morning highs - DAFNE Online

August 30, 2012 13:36

Phil Maskell DAFNE Graduate
Nottingham University Hospitals NHS Trust 194 posts

sjohno said:
susieq - do you take QA for the omelette, bacon and salad?

Unfortunately for me I have to take QA for all non carb foods......if I have an omelette with bacon, mushrooms and tomatoes at lunchtime this for me is 3CP, I am on a 1:1.5 ration so I take 6QA for that omelette. I can eat chicken with salad and still have to take QA

For 3CP to 6QA isn't that a ratio of 2:1? 1:1.5 on 3CP would be 2QA?

Just don't want to confuse things (any more than sorting this lot out) Wink

August 30, 2012 13:39

Phil Maskell DAFNE Graduate
Nottingham University Hospitals NHS Trust 194 posts

sjohno said:
Since taking the DAFNE course in November 2009 my HbA1c tests have been 6.8,6.1, 6.2,6.2, 6.1.

I have had T1 for 33 years and DAFNE is the best thing that has happened, it's been a bit of a bumpy learning process but I believe I have a good handle on it now

Nice, even with DAFNE I am more 7 than 6 Mad

August 30, 2012 14:53

susieq DAFNE Graduate
Northamptonshire Healthcare NHS Foundation Trust 19 posts

Sounds like I should be happy with what Ive got....My HbA1c is 7.3 and it's just the morning highs that bug me. I correct at breakfast and the rest of the day is ok. some lows when I am walking or shopping/housework etc. but then I have an excuse to have a biscuit lol. I am happy to read that you think I might be beating myself up about it. I reckon you're right. I worry toooooo much. I suppose 10.7 isn't way too off the scale to not be able to live with it.

I don't want a pump, and I don't really want to go without my usual food. so perhaps this is what it's gonna be... and I certainly don't want to wake up at 3am to inject!!!!!! Mad

Option 2 then. Smile

DAFNE was good, I loved the week, and it did give me confidence to tweak around and not be scared of what I was doing. don't get me wrong. they were great. I suppose I did expect too much in the fact that I wanted to be able to stick at one bi dose and be satisfied that my overnight levels would be stable. But asking that of the dreaded diabetes is asking for pigs to fly!

August 31, 2012 08:31

Carolin
Sheffield Teaching Hospitals 83 posts

sjohno said:
susieq - do you take QA for the omelette, bacon and salad?

Unfortunately for me I have to take QA for all non carb foods......if I have an omelette with bacon, mushrooms and tomatoes at lunchtime this for me is 3CP, I am on a 1:1.5 ration so I take 6QA for that omelette. I can eat chicken with salad and still have to take QA

Just a little word of warning for other DAFNE grad's. There is essentially NO carbohydrate in this meal so we wouldn't advise people to count as CPs or inject QA as there is a very high risk of hypos; however clearly with experience and understanding your own diabetes and response to different foods you will leanr exactly what you need.

Often if you find you are needing QA even if not eating carbs it can be an indication of BI not being high enough.

Keep it up! Smile

Carolin

August 31, 2012 09:25

susieq DAFNE Graduate
Northamptonshire Healthcare NHS Foundation Trust 19 posts

No Carolin, I don't take any CP's for non carb foods, which is great. after my meal I was a pleasant 7.7 before bed, then overnight it rises to 10.7 in the morning, but I am just going to live with it. I've raised my bi and it's now a good week since I did that and it's still 9.9 this morning, so, perhaps it's my lot. daytime levels are good, I just wondered WHY it rises and you can never get a pleasant wake-up reading. But if that's the lease of my worries, then I'll live with it. as Phil says, I'll take option 2. ! Smile

August 31, 2012 09:50

Carolin
Sheffield Teaching Hospitals 83 posts

Hi Susieq,

Others who have responded are correct about the Dawn Phenomenon; it's a natural release of hormones (particularly growth hormone) in the early hours of the morning as you wake up that causes your liver to release glucose into your blood stream. If there isn't enough insulin (BI) around at this time your BG will start to rise.

The best way of trying to control this is:
1. take your evening BI as late as possible (bedtime) so it's still got a reasonable level of action by morning time
2. increase the dose of your bedtime BI, but ALWAYS check your 3am BG before and after making increases to BI to ensure you're not dipping too low there (you should be above 4.5mmol/l). If you do start to have night-time hypos, you will need to cut back on your BI again.

Some people just never manage to control morning BG, however if all other BGs and HbA1c is good then it's best to just live with it as you say.

Good luck,

Carolin

August 31, 2012 09:51

Phil Maskell DAFNE Graduate
Nottingham University Hospitals NHS Trust 194 posts

susieq said:
No Carolin, I don't take any CP's for non carb foods, which is great. after my meal I was a pleasant 7.7 before bed, then overnight it rises to 10.7 in the morning, but I am just going to live with it. I've raised my bi and it's now a good week since I did that and it's still 9.9 this morning, so, perhaps it's my lot. daytime levels are good, I just wondered WHY it rises and you can never get a pleasant wake-up reading. But if that's the lease of my worries, then I'll live with it. as Phil says, I'll take option 2. !

Do you not fancy option 1 ? 4am injection sounds sooo appealing

Phil

August 31, 2012 10:17

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

If you have the confidence, lift your BI another 2 u and follow progress over the next few days and along with the dreaded 03:00 BG checks see what happens.
No improvement and good 03:00s - add another 2 u.
Wait a few days and see how you go. Once you get it right you may find that BG is within 1 mmol of your before bed result. Things will change over 28 days though.
Regards
Garry

August 31, 2012 10:56

DianeW DAFNE Graduate
South West Essex PCT 115 posts

Although obviously a good thing to eat less carbs/smaller portions at dinner, if you cover the carbs with the right amount of QA then bedtime reading should be ok and it follows if BI is correct then your morning reading shouldn't be that different from your bedtime reading. I had this problem and have had my Lantus split into morning and bedtime, but I find if you don't get the bedtime reading right then no amount of splitting seems to help....I presume you're not going hypo in the night which would make it high in morning?

August 31, 2012 13:23

susieq DAFNE Graduate
Northamptonshire Healthcare NHS Foundation Trust 19 posts

Hmmm, Phil, It does sound appealing, but I'll just have to resist !!! (the 3am jab!) LOL

DianeW I don't have night time hypo's no, I'm just 2yrs into this Diabetes!! and I'm sure with a little tweaking and a little help from you all I'll finally come to a reasonable - able to live with level. I tried adding another 2u of bi, but then was hypo'ing at 3am so back down it went, and back up the morning levels went.
onwards we go.... Rolling Eyes

August 30, 2012 13:36 Phil Maskell DAFNE Graduate Nottingham University Hospitals NHS Trust 194 posts	sjohno said: susieq - do you take QA for the omelette, bacon and salad? Unfortunately for me I have to take QA for all non carb foods......if I have an omelette with bacon, mushrooms and tomatoes at lunchtime this for me is 3CP, I am on a 1:1.5 ration so I take 6QA for that omelette. I can eat chicken with salad and still have to take QA For 3CP to 6QA isn't that a ratio of 2:1? 1:1.5 on 3CP would be 2QA? Just don't want to confuse things (any more than sorting this lot out)
August 30, 2012 13:39 Phil Maskell DAFNE Graduate Nottingham University Hospitals NHS Trust 194 posts	sjohno said: Since taking the DAFNE course in November 2009 my HbA1c tests have been 6.8,6.1, 6.2,6.2, 6.1. I have had T1 for 33 years and DAFNE is the best thing that has happened, it's been a bit of a bumpy learning process but I believe I have a good handle on it now Nice, even with DAFNE I am more 7 than 6
August 30, 2012 14:53 susieq DAFNE Graduate Northamptonshire Healthcare NHS Foundation Trust 19 posts	Sounds like I should be happy with what Ive got....My HbA1c is 7.3 and it's just the morning highs that bug me. I correct at breakfast and the rest of the day is ok. some lows when I am walking or shopping/housework etc. but then I have an excuse to have a biscuit lol. I am happy to read that you think I might be beating myself up about it. I reckon you're right. I worry toooooo much. I suppose 10.7 isn't way too off the scale to not be able to live with it. I don't want a pump, and I don't really want to go without my usual food. so perhaps this is what it's gonna be... and I certainly don't want to wake up at 3am to inject!!!!!! Option 2 then. DAFNE was good, I loved the week, and it did give me confidence to tweak around and not be scared of what I was doing. don't get me wrong. they were great. I suppose I did expect too much in the fact that I wanted to be able to stick at one bi dose and be satisfied that my overnight levels would be stable. But asking that of the dreaded diabetes is asking for pigs to fly!
August 31, 2012 08:31 Carolin Sheffield Teaching Hospitals 83 posts	sjohno said: susieq - do you take QA for the omelette, bacon and salad? Unfortunately for me I have to take QA for all non carb foods......if I have an omelette with bacon, mushrooms and tomatoes at lunchtime this for me is 3CP, I am on a 1:1.5 ration so I take 6QA for that omelette. I can eat chicken with salad and still have to take QA Just a little word of warning for other DAFNE grad's. There is essentially NO carbohydrate in this meal so we wouldn't advise people to count as CPs or inject QA as there is a very high risk of hypos; however clearly with experience and understanding your own diabetes and response to different foods you will leanr exactly what you need. Often if you find you are needing QA even if not eating carbs it can be an indication of BI not being high enough. Keep it up! Carolin
August 31, 2012 09:25 susieq DAFNE Graduate Northamptonshire Healthcare NHS Foundation Trust 19 posts	No Carolin, I don't take any CP's for non carb foods, which is great. after my meal I was a pleasant 7.7 before bed, then overnight it rises to 10.7 in the morning, but I am just going to live with it. I've raised my bi and it's now a good week since I did that and it's still 9.9 this morning, so, perhaps it's my lot. daytime levels are good, I just wondered WHY it rises and you can never get a pleasant wake-up reading. But if that's the lease of my worries, then I'll live with it. as Phil says, I'll take option 2. !
August 31, 2012 09:50 Carolin Sheffield Teaching Hospitals 83 posts	Hi Susieq, Others who have responded are correct about the Dawn Phenomenon; it's a natural release of hormones (particularly growth hormone) in the early hours of the morning as you wake up that causes your liver to release glucose into your blood stream. If there isn't enough insulin (BI) around at this time your BG will start to rise. The best way of trying to control this is: 1. take your evening BI as late as possible (bedtime) so it's still got a reasonable level of action by morning time 2. increase the dose of your bedtime BI, but ALWAYS check your 3am BG before and after making increases to BI to ensure you're not dipping too low there (you should be above 4.5mmol/l). If you do start to have night-time hypos, you will need to cut back on your BI again. Some people just never manage to control morning BG, however if all other BGs and HbA1c is good then it's best to just live with it as you say. Good luck, Carolin
August 31, 2012 09:51 Phil Maskell DAFNE Graduate Nottingham University Hospitals NHS Trust 194 posts	susieq said: No Carolin, I don't take any CP's for non carb foods, which is great. after my meal I was a pleasant 7.7 before bed, then overnight it rises to 10.7 in the morning, but I am just going to live with it. I've raised my bi and it's now a good week since I did that and it's still 9.9 this morning, so, perhaps it's my lot. daytime levels are good, I just wondered WHY it rises and you can never get a pleasant wake-up reading. But if that's the lease of my worries, then I'll live with it. as Phil says, I'll take option 2. ! Do you not fancy option 1 ? 4am injection sounds sooo appealing Phil
August 31, 2012 10:17 Garry DAFNE Graduate North Lincolnshire and Goole NHS Foundation Trust 328 posts	If you have the confidence, lift your BI another 2 u and follow progress over the next few days and along with the dreaded 03:00 BG checks see what happens. No improvement and good 03:00s - add another 2 u. Wait a few days and see how you go. Once you get it right you may find that BG is within 1 mmol of your before bed result. Things will change over 28 days though. Regards Garry
August 31, 2012 10:56 DianeW DAFNE Graduate South West Essex PCT 115 posts	Although obviously a good thing to eat less carbs/smaller portions at dinner, if you cover the carbs with the right amount of QA then bedtime reading should be ok and it follows if BI is correct then your morning reading shouldn't be that different from your bedtime reading. I had this problem and have had my Lantus split into morning and bedtime, but I find if you don't get the bedtime reading right then no amount of splitting seems to help....I presume you're not going hypo in the night which would make it high in morning?
August 31, 2012 13:23 susieq DAFNE Graduate Northamptonshire Healthcare NHS Foundation Trust 19 posts	Hmmm, Phil, It does sound appealing, but I'll just have to resist !!! (the 3am jab!) LOL DianeW I don't have night time hypo's no, I'm just 2yrs into this Diabetes!! and I'm sure with a little tweaking and a little help from you all I'll finally come to a reasonable - able to live with level. I tried adding another 2u of bi, but then was hypo'ing at 3am so back down it went, and back up the morning levels went. onwards we go....