Levemir issues

Hi J,

Back on the Lantus today (the relief!) - 12 units last night based on what was my usual dose previously.

You and Garry will be very proud of me - I only tested before each meal, washed my hands every time and didn't snack between meals (even though my friend offered me some delicious biscuits!).

Woke up at 14.1 (but then I had a hypo last night so may have been aftermath of that and usually takes 3 days for full Lantus results to kick in apparently - although I think it may have been faster with me). Corrected with +2 at breakfast. BG levels before lunch were 5.2 (yay!) and then was hypo (2.9) before evening meal. This may indicate that Lantus dose was too high as I was pretty accurate calculating lunch CP but at least it wasn't too high which might have meant that the Lantus was running out. Obviously that's one of the things that I'm going to be watching closely so we'll see how it goes.

I did my DAFNE course 3.5 years ago and I think that I'm definitely rusty on a lot of the principles. Along with everything else since having a baby, a lot of it seems to have disappeared from my brain. I'm going to go back over the information (if I can find it) and refresh my memory. I'm not sure if I got a handbook. If I did I can't remember for the life of me where it is but I guess I can find it all online. With me it's very much a case of trying to take more time and care over everything and to do it all properly. Like everything else though this has become much harder since having a kid (maybe this is just me though!)

I can't get in touch with the centre where I did my DAFNE course so I can't get hold of their code to confirm me as a DAFNE graduate so I can't access any of that information on this site at the moment. Would you mind letting me know the action of my quick acting insulin if that's OK? I'm on Novorapid.

By the way - I know you said that your time of the month affected your readings badly (by how much?). Do you find stress or tiredness have a bad effect? I think that those are major factors for me, particularly stress.

I understand what you said about accepting that you were on Levemir and being determined to make it work for you. I think I just need to find out whether Lantus was really the worse option though and I think that the only way I can do that is to go back on it and compare results. After all, you were having problems with the lifespan but, if that isn't a factor for me then I guess it may be a perfectly good option. Diabetes seems to be such an individual thing that everything seems to differ massively from person to person. I have read loads of stories of people who have found Levemir hugely helpful but I did also find a few who hadn't got along with it at all. Maybe I'm just one of those people and, if that's the case and there's another viable option then maybe it's just not for me.

You've definitely found out that the Lantus doesn't suit you so I think you're absolutely right in putting all your efforts into finding another option. How have your results been? Looking forward to seeing them.

By the way - my worst starving hypo experience was eating stale bread (and actually enjoying it!).

M xx

Melissa, just email us using the link at the bottom of each page telling us your name and the DAFNE centre you did the course at and we can get you verified as a graduate. The easiest option is to get your centre to give you a code, but if that is not possible then there are other ways !! You will then be able to access the online handbook which we will hopefully be updating soon to the latest version ( when we get sent it).

(My past two days worth of results are the last post on page 4 of this thread if you'd like to go look! )

Yay Mel! Sounds like there's improvement already! ^_^

If you get offered a biscuit - some times I take one, check what it will be on the packet and then put it in my lunchbox for later - could consider doing that when a friend offers!


Great work for keeping to controlled testing times! You'll be back on track in no time! However, give your body 24 hours to recover from a hypo - especially if you had one over night. You do this by not doing any corrections, okay? This may also be the cause of the second hypo before your evening meal. Besides that, keep up the good work! Be sure to keep an eye on those over night hypos - concentrate on those first if they keep happening (check at 3am for them - usually it's just your BI acting at that time).


Golly - you don't have a guidebook?! Blimey! Where exactly did you do your course? It might be worth dropping a message to one of the admin on this site so you can see what they can do for your situation. Saying this, you might find your new DAFNE team can provide you with a code. (I've just spotted marke's post so all's not lost! I look forward to seeing the updated guidebook marke! )

The reason we have the code in place is because the DAFNE guidelines can be dangerous to someone without prior education. Once you've done the course, you ask the course organiser or your DAFNE nurse for a code which you then can input into this site to open the online guidebook for you. Considering this is in place here, I'll be very surprised (and a bit worried!) if you could find it easily online generally.

Ah ha! To quote the disclaimer on the online DAFNE Guidebook:

The DAFNE Course Handbook was developed with the sole purpose of providing supporting material to accompany information given to individuals completing a 5-day DAFNE structured education course. These 5-day courses are delivered by appropriately trained and certified DAFNE Educators.

The DAFNE Course Handbook is not a stand-alone information source and should not be used by any individual who has not completed a 5-day DAFNE course or for any other purpose then that for which it was developed.

The DAFNE Course Handbook is not intended to provide or replace and personal medical advice provided by a healthcare professional

The DAFNE Programme and DAFNE Online assume no responsibility or liability for any injury, loss, damage or expense that may be caused by any action, or lack of action, that may be taken as a result of reading the DAFNE Course Handbook

Quick-Acting Analogue insulin

* Analogue insulin is a relatively new kind of insulin that works very quickly and can be used instead of soluble insulin. It will start to work less than 15 minutes after the injection, peaks between 50-90 minutes and may continue to affect the blood glucose level for 2 - 5 hours, which is a much shorter duration than soluble insulin. Brand names for quick acting analogue insulin's are:

* Humalog
* NovoRapid
* Apidra

Women with diabetes can have children. However, medical evidence shows an increased risk of complications for mother and baby when the mother has diabetes. Evidence also shows that this risk is minimised by normalising blood glucose before conception and throughout the pregnancy. You can continue to use your DAFNE skills throughout pregnancy; in fact most women have found pregnancy and the insulin adjustments much easier to manage following DAFNE.

Planning a pregnancy will help reduce the risk of problems. Continue to use a reliable form of contraception (see below) until you have got your HbA1c as good as possible (6%-7%). Folic Acid is recommended for all women planning pregnancy - see your GP for a prescription and start this as soon as possible (you should continue taking this until 12 weeks into pregnancy).

The normal level of HbA1c is lower during pregnancy so we encourage women to try to get their HbA1c below 7% if possible. During pregnancy is one of the few times we recommend testing your blood glucose level in between meals. The target levels during pregnancy are:

* Less than 6 mmol/l before meals.
* Less than 8 mmol/l 1-2 hours after meals / before bed.

Blood glucose levels and insulin requirements change significantly during the stages of pregnancy. Most commonly, during the first few weeks you may experience more frequent hypoglycaemia, sometimes with a reduction in symptoms, or even severe hypos, therefore it is useful for your partner to know how to help you to treat your hypos. You may also need to be more cautious about driving and test/record your blood glucose level before getting in the car to drive. You may be advised to avoid driving temporarily if you have lost your hypo warnings.

In the later stages of pregnancy (from around 26 weeks), insulin requirements usually increase. Follow the DAFNE guidelines for increasing your insulin doses and do not be surprised if you find your Background Insulin and/or Quick Acting : CP ratios are more than doubled by the end of your pregnancy.

Immediately after delivery of the baby, insulin doses return to pre-pregnancy levels (so it is useful to keep a record of what these were prior to pregnancy) and may need to be reduced further if you choose to breast-feed your baby; the guidelines for exercise can be a useful starting point for this.

Your doctor or diabetes nurse will be happy to discuss the local diabetes antenatal service and recommendations with you.

Good tip on the biscuit - thank you!

I may well have had a guidebook. In face I'm sure I probably did but I just don't know where it is. As part of my getting organised I will try and find it. Makes perfect sense about not having DAFNE information readily available but I will email Marke as he suggested so should be able to access info via this site as well.

I have to be honest and say that I had a really difficult time in pregnancy from start to finish. However, having said that, I have heard of several Type 1s who had a pretty straightforward time so don't worry too much about it. What will be will be. You do have to be ultra careful (but you obviously are already) and, in the later stages of pregnancy, your body starts resisting the insulin so you have to start upping your doses massively. With me, this changed on an almost daily basis so it was really hard to keep track of. I think the hardest thing is just the sense of guilt you feel when things aren't going too smoothly because everything you're doing is having a direct effect on the health of another person as well as yourself. It doesn't help with judgemental HCPs either. I'm certainly not including all HCPs in this description as many were absolutely fantastic. However, for anyone working in high risk ante-natal care, please note that saying "you wouldn't be in hospital if you could manage your own diabetes properly" to a very ill and very stressed pregnant diabetic lying in a hospital bed is not the patient care to be recommended. If I hadn't been so ill at the time I would have stabbed her! Sadly I didn't even get her name.

Anyway, suffice it to say that I want to get my control as good as I possibly can before attempting this for a second time - hence my irritation with my lask of success on the Lantus!

You're welcome - no reason to go without a treat hehe! ^_^

If it has disappeared, from the sounds of things, you'll be able to access the guidebook eventually. Might be worth asking your team if they can get you a new copy - I know I would if I'd lost mine....

Say, actually, I think that if I did lose it - once I had access to the guidebook on here, I'd print off the pages and put them together in a Project Folder. Considering marke has hinted that the guidebook will be updated at some point, I may look into doing this myself!

Golly, that does sound like a lot of diabetic hard work - but I'm guessing it's all worth while considering the result? I'm mostly scared of having highs and then having to have a cesarean section - the whole idea of it frightens me. I know my partner would probably like to be a Daddy so I'll keep your words in mind if we decide to try for one. I know I'll definitely have a planned pregnancy... my fears have made me so cautious (which my partner is thankful for which is nice).

I'm sorry to read that a HCP said something like that to you. Wasn't very helpful at all - especially if you're in hospital mainly due to a pregnancy! I'm guessing they didn't fully understand what was going on... hopefully you won't meet anyone else like that - especially for your second child.

I've emailed my DAFNE nurse yesterday so I'll also be seeing what she thinks about my plan of action that I've taken so far.

Edit: Things have started playing up again.. ketones are + already! I've shared my DAFNE diary with you MelissaF so you can look at it before I post results here.

Have a nice weekend M!

Hi J,

I've had a look at your diary (thanks for that) and it's a bit strange isn't it? Apart from forgetting your breakfast QA, your BG readings haven't been that bad at all so I'm puzzled as to why you've been getting the keytones. Did you hear back from your nurse at all? Let me know what she says.

Apart from the keytones though, it seems like your BG levels are lowering themselves generally so I guess the increased BI is working? What do you think?

I woke up at 4am today (or rather my son woke me up!) so I did a blood test then and it was 15 (not because of an earlier hypo). I wasn't sure whether I should correct it or leave til morning to see what happened. In the end I couldn't get back to sleep because I was worried about it being too high so I gave +2 to correct. Still woke up at 13 though so the mornings are still too high. However, it's only my 2nd day back on the Lantus so I'll give it another day or so before I panic. I don't remember mornings being this bad before on the Lantus so maybe it's just an adjustment period whilst it gets back into my system again.

Yes pregnancy is hard work and the highs are scary, however, as I said, it affects different people in different ways so there's no guarantee you would have the same issues at all. We had a tough start but I now have a gorgeous, healthy little boy so, yes, it was totally worth it. You'll understand that I'm slightly nervous about doing the same again though.

Yes it's definitely worth making sure that you plan a pregnancy. Get your control as good as you can before you start trying. Also, make your contacts aware that this is what your planning and find HCPs that can stay with you through the planning stage stage and then throughout your pregnancy. One of the problems that I had was that a lot of the high risk ante-natal team weren't too familiar with the DAFNE regime and it took a lot of convincing that this was how I wanted to manage things. Now I think most hospitals have diabetes teams who also cross over into ante-natal care so you have contacts who can support you for both. Also DAFNE is much more widespread so many more people are aware of it.

Also, just to reassure you... I've heard a lot of negative press for C-sections but, from my own personal experience, it was a really straightforward experience and I would be more than happy to repeat it. I started off my pregnancy wanting the natural birth thing (as I'm sure everyone does) but by the end of it I just wanted the quickest and safest option and it was absolutely fine. If it does happen to you at some point, I'm just saying don't stress about it - it's not a big deal.

Anyway, I won't waffle on. Good luck with banishing the mysterious keytones!

M xx

Hiya M,

I spoke to my DAFNE nurse and she has asked me to (this is the best I can remember of it anyway):

~Try to ignore the ketones for now because I am not officially ill - especially when my sugar levels were being as good as they were. Sometimes your body releases ketones in response to lack of food or exercise so try not to worry for now. If they go over ++, then respond because harm is more likely.

~Put my BI dose times back to 7am and 9pm. It would be very unusual if my BI was running out around the 12 hour mark - it commonly runs for a lot longer than that so put it back to see what happens.

~Put your BI doses both up to 10 and see how it goes.

I have posted my most recent results and as you can see, this morning I've hit the ++ ketones - so I have responded with sickday rules. I also have more indication of having a cold now but I know I also got very angry and stressed out yesterday because of how stupid and incompetent banks are(!). Perhaps the stress encouraged the cold to push harder finally... I have sneezed occasionally this past week... but even now, I don't feel particularly rough.

Being ill was the last thing I needed. -_-; I'm running out of time before my time of month - and I have a motorbike test and a car test to get ready for. This is going as well as my holiday planning (what really annoyed me last night).

Must concentrate on calming down.... I am very very hungry now (it's 10.56am) so I'll go do that.

*does bloodtest, scoffs some jellybabies and grabs some breakfast*

3.7! I finally see a hypo! This might be a turn over! Explains my morning grumpies too! LOL YAY!

*hungrily eats her yogurt and porridge* XD

Obviously, me adjusting for the ketones does skew the patterns for me so I don't know what to think today. I will apply hypo rules though and see how the day goes by. I will update my nurse later today (though she is aware of this thread too) so she can apply any more advice if needed...

What time was the 13 blood result in the morning? It may still be coming down... what was your BG before bed?
If you like and want to give your body the three day period to get Lantus properly on board, post your three days worth of results and we can do a full look over.

That's a relief to know your feelings on C-Sections. I guess that the fact I've not had any major operational things like that before, I just don't have a good picture of how it is. Your determination to have another little un' is very admirable for me to read. Maybe one day I will bite the bullet and wait for "the ride" to start (!).

Sometimes my diabetes reminds me of that Chinese Curse phrase: "May you live in Interesting Times". Seems quite apt for all these problems lol. ;P

I know what you mean... Sometimes after a run of high sugars it can be a relief to have a hypo in a way. It's such a shame that you're getting a cold with all of this going on as I know that something as simple as a cold can really throw your sugars out drastically. I'm really bad at sick day rules as well so I usually forget to do all of that and just end up running high until it all goes away again. Keep an eye on it all and apply the rules to the cold if you need to. Sounds like you've got a fair amount of stress going on in your life at the moment as well and that's something that always sends my sugars rocketing. I know that it sounds really stupid but try and chill out as much as you can. If your sugars are running high then always consider the fact that it might be factors like stress or illness as well as BI. Having said that though, it's interesting that you went to bed with perfect BG levels and woke up really high as that's what always seemed to happen to me on the Levemir. Having said that though, looking at your diaries, that doesn't particularly seem to be a pattern with you so maybe it was a one off and to do with the cold?

Try not to worry about timings. If you've got all this going on then you may just have to wait until next month if you're nearing your due date. It's only 5 days (or thereabouts!) anyway so you may just have to carry on experimenting after this one if over.

I'm sure it's largely psychological but I'm feeling so much more confident on the Lantus. My results aren't perfect at the moment but they're much better than they were. My BG this morning was too low. Not entirely sure why at the moment but, like you, I felt oddly relieved that it wasn't ridiculously high as it has been. Other than that though the results are really levelling out. I'm going to type them up and I'll share the diary with you.

Quite a few of my friends have said that I'm mad to consider having another child but I've always wanted to and I would be so sad if I didn't manage to. Having said that though, age is against me so I need to be pretty quick about it. Yes it scares me considering what happened before but you can't give up can you. I want to try and be better controlled this time round though. I don't think that I was brave enough with the BI last time round. It's scary going hypo when you're carrying another person around inside you but not as scary as going high as the potential affect on the baby is less damaging. Yes the C-section was fine. I've heard people spread scare stories about how terrible they are but my personal experience wasn't like that at all. Yes, if everything is straightforward then I'm sure there's no doubt that an uncomplicated natural birth is the best option for the child but so few people seem to have a straightforward birth these days. If there's any sort of risk involved then I'm all for the quickest and safest option. A friend of mine was fed scare stories about c-sections in her ante-natal classes and, when it came to the birth, she ended up having a horrific labour, resulting in an emergency c-section. By the time it came to the op, she was so scared about it because of what she had been told in advance. There's no point in scaring people. Sometimes you have to have medical intervention and it's the best option for both you and the baby. I just like to tell people my positive experience with the op as you only seem to read about negative ones.

Anyway, enough waffling. I'll get those diaries typed up!

M xx

I'm very tired from my big motorbike training today so I'll reply later properly. Shall post my results... has been very interesting.

As I've mentioned earlier in the thread, I am learning to drive. This is both car and motorbike. Today was my first full day of 500cc motorbike training and my blood results have been quite remarkable.

I put it down to adrenaline mostly - but what do you lot think? Have I responded to each high correctly do we think?
I can't shake the feeling that my ketones are natural weight loss on a related note.

I really need some food and rest... shall reply properly soon! -_-;; So tired...

Hi J,

Firstly, I hope that the training went well?

I'm assuming that you're not still feeling poorly as your results yesterday were pretty good weren't they?

Did you feel particularly stressed or nervous about the training? My sugars tend to rocket when I'm stressed which I guess is the adrenalin rush etc so I'm sure the same thing happens with nerves or anticipation. Having said that though, the first two highs are fairly soon after breakfast and you're back to 10 at lunchtime so you're not that far out really. Not having any insulin for the 3CPs at lunchtime would probably account for the 2nd high as well.

Your sugars are dropping back again so I would have a snack and maybe give yourself an additional unit or two to adjust but don't overdo it as it looks like it's dropping naturally as you relax. Have a bath and sit on the sofa with your feet up for a couple of hours and see what happens to the levels.

I can see why you wouldn't want to risk going low on a motorbike but maybe some insulin with your snack at 12.39 would have served you better? Better to be safe than sorry sometimes though I guess?

I've just realised that I didn't input my Lantus results. I'll try and do that now.

M xx