JayBee
DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts
|
vic, L has taken a look at your 20th and 21st September BG diary entries.
First off, he wants to emphasise that it is a very small sample for him to work with but he'll do the best he can (he's used to staring at least a few week's worth of BG results with me lol).
He does have a suggestion:
19BI
with meal ratios (QA:CP):
Breakfast: 1:1
Lunch: 1:1
Dinner: 1.5:1
Have you tried this arrangement before or anything similar?
If you have, how did it work out at the time? Can you show any results?
Don't panic if you can't find any. It's good that you've gone back to 18BI for now.. if it needs raising, we'll get to that when it's safe to. 
Edit: I'm going to leave my results for a few days before posting again. Have a nice weekend all!
|
novorapidboi26
DAFNE Graduate
NHS Lanarkshire
1,819 posts
|
wow that's a lot of hypos, at least one a day, how are the hypo warning symptoms, still strong....?
You mentioned your Lantus holding well, when? There is no evidence of it that I can see...
changing ratios and BI on a day to day basis is obviously not the way its meant to be done but I realize its a daily battle and hard, especially when you are having lots of hypos.... 
|
JayBee
DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts
|
novorapidboi26 said:
You mentioned your Lantus holding well, when? There is no evidence of it that I can see...
changing ratios and BI on a day to day basis is obviously not the way its meant to be done but I realize its a daily battle and hard, especially when you are having lots of hypos....
Agreed. I can't see any evidence either because the 48 hours rule is still not being applied, or any carb free meal, or over night checking.
My PM to vic yesterday:
After looking at the most recent 3-4 days worth of results, L thinks your best bet first is to put your evening meal ratio down because the hypos are consistent after that particular meal. He asks for you to put it to 1:1 for dinner and we'll look at your results again in the next few days.
On this note, please try to keep the same ratios for other meals to help with the pattern searching (based on the ratio shuffling around so far, round the breakfast ratio and the lunchtime ratio down to 0.5:1 while we're working stuff out with you).
So at a glance, look at following this arrangement for the next few days:
18BI
Breakfast and lunch: 0.5:1
Dinner: 1:1
With 48 hour rule still not being applied, I will withdraw from advising vic any further until it does start getting applied properly. It's plain as day that changing so frequently is not helping anyone.
Ball is in your court, vic.
|
novorapidboi26
DAFNE Graduate
NHS Lanarkshire
1,819 posts
|
from the diary visible above, its only the 25th that is there, out of the 2 dates you have given.......
even still that particular date doesn't show anything with regards to your dose of 18 being correct.
1. you had a hypo at 3 am which would suggest the 18 BI is too much, or the supper ratio isn't right.
2. you took 4 units correction at 21:08pm, what was you BG after this dose expired [4-5hours, 2:10am]?, not long after that time you took your 3:15am test and you were low! was this down to the 4 units correction ie. too sensitive, or was it your 18BI?
All explorable avenues in determining your 3:15 am hypo........
that's your problem at this stage, too many variables.....
you really want to pin down your overnight BI needs, so that means no QA insulin or carbs working in your system at the time of the pre bed blood sugar....repeat that 2-3 times......I apologize if you know this and have done this test....
having the carb free meal is OK though, needs to be repeated though to confirm a dose change, so once is not enough....
the thing about the carb free meal though is that it can only tell you what you daytime BI need might be, not your overnight need, which for most is significantly different from the day.....so you need to consider each portion of the day separately, which is a nuisance I know as your only on one dose of BI, but you could split it if your testing shows you need more in the AM than PM and vice versa.........
it makes managing the AM/PM much easier.......
|
JayBee
DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts
|
Let's see what the break down is...
vic demain said:
Lantus has been 18 for the past week and more.
This is good.
Carb free dinner 21/09/12.
You were testing 20BI then. You now need to check on 18BI.
Overnight check25/09/12.
I cannot see this entry (a 3am check, right?) on the BG diary. Was it deleted?
Warning symptoms are still good somehow.
When I was still fluctuating with my doses a while back, my symptoms were not weakened either. I think this is because on average we've still been around 8-9BG so our body manages to keep them, thank goodness.
Don't know where your pm went JWo as I haven't received one for 10 days or more.
I can send again if you like. They're both responses to your most recent message regarding this thread, subject: Ratios.
Been constant on 0.8:1, 0.6:1, 1.5:1 & 18 for a while, as said before weekends have to be different.
Feel like a naughty schoolboy 
I hate to break it to you vic but that is not consistent - it completely undermines the DAFNE rules, especially the 48 hour one. You should not have to adjust stuff that much. It's making your life harder needlessly.
What do you do during the day for those changes to even be considered? I did ask about exercise and stress in my PM too which I'll post here:
Sad to see that you have been suffering with hypos a lot the past few days.
I know it's difficult but try not to adjust any of your meal ratios unless it's been 48 hours - changing them every day will confuse patterns.
If you can also (you've been quite good the past few days probably because of hypos), try to minimise your corrections or be extra cautious with corrections. When you make the decision to correct, what do you expect 1QA to drop your BG by? Knowing this may help L with his workings.
I understand that things may change when you're at work but this may be due to a less obvious cause - how much exercise do you do at work for example? Would applying the DAFNE exercise rules perhaps work out better than making solid adjustments for meal ratios? Exercise rules are here for reference:
If 45 minutes of exercise: http://www.dafneonline.co.uk/hbook_topics/192
If you want to apply insulin adjustment for longer term exercise: http://www.dafneonline.co.uk/hbook_topics/193 -- Note on this page: For Lantus users you may need to focus on reducing QA and/or eating more CP's rather than reducing BI. You may wish to consider a twice daily BI, for example Isophane or Levemir.
Exercise can be a funny topic for us so feel free to bounce ideas or thoughts - especially if you don't think it's exercise. It may be stress, or (more hopefully) a dose puzzle waiting to be solved.
We need to get those hypos under control first especially considering their vicious frequency. As you saw from my BG diary, me hypoing during the night was making me high through the morning. Lord knows how long I'd been hypoing for during the night but it's a definite trouble maker for levels. 
L will look more into your BG diary today and try to give you a new suggested arrangement later today (he needs time to study the patterns and the doses taken, then to have a think). Hopefully before 10pm in time for your next BI dose.
The suggested arrangement was the one I posted earlier:
18BI
Breakfast and lunch: 0.5:1
Dinner: 1:1
|
JayBee
DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts
|
vic demain said:
Should I be taking like 1:1 across the day to be considered consistant?
(Let's not be specific to 1:1 because that is only the suggested starting point of DAFNE)
This rule of consistency applies for ANY RATIO you try after looking for patterns. What ratios you need are personal to you so you need to find them out.
If you didn't change the meal ratio (or in your case every meal ratio) the every day then yes, you would then be being consistent - you are pattern searching after all. You need consistency to see patterns and your body needs a minimum of 48 hours to tell you what it needs through monitoring.
Does this make sense? I'm getting the impression you're confused about how DAFNE works which is a bit worrying.
03:15 shows on the 26th.
26/09? The latest entry I can see on that day is 21:45.
I work in a very active job where I can walk over 12 miles a day and involve heavy lifting etc. Don't suffer from stress.
Why are you not applying DAFNE exercise rules if that is the case?
Edit:
If you need to know what the exercise rules are, they're here (re-posting):
If 45 minutes of exercise: http://www.dafneonline.co.uk/hbook_topics/192
If you want to apply insulin adjustment for longer term exercise: http://www.dafneonline.co.uk/hbook_topics/193 -- Note on this page: For Lantus users you may need to focus on reducing QA and/or eating more CP's rather than reducing BI. You may wish to consider a twice daily BI, for example Isophane or Levemir.
When it says reducing QA, it means minus-ing off your meal total dose, not outright adjusting a meal ratio.
eg, say you ate 5CPs and you were on 1:1 meal ratio and then you decided you would do Prolonged/intense - up to 4 hours.
Looking at the DAFNE exercise rules, this usually asks for 30% - 50% decrease before exercise so in this example:
Say in this case, your BGs were about 4.5... consider the 50% in light of this BG... so...
5QA - 50% = 2.5QA.
2.5QA is what you'd take for your food and your body being exercised will do the rest to keep your BGs okay. If you don't exercise tomorrow, then in this case, you'd go back to 1:1 as normal.
Whatever your basic needs (which at the moment we're trying to work out), you will need to work out your requirements for the exercise and minus off what you need and your meal ratios will stay the same because the exercise rules are short term adjustments. Also keep in mind that exercise, especially prolonged, can effect your sugar levels for over 24 hours afterwards so be wary of hypos and be careful of corrections (this is because exercise temporarily increases insulin sensitivity).
|
JayBee
DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts
|
I'm only reading and drawing conclusions from the BG diary results in front of me.
It was not my intention to make you feel like an idiot. Sorry.
As requested and promised, I will leave your situation completely alone now.
|