Recent Posts - DAFNE Online

May 2, 2013

Apollo 45 posts

Topic: General Discussion / Freestyle InsuLinx Meter

I don't think my old one touch meter would register anything above a 30mmol/L would just say "hi". I don't know if there are some special features on you Abbott meter that mean your happy to stick with it but when I wanted to change to a bayer conrtour USB for no other reason than I liked that it was more compact than the one touch I just phoned them up and said "post me one now" and they did. Actually they sent me 3 meters!

Not to make you feel even less special though but someone posted something similar about a recall on 2 specific models that lifescan make, I don't recall the models but one touch wasn't one of them.

May 2, 2013

Frank.M 5 posts

Topic: General Discussion / Freestyle InsuLinx Meter

I use a Freestyle InsuLinx Blood Monitoring Meter that functions well enough, although why it needs a secret code (only available from Health Care Professionals) to set it up seems a little unnecessary.

Last month the manufacturer, Abbott Diabetes Care, wrote to say they have determined that at extremely high levels of 56.8 mmol/L +plus the meter will display and store in memory an inaccurate low result - not what I wanted to hear, although at 56.8 mmol/L I think being in A&E semi-comatose attached to a drip looking for the toilet would tell me something was wrong. Ok, using 56.8 mmol/L had the desired effect and I took notice.

I telephoned Abbott DC and was told the upper range was the concern and lower levels less so, maybe not to you chum but I want to know a reading of 8.5 is not 3.5 and so did a quick check. A reading of 8.3 was 7.4 only 40 seconds later.
To resolve this Abbott have a software update available on the web-site that maintains settings and historical data, what is copied I leave to the imagination.
However to update you need a computer and connecting cable, I need to find mine?? but if I cannot they offered to send me a new meter.

This morning a copy of a newspaper dropped on my desk and a finger pointed to the article 'Meter fears for diabetics' that ends in the sentence 'Manufacturers Abbott Diabetes Care will provide patients with new meters'. Ugh! and I thought I was special.

May 1, 2013

Apollo 45 posts

Topic: General Discussion / injection technequie and body deformation

I've injected in muscle more than a few times and uttered a few choice phrases as I did so.

I have tried my backside once but found it to be a real pain the arse *boom boom!* seriously though I had trouble getting the shot on straight and was left with a lump where the insulin had pooled rather than spread.

I don't think the pinching alone would have caused the deformation although I can't see it helping any especially given I take a few minutes to give myself a shot. The deformation and should I still be pinching questions were really two different points on the same general subject. I think the deformation is largely down to taking most of my shots in that area. Do my backgrounds in the thighs and QA in the belly.

Having tried to take a few shots without pinching I'm finding it a little hard, I guess a big reason is that I'm not used to it though.

May 1, 2013

marke 655 posts

Topic: General Discussion / injection technequie and body deformation

Hi, I pinch some sites and not others. The basic issue is you want to avoid injecting into muscle, firstly because it will hurt Sad

and second because the absorption profile is different to fat/subcutaneous. This is what the diagram above is trying to show, If you, as I do, inject into your rear-end there is plenty of cushioning however the abdomen is a bit different and in some of us has areas with more fat than others Laughing

Of course needles are a lot shorter nowadays as well which makes life easier. It seems unlikely that pinching has caused deformations, although anything is possible.

May 1, 2013

marke 655 posts

Topic: General Discussion / New Graduate in DAFNE

As others have said, welcome and please feel free to ask questions, there is never a shortage of opinions or people happy to help. Doing DAFNE is the start of the journey and there are still plenty of interesting places to left to go Very Happy

May 1, 2013

marke 655 posts

Topic: General Discussion / Exercise

I'm with Warwick, although I would say that your BG can be lower for upto 48 hours it doesn't necessarily equate to hypo's it just means be aware you may need less insulin than usual. In all the years I went to a gym I never once hypo-ed during exercise, it made my BG higher than normal a few times but never too low, so I wouldn't worry about hypo's or masked hypo awareness. As stated as well the DAFNE Handbook has a section on exercise that provides the basics.
I think the over-riding message is , don't worry ! enjoy the exercise it has loads of benefits and really is good for you. The benefits far out weight the negatives Very Happy

May 1, 2013

JayBee 582 posts

Topic: General Discussion / Your Diabetes Science Experiment - Experiment 1

After several highs, I have decided to try testing my BI again. I will be doing the evening slot - diary above. I forgot about the 2 hour after meal thing, but I'm not convinced completely since I know QA is still working.

Will update.

May 1, 2013

Alan 49 280 posts

Topic: General Discussion / My current Diary

Leighton
If you're running consistently high, I hope you're testing for Ketones.

May 1, 2013

gills29 5 posts

Topic: Questions ? / Diabetes Education for nurses

Hi there, I am a DAFNE Graduate, but I am also a nurse with an interest in diabetes education. I am looking to get a post graduate qualification in Diabetes, but theres so many to choose from out there. Is there any that the HCP's (in particular the DSN's) can recommend as an actual accredited qualification?

Thanks Gillian x

May 1, 2013

Apollo 45 posts

Topic: General Discussion / injection technequie and body deformation

That link is brilliant, I'm going to read over that in great detail later thanks Warwick!

I'm not getting lumps, it's almost like when seated my belly looks like the correct pinch technique illustration for 8mm -12mm needles but without me needing to pinch it.

If I stand tall it gets stretched out evenly but once I sit everything bunches into a band between the belly button and the top of the hips.

like you I'm on the 4mm needles, was on a mix of 5mm & 6mm 3 years ago.

Looking at the rotation diagram they offer as a print off for the belly I don't think I've got enough fat above the belly button to rotate to the extent they suggest there.

May 1, 2013

Apollo 45 posts

Topic: General Discussion / New Graduate in DAFNE

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

Topic: General Discussion / New Graduate in DAFNE

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

Topic: General Discussion / My current Diary

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 434 posts

Topic: General Discussion / My current Diary

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 434 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 434 posts

Topic: General Discussion / Exercise

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 434 posts

Topic: General Discussion / New Graduate in DAFNE

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

Topic: General Discussion / New Graduate in DAFNE

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

Topic: General Discussion / Exercise

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

Topic: General Discussion / Exercise

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 1,818 posts

Topic: General Discussion / Exercise

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 1,818 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 135 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

Topic: General Discussion / Exercise

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.

May 2, 2013 Apollo 45 posts	Topic: General Discussion / Freestyle InsuLinx Meter I don't think my old one touch meter would register anything above a 30mmol/L would just say "hi". I don't know if there are some special features on you Abbott meter that mean your happy to stick with it but when I wanted to change to a bayer conrtour USB for no other reason than I liked that it was more compact than the one touch I just phoned them up and said "post me one now" and they did. Actually they sent me 3 meters! Not to make you feel even less special though but someone posted something similar about a recall on 2 specific models that lifescan make, I don't recall the models but one touch wasn't one of them.

May 2, 2013 Frank.M 5 posts	Topic: General Discussion / Freestyle InsuLinx Meter I use a Freestyle InsuLinx Blood Monitoring Meter that functions well enough, although why it needs a secret code (only available from Health Care Professionals) to set it up seems a little unnecessary. Last month the manufacturer, Abbott Diabetes Care, wrote to say they have determined that at extremely high levels of 56.8 mmol/L +plus the meter will display and store in memory an inaccurate low result - not what I wanted to hear, although at 56.8 mmol/L I think being in A&E semi-comatose attached to a drip looking for the toilet would tell me something was wrong. Ok, using 56.8 mmol/L had the desired effect and I took notice. I telephoned Abbott DC and was told the upper range was the concern and lower levels less so, maybe not to you chum but I want to know a reading of 8.5 is not 3.5 and so did a quick check. A reading of 8.3 was 7.4 only 40 seconds later. To resolve this Abbott have a software update available on the web-site that maintains settings and historical data, what is copied I leave to the imagination. However to update you need a computer and connecting cable, I need to find mine?? but if I cannot they offered to send me a new meter. This morning a copy of a newspaper dropped on my desk and a finger pointed to the article 'Meter fears for diabetics' that ends in the sentence 'Manufacturers Abbott Diabetes Care will provide patients with new meters'. Ugh! and I thought I was special.

May 1, 2013 Apollo 45 posts	Topic: General Discussion / injection technequie and body deformation I've injected in muscle more than a few times and uttered a few choice phrases as I did so. I have tried my backside once but found it to be a real pain the arse boom boom! seriously though I had trouble getting the shot on straight and was left with a lump where the insulin had pooled rather than spread. I don't think the pinching alone would have caused the deformation although I can't see it helping any especially given I take a few minutes to give myself a shot. The deformation and should I still be pinching questions were really two different points on the same general subject. I think the deformation is largely down to taking most of my shots in that area. Do my backgrounds in the thighs and QA in the belly. Having tried to take a few shots without pinching I'm finding it a little hard, I guess a big reason is that I'm not used to it though.

May 1, 2013 marke 655 posts	Topic: General Discussion / injection technequie and body deformation Hi, I pinch some sites and not others. The basic issue is you want to avoid injecting into muscle, firstly because it will hurt and second because the absorption profile is different to fat/subcutaneous. This is what the diagram above is trying to show, If you, as I do, inject into your rear-end there is plenty of cushioning however the abdomen is a bit different and in some of us has areas with more fat than others Of course needles are a lot shorter nowadays as well which makes life easier. It seems unlikely that pinching has caused deformations, although anything is possible.

May 1, 2013 marke 655 posts	Topic: General Discussion / New Graduate in DAFNE As others have said, welcome and please feel free to ask questions, there is never a shortage of opinions or people happy to help. Doing DAFNE is the start of the journey and there are still plenty of interesting places to left to go

May 1, 2013 marke 655 posts	Topic: General Discussion / Exercise I'm with Warwick, although I would say that your BG can be lower for upto 48 hours it doesn't necessarily equate to hypo's it just means be aware you may need less insulin than usual. In all the years I went to a gym I never once hypo-ed during exercise, it made my BG higher than normal a few times but never too low, so I wouldn't worry about hypo's or masked hypo awareness. As stated as well the DAFNE Handbook has a section on exercise that provides the basics. I think the over-riding message is , don't worry ! enjoy the exercise it has loads of benefits and really is good for you. The benefits far out weight the negatives

May 1, 2013 JayBee 582 posts	Topic: General Discussion / Your Diabetes Science Experiment - Experiment 1 After several highs, I have decided to try testing my BI again. I will be doing the evening slot - diary above. I forgot about the 2 hour after meal thing, but I'm not convinced completely since I know QA is still working. Will update.

May 1, 2013 Alan 49 280 posts	Topic: General Discussion / My current Diary Leighton If you're running consistently high, I hope you're testing for Ketones.

May 1, 2013 gills29 5 posts	Topic: Questions ? / Diabetes Education for nurses Hi there, I am a DAFNE Graduate, but I am also a nurse with an interest in diabetes education. I am looking to get a post graduate qualification in Diabetes, but theres so many to choose from out there. Is there any that the HCP's (in particular the DSN's) can recommend as an actual accredited qualification? Thanks Gillian x

May 1, 2013 Apollo 45 posts	Topic: General Discussion / injection technequie and body deformation That link is brilliant, I'm going to read over that in great detail later thanks Warwick! I'm not getting lumps, it's almost like when seated my belly looks like the correct pinch technique illustration for 8mm -12mm needles but without me needing to pinch it. If I stand tall it gets stretched out evenly but once I sit everything bunches into a band between the belly button and the top of the hips. like you I'm on the 4mm needles, was on a mix of 5mm & 6mm 3 years ago. Looking at the rotation diagram they offer as a print off for the belly I don't think I've got enough fat above the belly button to rotate to the extent they suggest there.

May 1, 2013 Apollo 45 posts	Topic: General Discussion / New Graduate in DAFNE 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

May 1, 2013 Garry 328 posts	Topic: General Discussion / New Graduate in DAFNE Welcome nitaparmar 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	Topic: General Discussion / My current Diary 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 434 posts	Topic: General Discussion / My current Diary 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 434 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 434 posts	Topic: General Discussion / Exercise 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 434 posts	Topic: General Discussion / New Graduate in DAFNE 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	Topic: General Discussion / New Graduate in DAFNE 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

Apr 30, 2013 Apollo 45 posts	Topic: General Discussion / Exercise 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	Topic: General Discussion / Exercise 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 1,818 posts	Topic: General Discussion / Exercise 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 1,818 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 135 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	Topic: General Discussion / Exercise 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.