Hoja de Calculo Kelly, para control diario de HC

Discussion Forum: Spreadsheets

This is the 12th in a series of discussion forums at Diabetes.Blog.Com. One of the "regulars" at the Symlin blogs (whose nom-de-plume is "the Babe") has generously offered to share a spreadsheet he calls "The Kelly Model." It may be found at the Diabetes Monitor, at the Kelly Model.

The Babe plans to explain the use of the spreadsheet and answer questions as they arise.

There are other spreadsheets to use to track how your diabetes is doing: see software at the Diabetes Monitor for some others. If you want to discuss another spreadsheet, and have a copy, I can upload it to a spot at the Diabetes Monitor where everyone can access it and download it (but please understand, I'll only post spreadsheets that do not have copyright restrictions).
Please note revised ground rules:

1. To share your thoughts, use the "Comments" link immediately below.
2. You must include a valid e-mail address in the posting form. This e-mail address is not displayed as part of your comments. If you do not provide your e-mail address, your comment may be removed without warning.
3. Optional: You can also add your e-mail address in the text of your comments if you are willing to have readers contact you.
4. Stay on the topic! All posts are monitored automatically, and any off-topic posts will be mercilessly removed.

I'll plan to add more forums for other topics upon request.

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at www.DiabetesMonitor.com

At the Diabetes Monitor today: Finding an eye care professional.
Posted by Bill the diabetesdoc at 00:00 in Discussion forums | Link | Comments (12)
Comments

"THE KELLY MODEL" #1

This is named after Kelly, who first person who inquired into it's availability. I wrote the original spreadsheet for my own use from scratch - no one else was involved. The software is MS Excel.

Under copyright law, I waive all of my rights. Use it however you wish.

There is nothing on this spreadsheet that cannot be done by hand - it is just MUCH faster using Kelly. People will find that they can track their average blood sugars and weight change quickly. Their diets can be adjusted "real time" as they go through the day. These items are VERY helpful in staying "on program".

Kelly is color-coded for ease of use (One time I removed the colors and started laughing - it was almost impossible for me to understand - and I wrote it!).

There is nothing in Kelly that is "locked in". You can change words, colors, abbreviations, data, etc. to fit your particular needs. Keep a copy of your current Kelly, then "play" with it all you want. If you screw it up, dump it and go back to your saved copy.

More later.

The Babe

PS - My apologies to Kelly if this sounds a bit "racy" - it is just easier to refer to the spreadsheet by name.
Written by: BioBabe at 2005/09/17 - 19:19:33


"THE KELLY MODEL" #2

Class now begins!

Please hold your questions until I have gone through the basics in the next several posts. I will then try to answer any "Kelly" questions.

Please continue to direct any non-Kelly questions to the Symlin blog.

-----------------------------------------------

CALORIES and DIET

Kelly is set up with a "balanced" 1400 calorie diet that I worked out with a nutritionist. If you do not agree with certain items or wish to change them, have at it! If you want to use 1700, by all means make the changes on Kelly.

The foods & calories listed at the left-bottom are what I always use. Per the dietitian, as long as the numbers work out during the day, it doesn't matter if you eat all of the fruit in the morning and veggies in the afternoon - whatever you decide to do is ok. This statement may sound trite, but the fact that I can have more meat, etc. at one meal and adjust for it later really helps me stay with this rather small list of food.

What I list as exchanges are not "hard core" - some came from the labels on packages, some from the nutritionist, some from an on-line "exchange" list.

My favorite snack is a big tablespoonful of salsa - I add the name and calories right into the data.

If you go over by 100 calories one day, try to go under by 100 calories the next day.

I have asked my wife to do no cooking until I get to my weight goal (I started at over 275).

I cook once a day, about 3 pm, generally using a George Foreman grill. I am evolving to a diet with more fish than meat because I get twice as much for the same calorie count.

The nutritionist said "use whole wheat bread, do not use low carb bread". I have taste-tested about 10 kinds of bread and found a whole wheat potato bread at 70 cal/slice that I really like. I keep it in the freezer and nuke 1 or 2 slices just before eating. Sandwiches are my preferred foods.

You will see NS beans listed. I have an edema problem due to diabetic issues, so I limit my salt intake. Canned green beans are available with and without salt. I use the NS variety and then try to improve the taste with various spices, primarily pepper.

More later.

The Babe

Written by: BioBabe at 2005/09/17 - 20:54:17


"THE KELLY MODEL" #3

DOSAGES

I always use Symlin @ 20 U-100 units just prior to meals 4 times a day. (I have also tried 3 and 5)

I always use Lantus (long acting insulin) at bedtime once a day. (I have also tried morning and noon).

In addition, I use about 8 other meds (not shown).

The "biggie" is Humalog, which I use after each meal. It is shown in yellow - for a very good reason!! After you have all of your other doses of meds "fixed", Humalog (or another short-acting insulin) is the variable that will help you achieve good glucose control (or lack thereof). It can also cause hypoglycemia. (Symlin alone cannot cause hypoglycemia - it can only be caused by insulin).

I will cover how I calculate Humalog dosage in a separate post.

I did a lot of experimenting to determine my doses and timing of Lantus and Symlin. Once they were "fixed" glucose control became much easier. I did the "dosage experimenting" on an earlier version of Kelly ... and I referred to my earliest spreadsheets and hand-written logs to help determine my best approach "going forward".

The object is to reduce the number of "variables" to just one - which for me is my short acting insulin.

Do not expect this dose determination to happen quickly!!!

More later,

The Babe

Written by: BioBabe at 2005/09/18 - 15:47:35


"THE KELLY MODEL" #4

GLUCOSE TESTING

There are 4 primary glucose tests a day listed on Kelly - 7am, 11am, 3pm, and 7 pm. Each test is done just prior to injecting Symlin, eating, and then injecting "short-insulin".

Change these times as you see fit. Many people are using Symlin 3 times a day. For awhile I injected 5 times a day. I currently prefer 4 times a day at 4 hour intervals, and I refuse to go under a three hour interval.

If "things are running right", these 4 tests will give you your four lowest glucose readings of the day. THESE FOUR TESTS ARE NOT YOUR DAILY GLUCOSE AVERAGE!!

The next four tests, if used, should each be done 90 minutes after starting each meal.

The average of these 8 tests will give you a reasonabe average of your blood sugars for the day. My goal is an average of 105 or below, which equates to an A1c of 5.5 or less (the normal range for non-diabetics). I have never been able to average 105 for more than a couple days at a time. My best average for a week was 115 - I was able to do that for 2 - 3 weeks in a row.

Kelly will automaticlly re-calculate the daily average as you enter each glucose test result during the day.

A little quirk of mine - I add one more number at the bottom - @ wakeup - which is the first test result from the following day. It reminds me how much my food and glucose from the prior day effects my glucose the following day. If you wake up with a high glucose, you will be "fighting" to get it back down most of the day.

I cannot over-stress the importance of waking up with good blood sugars ... day ... after day ... after day ... if you expect to have good "diabetic control".

As I went through my "learning curve", one day I tested 23 times. I recommend against doing anything like that. Right now I am testing 4 times a day and giving my poor finger a break (I do it all on my left ring finger). Yesterday my 4 tests were 83, 95, 88, and 99 with a 77 early this morning. (Those were extremely good, but impossible for me to maintain on a continuing basis). I had no low blood sugar events, but I was "pushing my luck" all day.

Keep in mind that "fasting blood sugars" and the above listed "average blood sugars" are just indicators. The "800 pound gorilla test" for diabetes is the A1c, which shows your average blood sugar over 90 - 120 days.

I am now at Day 84 on Symlin and will ask my doc for a scrip to get several tests, including the A1c, after I pass 90 days. I used to be able to predict my A1c fairly well, but I have done so much experimenting since I started Symlin that I don't even want to venture a guess as to my next A1c result.

More later,

The Babe


Written by: BioBabe at 2005/09/18 - 21:20:03


"THE KELLY MODEL" #5

DAYS and STACKING

I keep track of the number of days I have been on Symlin, along with the date, in the lower left hand corner of Kelly.

I keep the "current day" version of Kelly "pushed against" the left hand side of the Excel spreadsheet -and- at the "very top" of the spreadsheet (The A1 position). The column widths are "default" (10 spaces per column) except for the last two columns which are 4 and 5 spaces (You will see the numbers 4 and 5 in the upper right hand corner of Kelly.

I also keep a "clean" version of Kelly just to the right of the "current day" version of Kelly.

Each evening I use the "Insert - Row" feature to move the "current day" -and- the "clean" version of Kelly down the page. I then use the "Copy - Paste" feature ... (Do Not ... Cut - Paste!!) to install a "clean version" above the "current day" - to be used tomorrow.

After a few days you will find that this stuff becomes almost "automatic".

I initially made a "hardcopy" each day to keep in a 3-ring notebook. Now I just keep "pushing prior days" down the spreadsheet. There are a lot of rows down there!!

I recommend that you keep an "on-going" backup file in addition to your normal file. I needed the backup several times when first using the spreadsheet

More later,

The Babe





Written by: BioBabe at 2005/09/19 - 20:13:35

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Written by: Bill the diabetesdoc at 2005/09/21 - 17:33:58


"THE KELLY MODEL" #6

All of the colors were selected for ease of reading - there are no "subtle messages" - I'm not smart enough to do that!

Color changes are done in the FORMAT section of EXCEL.

BACKGROUND COLORS

Gray is background, field, border, etc.

White is where data is entered.

Yellow is ALWAYS related to Humalog - "caution"!

Red is "hot stuff". If I am having a problem with something, I use the red background. For instance, yesterday - for my weekly "cheat" - I had a Dairy Queen "Blizzard". Obviously it screwed up my "numbers", so I typed in BLIZZARD AT 7PM and then used the red background.

TEXT COLORS

Violet is used in titles, "fixed" items, etc.

Blue is "comments" that I write to myself. A current one is "Raise Lantus to 55?" which is reminder me to think this through in a few days, based on prior Kelly's.

Red letters are is summaries -or- extensions of data.

Black is the data entry color. I put "estimated numbers" in light black and "actual" numbers in bold, but that is just a personal preference.

More later,

The Babe

Written by: BioBabe at 2005/09/22 - 18:48:10

=== Off topic post ===
Please read Dubious comments at this blog

Thanks.
Written by: Bill the diabetesdoc at 2005/09/22 - 19:40:51


"THE KELLY MODEL" #7

HUMALOG (and other short-acting insulins)

I will address only Humalog. One time when on Symlin I tried "R" for a few days and felt that it would not work for me, so I went back to Humalog.

Of the insulin choices of which I am aware, Humalog appears to be the "scariest" - it certainly is for me. The reason I have all Humalog info on Kelly in a yellow background is basically to say to myself "Hey stupid, pay attention - this is SERIOUS stuff now"!! Testing, Lantus, Symlin, pills, etc are important - but Humalog is in a class all by itself.

I try to have my blood sugar at 85 four hours after injecting Humalog. I did not arrive at this number quickly or easily. I "worked back to it" over time. As late as yesterday, after I cheated with a "Blizzard" at 7 pm, I decided not to take the calculated amount of Humalog - and awoke this morning with a glucose of 162. (A few months ago I had a night-time "hypo" event, caused by an error I made with Humalog, that almost sent me to the hosplital. I will accept high glucose if needed to avoid that situation).

Part #1 of my Humalog index (often called a "sliding scale").

My Lantus (long-acting insulin), Glucophage, and Symlin are "fixed" - I rarely change the dosages. My diet is fairly "fixed" as far as the calories that I eat each of 4 times a day. My Humalog doses are "keyed" to these 4 items being "fixed" - change one of them and my Humalog index must be adjusted also - which takes some serious attention!

SPECIAL NOTE - I still do not have a good way to figure the results of occasional exercise on my Humalog - I am working on that. "The exercise effect" drops my blood sugar and seems to occur about 4 hours after my evening meal - even if I exercised in the afternoon.

My current list of 20 Symlin per meal, a 1400 calorie diet, 50 units of Lantus at bedtime, and 1000 Glucophage twice a day works out to the following formula for my Humalog:

Blood test -minus- 85 -divided by- 10 -times- 1.5 That sounds a little "hairy" in writing , so here is an example: Just before my 3 pm lunch my blood sugar is a bit high at 118. 118 - 85 = 33. 33 divided by 10 is 3.3
3.3 times 1.5 = 5 units of Humalog.

This could easily be shown on a chart, but - being an engineer, and having all the baggage that goes with that - I just do it in my head.

I have used this formula up to a glucose of over 200 and it seems to work ok.

Part #2 of my Humalog index.

Have y'all heard about the "Dawn Phenomena"? What it means is that, after you get up in the morning, your liver "kicks" some glucose into your blood stream to help you get the day started. If you are trying to maintain "tight" glucose control, you have to factor this into your Humalog dosage.

I use Symlin and eat 4 times a day. Each 4 hour interval has it's own unique Humalog "add-on":

7am = 10 units of Humalog

11am = 0 units

3pm = 10 units

7pm = 3 units

THESE ARE MY "NUMBERS" - YOURS WILL BE DIFFERENT!!!

Part #1 -and- Part #2 are added together to determine my Humalog injection, which is done 4 times a day, generally right after I eat.

Does this sound complicated? Of course it does!! But I want the absolute best glucose control I can get, and this Humalog calc is what works for me!!

!! THIS IS THE END OF THE "KELLY MODEL" INTRUCTIONS !!

Please put any "Kelly" questions on this blog rather than the Symlin blog.

The Babe