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Hi Elvie,

The first thing I noticed was that you're taking your evening BI at tea-time. For the majority of people following DAFNE and using BI twice a day, you will get the maximum benefit from taking your morning dose on getting up and your evening dose as you go to bed (ensuring they are 7hrs apart overnight) - this helps to control those morning (Dawn Phenomenon) BG better.

If you have done CP-free meals in the day to test out your morning BI and found that it needs to be higher, please bear in mind that once you have increased it you may need to re-evaluate your QA:CP ratios as they may need to be reduced with better BI coverage - follow the Step-Wise Approach Smile

As always, usually best to speak to your local Educator team if possible as they will know your medical history better.

Good luck,

Carolin

Dec 21, 2012

Warwick 425 posts

Topic: Questions for HCPs / Fasting blood sugars... what on earth is going on here??

I think that correcting with QA without a meal is fine. You just need to avoid over-correcting. If you hadn't corrected, at 07.06, you would have been high all day. I correct quite often with QA and without carbs, and I don't usually have any hypos as a result as long as I follow the DAFNE principles of correction - 1 unit of QA tends to drop BGs by 2-3 mmol/L. So your 4 unit dose of QA at 07.06 should have dropped the BGs by 8-12 units once the QA was absorbed, and looking at your 11.40 reading, it had dropped by 10.4 units which is within that 8-12 range.

Is your insulin good quality? Has it been out of the fridge for more than 30 days? Has it got hotter than 30 degrees at any point, does it look OK - not cloudy before injecting? It is very unusual that in the space of 90 minutes, you went from 5.2 to 15.3. It may just be a one-off though, and if you don't usually fast, then perhaps it is your body's way of coping without food. Also, unexplained rising of BGs can indicate that you are getting sick, or battling a virus etc.

Instead of fasting, you can achieve much the same result by having carbless meals - green vegetables, protein etc. Try an omelette with salad, and the carbs in that are very negligible, but you might see less fluctuations in your BGs.

If you get a reading higher than 13, then certainly correct with QA, with or without carbs. Two consecutive readings that are above 13 (e.g breakfast and lunch, lunch and dinner, dinner and bed, or bed and breakfast) is cause for a concern and you should be testing ketones if that happens. Any reading higher than 17 should always have a ketones check. If ketones are higher than 1.5, you need to follow the sick day rules - see the section "Coping when you are ill" in the DAFNE handbook.

In the data above, there is no record of a ketones check. Is that because you aren't doing one? It is really important to do one in the above situations as elevated ketones could lead to diabetic ketoacidosis.

All the best with it.
Warwick.

Dec 20, 2012

Guy 3 posts

Topic: Site Development / Do you use the Diary Graphs?

Hi
I have just spotted chrisinbrum's post about treating the absence of BG readings as zero values. I noticed the same issue when viewing my Blood Glucose Trend Chart. This does throw off the results.

Thanks

Guy

Dec 20, 2012

Gemsa 20 posts

Topic: Questions for HCPs / Fasting blood sugars... what on earth is going on here??

So I did DAFNE in October and I believe I totally understand the 'rules' in theory, they just don't seem to be replicating in practice. I know my background insulin is not right and have changed from lantus to levemir but still haven't got the dose right (I got two good days but none since).

So did a big long fast to try and see why its not behaving. I went low in the early afternoon so had a small snack of long acting (carb points are certainly correct as off the back of the packet... I don't eat anything unless I have exact carbs for it) and then just shot up and kept going up ever since. I reduced evening levemir because of morning levemir making me go low and I didn't want to go low overnight (possible reason for the 20 in the morning as was only 8 the night before). And I know I shouldn't have corrected with QA without eating a meal but I couldn't stand being so high as it was making me feel sick.

So which part of my dose is wrong?!

Dec 20, 2012

Warwick 425 posts

I don't feel qualified to comment sorry. Perhaps a HCP can comment?

Thanks,
Warwick.

Dec 19, 2012

marke 686 posts

Alan, who told you that Medway were running DAFNE ? The reason I ask is they were a DAFNE Centre but dropped out, as did my centre East Kent. Unfortunately in Kent they like to invent their own education programmes so as well as modifying DESMOND and calling it DEREK, they have also 'dropped'
DAFNE and come up with 'KATIE' ( which I'm still trying to get information on).
It would not suprise me if Meday have also invented their own course, it should NOT be called DAFNE however since it is not. Let us know if you find out what they are doing....

Dec 19, 2012

Elvie 6 posts

It's Levemir which lasts for 18 hours Sad

Dec 19, 2012

DianeW 115 posts

Sorry novorapidboi, I was looking at your answer on my phone and it didn't show a link LOL how funny.

That is really useful, thanks so much Very Happy

Have a very merry Xmas!

Dec 19, 2012

Sweetpea 4 posts

Topic: General Discussion / Help and advice please

15 is not a lot for ME, it's come from trying to get very tight control and working with my diabetes team.
I am planning for a pregnancy and need to get very tight control which means having as many basal rates as my body needs. Every person is different and have different things which affect their sugar levels, I have extra things which affect me such as stress, driving times, hormones etc etc.
Since having 15 basal rates I got my HBA1c down from 9.3% to 6.4%!

Dec 19, 2012

Warwick 425 posts

What sort of basal insulin are you on? Do you know its profile? E.g, does it last for 12 hours, 18 hours, 24 hours? If it only lasts for 12 hours, then I would suggest that you could leave your night time BI at 9 or 10, but increase the daytime BI by 1 or 2. If it lasts 18 or 24 hours, then it would be more complicated and need someone else to answer your query.

Thanks,
Warwick.

Dec 18, 2012

Garry 328 posts

What a good guide. You don't half pick out some belting info novarapidboi.
An early Merry Christmas to us all.
Regards
Garry

Dec 18, 2012

Elvie 6 posts

Hi Warwick, you are right that my BI levels are too low during the day, I've been aware of this for a while, but whenever I try to raise them I end up going hypo overnight, so I end up taking a couple of extra units at lunchtime to compensate. The whole situation is really frustrating.

Dec 18, 2012

novorapidboi26 1,819 posts

There is a link embedded in the word 'THIS

lol

Dec 18, 2012

DianeW 115 posts

Have a look at what?

Dec 18, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Ratio - have I calculated this right?

Maybe the ratio should've been 2:10 (or 2:1). But then I'd be frightened of going hypo. I had 2 pieces of toast with 1 poached egg for breakfast when my BG was 14.1.

Dec 18, 2012

Carolin 83 posts

Hi Alan,

One of the key projects within the DAFNE NIHR programme grant, was to evaluate the full DAFNE curriculum delivered 1 day per week over 5 weeks, compared with the standard 5 consecutive days.

There were 7 centres involved in this research programme which has only just completed the final 1-yr follow-up so results won't be available until next year. However, some of these centres have continued to offer 5-week courses to people who for whatever reason have not been able to attend a week-long course. To my knowledge this particular centre is not one that participated in the research so it may be a different programme that they are offering.

I don't know if there are any users online who did the 5-week DAFNE who wish to comment, but it seems that the feedback from both Educators and participants was positive and it's possible that in time you may be able to choose whether you do your course over 5 consecutive days, or 5 weeks.

Carolin

Dec 18, 2012

novorapidboi26 1,819 posts

Interesting......

I would say the 5 consecutive days is more effective also but it would seem that there are a lot of type 1s that would fins the 5 week approach a lot more flexible, which is good as DAFNE can reach a lot more people that way......

The curriculum may need to be re jigged as it wouldn't be wise to send patients away without them having at least the basics on dose adjustment..

Also a lot of people finish the course still trying to pin down there doses, the 5 week approach might see people actually getting there dose right and also being able to share how they done it with fellow students.....

Just some of my thought though.......PROS and CONS...

Dec 18, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Ratio - have I calculated this right?

So what went wrong do you think:

Ratio?
Correction?

Dec 18, 2012

Alan 49 284 posts

My niece (who is also a Type 1) is trying to get on a DAFNE course - she knows how well I got on after my course. Her local hospital (the Medway Maritime Hospital) runs DAFNE courses which are one day a week for five weeks, rather than the Monday to Friday course which I did. This doesn't seem to be a good way of learning to me - surely you lose the continuity of five consecutive days of instruction.

Is this the way DAFNE courses are being run now?

Dec 18, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Ratio - have I calculated this right?

BG - 11.2 - lunch

Dec 18, 2012

novorapidboi26 1,819 posts