Recent Posts

6.9 - bedtime
10.4 - this morning

- 19.23pm - tea & QA - @ 19.08 hypo 3.7
- 00.07am - bedtime test was done - @ 23.29 hypo 2.3 then @ 23.50 still hypo 3.9
- supper was 3 butter puffs with cheese - no QA

Apr 12, 2013

Apollo 45 posts

slow absorption is one of the reasons I give a slow shot so as not to oversaturate the fat I'm injecting into. I have had squirt back in the past and typically its been accompanied with a big lump as the insulin hadn't been injected deep enough under the skin either from the angle I put the needle in or because I'd lost focus and the needle had part come out causing a shallower injection site.

If you pull the needle out early you typically will see a few drops of insulin come out the needle as it's easier to come out in air than it is while under your skin. So by keeping it in you give it the time it needs to complete the full delivery.

I can't say I'd recommend it but one person in my DAFNE group who liked to just get it all over with as quick as possible always put "one for luck" on the end of every shot. By pulling out right away it's generally that last unit you miss out on so as they saw it if they put an extra unit in and missed out on one unit then it all balanced up. Worked for them but not something I'm keen on myself.

Apr 12, 2013

Apollo 45 posts

Topic: General Discussion / Control

Few follow up questions, I notice that sometimes your taking your breakfast at any time between 06:30-10:30 is the rest of your routine moving in the same way or are there some occasions where your having breakfast 4 hours after waking?

I ask as dawn phenomenon relates to hormones floating around for a while after you wake which as I understand it can hamper the effectiveness of the insulin which is why (like me) you have a 1:1.5 ration for breakfast but 1:1 for all other meals. If however your waking at the same time each day and having breakfast at different times then the levels of these hormones may vary quite significantly which in turn will impact your insulins efficiency to either a higher or lower effect and give you variable results.

There can be a number of factors that can impact how well or poorly insulin can work though. Are your activity levels quite constant? for example if you cycle to work some days and drive others then on the days you drive you'll need more insulin to get the same result as exercise can make a little insulin go a long way.

Do you have a hot bath/shower some days and not others? Your generally talking sauna levels to see a significant impact but like exercise heat can improve the efficiency of insulin.

As novorapidboi26 says though you need to verify your background insulin (BI) level is correct first. The idea is that if for some crazy reason you decided to fast for a day your BI should keep you level from morning to bed. To check it is fairly simple. Have your breakfast as normal but then come lunch if your levels are normal, just have a salad or something free from carbs or sugars (remember dressing for salads can have carbs so try to avoid them), if your levels low then skip it that day as you need to sugars to bring them back up, but if they are high but only by a little don't give a correction and have the carb free lunch. come dinner test again if you have only gone up or down by 2 or 3 units then your background is spot on, if there has been a big change one way or the other that will tell you that your background is either to high or to low.

When you know your background is right then you know that the QA insulin is dealing exclusively with your meals and not that it's picking up slack for a low BI or that a high BI isn't dealing with part of your meal sending your into hypos.

One thing I did notice looking at your readings is your corrections, on one occasion you gave a +8 correction. DAFNE guidelines are (or were when I did the course 7 years ago) that you should never take a correction of more than 4 units no matter how high your BG level. If you find yourself needing to take corrections more than that then you have misjudged the carbs somewhere or if it's a regular thing, your ratios are off.

Also at lunch on the 3rd of April you took a +5 correction for a 14.1 reading. Assuming that 1 unit of QA will take you down 3 BG units then your correction would have potentially pulled your BG level down to 0. The fact it didn't and you regularly go up after lunch makes me wonder if your ratios should all be a little higher BUT you need to get your background right first before you start to play with ratios. But more importantly in the short term I'd say you need to be more careful with your corrections and think about if the correction your giving runs the risk of taking you into hypo figures.

Apr 12, 2013

GLS 12 posts

A few says after changing things about and I am much happier. Thanks for the advice novorapidboi26. I have injected my evening levimer at 21:00 for the last few days and here are the results: Very Happy

9/4/13 - 10/4/13

22:30 BG 6.1
01:00 BG 3.4 (likley due to zumba class in earlier in evening)
03:00 BG 6.1
07:30 BG 9.9
08:15 BG 10.3

10/4/13 - 11/4/13

20:00 BG 6.9
21:00 BG 6.3
20:25 BG 8.4
00:00 BG 7.2
03:00 BG 6.4
05:00 BG 6.9
07:10 BG 8.3

11/4/13 - 12/4/13

20:12 BG 7.3
22:16 BG 9.7 (gave up the 1,3 and 5am tests and reduced BI to 14 as had been to zumba again in evening)
07:00 BG 7.7
08:22 BG 10.3

so all in all your advice has really helped me wake up at 7am with a good number. I dont usually eat breakfast till about 8, by which time it has usually gone up to nearly 10. Not sure whether to move my BI a bit later to maybe 22:00 - but then don't want to be in the same situation as I was to begin with, where I was taking it too late (and the morning does was running out!)

thanks again

Apr 12, 2013

mum2westiesGill 502 posts

4.1 - bedtime
11.8 - this morning

- 19.17pm - tea & QA
- 23.28pm - bedtime test was done
- supper was sandwich 2 slices - no QA

Apr 11, 2013

NuMo 28 posts

I understood from my Dafne course that it took the body 6 seconds to absorb the insulin. A slow count ensures that a full six seconds passes before withdrawing the needle.

Before I learnt this technique at Dafne, I did experience the insulin squirting out - somewhat disturbing! So now I do a slow count of 10 to be doubly sure

Apr 11, 2013

Stew B 125 posts

I hold for a slow-ish count of 10, which is probably less than 10 seconds, and then withdraw..

My supplementary question is why hold in the first place? Is it to allow the pen to deliver all the insulin (presumeably there's some kind of "back-up" since it's not going into a vein)? Is it to allow the body to absorb it? Is it to stop it squirting out under pressure? As Marke says what benefit is provided as against simply pressing the plunger and whipping it out? So many questions...

Stew

Apr 11, 2013

Alan 49 284 posts

Topic: General Discussion / Faulty meters

If you've got a One Touch meter you should read this: http://www.bbc.co.uk/news/health-22112565

Apr 11, 2013

novorapidboi26 1,819 posts

Topic: General Discussion / Control

Welcome to the forum

From your results above, your blood sugars go down after breakfast more than they go up, but I would agree it inst the same all the time, which is typical of Diabetes...... Very Happy

But because you are having the same thing for breakfast and same insulin dose it looks highly likely that the unpredictable fluctuations will be down to your background insulin......

You probably need more or less BI from breakfast onwards, your BI need could then change again from dinner on wards......

Because of this it would be wise to do a background check by doing some carb free testing between breakfast and lunch.....this will tell you whether or not you need more or less BI........

As you on a single dose, even if you do find that you need more or less, you probably wont be able to change it because it will effect the rest of your day and cause problems at other times.....

What background insulin are you on? I suspect Lantus!!

I would recommend splitting, however consulting with your diabetic team should be your first course of action, provided you are not confident enough on your own to make changes.....

Apr 11, 2013

Yvonne 1 post

Topic: General Discussion / Control

Van anybody explain why my blood sugars go up when i have exactly the same breakfast every day?

Apr 11, 2013

mum2westiesGill 502 posts

8.8 - bedtime
2.9 - this morning

- 19.41pm - tea & QA
- 22.34pm - bedtime test was done
- supper was sandwich 2 slices - 3 cps - 1u QA (using 0.5:10 ratio) (bit of a trial as never do QA at bedtime)
- but also last night had a treat size biscuit to finish off so should've been 4 cps but.........ended up with a chocolate hunger on me so took 2 more treat size biscuits upto bed!
- treated this morning's hypo with 4 jelly babies then BS was 3.5 so treated with 4 more jelly babies then BS was 8.8

Apr 10, 2013

GLS 12 posts

Thanks for replies.

I switched from Lantus to Levimer for reasons mentioned in last post. Although the steady 24hr action of the Lantus was good for me, I got so frustrated that I couldn't make changes in my BI for things like exercise (as on lantus the effect of changing dose isn't immediate).

So thought id give it a go, as wasn't too worried about an extra injection! And hoping to try for a baby soon, So thought the more flexibity I have the better.

Last night went well so fingers crossed I have another night of good bloods!

Apr 10, 2013

Footgirl 1 post

I read the info with my insulin! which states that the needle should be left for a count of 5. I count it as 5 seconds. I give the insulin reasonably slowly but I don't leave the needle in for very long - anyway sometimes it stings if I do!!

Apr 10, 2013

novorapidboi26 1,819 posts

Basically Levemir is much more effective and flexible than Lantus because any changes that you make to the dose of it can be witnessed the next day, and so is ideal for folk who exercise etc as they can cut there Levemir dose and it will accommodate the extra activity.......

So for example, someone could be going out hill walking all day, they could then drop their AM BI dose to account for this so they don't go low.....on Lantus you would not see the effect from the cut in dose till days later.........

Its also good for people who like a drink..........its wise to drop your BI dose on the night of drinking and on the next day for some, like me......... Wink

Levemir is much more flexible that Lantus that way and so that's why the 'manufacturers' suggest not to split it.....

But as SimonC says, everyone needs something different when it comes to insulin and if Lantus works for you better whether its split or not you should use it.......

The DAFNE handbook version of onset, peak and duration of the insulins is quite useful also....................found HERE - [Only Graduates can view currently........ Crying or Very sad

]

Apr 10, 2013

novorapidboi26 1,819 posts

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

Initial thoughts now that your overnight BI is pretty much spot on, is that you seem to be going higher from when you get up until you get some food inside you.........

this might be dawn phenomenon, or your overnight BI running out........

So you may want to think about taking your BI when you get up............this could also mean that your daytime BI might run out earlier in the night, but you should cross that bridge when you come to it...

If you are experiencing the morning liver dump then your best to get food and insulin in as quick as possible.

I get up For work and have a small yogurt straight away, this was tackle the DP..............I still do it and I am on a pump, old habits die hard........

hypos in the afternoon, naturally you would assume to much insulin at lunch, or breakfast in your case........ Wink

So that's what I would think about evaluating...................unless however you suspect the BI is out...........have you done daytime test of thought recently......

Apr 10, 2013

Apollo 45 posts

why on earth do they advise not splitting Lantus? Without going into all the theory, so long as your total dose isn't greater than you would have taken on a single shot the morning and evening profiles will just add together for the overlap period so I can't see any reason why it would cause a problem.

Just because the manufacturer market it as a one shot in 24 hours product it doesn't mean you can't portion it out if you want to.

what I mean by profile is they way in which the insulin works in your body, these are the profiles of Lantus & Levimer over a 24 hour period accoring to one diabeties website

The bottom of each graph is the time in hours and the height the line goes to shows you how hard the insulin is working at that time. As you can see the Lantus tends to peak after about 10-12 hours (which is why it's general recommended you split your dose into 2 shots 12 hours apart) while Lantus is a more constant effect.

Apr 10, 2013

SimonC 78 posts

Again - not a HCP, but I like my Lantus, but when it wasn't lasting the 24hours it claims, I just split it, I know HCP's don't advise it, but it now works really well for me. I was on 28 units at 2100hours, then split it to 14 units at 0900 and 2100, then, due to weight loss I was giving 10 at 0900 and 2100, but found that looking at the figures my BG was dropping towards the evening, so I am now on 9 at 0900 and 10 at 2100.

Lantus can be split - and if it works for you, then you should put your foot down and insist on Lantus - don't be bullied into treatment you don't like, can't get on with - you are in charge, not the doctors.

Apr 10, 2013

Apollo 45 posts

I'm also not a HCP but I switched about a year ago from Levimer to Lantus and I did find I needed less Lantus compared to Levimer so that fact you need to take more units of Levimer seems normal from my experience.

The reason I changed was that in addition to being more potent Lantus also tends to give a better 24 hour cycle. What I was finding with Levimer was that after about 20 hours it stopped working. The way to correct for that is to split the dose so you take 2 shots like you are but as Novorapidboi26 points out you need to take it the exact same time every day with as close to a 12 hour split as you can mange. I didn't like the idea of putting an extra shot in my daily routine so when they said Lantus offered a more balanced long lasting profile the switch made sense.

While they do both do the same basic task they are different substances and don't necessarily do it in the same way. One of the reasons that some people will take one over the other is that some people experience a burning sensation as they inject Lantus, I can't say I've experienced that myself but it could be that where they do work in slightly different ways that although one created no dawn phenomena for you it doesn't mean the other won't.

Out of curiosity what was your reason for switching? Granted we are all different but I've found Lantus to be a superior insulin, just a shame the company who make it can't design a quality injection system to save their lives.

Apr 10, 2013

mum2westiesGill 502 posts

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

Help/comments needed please on the last 3 days results
Mon 08/04 - Wed 10/04(so far)

Apr 10, 2013

mum2westiesGill 502 posts

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

Thank you Travler

Apr 10, 2013

mum2westiesGill 502 posts

7.1 - bedtime
4.9 - this morning

- 19.06pm - tea & QA
- 22.21pm - bedtime test was done
- supper was 4 butter puffs - 2 cps - 1u QA (bit of a trial as never do QA at bedtime)

Apr 10, 2013

novorapidboi26 1,819 posts