My current Diary

I will upload my Diary every week so that other people can comment on it and see if there are any patterns i am missing.

I'm a firm believing in making someone work at it themselves so they gain an understanding, so what patterns are you seeing and what is it that you think you need to do next? Even if you don't know how to correct the pattern, being able to spot it is an important skill.

So what do you see?

Also what insulins are you on? I would guess your background is Levimir.

The one thing I will say before I hear your thoughts though is your corrections are to high. DAFNE says you should never give yourself a correction of more than 4, if you feel the need to give more than that then your ratios of background must be out.

I have not seen BGs so high before and so consistently high and even with high doses with insulin ! If I get a BG of 15.0 I think of it as really serious and try not repeat what gave rise to it climbing to 15. Often for me it is eating out in restaurants where I seem to always underestimate CPs. I am on Novorapid and split Lantus. I guess your insulin is different?

Observations:
There is not always a Bedtime BG test. Need to have good Bedtime BGs to establish BI level for good fasting BG in the morning. In my case with Novorapid which acts for 4-4.5 hours, i always make sure bedtime is 5 hours after dinner - it is hard but I have achieved so far (3 years into diabetes) and try to have my BG between 7 and 8. Guidelines say 6-8. If bedtime BG is high then next morning BG tends to be high. So I would say, try to get good bedtime BG for a couple of days by increasing evening meal ratio and then look at the BI and probably find it needs increasing. We are all different obviously as i only need 9 units of lantus a day (6 at 11pm and 3 at 11am) - It does look that the BI needs to be increased or probably split. The QA:CP ratios increases for lunch and dinner have helped but not enough. The Sunday 9pm high BG after no CPs for a while and good BG reading before does indicate that BI ran out. So need to concentrate on getting BI right first

Hello,

As Apollo says, knowing what types of insulin you are on would be very helpful.

I think there are enough bedtime tests in the diary, but unfortunately we can't actually use a bedtime test on these readings because there is always the need to correct at bedtime, so we can't tell what of the morning reading comes from the BI and what from the QA.

Faced with such a sea of red, my initial feeling is similar to SA2010 - that your BI is too low, but without the true bedtime tests, we can't actually tell - it might be that your QA ratios are too low.

Some of those CP readings are a bit strange - 93.5 and 92.1 CPs? That is almost a kilo of carbs... Are you sure about that?

If you can concentrate on getting your bedtime reading below 10, then we can look at bedtime tests. I would suggest if you get a bedtime reading of 10 or below, then don't correct, but test at 3 am, and again before breakfast and we can then see whether BI is correct or not.

If the 3 am test shows a large rise into the high teens or twenties, then do please do correct. DKA is not the goal :-)

Cheers,
Warwick.

I actually think the BI is about right.

Tuesday Bed to Wed Morning, no QA and less than 1 unit of variation
Wednesday Lunch, no QA or carbs 7 hours later there has has been only 1.5mmols change in BG

I did think you needed to split your BI based on Sunday but then I noticed that you took the Saturday BI at 18:00 rather than your normal 21:00-22:00 so the high on Sunday night would be because you were walking round for 3 hours with no insulin at all in your system, maybe even longer if you're on Levimir as that often doesn't do a full 24 hour cycle.

Assuming your thyroid function is normal then I'd go with one of two potential issues

1) your carb counting is off, to check this eat foods that come in packets with the carbs printed on the side, if necessary weigh the foods and see if this makes a difference.

2) you are a phantom snacker but have not documented your snacking. I won't say that's something we have all done at some point but I know I have, The great thing about DAFNE is you can snack if you really want to but you do need to address it if you are.


Also what are your activity levels, by which I mean do you tend to exert yourself about the same amount day to day or are there some days you will do a much higher or lower level of physical activity.

Leighton
If you're running consistently high, I hope you're testing for Ketones.