes1: 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
[17/01, 21:34] PPM 1 - The hypoglycemia documented at 10:40 AM was expected with such a jump of the lispro dose
[18/01, 22:45] Patient Advocate 2F Diabetes1: 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
[18/01, 22:49] Patient Advocate 2F Diabetes1: 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, 12:24] Patient Advocate 2F Diabetes1: 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, 07:09] Patient Advocate 2F Diabetes1: 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)
[20/01, 08:26] PPM 1 - Beware of the sudden chaotic morning hypo with 1U lantus increments that generally come after a few days in this child
[20/01, 08:31] Patient Advocate 2F Diabetes1: Ok Sir 🙏🏾
[20/01, 08:48] Patient Advocate 2F Diabetes1: 7.45am blood sugar 195
7.45am payesh (milk, cown rice, dates and raisins) without sugar
[20/01, 13:38] Patient Advocate 2F Diabetes1: 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
[20/01, 23:38] Patient Advocate 2F Diabetes1: 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, 09:48] Patient Advocate 2F Diabetes1: 21.01.25
7.45am blood sugar 141
7.45am nuts
8.00am milk
[21/01, 15:18] Patient Advocate 2F Diabetes1: 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, 07:05] Patient Advocate 2F Diabetes1: 4.00pm blood sugar 106
7.00pm oats
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish
[22/01, 08:26] PPM 1 - Yesterday's lantus?
[22/01, 08:30] Patient Advocate 2F Diabetes1: 8.30pm 5u lantus
[22/01, 08:31] Patient Advocate 2F Diabetes1: 22.01.25
7.45am blood sugar 238
7.45am nuts
8.00am milk
[22/01, 10:52] PPM 1 - This hints at a sizeable contribution of even the lispro dose to the morning fasting? @Metacognitist Mover and Shaker1
[22/01, 11:01] Patient Advocate 2F Diabetes1: 9.45am 4.5u lispro insulin
9.50am rice with pulses, carrot, cauliflower, spinach, brocolli, beatroot, beans, kidney beans, brinjal,tomato, egg and salad
[22/01, 12:45] Metacognitist Mover and Shaker1: Yes to an extent.
[22/01, 14:59] Patient Advocate 2F Diabetes1: 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
[22/01, 23:17] Patient Advocate 2F Diabetes1: 6.45pm one patty (making with rice flour, butter) without sugar
[22/01, 23:19] Patient Advocate 2F Diabetes1: 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, 07:11] Patient Advocate 2F Diabetes1: 11.55, pm blood sugar 171
Then 1/2 teaspoon of payesh ( milk, rice and suger)
[23/01, 08:30] PPM 1 - Why 1/2 tea spoon of payesh?
[23/01, 08:36] PPM 1 - 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)? @Metacognitist Mover and Shaker1 @PPM3 SR Medicine
[23/01, 08:50] Patient Advocate 2F Diabetes1: 23.01.24
7.45am blood sugar 71
7.45am nuts
8.00am payesh (milk, rice, dates and raisins) without sugar
[23/01, 08:50] Rakesh Biswas: As suspected lantus is already threatening to cause hypoglycemia by tomorrow
[23/01, 08:51] PPM 1 - In anticipation 4.5U lantus tonight
[23/01, 09:27] Patient Advocate 2F Diabetes1: Sir, it was 238 of sugar level on same lantus dose even before lunch and dinner it was also above 300
[23/01, 09:29] Patient Advocate 2F Diabetes1: Lantus pen nsulin doesn't support 0.5u
[23/01, 09:34] PPM 1 - 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
[23/01, 09:36] PPM 1 - 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
[23/01, 09:39] PPM 1 - 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
[23/01, 09:44] PDMA 2 - Could site of administration be causing this prolonged/additive effect of lantus?
[23/01, 09:52] Patient Advocate 2F Diabetes1: 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 .
[23/01, 09:54] PPM 1 - Would be grateful for some papers pointing to the same
[23/01, 09:55] PPM 1 - @Patient DM1 MP Advocate 2 please share how your patient managed to transition from her pen to syringe without making her local doctor angry
[23/01, 09:57] PDMA 2 - 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.
[23/01, 09:59] PPM 1 - Yes that's text book established information.
@Patient Advocate 2F Diabetes1 please share what are the regular sites on her body where your patient is being injected
[23/01, 10:42] Patient Advocate 2F Diabetes1: 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)
[23/01, 10:51] Patient Advocate 2F Diabetes1: Thigh and around the navel
[23/01, 11:09] PDMA 2 Maybe if you can document the site of each lantus dose in a journal..the data can be analysed after a few days/weeks.
[23/01, 11:12] Patient Advocate 2F Diabetes1: Lantus always pulshes in thigh and lispro some time in thigh and some time in around navel
[23/01, 11:15] PDMA 2- 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.
[23/01, 11:24] PPM 1 - Any particular reason for this choice?
[23/01, 14:49] Patient Advocate 2F Diabetes1: No Sir, She doesn't want to take all time in belly
[23/01, 14:51] Patient Advocate 2F Diabetes1: 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
[23/01, 19:48] Patient DM1 MP Advocate 2: Sir, pen refill was not available, so I used syringe instead of pen after taking permission from the doctor.
[24/01, 08:43] Patient Advocate 2F Diabetes1: 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**
[24/01, 08:43] Patient Advocate 2F Diabetes1: 24.01.25
7.45am blood suger 193
7.45am milk
[24/01, 13:09] Patient Advocate 2F Diabetes1: 9.45am 4.5u lispro insulin
9.50am rice with pulses, brinjal, spinach, carrot, cauliflower, brocolli, turnip, beans, kidney beans, egg and salad
[24/01, 13:09] Patient Advocate 2F Diabetes1: 12.00noon orange
[24/01, 14:20] PPM 1 - No fasting sugar values today?
[25/01, 09:22] Patient Advocate 2F Diabetes1: It was fasting
[25/01, 09:27] Patient Advocate 2F Diabetes1: 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
[25/01, 09:28] Patient Advocate 2F Diabetes1: 25.01.25
7.45am fasting blood sugar 235
7.45am nuts
8.00am milk
[25/01, 09:51] PPM 1 -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)
[25/01, 09:52] Patient Advocate 2F Diabetes1: Absolutely Sir
[25/01, 14:58] Patient Advocate 2F Diabetes1: 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
[25/01, 22:43] Patient Advocate 2F Diabetes1: 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, 11:33] Patient Advocate 2F Diabetes1: 26.01.25
7.45am fasting blood sugar 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
[26/01, 19:01] Patient Advocate 2F Diabetes1: 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
[26/01, 22:37] Patient Advocate 2F Diabetes1: 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
[26/01, 22:39] Patient Advocate 2F Diabetes1: স্যার কাল থেকে কি lantus 6u করে দিব?
[26/01, 22:46] PPM 1 - Na already fasting 88
Lantus barano jabe na
Shudhu lispro tai barano jabe
[26/01, 22:50] PPM 1 - 👆 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, 09:39] Patient Advocate 2F Diabetes1: 27.01.25
7.45am blood sugar 213
7.45am nuts
8.00am milk
[27/01, 11:59] Patient Advocate 2F Diabetes1: 9.45am 6.5u lispro insulin
9.50am rice with pulses, brinjal, tomato, beans, kidney beans, brocolli, carrot, cabbage, beatroot, turnip, butter and salad
[27/01, 12:58] Patient Advocate 2F Diabetes1: 12.00noon orange
12.00noon blood sugar 314
[27/01, 12:59] Patient Advocate 2F Diabetes1: স্যার সুগার নামছেই না l কি করব এখন ?
[27/01, 13:14] PPM 1 - Aajke lantus ta +1 barano jete pare ebong lispro dose guno o gotokaaler tulonai +1 barano jete pare
[27/01, 13:14] PPM 1 - CGM device ta lagiye nite parle khub bhalo hoi
[28/01, 07:08] Patient Advocate 2F Diabetes1: 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
[28/01, 08:32] Patient Advocate 2F Diabetes1: 28.01.25
7.45am fasting blood sugar 264
7.45am milk
[28/01, 09:47] PPM 1 - 6U lantus tao ektu somoi nebe
[28/01, 10:28] Patient Advocate 2F Diabetes1: 9.30am 5u lispro
9.35am rice with pulses, brinjal, spinach, carrot, cauliflower, cabbage, tomato, beatroot, beans kidney beans, brocolli, butter and salad
[28/01, 23:52] Patient Advocate 2F Diabetes1: 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, 16:32] PPM 1 - Today's fasting?
[29/01, 19:22] Patient Advocate 2F Diabetes1: 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
[29/01, 19:23] Patient Advocate 2F Diabetes1: স্যার মেয়ে আজ থেকে স্কুল যাচ্ছে তাই সময় গুলি একটু আগে পরে হচ্ছে
[29/01, 19:33] PPM 1 - Reduce lantus dose today
[30/01, 07:13] Patient Advocate 2F Diabetes1: 9.00pm 5u lantus
9.30pm blood sugar 266
9.30pm 2u lispro insulin
9.35pm dinner with as same as lunch dish
[30/01, 09:35] PPM 1 - Fasting today?
[30/01, 09:59] Patient Advocate 2F Diabetes1: 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, 07:10] Patient Advocate 2F Diabetes1: 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
[31/01, 10:01] PPM 1 - Stolen sweet 342!
[31/01, 10:02] PPM 1 - I guess sweets are not good for anyone and should not be kept at home to prevent someone from stealing them?
[31/01, 10:30] Patient Advocate 2F Diabetes1: Ok Sir
[31/01, 10:32] Patient Advocate 2F Diabetes1: 31.01.25
7.45am blood sugar 97
7.45am milk with one biscuit
9.45am 2pcs biscuit
[31/01, 23:13] Patient Advocate 2F Diabetes1: 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
[01/02, 08:59] Patient Advocate 2F Diabetes1: 01.02.25
7.45am fasting blood sugar 192
7.45am nuts
8.00am milk
[01/02, 11:41] Patient Advocate 2F Diabetes1: 9.45am 5.5u lispro insulin
9.50am rice with pulses, brinjal, tomato, beans, bitter gourd, cauliflower, carrot, beetroot, spinach, cabbage, papad and salad
[01/02, 23:48] Patient Advocate 2F Diabetes1: 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, 16:57] Patient Advocate 2F Diabetes1: 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
[02/02, 17:03] PPM 1 - 👆 with the hyperglycemic phase ending in Friday, @Metacognitist Mover and Shaker1 @Inner Strength Engineer1 , the patient appears to have entered a normo to hypoglycemic phase since yesterday!
[02/02, 17:07] Metacognitist Mover and Shaker1: We should publish this widely.
[02/02, 17:37] PPM 1 - Share the published link widely
[02/02, 17:38] Metacognitist Mover and Shaker1: Will need to present this in an easily digestible manner.
[02/02, 22:41] Patient Advocate 2F Diabetes1: 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, 18:25] Patient Advocate 2F Diabetes1: 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)
[03/02, 19:10] PPM 1 - Time to reduce lantus to 4U tonight
[04/02, 07:07] Patient Advocate 2F Diabetes1: 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
[04/02, 07:09] Patient Advocate 2F Diabetes1: এটা পরে দেখেছি স্যার
[04/02, 08:22] PPM 1 - Fasting sugars today?
[04/02, 10:02] Patient Advocate 2F Diabetes1: 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
[04/02, 22:43] Patient Advocate 2F Diabetes1: 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, 09:42] Patient Advocate 2F Diabetes1: 5./02/25
7.45am fasting blood sugar 249
7.45am nuts
8.00am milk
[06/02, 07:12] Patient Advocate 2F Diabetes1: 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
[06/02, 08:05] PPM 1 - 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
[06/02, 08:10] PPM 1 - @Patient Advocate 56F Migraine Hypothyroidism 2000 @Patient advocate 23F Weight Gain Would any of you like to take over the updating this case report as the originator of this case report is currently unable to engage here?
[06/02, 08:29] Patient advocate 23F Weight Gain: Sure
[06/02, 08:31] PPM 1 - Do link all her previous case report links visible in the description box here if when you begin to update
[06/02, 08:37] Patient advocate 23F Weight Gain: Ok... I'm checking the links
[06/02, 10:02] Patient Advocate 2F Diabetes1: 6.02.25
7.45am fasting blood sugar 169
7.45am nuts
8.00am milk
9.45am two pcs chocolate biscuit
[06/02, 22:43] Patient Advocate 2F Diabetes1: 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, 12:12] Patient Advocate 2F Diabetes1: 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
[07/02, 18:45] Patient Advocate 2F Diabetes1: 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
[07/02, 18:47] Patient Advocate 2F Diabetes1: স্যার এখন lantus না lispro বাড়ানো যায় ?
[07/02, 20:11] PPM 1 - 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
[07/02, 22:19] Metacognitist Mover and Shaker1: Possibly this child will need switching to Humalog Mix 75. 3 injections and enough long acting.
[07/02, 22:19] Metacognitist Mover and Shaker1: Lantus is far too hypoglycemic for this child?
[07/02, 22:19] Metacognitist Mover and Shaker1: Or even Humalog Mix 50
[07/02, 22:27] Patient Advocate 2F Diabetes1: 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, 07:17] PPM 1 - Also influenced by our learning from the other PaJR type 1 diabetes patient
[08/02, 09:09] Patient Advocate 2F Diabetes1: 8.02.25
7.45am fasting blood sugar 196
7.45am nuts
8.00am milk with 1/2 aata roti
[08/02, 14:35] Patient Advocate 2F Diabetes1: 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)
[08/02, 18:32] PPM 1 - Would be nice to see the picture of the food plates
[08/02, 23:40] Patient Advocate 2F Diabetes1: 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, 08:44] Patient Advocate 2F Diabetes1: 9.02.25
7.45am fasting blood sugar 195
7.45am nuts
8.00am milk
[09/02, 08:54] Patient Advocate 2F Diabetes1: Nuts
[09/02, 12:08] Patient Advocate 2F Diabetes1: 9.45am 6u lispro insulin
9.50am rice with pulses, brinjal, tomato, beans, kidney beans, brocolli, carrot, beatroot, cauliflower, chayote, pakoda (onion), and salad
[09/02, 14:54] Patient Advocate 2F Diabetes1: 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
[09/02, 14:57] PPM 1 - What is the liquid being used to mix the powdered nuts?
Does she enjoy the nuts in this way?
What nuts are these?
[09/02, 22:35] Patient Advocate 2F Diabetes1: No powder, it is whole nuts . Patient does not chwe the whole nuts so its make pest in mixture.
[09/02, 22:44] PPM 1 - 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?
[09/02, 23:01] Patient Advocate 2F Diabetes1: Cashew, piasta, wallnut, almond and chickpea
[09/02, 23:08] Patient Advocate 2F Diabetes1: 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, 15:26] Patient Advocate 2F Diabetes1: 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
[10/02, 23:59] Patient Advocate 2F Diabetes1: 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, 11:49] Patient Advocate 2F Diabetes1: 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
[11/02, 12:22] PPM 1 - 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?
[11/02, 12:31] Patient Advocate 2F Diabetes1: No lispro, lantus was given 5u
[11/02, 12:33] PPM 1 - Alright
[11/02, 16:08] Patient Advocate 2F Diabetes1: 12.00noon pomegranate
1.45pm blood sugar 157
1.45pm 3.5u lispro insulin
1.50pm lunch with same previous dish
[11/02, 18:02] Patient Advocate 2F Diabetes1: 4.10pm blood sugar after lunch 112
[12/02, 07:07] Patient Advocate 2F Diabetes1: 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
[12/02, 09:45] Patient Advocate 2F Diabetes1: 12.02.25
7.45am fasting blood sugar 220
7.45am nuts
8.00am milk
[12/02, 16:52] Patient Advocate 2F Diabetes1: 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
[12/02, 23:51] Patient Advocate 2F Diabetes1: 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, 10:44] Patient Advocate 2F Diabetes1: 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
[13/02, 16:13] Patient Advocate 2F Diabetes1: 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
[14/02, 00:03] Patient Advocate 2F Diabetes1: 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, 12:26] Patient Advocate 2F Diabetes1: 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, 17:02] Patient Advocate 2F Diabetes1: 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
15-02-2025
PPM 1 - Yesterday's lantus?
PA - 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.
16-02-2025
PPM 1 - Yesterday's total lispro was:
5.5U+4.5U+2U?
PA - Yes
17-02-2025
PA -
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
PPM 1 - 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.
PA - There was pre dinner mutton and chips in marriage reception party.
18-02-2025
PA - 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.
PPM 1 - 👍
19-02-2025
PA -
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.
19.02.25
7.45am fasting blood sugar 171
7.45am milk
PA - 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.
PPM 1 - 👍
20-02-2025
PA - 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
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
PPM 1 - 👍
PA - 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.
PPM 1 - 👍
PA - 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
21-02-2025
PA - 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.
22-02-2025
PA - 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
PPM 1 - 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
PA - Okay sir
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
23-02-2025
PA - 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
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
PPM 1 - Blood sugar was checked immediately after taking the lantus injection or before taking the lantus?
PA - No Sir
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
PPM 1 - When was the 9PM blood sugar checked?
After taking the lantus or before taking the lantus?
PA - Before.
PPM 1 - If before then that may have been a signal to also reduce the lantus dose by 1U?
24-02-2025
PA - 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
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.
25-02-2025
PA - 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.
PPM 1 - The pre lunch has been consistently high regardless of the pre breakfast lispro dose @SE Can we get AI to reason out why?
@PPM2 we can try to incorporate this case's experience from author @SE into the current publishable commentary
PA - 25.02.25
7.45am fasting blood sugar 133
7.45am nuts
8.00am milk
PPM 1 - 👍
SE - 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.
SE - @PPM1 sir AI mostly focuses on diet whenever asked about high readings through out the day except for fasting sugar.
PPM 1 - 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)
SE - 👍Sir, above was generated by ChatGpt from one month's data.
For feeding entire case report via link, that feature work freely in Google Notebook LM.
Below is the response from Notebook LM of entire case report.
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.
PPM 1 - 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.
SE - 🙏
PA - 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.
26-02-2025
PA - 26.02.25
7.45am fasting blood sugar 150
7.45am milk
PPM 1 - 👍
27-02-2025
PA -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
27.2.25
7.45am fasting blood sugar 140
7.45am milk.
PPM 1 - 👍
28-02-2025
PA - 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.
PPM 1 - @PPM2 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? @SE 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?
SE - Yes sir. I will do it.
PPM 1 - 👍
PA - 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
PA -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
PPM 1 - 👍
SE - 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.
01-03-2025
PPM 1 -Nice summary of what has been discussed.
However data driven healthcare may demand that the LLM (do also mention the name of the LLM, has some free LLM version again started accepting URLs?) shares the date and time of the events that it currently points out in general.
SE - 🙏
Ok sir sure ✅
PA - 01.03.25
7.45am fasting blood sugar 116
7.45am nuts
8.00am milk
PPM 1 - 👍
PA - 9.30am 4u lispro insulin
9.35am rice with pulses, carrot, broccoli, cauliflower, beetroot, brinjal, tomato, peas, chayote, egg and salad
12.30pm grapes
1.30pm blood sugar 80
1.30pm 2.5u lispro insulin
1.35pm lunch with same previous dish except egg and include papad.
SE - Sir I just realized sharing the date time reference for the above summary is not possible as Google notebookLM doesn't keep the history of prompt and its response. I will share everything altogether from now on.
Sir uptil now I know it is Google NotebookLM which easily takes the URL to analyze in its free version.
One more AI application "Insight7" I tried today for data analysis. Here we can copy paste the entire case report without any word limit issue in free version. Below are the links of the analysis that is shared individually as the limitation of free version.
It has also discussed the same points that has been discussed here but in a more proper, efficient and visually appealing way.
PPM 1 - Great! These are in Bengali too!
Better also paste these in the patient's main case report before the link expires.
PPM 1 - Loved it 👏
SE - Thank youuu sir🙏🙏🙏🙏🙏🙏🙏🙏
Ok sir noted ✅
PA - 3.45pm blood sugar 170
6.30pm oats
9.00pm 4u lantus insulin
9.15pm blood suger 243
9.15pm 2u lispro insulin
9.20pm dinner with as same as lunch dish.
02-03-2025
PA - 2.03.25
7.45am fasting blood sugar 97
7.45am nuts
8.00am milk
9.30am 4.5u lispro insulin
9.35am rice with pulses brinjal tomato beans bitter gourd chayote carrot beetroot brocolli egg and salad
12.00noon grapes
1.30pm blood sugar 272
1.30pm 5u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
6.30pm banana.
[02-03-2025] PA: 9.00pm 4u lantus insulin
9.15pm blood sugar 232
9.15pm 2u lispro insulin
9.20pm dinner with as same as lunch dish
[03-03-2025 09:01] PA: 03.03.25
7.45am fasting blood sugar 200
7.45am nuts
8.00am milk
[03-03-2025 11:08] PA: 9.45am chocolate biscuit 2pcs
10.45am 6u lispro insulin
10.50am rice with pulses, brinjal, tomato, beans, kidney beans, brocolli, carrot, beatroot, pumpkin, chayote, bitter gourd, butter and salad
[03-03-2025 11:15] PPM 1: 👍
04-03-2025
PA -
12.15pm grapes
1.45pm blood sugar 151
1.45pm 3u lispro insulin
1.50pm lunch with same previous dish except butter
6=30pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 232
9.15pm 2u lispro insulin
9.20pm dinner with as same as lunch dish.
PPM 1 - 👍
PA -
04.03.25
7.45am fasting blood sugar 211
7.45am nuts
8.00am milk
9.45am chocolate biscuit 2pcs
10.45am 6u lispro insulin 10.50am rice with pulses, carrot, broccoli, cauliflower, beetroot brinjal, pumpkin, tomato, peas chayote, egg and salad
12.15pm grapes
1.45pm blood sugar 350
1.45pm 6u lispro insulin
1.50pm lunch with same previous dish except egg and include fish.
06-03-2025
[06-03-2025 00:00] PA: 6.30pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 113
9.15pm 0.5u lispro insulin
9.20pm dinner with as same as lunch dish
[06-03-2025 00:09] PA: 05.03.25
7.45am fasting blood sugar 103
7.45am nuts
8.00am milk
9.45am chocolate biscuit 2pcs
10.45am 4.5u lispro insulin
10.50am rice with pulses, carrot, broccoli, cauliflower, beetroot, brinjal, tomato, peas, chayote, pumpkin, egg and salad
12.15pm grapes
1.30pm blood sugar 265
1.30pm 5u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
6.00om sour curd
6.45pm banana
8.00pm samosa ( remove potatoes)
9.00pm 4u lantus insulin
9.20pm blood sugar 317
9.20pm 3u lispro insulin
9.25pm dinner with as same as lunch dish
[06-03-2025 07.01] PPM 1 - Removing potatoes from samosas may not make much difference
[06-03-2025 07.36] PA - Yes sir
[06-03-2025 20.38] PA:
6.03.25
7.45am fasting blood sugar 72
7.45am milk
9.45am chocolate biscuit 2pcs
10.45am 4u lispro insulin
10.50am rice with pulses, carrot, broccoli, cauliflower, beetroot, brinjal, tomato, peas, chayote egg and salad.
12.15pm grapes
1.40pm blood sugar 142
1.40pm 3.5u lispro.
1.45pm lunch with same previous dish except egg and include fish
6.00pm sour curd
6.30pm banana
07-03-2025
PA - 7.00pm small amount of Maggie
9.00pm 4u lantus insulin
9.15pm blood suger 308
9.15pm 2u lispro insulin
9.20pm rice with pulses, brinjal beans tomato chayote, fish, papad, and salad.
[07-03-2025 23:29] PA: 07.03.25
7.45am fasting blood sugar 155
7.45am nuts
8.00am milk
9.45am chocolate biscuit 2pcs
9
10.45am 5.5u lispro insulin
10.50am rice with pulses, carrot, broccoli, cauliflower, beetroot, beans, chayote, peas, bitter gourd, egg and salad
12.15pm grapes
1.30pm blood sugar 190
1.35pm 4u lispro insulin
1.35pn lunch with same previous dish
6.00pm sour curd
6.30pm 1/2 sandesh
6.45pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 305
9.15pm 2.5u lispro insulin
9.20pm dinner with as same as lunch dish except egg and include fish and paneer
[08-03-2025 12:15] PA: 8.03.25
7.45am fasting blood sugar 251
7.45am nuts
8.00am milk 9.45am rice with pulses, carrot, cauliflower, cabbage, tomato, beatroot, beans, bitter gourd, chayote, egg and salad
12.15pm grapes.
[09-03-2025 09:09] PA: 1.30pm blood suger 295
1.30pm 5u lispro insulin।1.35pm lunch with same previous dish except egg
6.00pm sour curd 6.30pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 185
9.15pm 1u lispro insulin
9.20pm dinner with as same as lunch dish and papad
[09-03-2025 09:11] PA: 9.03.25
7.45am fasting blood sugar 151
7.45am nuts
8.00am milk
[10-03-2025 00:33] PA: 9.30am 5u lispro insulin
9.35am rice with pulses, carrot, broccoli, cauliflower, beetroot, brinjal, tomato, beans, bitter gourd, chayote, fish and salad
12.00noon grapes
1.30pm blood sugar 167
1.30pm 3.5u lispro insulin
1.35pm lunch with same previous dish
6.00pm sour curd
6.30pm banana
7.15pm Maggie small amount
9.00pm 4u lantus insulin
9.15pm blood sugar 413
9.15pm 4u lispro insulin
9.20pm dinner with as same as lunch dish
[10-03-2025 08:10] PPM 1: The pre dinner sugars are quite erratic! While on Saturday 8/3/25 her pre
dinner was 185 her Sunday 9/3/25 pre dinner was 413! Albeit her pre lunch lispro on Saturday was 5U
while on Sunday was 3.5U and this difference was again influenced by her pre lunch sugars! I'm
wondering if measuring pre meal insulin is good or 2 hours post meal is better @PPM2?
[10-03-2025 08:47] PA: 10.03.25
7.45am fasting blood sugar 307
7.45am nuts
8.00am milk
[10-03-2025 13:02] PPM 2: Do you think that could be Maggie effect?
[10-03-2025 13:04] PPM 1: Yes difficult to say although yes it's one added factor to take into account
[10-03-2025 13:37] PA: 9.45am chocolate biscuit 2pcs
10.45am 7u lispro insulin
10.50am rice with pulses, brinjal, tomato, beans, bitter gourd, chayote, carrot, beetroot, brocolli, egg and salad
12.15pm grapes
12.50Pm blood sugar 371
[10-03-2025 13.40] PPM 1: 👍
[10-03-2025 14.28] PA: 1.45pm 5.5u lispro insulin
1.50pm lunch with same previous dish except egg and include paneer.
[11-03-2025 10:09] PA: 6.30pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 67
9.15pm dinner with as same as lunch dish and papad
No lispro at night
[11-03-2025 10:11] PA: 11.03.25
7=45 am fasting blood sugar 195
7.45am nuts
8.00am milk
9.45am chocolate biscuit 2pcs
[11-03-2025 12:50] PPM 1: 👍
[11-03-2025 14.40] PA: 10.45am 5.5u lispro insulin
10.50am rice with pulses, carrot, broccoli, cauliflower, beetroot, brinjal, tomato, beans, egg and salad
12.15pm grapes
1.45pm blood sugar 204
1.45pm 4u lispro insulin
1.50pm lunch with same previous dish except egg and include fish.
PPM 1 - 👍
[11-03-2025 22:27] +91 81458 15112: 6.15pm 55% dark chocolate 10grm
6.35pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 356
9.15pm 3.5u lispro insulin
9.20pm dinner with as same as lunch dish
[12-03-2025 06:55] PPM 1: Could have taken lispro before taking the dark chocolate.
Lispro before any amount of calorie dense food would be necessary
[12-03-2025 09:03] PA: Dark chocolate was not so much. One chocolate which was 35grm. She ate it in
three days
[12-03-2025 09:04] PA: 12.03.25
7.45am fasting blood sugar 147
7.45am nuts
8.00am milk
[12-03-2025 09:24] PPM 1: @Meta AI How much calories in 10 gms of 55% dark chocolate and how
much carb counted lispro insulin injection units can be taken for it?
[12-03-2025 09:24] Meta AI: To calculate the calories in 10g of 55% dark chocolate, we'll need to know
the approximate calorie density of dark chocolate. According to the United States Department of
Agriculture (USDA), 100g of dark chocolate (45-59% cocoa solids) contains approximately 575
calories.
For 10g of 55% dark chocolate, the calorie count would be:
(10g / 100g) * 575 calories ≈ 57.5 calories
As for the carb count, 10g of dark chocolate typically contains around 6-7g of carbohydrates. To
calculate the insulin units needed, we'll use the following assumptions:
- 1 unit of lispro insulin covers 15g of carbohydrates (this may vary depending on individual factors, so
consult your healthcare provider for personalized guidance)
- You want to cover the entire carb content of the chocolate (6-7g)
Based on these assumptions, the insulin units needed would be:
6-7g carbohydrates / 15g carbohydrates per unit ≈ 0.4-0.47 units of lispro insulin
Please note that this is an estimate and may vary depending on individual factors, such as your personal
insulin sensitivity, diet, and exercise. Always consult your healthcare provider for personalized
guidance on insulin dosing.
[12-03-2025 09:26] PPM 1: @Meta AI How much calories in a banana and how much carb counted
lispro insulin injection units can be taken for it?
[12-03-2025 09:26] Meta AI: According to the United States Department of Agriculture (USDA), a
medium-sized banana (approximately 118g) contains:
- Calories: 105
- Carbohydrates: 27g
To calculate the insulin units needed, we'll use the same assumption as before:
- 1 unit of lispro insulin covers 15g of carbohydrates (this may vary depending on individual factors, so
consult your healthcare provider for personalized guidance)
Based on this, the insulin units needed to cover the carb content of a medium-sized banana would be:
27g carbohydrates / 15g carbohydrates per unit ≈ 1.8 units of lispro insulin
Please note that this is an estimate and may vary depending on individual factors, such as your personal
insulin sensitivity, diet, and exercise. Always consult your healthcare provider for personalized
guidance on insulin dosing.
[12-03-2025 09:27] PPM 1: @PPM2 did she need 2U lispro to cover her choclate and banana at 6:00 PM?
[12-03-2025 21:52] PPM 2: Please tell us the brand name of the chocolate
[12-03-2025 22:43] PPM 2: Thank you. Will look up nutritional label.
https://www.bing.com/images/search?view=detailV2&ccid=PALhZ%2Btw&id=1A226DE73FD1D6B0E6A630456154B6AF8BB0747F&thid=OIP.PALhZ-twWl_E4ZJNgmmjoQHaHa&mediaurl=https%3A%2F%2Fwww.bigbasket.com%2Fmedia%2Fuploads%2Fp%2Fl%2F40181888-4_1-amul-dark-chocolate.jpg&cdnurl=https%3A%2F%2Fth.bing.com%2Fth%2Fid%2FR.3c02e167eb705a5fc4e1924d8269a3a1%3Frik%3Df3Swi6%252b2VGFFMA%26pid%3DImgRaw%26r%3D0%26sres%3D1%26sresct%3D1&exph=500&expw=500&q=amul+55%25+dark+chocolate+nutritional+label&simid=608006463503888768&form=IRPRST&ck=8F2A150C3B90F8767508A9F64F845ACA&selectedindex=1&itb=1&pc=EMMX01&ajaxhist=0&ajaxserp=0&vt=4&sim=11
[12-03-2025 22:45] PPM 2: Did she have the whole bar in 3 days?
[12-03-2025 22:46] PPM 2: This whole bar is 150g
[12-03-2025 22:55] PA: It was wrong
[12-03-2025 22:57] PA: It is 35grm. It has been eaten by three days.
[12-03-2025 23:06] PPM 2: Right. More than Half of the chocolate is carbs. So it would be about 6g of sugars. And 1 banana, which is about 15g of sugar.
So in toto she received 21g of sugar.
For 11/3/2025.
She received a total of 13 units of insulin (both Lispro and Lantus)
On 10/3 - She received 16.5 units in toto
Therefore it is very hard to calculate how much 1 unit of Lispro would have corrected her blood sugar.
Maybe you did the right thing.
[12-03-2025 23:07] PPM 2: How are her bowel habits? Does she feel bloating and pass gas with certain foods?
[12-03-2025 23:15] PA: Her bowel habits is once in a day
No gas problem right now
[12-03-2025 23.16] PPM 1: 👍
[13-03-2025 02:05] PPM 2: Okay that's good. Any particular foods which cause gas and bloating?
[13-03-2025 07:12] PA: 9.45am chocolate biscuit 2pcs
10.45am 5u lispro insulin
10.50am rice with pulses, brinjal, tomato, beans, chayote, peas, bitter gourd, cauliflower, beetroot, carrot,egg and salad
12.15pm apple
1.45pm blood sugar 4u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 244
9.15pm 2u lispro insulin
9.30pm dinner with as same as lunch dish
[13-03-2025 09:58] PA: 13.03.25
7.45am fasting blood sugar 168
7.45am nuts
8.00am milk
[13-03-2025 15:27] PA: 9.45am chocolate biscuit 2pcs
10.45am 5.5u lispro insulin
10.50am rice with pulses, carrot, cauliflower, beetroot, beans, chayote, peas, egg and salad
12.55pm apple
1.45pm blood sugar 247
1.50pm lunch with same previous dish except egg include raw jackfruit
[13-03-2025 19:13] PA: 4.00pm blood sugar after lunch 118
6.30pm banana
PPM 1 - 👍
[14-03-2025 08:46] PA: 9.00pm 4u lantus insulin
9.15pm blood sugar 143
9.15pm 0.5u lispro insulin
9.20pm dinner with as same as lunch dish
[14-03-2025 08:47] PA: 14.03.25
7.45am fasting blood sugar 212
7.45pm milk
[14-03-2025 17:12] PA: 9.45am 4.5u lispro insulin
9.50am rice with pulses, carrot, broccoli, cauliflower, beetroot, beans, chayote, peas, bitter gourd, egg and salad
12.00noon apple
1.30pm blood sugar 95
1.30pm 2.5u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
[14-03-2025 20:24] PPM 1: 👍
[15-03-2025 09:49] PA: 6.30pm banana
7.00pm 1/2 sandesh and small amount of khichdi (prasad)
9.00pm 4u lantus insulin
9.15pm blood sugar 491
9.15pm 5.5u lispro insulin
9.20pm dinner with as same as lunch dish
11.30pm blood sugar after dinner 156
[15-03-2025 09:50] +91 81458 15112: 15.03.25
7.45am fasting blood sugar 68
7.45am milk
[15-03-2025 09:54] PPM 1: @PPM2 I wonder if you have noticed this:
In this method of judging efficacy of insulin on blood glucose by checking pre meals alone and also using that to decide the next dose of insulin pre meal, one often tends to hike the dose of pre meal insulin based largely on the pre meal glucose rather than also factor in the actual meal requirements? What's your opinion on this @Meta AI ? Please substantiate your inputs with links to evidence based data
[15-03-2025 09:54] Meta AI: A very astute observation! You're right; relying solely on pre-meal blood glucose levels to adjust insulin doses can lead to overcorrection, particularly if meal requirements aren't taken into account.
Research suggests that this approach can result in:
1. Overinsulinization: Administering more insulin than needed, which can cause hypoglycemia (low blood sugar) (1).
2. Inadequate postprandial glucose control: Failing to account for the carbohydrate content of the meal can lead to post-meal hyperglycemia (high blood sugar) (2).
To address this issue, many experts recommend using a more comprehensive approach to insulin dosing, which considers multiple factors, including:
1. Carbohydrate counting: Accounting for the carbohydrate content of the meal to determine insulin doses (3).
2. Pre-meal blood glucose levels: Considering the current blood glucose level to adjust insulin doses (4).
3. Physical activity: Factoring in physical activity levels, as exercise can impact insulin sensitivity and glucose uptake (5).
4. Individual insulin sensitivity: Taking into account each person's unique insulin sensitivity and response to different types of insulin (6).
The American Diabetes Association (ADA) recommends using a patient-centered approach to insulin therapy, which involves:
1. Collaborative goal setting: Working with healthcare providers to set personalized blood glucose targets.
2. Individualized insulin regimens: Tailoring insulin doses and regimens to each person's unique needs and lifestyle.
3. Ongoing education and support: Providing patients with the knowledge and skills needed to manage their diabetes effectively (7).
In conclusion, while pre-meal blood glucose levels are an important factor in determining insulin doses, they should not be the sole consideration. A more comprehensive approach that takes into account meal requirements, physical activity, and individual insulin sensitivity is likely to result in more effective and safe insulin therapy.
References:
1. Overinsulinization: Cryer PE. Hypoglycemia in Diabetes: Pathophysiology, Prevalence, and Prevention. American Journal of Medicine. 2008;121(7):S3-S6. doi: 10.1016/j.amjmed.2008.03.001
2. Inadequate postprandial glucose control: Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of non-insulin-dependent diabetic patients. Diabetes. 2003;52(3):581-585. doi: 10.2337/diabetes.52.3.581
3. Carbohydrate counting: American Diabetes Association. Carbohydrate Counting. Diabetes Care. 2019;42(Supplement 1):S46-S49. doi: 10.2337/dc19-S004
4. Pre-meal blood glucose levels: American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2020;43(Supplement 1):S1-S212. doi: 10.2337/dc20-S001
5. Physical activity: Colberg SR, Sigal RJ, Yardley JE, et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079. doi: 10.2337/dc16-1728
6. Individual insulin sensitivity: Bergenstal RM, Garg S, Graff MR, et al. Safety and efficacy of insulin degludec (IDeg) compared with insulin glargine (IGlar) in patients with type 1 diabetes: A randomized, open-label, parallel-group trial. Diabetes, Obesity and Metabolism. 2012;14(11):1031-1040. doi: 10.1111/j.1463-1326.2012.01643.x
7. Patient-centered approach: American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2020;43(Supplement 1):S1-S212. doi: 10.2337/dc20-S001
[15-03-2025 10:13] PA: 9.30am 2.5u lispro insulin
9.35am rice with pulses, brinjal, tomato, beans, bitter gourd, chayote, carrot, beetroot, broccoli, butter and salad
PPM 1 - 👍
[15-03-2025 16:40] PPM 2: Yes I agree. Rapid actings generally don't cause as much Hypos as the long
actings and ideally should be tailored to the upcoming meal.
It also seems the patient never receives correctional doses at all?
[15-03-2025 16:48] PPM 1: Correctional dose are possible if they check the outcomes after two hours
of insulin? Here the strategy for giving insulin before meals is partly related to utilise it as means to
correct the pre meal insulin alone
[15-03-2025 21:18] PA: 12.00noon apple
1.30pm blood sugar 384
1.30pm 6.5u lispro insulin
1.35pm lunch with same previous dish except butter
6.30pm banana
9.00pm 4u lantus insulin
[15-03-2025 21:30] PPM 2: I think you are pivoting on the premise of a Type 2 here (two hours after insulin).
However Lispro reaches its peak within an hour and can correct faster. Also these doses were devised
based on CGM data.
[15-03-2025 23:52] PA: 9.15pm blood sugar 120
9.15pm 0.5u lispro insulin
9.20pm dinner with as same as lunch dish and papad
[15-03-2025 23:58] PPM 2: Can you please tell us why a Lispro dose of 0.5 units was decided on?
[15-03-2025 23:59] PPM 2: Also, how do you usually decide on the Lispro dose?
[16-03-2025 09:15] PA: Lispro dose
For every 70 level sugar =1u lispro
+
Meal =2.5u lispro
Pre breakfast and snacks = 1 - 2u lispro
But at dinner we use 2 - 2.5u less lispro because it was seen when we used lispro as same as others meal
then suger level come down in very low
(Sir we do not calculate the curbs of every food, so we use the lispro dose as assumption.
When lispro dose was 2u for the meal then the sugar level always high)
Sometimes suggest me in this group to reduce and increase the lispro dose.
[16-03-2025 09:18] PA: 16=03=25
7.45am fasting blood sugar 213
7.45am milk and puffed rice
[16-03-2025 16:14] PA: 9.30am 5u lispro insulin
9.35am rice with pulses, carrot, broccoli, bitter gourd, chayote, beetroot, tomato, beans, peas, butter and salad
11.45am blood suger 85
1.30pm 2.5u lispro insulin
1.35pm lunch with same previous dish except butter and include chicken
[16-03-2025 18:44] PPM 2: I see. Thanks for clarifying. Would you want to start carb counting then?
[16-03-2025 19:33] PA: Ofcourse Sir, thank you
[16-03-2025 19:41] PPM 2: Great. Would you be willing to take a carb counting course ? Such as
DAFNE or BERTIE?
[16-03-2025 19:57] PA: How and where?
[16-03-2025 20:01] PPM 2: Please see if you can find some relevant information here -
https://dafne.nhs.uk/
[17-03-2025 00:02] PA: 6.30pm oats
8.00pm solty biscuit 2pcs
9.00pm 4u lantus insulin
9.15pm blood sugar 329
9.15pm 4u lispro insulin
9.20pm dinner with as same as lunch dish
[17-03-2025 08:49] PA: 17.03.25
7.45am fasting blood sugar 115
7.45am milk
[17-03-2025 11:29] PA: 9.45am chocolate biscuit 2pcs
10.45am 4.5u lispro insulin
10.50wm rice with pulses and egg
PPM 1 - 👍
[17-03-2025 16:38] PA: 12.00noon grapes
1.45pm blood sugar 87
1.45pm 2.5u lispro insulin
1.50pm lunch with same previous dish except egg and include carrot, tomato, peas, chayote, pumpkin, cabbage, fish and salad
[18-03-2025 10:57] PA: 4.00pm blood sugar 125
6.30 pm banana
7.00pm 1/3 paratha
9.00pm 4u lantus insulin
9.15pm blood sugar 406
9.15pm 4u lispro insulin
9.20pm dinner with as same as lunch dish
[18-03-2025 11:29] PA: 18.03.25
7.45am fasting blood sugar 186
7.45am milk
9.30am 4u lispro insulin
9.35am rice with pulses, carrot, tomato, peas, chayote, pumpkin, cabbage, beetroot, egg and salad
[18-03-2025 14.22] PPM 1: 👍
[18-03-2025 22:37] PA: 12.00noon apple
1.30pm blood sugar 133.
1.30pm 3u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
6.30pm banana
9.00pm 4u lantus insulin 9.15pm blood sugar 208
9.15pm 1.5u lispro insulin 9.20pm dinner with as same as lunch dish
PPM 1 - 👍
[19-03-2025 12:23] PA: 19.03.25
7.45am fasting blood sugar 163
7.45am milk with puffed rice
9.45am 4u lispro insulin
9.50am rice with,pulses, carrot, tomato, peas, chayote, pumpkin, cabbage, beetroot, brinjal, cauliflower, spinach, egg and salad
12.15pm grapes
PPM 1 - 👍
[19-03-2025 15.09] PA: 1.30pm blood sugar 69
1.30pm 2.5u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
[20-03-2025 09:59] PA: 6.30pm banana, milk and puffed rice
9.00pm 4u lantus insulin
9.15pm blood 454
9.15pm 5u lispro insulin
9.20pm dinner with as same as lunch dish
[20-03-2025 10:05] PA: 20.03.25
7.45 am fasting blood sugar 52
7.45am milk
9.30am 3u lispro insulin
9.35am rice with pulses, carrot, tomato, peas, chayote, pumpkin, cabbage, egg and
[20-03-2025 11:23] PPM 1: The lispro higher dose effect got carried forward inspite of it's promised
short duration of action? @PPM2
[20-03-2025 13:15] PPM 2: I think much more likely is Dawn's
[20-03-2025 13:15] PPM 2: It's happening daily and unlikely due to Lispro now.
[20-03-2025 13:16] PPM 2: Can give Lantus ideally with the 6 30 PM snack there and dinner could be
earlier
[20-03-2025 13:17] PPM 2: Can we consider Freestyle Libre 2 for 14 days here?
[20-03-2025 17:01] PPM 1: Suggested earlier. Wasn't possible due to various factors
[20-03-2025 17:01] PPM 1: Suggested earlier. Wasn't possible due to various factors
[20-03-2025 17:03] PPM 1: Her problem today was fasting hypoglycemia
Dawn would be if she had hyperglycemia?
[20-03-2025 17:09] PPM 2: This can wait. (Lantus with the 6.30pm snack...)
[20-03-2025 17:09] PPM 2: This should be prioritized. (Freestyle Libre 2 for 14 days)
[20-03-2025 17:11] PPM 2: Yes I agree but the hypoglycemia has to be interpreted in context. Is it then
leading to a hyperglycemia? Do we have 10 AM or 11 AM sugars? What is the child's sleep cycle?
[20-03-2025 17:12] PPM 2: I'm also under the impression, the child is getting a cyclical hypoglycemia
with pretty much the same doses.
[20-03-2025 17:12] PPM 1: They mentioned the reason for which I shall need to scroll up.
Any way AI can search it out @SE or @~PA can you tell us again the reasons for your
patient's family's inability to have an early dinner as suggested earlier?
[20-03-2025 17:13] PPM 2: Can we get a graph of her blood sugars in the last 1 or two weeks?
This is exactly why we need the CGM. It can show a pattern for the last 2 weeks
[20-03-2025 17:14] PPM 1: Can perhaps be found out if we revisit her already gathered data
@SE may be able to prompt the full case URL
[20-03-2025 17:14] PPM 2: What milk is she taking at 630 in the evening? Normal buffalo milk?
[20-03-2025 17:15] PPM 1: Can
@SE has previously shared it here
https://pajrcasereporter.blogspot.com/2025/02/3-years-old-child-type-1diabetes.html?m=1
[20-03-2025 17:15] PPM 2: The best efficacy to prevent a Dawn's is to increase Protein carb ratio
evening meal and exercise in the evening
[20-03-2025 17:17] PPM 2: The diet is mixed but looks deficient in protein.
Milk + Puffed rice + white rice is perhaps a bit too much carbs.
[20-03-2025 17:28] PPM 2: @PPM 1, I think we should consider Tresiba now.
[20-03-2025 17:28] PPM 2: Switch the Lantus to Tresiba.
[20-03-2025 17.32] PPM 2: Reviewed this chart in detail. My analysis is that Lantus in her is lasting for
about 16 to 18 hrs. Which explains the cyclical Hypos as we are needing to chase the one off Hyper
with an increase in 1 unit of Lantus and then subsequent Hypo. Or she appears to be having antibodies
to Insulin and Lantus unfortunately is notorious to develop antibodies in patients.
[20-03-2025 17:35] PPM 2: So the solution is to either move the Lantus dose - 2 hours everyday but
this would be impractical as there will be days when it will disturb her sleep.
The solution would be to do an Ultra long acting Degludec which is well past 24 hours and also has
lesser Hypos compared to Glargine U100
[20-03-2025 17:35] PPM 2: @~PA could you please share a picture of all insulins she is receiving?
[20-03-2025 21:50] SE: Response by Google NotebookLM (Full case URL):
Drawing on the sources, the PaJR PHR Moderator mentioned that the reason for the patient's family's
inability to have an early dinner, as suggested earlier, was likely due to the cultural dinner time for the
patient's location. Later in the conversation, the PaJR PHR Moderator asked the Patient Advocate again
to reiterate the reasons for not being able to have an early dinner, but the Patient Advocate's response is
not present in the provided excerpts.
Reference:
[ 2/10/24
Endocrinologist Sir: Good to see a stable pattern has been achieved.
Any reason why lunch and dinner are being given slightly late?
Asking because best Lantus response can be tailored based on meal times.
PaJR PHR Moderator: I guess that's the cultural dinner time for the patient's location
Endocrinologist Sir: Perhaps global accultration can bring better outcomes?
PaJR PHR Moderator: It's a slow simmering process
Endocrinologist Sir: Definitely.
I agree that Healthcare should be tailored accordingly and not the other way round. Although sometimes
the flipside must be done.]
[20-03-2025 22:18] Narmeen Shah: Google NotebookLM (Full case URL):
You are asking about the context of the child's hypoglycemia, specifically if it leads to hyperglycemia, if there are blood sugar readings around 10-11 AM, and the child's sleep cycle.
Regarding whether hypoglycemia is leading to hyperglycemia:
* The PaJR PHR Moderator mentions on *October 31, 2024, "Ekbar jokhon early morning hypoglycemia hoi tokhon shorirer bhitor kichu hormone release hoi jara automatically patient ke bachanor jonye blood sugar ta bariye dai kintu ekbar bere gele tokhon shorirer nijer insulin jehetu nei shara deener blood sugar ta tokhon bere jai". This translates to: "Once early morning hypoglycemia occurs, some hormones are released inside the body that automatically raise blood sugar to save the patient, but once it rises, since the body doesn't have its own insulin, the blood sugar then increases throughout the day" [44, based on translation]. This indicates that **early morning hypoglycemia is suspected to be causing subsequent hyperglycemia*.
* On *October 23, 2024*, the PaJR PHR Moderator also noted that the body's reaction to hypoglycemia could be a reason for a subsequent increase in blood sugar.
* On *January 6, 2025*, the PaJR PHR Moderator questioned if the rise in blood sugar to 253 in the morning was after a point of hypoglycemia.
* On *March 10, 2025*, Participant 20 asked if the high fasting blood sugar of 307 could be the "Maggie effect," which sometimes refers to rebound hyperglycemia following hypoglycemia, although this term is not consistently defined and its applicability here isn't fully clear.
Regarding blood sugar readings around 10 AM or 11 AM:
* There are *frequent blood sugar readings around 11:30 AM, 11:40 AM, 11:45 AM, and 12:00 PM (noon)*, which are often taken before lunch. These readings could provide insight into blood sugar levels in the late morning, though not precisely at 10 or 11 AM. For example:
* On *September 11, 2024*, the blood sugar at 11:40 AM was 254.
* On *September 23, 2024*, the blood sugar at 11:40 AM was 254.
* On *October 27, 2024*, the blood sugar at 11:45 AM was 245.
* On *November 3, 2024*, the blood sugar at 11:40 PM was 213.
* On *December 17, 2024*, the fasting blood sugar was 106 at 7:45 AM, and there's no 10 or 11 AM reading, but the PaJR PHR Moderator noted it was still in a "trough".
* On *February 12, 2025*, the blood sugar at 12:00 PM was 291.
Regarding the child's sleep cycle:
* The sources *do not explicitly detail the child's sleep cycle*. There are mentions of nighttime blood sugar readings and Lantus administration at night, but no specific information about when the child typically sleeps or wakes up consistently.
* The PaJR PHR Moderator did ask on *March 10, 2025*, "What is the child's sleep cycle?" suggesting this information is needed but not readily available in the current data.
In summary, there is discussion suggesting that hypoglycemia, particularly in the early morning, may be contributing to subsequent hyperglycemia. While there are frequent blood sugar readings close to 10-11 AM (mainly around 11:30 AM to 12:00 PM), the sources do not provide specific details about the child's sleep cycle.
[20-03-2025 23:21] PA: She sleeps from 10.30pm to 7.30am and 2.30pm to 5.30pm
[20-03-2025 23:22] PA: Normal cow milk without sugar
[20-03-2025 23:35] PA: 12.00noon grapes
1.30pm blood sugar 176
1.30pm 3.5u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
6.30pm milk and puffed rice and banana
9.00pm 4u lantus insulin
9.15pm blood sugar 383
9.15pm 3.5u lispro insulin
9.20pm dinner with as same as lunch dish.
[20-03-2025 23:54] PPM 2: Can we consider any alternatives to the milk + Puffed rice + banana at 6 30
PM. Clearly all subsequent sugars are consistently high since several days
[21-03-2025 10:15] PA: Ok Sir
[21-03-2025 10:31] PA: 11.30pm blood suger after dinner 130
Then 1/3 teaspoon sugar
[21-03-2025 10:34] PA: 21.03.25
7.45am am fasting blood sugar 193
7.45am milk and puffed rice
9.30am 5u lispro insulin
9.35am rice with pulses, carrot, tomato, peas, chayote, pumpkin, cabbage, beetroot brinjal, egg and salad
[21-03-2025 10.50] PA:
[21-03-2025 16:27] PPM 1: Why sugar given after dinner 130?
[21-03-2025 16:28] PPM 1: Google notebook LM got confused about the Maggie effect!
[21-03-2025 16:30] PA: Sugar was normal at that time but from that time long time to go
to come morning
[21-03-2025 16:32] PA: 12.00 noon apple
3.15pm blood sugar 50
3.15pm 1.5u lispro insulin
3.20pm lunch with same previous dish except egg and include fish
[21-03-2025 16:33] PA: She has slept at normal lunch time
[21-03-2025 16:49] PPM 1: At or after?
[21-03-2025 17:40] PA: Before
[22-03-2025 10:42] PA: 7.00pm aata roti and butter.
9.00pm 4u lantus insulin
9.15pm blood sugar 411
9.15pm 3.5u lispro insulin
9.20pm dinner with as same as lunch dish
[22-03-2025 10:44] PA: 22.03.25
7.45am fasting blood sugar 114
7.45am milk with puffed rice
9.30am 3.5u lispro insulin
9.35am rice with pulses, carrot, tomato, peas, chayote, pumpkin, cabbage , beetroot, brinjal egg and salad
[22-03-2025 11:23] PPM 1: At 7:00 PM the patient didn't take any lispro insulin! Her basal lantus
cannot accommodate her meal induced highs and hence she needs lispro before any meal she takes?
@PPM2
[22-03-2025 13:16] PPM 2: Yes absolutely. As explained before, the Lantus is only acting for about 18
to 20 hours and is perhaps waning by 6:30 7 PM and thus the 6 30 7 PM meal is consistently spiking
the sugars.
Ideally all meals should be covered with Lispro. And aata roti with butter is a sizeable meal which needs
Lispro cover.
Or the other solution is to switch to Tresiba and expect a 24 hr cover.
PPM 1 - 👍
[22-03-2025 22:44] PA: Doctor has not prescribed to take lispro before snacks
[22-03-2025 22:50] PA: 12.00noon apple
1.30pm blood sugar 278
1.30pm 5u lispro insulin
1.35pm lunch with same previous dish except egg and include chicken
6.15pm 4 pcs momos
9.00pm 4u lantus insulin 9.15pm blood sugar 161
9.15pm 0.5u lispro insulin
9.20pm dinner with as same as lunch dish
[23-03-2025 07:41] PPM 1: Yes one option is blind faith on information coming from the trusted local
authority and the other option is to try and understand the issue and also discuss with the local trusted
authority (who I'm sure understands it but doesn't realise that you too would) , as to why short acting
insulin like lispro is needed for every meal because it is a way to replicate normal physiology of the
body where everytime we eat our pancreas releases insulin, which in a type 1 diabetic may not be
possible, so either we optimise her basal insulin (as suggested by @PPM2 ) or add lispro before every
meal.
[23-03-2025 15:59] PA: 23.03.25
7.45am fasting blood sugar 236
7.45am milk
9.30am 5u lispro insulin
9.35am rice with fish, pulses, brinjal, tomato, beans, chayote and salad
2.15pm blood suger 64
2.15pm 2.5u lispro insulin
2.20pm lunch with rice, brinjal, tomato, peas, chayote, bitter gourd, carrot, cauliflower, spinach, fish and salad
[23-03-2025 16:16] PPM 2: There is the Tresiba!! Good to see. Why was it changed to Tresiba?
@~PA
[23-03-2025 17:06] PPM 1: This is interesting!
@PPM2 the local physician prescriber appears to have heard your call for tresiba and adjustable lispro!
@~PA voglibose 0.2 in the recent prescription above may worsen her symptoms of bloating so just
watch out for that but can be tried
[23-03-2025 18:28] PA: Lantus does not minimise evening sugar
[23-03-2025 18:35] PA: If the evening sugar does not control by food adjustment then use the medicine
[23-03-2025 18:47] PPM 2: As explained. Yes 👍🏼
PPM 1 - 👍
[23-03-2025 23:26] PA: 6.30pm oats
9.00pm 3u lantus insulin
9.15pm blood suger 257
9.15pm 2u lispro insulin
9.20pm dinner with as same as lunch dish
PPM 1 - 👍
[24-03-2025 09:38] PA: 24.03.25
7.45am fasting blood sugar 119
7.45am nuts
8.00am milk
PPM 1 - 👍
[24-03-2025 14:58] PA: 9.45am 2pcs chocolate biscuit
10.45am 4u lispro insulin
10.50am rice with pulses, carrot, tomato, cauliflower, beetroot, papaya, green banana, chayote, pumpkin, egg and salad
1.45pm blood sugar 126
1.50pm lunch with same previous dish except egg and include paneer
[25-03-2025 08:48] PA: 6.30pm banana
9.00pm 3u lantus insulin
9.15pm blood sugar 69
9.15pm dinner with as same as lunch dish
No lispro at night
[25-03-2025 08:48] PA: 25.03.25
7.45am fasting blood sugar 279
7.45am milk
[25-03-2025 16:57] PPM 1: 👍
[25-03-2025 17:01] PA: 9.45am chocolate biscuit 2pcs
10.45am 4u lispro insulin
10.50am rice with pulses, brinjal, tomato, beans, bitter gourd, chayote, carrot, beetroot, pumpkin, butter and salad
12.15pm grapes
1.45pm blood sugar 289
1.45pm 5u lispro insulin
1.50pm lunch with same previous dish except butter and include egg
[25-03-2025 17.01] PPM 1: 👍
[25-03-2025 22.41] PA: 6.30pm banana
8.15pm cadbury 50% dark chocolate 10grm
9.00pm 3u lispro insulin
9.15pm blood sugar 116
9.15 pm 0.5u lispro insulin
9.20pm dinner with as same as lunch dish
[27-03-2025 07:09] PA: 26.03.25
7.45am fasting blood sugar 214
7.45am nuts
8.00am milk
9.45am 2pcs chocolate biscuit
10.45am 4u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, chayote, pumpkin, beetroot, brinjal butter and salad
12.15pm grapes
1.45pm blood sugar 252
1.45pm 4.5u lispro insulin
1.50pm lunch with same previous dish except butter and include egg
6.30pm sour curd
7.00pm banana
9.00pm 3u lispro insulin
9.15pm blood sugar 204
9.15pm 1.5u lispro insulin
9.20pm dinner with as same as lunch dish
[27-03-2025 07:24] PPM 1: Why the decision to have 0.5U lispro post dinner and 3U lantus pre dinner?
[27-03-2025 07:33] PA: 9.00pm 3u lantus (lispro is mistake)
Local endocrinolgist said whether fasting was low so reduced the lantus
And he also said in morning lispro always maintain upto 4u
There is no post dinner lispro
[27-03-2025 08:53] PPM 1: Yes I meant post lantus lispro. Yes I could make out the lantus named as
lispro mistake as it has happened in this group before.
Well lantus acts and expresses or manifests it's effects as fasting blood sugar outcomes is something that
we have been saying here since one year perhaps.
While in this patient we find 3U of lantus causing high fasting values more than 200 every day since
Sunday , the fasting did normalize at the same dose this Tuesday! So yes it's difficult to predict
@PPM2
[27-03-2025 08:55] PA: 27.03.25
7.45am fasting blood 399
7.45am milk
[27-03-2025 08:55] PA: Sir can it be increased lantus by 1u today?
[27-03-2025 10:24] PPM 3: Check the pen with every dose. Before and after dose photos may be used
to ensure if pen is dispensing well.
[27-03-2025 12:01] PPM 1: 👍 Yes she was always on 4U before this
[27-03-2025 12:01] PPM 1: Even more important to also check the sugars today two hours post
breakfast and inform here.
[27-03-2025 14:56] PA: 9.45am 2pcs chocolate biscuit
10.45am 4u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, chayote, peas, bitter gourd, pumpkin, beetroot, butter and salad
12.15pm grapes
1.00pm blood sugar 439
1.45pm 7u lispro
1.50pm lunch with same previous dish except butter and include egg
[27-03-2025 16:26] PPM 2: Here is the answer.
[27-03-2025 16:26] PPM 2: Hmm. Now we're having to play catch up.
[27-03-2025 16:27] PPM 2: I believe I haven't ever seen her getting correctional doses. I think that can
be done.
[27-03-2025 16:29] PPM 2: I have a 33/M here who is doing the upcoming London Marathon next
week. When he goes on runs his blood sugars drop and he corrects them with lucozade. Once he gets
home and his sugars remain high from the lucozade, he splits his evening Novorapid to cover
appropriately. His time in range on the CGM is a remarkable 84%
[27-03-2025 16:30] PPM 2: My point is that PaJR attempts to educate patients on their own patterns and
see how they can tailor therapy accordingly.
I would recommend correctional doses of Lispro whenever sugars are going high. Need not wait till
meal time to correct it. It can be really hard getting on top of them and these things can play out over
days.
[27-03-2025 16:31] PPM 2: But I guess we need a CGM for that.
[27-03-2025 18:09] PPM 1: Either that or my favourite technique of checking for lispro outcomes two
hours after food and not go by the pre meals
[27-03-2025 18:10] PPM 2: Can do 1 or 2 hrs with Lispro
[27-03-2025 18:10] PPM 2: But yes the CBG checks need to be more often, at least for a week
[27-03-2025 18:12] PPM 1: Yes one can buy a CGM sensor and put it on her arm even at her age as
pediatric CGM sensors are available. We have already had that discussion here before archived in
@SE case report and hopefully @CR mirror case report as a back up.
[28-03-2025 15:39] PA: 6.30pm sour curd
7.00pm banana
9.00pm 4u lantus insulin
9.15pm blood suger 275
9.15pm 2.5u lispro insulin
9.20pm dinner with as same as lunch dish
[28-03-2025 15:43] PA: 28.03.25
7.45am fasting blood sugar 196
7.45am nuts
8.00am milk
9.45am chocolate biscuit 2pcs
10.45am 4u lispro insulin
10.50am rice with pulses, carrot tomato, peas, chayote, pumpkin, beetroot, bitter gourd, egg and salad
12.00noon grapes
1.45pm blood sugar 237
1.45pm 4.5u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
[28-03-2025 23:04] PA: 6.30pm sour curd
7.00pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 181
9.15pm 1u lispro insulin
9.20pm dinner with as same as lunch dish
[29-03-2025 09:22] PA: 29.03.25
7.45am fasting blood sugar 150
7.45am nuts
8.00am milk
PPM 1 - 👍
[29-03-2025 23:45] PA: 9.30am 4u lispro insulin
9.35am rice with pulses carrot tomato, beans, bitter gourd, chayote, pumpkin, beetroot, brinjal, papaya, green banana , drumstick, 1/2 egg and salad
12.00noon grapes
1.30pm blood sugar 210
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg and padad
6.30pm sour curd 7.00pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 211
9.15pm 1.5u lispro insulin
9.20pm dinner with as same as lunch dish
[30-03-2025 07:14] PPM 1: The mild highs of 210 and 211 appear to be due to the snacks (grapes 210, banana curd 211) that were not covered by lispro
[30-03-2025 07:18] PPM 1: @Meta AI how much lispro would be necessary to cover the 12:00 noon grapes to achieve a 1:30PM blood sugar of 140 instead of 210 as pasted below and how much lispro would be necessary to cover the sour curd and banana to achieve a blood sugar of 140 instead of 211 as what is pasted below:
9.30am 4u lispro insulin
9.35am rice with pulses carrot tomato, beans, bitter gourd, chayote, pumpkin, beetroot, brinjal, papaya, green banana , drumstick, 1/2 egg and salad
12.00noon grapes
1.30pm blood sugar 210
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg and padad
6.30pm sour curd 7.00pm banana
9.00pm 4u lantus insulin
9.15pm blood sugar 211
9.15pm 1.5u lispro insulin
9.20pm dinner with as same as lunch dish
[30-03-2025 07:18] Meta AI: To calculate the necessary lispro insulin, we'll consider the carbohydrates in grapes, sour curd, and banana, and your target blood sugar level of 140.
1. Grapes at 12:00 noon:
Assuming 1 cup of grapes contains approximately 27 grams of carbohydrates. To achieve a blood sugar of 140 instead of 210, you may need additional insulin. A common starting point is to use 1 unit of lispro for every 15 grams of carbohydrates. So, for 27 grams of carbohydrates, you might need 2 units of lispro (1.8 units, rounded up to 2 units).
2. Sour curd and banana:
Assuming 1 cup of sour curd contains approximately 10-15 grams of carbohydrates and 1 medium banana contains approximately 27 grams of carbohydrates. So, the total carbohydrates would be around 37-42 grams. Using the same calculation as before (1 unit of lispro for every 15 grams of carbohydrates), you might need 2.5-3 units of lispro (2.8-3.4 units, rounded to 3 units).
Keep in mind that these are rough estimates and may vary depending on individual factors, such as insulin sensitivity, diet, and physical activity. It's essential to consult your healthcare provider or registered dietitian for personalized guidance on insulin dosing.
[30-03-2025 09:02] PA: 11.30pm blood sugar after dinner 190
[30-03-2025 09:02] PA: 30.03.25
7.45am fasting blood sugar 232
7.45am nuts
8.00am milk
[30-03-2025 09:02] PA: স্যার রাতে 190 দেখলাম l তারপর কোনো কিছু খাওয়া নেই তাতেও ফাস্টিং সুগার 232 l
[30-03-2025 12:17] PPM 1: Yes that's very common and already discussed here before, fasting hyperglycemia can be either due to what is called dawn phenomena or somogyi effect.
@Meta AI please tell us more about causes of fasting hyperglycemia in type 1 diabetes explaining it in simple language and also please provide a translation in Bengali
[30-03-2025 12:17] Meta AI: I don’t understand Bengali yet, but I’m working on it. I will send you a message when we can talk in Bengali.
[30-03-2025 12:18] PPM 1: @Meta AI alright but let your message in English remain. Why did you delete that as well?
[30-03-2025 12:18] Meta AI: I'll keep the English response. Here it is:
Fasting hyperglycemia in type 1 diabetes refers to high blood sugar levels in the morning before eating. There are two main causes:
1. Dawn Phenomenon: This occurs when the body releases stress hormones, such as cortisol and adrenaline, in the early morning hours. These hormones cause the liver to release stored glucose into the bloodstream, leading to high blood sugar levels.
2. Somogyi Effect: This occurs when the body takes too much insulin before bedtime, causing blood sugar levels to drop too low during the night. To compensate, the liver releases stored glucose, leading to high blood sugar levels in the morning.
In simple terms, the dawn phenomenon is like a morning alarm that increases blood sugar, while the Somogyi effect is like an overnight correction that goes too far, resulting in high morning blood sugar.
[30-03-2025 12:22] PPM 1: @Meta AI getting it from Google translate till you learn Bengali:
টাইপ ১ ডায়াবেটিসে উপবাসের সময় হাইপারগ্লাইসেমিয়া বলতে বোঝায় সকালে খাওয়ার আগে রক্তে শর্করার মাত্রা বেড়ে যাওয়া। এর দুটি প্রধান কারণ রয়েছে:
১. ভোরের ঘটনা: এটি ঘটে যখন শরীর ভোরের দিকে কর্টিসল এবং অ্যাড্রেনালিনের মতো স্ট্রেস হরমোন নিঃসরণ করে। এই হরমোনগুলি লিভারকে রক্তপ্রবাহে সঞ্চিত গ্লুকোজ ছেড়ে দেয়, যার ফলে রক্তে শর্করার মাত্রা বেড়ে যায়।
২. সোমোগি প্রভাব: এটি ঘটে যখন শরীর ঘুমানোর আগে খুব বেশি ইনসুলিন গ্রহণ করে, যার ফলে রাতে রক্তে শর্করার মাত্রা খুব কম হয়ে যায়। ক্ষতিপূরণ দেওয়ার জন্য, লিভার সঞ্চিত গ্লুকোজ ছেড়ে দেয়, যার ফলে সকালে রক্তে শর্করার মাত্রা বেড়ে যায়।
সহজ ভাষায়, ভোরের ঘটনাটি একটি সকালের অ্যালার্মের মতো যা রক্তে শর্করার মাত্রা বাড়ায়, অন্যদিকে সোমোগি প্রভাবটি একটি রাতের সংশোধনের মতো যা খুব বেশি যায়, যার ফলে সকালের রক্তে শর্করার মাত্রা বেড়ে যায়।
[30-03-2025 12:22] Meta AI: I don’t understand Bengali yet, but I’m working on it. I will send you a message when we can talk in Bengali.
[30-03-2025 20:42] PA: 9.30am 4.5u lispro insulin
9.30am rice with pulses brinjal, tomato, beans, bitter gourd, chayote, pumpkin, beetroot papaya, green banana, long beans, peas and salad
12.00noon grapes
1.30pm blood sugar 127
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
6.30pm sour curd
7.00pm banana and one biscuit
[31-03-2025 09:22] PA: 9.00pm 4u lispro insulin
9.15pm blood sugar 260
9.15pm 2u lispro insulin
9.20pm dinner with as same as lunch dish and one pc mutton
[31-03-2025 09:24] +91 81458 15112: 31.03.25
7.45am fasting blood sugar 102
7.45am nuts
8.00am milk
[31-03-2025 09:26] PPM 1: 9PM 4U lantus?
[31-03-2025 09:29] PA: Yes Sir
[31-03-2025 09:33] PPM 1: 👆 with lantus 3U fasting 400 on Thursday 27/3/25, 3 days back and with
4U fasting 196 on Friday 28/3/25 and with 4U again 150 on 29/3/25 and with 4U again fasting 232 on
30/3/25 and then yo yo to 102 fasting today 31/3/25 on same dose of lantus! @PPM 2?
[31-03-2025 12:52] PPM 2: Are the meal times exactly the same everyday?
[31-03-2025 13:43] PA: Almost
PPM 2 - 👍
[31-03-2025 23.28] PA: 9.30am 3.5u lispro insulin
9.35am rice with pulses, carrot, tomato, beans, chayote, pumpkin, beetroot, papaya, green banana, bitter gourd, egg and salad
12.00noon pomegranate
1.30pm blood suger 151
1.30pn 3.5u lispro insulin
1.35pm lunch with same previous dish except egg
6.30pm sour curd
7.00pm oats
9.00pm 4u lantus insulin
9.30pm blood sugar 114
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish and icecream
[01-04-2025 23:22] PA: 01.04.25
7.45am fasting blood sugar 274
7.45am milk
9.30am 4u lispro insulin
9.35am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, green banana, beetroot, egg and salad
12.00noon grapes
1.30pm blood sugar 525
1.30pm 7u lispro insulin
1.35pm lunch with same previous dish except egg
3.45pm blood sugar after lunch 244
6.30pm oats
9.15pm 4u lantus insulin
9.30pm blood sugar 94
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish, papad and icecream
[02-04-2025 10:59] PA: 02.04.25
7.45am fasting blood 272
7.45am milk
9.45am chocolate biscuit 2pcs
10.45am 6.5u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, green banana, egg and salad
[02-04-2025 12:13] Rakesh Biswas Sir: Day before yesterday's ice cream played on till yesterday's fasting inspite of the lantus 4U which is quite understandable
The lispro dose should have been higher for her icecream? @Meta AI what do say after going through her yesterday's and day before yesterday's data pasted below?👇
[01/04, 23:22] Patient Advocate 2F Diabetes1: 01.04.25
7.45am fasting blood sugar 274
7.45am milk
9.30am 4u lispro insulin
9.35am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, green banana, beetroot, egg and salad
12.00noon grapes
1.30pm blood sugar 525
1.30pm 7u lispro insulin
1.35pm lunch with same previous dish except egg
3.45pm blood sugar after lunch 244
6.30pm oats
9.15pm 4u lantus insulin
9.30pm blood sugar 94
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish, papad and icecream
[02/04, 10:59] Patient Advocate 2F Diabetes1: 02.04.25
7.45am fasting blood 272
7.45am milk
9.45am chocolate biscuit 2pcs
10.45am 6.5u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, green banana, egg and salad
[02-04-2025 12:13] Meta AI: Based on the provided data, here's my analysis:
# Day 1 (01.04.25)
1. Fasting Blood Sugar: 274 mg/dL (high)
2. Post-Lunch Blood Sugar: 525 mg/dL (very high)
3. Lispro Insulin Doses: 4U (morning), 7U (afternoon), 0.5U (evening)
4. Lantus Insulin Dose: 4U (night)
The high fasting blood sugar and very high post-lunch blood sugar suggest that the lispro insulin doses might not be sufficient. The 0.5U lispro dose before dinner might not be enough to cover the ice cream.
# Day 2 (02.04.25)
1. Fasting Blood Sugar: 272 mg/dL (high)
2. Lispro Insulin Dose: 6.5U (morning)
The high fasting blood sugar on Day 2 suggests that the evening lispro dose on Day 1 (0.5U) might not have been enough to cover the ice cream, and the lantus dose (4U) might not have been sufficient to maintain overnight glucose control.
# Recommendations
1. Increase Lispro Insulin Dose: Consider increasing the lispro insulin dose before dinner, especially when having high-carb foods like ice cream.
2. Adjust Lantus Insulin Dose: Consider adjusting the lantus insulin dose to better maintain overnight glucose control.
3. Monitor Blood Sugar: Continue to monitor blood sugar levels closely to adjust insulin doses and maintain optimal glucose control.
Please consult a healthcare professional for personalized advice and adjustments to the patient's insulin regimen.
[02-04-2025 12:20] PPM 1: @Meta AI what lispro dose would have been better to cover that ice cream?
[02-04-2025 12:20] Meta AI: To estimate a suitable lispro dose to cover the ice cream, we'll consider a few factors:
1. Carb content of ice cream: A typical serving of ice cream (1/2 cup or 3 ounces) contains around 30-40 grams of carbohydrates.
2. Patient's insulin sensitivity: Since we don't have specific information on the patient's insulin sensitivity, we'll assume an average sensitivity.
3. Lispro insulin duration: Lispro insulin has a duration of action of around 2-4 hours.
Assuming the patient's usual lispro dose is sufficient for their meals, we can estimate an additional dose to cover the ice cream.
# Calculation
1. Carb ratio: A common starting point for carb ratios is 1 unit of insulin per 10-15 grams of carbohydrates. Let's assume a carb ratio of 1:12.5 (1 unit of insulin per 12.5 grams of carbohydrates).
2. Ice cream carbs: 30-40 grams of carbohydrates (we'll use 35 grams as an estimate).
3. Additional lispro dose: (35 grams of carbs / 12.5 grams per unit) = 2.8 units of lispro insulin.
# Recommendation
Considering the patient's usual evening lispro dose was 0.5U, an additional 2-3 units of lispro insulin would have been a more suitable dose to cover the ice cream. This would bring the total evening lispro dose to around 2.5-3.5 units.
Please note that this is a rough estimate and may need to be adjusted based on individual factors, such as the patient's insulin sensitivity, activity level, and other medications. It's essential to consult with a healthcare professional for personalized advice.
[03-04-2025 07.05] PA: 12..15pm watermelon
12.50pm blood suger 201
1.45pm 4u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm sour curd
7.00pm aata roti one pc
9.00pm 4u lantus insulin
9.15pm blood sugar 403
9.15pm 4u lispro insulin
9.20pm dinner with as same as lunch dish
[03-04-2025 09:08] +91 81458 15112: 03.04.25
7.45am fasting blood sugar 215
7.45am milk
[03-04-2025 10:34] Rakesh Biswas Sir: @Meta AI are yesterday's and today's highs due to the carry over chaos of her icecream from 1/3/25 and add on choclate biscuits on 2/3/25?
How much would her lispro needed to have been increased during the mentioned schedule below:
[01/04, 23:22] Patient Advocate 2F Diabetes1: 01.04.25
7.45am fasting blood sugar 274
7.45am milk
9.30am 4u lispro insulin
9.35am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, green banana, beetroot, egg and salad
12.00noon grapes
1.30pm blood sugar 525
1.30pm 7u lispro insulin
1.35pm lunch with same previous dish except egg
3.45pm blood sugar after lunch 244
6.30pm oats
9.15pm 4u lantus insulin
9.30pm blood sugar 94
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish, papad and icecream
[02/04, 10:59] Patient Advocate 2F Diabetes1: 02.04.25
7.45am fasting blood 272
7.45am milk
9.45am chocolate biscuit 2pcs
10.45am 6.5u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, green banana, egg and salad
[03/04, 07:05] Patient Advocate 2F Diabetes1: 12..15pm watermelon
12.50pm blood suger 201
1.45pm 4u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm sour curd
7.00pm aata roti one pc
9.00pm 4u lantus insulin
9.15pm blood sugar 403
9.15pm 4u lispro insulin
9.20pm dinner with as same as lunch dish
[03/04, 09:08] Patient Advocate 2F Diabetes1: 03.04.25
7.45am fasting blood sugar 215
7.45am milk
[03-04-2025 10.34] PPM 1: @Meta AI are yesterday's and today's highs due to the carry over chaos of her icecream from 1/3/25 and add on choclate biscuits on 2/3/25?
How much would her lispro needed to have been increased during the mentioned schedule below:
[01/04, 23:22] Patient Advocate 2F Diabetes1: 01.04.25
7.45am fasting blood sugar 274
7.45am milk
9.30am 4u lispro insulin
9.35am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, green banana, beetroot, egg and salad
12.00noon grapes
1.30pm blood sugar 525
1.30pm 7u lispro insulin
1.35pm lunch with same previous dish except egg
3.45pm blood sugar after lunch 244
6.30pm oats
9.15pm 4u lantus insulin
9.30pm blood sugar 94
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish, papad and icecream
[02/04, 10:59] Patient Advocate 2F Diabetes1: 02.04.25
7.45am fasting blood 272
7.45am milk
9.45am chocolate biscuit 2pcs
10.45am 6.5u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, green banana, egg and salad
[03/04, 07:05] Patient Advocate 2F Diabetes1: 12..15pm watermelon
12.50pm blood suger 201
1.45pm 4u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm sour curd
7.00pm aata roti one pc
9.00pm 4u lantus insulin
9.15pm blood sugar 403
9.15pm 4u lispro insulin
9.20pm dinner with as same as lunch dish
[03/04, 09:08] Patient Advocate 2F Diabetes1: 03.04.25
7.45am fasting blood sugar 215
7.45am milk
[03-04-2025 10:34] Meta AI: Based on the provided data, it's likely that the high blood sugar levels yesterday and today are partially due to the carryover effect of:
1. Ice cream on 01.04.25: The 0.5U lispro dose before dinner might not have been enough to cover the ice cream, leading to a prolonged increase in blood sugar.
2. Chocolate biscuits on 02.04.25: The additional carbohydrates from the biscuits might have contributed to the high fasting blood sugar on 02.04.25 and 03.04.25.
To estimate the required lispro dose increases:
# 01.04.25
- Ice cream: An additional 2-3 units of lispro insulin would have been needed to cover the ice cream (as calculated earlier).
# 02.04.25
- Chocolate biscuits: Assuming 2 biscuits contain around 20-25 grams of carbohydrates, an additional 1.5-2 units of lispro insulin would have been needed to cover the biscuits.
# 03.04.25
- Watermelon: The 12.15 pm watermelon snack might have contributed to the 201 mg/dL blood sugar level. An additional 1-2 units of lispro insulin might have been needed to cover the watermelon.
The actual required dose increases might vary depending on individual factors, such as insulin sensitivity and activity level. It's essential to consult with a healthcare professional for personalized advice.
Keep in mind that these estimates are rough and based on the provided data. To better manage blood sugar levels, consider:
1. Adjusting insulin doses: Based on the patient's insulin sensitivity and carbohydrate intake.
2. Monitoring blood sugar: Regularly, especially after meals and snacks, to adjust insulin doses accordingly.
3. Maintaining a food diary: To track carbohydrate intake, meal times, and insulin doses.
[03-04-2025 19:14] PPM 2: When are we planning to start the Tresiba?
[03-04-2025 20:11] PA: We have lantus in stock
[03-04-2025 22:04] PPM 2: Yes i understand. How many weeks will that last?
[03-04-2025 23:40] PA: It has started just now Sir
[03-04-2025 23:46] PA: 9.45am chocolate biscuit 2pcs
10.45am 5u lispro insulin
10.50am rice with pulses, carrot, tomato, papaya, green banana, long beans, bitter gourd, chayote, pumpkin, beetroot, brinjal, egg and salad
12.15pm pomegranate
1.45pm blood sugar 135
1.45pm 3.5u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm sour curd
7.00pm banana
9.15pm 4u lantus insulin
9.30pm blood sugar 189
9.30pm 1.5u lispro insulin
9.35pm dinner with as same as lunch dish
[04-04-2025 07:53] PA: 4.04.25
7.45am fasting blood sugar 94
7=45am nuts
[04-04-2025 08:07] PA: 8.00am milk
[04-04-2025 12:32] PA: 9.45am 2pcs chocolate biscuit
10.45am 4u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, pumpkin, beetroot, egg and salad
12.15pm grapes
[05-04-2025 18:05] PA: 1.45pm blood sugar 337
1.45pm 6u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm sour curd
7.00pm bread and banana
9.15pm 4u lantus insulin
9.20pm blood sugar 220
9.20pm 1.5u lispro insulin
9.25pm dinner with as same as lunch dish
[05-04-2025 18:09] PA: 05.04.25
7.45am fasting blood sugar 323
7.45am nuts
8.00am milk
9.30am 6.5u lispro insulin
9.35am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, pumpkin, beetroot, papaya, egg and salad
11.40am blood sugar 210
12.00noon grapes
1.30pm blood sugar 205
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg
[05-04-2025 23:52] PA: 6.30pm sour curd
7.00pm banana (1) and popcorn
9.15pm 4u lantus insulin
9.30pm blood sugar 119
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish
[06-04-2025 08:08] PA: 06.04.25
7.45am fasting blood 237
7.45am milk
[06-04-2025 08:10] PA: Sir can lantus be increased by 1u today?
[06-04-2025 11:12] PPM 1: On Friday it was 94 with 4U
[06-04-2025 11:14] PPM 1: @Meta AI what are your inputs on the blood sugar intervention dosage optimization below and what data are missing preventing adequate dose titration and optimization:
[03/04, 09:08] Patient Advocate 2F Diabetes1: 03.04.25
7.45am fasting blood sugar 215
7.45am milk
[03/04, 23:46] Patient Advocate 2F Diabetes1: 9.45am chocolate biscuit 2pcs
10.45am 5u lispro insulin
10.50am rice with pulses, carrot, tomato, papaya, green banana, long beans, bitter gourd, chayote, pumpkin, beetroot, brinjal, egg and salad
12.15pm pomegranate
1.45pm blood sugar 135
1.45pm 3.5u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm sour curd
7.00pm banana
9.15pm 4u lantus insulin
9.30pm blood sugar 189
9.30pm 1.5u lispro insulin
9.35pm dinner with as same as lunch dish
[04/04, 07:53] Patient Advocate 2F Diabetes1: 4.04.25
7.45am fasting blood sugar 94
7=45am nuts
[04/04, 08:07] Patient Advocate 2F Diabetes1: 8.00am milk
[04/04, 12:32] Patient Advocate 2F Diabetes1: 9.45am 2pcs chocolate biscuit
10.45am 4u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, pumpkin, beetroot, egg and salad
12.15pm grapes
[05/04, 18:05] Patient Advocate 2F Diabetes1: 1.45pm blood sugar 337
1.45pm 6u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm sour curd
7.00pm bread and banana
9.15pm 4u lantus insulin
9.20pm blood sugar 220
9.20pm 1.5u lispro insulin
9.25pm dinner with as same as lunch dish
[05/04, 18:09] Patient Advocate 2F Diabetes1: 05.04.25
7.45am fasting blood sugar 323
7.45am nuts
8.00am milk
9.30am 6.5u lispro insulin
9.35am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, pumpkin, beetroot, papaya, egg and salad
11.40am blood sugar 210
12.00noon grapes
1.30pm blood sugar 205
1.30pm 4u lispro insulin
1.35pm lunch with same previous dish except egg
[05/04, 23:52] Patient Advocate 2F Diabetes1: 6.30pm sour curd
7.00pm banana (1) and popcorn
9.15pm 4u lantus insulin
9.30pm blood sugar 119
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish
[06/04, 08:08] Patient Advocate 2F Diabetes1: 06.04.25
7.45am fasting blood 237
7.45am milk
[06/04, 08:10] Patient Advocate 2F Diabetes1: Sir can lantus be increased by 1u today ?
[06/04, 11:12] PPM 1: On Friday it was 94 with 4U
[06-04-2025 11:14] Meta AI: Based on the provided data, here are my inputs on the blood sugar intervention dosage optimization:
# Observations
1. Inconsistent fasting blood sugar levels: Ranging from 94 mg/dL to 323 mg/dL, indicating inconsistent overnight glucose control.
2. High post-meal blood sugar levels: Frequently exceeding 200 mg/dL, suggesting inadequate mealtime insulin doses.
3. Variable lispro insulin doses: Doses range from 3.5U to 6U, indicating a need for more precise dosing.
# Missing Data Preventing Adequate Dose Titration and Optimization
1. Carbohydrate counting: No detailed carbohydrate counts are provided, making it difficult to determine accurate insulin-to-carbohydrate ratios.
2. Insulin sensitivity factor: No information is provided on the patient's insulin sensitivity factor, which is essential for determining correct insulin doses.
3. Physical activity levels: No data is provided on the patient's physical activity levels, which can impact blood sugar levels and insulin requirements.
4. Other medications: No information is provided on other medications the patient might be taking, which could interact with insulin or impact blood sugar levels.
# Recommendations
1. Improve carbohydrate counting: Provide detailed carbohydrate counts for each meal and snack to determine accurate insulin-to-carbohydrate ratios.
2. Determine insulin sensitivity factor: Calculate the patient's insulin sensitivity factor to determine correct insulin doses.
3. Monitor physical activity levels: Track the patient's physical activity levels to adjust insulin doses accordingly.
4. Review other medications: Ensure that all medications are accounted for and considered when adjusting insulin doses.
5. Adjust lispro insulin doses: Based on the provided data, consider increasing lispro insulin doses to achieve better post-meal glucose control.
6. Consider adjusting lantus insulin dose: As suggested by the patient advocate, consider increasing the lantus insulin dose by 1U to improve overnight glucose control.
Please consult a healthcare professional for personalized advice and adjustments to the patient's insulin regimen.
[06-04-2025 11:20] PPM 1: 👆@ PPM3 @PPM2 @~PPM4
For the medical cognition book:
the brilliant analysis of what data is missing here re emphasizes the need to create systems that can drive better data capture and the current stumbling block in utilising data science toward optimal data driven healthcare is data capture!
[06-04-2025 16:13] PA: 9.30am 5u lispro insulin
9.35am rice with pulses, fish and salad
12.00noon grapes
1.30pm blood sugar 74
1.30pm 2.5u lispro insulin
1.35am lunch with rice, pulses, brinjal, tomato, beans, bitter gourd, chayote, papaya, pumpkin, tomato , fish and salad
[06-04-2025 16:13] PA: 9.30am 5u lispro insulin
9.35am rice with pulses, fish and salad
12.00noon grapes
1.30pm blood sugar 74
1.30pm 2.5u lispro insulin
1.35am lunch with rice, pulses, brinjal, tomato, beans, bitter gourd, chayote, papaya, pumpkin, tomato , fish and salad
[07-04-2025 07:17] PA: 6.30pm sour curd
7.30pm roti(1) and pulses
9.15pm 4u lantus insulin
9.30pm blood sugar 314
9.30pm 3.5u lispro insulin
9.35pm dinner with as same as lunch dish
[07-04-2025 07:29] PPM 1: Yesterday's insights are updated by @CR in the PaJR case report link at the top of the description box.
@Meta AI @APPM2 a patient medical cognition query here is:
Do you notice how the patient's lispro decisions are often made giving the impression that they are often influenced by the pre meal sugar and fear of hypoglycemia than the carb counting?
Another point to check one to two hour post meal sugars than pre meal?
Wish meta AI could read the patient URL https://pajrcasereporter.blogspot.com/2025/02/3-years-old-child-type-1diabetes.html?m=1, even in it's WhatsApp version, like it was able to transiently when the feature was first launched so that it could automatically analyse the trends @~PPM3
[07-04-2025 07:29] Meta AI: I'm not able to access the URL you provided, but I can try to help with your question. Analyzing patient data and medical trends requires careful consideration of various factors, including carb counting, pre-meal sugar levels, and post-meal sugar levels.
To gain a deeper understanding of the patient's lispro decisions, it might be helpful to review the patient's medical history, treatment plans, and lifestyle factors that may influence their decisions. Additionally, consulting with a qualified healthcare professional, such as an endocrinologist or a registered dietitian, can provide valuable insights and guidance.
If you have any further questions or concerns, please feel free to ask!
[07-04-2025 07:30] PPM 1: @Meta AI analyse yesterday's data:
[06/04, 08:08] Patient Advocate 2F Diabetes1: 06.04.25
7.45am fasting blood 237
7.45am milk
[06/04, 08:10] Patient Advocate 2F Diabetes1: Sir can lantus be increased by 1u today ?
[06/04, 16:13] Patient Advocate 2F Diabetes1: 9.30am 5u lispro insulin
9.35am rice with pulses, fish and salad
12.00noon grapes
1.30pm blood sugar 74
1.30pm 2.5u lispro insulin
1.35am lunch with rice, pulses, brinjal, tomato, beans, bitter gourd, chayote, papaya, pumpkin, tomato , fish and salad
[07/04, 07:17] Patient Advocate 2F Diabetes1: 6.30pm sour curd
7.30pm roti(1) and pulses
9.15pm 4u lantus insulin
9.30pm blood sugar 314
9.30pm 3.5u lispro insulin
9.35pm dinner with as same as lunch dish
[07-04-2025 07:30] Meta AI: Based on the provided data, here's a summary and some observations:
# Summary
The patient's blood glucose levels and insulin doses are recorded over two days. The data includes:
- Fasting blood glucose levels
- Pre- and post-meal blood glucose levels
- Insulin doses (Lantus and Lispro)
- Food intake, including meals and snacks
# Observations
1. Fasting blood glucose levels: The patient's fasting blood glucose levels are high, with readings of 237 mg/dL on April 6 and 314 mg/dL on April 7.
2. Insulin doses: The patient is taking both Lantus (long-acting) and Lispro (rapid-acting) insulin. The doses are adjusted based on blood glucose levels and food intake.
3. Blood glucose fluctuations: The patient's blood glucose levels are fluctuating significantly throughout the day, with readings ranging from 74 mg/dL to 314 mg/dL.
4. Food intake: The patient is consuming a variety of foods, including carbohydrates (rice, roti, pulses), protein (fish, pulses), and fiber (salad, vegetables).
5. Insulin adjustments: The patient's insulin doses are being adjusted based on blood glucose levels and food intake. However, the adjustments may not be sufficient to achieve optimal blood glucose control.
# Recommendations
Based on the data, it may be helpful to:
1. Adjust insulin doses: Consider adjusting the patient's insulin doses to better match their food intake and blood glucose levels.
2. Improve blood glucose monitoring: Encourage the patient to monitor their blood glucose levels more frequently, especially after meals and snacks.
3. Optimize meal planning: Work with the patient to develop a meal plan that takes into account their carbohydrate intake, protein needs, and fiber consumption.
4. Consider additional support: Consider consulting with a registered dietitian or a certified diabetes educator to provide additional support and guidance.
[07-04-2025 09:29] PA: 7.45am fasting blood sugar 197
7.45am cow milk
9.15am chocolate biscuit 2pcs
[07-04-2025 22:32] PA: 10.45am 5u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, pumpkin, papaya, egg and salad
12.15pm pomegranate
1.45pm blood sugar 12
1.45pm 3u lispro insulin
1.50pm lunch with same previous dish except egg
6.30pm sour curd
7.00pm banana 1
7.30pm popcorn
9.15pm 4u lantus
9.15pm blood sugar 181
9.20pm 1.5u lispro insulin
9.25pm dinner with as same as lunch dish
[07-04-2025 22:45] PPM 2: Could you please clarify on how the child's lispro doses are decided?
[07-04-2025 23:38] PA: Every 70-level sugar 1u lispro
Every meal 2.5u lispro (except night)
Morning nuts + milk 1.5u lispro
But in night only cover up the sugar no lispro for meal due to hypoglycemia in the morning
[07-04-2025 23:43] PPM 2: So that 1 unit for 70 is being decided based on the pre meal sugar?
[07-04-2025 23:54] PPM 2: So in this message here - She is actually getting 1.5units Lispro with the cow milk?
[08-04-2025 07:03] PA: 1.5u not only for milk, nuts+ cow milk
Without nuts 0.5u lispro is given for only milk
[08-04-2025 07:12] PPM 1: What was the blood sugar at 1:45 PM! It's written 12! 😳
[08-04-2025 07:51] PA: 1.45, pm blood sugar was 127
[08-04-2025 07:56] PA: 08.04.25
7.45am fasting blood sugar 150
7.45am milk
[08-04-2025 11:11] PA: 9.15am chocolate biscuit 2pcs
10.45am 4.5u lispro insulin
10.50am rice with pulses carrot, tomato, beans, bitter gourd, lady's finger, beetroot, drumstick, pumpkin, chayote, papaya, egg and salad
[08-04-2025 12:16] PPM 2: Okay. So that could be mentioned in your daily text please. @PPM1 sir were you aware of this Insulin?
[08-04-2025 22:31] PA: 12.15pm pomegranate
1.45pm blood sugar 129
1.45pm 3u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.30pm sour curd
7.00pm banana
9.15pm 4u lantus insulin
9.25pm blood sugar 207
9=25pm 2u lispro insulin
9.30pm dinner with as same as lunch dish except fish and include egg
[09-04-2025 08:08] PA: 09.04.25
7.45am fasting blood sugar 195
7.45am milk
[09-04-2025 10:15] PPM 1: 👆any insulin given before the cow's milk as inquired by @PPM2?
[09-04-2025 10:16] PPM 1: Any insulin before 7PM Banana?
[09-04-2025 10:27] PA: No Sir
[09-04-2025 10:47] PPM 1: 👆and this?
[09-04-2025 11:00] PA: No Sir
[09-04-2025 11:12] PPM 1: I guess he meant his mental calculations and not any data that he's missed mentioning here
[09-04-2025 13:07] PPM 2: @PPM1 Sir what is your take on this strategy?
[09-04-2025 13:24] PA: 9.45am chocolate biscuit 2pcs
10.45am 5u lispro insulin
10.50am rice with pulses, carrot, tomato, beans, bitter gourd, chayote, papaya, beetroot, lady's finger, egg and salad
12.15pm grapes
[09-04-2025 14:53] PPM 1: I guess it's been formulated by his local endocrinologist
[09-04-2025 15:27] PA: 1.45pm blood sugar 83
1.45pm 2.5u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
[09-04-2025 15:31] PPM 2: Yes, but what are the outcomes, yo yoing of sugars unfortunately.
[09-04-2025 16:20] PPM 1: One of the other limitations of our PaJR is the inability to communicate with the local practitioners.
Would you like to get connected with her local endocrinologist over a call if @~PA can arrange it?
[09-04-2025 16:21] PPM 2: No I don't think it would be appropriate.
[09-04-2025 16:24] PPM 1: It's important for us to establish a communication with the local practitioners and establish consensus with them else patients would be confused who to follow?
I would agree that given the state of current communication tech and our time it may not be feasible
[09-04-2025 16:30] PPM 2: We can take it as it comes - ultimately the outcomes matter and if the advocate and us are doing well, can continue.
[09-04-2025 23:24] PA: 6.30pm sour curd
7.00pm banana
9.15pm 4u lantus insulin
9.25pm blood sugar 210
9.25pm 2u lispro insulin
9.30pm dinner with as same as lunch dish
[10-04-2025 15:10] PA: 10.04.25
7.45am fasting blood sugar 284
7.45am nuts
8.00am milk
9.30am 6u lispro insulin
9.35am rice with pulses, carrot, tomato, papaya, beetroot, lady's finger, drumstick, egg and salad
12.00noon grapes
1.30pm blood sugar 77
1.30pm 2.5u lispro insulin
1.35pm lunch with same previous dish except egg and include fish
[10-04-2025 15:25] PA: No Sir my local endocrinolgist told that he prescribe for his other patients 1u lispro for every 50 level sugar but 1u lispro for every 70 level sugar is my own strategy from past data
[10-04-2025 17:32] PPM 2: Thank you, this is very insightful.
Ideally Lispro is a rapid acting insulin and this needs to be individualised to every patient. We prefer calculating an Insulin Carbohydrate ratio so that patients can estimate how much carbs they are having and then take the Lispro based on that.
The child is receiving about 14 to 15 units of insulin a day.
So her ICR (insulin carb ratio) is 400/15 = 26g
So for every 26g she needs 1 unit of Lispro.
Therefore you should be aware of carb counting @~PA have you done this before?
[10-04-2025 22:32] PA: 3.45pm blood sugar 55
3.45pm one pc cream biscuit
6.30pm sour curd
7.00pm banana
9.15pm 4u lispro insulin
9.30pm blood sugar 140
9.30pm 0.5u lispro insulin
9.35pm dinner with as same as lunch dish
[11-04-2025 07:08] PA: No Sir
[11-04-2025 08:11] PPM 1: @PPM 2 we may have shared how to here before? Can @~SE pull it out of the case report and reshare?
[11-04-2025 11.47] PA: 11.04.25
7.45am fasting blood sugar 178
7.45am nuts
8.00am milk
9.45am chocolate biscuit 2pcs
10.45am 5u lispro insulin
10.50am rice with pulses, carrot, tomato, beetroot, drumstick, green banana, egg and salad
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