[22-07-2025 23:35] PA: 9.15pm 5u tresiba insulin
9.30pm blood sugar 67
9.30pm 1.5u lispro insulin
9.35pm dinner with as same as lunch dish
[23-07-2025 08:05] PA: 23.07.25
7.45am fasting blood sugar 210
7.45am nuts
8.00am milk
[23-07-2025 10:19] PPM 1: Any symptoms of hypoglycemia or any further episodes of reduced blood sugar noted after yesterday's dinner?
[23-07-2025 10:22] PA: Nothing like that
[23-07-2025 22.21] PPM 1: Keeping a close eye.
[23-07-2025 22.54] PA: 9.45am 2pcs chocolate biscuit
10.45am 5.5u lispro insulin
10.50am rice with pulses pointed gourd, chayote, papaya, green banana, spiny gourd, tomato, long beans, bitter gourd, sponge gourd egg and salad
12.30pm mango
1.45pm blood sugar 75
1.45pm 2u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.00pm sour curd
9.15pm 5u lispro insulin
9.30pm blood sugar 190
9.30pm 4u lispro insulin
9.30pm dinner with as same as lunch dish
[24-07-2025 09:42] PPM 1: User driven Orwellian eye? https://userdrivenhealthcare.blogspot.com/2025/07/user-driven-orwellian-eyes-at-pivot-of.html?m=1
[24-07-2025 11:11] PA: 24.07.25
7.45am fasting blood 80
7.45am milk
9.45am chocolate biscuit 3pcs
10.45am 4u lispro insulin
10.50am rice with, pulses, pointed gourd, chayote, papaya, green banana, long beans, spiny gourd, tomato, egg and salad
[24-07-2025 16:20] PPM 2: Nice comments at the end. Yes this is in one way flipped Orwellianism.
The Tresiba appears to be working it's magic.
[24-07-2025 19:25] PA: 12.30pm mango
1.45pm blood sugar 150
1.45pm 3.5u lispro insulin।
1.50pm lunch with same previous dish except egg and include fish
6.00pm sour curd
7.00pm guava
[24-07-2025 23:51] PA: 9.15pm 5u tresiba insulin
9.30pm blood sugar 126
9.30pm 2.5u lispro insulin
9.35pm dinner with as same as lunch dish
[25-07-2025 08:22] PA: 25.07.25
7.45am fasting blood sugar 126
7.45am nuts
8.00am milk
[25-07-2025 19:09] PA: 9.45am 3.5u lispro insulin
9.50am rice with pulses, sponge gourd, papaya, green banana, long beans, bitter gourd, chayote, pumpkin, spiny gourd, tomato and salad
12.00noon mango
1.30pm blood sugar 143
1.30pm 3.5u lispro insulin
1.35pm lunch with same previous dish and egg
6.00pm sour curd
6.30pm banana
[25-07-2025 19:11] PPM 2: @PA what has your impression been of Tresiba compared to Lantus
[25-07-2025 19:27] PA: Let me see for few more days Sir.
[25-07-2025 19:35] PPM 2: Yes agreed. How many days has it been since starting Tresiba?
[25-07-2025 19:36] PA: 18.07
PPM 1: 👍
[25-07-2025 23:25] PA: 7.00pm ripe jackfruit
9.15pm 5u Tresiba insulin
9.30pm 6u lispro insulin
9.35pm dinner with as same as lunch dish
[25-07-2025 23:27] PA: 9.30pm blood sugar 505
[26-07-2025 02:11] PPM 2: 505?! Is it a typo?
[26-07-2025 02:11] PPM 2: Any symptoms?
[26-07-2025 08:30] PA: No Sir
[26-07-2025 08:31] PA: 11.45pm blood sugar after dinner 115
[26-07-2025 08:32] PA: 26.07.25
7.45am fasting blood sugar 62 (no symptoms)
7.45am nuts
8.00am milk
[26-07-2025 08:52] PPM 1: Jackfruit
[26-07-2025 08:55] PPM 1: Interesting how the increased lispro has influenced the fasting inspite of the same dose of tresiba, which also I guess is still slowly building a steady state level!
[26-07-2025 18:45] PA: 9.45am 3.5u lispro insulin
9.50am rice with pulses, pointed gourd, bitter gourd, chayote, papaya, green banana, spiny gourd, tomato, long beans, egg and salad
12.00noon sugercane juice 100ml
1.30pm blood sugar 227
1.30pm 4.5u lispro insulin
1.35pm lunch with same previous dish except egg and include paneer
[26-07-2025 18:45] PA: 6.00pm sour curd.
[27-07-2025 08:54] PA: 7.00pm ripe jackfruit 4 teaspoons
9.15pm 5u tresiba insulin
9.30pm blood sugar 218
9.30pm 4u lispro insulin
9.35pm dinner with as same as lunch dish
[27-07-2025 09:11] PA: 27.07.25
7.45am fasting blood sugar 136
7.45am milk
[27-07-2025 11:33] PPM 1: Jackfruit tea spoons? Is it being given after mashing?
[27-07-2025 11:40] PA: Exactly
[27-07-2025 11:41] PA: 9.45am 4u lispro insulin
9.50am rice with pulses carrot, tomato, papaya, green banana, spiny gourd, ribbed gourd, pointed gourd, chayote, butter and salad
[27-07-2025 11:58] PPM 1: Mashing it up may make her avoid the fiber and only take the liquid sugary portion of the fruit
[27-07-2025 15:57] PA: 12.00noon guava
12.30pm milk chick 15grm
1.30pm blood sugar 116
1.30pm 3u lispro insulin
1.35pm lunch with same previous dish except butter and include paneer
[27-07-2025 23:31] PA: 6.00pm sour curd
7.00pm payesh (milk, rice, cashu, raisins)
9.15pm 5u tresiba insulin
9.30pm blood sugar 334
9.30pm 4.5u lispro insulin
9.35pm dinner with as same as lunch dish
[28-07-2025 08:08] PA: 28.07.25
7.45am fasting blood sugar 75
7.45am nuts
8.00am milk
[28-07-2025 09:54] PPM 1: 7:00 PM left uncovered and hence easy to explain the 9:30 PM high
[28-07-2025 18.03] PPM 2: Looks like the Tresiba has fully bedded in now.
We just need to teach carb counting now.
@PA any luck with the book on carb counting? Have you been able to buy it?
[28-07-2025 19.08] PA: No sir.
[28-07-2025 23:52] PA: 9.45am chocolate biscuit 2pcs
10.45am 4u lispro insulin
10.50am rice with pulses, carrot, tomato, papaya, ribbed gourd, green banana, long beans, bitter gourd, chayote, papaya, butter and salad
12.30pm sweet lemon ( mosambi)
1.45pm blood suger 263
1.45pm 5u lispro insulin
1.50pm lunch with same previous dish
6.00pm sour curd
6.30pm cucumber
9.15pm 5u tresiba insulin
9.30pm blood sugar 171
9.30pm 3u lispro insulin
9.35pm dinner with same previous vegetable and khichdi
[29-07-2025 21:15] PA: 29.07.25
7.45am fasting blood sugar 122
7.45am nuts
8.00am milk
9.45am chocolate biscuit 2pcs
10.45am 5u lispro insulin
10.50am rice with pulses, carrot, papaya, green banana, chayote, pointed gourd, sponge gourd, egg and salad
12.30pm sweet lemon
1.45pm blood sugar 142
1.45pm 3.5u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.00pm sour curd
8.30pm sugar free sandesh
9.15pm 5u tresiba insulin
[29-07-2025 23:54] PA: 9.30pm blood sugar 140.
9.30pm 3u lispro insulin
9.35pm dinner with as same as lunch dish
[30-07-2025 10:21] PA: 30.07.25
7.45am fasting blood sugar 77
7.45am nuts
8.00am milk
9.45am chocolate biscuit 2pcs
[30-07-2025 23:31] PA: 10.45am 4u lispro insulin
10.50am rice with pulses brinjal, sponge gourd, papaya, green banana, long beans, bitter gourd, chayote, pointed gourd tomato, egg and salad
1.45pm blood sugar 87
1.45pm 2.5u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.15pm sour curd
9.15pm 5u tresiba insulin
9.30pm blood sugar 112
9.30pm 2.5u lispro insulin
9.35pm dinner with as same as lunch dish
[31-07-2025 00:01] PPM 2: 2 weeks in and Tresiba seems all but the solution to her glycemic problems? @PPM1 Sir
[31-07-2025 08:57] PA: 31.07.25
7.45am fasting blood sugar 113
7.45am nuts
8.00am milk
[31-07-2025 23:26] PA: 9.45am chocolate biscuit 2pcs
10=45am 4.5u lispro insulin
10.50am rice with pulses, pointed gourd, chayote, papaya, green banana, long beans, bitter gourd, sponge gourd, egg and salad
12.30pm sweet lemon
1.45pm blood sugar 113
1.45pm 3u lispro insulin
1.50pm lunch with same previous dish except egg
4.00pm blood sugar 111
6.00pm sour curd
7.45am milk chick 30grm
9.15pm 5u tresiba insulin
9.30pm blood sugar 182
9.30pm 3.5u lispro insulin
9.35pm dinner with as same as lunch dish
[01-08-2025 09:19] PA: 1.08.25
7.45am fasting blood sugar 64 (no symptoms)
7.45am nuts
8.00am milk
[02-08-2025 00:01] PA: 9.45am chocolate biscuit 2pcs
10.45am 4u lispro insulin।
10.50am rice with pulses, brinjal, tomato, long beans, bitter gourd, chayote, papaya, green banana, sponge gourd, egg and salad
12.30pm sweet lemon
1.45pm blood sugar 207
1.45pm 4.5u lispro insulin
1.50pm lunch with same previous dish except egg and include fish
6.00pm sour curd
7.00pm cucumber
9.15pm 5u tresiba insulin
9.30pm blood sugar 55 ( no symptoms)
9.30pm dinner with as same as lunch dish
9.45pm 1.5u lispro insulin
[02-08-2025 00:03] PA: বলছি যে স্যার Lantus ইনসুলিন কিছুটা বাকি পরে আছে, সেটা কি মাঝে মাঝে ব্যবহার করা যাবে ?
[02-08-2025 00:42] PPM 2: @Meta AI please translate to English
[02-08-2025 00:42] Meta AI: The response is already in English. If you're looking for a translation into a different language, please let me know the target language, and I'll be happy to assist.
If you have any further questions or need clarification on the comparison between Tresiba and Lantus, feel free to ask!
[02-08-2025 00:43] PPM 2: Better not as may lead to insulin stacking and bad outcomes
[02-08-2025 07:06] PPM 1: Inputs from our pediatric endocrinologist regarding this child's recurrent asymptomatic hypoglycemia 👇
[02/08) Pediatric Endocrinologist:
I want to reiterate that utmost care must be taken to use age-appropriate targets for this child who is <5/6 years of age. In the absence of CGM, A1C offers the best assessment of overall control and should be used to guide changes in insulin dose.
There is evidence that hypoglycemia, even asymptomatic, in a child this age (even 2-3), can cause neurocognitive damage that may not become evident until later.
I think that paradigms where CGM use guides therapy or adult thresholds are being applied to this child’s treatment.
While any value </=70 mg/dL should be concerning, even a couple <54 mg/dL should be scary. It is compounded further by very poor understanding of dietary factors by the family.
Since hyperglycemia (in the absence of ketosis) is not as damaging in a prepubertal child, I would not be so aggressive.
I think resources should be put into ensuring that the child’s family appreciate that the child doesn’t need a special diet - the whole family needs the diet the child requires. They should be taught to eat and feed her a lower carb diet than they’re doing now - that will gradually bring her sugars down safely without the need to increase insulin doses that lead to hypos.
[02-08-2025 07:11] PPM 1: আমাদের পেডিয়াট্রিক এন্ডোক্রিনোলজিস্টের এই শিশুর বারবার হলেও উপসর্গবিহীন হাইপোগ্লাইসেমিয়া নিয়ে মতামত 👇
[০২/০৮) পেডিয়াট্রিক এন্ডোক্রিনোলজিস্ট:
আমি আবারও বলছি যে, এই <৫/৬ বছর বয়সী শিশুর জন্য বয়স-অনুযায়ী টার্গেট ব্যবহার করতে অবশ্যই বিশেষ যত্ন নিতে হবে। CGM না থাকলে, A1C মোট নিয়ন্ত্রণ মূল্যায়নের জন্য সেরা ও সর্বাধিক নির্ভরযোগ্য পদ্ধতি এবং ইনসুলিন ডোজ পরিবর্তনে এটি গাইড হিসেবে ব্যবহার করা উচিত।
প্রমাণ আছে যে, এমনকি উপসর্গবিহীন হলেও, এই বয়সের (এমনকি ২-৩ বছরেও) শিশুর ক্ষেত্রে হাইপোগ্লাইসেমিয়া নিউরো-কগনিটিভ ক্ষতি করতে পারে, যা হয়তো পরে প্রকাশ পেতে পারে।
আমার মনে হচ্ছে এখানে থেরাপির জন্য CGM-এর ওপর নির্ভর করা হচ্ছে বা প্রাপ্তবয়স্কদের মানদণ্ড শিশুর চিকিৎসায় প্রয়োগ হচ্ছে।
যে কোনো মান </=৭০ mg/dL চিন্তার বিষয় হওয়া উচিত, এমনকি কয়েকটি মান <৫৪ mg/dL হলে সেটা আরও বেশি চিন্তার কারণ। এটি পরিবারের ডায়েট সংক্রান্ত দুর্বল বোঝাপড়া দিয়ে আরও জটিল হচ্ছে।
কারণ, কিটোসিস ছাড়া হাইপারগ্লাইসেমিয়া প্রিপিউবার্টাল শিশুর জন্য ততটা ক্ষতিকর নয়, তাই আমি খুব আক্রমণাত্মক (aggressive) হতাম না।
আমার মতে, এই পরিবারের বুঝতে হবে যে শিশুকে আলাদা ডায়েট দেওয়ার দরকার নেই— সকলেরই শিশুর চাহিদা অনুযায়ী খাওয়া উচিত। তাদের শেখাতে হবে কীভাবে এখনকার তুলনায় কম কার্বোহাইড্রেট বিশিষ্ট খাবার খেতে ও খাওয়াতে হবে— এতে তার সুগার নিরাপদে ধীরে ধীরে ঠিক হবে, ইনসুলিন বাড়ানোর দরকার হবে না, ফলে হাইপো হওয়ার ঝুঁকিও কমবে।
[02-08-2025 07:12] PPM 2: Agree with all points and very useful learning for me as well.
As a counter -
What symptoms are being looked for in the child?
This paper suggests hypoglycemia cutoffs for children can be different and their symptoms subtle that they cannot recognise them
[02-08-2025 07:20] PPM 1: Thanks!
To quote from that paper:
Neonates >48 h of life, infants, and younger children unable to communicate: HY is defined as PG <50–70 mg/dl (i.e. the normal threshold for neurogenic responses). Notably, recurrent PG levels in this range may cause the HY-associated autonomic failure, that in turn can attenuate HY autonomic symptoms (HY unawareness). Conflicting results on the definition of a safety glucose target level have emerged (16, 17). Currently, an acceptable threshold for this group is still considered 60 mg/dl
No other cut offs mentioned for older children in that paper.
[02-08-2025 07:23] PPM 2: Exactly. Need to clarify on subtle symptoms child may not be able to communicate.
[02-08-2025 07:24] PPM 1: And till then take the cut off as 50-70 as quoted from the above paper?
[02-08-2025 07:25] PPM 2: 60 perhaps. I'm not fully sure myself.
[02-08-2025 08:06] PPM 1: Shared by our pediatric endocrinologist just now from the January 2025, ADA clinical practice guidelines:
[02/08, 07:46] Pediatric Endocrinologist:
The symptoms of hypoglycemia in a child aged 4-5 years with T1D are most commonly behavioral and neuroglycopenic, including irritability, mood swings, lethargy, drowsiness, sudden quietness, and, in severe cases, confusion, seizures, or loss of consciousness. Classic autonomic symptoms such as tremor, palpitations, and sweating are less frequently recognized or reported in this age group.
The progression from mild to severe hypoglycemia can be rapid, and the risk of severe events is highest in children under 6 years, with an incidence of 40.9 per 100 patient-years. Recognition and management depend almost entirely on vigilant caregiver observation and routine blood glucose monitoring.
The American Diabetes Association defines hypoglycemia in children as a blood glucose <70 mg/dL.
Level 1 hypoglycemia: <70 to >/=54 mg/dL - in a child this age, symptoms may not be recognized or may be nonspecific, like irritability, weakness, or hunger.
Level 2: <54 mg/dL - neuroglycopenic symptoms such as mood swings, sudden loss of attention, seizures, blank states, etc. More likely if BG <50 mg/dL.
Level3: altered mental or physical functioning requiring assistance from another person for treatment, regardless of the blood glucose.
[02-08-2025 08:30] PA: কাল সন্ধ্যা 6 টায় দই খাওয়ায় পর একটু পড়াশুনা করার পর আমাদের সামনেই খেলছিল তারপর 9 টার সময় 15-25 মিনিট একটু টিচারের নাচের প্র্যাকটিস করলো l ওর মধ্যে কিছুই ব্যতিক্রম লক্ষ্য করা গেলনা l
[02-08-2025 08:31] PA: 2.08.25
7.45am fasting 169
7.45am nuts
8.00am milk
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