Levemir issues

Sorry to be Mr Pendantic, but exercise can affect your BG for upto 24 hours not 2 hours ! If for example you do exercise in the evening it can still affect your insulin needs the following morning. I know this is true because it used to happen to me a lot when I went to the Gym in
the evenings.... I agree with the rest of the post though :-)

Look! Consistantly around 10! Finally a pattern - and all it took was me doing no corrections and having nothing between meals lol! ^_^

Considering the slight raise over night, I will make my first change putting one more unit on my Evening BI and leaving it for two days (unless I hypo).

Melissa - do you notice how I'm high between the 10s? My QA insulin is still working during those times. Even when I do my evening blood test, I know my QA from dinner won't run out until at least 11.30pm. I will be doing a test around 3am to see how I get on over night tonight.



*giggles* Oh noes! It's Mr Pendantic!

I'm not sure I agree with you Marke about exercise because my DAFNE nurse (JJPAG on here) made a point of it to me when I was trying to determine why I had a high so long after the exercise. She said that the high would not have been a result of the exercise (we're talking 4+ hours here) because it stops effecting your body after about 2 hours.

Why would we be told different things? :/ Maybe it's more down to how well your body responds to exercise.. I mean, someone who doesn't exercise as much won't respond to their insulin in the same way as someone who does exercise a lot.

Does that make sense? I think we covered this in my last DAFNE group meet back in August too.

On another thought - perhaps what kind of exercise you do is also a factor? eg, How strenuous...

Hi J,

Going to be a fairly quick reply I'm afraid as I'm still at work but thank you so much again for all the info. I'm just going to try and answer a few of your main questions...

You're right, I definitely do over-correct. I just panic with the levels too high but I'm really going to try not to.

My educator didn't really give me a reason for trying Levemir. She just thought that it "might help". My control was bad at the time but that was because I wasn't being a very good girl with my DAFNE. The harder I try with it, the more results I see obviously. I've been asking her for clearer reasons why she thinks it's the better option but the "flexibility" one is all that I have at the moment. I agreed to the change because you will agree to anything that might make your diabetes more managable don't you? (except maybe a pump!) I mailed her again today actually with more questions based on all this info but I haven't heard back yet.

Exercise doesn't really apply to me I'm afraid. My little boy is hard work but it's not really strenous exercise and I don't do anything else (yes, I know I should).

I genuinely didn't realise about the 12 hour gap with the Levemir. Novorapidboi told me about it so I've been doing it for the last 2 days. No result yet but we shall see.

Sometimes I do blood tests between meals because (a) I'm driving or (b) I feel odd. I understand that it's not going to give me a good picture of my patterns but for something like driving I really have to. I should probably just test before meals and ignore the other results. A few days ago I tested at 16 before I left work and tested again a little while later before eating with a friend and it had dropped to 5.6 in 45 minutes!

When you're pregnant you have to test before meals and then within an hour after eating (it should have dropped to below 8 within that hour - hah!). I think, because I've got pregnancy on my mind at the moment I think about that quite a lot as well even though I don't need to be testing like that at the moment.
The extras I eat in between meals are sometimes snacks and sometimes just thinks like a latte (2 units!). I guess I should do without them for the sake of the exercise really - you're right.

Looking back at your points I think that one of the main points you make is that I'm a bit jumbled with my eating and treatments and not very consistant with anything. I think that you're absolutely right. I think that part of it is panic at feeling like I've got a limited time to get it sorted. I think I just need to take some deep breaths and re-evaluate.

What was your HbA1c the last time you had it tested if you don't mind my asking?

M

My last HbA1c was 8.5%, or under the new system, IFCC 69mmol/mol. I'm still mainly familiar with HbA1c so the new results system confuses me still - but whatever way I look at it, this was an improvement on my last HbA1c which was above 9%. I went on Levemir towards the end of this result.


Try very hard to not over correct - or snack - if you can. Trust me, the results will be worth while in the long run! Once everything is clarified, your freedoms will come back. Don't panic - remember, short term highs won't do you any long term harm. One day of highs can help for more days of good levels.

You can do it! ^_^


Also, for a suggestion, how about for each hypo you have, if it's not right before a meal, you only eat 2 fast CPs (tablets, jelly babies, etc) and 2 slow CPs... this is so you don't have to inject more insulin (for example, 13 Nov - you had a hypo over 3 hours before your next meal. To make sure you got what you needed, it would have been better to leave off 2 units off the 5 slow CPs - this is to make sure you recover during the time before your next meal). See the hypos section of the DAFNE booklet (bottom of page 37 to be exact) to see what I'm talking about.


Don't worry if you don't know things - or even forget things about DAFNE - it'll happen (especially when you're having a hypo - logic goes out the window usually for me!)


I think if that's the case with the educator, perhaps it's not worth worrying about too much now. If you feel that you weren't being very good with your DAFNE towards the end of using Lantus, how can you be sure that going back is worth it really?

I do get you with agreeing with changes very easily though. If only diabetic control was something you could quick fix! ^_^ I'm sure they meant well.

It's funny you mention about pumps - I was told that if you're offered a pump at my hospital it's usually because you're not one for controling your sugar levels well. I never want to go on a pump generally and in a way, this statement from my hospital makes me even more determined to get my levels under control!


You'll be surprised how much exercise just playing with your little boy will provide! Picking him up for example... that's lifting a weight!


That's perfectly fine about trying out the 12 hour markers for the BI doses. I hope it provides some results!


The between meal stuff for things like driving is understandable - I test every time before I drive as well (every diabetic should do).

However, its the snacking and insulin taking that's the main problem because you're taking on extra QA. If you start to feel funny, see if you are low rather than just eat something - doing so will help with pattern finding - especially if you find you hypo after lunch or dinner as well (like I did for the 8th November in my first set of copied and pasted results back on page 3 of this thread - I put my morning BI down for this because it affected me during the day).


When I was still on Lantus I used to have to snack around 11am but that was because I was taking the incorrect amount of insulin. Unfortunately, I didn't realise that until quite some time after doing DAFNE - the breakfasts I used to eat to compensate were a lot of CPs! I hope something similar is not happening with you... (signs are showing on 14 and 15 Nov results I think).


Let's see how we get on... leave it for a few days and post our results together if you like. We can do this, M!

Mellissa
May I ask - Do you always wash your hands before blood testing?
Most BG kits now use such a small blood sample that any contamination error has a really dramatic effect.
BG 16 to 5.6 in 45 minutes is very unusual.

I say this from experience with an Medisense Abbott Optium Xceed meter which on 5 second Optium Plus test strips uses a tiny blood sample - 0.6 μL.
They did a 3 second strip for a time which used an even smaller blood sample. But not sure whether they are available now.
Anyway I proved contamination error to myself by repeated trials of unwashed hands v washed hands - washed immediately after - and saw errors of up to 8 BG.

My conclusion was that I had to always accept the need for lack of contamination and to stick with washed hands at testing time.

Regards Garry

Wow, that's quite a contrast of results for not washing your hands, but it does make sense! :/ I'm quite religious with my hand washing before meals so this potential problem shouldn't be an issue for me (hopefully).

On a similar note - do you avoid the 99.9% hand cleaning stuff? I hate it, personally, so I usually do. I'm often worried it'll make my results in correct - along very similar lines to being as bad as not washing your hands.

There is also those cleaning wipes as well - I used to grab the clean wipes that you get at places like KFC but my nurse told me that they had chemicals that would throw my blood results off so I avoid those too now.

Would be great to have a simple wipe that doesn't require water... would be a great addition to our medical kits! ^_^

Hi guys,

Thanks Garry, you're right, I'm not always good at washing my hands before tests (probably because I test far too much as well as I've explained to J). I'll try to from now on and I'm going to test my meter with the control fluid as well just to make sure that that's all working OK.

Can I just check, are all wipes not recommended? Can you use something like baby wipes or are they as bad for potentially throwing out your readings?

J - everything that you say is totally correct and you're right. I am confusing my results by snacking/testing at the wrong times/over-correcting etc. I would like to say that it's because I've had diabetes for so long that I'm not as careful as I used to be but that's really no excuse as you've had it for just as long as me and you're so much better. I think that your point is valid though - if I'm ultra careful for a few weeks just to see how things pan out then there's no reason why I can't go back to eating snacks etc if I want to, once I can gauge better how to deal with them. That's what DAFNE's all about I guess isn't it really? The hypo and subsequent eating that you referred to was me giving into the ravenous hunger that usually accompanies a hypo for me. I know that I should really eat 4 jelly babies but sometimes I'm not thinking straight and I shovel in some biscuits as well!

However, I'm afraid that I think I'd going back on the Lantus. I make an appointment today to see another DAFNE educator for another opinion and, when I got there, she was on a course and I was seen by a lady with no DAFNE training. Not her fault and she was very nice but I haven't heard back from the other two people I've left messages for either and I think I'm just going to stick my neck out and go with my gut feeling. The lady I saw today said that she didn't think that it was a major problem for me to revert to the Lantus for a bit. I said that if it didn't make things any better then I would go back on the Levemir and give it another go. I want to see if it makes me more stable and I'm going to keep a close eye on my evening readings to check whether I think it's not lasting the 24 hours. If it seems to be lasting then I guess there's no reason why the Levemir is a better option as the two insulins apparently work in very similar ways.

I know that you're probably going to think that I'm wimping out but I've got a very very short period of time to get this right if I want to have another baby and I'm really not heading in the right direction at the moment.

My motivating factor today was the fact that, for once, my blood sugars were relatively normal (7.9) when I woke up this morning. I had my usual 3 units of Levemir and a breakfast of 3 CP (weighed) with 3 units of insulin. I had to drive to pick up my son from nursery at 12.30 so I tested before getting in the car and my sugars were 7.6 so I thought fantastic, that's all worked today. When I tested for lunch an hour later it had jumped to 13.9 for absolutely no reason whatsoever. Weirdly enough I hadn't read Garry's post at that point so I washed my hands just to make sure and it came out the same. I can't find any reason why it should have done that and it freaks me out! At the moment, the only reason that I've got for using Levemir is that it might help and it isn't so I think I'm giving up. I will let you know what I find out with the Lantus though and see what happens.

Having said that though, any support you need for your regime, please let me know if I can help. You obviously know far more that I do about the technicalities of it but if you just want a second opinion or just a moan every now and then please tell me. You've managed to get your BG levels stabilised (albeit at a slightly higher level than you want) so I guess you're closer to finding a pattern. Keep me posted and I'll let you know what happens with mine.

M xx

I love cooking.
Worst errors arose when preparing something, putting it on the table and then thinking...Doh...havn't done blood...getting a wacky result and then washing hands - repeating blood test and getting the expected BG. So that's what set me investigating.
Even found that unless my hands were perfectly dry that errors crept in.
Reading your replies above reminded me that one of the best things that I have done since DAFNE is not overCPing after hypo.
I was a villain for too much carbohydrate... go downstairs at 03:00... test to confirm hypo and then have two glasses of milk and three biscuits... result... well you know the result... BG 13 - 15 with a worst case 21.5.
Regards
Garry

Hiya M,

I'm not sure how badly they affect, but I would personally put even baby wipes as problem causers along with any other wipes. I believe it mainly depends on what chemicals are on them and most of the time I really don't know what ones are good or bad (if any) so I'd rule them out as a blood testing cleaning option - but that is me.

It's okay - we've been in the same boat at least a few times in our lives! I've lost count on how many times I've said to myself "I don't understand what's going on any more!" Even with your decision now to return to Lantus, remember that you'll still need to work hard to work out the Lantus doses, especially if there is the potential of your body's change in demand (which may have been the cause of the problems you were having towards the end of your last use of Lantus).

If it helps you feel better, I did go through this sort thought pattern too but not long after it started I decided that "I'm on Levemir now, let's do this" and became very stubborn with it. I'm probably quite good at being stubborn when it comes to my control LOL.

I look forward to when you've sussed it all M! You'll spend a lot less time feeling rubbish and find it a lot more easier to spend more time enjoying your family! ^_^

I don't know about being better than you, m'dear! I've only been on DAFNE for a year or so which might be assisting me with my understanding of the DAFNE regime. I know it's very easy to slip into a routine with controlling your levels generally (you'll see what I mean when I post my two day results here after 7pm today - I'm waiting for something to happen first! ) and this can aid in losing track of what you knew before. Daft I know, but we all do it! So easy to get angry with yourself too! ARGH!

I find it helps me greatly to carry my DAFNE guidebook with me - it may be worth you adopting this habit as well if you feel you are not 100% confident with your DAFNE understanding. You may need it for those times when you can't think straight because of a high or a low - helps you re-focus!

Here's a good thing to remember when you're famished and you're hypo as well - you eat 2 fast and 2 slow - fair enough - and then IF it takes more than 5 minutes for you to feel better... wash your hands and do another blood test to see where you are. IF you're still hypo (below 3.5) then proceed to repeat the 2+2!

It's what I tell myself when I'm absolutely gagging for food when low... and it does help (well, me anyway lol). Helps you stop attempting to over eat for your hypo. ;)
Though I gotta admit, when pigging out while hypo in the past, it can be so lovely sometimes! XD Must be strong though, gah! LOL

Looking at what you've said about your blood tests - firstly, well done for blood testing before each meal and before driving!

When it comes to the rise up to 13.9 afterwards, this can be related to your BI running out. *has a quick look at your results posted on Page 1* Ah yes - assume that Levemir works up to 12 hours for you - Your Evening BI would have run out by then and so your Morning BI will be the only one working. Considering we're not 100% on how long your BI doses work for, this is a potential reason for this rise.

The only way we could pin point indefinitely is to only eat exact 1:1 ratio meals (so no half units unless you have a half until pen for your QA) and see what your body does in response over the day (like my day where I was consistantly 10 for each meal).

Obviously, this doesn't matter too much now considering you'll be changing over to Lantus again, however, if you get similar patterns with Lantus, keep this in mind.

On that note, if you want to post your results once you're back on Lantus, you're more than welcome!
Shall need to know a few things though - like working times of Lantus for you and what QA you're using - it'll help with the pattern finding, as well as your general understanding of your body's insulin demands! ^_^

I forget if I mentioned before, but I, as you know, use Levemir and my QA insulin is Humalog (which, according to the DAFNE guidebook *runs off and gets her guidebook out of her bag!*... works for around 2 - 5 hours. I'm pretty sure it works for 5 hours for me considering my most logical results are after 5 hours (as you can hopefully see from the results I've posted on this thread).

The fact I had 10 at every meal is a pattern! It was telling me that I needed to put my BI up but I decided to target my Evening BI first and leave it two days to see how it goes. Not long now until my two days are up and I post my new results - has been interesting and I feel I have learnt something valuable if the pattern I got from yesterday (the day after the 10s and putting my Evening BI up by one unit) is the same today. I did get ketones again but I'm sure I'm going to get it all nipped in the bud now...

Shall post them after 7pm! >

Okay! Results are up! With as much detail as I can manage!

What's our thoughts on my decision to change the timing of my Evening BI dose from 9pm to 7pm? I am very curious! :3
Be sure to be aware of the Ketones!

Speaking of ketones, I think we should have a detail bit for it.... ketones are very important for when you're ill.