Recent Posts - DAFNE Online

Apr 17, 2013

Gari 17 posts

Topic: General Discussion / Dealing with large carb meals

Thanks you one I like your way of thinking. I think I will try this today at lunch I will report back and let you know how it goes. Fingers crossed for me.

Apr 17, 2013

Gari 17 posts

Topic: General Discussion / Dealing with large carb meals

Hi travler
My normal time is just before I start eating my meal. The kind of meals include all takeaways and any meal with some carbs e.g bout 8 to 10 cp's plus dessert of maybe 5 to 7 cp's. I take novo rapid and a single dose of lantus.

Apr 17, 2013

Warwick 425 posts

Topic: General Discussion / Dealing with large carb meals

I can't take more than 8 units of QA at a time without hypoing, so I also split my doses for very high carb meals. I usually test 2 hours after the first injection and correct any high value at that time to take my BGLs down to 8.0. That gives me a bit of leeway with the QA already on board.

I find I also need to do this with slow-release foods like beans, chick peas and lentils. It feels a bit odd injecting QA when my BGLS are in the 5s before bed after a Nachos dinner, but I forgot to do this correction a couple of nights ago and had BGLs of 12.5 before breakfast after going to bed with BGLs of 5.8. The times that I have remembered, I've been fine overnight and woken with normal range BGLs.

Apr 17, 2013

Warwick 425 posts

Topic: General Discussion / Increased blood glucose after exercise

Anaerobic exercise happens at high intensity, so if your cycling was at high intensity both ways, then that would be anaerobic, but if it is the sort of cycling that you could whistle a tune while riding, then it will be very aerobic instead.

I cycle to and from work each week day, (an hour each way, gradual uphill on the way to work, nice and downhill on the way home) and my BGLs follow the pattern of aerobic activity. It is fairly rare that I cycle with intensity - having a newborn in the house means I am too sleep-deprived to feel energetic enough :-) I never hypo on the way to work because it is within a couple of hours after breakfast and I have both carbs and QA on board, but I do have to be careful in the hours afterwards until lunchtime. Going home, I have to eat before cycling or I will with 100% certainty hypo. I could lower BI, but it tends to lead to highs at other times, so I don't.

I'd suggest that you don't take additional QA unless you see a definite pattern of highs after cycling. If you do, then you can cautiously increase your QA before cycling, but one-off rises in BGLs do happen, especially with new activities so you may not see that again.

Take care,
Warwick.

Apr 16, 2013

Apollo 45 posts

Topic: Questions for HCPs / novo-rapid insulin duration

Hi Paul,

just another bumbling graduate rather than a HCP here but I think it's pretty hard to give set guidelines on how much of your insulin is spent and how much is still working. as a VERY rough guide there is the graph in the DAFNE handbook which I suspect you have seen already as some of what you said is almost a direct quote from it.

As a rough guide though you can see by hour 3 there is very little life left in it and by hour 4 you can almost assume it's all gone as a general rule. There are however a number of factors that can change how quickly the insulin will work, some are down to your physiology, some are environmental so that can only ever be taken as a rough guide and certain not something to do precision maths with to keep you just above 4mmols

Personally I try to keep 4 hours between meals but if I had a late breakfast and can't push back lunch so there has only been 2 hours between the meals and I test and find I'm high, I choose to trust that I gave enough insulin earlier and it will bring me back down given time to finish working and take only the insulin that my lunch dictates (i.e. no correction)

If I were you then should I find myself eating again less than 4 hours after my last shot I'd test, eat & inject without correction for any highs (obviously correct if there is a low) and then test again in 4-5 hours time and correct if required then. Also should you find yourself a bit close to the 4 mark the quickest way to get your levels up is with a sugary liquid, personally I go with a can of coke which I find hits the blood in under 5 mins.

Not sure that's quite the advice you were looking for but I think there are probably a few to many unknowns to do exactly what you hoped to do, that said after a few months you may find you get a better understanding of how you personally react to the insulins you use and you may be able to refine things slightly better.

Another thing that may be worth while to you is a continuous glucose monitor, which is a test meter you leave attached to you and tests every few minutes. Most have the option to then alert you if you're going low so you can prevent yourself going under 4mmols. I'm not sure if these are available on the NHS or not though so there may need to be an element of self funding on your part if this was something you wanted to look into. certainly asking you diabetic healthcare team what your options are with it though, they do tend to be expensive though.

Apr 16, 2013

Apollo 45 posts

Topic: Site Development / Insulins

I'm on a motorbike forum and we have it set up so that we can put what bikes we have under our user name in forum posts. This is useful as if someone starts saying "on my bike I..." you know without them needing to point it out what kind of bike out is and how better to advise them or how their experience relates to what you were asking about.

As such I wondered if we could set it up so that we could list what insulins we are on in the same way?

Or as a signature file. In fact a signature file would be brilliant to as every time I give someone an opinion I find myself wishing I could turn on a signature that said something like "I'm guessing here as much as you are if it makes sense then take the advice at your own risk, if it doesn't then talk to a medical professional"

Apr 16, 2013

Apollo 45 posts

Topic: General Discussion / Dealing with large carb meals

When is your normal time?

I know some take it before the meal, while others like myself prefer after so they have a better idea of how much carbs they have consumed. If your in the former group then taking the shot after would mean that your BG levels would already be slightly elevated which may help counter the fact that the sugars are being released more slowly.

Can you give some examples of the kinds of meals you experience this with? Also what insulins are you on? If your BI is levemir is it split?

As the release of sugars 4 hours after meal sounds to be very slow and this most often occurs with your evening meal have you considered putting one or two extra units of your BI in to deal with it as the slow release pattern seems to better match the sugar release profile you mention and I'm wondering if the large meal is actually having an impact on your metabolism and what your experiencing is actually fat being burned to BG rather than carbs. ÃŒ know when I have a hot curry that I have to put in a few extra units than the carbs there would typically suggest. If it is metabolism in your case then a great way to slow it down is alcohol...

Apr 16, 2013

youone 102 posts

Topic: General Discussion / Dealing with large carb meals

Hi
This is the issue I've tried to understand and control like yourself over the years I've tackled it in different ways until I settled on an option similar to what Dafne teaches us.
The method which I use is based on my experience over the 40 years i,'be been type 1,
I guessed that it wasn't the amount of CP's I was taking it was the amount of insulin QA, I had no knowledge of Dafne or their principal's, but I took an educated guess that my body couldn't use the amounts of insulin I was taking in response to large meals of CP's.
In response to this I set a limit of 10 units of QA maximum I would inject at a time.
Hence a very large meal of 240 carbohydrates this was the way I controlled by condition before Dafne. My QA would be split into 3, 10 before meal 10 after the meal usually 2 hours then after 4 hours I would do a BG and do a correction, I use the word correction because of Dafne, I responded to the BG test, if it was OK I didn't inject if it was high I did.
I found this method of drip feeding small amounts of QA worked or in other words my body could cope with the amounts of QA and was able to use it, I may have been just lucky that the amount I settled on 10 was right for me, where all different,
Now with Dafne I use a lower number since I know now that 1 unit of QA will bring down my BG by 2 to 3
So for example if I had 18 CP's
Soon as I have ordered I would take 6 QA if my ratio was 1:1
Two hours later I would take or when the meal had finished after a test 6 more QA
Finally 4 hours after again re a BG reading I would correct
Most occursions I would have to take the full 6, but I find the drip method gives me least chance of overkill and going into a hypo spiral.
This method only differs from ture Dafne to the point where you inject before you eat but we all carry something for low BG and if the group or party your with know your a type1 it shouldn't be an issue,since I've sometimes taken a CP while waiting for the meal to come.
I don't think there's an ideal way in tackling really high CP meals since I believe your body can only use so much QA at a time.
Saturation occurs and like a flood you may experience a hypo later on. I'm not an expert and may be totally incorrect, but it worked for me
Like you I'm very interested in other members views and methods to control large CP meals
I look at it like this, we all eat about 20+ CP's a day you control this by taking your QA to match your CP intake at a meal usually 3 meals
By doing this when taking similar amounts of CP's at once, by splitting your QA by 3 over a period you give your body a chance to use it correctly.

Apr 16, 2013

Gari 17 posts

Topic: General Discussion / Increased blood glucose after exercise

Hi Warrick i went for a 30 minute cycle in to london and then walked round for about 30 mins then cycled back again about 30 minutes. I was hovering around 4.5 for a few hours after. I gave a 40% reduction for my dinner and had a hypo. So i suppose w
Your theory about eating extra carbs for aerobic exercise is right. What i worry about is finding the right balance of knowong when i am doing aerobic or anaerobic this could e a fine line. So the taking of QA before exercise sounds a little scary incase when i start it turns out that it will be aerobic. Any thoughts

Apr 16, 2013

Gari 17 posts

Topic: General Discussion / Dealing with large carb meals

Hi all.
I seem to be generally well controlled with my blood glucose levels. Except when it comes to eating very large carb meals. I have a huge appetite. Generally my meals are never huge in carbs probably no more than 10cp's worth. But when i seem to approach the 15cp size meal or over i do seem to have trouble. This is especially an issue if i want to have a dessert. (Which is not that often). I know that high fat and carb meals can take longer to process, and have been advised to split my QA dose e.g take half the dose at normal time and half 1 hour later. Having attempt this on a few occasions and had hypos, i have tried taking the first half of the dose and then kept an eye on my blood glucose levels. What i have noticed is that it isn't until the first QA dose has worn off e.g 4 hours that my blood glucose seems to then rise and therefore need the rest of the dose. So obviously this is an issue if it is an evening meal. Also if i give the full second dose just as my levels start to rise that also seems to send me into hypo. If i don't give the second dose i wake up with the very high levels that obviously needed the second dose of QA.
Has anyone had any issues with large carb and fat meals, and have any advice on how to manage. This is also a major issue when eating out with friends.

Apr 16, 2013

paulj 36 posts

Topic: Questions for HCPs / novo-rapid insulin duration

by my understanding the above quick-acting insulin has onset period of less than 15 minutes. a peak between 50 and 90 minutes and a duration of up to 5 hours. not trying to be to technical is it known in percentage terms how this time period is broken down ie how much insulin is still to be used after a meal which was consumed say 4 hours ago and 10 units of the above insulin was used in total? why i ask is that as a bus driver i work various shift patterns and on some occassions will have another meal break within the total effective period of this insulin which in turn would i suspect have a bearing on my next insulin dosage to combat my next meal/snack.obviously if i take to much and go to low i.e below 4mll i would be unable to drive.iam curious if anyone could shed any light on this matter or whether i am looking to deeply into the above.any thoughts would be much appreciated

cheers paulj Very Happy

Apr 16, 2013

hollylouise 7 posts

Topic: General Discussion / feeling unnormal

I dont care now because at the end of the day thatbisnkeeping me alive so if people wont to be narrow minded then let them after going into a coma andnmy parents being told to ring faimlynand freinds to come up and say their last goodbyes was a reall eye opener im me I think diabitse has made me the person I am todaynive had it since I was 5 yearsnold andnim now 19 going to be 20 in october asni said at the end of the daynim taking my insulin to keep me alive so if you dont like it dontnlook why shouldni hide away if people wont to be so dam rude

Apr 16, 2013

Apollo 45 posts

Topic: General Discussion / feeling unnormal

bit late to the party but incase anyone else is reading over this here is my two cents.

When I was diagnosed I felt like I was defective and it was something to be ashamed of, I didn't want to eat out or have anyone see me taking a blood glucose reading let alone a shot. When I did go to eat out some months later I went to a restaurant run by a family friend largely because it meant I could use their office to take the shot.

As has been said the longer you have had it the more you get used to it and the less you care. It's something a lot of people don't really understand so they see you taking a shot and they wonder if your doing drugs. My way of dealing with it is now rather than trying to shy away and be embarrassed about it I try to be as open as I can. I do try to be discrete but I won't suspiciously slink away to a secluded corner. Then every so often I'll make a bit of a show of it, for example I was in the comedy store a while back, the show had ended & most people were leaving. It's a very narrow exit and my date had decided to use the toilet while the crowds cleared. I then realised I'd not taken a shot for the meal I'd had before the show so I preped a shot up. I saw some of the people in the crowd giving me odd looks but rather than hide away I carried on and as I started to inject the insulin allowed this euphoric look to appear on my face and then gave them the old "crazy eyes" smile Cool

You do have off days though and sometimes it may not even be diabetes that is the reason. You may be upset with a loved one, work may be getting you down or what ever else but then you have to go take a shot and it will be the straw that breaks the camels back and an easy one to vent on because there is no fix, there is no reason it's just something you have to manage. But by getting upset about that is saves you having to deal with the other things that are bothering you that maybe you can fix but just don't feel like dealing with.

Apr 16, 2013

DianeW 115 posts

Topic: Carbohydrate Counting / Tesco sandwich labelling

Something in the whole re-labelling process has gone wrong. Who "signed it off" as ok i wonder?

Apr 16, 2013

hollylouise 7 posts

Topic: General Discussion / feeling unnormal

Im alot better now I dont care wjonis watching but I was of the scale even the hospital coildnt record what my sugars were

Apr 16, 2013

Vickyp 137 posts

Topic: General Discussion / My Blood Glucose Diary - all comments welcomed!

True...my general rule is above 5 to drive!

Apr 16, 2013

Apollo 45 posts

Topic: General Discussion / My Blood Glucose Diary - all comments welcomed!

indeed you are correct, I should have said bellow target rather than hypoing.

Although it's worth noting that the police will consider you under the influence (in the same way as having drunk to much) if you drive with a BG of 4.0 or less which is why I tend to think of 4.5 or less as starting to hypo. Although I've never actually even heard of anyone being asked to take a blood glucose test by the police.

Apr 16, 2013

NuMo 28 posts

Topic: Carbohydrate Counting / Tesco sandwich labelling

This is all so true.

And then you get the manufacturers who brag about their labelling and print in nice big print "all" the important information for easy access, leaving out the carbs and only giving sugar. It's as if they think the only people who need this information will be dieters. People like us or celiacs, for example, with real dietary needs are not catered for.

Apr 16, 2013

Vickyp 137 posts

Topic: General Discussion / My Blood Glucose Diary - all comments welcomed!

According to DAFNE rules a hypo is 3.5 or below. But agree that BI needs reducing.

Apr 16, 2013

Apollo 45 posts

Topic: General Discussion / My Blood Glucose Diary - all comments welcomed!

Friday and staturday you appear to have had no carbs or QA in the morning and yet your BG has plummeted from high to hypo by lunch. Also as you're hypoing in the night why have you not lowered your BI shots from 10 to 8 both AM and PM? DAFNE guidelines say that if you hypo from BI you reduce it immediately.

Also on Sunday and Monday your breakfast corrections are 1 unit to high in each case. You want your Blood Glucose (BG) to be 6 and 1 unit of QA will drop you 3 BG units.

So on Sunday with a BG of 10.2 you gave a correction of 2 units of QA.

2QA x 3 = drop of 6BG

10.2 - 6 = 4.2 which is a hypo

So on Mondaywith a BG of 13.4 you gave a correction of 3 units of QA.

3QA x 3 = drop of 9BG

13.4 - 9 = 4.4 which is a hypo

That said I'm not sure your breakfast ratio is correct but until you get the background fixed you can't work that out.

My advice would be drop the BI from 10 to 8 for both shots. Repeat the fasting test and see what results you get. It may be that this is a little low and you will want 9 & 9 or one as a 9 & one as 8, but with the number of hypos you have exhibited in 5 days taking off 4 units of BI (2 AM + 2 PM) would seem a wise precaution as you can always bring it back up again if it's to low.

leave your meal ratios at they are for now as you can only change one thing at a time but when you take corrections do the maths to work out where that will put you if each unit drops you 3BG units, if you work out that a correctionwill put you under a BG level of 6 then make the correction smaller.

Apr 16, 2013

Apollo 45 posts

Topic: General Discussion / Coke or DIET Coke that is the question?

When I first saw that ad I also thought "what if I'd just had a hypo, that bloke could have killed me!", especially as my hypo cure of choice is a red can of cocacola. That said it's a very rare occasion I don't walk out the door with either a can of coke or some other hypo treatment on me as I don't want to be dependent on finding an open retailer to supply me with the sugary goods that I need.

The reality of the ad though is it's staged, the odds of even half the cinema having decided to buy a coke let alone everyone in there is so remote it would have taken them years of attempts to have filmed that ad. Also as good as they have got coke zero I would lay down Â£20 that in a blind taste test I could tell them apart without a problem. So while the situation itself is poorly thought out, even ignoring diabetics and just looking as you hinted at the recent horse meat scandal of miss selling & how the public is against that, it is advertisers poetic license and not something to be taken seriously or a deliberate maligned attempt to rail road diabetics as second class citizens.

If that were something they were doing in the real world then I'd agree with you but as it stands I'd just ignore it.