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Mar 9, 2014
Peter
109 posts
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Topic: Questions for HCPs / How to avoid High glucose when travelling In my experience the biggest problems with traveling are caused by time zone differences and dietary differences at the destination. These typically make long distance travel more different than short haul. Based on your DAFNE centre I'm assuming your travel was from UK and so neither of the factors mentioned should have had a large impact. The other possibility may be stress arising from whatever business activities you were undertaking whilst abroad. I certainly find it more difficult to maintain good control whilst traveling, but never to the extent you're describing. If I were to triple my QA I would end up in hospital, but I do find that it's very easy to eat more carbs. than usual at all meals, so do ensure that you are applying the DAFNE principles correctly to each meal. Also do you stick to the same routine whist away e.g. same time of day for BI injection(s), same time difference between QA and eating? For me the latter is always more of a challenge when traveling as when cooking at home I know in advance both when the food will arrive and how many carbs. there will be, allowing insulin to be taken in advance. Neither of these are certain when traveling which results in more post-meal corrections which, in my case, are nothing like as efficient as insulin taken 15-30 minutes before eating.I spent 2 days in Prague last week, and had a couple of readings above 10, but corrected those as usual. This week it's Atlanta, which certainly brings timezones into play, and portion sizes are the usual challenge whilst eating  I've been regularly traveling on business for many years, so it can be done without the extreme measures you suggest.The best solution would be CGMS or a pump. Suggest you discuss that with your HCP at your next visit. However, from personal experience, neither of the solutions are easy to get hold of. However, I'm certain that you should not be having to think about not traveling or not eating whilst away. DAFNE should be giving you the tools to cope. If it is such a concern for you, then talk to the HCPs and push for a pump or perhaps for loan of a CGMS during your next trip to see if that helps. I was lucky enough to have a CGMS on loan for a period of 6 weeks, and learnt more in that time about the management of the condition than I had in the previous 40 years. Good luck. |
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Mar 9, 2014
mum2westiesGill
502 posts
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Topic: General Discussion / Targets - too many BGs out of target Hi,What can I do to get more BGs within my target ranges: Breakfast, lunch, dinner - 4 - 7 Bedtime - 8 - 12 Was thinking of tweaking my ratios: Current ratios for breakfast, lunch & tea - 1:1 (1u to every 10g carbs) |
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Mar 9, 2014
novorapidboi26
1,819 posts
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Topic: General Discussion / mihaela's as glen says, try and take your BI at the same time every day to ensure full coverage over the whole day.....it looks at though you need to test your BI also, as you aren't eating a lot anyway, at least at the start of the week......you should start with the overnight BI...........as starting the day with good numbers means you can carry out another BI test during the day without worrying about higher numbers, as you cant correct when testing your BI.... |
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Mar 8, 2014
Justinjroberts
9 posts
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Topic: Questions for HCPs / How to avoid High glucose when travelling I have just returned form a couple of short business trips: Dublin last week and Amsterdam the previous week. For both trip I was only away from early Wednesday morning returning Thursday evening. On both occasions my blood glucose level hit 10 15 13 10 12 10 while in Amsterdam, then 15 18 13 12 11 10 14 16 12 15 when in Dublin, prior to my travelling my levels where normal 5 and 6 with a 1 to 1 ratio. When in Dublin I doubled and tripled my fast acting insulin and it still had no affect, instead of taking 10 I would take 30 and still it stayed high. I always find I need to up my dosage when eating in hotels and restaurants , however it always goes back to normal and I have never before experienced such a run of very high levels. I would be interested to hear any comments as I can only think on either not travelling or eating nothing while away. The whole experience was utterly unpleasant and made it very difficult to work normally due to the extreme tiredness the high levels caused. |
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Mar 8, 2014
Vickyp
137 posts
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Topic: Carbohydrate Counting / reliable metre readings Hi Brian, I got replacement strips from Abbott, I was sent a letter about it. I didn't notice any lows that I didn't actually feel. The meter in PDM does read lower than my optium meter, but is well within the 20% tolerance between meters! and the new strips haven't shown much difference!I spoke to my pharmacist and they had a blank look on their face but said that they have new strips....July 2015...so a month early! Abbott sent me 600 strips so by the time those run out (2.5 months) the pharmacy should have new ones with dates after August 2015! I am not sure about cgm, I feel the lows before they are too low and rarely go higher than 10. I may have to get a cgm if I get pregnant! Vicky x |
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Mar 8, 2014
dunkers7
24 posts
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Topic: Questions for HCPs / stress Sometimes it can cause both hypos and hypers!The pattern I've found when I go for a 5k run in the evening seems unusual: * BG drops initially, usually by 10 when testing immediately post exercise, assuming no food/drink during the run * 2 hours later, BG goes back up to almost the level it was before I started the run! (I think this is due to the adrenaline) * Overnight, BG will drop by 10 unless I have negatively corrected my levemir for exercise, or eaten some carbs before bed. My BG going back up confused me initially, but it turns out that's just what consistently happens in my case. Only way to know for sure what stress does to your BG is to test it. |
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Mar 8, 2014
Alan 49
284 posts
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Topic: Questions for HCPs / stress As glen4 says: an adrenaline rush can cause high blood-sugars. The adrenaline triggers the liver to release glucagon (?) into the blood because the body assumes you're going to require extra energy. When I go swimming, my BG is always higher afterwards. My HCP explained that going to a swimming bath and meeting people you know etc, can cause the adrenaline rush. |
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Mar 8, 2014
youone
102 posts
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Topic: Carbohydrate Counting / reliable metre readings
hi The tests finally came through with the Secondary diabetes diagnosis, your mind must be at rest now you have a understanding of whats happening, a rare type of diabetes, i'm sure the doctors will look after you. maybe a CGM would help with them lows giving you a warning before it happens. the USA seems to be well ahead of us in D devices, Our advantage is we don't pay in full for our pumps etc. I'm glad for you, its always more a worry not knowing what you've got. I got this post, its QA with abbott regarding the recent recall. since your a omnipod user it maybe useful to you. although it's mainly for the USA users On Friday, I had the opportunity to speak with Jessica Sachariason, the Public Affairs Manager for Abbott Diabetes Care. I relayed to her the different complaints and concerns that I had heard, and I also asked her a series of questions that I felt Abbott had not yet addressed. However, she had to go back and get the "proper" answers to meet Abbott's legal department's requirements, so the answers are somewhat formal and stilted. That being said, I feel a bit better knowing that Abbott has now heard at least some of the complaints and issues that arose from this recall. ~*~ What was the issue that caused the erroneous low blood sugars? Was this a technical defect or was it a quality control issue? Why does the Freedom meter work but not the PDM or the older meters? The root cause has been determined to be a strip manufacturing process error, which only expresses when a strip is used with a non-applied voltage meter (FreeStyle, FreeStyle Flash, and the FreeStyle meter built into the Omnipod system). The manufacturing error causes a decreased response in the system glucose readings. Meters, such as the FreeStyle Freedom, with applied voltage are not impacted and do not express a decreased response in the system glucose readings. What has been done to resolve this issue? Abbott has implemented additional quality control processes. At Abbott, the health and safety of patients is our highest priority. The replacement test strips provided to OmniPod users have undergone additional quality testing to ensure they produce accurate results. Going forward, all test strips will receive this testing. How long had Abbott known about the defect? Does this stem from the November 2013 recall of your test strips? Following the conclusion of the investigation linked to the November recall, Abbott expanded the recall. Abbott contacted the FDA and promptly initiated a product recall in affected markets and has communicated with all affected parties. How will customers know they are getting accurate test strips moving forward? Strip vials with expiration dates of August 2015 or after are strips that are safe for you to use with your OmniPod. Strips with expiration dates before August 2015 should not be used with your OmniPod, but can be used safely with a FreeStyle Freedom meter. Are you working with pharmacies to prevent old test strips from going to customers who don’t have the Freedom meter? Are pharmacy stocks being replaced with the new test strips? When is it safe to reorder test strips? Approximately 99 percent of the U.S. customer base who use Abbott’s FreeStyle family of meters are not impacted as they do not use FreeStyle Flash or FreeStyle Blood Glucose Meter systems. In regards to the question about the replacement strips for OmniPod users, the 400 replacement test strips will be about a 2 – 3 month supply of strips. This amount should cover the customer until the customer’s next visit to the pharmacy to replenish their next test strip supply. Due to these factors, there is no action required by doctors, pharmacies, and suppliers. If an HCP, pharmacy or supplier has a question, they should contact Abbott’s diabetes care customer service and a representative will provide support. As mentioned above, strip vials with expiration dates of August 2015 or after are strips that are safe for you to use with your OmniPod. Strips with expiration dates before August 2015 should not be used with your OmniPod, but can be used safely with a FreeStyle Freedom meter. |
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Mar 6, 2014
Vickyp
137 posts
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Topic: Questions for HCPs / stress Katrin3014 I've had hypos during periods of stress; as far as aware generally it causes hypers but in some individuals it can cause hypos |
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Mar 6, 2014
glen4
46 posts
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Topic: Questions for HCPs / stress
Yeah I've had that before! I've been 8.0 before my run. I've covered 8 miles in warm weather fairly quickly! Then to my amazement I've been 16.4!? I've expected it to be lower or around the 4.0-5.0 range! A couple of HCP'S have said it could be an adrenaline rush!? It varies from person to person! It doesn't happen every time! Did you get a rapid/sharp fall later in the day? |
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Mar 5, 2014
dunkers7
24 posts
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Topic: Questions for HCPs / Think my Novorapid is too slow! Sheila, do you use Background Insulin? I wonder if you could be taking too much BI but not enough QA?Could maybe try a carb free meal to check? If taking too much BI but not enough QA, I would be expected that you to see rising blood glucose after meals, followed by a steady drop? I ask because I now know I have been taking too much BI and am seeing similar behaviour. Also now starting to see I'll need a QA:CP ratio change as the BI drops. |
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Mar 5, 2014
Garry
328 posts
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Topic: Questions for HCPs / new to dafne Tuesday 04/03 - your corrections have not worked...as you may be insulin resistent at the moment.Do you have a cold coming on today? I personally find that two days before I get an infection, my BGs start to drift off. That may be what is happening for you too. Anyway, I see lots of green in your diary and that's good. OK a few bumps along the way...but if you use the graph facility after you have entered data it helps you see an averaged result for each time of day and assists in seeing the trends better. I notice that Thursday 27/02 and Friday 28/02 both show your BI dose. I take it only one 10u was taken? We need get the data right as in the background, the diary can help you total your daily intake of QA and BI using the Show Summary View hyperlink at the very top of the diary page. This is of help if you need apply sick day rules at any time. You are on the right track. Frustrating I know, for things not to pan out immediately, but that's the way it is. So many factors are in the mix in your body - hormones, food types and their associated GIs, exercise and hormone released during exercise, illness.....I could carry on! You are doing fine. Tuning in progress...until the temperature changes and then like a piano you are out of tune again! Just stick at it. Regards Garry |
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Mar 4, 2014
glen4
46 posts
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Topic: General Discussion / mihaela's You don't seem to have a set time/routine for your BI in the evening! Maybe try injecting the BI at tea-time? Around 1800hrs maybe?
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Mar 4, 2014
mihaela
7 posts
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Topic: General Discussion / mihaela's normal |
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Mar 4, 2014
hannahlaw
4 posts
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Topic: Questions for HCPs / new to dafne Ive uploaded my diary since reducing my background to 10u but I still seem to run high and not in target despite my corrections! Should I up my bi to 12u? I dont want to be running high and out of targetThanks for your reply also Garry. I hope to get some more advice based on my results above Cheers hannah x |
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Mar 4, 2014
MicheleW
2 posts
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Topic: General Discussion / BG drop Thank you very much for your reply Warwick, I greatly appreciate all the information you have given. I will continue to monitor my levels and see if it happens again! |
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Mar 4, 2014
Garry
328 posts
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Topic: Questions for HCPs / new to dafne Welcome hannahlaw Some consultants suggest dropping BI by 20% to ensure that you see the result. Your HCP team are of the same mindset. Please give it time. Don't make changes on the back of one overnight result. You dinner may have been slowly digested and, and, and....lots of things get in the way. The body is a mighty complex thing and takes time to adjust. As Warwick suggested, a minimum of 3 days with consistent results to review to help you decide. Regards Garry |
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Mar 4, 2014
hannahlaw
4 posts
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Topic: Questions for HCPs / new to dafne Hi warwick.This is my diary the week I was on my dafne course and because my hypo was at 2.2 it took me ages to get back out of it plus I dont always have a breakfast and although I may sit on target or near enough on target at night I always seem to creep up during the day with a carb free breakfast then find myself correcting alot and thats why the dafne team and I decided to drop bi by 4 units as was suggesting I had too much insulin if that makes sense? Last night I went to my bed at 5.3 and woke up this morning at 11.7 which would suggest I dont have enough bi to keep me stable through the night?? Last night being my 4th night of reducing my bi I think tonight I will change to 12 units and continue for the next week to see the difference in my resulys when waking in the am! Thanks for your reply. Will upload diary in a few days and see if it makes a difference! Hannah x |
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Mar 4, 2014
Warwick
423 posts
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Topic: General Discussion / BG drop Hi Michele,There are a few possibilities. If your meal was really high GI, then you may have already absorbed all the carbs you had for dinner, but your QA is still working with not enough carbs to use it up on without dropping your blood glucose. If you have exercised previously in the day, or even the day before, then it is known that hypos can occur for up to 48 hours after that exercise, especially strenuous exercise. Stress tends to send BGs higher, so if you suddenly relaxed, then your stress-induced insulin resistance may have disappeared and dropped your BGs as a result. Alcohol can lead to hypos as the liver is occupied with breaking it down, and only once it has done that can it get on with its normal function. And sometimes it just happens for no apparent reason, If it is happening regularly, then that is cause for concern, but if it is a once-off, then I wouldn't worry about it. |
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Mar 4, 2014
Warwick
423 posts
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Topic: Questions for HCPs / new to dafne Hi Hannah, and welcome to DAFNE.I suspect that your Friday BI dose actually happened on Saturday, otherwise you took 10 units of BI twice only a couple of hours apart and with no hypos afterwards, that seems unlikely :-) Lantus isn't particularly responsive to changes and can take up to three days before you see a pattern change. Can I ask why it was dropped by 4 units? The golden rules of DAFNE suggest changing BI by only 10% or 1-2 units at a time. 10% of 14 is 1.4, so you would usually only be looking to drop it by 1-2 units to 12 or 13. It may be though that there was a really good reason for dropping it by more than that. Based on your diary, I don't think that you need to split based on what is shown so far. I would suggest increasing BI to 12 or 13 units though and leaving it for three days to see what happens. I am on Lantus myself, and I split it about a year ago. The reason I did that was that previously I was on a before bed once daily BI injection, but I found that my BGs would rise between having a meal and going to bed. Increasing my QA ratio caused me to have hypos, so it became apparent that my BI was running out early, hence the need to split the dose. There isn't enough data yet in your diary since you dropped the BI to tell if this is happening with you. It will be interesting to see your diary a week after increasing the BI to 12 or 13. If you do decide to split it, it needs to be done carefully to avoid hypos or hypers. Basically, it involves dropping a unit from your evening BI injection and adding it to the morning injection, You keep doing that until you are happy with the splits. You don't necessarily need to do half and half. If you find that 12 units of BI are what you need each day, you could have two lots of 6, or one of 4 in the morning and one of 8 at night depending on your needs. Cheers, Warwick. |
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Mar 3, 2014
HelenP
218 posts
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Thanks Susan, I have heard of the Calorie King before but as I had no need did not pay much attention. I am finding the whole iPad thing a tad daunting but I will persevere. Grandchildren in hysterics sort of daunting! Son-in-law will have me sorted before he goes home next Saturday! #1 grandson has contracted to teach me how to use the App in a morning. Granddaughter (older/wiser?) thinks it will take much longer. Thanks for your help. Helen |
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Mar 3, 2014
susanh
20 posts
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Topic: DAFNE Online Mobile / Advice: iPad (mini) Apps. Hi Helen,The DAFNE Online App has links to the Australian DAFNE CP List (in the Settings, just choose your CP List Country as Australia). Beyond that, a quick search of the App Store will show you that there are definitely lots of carb counting apps out there but unfortunately for us in Australia, many of them are US or UK-based so we find that the foods and/or values can be quite different. Our dietitians often recommend the Calorie King app (only on Apple devices) as it is one of the most comprehensive carb counting apps around, and it is Australian. You could also look up the Traffic Light Guide app (also known as the Australian Carb Counter; available with Apple & Android) as this is also Aussie-based. I'm sure the other grads will have some more suggestions for you too! Cheers, Susan |
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Mar 2, 2014
hannahlaw
4 posts
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Topic: Questions for HCPs / new to dafne Ive just completed dafne this week and it seems I was on too much BI (14u lantus) at night and would drop or hypo! So reduced BI to 10u and it seems im climbing from night to morning plus with a carb free b/fast I still climb yet the rest of the day im near enough on target and my corrections work. We were discussing changing my BI to split insulin do you think its still to early to tell from looking at my diary? Any help would be gratefulHannah x |
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Mar 2, 2014
HelenP
218 posts
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Topic: DAFNE Online Mobile / Advice: iPad (mini) Apps. Hi,I have just been given an iPad Mini and my son in law is anxious to set me up. I really have NO idea (I do not own a Smart Phone) but he tells me that there must be Apps that would help with the diabetes. We tried to find stuff but I was not able to recognise what I wanted. I am looking for an App that will allow me to go to a known restaurant (e.g. MacDonalds) and get carb values for what i order. Similarly for non chain restaurants but also in everyday situations. I think I will use this mainly when travelling. Any ideas/recommendations? Not interested in recording BGs etc as I am on a pump but would love access to reliable carb values. Helen |