# RE: [IPk] Care?

```Hi Paul -

It's important to remember that we're all our own primary care givers. Just
because the doctor told her to change doesn't mean she has to. If she
doesn't feel like dealing with the doctor's issues now she should just
continue doing what she thinks might work and explain it to him the next
time. He's not there twenty four hours a day, so even with the best
intentions he doesn't know all the ins and outs. I would strongly advise
against an insulin change during a period of stress when you know that
period of stress will be coming to an end. It would be much better to wait
until after the exams, I think.

It's really important to take stress into consideration. I don't know if
stress affects my BGs, but I do know it affects my eating habits, and that
affects my BGs. At the moment I'm very busy and I don't have the time I used
to have to think about my diabets. My results are not what I would like them
to be, but when I consider that I'm working, studying, trying to renovate
the house and plant the garden, as well as family and social commitments,
then I'm doing bloody well! I've also recognised that I don't have the time
to devote to this now, and I'm just going to do the best I can, and try to
control some of the dietary factors that give me problems.

You're saying that Emily's BGs are swinging high /low. I wonder if perhaps
she would benefit from reviewing carb counting if she has a minute. Another
thing that may be helpful is to eat packet foods for the time being. Why?
Because you can match insulin to the carb amount on the packet,  and there
isn't the variation there is with fresh food. So, if you buy a frozen
dinner, you can read the packet, see that there's say, 56g of carb in it,
divide that by the amount of carb per unit of insulin (I get 17g of carb per
unit of insulin) and decide how much insulin to take based on that. In this
example, I would need to take 56g/17g = 3.3 units of insulin. The other
thing is, if she's using velosulin, it might help to try to wait  a half
hour between bolusing and eating: that could help smooth out some peaks.
And, try not to test before the meal bolus is finished (it would be about 5
hours for velosulin, I think, and 3-4 hours for humalog). This could help
prevent any overcompensation for what appears to be a high blood sugar when
you actually have enough meal bolus left to cover it.

elizabeth
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