Help with adjustments post DAFNE

Hi everybody
I am new to the forum. I have had diabetes for 13 years and have never gained control. I am now trying to get excellent control as I hope to start a family as soon as possible. I am attending pre conception sessions at the hospital but appointments are quite far apart and each day is precious to me to try and get control. I completed the DAFNE course last week as a starting point of getting better control and since then my readings are a bit more stable but high. I find it very difficult to look at my own results and see patterns and where to make changes so I am hoping that you can all help me please. I have attached the last few days of my diary and would be very very grateful for any comments/suggestions.
Some info to note:
I am on Novorapid and Levemir (switched from Lantus to Levemir 1 week ago.)
Dafne nurses said that I am not to test between meals as temptation to correct highs but I do test sometimes when I am about to drive etc and they are going up to 18, I am really not happy about this. The nurses also seem to not want me to change the ratio of 1:1 for fast acting insulin but I am so tempted to just triple it! I really am desperate now and feel as if I am just wasting more and more time by trying to do things slowly.
Any help will be greatly appreciated.
If you need any further information to help please just ask me.

Many thanks x

Hi Sugarplum,
It looks as though you are doing corrections at ever meal and from what I remember from my DAFNE course it would suggest that your BI is too low as you are having to make corrections at every meal.
You could have a Carb free lunch or dinner and do a 3AM BG check as this will help show how your BI is working or not as the case may be
Going with the stepwise approach DAFNE recommends you wait for a pattern and do not make more than one change within a few days to allow you to see if things stabilise or a pattern emerges.
Would be interesting to see the rest of your results for this week.
I see you increased your BI on Wed from 12 to 14 but from looking at Thu BGs they are still high during the day (even after corrections), I would look at increasing your morning BI also.
How much QA and BI were you on before your DAFNE course?
I am on Novorapid and Lantus which I take once a day at night (22:00) and found I had to increase my dinner ratio as my BI was running out but given that you have split your Levemir this prob won't be the case for you. Also don't know much about Levemir.
I can totally understand your frustrations and need for urgency given you want to start a family and obviously need your BG to be as low as possible and stable.
Keep at it and always look for patterns, remembering when looking at your BG and Insulin, the event prior to the data you are looking at should help you identify where to start looking at changes (e.g. If your lunch BG is high or low look at the previous amount of Insulin you took - does this need adjusting?).
Cheers,
Anele.

Hi Anele
Thank you for your reply.
That’s what I am finding hard to grasp about the BI, it is so tempting to just up my QA like I always have. This morning my reading was 6.7, my only one in target this week.
I think I will try the carb free lunch today and 3am check, thanks for reminding me of this.
I was going to increase my morning BI today but I forgot, I will do that tomorrow.
Before DAFNE I was taking 26 Lantus at 9pm and Novorapid varied, I was doing a rough estimate of approx 2.5:1 and 3:1 ratio but my last HBA1c was 9.3 so that wasn’t working either.
I feel as if I am not allowed to change my ratio, at what point can I decide it’s that and not the BI?
I was so confident when I finished the course and now I seem to be swamped with it all and can’t remember anything!
I have been advised to get 3 months in target HBA1c results before conception and it feels like the starting posts are moving every day.

Hi Sugarplum,
Well done with your 6.7 this morn
I have only been a diabetic for a year and a half so my body is still producing BI as I am only on 7U of BI (Lantus) at night.
The fact that you're having to correct at every meal would make me think it is your BI that is insufficient.
Once you start getting lower BGs then I would look at your QA ratios.
My BGs before bed (and taking ny BI) were creeping up to >10 when they were never as high as that when I was on Humulin M3 twice a day (but again I was and still am a little, in my "Honeymoon phase". As it was only my before bed BGs that were high (lunch I tend to be low) led me to assume that my BI is fine and it is just running out as it gets to close to the 24 hrs. I have confirmed this by having carb free dinners and lunches and they show my BI is ok (at the moment!).
That's what led me to up my dinner QA ratio as the rest of mt BGs are mostly on target.
I would be intrested to hear what other DAFNE graduates and HCPs thoughts are on your stata as I am fairly new to diabetes unlike yourself with 13 years experience.
Will be interesting to see what happens the rest of today and once you up your morning BI.
Good luck!
Anele x

I like the way we are able to help one another.
Seems to me that you have been given good advice about your BI probably being at the root of your current control.
Please bear in mind that BI changes though - for the vast majority us anyway – normally take 3 days to show any result.
These types of insulins have a long term impact on our physiology and I know it’s difficult when you want to see an immediate improvement - but you must have good control of the changes - or you will never be able to understand what is happening. Our bodies are not machines....and slow change helps us better understand the results of improved background control.
So please do it the DAFNE way. Slow and controlled. Only changing one thing at a time and waiting for results to help you move in the right direction.
If you are confident enough, continue posting your results and I like to think that there are many type 1 diabetics, with long term first person experience with your insulin combination, that can offer support.

Regards
Garry

I'm not sure I agree that the BI is the first thing to change...

Looking at your results you are 'reasonably' stable with your BG readings...although obviously you would want to be stable between approx 4 and 7. But you are stable (roughly) between 10-14. I would say that if you're fairly level throughout the day then your BI might be ok, and once you should work on getting one result down to the DAFNE target range. Then your current BI should keep you there.

I'd pick one of your meals (breakfast maybe) and look at that. You always correct there so the 1:1 ratio needs adjusting in my opinion. If you look at the correction you take most of the time you are close to a 1.5:1 ratio, so I'd just change your ratio to that. That seem to keep you level for the lunch BG test, so maybe you should correct more with the breakfast QA, slowly though so you don't drop too much.

Try to get the breakfast dose of QA right and if you come into target for lunch then you might stay in target following that maybe.

Am I on completely the wrong track here? I thought DAFNE said to look at where there is a pattern in corrections being taken and work on those. To me, the fact you are fairly stable (although high) throughout the day suggests the BI might be ok.

Does anyone agree or have i confused myself and got it wrong??

I would agree to the 1.5:1 Ratio

Karl