Help...AWOL bm's

My bm's were at a pretty stable high last week whilst on DAFNE. For the last 3 days of eating and exercising normally my bm' are on a sea saw. Hypo one minute, high sugars the next. It's making me feel unwell.
Is this just my bm's settling? I'm doing everything as directed and am using the DAFNE app to work out my insulin doses.

Any ideas? Cheers

Hello Sharon,

Are you able to share some of your diary with this thread? It will make it easier to assist.

Thank,s
Warwick.

Here they are....

Hello Sharon,

Are you sure that this is correct? The reason I ask is that basal insulin usually doesn't change from day to day unless there is a special reason for it to do so, but from your diary, you took no BI on Thursday, 27+27=54 units on Friday, none on Saturday, 27 units on Sunday, 22-8=14 units on Monday.

If you can have your BI intake much the same from day to day, then it will certainly help with identifying patterns.

Also, if you can post what types of QA and BI insulin you are on, then that helps in working out how long each are likely to be active for in your body.

Thanks,
Warwick.

Sorry, think that is my error with the app....I'm on 27u lantus at night and humalog QA.

OK. Thanks for that. On Saturday at 12.07, you are 16.8. 1 hour later, you have a hypo, but according to the diary you should have almost no QA in your body as the 9 am dose will have been used up.

I note that the 1207 entry is before exercise though. Can I ask what the exercise was? I'm curious to know what would drop your BGs so quickly and so far without any QA being present.

In general, with the DAFNE approach, we aim to get your BI correct, before looking at the QA. The easiest way to do that is to check your before-bed readings with your before breakfast readings. If they differ by more than 1.5, then that tends to indicate that the BI needs changing.

Unfortunately, based on your readings so far, we can't do that as your before bed readings are high, and you then need to correct them with QA which negates the BI overnight test.

There are a couple of possibilities as to why your before bed readings are high. First, it may be that your dinner QA ratio is too low and you need to increase it. The second possibility is that your Lantus runs out before the full 24-hour period.

I found this myself when I was on Lantus. My readings would peak before bed, but increasing dinner QA would cause a hypo shortly after dinner. Switching to injecting Lantus twice a day solved the issue for me.

I suggest looking at slightly increasing your dinner ratio from 1.5:1 to 2:1. Then run a check of your BGs about 90 minutes after dinner to check that you are not dropping too low.

Doing this will either cause you to hypo after dinner, or reach bed time with good BGs (hopefully the latter). If you start getting good BGs at bed time, then we can start looking at whether your BI is at an appropriate level.

If you start having hypos after dinner, then we can look at dropping the QA dinner ratio back to what it is now and increase the BI instead, and how to split the dose so that it lasts the full 24 hours.

Cheers,
Warwick.

well i have discussed my results with my health care professionals, who think it is due to me being overly sensitive to activity (your point of how can sugars drop so low with no QA present).... i have only done mild exercise- walking for example. i do however also have insulin resistance, so could well be a combo of insulin resistance and insulin sensitivity during mild exercise. Who would have thought it could be that complicated?
I am continuing to monitor for another week- reducing my insulin ratios to avoid the hypos, and if this is still the case next week it is being suggested that i look into the insulin pump!

Cool. DAFNE tends to help, but it doesn't work for everyone, and sometimes a pump is the best way of managing type 1. I recommend trying to get your BG management under the best control possible, because it will help when and if you go on a pump.

Take care,
Warwick.