Whats happening?

Hi there - an update for you all... am now on Levemir 25u am & pm...
Ratios 3:1 Breakfast; Lunch 3:1; Dinner 2.5:1
Corrections are higher than DAFNE rules as insulin resistant.

And its not working - I am stable throughout the day but start at 11.2-14.8 mmols most mornings so stay above 10 most of the day...

My DSN seems to take ages to get back to me; then suggests basal as the problem... I am now on more than pre-DAFNE and gaining weight...

I cannot cope with a low carb diet - and am trying so hard... :-(

Blood Sugar Diary
Time 800 1200 1700 2100
Date CP
01/02/2011 BG 13.6 11.2 8.2 11.2
QA 18+4 12+2 8 4+2
BI 25 25
Time
Date CP
02/02/2011 BG 13.4 12.8 8.4 12.4
QA 18+4 12+2 12 5+2
BI 25 25
Time
Date CP
03/02/2011 BG 12.7 13.6 11.3 5.1
QA 18+4 12+4 12+2 6
BI 25 25
Time
Date CP
04/04/2011 BG 11.5 13.8 18.6 7.4
QA 18+2 9+4 6+10 8
BI 25 25
Time
Date CP
05/02/2011 BG 11.2 10.2 9.9 10.2
QA 18+2 9+2 8.5 +2 5+2
BI 25 25
Time
Date CP
06/02/2011 BG 14.6 12.8 11.1 10.8
QA 9+6 15+2 6+2 2+2
BI 25 25

Sorry its not on DAFNE sheet x

Thanks

The DAFNE Online diary is so easy to keep. Why not try it?
Without any CP values it's hard to offer any advice. Note your ratios given, but have to admit that I change ratios up and down after establishing a repeating pattern over 2 or 3 days.
How do you feel? Have you any signs of infection?
Like you I am on high ratios but generally manage to keep things under control - except two days before getting a minor infection such as a cold when my insulin resistance seems to change gear!
Following a routine visit last week to my Db clinic, have just started Metformin to try help reduce ratios but no change yet after 6 days. I'll just take it steady and see what happens.
Stick with it and hopefully someone will be able to offer some good advice.

Regards Garry

Hey there, its not nice when we lose track of whats going on, its happened to me a few times......

Just go back to basics, you have made a significant change recently, that being your split background dose. I can almost say with complete certainty that your current 50:50 split wont be correct as its very common for people to have different BI needs during the day than they have at night.

If you could fill out the online diary with as much information we could all give our opinions much easier......I think you should do some BI testing...

I wouldn't worry about the high ratios, I am also on high ratios, hopefully the metformin will be worth it.............maybe try going out for walks, that should help drop your BGs and have an after effect the next couple of hours, this may make you feel better and more motivated to get to the bottom of this.......

Garry - I feel tired but there is no sign of infection -- my readings have been like this for months..

NRBoi - I have been on the Levemir for a month now.. and started on 23 -23 then 25 - 23 now 25:25
Will do some 3am checks... what other BI checks could I do??

Been on the metformin for 6 months now - cannot tolerate higher doses..

Thanks..

The 3am test only confirms your overnight dose which you take in the second half of the day is holding you steady, once your happy your evening dose is holding you steady overnight, you can then move on to your daytime dose, to check this is correct you have to have a carb free meal, that could be breakfast or lunch.


One day you could have a scrambled egg or something so that you don't have any carbs or QA inside you, by next meal time you should be the same as you were before the previous meal...give or take a few mmol...you can try this out a few days just to confirm but if your not holding steady then you need to up or down your BI dose for during the day.......

As soon as this is established you can relax a little and concentrate on your QA doses, and less stress equals better BGs.........and then you can eat as many carbs as you want.......

If you can try and get some diary entries up, its a really good facility......

Hi there

Heres my BG Diaries for the past couple of days - my DSN is on holiday again :-( and getting frustrated with it all...

Thanks NRBoi - will try that with the no carb meal - lunch is easier in the week; but will try at weekend as its easier to have a fry up lol

Well DSN got back to me after a moany email.. (really needed to do it!) and got to up basal to 28 on both doses and do a 2am check... and then try a carb free meal (like you suggested NRBoi) at the weekend...
Mmm and asked about insulin pump/CGM - need to ask at clinic in 5 weeks

Will give it a go x

Good to see your diary up and running Jo Penn. Good move.
I find that everything seems much clearer to me when I go back and review my own results retrospectively…especially after things have gone awry!
Helps me correct my mistakes and missing entries too. How many times have I seen QA 11.3…must have a very clever and accurate pen…Doh...entered my BG in the wrong field again.
You have a different approach to me in recording.
I only make one entry for breakfast as I take both my QA and BI during breakfast...and again only one entry at tea.
In doing that I find that it helps keep my split dose BI 12 hours apart and good consistent flowing overlap between them.
During the week I normally have breakfast at 06:45 and dinner 18:00 to 19:00 and then breakfast again at 06:45 - so give or take an hour it remains at 12 and 12.
If I get up late on a weekend it normally moves all mealtimes on - and so it tends to stay at 12 and 12 albeit with errors weekend start and finish - but still not too inaccurate.
I see your BI split is around 14 hours during the day and 10 at night. At your new, higher BI, you might try even it up if at all possible.
With recording in the OnLine diary, I hope you gain confidence in making your own decision about BI dose changes too. After all, you change one type of insulin every meal, so why should your BI be any different?
I try to take a steady view of this over 3 or 4 days results though – in the vain hope that I see a clear pattern before making BI changes. It is complicated enough without bringing another factor into play, making it too difficult to recognise the pattern. I use the graph feature on the diary all the time to help me see emerging patterns.
I now realise that I have only tinkered with BI units in the past...1u up or down, but my consultant has just told me to change 10 to 20% if I wanted to change BI and that way to see quick direct effects. He promptly advised me to knock 4u off my 28u BIs which I have done with little adverse effect.
Low dose Metformin has so far not helped my ratios but it is only 8 days. I live in hope.

Regards

Garry