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Willingness to change | GRIN model , addiction management |
Carb Counting Skills | Core skill might need revision |
Insulin Carb Ratio | Revise. It might reduce in longer term T1 as sensitivity returns |
Insulin protein Ratio | Inform patient of protein effects and delayed glycaemia. Bolus for protein |
Insulin assessment | Will the insulin choice suit a low carb lifestyle? Would a less rapid insulin be better in very low carb? |
Basal adjustment | Usually accurate but testing it will refine the dose. Twice daily dose a good option |
Testing proficiency | Can the patient use the glucometer and understands the need for frequent testing 4-6 times a day. Does the patient have adequate test strips? |
CGM eligible? | 20% of T1 are eligible. With frequent testing a case can be made. It is possibly the single biggest agent to educate the patient. |
Shopping list?
| Plenty of online recipes and a starter fortnight list here. Check the nutrition section |
Ketone testing equipment? | Blood ketones are best. Enable patients to get an idea of their personal ketone levels in nutritional ketosis. Urine sticks a minimum and ok for DKA but not ketosis measurement as urine testing may go negative in the presence of higher blood ketones on a keto diet . |
Ideas for managing sleep. An important part of a keto lifestlye | Sleep hygiene, no food after 8pm, screen protectors against blue light, etc |
Ideas for managing stress. Important in any dietary management of T1
| Stress hormones affect blood glucose |
Ideas for regular physical activity. Important in T1 and often underestimated | Encourage regular physical activity. Strength, joint flexibility and aerobic training should be included in any recommendation. Increased muscle mass increases insulin sensitivity and glucose handling. There is a practical webinar on this important topic. |
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