Can't figure out what I'm doing wrong

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Caimin DAFNE Graduate
St Vincent's Healthcare Group
4 posts
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Hi Folks -

I'm a recent DAFNE graduate, and prior to the week I was on 40 BI and roughly 30 QA per day, with not great control. My last HB1aC was 9.4%

For the week of DAFNE, I went to 22 BI and QA ratio of 1:1 and typically, while I was doing the course, my bloods were pretty good.
However in the last ten days or so, it feels like I've lost all control and I cannot see what I'm doing wrong. I've gone back up to 26 BI and 3:1 ratio and my bloods are constantly over 10. I wake with a BG of something like 13, take a correction of +4 NovoRapid and two hours later my bloods have gone up.

At the moment, I can only think of two possibilities: I've wrecked my insulin (I store it on the bottom shelf of the fridge) or I've coincidentally become super-resistant to insulin in the last two weeks. Just today, at 4pm I had BG of 12, took 15 QA out of frustration and two hours later my bloods had dropped by maybe 2.

If anyone can offer any advice, i'd be grateful. I feel like such a failure at the moment.

thanks,
Caimin

JayBee DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts

It is very puzzling to look at... try not to be disheartened though. Keep working at it.

Besides the one off good result during the day, your results do seem to be fairly consistent - I mean, looking at the last day (7/12), 10 - 12 is not that much difference. This suggests that you mainly need to put your BI up... but saying that, your 5/12 results are very strange.

With this...

How are you feeling? Have you been testing for ketones? There is also the possibly that illness could be affecting your insulin responses.
The common cold affected me recently so it's a thought that comes to mind. Sad

Hopefully a HCP will also reply to this thread... if not, best contact your DAFNE team for advice.

Caimin DAFNE Graduate
St Vincent's Healthcare Group
4 posts

thanks for the reply. I should have said that I'm testing for Ketones and not showing any. My main area of suspicion at the moment is that my insulin is inactive. When I finished the dafne course, I got all my insulin pens, put them in a clear plastic box and put them on the bottom of the fridge, in the salad drawer - my feeling now is that it's too cold for them there, and that it's made my QI ineffective, so the lantus is in effect doing all the work. I took 20 units of QI last night and it hardly affected my bloods at all.
I've thrown out all my existing pens and will replace them today.
I do appreciate the help, and apologise that my first post is a moany one - i'm quite chirpy normally Smile

JayBee DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts

I'm glad to hear there are no ketones. Smile No worries about being moany, even I would be when it comes to control loss! If you feel it might be linked to fridge temp and damaged insulin, keep an eye out for a small thermometer and put it in your fridge... Provides piece of mind! Besides that, I hope the insulin restock solves the issues you're having. Smile

Garry DAFNE Graduate
North Lincolnshire and Goole NHS Foundation Trust
328 posts

As you suggest, the cold drops to the bottom of the fridge and your insulin may be too cold.
I'm lucky. Our fridge has a covered tray right at the top of the door.
When I measured using our oven/meat cooking digital thermometer showed this area of the fridge at +2°C in summer.....but I must admit I have not checked it under current conditions!
I'll have a look tonight and post the outcome.
Regards
Garry

Caimin DAFNE Graduate
St Vincent's Healthcare Group
4 posts

Hi guys, just thought I'd give a very early update. It looks like things are better today, bloods at lunchtime were 5 and after carb free dinner were 7. I think possibly my n/r was compromised and the lantus was doing all the work. I'll come back in a day or so to confirm. Nice having the backup here, hope I can pay it forward soon.

maria51 DAFNE Graduate
Frankston Hospital (Peninsula Health), Victoria
22 posts

I'm on lantus and novarapid and store it in the middle compartment of the fridge door as per Dafne instructions. The information leaflet enclosed with both N/R & lantus say to store them between 2 - 8 celcius & not too near the freezer section or cooling element (where ever that is ). I agree with Garry that cold does drop to the bottom. Good to hear that your problem was resolved.

Caimin DAFNE Graduate
St Vincent's Healthcare Group
4 posts

thanks all. In retrospect, I think it was my Lantus dose - I've upped it to 30 and things seem to be grand now. I don't really understand why 22 was fine for the DAFNE week and it's gone up now, but the main thing is that things have resolved themselves. Is 8 units a big change? I'm not really used to adjusting doses, so maybe it's a minor thing, and I just think that an adjustment of 8 is a bigger deal than it is.

Garry DAFNE Graduate
North Lincolnshire and Goole NHS Foundation Trust
328 posts

Sorry it has taken me 4 days to get round to the promised fridge check.
The results of which sort of surprised me.
Please bear in mind that the digital oven thermometer used could hardly be considered calibrated and traceable to National Standards .... but with an ambient kitchen temperature of 23° C ... just finished cooking ... the temperature in my insulin storage area of the fridge had risen to + 7° C. Bottom of the fridge at this time was + 6° C ... a much lower variation than I expected to find Caimin. I had not bothered in the past to check temperature in the bottom of the fridge. Perhaps the fridge design is better than I expected. I have in the past physically noted the temperature variation across the fridge. So I think I turned down the fridge stat too much a few months ago and have hopefully adjusted it to a more suitable temperature now.
My thanks to you Caimin for getting me to check it out.
Regards
Garry