Recent Posts - DAFNE Online

Mar 23, 2014

Warwick 425 posts

Topic: General Discussion / BI and morning BG

Nice one. :-)

Mar 22, 2014

PVT1 6 posts

Topic: General Discussion / BI and morning BG

Hi
My BG before bed last night was 5.8, I increased BI to 50 units and did a 3am test to find it holding steady at 5.6. At 9am it was 5.6 and at lunch it was 5.5 and before tea 5.8.

So delighted with today's readings, near perfect. Here's hoping they remain stable and consistent. Will update as I continue

Mar 22, 2014

GR8 5 posts

Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses

Hi dunkers7

Thanks for the tips. Not much of a drinker or dancer so usually just chatting and drinking.

Can manage spirits no problem just trying to figure out the beer

Thanks

Mar 22, 2014

dunkers7 24 posts

Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses

Hi GR8,

I wasn't carb counting at this point, but in general, I've found bottles of beer raise BG a lot initially then they drop a little later, assuming no QA taken. 3CP sounds about right for Corona.

Possibly worth thinking about what you're doing when out too though. How practical taking QA is, if you're likely to be dancing for long periods, that kinda thing?

I drink very little now, but when I was a student and in the drinking quite a lot phase, I found spirits a lot easier to manage in social situations since they drop BGs a lot more than they raise them.

Mar 22, 2014

Warwick 425 posts

Topic: Questions for HCPs / BI insulin running out

Hello Justin,

I switched the other way a few years ago from Humalin to Lantus, and I don't remember it being a problem,although at the time, I was on BI only due to the honeymoon period.

Are you taking breakfast around 7 am? If so, then one answer may be to increase your breakfast QA ratio a bit, and push your morning BI time out to 10 am, giving you an extra few hours at the other end of the day before it runs out. This would hopefully coincide with dinner, and you can increase your QA slightly then to get you to your 10 pm BI dose.

Another alternative would be asking to switch back to Lantus, or onto another BI like Levemir (although if you were switched off Lantus, then there may have been good reasons for doing so).

Lastly, you could split your BI into three injections, with the existing two as is, and a third around midday to see you through to your evening dose.

With Lantus, although it is billed at 24 hours, I found that it lasted about 20, and increasing my dinner QA led to hypos. Splitting my Lantus dose into a morning and evening dose solved the issue.

For that reason, that third option may be your best option. There would be a bit of trial and error though as to what each BI dose should be. Ideally, you would want to take each dose about 8 hours apart, and then work out if taking a third of your total daily BI for each dose was appropriate.

Mar 21, 2014

GR8 5 posts

Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses

Hi

I have just completed the DAFNE course and am just going over calculations for QA insulin to counteract the carbs in beer, etc...

I am not a regular or big drinker but will occasionally have a few beers when out.

DAFNE state that a pint of lager counts for 1CP. With this in mind I went to look online at carbs in bottles of beer (in particular Budweiser and Corona). Budweiser came back with each bottle is 30g of carbs/ 3CPs. This seems quite high in comparison to rating for a pint of lager.

If I was to half my QA insulin ratio and go with these higher figures and they are not correct I am likely to increase chance of delayed hypo, especially if I had a few beers.

Does anyone have any advice or experience of carb counting for bottles of beers?

Thanks

Mar 21, 2014

Justinjroberts 9 posts

Topic: Questions for HCPs / BI insulin running out

I am currently on Humalin I as a BI insulin, taking it at 7am/7.30am and again at 10pm. It covers my levels over night but the last two evenings yesterday and today I experienced a spike into double figures at 5pm, it seems that the BI is only lasting for 10 hours!

To correct I had to take Novorapid but very high doses, last night 15 of Novorapid brought my levels down from 15 to 8 and I exeperienced no hypo and ate nothing. I am fairly new to Humalin I having been switched from Lantus four weeks ago. Has anyone else experienced this as I am not keen on having to take such high levels of Novorapid to rectify with such little affect.

Mar 20, 2014

dunkers7 24 posts

Topic: General Discussion / Need to lower BI in the morning, is it a problem?

Thanks Warwick,

Yes good point about lunch and makes sense on the BI.

The plan was always to do some BI testing at lunch time to establish whether reducing BI is the right thing to do. Today, I didn't hypo so some BI testing actually happened. Looks like that morning BI is just about holding now.

Bigger picture is, that's an overall drop of 11 on my morning BI dose since starting the DAFNE course last month, so that really has been a big change. Getting there!

Mar 20, 2014

Garry 328 posts

Topic: General Discussion / BI and morning BG

If you go back to your diary you can edit individual entries by clicking the time of the entry which gets you into an edit screen. Please take little notice of between meal BGs.
These are good for information, as they may help you understand your normal QA uptake times, but if you compensate for these additional results you will stack up QA doses with the outcome that you see. Slowly, slowly. Wait until the meal time and compensate then, if necessary.
Try not to make lots of changes.
Change one thing at a time and see what happens over a few days and then decide whether or not the change is beneficial. The graphs produced by the diary can be helpful here.
Keep up the Ketone checks too, if greater than 13 or 14 mmol/L. You can enter the actual value from your meter but your diary only shows true. Keep an eye on them as a run of high BGs, plus ketones, normally give me forewarning that I'm going to feel sick tomorrow or the day after.
Regards
Garry

Mar 20, 2014

Garry 328 posts

Topic: General Discussion / BI and morning BG

For me, a snack is normally less than 2 CPs and depending on my result immediately before would determine what to do.
If normal, or little lower BG at time of snack, I'd usually let it ride to the next meal and if necessary compensate then. I do the pre-meal blood and...for me...pre-meal insulin. I find I need take my insulin before a meal in order to get the Humalog QA active enough in my system, to trim off post-meal spikes in BG.
If high before, when contemplating a snack, I wouldn't have the snack.
If taking an extra meal I would use the ratio appropriate for that time of day. My ratios currently are: - 2, 2.2 and 2:1, breakfast, lunch and dinner respectively, so not much varaition at the minute. In the past however they have been plenty of changes, the widest range used was 3, 2.5 and 1.5:1 across the day. You will find that you may need adapt and make many changes over time. As long as the results are good...that's fine.
Bear in mind though that if you take matching QA for an extra meal and then eat your normal meal within 3 or 4 hours you have to expect an elevated BG. Don't add any compensation QA for the normal meal as you'll likely to be stacking QA doses up which may crash you later.
Regards
Garry

Mar 20, 2014

PVT1 6 posts

Topic: General Discussion / BI and morning BG

Warwick

Agree and understand everything you say. I am confident it is DP, as my week doing DAFNE actually lowered my BI from a previous dose of 56 units and the reason for this was a pattern had emerged which showed it was oulling sugars down in the daytime. However, to validate I will do a couple of 3am tests.

I do have good hypo awareness and yes I do wake at night when having a hypo although I am usually quite severe. Having said that it is very rare when this happens.

My results in the daytime are really confusing at the minute, sometimes they are hovering in the early teens and then seem to drop before tea. But I agree, getting the BI cracked is the key to everything else. If it is the DP, what do I need to do to get better morning readings, or do I just accept it for what it is?

Also would be grateful for any advice on my question of snacking and ratios from an earlier post.

Thanks all for the advice so far, really appreciated.

Mar 20, 2014

Warwick 425 posts

Topic: General Discussion / BI and morning BG

The basic strategy of DAFNE is to get the BI right first, and then tackle QA ratios. Trying to do it any other way just gets frustrating.

I'll ignore Saturday, when you had a hypo before bed and carbs and so it will have affected the morning readings.

The rest of the readings show that your morning readings are always higher than your before bed readings. There can be two reasons for this:

1) Your BI is too low and increasing it will fix this.

2) You have Dawn Phenomenon (along with most of the rest of us), and if you increase your BI, you will likely hypo during the night while waiting for DP to begin about 3-4 a.m.

Given that you already increased your BI recently, you may want to wait another few days to check whether things change for the better or not. If they don't, then I recommend putting up your BI by another couple of units.

If you could do a couple of 3 am tests too, it would be helpful in identifying if your BGs are good at 3 am and about to spike due to DP, or if they are high then too, in which case it should be safe to increase your BI.

Make getting your BGs before bed and before breakfast within 1.5 of each other, and you can then worry about ratios etc after that.

Do you have good hypo awareness? Do you wake at night when you have a hypo?

Cheers,
Warwick.

Mar 20, 2014

Warwick 425 posts

Topic: General Discussion / Need to lower BI in the morning, is it a problem?

Hi Dunkers7,

One thing to be careful of is that if you reduce your morning BI, you may eliminate your lunchtime hypos, but your afternoon reading may start to spike instead, so do be careful there.

Another option may be to keep the BI the same, but perhaps have lunch half an hour earlier, or at least do a test half an hour to an hour earlier than lunch and take carbs if it is indicated.

Mar 19, 2014

dunkers7 24 posts

Topic: General Discussion / Need to lower BI in the morning, is it a problem?

Thanks Garry,

That's helpful, I had thought that QA generally wears off after about 3 hours, and after that the problem was more likely to be BI - suppose I may need to be a bit more open minded about this and consider the outcome as you say.

I can also see that, when I'm having hypos well after lunch on a 0.5:1 ratio and my lunch time BG is in target, reducing the morning BI is perhaps the only option for reasonable control, as today and yesterdays results highlight.

Anyway, it's all good stuff! Like I say it's very much a work in progress and there is more than one problem to fix.

Thanks for your help.

Mar 19, 2014

PVT1 6 posts

Topic: General Discussion / BI and morning BG

As promised here is my diary

Frustrated im not cracking it yet, would be so grateful if someone could offer advice

Mar 19, 2014

PVT1 6 posts

Topic: General Discussion / BI and morning BG

Hi
One other quick question, when having a snack do you stick to your dose ratio or just match it 1:1? Therefore if a snack was 5cp would you take 5 units or 10 units if your mealtime ratio is 2:1?

Regards

Mar 19, 2014

Garry 328 posts

Topic: General Discussion / BI and morning BG

Logically no. It wouldn't. Your BI is active and more or less...depending on your individual response to Lantus...in the middle of its delivery time. If you rise by say more than 1 or 2 mmol/L overnight it would be one of two things: - too little BI, or maybe or if you are like the majority of us on here, more insulin resistant on a morning. To wake us up, at some time during the early morning, our body secretes adrenalin or Epinephrine - it's proper name. This makes us insulin resistant, some of us more resistant than others and this slows the absorption and effect of the BI that you have taken. Once the BI is held back, your BG rises as a consequence.
For a night check most of us look to use 3:00 am.......an unGodly hour I know. But this has been chosen, I guess, as it is probably before the start of the impact of any early morning adrenalin.
I'll look out for your diary posting. You are able to share your diary with an individual too using the link at the top right of the diary page under Tools and click Shared Diaries. This also allows Health care Professionals to stay in touch with your ongoing results too.
Regards
Garry

Mar 19, 2014

PVT1 6 posts

Topic: General Discussion / BI and morning BG

Garry
Thanks for the warm welcome.
Would a split dose potentially stop this morn high? I guess I need to wake myself at around 4am and see what my sugars are doing.

Will upload my results this evening

Mar 19, 2014

Garry 328 posts

Topic: General Discussion / BI and morning BG

Welcome PVT1. Smile

Hope you find plenty good support here from your fellow diabetics.
I've learnt many things, over the time that I have used the forum.
Other people's postings on here can give us a supporting insight into how others deal with the joy of being a type 1.
Like you, I used to take a single Lantus dose of something over 60 u....I looked back to my first diary entry on here 23/11/2009 to try and tell you an accurate number...but did not get the answer to my own question...as even then I was using split dose, as for me Lantus lasted 16 to 18 hours and not the claimed duration. My current split is 30u before breakfast and 26u before dinner as I find this usually keeps the BI doses about 12 hours apart.
Please use your online Diary. It can provide you with plenty of help and you will be surprised how much information you can drag out of it to support your efforts.
Regards
Garry

Mar 19, 2014

Garry 328 posts

Topic: General Discussion / Need to lower BI in the morning, is it a problem?

Think of your ratios in another way. A dose of QA, produces an outcome - 4 or 5 hours later. It's the ratio before your high BGs start that needs sorting.
Try and look at your breakfast QA ratio and change for 1.5:1 to 1:1 and spot the pattern over a few days.
Your individual BI dose changes will take 3 days to show an understandable result as normally we respond very slowly to changed BI doses.
You may well be right in that, on a morning your QA+BI acting together very rapidly change your BG, but fixing that is best done by QA alterations which you can see the result of straight away.
May I suggest that you leave your BI alone for now at your original 10 + 11 and focus on QA ratios at meal times to try and get those right.
Shame that on Saturday 15th 22:15 you had CHO and that affected the following mornings BG...or you would have had a good indication as to whether your daily BI dose was roughly right. Ideally most of us look to go to bed and get up on a result which is within 1 or 2 mmol/L of the previous night result.
Stick with it dunkers7...and please take your time making changes. Too rapid...and if you are anything like me, I'll get confused. Doesn't take much to do that to me however Embarassed

Regards
Garry

Mar 19, 2014

PVT1 6 posts

Topic: General Discussion / BI and morning BG

Hi all

This is my first post having completed Dafne last week. I must say the experience was life transforming and I wish I had known this 18 yrs ago when diagnosed.

I have almost cracked the regime, getting stable sugars generally in daytime, however I am consistently between 10-13 on a morning even if sugars are in range before bed. I take one dose of lantus before bed, 43 units (was 56 before dafne). I did fast in the morning a couple of times and sugars seem to hold steady which indicates the right BI dose.

I have seen on here reference to dawn phenom, could I be experiencing this? If so how do I combat it as I really want to get my morning reading nearer to range.

I still have some way to go to getting a really good consistent measure across the board but I already feel better for the new regime. My HBA1C in Jan was 59 which for me was good, but even with this and in hindsight I realise that my stability wasn't as good as it could be so Dafne should help lots.

I haven't uploaded any data yet as I have a weeks worth from last week to upload from my paper diary

Mar 18, 2014

dunkers7 24 posts

Topic: General Discussion / Need to lower BI in the morning, is it a problem?

Hi all,

I'm new to DAFNE and results are very much a work in progress as you will see!

Main thing I want to concentrate on is eliminating the lunch time hypos, which have happened 4/5 days as you'll see, so there is a clear pattern.

My approach so far has generally been to reduce morning BI (Levemir) to try to avoid the hypos and get to a position where I can try a carb free meal at lunch time - that would let me test whether the morning BI is correct or not. Hypos have meant that carb free lunch has not yet been possible as I'll probably go hypo (or have already been hypo) and have to eat, which would confound the results unfortunately. I am now trying a 0.5:1 ratio at lunch time while reducing the BI until I can avoid the hypos.

However, while I am making the changes, I am a little concerned to see how much the morning BI is reduced to now. I foresee that I may get to a point where I am taking hardly any morning BI at all! Is it generally accepted that morning and evening BI doses can be quite different on a Levemir split, or does this go against how the BI is supposed to work?

Mar 18, 2014

Andy Watt 2 posts

Topic: General Discussion / New to dafne

Thanks for that Garry, i'll certainly give it a go

Mar 23, 2014 Warwick 425 posts	Topic: General Discussion / BI and morning BG Nice one. :-)

Mar 22, 2014 PVT1 6 posts	Topic: General Discussion / BI and morning BG Hi My BG before bed last night was 5.8, I increased BI to 50 units and did a 3am test to find it holding steady at 5.6. At 9am it was 5.6 and at lunch it was 5.5 and before tea 5.8. So delighted with today's readings, near perfect. Here's hoping they remain stable and consistent. Will update as I continue

Mar 22, 2014 GR8 5 posts	Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses Hi dunkers7 Thanks for the tips. Not much of a drinker or dancer so usually just chatting and drinking. Can manage spirits no problem just trying to figure out the beer Thanks

Mar 22, 2014 dunkers7 24 posts	Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses Hi GR8, I wasn't carb counting at this point, but in general, I've found bottles of beer raise BG a lot initially then they drop a little later, assuming no QA taken. 3CP sounds about right for Corona. Possibly worth thinking about what you're doing when out too though. How practical taking QA is, if you're likely to be dancing for long periods, that kinda thing? I drink very little now, but when I was a student and in the drinking quite a lot phase, I found spirits a lot easier to manage in social situations since they drop BGs a lot more than they raise them.

Mar 22, 2014 Warwick 425 posts	Topic: Questions for HCPs / BI insulin running out Hello Justin, I switched the other way a few years ago from Humalin to Lantus, and I don't remember it being a problem,although at the time, I was on BI only due to the honeymoon period. Are you taking breakfast around 7 am? If so, then one answer may be to increase your breakfast QA ratio a bit, and push your morning BI time out to 10 am, giving you an extra few hours at the other end of the day before it runs out. This would hopefully coincide with dinner, and you can increase your QA slightly then to get you to your 10 pm BI dose. Another alternative would be asking to switch back to Lantus, or onto another BI like Levemir (although if you were switched off Lantus, then there may have been good reasons for doing so). Lastly, you could split your BI into three injections, with the existing two as is, and a third around midday to see you through to your evening dose. With Lantus, although it is billed at 24 hours, I found that it lasted about 20, and increasing my dinner QA led to hypos. Splitting my Lantus dose into a morning and evening dose solved the issue. For that reason, that third option may be your best option. There would be a bit of trial and error though as to what each BI dose should be. Ideally, you would want to take each dose about 8 hours apart, and then work out if taking a third of your total daily BI for each dose was appropriate.

Mar 21, 2014 GR8 5 posts	Topic: Carbohydrate Counting / Alcohol, carb counting and insulin doses Hi I have just completed the DAFNE course and am just going over calculations for QA insulin to counteract the carbs in beer, etc... I am not a regular or big drinker but will occasionally have a few beers when out. DAFNE state that a pint of lager counts for 1CP. With this in mind I went to look online at carbs in bottles of beer (in particular Budweiser and Corona). Budweiser came back with each bottle is 30g of carbs/ 3CPs. This seems quite high in comparison to rating for a pint of lager. If I was to half my QA insulin ratio and go with these higher figures and they are not correct I am likely to increase chance of delayed hypo, especially if I had a few beers. Does anyone have any advice or experience of carb counting for bottles of beers? Thanks

Mar 21, 2014 Justinjroberts 9 posts	Topic: Questions for HCPs / BI insulin running out I am currently on Humalin I as a BI insulin, taking it at 7am/7.30am and again at 10pm. It covers my levels over night but the last two evenings yesterday and today I experienced a spike into double figures at 5pm, it seems that the BI is only lasting for 10 hours! To correct I had to take Novorapid but very high doses, last night 15 of Novorapid brought my levels down from 15 to 8 and I exeperienced no hypo and ate nothing. I am fairly new to Humalin I having been switched from Lantus four weeks ago. Has anyone else experienced this as I am not keen on having to take such high levels of Novorapid to rectify with such little affect.

Mar 20, 2014 dunkers7 24 posts	Topic: General Discussion / Need to lower BI in the morning, is it a problem? Thanks Warwick, Yes good point about lunch and makes sense on the BI. The plan was always to do some BI testing at lunch time to establish whether reducing BI is the right thing to do. Today, I didn't hypo so some BI testing actually happened. Looks like that morning BI is just about holding now. Bigger picture is, that's an overall drop of 11 on my morning BI dose since starting the DAFNE course last month, so that really has been a big change. Getting there!

Mar 20, 2014 Garry 328 posts	Topic: General Discussion / BI and morning BG If you go back to your diary you can edit individual entries by clicking the time of the entry which gets you into an edit screen. Please take little notice of between meal BGs. These are good for information, as they may help you understand your normal QA uptake times, but if you compensate for these additional results you will stack up QA doses with the outcome that you see. Slowly, slowly. Wait until the meal time and compensate then, if necessary. Try not to make lots of changes. Change one thing at a time and see what happens over a few days and then decide whether or not the change is beneficial. The graphs produced by the diary can be helpful here. Keep up the Ketone checks too, if greater than 13 or 14 mmol/L. You can enter the actual value from your meter but your diary only shows true. Keep an eye on them as a run of high BGs, plus ketones, normally give me forewarning that I'm going to feel sick tomorrow or the day after. Regards Garry

Mar 20, 2014 Garry 328 posts	Topic: General Discussion / BI and morning BG For me, a snack is normally less than 2 CPs and depending on my result immediately before would determine what to do. If normal, or little lower BG at time of snack, I'd usually let it ride to the next meal and if necessary compensate then. I do the pre-meal blood and...for me...pre-meal insulin. I find I need take my insulin before a meal in order to get the Humalog QA active enough in my system, to trim off post-meal spikes in BG. If high before, when contemplating a snack, I wouldn't have the snack. If taking an extra meal I would use the ratio appropriate for that time of day. My ratios currently are: - 2, 2.2 and 2:1, breakfast, lunch and dinner respectively, so not much varaition at the minute. In the past however they have been plenty of changes, the widest range used was 3, 2.5 and 1.5:1 across the day. You will find that you may need adapt and make many changes over time. As long as the results are good...that's fine. Bear in mind though that if you take matching QA for an extra meal and then eat your normal meal within 3 or 4 hours you have to expect an elevated BG. Don't add any compensation QA for the normal meal as you'll likely to be stacking QA doses up which may crash you later. Regards Garry

Mar 20, 2014 PVT1 6 posts	Topic: General Discussion / BI and morning BG Warwick Agree and understand everything you say. I am confident it is DP, as my week doing DAFNE actually lowered my BI from a previous dose of 56 units and the reason for this was a pattern had emerged which showed it was oulling sugars down in the daytime. However, to validate I will do a couple of 3am tests. I do have good hypo awareness and yes I do wake at night when having a hypo although I am usually quite severe. Having said that it is very rare when this happens. My results in the daytime are really confusing at the minute, sometimes they are hovering in the early teens and then seem to drop before tea. But I agree, getting the BI cracked is the key to everything else. If it is the DP, what do I need to do to get better morning readings, or do I just accept it for what it is? Also would be grateful for any advice on my question of snacking and ratios from an earlier post. Thanks all for the advice so far, really appreciated.

Mar 20, 2014 Warwick 425 posts	Topic: General Discussion / BI and morning BG The basic strategy of DAFNE is to get the BI right first, and then tackle QA ratios. Trying to do it any other way just gets frustrating. I'll ignore Saturday, when you had a hypo before bed and carbs and so it will have affected the morning readings. The rest of the readings show that your morning readings are always higher than your before bed readings. There can be two reasons for this: 1) Your BI is too low and increasing it will fix this. 2) You have Dawn Phenomenon (along with most of the rest of us), and if you increase your BI, you will likely hypo during the night while waiting for DP to begin about 3-4 a.m. Given that you already increased your BI recently, you may want to wait another few days to check whether things change for the better or not. If they don't, then I recommend putting up your BI by another couple of units. If you could do a couple of 3 am tests too, it would be helpful in identifying if your BGs are good at 3 am and about to spike due to DP, or if they are high then too, in which case it should be safe to increase your BI. Make getting your BGs before bed and before breakfast within 1.5 of each other, and you can then worry about ratios etc after that. Do you have good hypo awareness? Do you wake at night when you have a hypo? Cheers, Warwick.

Mar 20, 2014 Warwick 425 posts	Topic: General Discussion / Need to lower BI in the morning, is it a problem? Hi Dunkers7, One thing to be careful of is that if you reduce your morning BI, you may eliminate your lunchtime hypos, but your afternoon reading may start to spike instead, so do be careful there. Another option may be to keep the BI the same, but perhaps have lunch half an hour earlier, or at least do a test half an hour to an hour earlier than lunch and take carbs if it is indicated.

Mar 19, 2014 dunkers7 24 posts	Topic: General Discussion / Need to lower BI in the morning, is it a problem? Thanks Garry, That's helpful, I had thought that QA generally wears off after about 3 hours, and after that the problem was more likely to be BI - suppose I may need to be a bit more open minded about this and consider the outcome as you say. I can also see that, when I'm having hypos well after lunch on a 0.5:1 ratio and my lunch time BG is in target, reducing the morning BI is perhaps the only option for reasonable control, as today and yesterdays results highlight. Anyway, it's all good stuff! Like I say it's very much a work in progress and there is more than one problem to fix. Thanks for your help.

Mar 19, 2014 PVT1 6 posts	Topic: General Discussion / BI and morning BG As promised here is my diary Frustrated im not cracking it yet, would be so grateful if someone could offer advice

Mar 19, 2014 PVT1 6 posts	Topic: General Discussion / BI and morning BG Hi One other quick question, when having a snack do you stick to your dose ratio or just match it 1:1? Therefore if a snack was 5cp would you take 5 units or 10 units if your mealtime ratio is 2:1? Regards

Mar 19, 2014 Garry 328 posts	Topic: General Discussion / BI and morning BG Logically no. It wouldn't. Your BI is active and more or less...depending on your individual response to Lantus...in the middle of its delivery time. If you rise by say more than 1 or 2 mmol/L overnight it would be one of two things: - too little BI, or maybe or if you are like the majority of us on here, more insulin resistant on a morning. To wake us up, at some time during the early morning, our body secretes adrenalin or Epinephrine - it's proper name. This makes us insulin resistant, some of us more resistant than others and this slows the absorption and effect of the BI that you have taken. Once the BI is held back, your BG rises as a consequence. For a night check most of us look to use 3:00 am.......an unGodly hour I know. But this has been chosen, I guess, as it is probably before the start of the impact of any early morning adrenalin. I'll look out for your diary posting. You are able to share your diary with an individual too using the link at the top right of the diary page under Tools and click Shared Diaries. This also allows Health care Professionals to stay in touch with your ongoing results too. Regards Garry

Mar 19, 2014 PVT1 6 posts	Topic: General Discussion / BI and morning BG Garry Thanks for the warm welcome. Would a split dose potentially stop this morn high? I guess I need to wake myself at around 4am and see what my sugars are doing. Will upload my results this evening

Mar 19, 2014 Garry 328 posts	Topic: General Discussion / BI and morning BG Welcome PVT1. Hope you find plenty good support here from your fellow diabetics. I've learnt many things, over the time that I have used the forum. Other people's postings on here can give us a supporting insight into how others deal with the joy of being a type 1. Like you, I used to take a single Lantus dose of something over 60 u....I looked back to my first diary entry on here 23/11/2009 to try and tell you an accurate number...but did not get the answer to my own question...as even then I was using split dose, as for me Lantus lasted 16 to 18 hours and not the claimed duration. My current split is 30u before breakfast and 26u before dinner as I find this usually keeps the BI doses about 12 hours apart. Please use your online Diary. It can provide you with plenty of help and you will be surprised how much information you can drag out of it to support your efforts. Regards Garry

Mar 19, 2014 Garry 328 posts	Topic: General Discussion / Need to lower BI in the morning, is it a problem? Think of your ratios in another way. A dose of QA, produces an outcome - 4 or 5 hours later. It's the ratio before your high BGs start that needs sorting. Try and look at your breakfast QA ratio and change for 1.5:1 to 1:1 and spot the pattern over a few days. Your individual BI dose changes will take 3 days to show an understandable result as normally we respond very slowly to changed BI doses. You may well be right in that, on a morning your QA+BI acting together very rapidly change your BG, but fixing that is best done by QA alterations which you can see the result of straight away. May I suggest that you leave your BI alone for now at your original 10 + 11 and focus on QA ratios at meal times to try and get those right. Shame that on Saturday 15th 22:15 you had CHO and that affected the following mornings BG...or you would have had a good indication as to whether your daily BI dose was roughly right. Ideally most of us look to go to bed and get up on a result which is within 1 or 2 mmol/L of the previous night result. Stick with it dunkers7...and please take your time making changes. Too rapid...and if you are anything like me, I'll get confused. Doesn't take much to do that to me however Regards Garry

Mar 19, 2014 PVT1 6 posts	Topic: General Discussion / BI and morning BG Hi all This is my first post having completed Dafne last week. I must say the experience was life transforming and I wish I had known this 18 yrs ago when diagnosed. I have almost cracked the regime, getting stable sugars generally in daytime, however I am consistently between 10-13 on a morning even if sugars are in range before bed. I take one dose of lantus before bed, 43 units (was 56 before dafne). I did fast in the morning a couple of times and sugars seem to hold steady which indicates the right BI dose. I have seen on here reference to dawn phenom, could I be experiencing this? If so how do I combat it as I really want to get my morning reading nearer to range. I still have some way to go to getting a really good consistent measure across the board but I already feel better for the new regime. My HBA1C in Jan was 59 which for me was good, but even with this and in hindsight I realise that my stability wasn't as good as it could be so Dafne should help lots. I haven't uploaded any data yet as I have a weeks worth from last week to upload from my paper diary

Mar 18, 2014 dunkers7 24 posts	Topic: General Discussion / Need to lower BI in the morning, is it a problem? Hi all, I'm new to DAFNE and results are very much a work in progress as you will see! Main thing I want to concentrate on is eliminating the lunch time hypos, which have happened 4/5 days as you'll see, so there is a clear pattern. My approach so far has generally been to reduce morning BI (Levemir) to try to avoid the hypos and get to a position where I can try a carb free meal at lunch time - that would let me test whether the morning BI is correct or not. Hypos have meant that carb free lunch has not yet been possible as I'll probably go hypo (or have already been hypo) and have to eat, which would confound the results unfortunately. I am now trying a 0.5:1 ratio at lunch time while reducing the BI until I can avoid the hypos. However, while I am making the changes, I am a little concerned to see how much the morning BI is reduced to now. I foresee that I may get to a point where I am taking hardly any morning BI at all! Is it generally accepted that morning and evening BI doses can be quite different on a Levemir split, or does this go against how the BI is supposed to work?

Mar 18, 2014 Andy Watt 2 posts	Topic: General Discussion / New to dafne Thanks for that Garry, i'll certainly give it a go