Help with BI - DAFNE Online

January 31, 2016 17:00

derekh1965 DAFNE Graduate
NHS Lothian 90 posts

[Shared diary only visible when logged in]

Hi
I am strugglig with my BI dosage.
I take levermir and when calculating I am using the formula for calculatig the total insulin dose, 0.5 x weight in kilos and I weigh 77k = 38/ /2 = 19 total BI. So I inject half or less upon waking and the rest in the evening. But I always wake up high no matter what time I inject my evening BI. I hope I am correct in my calculating if not please correct me.
As you see from my diary There are a lot of high sugars although my HBA1C has been excellent for the past year according to the HCP.

January 31, 2016 18:47

alturn DAFNE Graduate
NHS Grampian 78 posts

I would suggest not calculating your BI. It may take a while, but try to find the number of units to keep you stable, and one of the DSNs suggested minimising difference between am and pm units. After a BI change, don't alter it for a while (I try 3 days). QA should be calculated for meals and corrections. You may need to correct until BI is correct. May also need to try fasting (no carbs) to get BI correct.

The formula (Weight * 0.5) is a rough guide to your total (QA + BI) per day, so your range would be 38 up to about 60 (based on DAFNE manual). Assuming 38, about 1/2 is BI so maybe try 10 am and 10 pm.

For comparison, I weigh 65Kg and currently take 11 Levemir am and pm and about 12 Novorapid so I am nowhere near 50/50 BI/QA.

Hope this helps.

January 31, 2016 20:41

derekh1965 DAFNE Graduate
NHS Lothian 90 posts

hi alturn
thanks for your reply and help. I will try your suggestion and take my BI at 10:30 tonight and then 10:30 tomorrow morning. I took 8 units BI this morning and will take 12 this evening, giving a total of 20 units.
Hope my BS isn't high tomorrow..
Iwill post my results in a couple of days.
Derek

February 01, 2016 03:04

Warwick DAFNE Graduate
Diabetes Australia-Vic, Melbourne, Victoria 422 posts

Hi Derek,

Follow the DAFNE principles for changing BI and see how that helps. Only increase by 1 unit or 10% of the dose given. Wait three days before making any further changes. If it leads to hypos, then cut the dose back.

In practise, I think it may depend a bit on the type of basal insulin. When I was on Levemir, I found that changes were very quick to filter through and I didn't need to worry about the three day principal. With Lantus which I am on at the moment though, changes can easily take three days before any noticeable changes are visible.

Also, hypos may occur as a result of a QA dose, so I try and work out whether a hypo could be because of my QA before I change my BI dosing.

I wouldn't rely on a formula to work out your BI dose. It's works to get a starting value, but my BI doses change all year around. This time last year, I was on 6 in the morning and 6 at night. Now I am on 10 in the morning and 12 at night. Who knows where I will be in a couple of months :-)

All the best with it.
Warwick.

January 31, 2016 17:00 derekh1965 DAFNE Graduate NHS Lothian 90 posts	[Shared diary only visible when logged in] Hi I am strugglig with my BI dosage. I take levermir and when calculating I am using the formula for calculatig the total insulin dose, 0.5 x weight in kilos and I weigh 77k = 38/ /2 = 19 total BI. So I inject half or less upon waking and the rest in the evening. But I always wake up high no matter what time I inject my evening BI. I hope I am correct in my calculating if not please correct me. As you see from my diary There are a lot of high sugars although my HBA1C has been excellent for the past year according to the HCP.
January 31, 2016 18:47 alturn DAFNE Graduate NHS Grampian 78 posts	I would suggest not calculating your BI. It may take a while, but try to find the number of units to keep you stable, and one of the DSNs suggested minimising difference between am and pm units. After a BI change, don't alter it for a while (I try 3 days). QA should be calculated for meals and corrections. You may need to correct until BI is correct. May also need to try fasting (no carbs) to get BI correct. The formula (Weight * 0.5) is a rough guide to your total (QA + BI) per day, so your range would be 38 up to about 60 (based on DAFNE manual). Assuming 38, about 1/2 is BI so maybe try 10 am and 10 pm. For comparison, I weigh 65Kg and currently take 11 Levemir am and pm and about 12 Novorapid so I am nowhere near 50/50 BI/QA. Hope this helps.
January 31, 2016 20:41 derekh1965 DAFNE Graduate NHS Lothian 90 posts	hi alturn thanks for your reply and help. I will try your suggestion and take my BI at 10:30 tonight and then 10:30 tomorrow morning. I took 8 units BI this morning and will take 12 this evening, giving a total of 20 units. Hope my BS isn't high tomorrow.. Iwill post my results in a couple of days. Derek
February 01, 2016 03:04 Warwick DAFNE Graduate Diabetes Australia-Vic, Melbourne, Victoria 422 posts	Hi Derek, Follow the DAFNE principles for changing BI and see how that helps. Only increase by 1 unit or 10% of the dose given. Wait three days before making any further changes. If it leads to hypos, then cut the dose back. In practise, I think it may depend a bit on the type of basal insulin. When I was on Levemir, I found that changes were very quick to filter through and I didn't need to worry about the three day principal. With Lantus which I am on at the moment though, changes can easily take three days before any noticeable changes are visible. Also, hypos may occur as a result of a QA dose, so I try and work out whether a hypo could be because of my QA before I change my BI dosing. I wouldn't rely on a formula to work out your BI dose. It's works to get a starting value, but my BI doses change all year around. This time last year, I was on 6 in the morning and 6 at night. Now I am on 10 in the morning and 12 at night. Who knows where I will be in a couple of months :-) All the best with it. Warwick.