Until I start a DAFNE course

Hi

I've been a Type 1 diabetic for over 30 years and and really struggling to get my HBA1C lower than 10!! I also seem to be yo-yoing between very low and very high bloodsugars and I also do alot of exercise so either end up over eating to compensate for low bloodsuagrs or they run high. I've just had my latest hospital appointment and they said I really need to do a DAFNE course but I think there is quite a waiting list until at least August. In the meantime is there any basic guidance I can floow to start stabilising bloodsugars and stop having hypos almost once a day and the over compensating so then my bloodsugar goes high again! I inject 12 units og Glargine AM and 4-6 units of Novorapid between each meal

I'm also desperately trying to loose some weight (5ft 4 11 stone) for my wedding in May and as I've really read into insulin/cortisol etc I know the key has to be better diabetic control

Any help, links, websites etc much appreciated!!

Thanks

Vicky

Although DAFNE covers a huge range of material, all of which is important, the main way to reduce HbA1c is to get your BGs consistent without the wild dips and peaks.

The first step involves getting your basal insulin (long acting insulin) correct, and then once that is under control, fixing your QA ratios. DAFNE will teach you how to do this which involves counting carbs (if you don't know how to already).

Without being a graduate, are you able to use this website to keep a diary? If so, could you fill in the diary over the next week and share it? We can then give you pointers of things to try to help the control.

Some points to note for filling in the diary:

1) A CP is a Carbohydrate Portion = 10g of carbohydrate. You can use the carb counter link to the right of this website, or the nutrition panel on packets to identify this. E.g, dry pasta is about 70g carb per 100g, so if you are having 50g of pasta, then that is 50g x (70/100) = 35g carb = 3.5 CP. If you are having a hypo, or correcting with food, add a + symbol, e.g if you have 30g carb (jellybeans say) when having a hypo, then in this box write 0+3.

2) BG is your blood glucose reading.

3) QA is the number of units of quick acting insulin you take with the meal. Again, use a + symbol if doing any correction. E.g, say I have dinner which contains 50g of carbs, I would take 2.5 units of insulin for that usually. If however, my BGs are 12, and I expected them and want them to be around 6.0, then I'd take an additional 2 units of insulin to bring them down into that range. So in this box for this meal, I would write 2.5+2 where the 2.5 is for the meal, and the 2 is the correction.

4) BI is the number of units of Basal Insulin you take.

5) Ratio is the amount of QA you take for each CP. I am on 0.33:1 (a third ratio) for breakfast, 0.5:1 (half ratio) for other meals. So for example, I have 100g carb for breakfast and usually inject 3.5 units of QA for this. If I was having 100g carb at lunch, I would inject 5 units of QA. Don't worry if your ratios are significantly different to me. Some people are on as many as 2:1 or 3:1. Everyone is different.

6) If your BGs are higher than 13 on two consecutive readings, e.g. breakfast and lunch, or lunch and dinner, or higher than 17 on one reading, then take a ketones reading. Ketones above 1.5 are bad news and you should consider getting medical assistance if your ketones are this high. Ketones can be read with an Optium Exceed meter. There may be other meters that do this too.

I have attached a portion of my diary so you can see how I fill it out.

I exercise a lot too, so understand the point about overeating - I struggle with this myself. Before being diagnosed, I ate anything I liked as I exercised so much that I never needed to worry about weight, but my diet is now much better as a result of diabetes, although my chocolate addiction is hard to control.

Thats brilliant!! Thank you so much Warwick-I beleive I can use the BG diary on here so I'll crack on with that from today. I am not sure of my ratios though for QA I use Novorapid and beleive its 1 unit to reduce BG by 2 does that mean its a 1:2? Sorry thats the only bit I dont know about

Amazing reply! Thank you

Your ratio will be 0.5:1 - half ratio. You were correct with you 1:2, but I think the DAFNE diary like the second number to be a 1, so 0.5:1.

Cheers,
Warwick.

Oh, and you can use subtraction too. You can see on Wednesday that before breakfast I deducted 0.5 from my usual 3 units of QA because my BG was only 4.2 and I prefer it to be between 5.5-6.5. Taking my usual amount might have led to a hypo later on.

I should have also mentioned that the target BG range varies depending on type of day:

Before breakfast 5.5 – 7.5 mmol/L
Before other meals 4.5 – 7.5 mmol/L
Before bed 6.5 – 8.0 mmol/L
At 3am 4.5 mmol/L or above
Before driving Above 5 mmol/L

In practice, I find it is just easier to aim for 6.0 at all times and that works better for me. Aiming for that usually gets me in the right range.

Oh, and read the fine print on your QA insulin and find out what its duration is. Most are about 3-4 hours. Don't bother testing within that duration unless you feel hypo symptoms. Your BGs tend to stay elevated during that period and there isn't anything that can really be done about that, but 3-4 hours after a meal, you will be wanting to be in the 4.0-8.0 range, preferably around 6.0.

Let me know if you have any questions.

Cheers,
Warwick.

Warwick that is excellent! This has really explained alot to me and I agree with your point about after a meal-its very hard to keep the BG down within the insulin's lag time as I call it-just nothing we can do about that but if overall I can 1) keep stable rather than yo-yo and 2) keep as close to the 6-7 range i'd be very happy

I've already begun my diary and it lets me fill it all in so thats great-I'll send it to you in a week's time

One question-I am on a very healthy eating plan so, for example I made a turkey stir-fry last night from scratch with diced turkey breast, 2 small courgettes, pack of mange tous peas, some garlic, onion, ginger and chilli with a splash of light soy and some herbs. To calculate carb CP where can I find values for things like lean turkey, different vegetables? Or do I look at the packaging then calculate from there? I've looked in the CP booklet on here but that seems to be all fast foods rather than lean and clean?!

Thanks once again for everything

Hi, you can access everything except the online handbook, because we are not allowed to give access to this unless you are a graduate. If others give you advice that is outside of our control
With regards to the online carb book , you can add your own entries and eventually they get verified and approved by Health Care Professionals. Again the 'verified' entries in the carb book come from the standard course carb book I'm afraid. If you want a bigger list of carb values there are books around usually aimed at people dieting however if the contain carb values then they are just as good. I have two at home but can't remember the names of them, will try to remember to dig them out and post the names and ISBN of them later.

Out of interest, how much insulin did you take for that? You will go crazy if you try and work out the carb values of all of that. As you will learn on DAFNE, there are a lot of foods that you just don't need to worry about because the carb value is so low, and I think all of those foods that you mentioned come under that heading. I'm not sure about corgettes or the peas.

In general calculate carb values for the "carb portion" of a meal like potatoes, pasta, rice, cous cous, quinoa, weet bix, muesli, bread, dairy products etc. Also, look for the carb content of sauces (sweet chilli sauce has heaps), pasta sauces etc. Desserts obviously. Vegetables tend not to have much, but pretty much all fruit does. Biscuits, chocolate, crisps etc also have a high carb content.

Legumes - lentils, chick peas, beans etc do contain carb but it is very slow release. I love these foods but I find them a nightmare to dose for. If I give the correct amount of insulin, I will hypo as these release carbs too slowly. If I give only enough not to hypo, then my BGs will slowly rise later on and I will become too high. I only have these now for breakfast and sometimes lunch so I can correct for them at later meal times. Having them at dinner time will lead me to have very high BGs overnight.

My fellow DAFNE graduates swear by this website:

http://www.calorieking.com.au/

It is for Australians, but some of the foods will be similar to the UK. There is bound to be something similar for the UK diabetic population. You can always type carbohydrate and the name of the food into Google and you will probably get an answer pretty quickly.

Good work, and I look forward to seeing your diary.

Cheers,
Warwick.

Vikz2006 said:
...I am not sure of my ratios though for QA I use Novorapid and beleive its 1 unit to reduce BG by 2 does that mean its a 1:2? Sorry thats the only bit I dont know about /quote]

Just to clarify, your ratio is the amount of QA you need to cover your CPs, so if you use 1u of Novorapid for each 1CP (10g) then that's a 1:1 ratio.

The additoinal QA you need to bring down high BG is just known as your correction (or correction factor), and 1u to bring you down 2mmol/l sounds relevant; we usually say 1u can bring you down by between 2-3mmol/l so you need to be cautious.

Carolin