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Hi,

If you have any questions don't be afraid to ask, I've been a type 1 for 7 years and a DAFNE grad for 6 years. I considered myself to be quite knowledgeable on diabeties till I joined here and started to learn new things I'd not previously considered. There are a lot of people here with a lot of know how and real world experience so if you have something your not sure about just ask and be flooded by opinions Very Happy

May 1, 2013

Garry 328 posts

Welcome nitaparmar Smile

Hope you find the forum useful and when necessary, supportive.
We are all in the same boat and sometimes need help with the paddling!
Regards
Garry

May 1, 2013

Apollo 45 posts

I actually think the BI is about right.

Tuesday Bed to Wed Morning, no QA and less than 1 unit of variation
Wednesday Lunch, no QA or carbs 7 hours later there has has been only 1.5mmols change in BG

I did think you needed to split your BI based on Sunday but then I noticed that you took the Saturday BI at 18:00 rather than your normal 21:00-22:00 so the high on Sunday night would be because you were walking round for 3 hours with no insulin at all in your system, maybe even longer if you're on Levimir as that often doesn't do a full 24 hour cycle.

Assuming your thyroid function is normal then I'd go with one of two potential issues

1) your carb counting is off, to check this eat foods that come in packets with the carbs printed on the side, if necessary weigh the foods and see if this makes a difference.

2) you are a phantom snacker but have not documented your snacking. I won't say that's something we have all done at some point but I know I have, The great thing about DAFNE is you can snack if you really want to but you do need to address it if you are.

Also what are your activity levels, by which I mean do you tend to exert yourself about the same amount day to day or are there some days you will do a much higher or lower level of physical activity.

May 1, 2013

Warwick 423 posts

Hello,

As Apollo says, knowing what types of insulin you are on would be very helpful.

I think there are enough bedtime tests in the diary, but unfortunately we can't actually use a bedtime test on these readings because there is always the need to correct at bedtime, so we can't tell what of the morning reading comes from the BI and what from the QA.

Faced with such a sea of red, my initial feeling is similar to SA2010 - that your BI is too low, but without the true bedtime tests, we can't actually tell - it might be that your QA ratios are too low.

Some of those CP readings are a bit strange - 93.5 and 92.1 CPs? That is almost a kilo of carbs... Are you sure about that?

If you can concentrate on getting your bedtime reading below 10, then we can look at bedtime tests. I would suggest if you get a bedtime reading of 10 or below, then don't correct, but test at 3 am, and again before breakfast and we can then see whether BI is correct or not.

If the 3 am test shows a large rise into the high teens or twenties, then do please do correct. DKA is not the goal :-)

Cheers,
Warwick.

May 1, 2013

Warwick 423 posts

Topic: General Discussion / injection technequie and body deformation

Hello Apollo,

I switched from 8 mm to 4 mm needles on the DAFNE course a year ago, and we were told then that we didn't need to pinch with a 4mm needle. (I have a BMI of about 24).

Do make sure that you are rotating your sites regularly though. This site covers correct technique:

http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7282

I'm not sure whether you are saying that you are developing lumps in your abdomen as a result of injecting into the same place too often, or just developing visceral fat around the abdomen which I also experience. I am slim and muscular everywhere else, but a slight thickening around the girth due to my current messy divorce with Mrs Chocolate. I've only noticed it since being diagnosed 3 years ago, so it is possible that that is related to injecting.

There are many other sites that you can inject though. One of my diabetes support group only injects QA in her arms (skin above the tricep). I tend to inject QA into the abdomen, and BI into my sides. I tried the back, but it was too hard to work out whether I had injected or not when I couldn't see what I was doing. Thighs and calves are also possibilities.

Cheers,
Warwick.

May 1, 2013

Warwick 423 posts

Hello Diane,

You may actually find that your BGs rise after exercise if it is anaerobic and that you need more insulin prior to exercise as Gari found in this thread:

http://dafneonline.co.uk/forums/1/topics/2128

It really is a question of trial and error. Personally I find that if I exercise for an hour, then I either need to do it shortly after a meal (with slightly reduced QA), or I need to take some carbs (about 30 g) before or during the exercise.

I also recommend regular and increased testing afterwards - hypos can occur for up to 48 hours after exercise depending on the intensity and duration of the exercise.

Despite all that, it is still definitely worth it to keep exercising.

In terms of losing weight, the best time to exercise is shortly after eating because you can reduce QA rather than needing to take extra carbs to avoid a hypo. If you experience dawn phenomenon, then another good time to exercise to lose weight is prior to breakfast when your BGs are high from the rush of hormones as you don't need to take carbs, AND your BGs will come down from their high levels.

I recently attended a conference on exercising with type 1 diabetes. The general advice from that was that there is no BG reading that is too high to exercise as long as your ketone levels are normal. Follow the DAFNE advice with regards to that - any BG reading above 13 prior to exercise should be accompanied by a ketone test. If ketones are present (0.5 or above), then do not exercise. Take some QA to bring the ketones down and exercise later, or another day when ketone levels are normal.

All the best,
Warwick.

Apr 30, 2013

Warwick 423 posts

Hello,

Welcome to DAFNE. I was diagnosed September 2010, so there has been a steep learning curve. Coming up to my DAFNE 12 month review tomorrow which I am looking forward to, and looking at the difference pre-DAFNE and 12 months on, the differences are quite considerable.

All the best with it and looking forward to seeing you in these forums.

Warwick.

Apr 30, 2013

nitaparmar 2 posts

Hi all,

I attended DAFNE last month. It was nice to be around other people who are in the same situation as me.

I was diagnosed three years ago so this is all new to me...

Just wanted to say hey Smile

Apr 30, 2013

Apollo 45 posts

QA insulin tends to last about 4-5 hours although generally it's done most of it's work 3 hours after you take it so 2 hours after your shot is not a bad time to go, it will show you that exercise will have an impact on your sugars without it being to drastic.

It's better to be overly cautious than not cautious enough, just do what your comfortable with, as you learn what works for you'll become more confident with it and will be equipped to make better judgement calls.

You may find that you need a little less insulin for the meal after your exercise too. If when you test for that meal you find your high I'd give no correction for it and use is as a sort of buffer zone. If you want to decrease your insulin a little for your lunch you can however so long as you have a hypo treatment to hand and have a reliable hypo sense there is no real harm in going that way and treating the onset of the hypo if it happens.

Don't let this scare you but one thing to be aware of is that when exercising hypo awareness can be slightly masked. Cold sweats are easily missed when your dripping with sweat and if you have really been pushing yourself you muscles may be tired and shakey as a result of the exercise so that slight tingle can be harder to spot. If you find yourself in any doubt just do a quick finger prick test, and if you do find you were low don't think you have lost your hypo awareness it's a little like being walking round the house at night with the lights off, you may not be able to see to well but it doesn't mean you have gone blind. Once you cool down from your workout your hypo sense will be just as it was before.

There are some famous sports people out there with type 1 diabetes so while it's understandable that you would be scared by starting an exercise regime, diabetes it just a small obstical to overcome no an impassable barrier.

Apr 30, 2013

DianeW 115 posts

OK thanks both of you, that's very helpful.

as I am intending to go in the morning I will reduce my QA at breakfast. If I go a couple of hours after breakfast, and I have reduced my dose, I have no idea what my reading will be when I test then, I mean if it is 5 or 6 I would panic a bit to be honest! If it was between 7 and say 10 I would feel ok. I know I am probably being over cautious and as long as I have glucose etc on me I will be ok.

Apr 30, 2013

novorapidboi26 1,819 posts

You will have to carry out a bit of trial and error testing for your own personal needs, but the general advice as detailed by Apollo, is that for short periods of medium to intense levels of activity you should consider reducing your previous meals QA dose, keeping in mind that you may need extra CPs during and after. Whether you need CPs during your activity will be determined after you have tested and analyzed your results.....

Longer period of low to medium intensity activity is usually catered for with a reduction in BI, basically due to the slower effects the activity will have.......

The DAFNE handbook has quite a good basic guide but you will need to make your own personal observations to fine tune your reductions......

Apr 30, 2013

Apollo 45 posts

Topic: General Discussion / injection technequie and body deformation

I think that may be it, I was so skinny at the time that I needed to pinch to find something to get the needle into and no one has ever told me otherwise as they probably didn't realise I was doing it so it's just never been corrected. I'll give no pinching a go and see how I get on.

Apr 30, 2013

novorapidboi26 1,819 posts

Topic: General Discussion / injection technequie and body deformation

I am pumping now, but have never pinched in all the 14 years I have been diabetic.......

My wee brother did back in the late eighties, but I believe that it was old ill informed advice, at least now with the newer more flexible needle lengths.......

if you were really skinny it may have helped though.....

Apr 30, 2013

Vickyp 137 posts

Topic: General Discussion / injection technequie and body deformation

I have a lot of fat to pinch ( although a lot less than last year)... but dont pinch I just insert needle and count to 10 before removing it and have no issues with injection sites

Apr 30, 2013

Apollo 45 posts

For an hour down the gym I wouldn't reduce background insulin. I reduce my background if I'm going to do a days paintball or something where I'm going to be much more active all day long. If I'm just going to do a hours running though then I just change the quick acting (QA).

If you took some insulin prior to exercise (QA generally last for 4 hours) and didn't reduce the dose in advance then you need to take on some carbs, if you're taking insulin after exercise though then you can just reduce your ratios for that meal. Do carry some quick carbs on you though should you get in distress and I'd advise testing your BG before exercise and apply the same rules you would do if you were going to drive, i.e. bring it up to 5.0 before starting.

You do need to be careful about being to high as well though as if your sugars are something mad like 15+ then that's not very good for you at the best of times, if you then start to put your body under physical stress it's only going to compound the problem.

Best advice is be progressive, it's good advice for anyone starting a new exercise regime but don't push yourself to far to fast. By easing in you'll see what impact a little exercise has and how increasing that load impacts you. Also if you're in a gym there are going to be other people around including staff, pick someone and tell them you're diabetic, show them how your test meter works, what hypo cures you have on you and what to do should you get in distress.

If you are still nervous about it though then test every 30 mins. That will give you a good idea of how your bloods are reacting to the exercise and after a while you won't need to do that any more because you'll be able to predict it from past experience.

You probably know this already but there is also a section on exercise in the DAFNE Course Handbook which is in the DAFNE tools on the right of the screen. Lots of advice in there too.

Apr 30, 2013

Apollo 45 posts

Topic: General Discussion / injection technequie and body deformation

When I was diagnosed I was taught pinch up some fat, stick in a needle (which I generally do slowly rather than a quick stab in). Now at the time I had a BMI of 16.1 so you could practically make out my skeleton. This wasn't due to an eating disorders it just took me a while to seek help and my body had burned off all my fat by the time I did. As such if I didn't pinch I wasn't going to get a lump of flesh thick enough to put a needle in.

I was just emptying a box of needles into the trays I use to help track what shots I've done that day (think of it like a pill box with meals marked out but for needles) and I did something I don't normally do these days. I glanced over the instructions, as a man we tend to ignore these even when we don't know what we are doing but when we do reading guidance is almost unheard of but it was a few lines of large type on the flaps of the box and one of them read:

Suggested injection technique: insert straight in, without pinch-up."

These are 4mm needles where as when I was diagnosed I was on 6mm needles so maybe not needing to pinch is something to do with that. Although I'm not flabby my belly is a little deformed and maybe all the pinching has a part to play as you pull the fat out 3 times a day then it's going to have a tendency to stay there after a while.

So my question is what do other people do and has anyone got any advice on how to tone up my abs a little without compromising my ability to inject there? I'm not looking to develop a 6 pack but I'd like to do something about the slight sag I've developed in the belly area as a result of my injecting insulin. My current BMI is 21.2 so I'm far from overweight but I guess it does bother me that my stomach area almost seems to contradict that statement.

So what do other people do and has anyone got any tips?

Apr 30, 2013

DianeW 115 posts

Can anyone advise me as someone who has never used a gym before or done much exercise please. If I'm doing say an hour's exercise, DAFNE says to reduce insulin by 20-50% prior to the exercise. Does that mean short acting AND long acting? Do I also take extra cps? Or does that depend on my blood sugar? I also read that if you want to lose weight it is better to decrease the insulin. I am really nervious about going. I know I will have to work it out for myself as I go along but I wondered if anyone had any advice, thank you.

Apr 29, 2013

SA2010 69 posts

I have not seen BGs so high before and so consistently high and even with high doses with insulin ! If I get a BG of 15.0 I think of it as really serious and try not repeat what gave rise to it climbing to 15. Often for me it is eating out in restaurants where I seem to always underestimate CPs. I am on Novorapid and split Lantus. I guess your insulin is different?

Observations:
There is not always a Bedtime BG test. Need to have good Bedtime BGs to establish BI level for good fasting BG in the morning. In my case with Novorapid which acts for 4-4.5 hours, i always make sure bedtime is 5 hours after dinner - it is hard but I have achieved so far (3 years into diabetes) and try to have my BG between 7 and 8. Guidelines say 6-8. If bedtime BG is high then next morning BG tends to be high. So I would say, try to get good bedtime BG for a couple of days by increasing evening meal ratio and then look at the BI and probably find it needs increasing. We are all different obviously as i only need 9 units of lantus a day (6 at 11pm and 3 at 11am) - It does look that the BI needs to be increased or probably split. The QA:CP ratios increases for lunch and dinner have helped but not enough. The Sunday 9pm high BG after no CPs for a while and good BG reading before does indicate that BI ran out. So need to concentrate on getting BI right first

Apr 29, 2013

Apollo 45 posts

I'm a firm believing in making someone work at it themselves so they gain an understanding, so what patterns are you seeing and what is it that you think you need to do next? Even if you don't know how to correct the pattern, being able to spot it is an important skill.

So what do you see?

Also what insulins are you on? I would guess your background is Levimir.

The one thing I will say before I hear your thoughts though is your corrections are to high. DAFNE says you should never give yourself a correction of more than 4, if you feel the need to give more than that then your ratios of background must be out.

Apr 29, 2013

Apollo 45 posts

Topic: General Discussion / Rapid-acting Insulin - Overstacking

Same as Vickyp

Although this was discussed in another thread and someone pointed out that there are meters which will calculate how much of the insulin will still be active in your system from your earlier shot. They take some calibration and setting up though apparently.

Apr 29, 2013

Warwick 423 posts

Topic: Questions for HCPs / "Bed time" testing time & BG hit and miss

I'm coming to this thread late, and you appear to be on top of it anyway, but thought I'd share my experience.

Like you, I am on Humalog and Lantus. And like you, I was getting highs in the evenings before bed. In January I switched to twice a day, and the issue disappeared. Before the switch I was taking 23-24 units of Lantus at night. After the switch, I found that I needed 13 units morning and night - an increase of 2-3 units overall.

The alternative was to up my dinner QA, but I kept hypoing when I did that. So if you do need to split again, then keep in mind that you may need to slightly increase your BI.

Cheers,
Warwick.

Apr 29, 2013

Anthony Murray 9 posts

Topic: Questions for HCPs / "Bed time" testing time & BG hit and miss

Thanks

Apr 29, 2013

Leighton84 3 posts