Recent Posts - DAFNE Online

Oct 10, 2013

hannahdefries 12 posts

Topic: General Discussion / Exercise & BG levels

Im still very unsure of where I am going wrong with this, I was away for 1 week so didn;t have much exercise at all and was having to 'guess' my cp's as was on holiday so my BG were a little crazy at times. I can go to sleep on a 5.8 and then i wake on around 12.. Yet other mornings i will wake on 5.5 for example! My levels 9 times out of 10 are high before exercise so i am still taking 3 or 4 units before i run, then i test when im back and often around 10-14, I then correct with my breakfast and am normally okay around lunch time.

Oct 10, 2013

Garry 328 posts

Topic: General Discussion / Milking fingers causes low BG readings

Yes I'm sure that your meter information is correct as anything that takes up volume - as marke suggests - in a small sample is going to 'dilute' that sample and give a lower result.

When you finger ends are tender though and look like pin cushions there is no way that I would deepen the stab.

Yes, I encourage blood out of my fingers always. With this consistant approach I get reproducibility of results.
Recognising that BG meters do not give absolute mmol/L values and that so many factors affect the meter result I am satisfied to have reliable, repeatable numbers.
I use an Abbott Optium Xceed meter, the blood sample is only a tiny one - 0.6 Î¼L and I found results varied even between barely wetting the strip and giving it a large dollop of blood. Small blood samples gave lower results than large blood samples.
Unwashed hands gave remarkably different results from clean, dry hands.
So I just try and reproduce a consistent same size sample all the time from washed and dried hands.
With fingers feeling the way mine do - thatâ€™s a small blood sample from a minimum stab depth.
Regards
Garry

Oct 9, 2013

novorapidboi26 1,819 posts

Topic: General Discussion / Milking fingers causes low BG readings

if you prick your finger and there just isn't enough, a little encouragement it better than another stabbing.........lol

Oct 9, 2013

marke 686 posts

Topic: General Discussion / Milking fingers causes low BG readings

my understanding and it could be wrong, is that if you squeeze the blood out you could also squeeze out subcutaneous matter that affects the reading. This is why they say don't milk...
That said I too do it, its one of those things that the medical profession think patients don't do, that in reality they do all the time Laughing

Oct 9, 2013

JayBee 587 posts

Topic: General Discussion / Milking fingers causes low BG readings

I've also heard that it generally skews the BG result.

I've outright ignored this though. Blood is blood as far as I'm concerned.

Oct 9, 2013

Alan 49 284 posts

Topic: General Discussion / Milking fingers causes low BG readings

I can't see how massaging your finger can decrease the blood-sugar readiing.

Perhaps an HCP could answer that.

Oct 9, 2013

novorapidboi26 1,819 posts

Topic: General Discussion / Basal Testing - nighttime

The 3am time is just a guide to be honest. It represents a time where the blood stream will have minimum influence from other hormones, specifically those which occur in the morning when your body starts to wake up, so those hormones associated with the dawn phenomenon.

So if you were testing your blood sugar at this time it would be to establish whether or not your blood sugar has been held steady overnight, before the dawn phenomenon actually starts, which is important information when deciding whether or not to increase your overnight basal dose.

For general basal testing its actually most effective to test your blood sugar every hour..........so if you have confirmed that you are experiencing the dawn phenomenon but still want to check if your basal dose is correct, then testing before bed and at 3am would give a good indication. Any time after that wouldn't be accurate as your blood sugar may be rising due to events not in your control.......

That's was a bit long winded, sorry, ultimately it may not matter if you tested at 3am or 3:43. Everyone's hormonal release can start at different times you see, some earlier than 3am, some later, depends on the body clock and when you get up in the morning....

What was your pre bed and 3 am test results last night ?

Oct 9, 2013

mum2westiesGill 502 posts

Topic: General Discussion / Basal Testing - nighttime

Should this be done at exactly 3:00am or can it be up to so many minutes either side?

I did one last night when I woke up to go downstairs which was 3:43am.

Oct 9, 2013

novorapidboi26 1,819 posts

Topic: General Discussion / Milking fingers causes low BG readings

Lol....I think there's more than enough blood in there.....

Increase the lancet depth setting....

That's if you actually think that milking it makes a significant difference....

I don't.... Smile

Oct 9, 2013

novorapidboi26 1,819 posts

Topic: General Discussion / Milking fingers causes low BG readings

Lol....I think there's more than enough blood in there.....

Increase the lancet depth setting....

That's if you actually think that milking it makes a significant difference....

I don't.... Smile

Oct 9, 2013

Louise1988 69 posts

Topic: General Discussion / Milking fingers causes low BG readings

I have to milk my fingers, I don't have enough blood to let it come out on it's own!

Oct 9, 2013

Jimandbillow 8 posts

Topic: Questions for HCPs / Insulin on board algorithms in pumps

Thanks for the reply novorapidboi26. I agree about the scenario being fairly uncommon, but possible if you were to do some light/unexpected exercise or unknowingly overestimate your insulin etc between the 2 meals. I am just not sure why the pump wouldn't take the IOB into account for every dose instead of just when a greater correction dose is needed.

Have you tried rapid calc app for iphones? I think this has better algorithms set within it.

Oct 8, 2013

izzi1234 5 posts

Topic: General Discussion / Diet Drinks

diet coke is all that is available near me .

I think diet lemonade should be sold in pubs and restaurants.

I dont mind diet coke but its got a lot of caffeine in it

Oct 8, 2013

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Insulin on board algorithms in pumps

If no correction is suggested when you test mid meal, this means that the IOB is sufficient..........

Maybe if the difference between the correction is less than 1 it might just suggest the food insulin only.......

I need to set up the above scenario for myself.......its very rare for me to be lower than I thought mid meal, unless there is alcohol in my system......

Oct 8, 2013

novorapidboi26 1,819 posts

Topic: General Discussion / Milking fingers causes low BG readings

I have heard people on the diabetes support forum say its best to let it come out on its own.......

personally I don't take much notice, it has never seemed to cause me problems.........the meters are hardly that accurate anyway......... Very Happy

Oct 8, 2013

novorapidboi26 1,819 posts

Topic: General Discussion / afternoon hypos

usually if your background insulin is a single dose and its doing an important job like holding off the DP, then you should consider reducing your lunch ratio, or as you say taking a unit off your lunch dose would be worth a shot...... Very Happy

you say in your comments you don't get hypo warnings anymore, for that reason alone I would personally drop the BI so as to increase your levels throughout the whole day........

have you discussed options to regain your hypo awareness with you diabetic team...............?

Also, considering a split dose of BI is much more flexible, especially when varying levels of activity are concerned.......

Oct 8, 2013

john m 15 posts

Topic: General Discussion / afternoon hypos

keep having hypos in the afternoon only mon-fri well im in work sat /sun is ok maybe because im less active at weekends decreasing my bl could give me high bg reading in the morning because i suffer with dawn phenomenom or could i do 1 unit less at lunch not sure what to do ?

Oct 8, 2013

Alan 49 284 posts

Topic: General Discussion / Milking fingers causes low BG readings

The User Manual that came with my Mendor Discreet BG meter says that when testing BGs, milking the finger to get the blood 'may cause low test results'.

I've never heard this before - is this true?

Oct 8, 2013

Jimandbillow 8 posts

Topic: Questions for HCPs / Insulin on board algorithms in pumps

Thanks for the responses guys....

Davey38 - your comment 'Active Insulin means there has been a correction' is only applicable to the roche pump as roche only count correction insulin as active insulin. Medtronic and every other company count any insulin taken as active insulin.

novorapidboi26 - Medtronic will only subtract the active insulin from the correction part of a dose if the correction is greater than the IOB. So if no correction is needed the pump will not subract the IOB from the bolus suggestion, which personally I think is wrong as it could lead to a hypo in the scenario explained above.

Oct 8, 2013

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Insulin on board algorithms in pumps

I am also on a Medtronic pump, the paradigm 754........

your pump should only recommend you take the full 3.0 units if the correction of the 7.0mmol equals that of the remaining insulin....I think..........

I would love to confirm but I have no more insulin left and I am 4.2......

Does your pump not subtract the active insulin and then add a correction (which can also be negative)...?

Oct 8, 2013

Davey54 8 posts

Topic: Questions for HCPs / Insulin on board algorithms in pumps

Hi Jim, I use a ACCU-CHEK COMBO.
Active Insulin means there has been a correction, so that's gone don't worry. The 6 units of insulin you had is at it's peak 2 hours after. Therefore, if I was you I wouldn't have any insulin with the 30g carbs, to do so causes what's called STACKING and will probably cause an hypo. Remember that no insulin with the 30g will increase your BG level, better that than an hypo. It will be corrected the next time you test and take on carbs.
Ultimately you have to do what you're comfortable with. GOOD LUCK!

Oct 8, 2013

Louise1988 69 posts

Topic: General Discussion / 3am tests

Hi Garry, thanks for your reply. I'm currently on just 8u of levemir, which I take at 9pm. I'm wondering whether I need to lower this, as I keep getting hypos during the day, so I'm trying to see how much of an effect my basal rate has on the rest of the day. My morning rates aren't too bad, around 5-6. I'm only on tiny doses as it is, and just want to get my levels up. Will post in a few days and let you know.

Oct 8, 2013

Garry 328 posts

Topic: General Discussion / 3am tests

Carb free dinner is not necessary Louise1988.
Take your dinner as normal with the matching QA. BI dose as normal, at normal time.
You are only checking that your BI is right. We all need an established background insulin level to keep us ticking over, especially when comparatively inactive. So I hope you find that your before bed, 3 am and before breakfast BGs are ideally within 1 mmol/L â€“ donâ€™t fret if they are not though. No changes really necessary if they are pretty even. You do need plenty of days results to compare with one another though as lots of other things get in the way of our understanding the body - it is a dynamic â€˜fickleâ€™ machine.
You may wish to post again in a week or so when you have data. Please let us know your particular BI and typical dose/s. Currently, I split Lantus 27u at 06:30 and 27u 18:00 to 19:00. But Iâ€™m sure someone here will be able to advise you better, if using your type of BI.
Regards
Garry

Oct 8, 2013

Jimandbillow 8 posts

Topic: Questions for HCPs / Insulin on board algorithms in pumps

Hi...

I have a question about bolus advice when there is active insulin involved. I use a Medtronic pump.

Here's a scenario...

My carb ratio is 1u:10g, my correction factor is 1u:3mmol/L, BG target 6.5mmol/L

My BG is 6.5 and I eat 60g food and take 6u of insulin. In the next 2 hours I do a little exercise but nothing too dramatic. I then decide to have 30g (3u insulin) of food which is 2 hours after the 6u I took. I test my BG and they are 7.0mmol/L. Clearly I have insulin still working (approx 2.3 units). My pump will still suggest that I take the full 3u even though it will show that there is insulin on board. Why? Should it not take my lower than expected BG levels into account and suggest something like a 0.9 U dose?

It appears that most calculators use an algorithm similar to this but I don't see the reasoning behind this as in this scenario that is not unusual, I will clearly have a hypo if the full dose is taken.

Thanks

Oct 10, 2013 hannahdefries 12 posts	Topic: General Discussion / Exercise & BG levels Im still very unsure of where I am going wrong with this, I was away for 1 week so didn;t have much exercise at all and was having to 'guess' my cp's as was on holiday so my BG were a little crazy at times. I can go to sleep on a 5.8 and then i wake on around 12.. Yet other mornings i will wake on 5.5 for example! My levels 9 times out of 10 are high before exercise so i am still taking 3 or 4 units before i run, then i test when im back and often around 10-14, I then correct with my breakfast and am normally okay around lunch time.

Oct 10, 2013 Garry 328 posts	Topic: General Discussion / Milking fingers causes low BG readings Yes I'm sure that your meter information is correct as anything that takes up volume - as marke suggests - in a small sample is going to 'dilute' that sample and give a lower result. When you finger ends are tender though and look like pin cushions there is no way that I would deepen the stab. Yes, I encourage blood out of my fingers always. With this consistant approach I get reproducibility of results. Recognising that BG meters do not give absolute mmol/L values and that so many factors affect the meter result I am satisfied to have reliable, repeatable numbers. I use an Abbott Optium Xceed meter, the blood sample is only a tiny one - 0.6 Î¼L and I found results varied even between barely wetting the strip and giving it a large dollop of blood. Small blood samples gave lower results than large blood samples. Unwashed hands gave remarkably different results from clean, dry hands. So I just try and reproduce a consistent same size sample all the time from washed and dried hands. With fingers feeling the way mine do - thatâ€™s a small blood sample from a minimum stab depth. Regards Garry

Oct 9, 2013 novorapidboi26 1,819 posts	Topic: General Discussion / Milking fingers causes low BG readings if you prick your finger and there just isn't enough, a little encouragement it better than another stabbing.........lol

Oct 9, 2013 marke 686 posts	Topic: General Discussion / Milking fingers causes low BG readings my understanding and it could be wrong, is that if you squeeze the blood out you could also squeeze out subcutaneous matter that affects the reading. This is why they say don't milk... That said I too do it, its one of those things that the medical profession think patients don't do, that in reality they do all the time

Oct 9, 2013 JayBee 587 posts	Topic: General Discussion / Milking fingers causes low BG readings I've also heard that it generally skews the BG result. I've outright ignored this though. Blood is blood as far as I'm concerned.

Oct 9, 2013 Alan 49 284 posts	Topic: General Discussion / Milking fingers causes low BG readings I can't see how massaging your finger can decrease the blood-sugar readiing. Perhaps an HCP could answer that.

Oct 9, 2013 novorapidboi26 1,819 posts	Topic: General Discussion / Basal Testing - nighttime The 3am time is just a guide to be honest. It represents a time where the blood stream will have minimum influence from other hormones, specifically those which occur in the morning when your body starts to wake up, so those hormones associated with the dawn phenomenon. So if you were testing your blood sugar at this time it would be to establish whether or not your blood sugar has been held steady overnight, before the dawn phenomenon actually starts, which is important information when deciding whether or not to increase your overnight basal dose. For general basal testing its actually most effective to test your blood sugar every hour..........so if you have confirmed that you are experiencing the dawn phenomenon but still want to check if your basal dose is correct, then testing before bed and at 3am would give a good indication. Any time after that wouldn't be accurate as your blood sugar may be rising due to events not in your control....... That's was a bit long winded, sorry, ultimately it may not matter if you tested at 3am or 3:43. Everyone's hormonal release can start at different times you see, some earlier than 3am, some later, depends on the body clock and when you get up in the morning.... What was your pre bed and 3 am test results last night ?

Oct 9, 2013 mum2westiesGill 502 posts	Topic: General Discussion / Basal Testing - nighttime Should this be done at exactly 3:00am or can it be up to so many minutes either side? I did one last night when I woke up to go downstairs which was 3:43am.

Oct 9, 2013 novorapidboi26 1,819 posts	Topic: General Discussion / Milking fingers causes low BG readings Lol....I think there's more than enough blood in there..... Increase the lancet depth setting.... That's if you actually think that milking it makes a significant difference.... I don't....

Oct 9, 2013 novorapidboi26 1,819 posts	Topic: General Discussion / Milking fingers causes low BG readings Lol....I think there's more than enough blood in there..... Increase the lancet depth setting.... That's if you actually think that milking it makes a significant difference.... I don't....

Oct 9, 2013 Louise1988 69 posts	Topic: General Discussion / Milking fingers causes low BG readings I have to milk my fingers, I don't have enough blood to let it come out on it's own!

Oct 9, 2013 Jimandbillow 8 posts	Topic: Questions for HCPs / Insulin on board algorithms in pumps Thanks for the reply novorapidboi26. I agree about the scenario being fairly uncommon, but possible if you were to do some light/unexpected exercise or unknowingly overestimate your insulin etc between the 2 meals. I am just not sure why the pump wouldn't take the IOB into account for every dose instead of just when a greater correction dose is needed. Have you tried rapid calc app for iphones? I think this has better algorithms set within it.

Oct 8, 2013 izzi1234 5 posts	Topic: General Discussion / Diet Drinks diet coke is all that is available near me . I think diet lemonade should be sold in pubs and restaurants. I dont mind diet coke but its got a lot of caffeine in it

Oct 8, 2013 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Insulin on board algorithms in pumps If no correction is suggested when you test mid meal, this means that the IOB is sufficient.......... Maybe if the difference between the correction is less than 1 it might just suggest the food insulin only....... I need to set up the above scenario for myself.......its very rare for me to be lower than I thought mid meal, unless there is alcohol in my system......

Oct 8, 2013 novorapidboi26 1,819 posts	Topic: General Discussion / Milking fingers causes low BG readings I have heard people on the diabetes support forum say its best to let it come out on its own....... personally I don't take much notice, it has never seemed to cause me problems.........the meters are hardly that accurate anyway.........

Oct 8, 2013 novorapidboi26 1,819 posts	Topic: General Discussion / afternoon hypos usually if your background insulin is a single dose and its doing an important job like holding off the DP, then you should consider reducing your lunch ratio, or as you say taking a unit off your lunch dose would be worth a shot...... you say in your comments you don't get hypo warnings anymore, for that reason alone I would personally drop the BI so as to increase your levels throughout the whole day........ have you discussed options to regain your hypo awareness with you diabetic team...............? Also, considering a split dose of BI is much more flexible, especially when varying levels of activity are concerned.......

Oct 8, 2013 john m 15 posts	Topic: General Discussion / afternoon hypos keep having hypos in the afternoon only mon-fri well im in work sat /sun is ok maybe because im less active at weekends decreasing my bl could give me high bg reading in the morning because i suffer with dawn phenomenom or could i do 1 unit less at lunch not sure what to do ?

Oct 8, 2013 Alan 49 284 posts	Topic: General Discussion / Milking fingers causes low BG readings The User Manual that came with my Mendor Discreet BG meter says that when testing BGs, milking the finger to get the blood 'may cause low test results'. I've never heard this before - is this true?

Oct 8, 2013 Jimandbillow 8 posts	Topic: Questions for HCPs / Insulin on board algorithms in pumps Thanks for the responses guys.... Davey38 - your comment 'Active Insulin means there has been a correction' is only applicable to the roche pump as roche only count correction insulin as active insulin. Medtronic and every other company count any insulin taken as active insulin. novorapidboi26 - Medtronic will only subtract the active insulin from the correction part of a dose if the correction is greater than the IOB. So if no correction is needed the pump will not subract the IOB from the bolus suggestion, which personally I think is wrong as it could lead to a hypo in the scenario explained above.

Oct 8, 2013 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Insulin on board algorithms in pumps I am also on a Medtronic pump, the paradigm 754........ your pump should only recommend you take the full 3.0 units if the correction of the 7.0mmol equals that of the remaining insulin....I think.......... I would love to confirm but I have no more insulin left and I am 4.2...... Does your pump not subtract the active insulin and then add a correction (which can also be negative)...?

Oct 8, 2013 Davey54 8 posts	Topic: Questions for HCPs / Insulin on board algorithms in pumps Hi Jim, I use a ACCU-CHEK COMBO. Active Insulin means there has been a correction, so that's gone don't worry. The 6 units of insulin you had is at it's peak 2 hours after. Therefore, if I was you I wouldn't have any insulin with the 30g carbs, to do so causes what's called STACKING and will probably cause an hypo. Remember that no insulin with the 30g will increase your BG level, better that than an hypo. It will be corrected the next time you test and take on carbs. Ultimately you have to do what you're comfortable with. GOOD LUCK!

Oct 8, 2013 Louise1988 69 posts	Topic: General Discussion / 3am tests Hi Garry, thanks for your reply. I'm currently on just 8u of levemir, which I take at 9pm. I'm wondering whether I need to lower this, as I keep getting hypos during the day, so I'm trying to see how much of an effect my basal rate has on the rest of the day. My morning rates aren't too bad, around 5-6. I'm only on tiny doses as it is, and just want to get my levels up. Will post in a few days and let you know.

Oct 8, 2013 Garry 328 posts	Topic: General Discussion / 3am tests Carb free dinner is not necessary Louise1988. Take your dinner as normal with the matching QA. BI dose as normal, at normal time. You are only checking that your BI is right. We all need an established background insulin level to keep us ticking over, especially when comparatively inactive. So I hope you find that your before bed, 3 am and before breakfast BGs are ideally within 1 mmol/L â€“ donâ€™t fret if they are not though. No changes really necessary if they are pretty even. You do need plenty of days results to compare with one another though as lots of other things get in the way of our understanding the body - it is a dynamic â€˜fickleâ€™ machine. You may wish to post again in a week or so when you have data. Please let us know your particular BI and typical dose/s. Currently, I split Lantus 27u at 06:30 and 27u 18:00 to 19:00. But Iâ€™m sure someone here will be able to advise you better, if using your type of BI. Regards Garry

Oct 8, 2013 Jimandbillow 8 posts	Topic: Questions for HCPs / Insulin on board algorithms in pumps Hi... I have a question about bolus advice when there is active insulin involved. I use a Medtronic pump. Here's a scenario... My carb ratio is 1u:10g, my correction factor is 1u:3mmol/L, BG target 6.5mmol/L My BG is 6.5 and I eat 60g food and take 6u of insulin. In the next 2 hours I do a little exercise but nothing too dramatic. I then decide to have 30g (3u insulin) of food which is 2 hours after the 6u I took. I test my BG and they are 7.0mmol/L. Clearly I have insulin still working (approx 2.3 units). My pump will still suggest that I take the full 3u even though it will show that there is insulin on board. Why? Should it not take my lower than expected BG levels into account and suggest something like a 0.9 U dose? It appears that most calculators use an algorithm similar to this but I don't see the reasoning behind this as in this scenario that is not unusual, I will clearly have a hypo if the full dose is taken. Thanks