Blood Sugar Trampoline

Just in case and then it did…

When you plan for the unexpected and then the unexpected happens you never feel more grateful for the time you spent on the “just in case” supplies.

Last week, our family took a road trip across the country to GO TO IKEA!!!! It was very exciting as we were finally converting our Playroom/home office to a Teen Cave… home office (I’m not sure we’ve told them that yet? ;-s Oh well. Oops!

After a very long, but successful day, we were on our way back west. Our plan was to stop at the infamous exit 23 on the M7 to have dinner. However, a few short minutes after we drove passed exit 22, there it was! About two kilometers of red brake lights. Quickly we flashed our hazard lights on to warn the cars behind us that we were all coming to a complete stop.

And there we sat for two and a half hours!!!

We watched the fabulous sunset, our thoughts never straying too far from what had caused this stop and hoping that no one was hurt and we watched the emergency vehicles and personnel travel back and forth.

I monitored my blood glucose very closely on my CGM as my alarm letting me know that my levels were dipping below 4.4mmols/l (79 mg/dL). I managed to keep it above 4.0mmols/l (72 mg/dL) but I didn’t want to aggressively bring it up as I didn’t know when dinner would happen. When we did get to eat, I wolfed down fast food and so was kept away a lot that night with high blood sugars. Sometimes there is just no winning with diabetes! But you know what, I wasn’t willing to eat something as large as a human any more. I wasn’t hungry any more.

I planned for a “just in case”, I worked with what I had and it all worked out better than it might have than if I hadn’t.

These two and a half hours gave me so much time to be grateful for some coincidences and for some good planning.

  • I never take a car trip without some snacks. Even, if I end up not eating it, I still do it. We had a box of Lidl Bread Sticks and when my blood sugars were 4.4 mmol/l those breadsticks kept them from dropping any further. But slowly. As well as keep hungry children content.
  • Always use a bathroom when the car stops! This lesson was shared with me by my husband’s Aunt and is always remembered. Two and a half hours is still a long time and I was still very glad to eventually see the bathrooms of Exit 23.
  • I always carry glucose tabs in my glucose meter case. Always! If I ever get disoriented they are there staring at me and hopefully I will recognise them as the solution. And I always carry a spare pack in my handbag because you never know when you might need more that your usual amount. I was so glad that I had them if I needed them.
  • I’m so grateful there were two adults in the car and that I wasn’t driving.

Even though something like this has only happened to me once before and is unlikely to happen again. It’s worth being prepared for the “just in case”; having a couple of snacks and some glucose in car whenever you take a roadtrip.

Type 1 Diabetes and Pregnant

I’m going to be an auntie again, after a 7 year gap in the birth of nephews and nieces. It’s going to happen any minute now. An-ny minute!!!

And like any good big sister I’ve been sharing valued advice about the last days of pregnancy. I’m sure it’s very welcome advice too:-D OMG, I can’t wait to kidnap babysit this small baby.

ONE MOMENT PLEASE! Sarah, please tell baby to get the head down, engage and one big whosh from in there:-)

WHERE WAS I? All this sisterly advice has prompted me to remember being pregnant myself all those years ago and what I wish I knew then. It’s also one of the questions most asked by young women with type 1 diabetes. In fact, I remembered being asked by two young women, separately, but during the same event. I’m only too happy to share this because I didn’t have anyone to ask before either of my pregnancies and I really wish I had.

These days, there are a couple of books written by women who have been there, namely “Balancing Pregnancy with Pre-existing Diabetes: Healthy Mom, Healthy Baby” by Cheryl Alkon, and Diabetes Daily’s “Pregnancy with Type 1 Diabetes: Your Month-to-Month Guide” by Ginger Vieira and Jennifer Smith.

And there are a number of great blogs and private community groups on social media where you can have a chat to others; have a look at SixUntilMe, BelowSeven,
Diabetes Sisters Pregnancy Section, Diabetes Forecast’s Real Life Stories and the Facebook group – Type1 Diabetes, Conception, Pregnancy & Motherhood in Ireland.

What I remember most from both of my pregnancies;

Two days before the birth of my first baby. HUGE!
  • I felt like I was eating ALL. OF. THE. TIME.

– I would eat my meals, get full half way and then have to force the rest of it down because I had taken my insulin before I started eating. That eating for two stuff is pure nonsense – my stomach shrank! I could only eat small amounts at a time.

– Then I would have to eat In between meals to bring my blood glucose levels up from hypo levels.

  • I wish I had acted on my instinct to take half my meal bolus before eating and half after if I needed it. And I also wished I was using an insulin pump and not Multiple Daily Injections at that time so I could have adjusted my background insulin to avoid hypo snacks between meals.
  • The anxiety of of having a tiny developing human attached to your dysfunctional body and to deliver a healthy human.
  • Being very tired during my first pregnancy and napping a lot. I remember being totally exhausted and wiped out during my second pregnancy.
  • How different it was giving birth in an Irish hospital compared to an american hospital. In one hospital I was treated like a queen and my husband was included every step of the way. The other I felt like I was in the way and I had to insist that my husband not be forgotten about.
  • At my first prenatal appointment I was given a printout of all the appointments I would have over the pregnancy, what would be done at each appointment and why. It was awesome! It showed me that they had a procedure for high risk pregnancies. My second pregnancy felt a bit like my OBGYN was making it up as he went along and my Endo didn’t really want to be involved that much at all. I did refer to the print out during my second pregnancy but none of the tests were done of No. 2.
  • I did not have an insulin pump or cgm for either of my healthy pregnancies. So I remember checking my blood sugars A LOT!
  • There were lots of medical appointments but I didn’t mind. I had more ultrasounds that a “normal” pregnancy and that was a huge perk!
  • Both of my babes were born by elective caesarean because my doctors suspected that I was having large babies. Even so, my first birth was an amazing experience filled with joy and excitement.
  • My second birth was not so. I felt like I was just in the way; that the theatre staff were getting frustrated with me for just being there. Only for a really good anesthetist my son would have been whisked off for a 24 hour blood glucose observation without me being able to hold him. He suggested that I could nurse my son while I was in recovery rather than allowing that staff member to rush him off. That was the best.

Today, my oldest baby will be thirteen next month; Yikes! My youngest is 10. They are both healthy, beautiful and outstanding young people. Neither has diabetes and for this I am grateful.

For anyone who is starting on your journey towards starting a family; it’s so worth it!

Having a good and understanding medical team makes a huge difference in being able to cope with all of the anxiety of having a tiny developing human attached to you.

Ask lots of questions-your doctors and nurses have all done this numerous times but you haven’t. So it’s up to them to answer all of your questions with patience and kindness even if it’s the tenth time they’ve been asked that question that day. Maybe even preempt a couple of your questions.

And most importantly, do a pre-conception clinic to get your body ready for this amazing journey 😀

The Hard Diabetes Changes

I’ve been using an insulin pump for almost seven years and it’s unlikely that I will go back to injection pens. However, I know that things change over time and how I feel about things also change, so I will never say that I will never go back to injection pens because the future is unpredictable.

This week, I have been thinking a lot about all the times I’ve changed the way I manage my diabetes and how difficult some of those changes were. 

I remember when I was transitioning from pens to my pump and that period where I was “practicing” with it. I swear I just wanted to throw it against a wall it was so annoying. But I was also doing twice the work; I was injecting the real insulin with my pens and calculating pretend insulin doses with saline in the pump. It took twice the time for no extra gain. I did that for three days.

I sat in my kitchen one of those three days and thought to myself what if, after all I went through to get this pump, I actually hate it? What if it drives me batty? Why am I changing everything? And the horrifying thought of what if it doesn’t help me?

Then I reminded myself that very few people around the world give their pumps back – they continue to use them and are happy with it. I had seen this research on the internet. I also reminded myself that if I didn’t like it that I could go back to pens. I reminded myself that change is always hard.

I remember when, after living with type 1 diabetes for 6 years, I changed from two injections per day to four! I remember thinking “how is this better?” when it was suggested. I didn’t want to do it but my research told me it was a better way and it was worth trying.But it was better.

I remember when my first blood glucose meter became obsolete. I think I used it for 5 years!!! I know, it was crazy! It was a pain to try a new one. Not to mention changing to new test strips. But it was a good change.

I remember when I went from checking my blood glucose twice per day to four and then to seven. That was a pain but, again, worth it. I learned so much about managing my insulin doses to match the needs of my body from all of those tests. Now, it’s simply out of habit that I still maintain those 7 tests.

I remember when I tackled proper carb counting and not just guessing – that was a lot of extra work for a couple of weeks. Again worth it.

I was not happy with the results I was getting in my life with diabetes and even though change is always going to be difficult at first, it’s worth remembering that some changes are worth it. Some were not worth the effort and I didn’t continue with them. But doing nothing was not an option. If I didn’t try I would never know if it was better.

Scary Diabetes Heart Stuff

Last week, our local type 1 diabetes support group organised a talk on heart disease and it’s association with type 1 diabetes (with a great speaker and a good crowd – thanks to all who attended).

I feel that out of all the complications of diabetes it’s not talked about as much as the diabetic retinopathy, foot disease or kidney disease complications.

Yet, I also feel that it’s the sneakiest of all the complications. There are warning signs for diabetic retinopathy, foot disease or kidney disease and, in today’s world, it is possible to maybe halt the progression of these complications.

But unless you are paying close attention to all the risk factors; high blood pressure, high cholesterol, family history and the lifestyle factors, it can seem like it comes from nowhere. Not to mention that better glycemic management is linked to weight gain, which increases our risk again! Yeah, right – how can we win?

I also was under the impression that because I eat healthily and exercise I had that box firmly ticked and didn’t have to worry about heart disease. That heart disease related more to people with type 2 diabetes. A cholesterol level of 5.7 told me otherwise.

And then I found this;
“Heart attacks and other cardiovascular complications cause the death of nearly 3 out of every 4 people with type 1 diabetes, compared with just 1 in 4 people in the general population.” according to a Swedish study published online September 18 2015 in medical publication; Lancet Diabetes & Endocrinology.

Dang it – I should always question what I think I know!

Our speaker was very concerned about giving us negative and scary information. But I was like “bring it”! I was not scared or running from the room hysterically. And I was surprised at my reaction.

All this information might seem like it’s scaremongering. But I was not scared or running from the room hysterically. P.S. I do firmly believe that fear is not a good motivator for anybody!!!

When I was younger, I really didn’t want to hear about the worst case scenarios. Those nasty complications that would happen to me if I didn’t do as I was told. I didn’t want to know about what could happen down the road.

Well, I seem to be at that point “down the road” where information, even scary information, gives me power over it. At our presentation, I was calmly thinking to myself “it’s good that I know this” and “it’s not going to catch me out because I know this scary diabetes heart stuff now”.

It feels strange now that information about what were once “scary diabetes complications” is now information that gives me power over my diabetes. This information empowers me to stay healthy… but I was also ready to hear it.

This Is How I Do Diabetes Clinic

This post was inspired by the Diabetes Dominator – Danielle Hargenrader and her video series This is how I do Diabetes. Thank you so much, Danielle.

My recent visit to my diabetes clinic took five hours door to door. This is probably not unusual for many people attending outpatient clinics in public hospitals in Ireland. However, for someone who has good management of their diabetes and is a very low maintenence patient; it seems a bit …  uumm, Not Sensible.

Here’s how my visit went;

I left my house at 1pm and an hour later I pulled into the queue, yes queue, for the car park at the hospital. I queued for fifteen minutes before I squeezed my Mazda into a parking spot. I had 15 minutes before my scheduled appointment and after sitting for an hour with more sitting in my future I walked over to the main hospital building used the bathroom and got a coffee. Input to replace output 😉

I headed back over to the diabetes clinic building and I was called by the healthcare assistant for blood pressure and weight in within minutes. Then back to waiting room where I noticed a sign “Be quiet, clinic in progress”. Eemm ok! What parties have I been missing?

I’m really glad the my clinic has free WiFi – definitely helps pass the time. Most of the time I like to be disconnected from the internet when I leave the house but not for huge chunks of time in a waiting room.

A loooong time later, I took an open slot with the dietitian. What else was I doing? I was going to ask to see one anyway to get advice on areas that could help reduce my cholesterol. So this was a long educatio session, maybe 20 minutes.

AND, back to the waiting room. At this point, I was making small talk with some of the other patients there. It was an insulin pump clinic so we all had that in common. We chatted about different blood glucose meters, some of the apps that come with them, the Freestyle Libre and other CGM’s.

Another long wait later, I was called by the non consultant doctor for review. This really didn’t go anywhere. or add any value to my visit. It took me a couple of tries to log into my online records. And while I took over her keyboard, she took a call. Once I had pulled up my reports, she pointed out how my blood glucose range was very wide. Somethink I alread knew and we actually quite recent. She then asked me a couple of generic questions, you know, how many hypos do you have on average, per week, and such.

About 10 minutes later my non consultant doctor asked for the Consultant to review my case. I’m not really sure why. And then we waited for that to happen.

Once my consultant came into the room the appointment progressed much quicker and was more beneficial to me. I got to discuss all the things I needed to, got all the answers I needed and a prescription for last weeks statin too.

I used bathroom once more, checked my blood glucose and drove out of the car park at 5pm, arriving home to my door at 6:05pm

In total that’s two hours in the clinic, one hour drive each way and time for parking, coffee and loo break. Time actually spent with a healthcare professionals was approx. 45 minutes.

That’s really my whole day gone. And I had organise to have my children collected from school as it was an afternoon appointment.

5 hours to be healthy!

Statin a New Phase of Diabetes

Here's to a Healthy Heart! Rock on!

23 years, 10 months and 9 days! That’s how long I’ve been an “insulin only” chick with type 1 diabetes. Last week, I started taking an additional medication in the form of a statin.

Alas, now at age 44 and a cholesterol of 5.7 (the recommendation is 4.5 for people with type 1 diabetes) and a LDL of 3, I’m statin a new phase of diabetes.

I have lived with type 1 diabetes for almost 24 years. I’ve gone from hypodermic needles, to refillable pens, to disposable pens, to an insulin pumps and CGM. I’ve used a good few different types of insulins that I can’t remember the name of.

However, I was very proud of the fact that the only medication I took all this time was insulin. The mischievous side of me always got a kick out of some healthcare professionals surprise to this. Why, Yes, insulin is the only medication I take!

Now it seems those days are gone. And while I’m not ok with getting old (see here), still. I am, oddly, ok with this new phase…. now!

When my consultant first suggested a statin I was very reluctant. At that point, we didn’t have any lab results for my cholesterol but considering my age of over 40, she said it would be a sensible preventative measure. I said I would consider it…. maybe?

As the months went by, I did some research on type 1 diabetes and heart disease. I found out that heart disease in people with type 1 diabetes doesn’t present always with symptoms like it does in people who do not have diabetes. This is good to know!

Heart attacks and other cardiovascular complications cause the death of nearly 3 out of every 4 people with type 1 diabetes, compared with just 1 in 4 people in the general population, according to a Swedish study published online September 18 2015 in medical publication; Lancet Diabetes & Endocrinology. OK now I”m paying attention! I’m not trying to scare people. It’s just that, for me, this information is being forewarned.

And it just so happened that we had a person who had recently had a heart attackat at one of our diabetes support group meetings. Then, George at Ninjabetic US wrote about his recent heart scare. Thank you George.

Yep! Frightened the bejaysus out of me. Lots of “signs” from the universe and I wasn’t going to ignore these ones. Sometimes a little fright is what I need – but mostly fear is not a good motivator!!!! (Note: for all those who try to use it as one).

I also thought about how it’s possible that only one heart attack can take me from this world. While losing my eyesight or a limb is more likely to leave me in it. And yes, the possibility of losing my sight would bring a sadness to me that would make living difficult to cope with, BUT I would still be alive.

So, I’m totally onboard with preventing my heart attack or a stroke. I started taking Rosuva (Rosuvastatin), the generic equivalent of Crestor, last week and I’m also finding one or two remaining areas in my diet where I can trim some fat off.

So take that cholesterol!

P.S. If there is anyone who would like more information and you live in the Co. Clare area. We are having an information evening on Type 1 Diabetes & A Healthy Heart with Dr. Ray O’Connor, GP
When: Tuesday 21st February at 8pm
Where: The Temple Gate Hotel Ennis, Co. Clare.

Here's to a Healthy Heart! Rock on!

New Year New Me… meh!

Now that January is over I can stop saying “It’s the new year!” I know, I know! I’m probably a couple of weeks behind everyone else.

New year’s resolutions are a distant memory as is a reason, as good as any, for some people to have a new beginning. And, apparently, that only ever means a diet, maybe a gym membership that never gets used and a bombardment of media ads to be healthy, get fit and go on a diet. I felt this year it was more annoying than usual. I actually have a friend who refuses to buy a women’s magazine for the months of December and January for this reason!

I still try to embrace the whole new year resolutions malarkey but in the essence of trying to be nicer or work on my patience.

However, just as the year was wrapping up I stumbled across a couple of things that has made me leap, all in, with a genius idea for next year’s new year resolutions. (And Yes I know that self praise = no praise, i.e. I’m not a genius 🙂

Here’s what happened;
In December, I read this piece from DiaTribe on New Apps in Diabetes. It was really interesting (Thank you DiaTribe). However, it was this video, by Dr. David Sobel on “how people are not unmotivated; they are overwhelmed.” that fired up my brain.

In the video, Dr. Sobel talks about how health care professionals tend to overwhelm their patients with lots, and lots of information and a long list of things they need to do to become healthier. And what often happens is that people end up being so overwhelmed with all of it and leave the office feeling so much worse than when they went in. But worse than that, they become paralyzed to do anything.

And I thought about this, especially, while at our local Type 2 Diabetes meet up in January, as I was looking through Diabetes Ireland’s Healthy Eating guide for people with type 2 diabetes with page after page of advice and no clue where to start.

I put it to our type 2 diabetes support group that if they were given a list of small defined tasks such as;

– Cut back on sugar in your beverages by even 25%
– If you take an artificial sweetener reduce it by one if you take more than one
– Switch from full fat milk to low fat
– Switch from low fat to skim
– 10 minutes of moving 3 times a week
– Switch your daily Latte/Cappuccino to tea or straight coffee, etc.

And what if they only had to pick one thing from that list and stick to it for 10 weeks, would they be more likely to make it a change for life? Or how about the first thing they do is make a list of all the things they would like to change or things they would like to bring into their lives.

Some said “yes” and some were skeptical. So I suppose it’s back to “New Year, New me Meh! But for me, talking all this through with the group gave me focus on what I’m going to do about my elevated cholesterol. Watch this space;-)

I also like the idea that Dr. Sobel came up with to have our invitation to our annual diabetic eye screening come from our eyes to address the 50% of people who do not attend their eye screening appointment. Mine would go something like this;

 

 

Am I Ready for my Diabetes Appointment? Yikes!

My next diabetes clinic appointment is next week. It’s been eight months since I was last there. I’m not sure how I feel about having such a long time between appointments but maybe that’s another post?

Diabetes, especially type 1 diabetes, is one of the few conditions where you actually have to prepare for your clinical review appointment. It’s how you will get the most out of your visit.

For a lot of years, I just showed up with my “diary” and walked out of there disappointed. If truth be told, I was very resentful that I had to be there and a little down in the dumps about the whole diabetes thing. During these years my primary goal was to get out of there as fast as possible and get on with my life.

I became more motivated at my diabetes clinic appointments when I was considering starting a family. And that motivation and effort has paid off.

I don’t dread my clinic appointment, like many do, because I feel this is my chance to get help if I need it, or to review where I need a little extra support from my team. But I do dread the getting ready for my appointment! It is a lot of work.

Everyone has a different way they prepare for their clinic appointment. Here’s how I prepare for it;

SAVING UP QUESTIONS TO ASK
In between appointments, if a, non-urgent, question pops into my head I try to write it down somewhere – preferably somewhere near my Long Term Illness book which I’m already in the habit of bringing with me. This coming visit I need to get an updated letter for travelling and I’ve already noted it.

Save up your Questions
Save up your Questions

THE LABS
About two/three weeks before my appointment, I have my blood drawn in my GP’s office to be sent to the lab. The results are usually sent to my clinic automatically but sometimes that hasn’t happened on time or at all, so before my appointment I collect a copy of my results and keep a copy for my own records.

BLOOD GLUCOSE RECORD
This first and last thing I do to get ready for this meeting is to upload all of my blood glucose meters (I use two) to the software programme I use for my insulin pump. I also upload all the information from my insulin pump.

LONG TERM ILLNESS BOOK
I bring my Long Term Illness book with my to my appointment so that I make sure it has been updated every six months. I also print out a list of all the “stuff” I use. My LTI book is 10 years old and there is a lot of stuff on it that I no longer use. This also saves a bit of time and scores me some brownie points with my endo. Always useful.

PRE-EMPT QUESTIONS I MIGHT BE ASKED
I try to preempt questions I might be asked about specific high or low blood glucose readings as best I can. I try to remember that the important readings are the ones that I can’t account for. Sometimes, I have to remind my healthcare professionals of that too.The highs and lows that are from the usual culprits are ones that I can address myself. Its those very rare highs and lows where I don’t know what the cause was that are a problem. If I don’t know what caused them then how can I prevent them from reoccurring.

So, am I ready for my diabetes clinic appointment? As ready as I’ll ever be! 😀

 

Here is another article I thought had some very useful tips on getting the most out of your diabetes appointment.

My Blood Tests for Diabetes Clinic

My diabetes clinic appointment is coming up next month and I scheduled my blood draw for my labs with my GP’s surgery. I usually get them done about 2-3 weeks before my appointment so that I have enough time to collect and copy them for my own records.

The regular blood draw for labs is one of the “joys”  of having type 1 diabetes. And for this one,  I scheduled a fasting blood sample because my cholesterol was due to be checked. However, I have read that being fasting for this test doesn’t actually affect the accuracy of the result. But do I want to have that “discussion” with my nurse practitioner or not yet?!?

The morning came and I had written a note for myself to remind me not to have breakfast. Sometimes, I wonder “What I’m like?”

Low (pun) and behold my CGM started to alert me to the fact that my blood sugars were below 4.1 mmol/l (74 mg/dl) with a ⬊. I did a check on my meter just to be sure. And YEP!

Fasting Blood Sugar No before driving!!!

So what to do? I decided to still forego brekkie and top up with 2 glucose tablets, which is usually enough to bring me back into the 5’s. The important thing for me to remember was that I was driving – it was only a short drive but none the less driving. Don’t drive under 5 mmol/l (90 mg/dl).

By the time we left the house for the school drop off I was at 5 mmol/l. After I dropped the kids off at school, I went home and literally didn’t breathe so that my blood glucose wouldn’t drop any further. I only had to hold out til 9.50am.

I made it! I told my nurse what I used to bring my sugars up to make it safe to drive and she didn’t even bat an eyelid. So that was great!

However, there’s another disadvantage to trying to do fasting blood tests when you have type 1 diabetes and that’s when your done with your appointment.

I was starving, famished, could have eaten a horse. I ended up at the closest cafe and ordered the lesser of all the evils … or so I thought; a plain cheese and ham croissant. Definitely not a great option, unhealthy and boy did it send my blood sugars into the clouds.

2017-01-17 bbs
I feel like I should’ve gone all out and had the muffin. But at least this job is done for another year.

The Hill and the Hypo

Last week this happened but I was only just getting back into the swing of things and so only writing about this week.

Jetlag day 4 and feeling like a functioning human being again. I must have slept really well because all my aches and pains subsided. See last week’s depressing post.

It’s also Day 2 of the kids being back to school and day 2 of me getting back into my walking regime. I was feeling so good and my ankle was feeling so good that I decided to try that hill. The one that I haven’t tried in about 3 months due to injured accilles tendon. And go that bit further.

When I reached the top I felt like Rocky!!! I almost did an air fist pump but that would have looked sad – it’s not a very big hill :-S

Really small hill :-)
Really small hill 🙂

Anyway, I was well on my way home when I felt my insulin pump on my hip start to buzz to alert me to the fact that my blood sugar was 4.1 mmol with a ↓ Then I remembered that I really should have factored in how much insulin I took for breakfast the previous hour and how I didn’t know then that I was going to go that bit further. Oops!

Luckily, I always carry glucose in my meter case. And I always shove my meter case in my coat pocket. I grabbed a couple of the glucose tabs but I could already feel the river of sweat streaming down my forehead, down my back and down my front. And I knew it wasn’t the moderate workout I I had hoped for. My arms and legs felt like they belonged to Raggedy Ann or Andy. A little further on I took another couple of glucose tabs because I knew this was a serious hypo.

I was still thinking clearly, surprisingly, because I felt that I wasn’t at the point where I needed to call for backup. I felt I could still make it home, shakingly, and flopsy-mopsy style(cos that’s what it felt like) but I could make it.

And I did! I got inside my front door and sat on the stairs, laid back and just wait for the intense heat steaming from my body to stop.

The lesson I hope I have learned from this experience is that I need to factor in previous insulin dose into spontaneity.

However, the likelihood of that lesson sinking in and popping out immediately when needed is doubtful. One can only hope!

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