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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

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

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

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

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

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

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

Mar 18, 2014

Garry 328 posts

Welcome Andy Watt Smile

Good outcome for you I'm pleased to see. Tackle the hypos as soon as possible.
Take it steady. Ensure some consistant days worth of results between dose changes as most people find outcomes can be a little unpredictable over short time scales.
When you get things under control you may feel confident enough to run a little high for three months to help try and re-establish your hypo warning symptoms. This tactic certainly worked for me.
Regards
Garry

Mar 18, 2014

Andy Watt 2 posts

Hi Lucy, I have just done the DAFNE course Mon - Fri last week and I also had my BI changed from Lantus to Levemir. I work 12 hour shifts and most of my low BG results happen at my work, I also have no Hypo awareness at all. I went back to work on Saturday night, and because I work 7 till 7 day or night, we decided to go for 06.30 and 18.30 for my Levemir injections, I was on 20 units of Lantus so I started on 10 units of Levemir am/pm, when I take my injection before I start my shift I only take 8 units and because my job is really physical I was told to knock 1 unit off my QA injections, I still had a few really low BG results (1.4 + 1. Cool

on Saturday so on Sunday night I knocked 3 units off my QA injections and when I got home yesterday morning I was sitting at 8.6 , which I was really happy with. I'm going to stick with that theory when i'm working and see how I get on... Hope you get sorted, mind it will take time to get what works best for you .

Mar 17, 2014

Lucyx78 11 posts

Thanks so much for the advice and support. I'm really hoping it works for me. I'm a little frustrated with my BG readings at the moment but like you said it was an absolute eye opener the DAFNE course.

Mar 17, 2014

Robert P 1 post

Mollymynett- Keep with it, I did the course a couple of months ago now, still I have those 'up & down days.' I've been diagnosed for only 2 years and have only every been on the twice a day insuline (I'm rubbish with insulin names!). The DAFNE course was amazing, real eye opener.You will get there.

Mollymynett said:
Hi I've just recently done the dafne . I've been an insulin dependent diabetic for 33years . Since I was 3 .ive had my ups and downs . Feeling a little down as changed from lantus to lev emir now twice daily . Can't seem to get my levels down from double figures . Feeling slightly frustrated is this normal . Thanks in advance

Mar 16, 2014

alturn 78 posts

Sorry if I appear vague but always wary of offering advice in case it causes problems - and everybody is different.

First I would ignore readings during DAFNE course - different timings, activities, brain activity, DAFNE course etc.

Dropping 26+20 to 14+14 seems a large change at one go to me, but that's done so onwards and better BG Exclamation

, it's all for the best for you.

If you can get your BI so you change between meals/overnight is about +2/-2 (DAFNE target) then your BI is probably correct - change am or pm and monitor for 2/3 days, may need to have carb-free meals. When BI is stable, then adjust your ratios. That's the theory. This is not a quick process, so keep at it, I still find it very difficult to accept I have to change QA/BI. So often there is no correct answer, so we just have to make a decision and get on with it - any decision may be better than none.

When high (over 10 in my opinion), insulin may nor work the same so you may need larger adjustments to bring it down. You could publish your BG diary which might help others to advise (assume you input your readings, possibly in a new forum)?. And continuous adjustments probably means BI is incorrect.

Work (I used to do that), physical or mental, can affect you by causing highs and lows, so yes - trial and error. Have you looked at other forums to see if there is anything you could learn? You may need different regime for work/not work.

Best wishes for your first day at work. Laughing

Mar 16, 2014

Lucyx78 11 posts

Hi
Thank you for your reply and advice. Yeah I am on am and pm levemir. My diabetes specialist nurse dropped my am from 26 units to 14 and 20 units to 14. All last week whilst on the course they were reading high. I've increased my pm BI to 16 and the am has come down slightly but still not within range. Would you also suggest increasing my am BI first before I increase QA to see if it had an affect on day time Bg? I am doing corrections with every meal I have but not having much affect. And these high readings make me feel a bit rubbish. I go back to work tomorrow and it's quite an active job so I will also have to consider how that has an effect on my BG. Trial and error. I suppose

Mar 16, 2014

Lucyx78 11 posts

Hi
Thank you for your reply and advice. Yeah I am on am and pm levemir. My diabetes specialist nurse dropped my am from 26 units to 14 and 20 units to 14. All last week whilst on the course they were reading high. I've increased my pm BI to 16 and the am has come down slightly but still not within range. Would you also suggest increasing my am BI first before I increase QA to see if it had an affect on day time Bg? I am doing corrections with every meal I have but not having much affect. And these high readings make me feel a bit rubbish. I go back to work tomorrow and it's quite an active job so I will also have to consider how that has an effect on my BG. Trial and error. I suppose

Mar 16, 2014

alturn 78 posts

Welcome

I wouldn't be concerned about HBA1C (it's a long term test) but concentrate on BG and adjust according to DAFNE rules - if BG is within range and avoiding hights and lows, HBA1C should come within target. This may take several months - think my best HBA1C was a year after DAFNE (Sep 2012). After DAFNE my aim was to reduce the highs (causing blurred vision, not occurred since DAFNE) and lows (2.0 and less) and my HBA1C eventually came down to virtually perfect - but since then I've had a relapse. It's a bit of a game - me versus BG!

I also had to increase my Levemir after DAFNE (from 16 pre-DAFNE now at 24 per day split am and pm) which took some time to show up. The timing of Levemir may also affect BG.

BG/HBA1C may depend on external factors - stress, different regime, even getting used to DAFNE from what you did before, eating differently.

If your levels are reasonably consistent it's probably easier to fix.

If high am and lunch time, possibly need to adjust evening Levemir (assuming you are on on Levemir am and pm, and QA for meals). Remember BI changes can take a few days to show up in BG.

Hope this make sense and helps.

Mar 16, 2014

Lucyx78 11 posts

Hi
I am a new dafne graduate I completed the course last week. I am just wondering how long roughly does it take to notice real changes to hba1c ? I am still adjusting my levemir at the moment as my morning and before lunch time readings are in double figures.
If anyone can give any advice I would really appreciate it

Mar 16, 2014

Glock87 2 posts

Thanks for the replys guys

Mar 16, 2014

Warwick 423 posts

Hi Mark,

Best to use trial and error. If you find your BGs go high on a lower ratio, then up the ratio until you get results you like. Shift work can alter so many different things in your body that it is impossible to say without seeing what happens from trial and error.

When I did shift work, I only needed 5 hours sleep per day, but when I switched back to day shift, I would need 8 or 9. That can have a big effect on blood glucose levels and ratios.

Cheers,
Warwick.

Mar 14, 2014

alturn 78 posts

You could try 2.5:1.

Or use the ratio of the meal nearest to your "late" meal, possibly adjusting.

If you have two meals, and QA insulin for each, and the the second QA is taken while the first QA is still persists (believe QA persists for 4-5 hours) is there a risk of hypo, especially as ratios are highish? Perhaps someone else can clarify?

Mar 14, 2014

Glock87 2 posts