Recent Posts - DAFNE Online

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / BG Diary entries

I would still test at bedtime, if I was was wanting to see what my BI was doing........

I don't always test before bed though as I know my BI is right, at least for now...

So not all the time, but definitely if your going through a stage of adjustment, which you are at the moment......

Nov 20, 2012

mum2westiesGill 502 posts

Topic: General Discussion / BG Diary entries

If your last insulin dose of the day is BI (background insulin) and you take this early evening but you don't go to bed until much later would you

- put the BI amount into your diary and the time
then
- test at your actual bedtime ie when you get into bed and mark this as BED

Thanks for any replies Smile

Nov 20, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Lantus - changing time

I normally take my lantus (BI) at 11:00pm or an hour or so either side. This is usually also my bedtime.
I take humalog (QA) at around 08:00pm ish when I have my evening meal.
I'm going to start taking my lantus earlier in the evening. Any votes on my new time please?

Nov 20, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Lantus - decreasing

novorapidboi26 said:
Lol,

I realise that must of sound wrong, but I was referring to adding on a few more units to your reduction total....

Ahh I see lol Laughing

.

Anyway It's no too late to reduce it again tonight (after already reducing last night) by another 2u so from 34u to 32u (in total from 36u to 32u). I'm also going to start taking it much earlier in the evening. I usually take it about 11:00pm or within an hour either side. Then I'm going to wait 4/5 days / 1 week to see what changes it brings.

I did actually phone my DSN & she confirmed together with me all of the above. DSN also said I could maybe even reduce it to 30u.

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Lantus - decreasing

Lol,

I realise that must of sound wrong, but I was referring to adding on a few more units to your reduction total....

Nov 20, 2012

SA2010 69 posts

Topic: General Discussion / Insulin Pens for NovoRapid & Lantus

Thanks Lauren for the feedback. I have put my request for 'Novopen Echo' to the GP. Will research the clickmaster further before asking to switch to it. In any case I would need to get to the end of my current Lantus batch of 5 pens.

Simon

Nov 20, 2012

SA2010 69 posts

Topic: General Discussion / Ratios

Spot on. You round up or down depending on where your BG is at within the target range. You take that into account also if outside target range.

I have switched to a half-unit pen because I am very sensitive to insulin

Simon

Nov 20, 2012

SA2010 69 posts

Topic: General Discussion / Lantus - decreasing

Hi

Surely you need to be more aggressive with your Lantus reductions with so low and persistent BG readings and below 3.0. The stepwise chart in the DAFNE Handbook says BI reduction of 1-2 units but also says 10%-20% so in your case I would say that would be a reduction of 4 to 7 units from 36 rather than 1 to 2.

Over time I have come down from a peak of 20 units Lantus day now to just 8 split as 4 and 4 Probably still not my optimum level - I probably need to bring it up to 9 - But each person is different so in your case you need a much higher level

PS: Should get in the habit of putting the Fast Acting CPs in the BG Diary CP fields as it would make it easier to see the action taken on hypos and what effect it had on the BG subsequently.

Nov 20, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Lantus - decreasing

novorapidboi26 said:
If you are confident enough then yeah, add on the additional units and then proceed with the 3 days testing (3 am etc...)........

Have you been ill........?

Any alcohol......?

Hi novorapidboi26
Thank you for your reply but I was asking about decreasing units.

Nov 20, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Ratios

How many units of insulin would you have on a
0.5:1 ratio

for example 5 CPs / being 52.0g of carbs?

would it be 0.5 times 5 = 2.5?

Then with a one unit pen (I don't have a half unit pen) & taking into consideration bs levels being low or high it would be rounded down to 2u or rounded up to 3.

I've never done DAFNE so am I right with my workings out please?

Nov 20, 2012

Gibsjoh 2 posts

Topic: General Discussion / Levemir

Yes been using pens for a good few years and had no problems, thought it was maybe the way I have been carrying the spare insulin with me but for some reason just the Levemir vials have been faulty.

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: Questions for HCPs / FASTING TARGET

Well, all targets are specific to each individual, but ultimately we want to be between 4-7 at the before meal occasions and the fasting time........

Fasting target is the range of blood sugar your at when you wake up, most people find they are higher at this time, due to an increased increased insulin resistance [glucagon] and glucose secretion from the liver. These two processes are happening because of the fact you have been fasting and there is no fuel on board......

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: Questions for HCPs / insulin pump

Not an HCP or Pump user yet however I can explain..........

The corrections are programmed into the pump.....

However corrections can change as you know, so in the morning 1 unit could drop you by 3 mmol/l and at night that may go down to 1 mmol/l.....

The pump can accommodate for these varying levels of resistance to corrections at different times of the day.

So by using the information that the user had given it, together with the specified blood sugar targets for that time of the day, its purely a simple arithmetic calculation...

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: Questions for HCPs / exercise query

I think with long periods of light to moderate activity levels you should actually decrease your BI dose, this will deal with a slower dropping blood sugar level and can accommodate for the hours after the activity also....

Now, I am not a great fan of too much exercise so my advice may not be very good, however I would say that option 1 would be good.

Take your normal 1:1 ratio, and also consider increasing the time from injection to actually eating breakfast. This will help you avid hitting the 20+ blood sugar readings.....

As you would have reduced your BI you would find that you may not need extra CPs during or after.........best to test this approach with caution, as you would with any new approach, as we are all different...

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: Questions for HCPs / exercise query

I think with long periods of light to moderate activity levels you should actually decrease your BI dose, this will deal with a slower dropping blood sugar level and can accommodate for the hours after the activity also....

Now, I am not a great fan of too much exercise so my advice may not be very good, however I would say that option 1 would be good.

Take your normal 1:1 ratio, and also consider increasing the time fro injection to actually eating breakfast. This will help you avid hitting the 20+ blood sugar readings.....

As you would have reduced your BI you would find that you may not need extra CPs during or after.........best to test this approach with caution, as you would with any new approach, as we are all different...

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Insulin Pump approval

Leigh,

Can I ask what kind of numbers you get in the morning......?

I also suffer from this however its not bad enough to get me up out of bed at that time....!!

I assume your on a split dose of BI and your PM one is as late as possible......[before bed]...

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Levemir

I take it you use actual pens as opposed to disposables?

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Ratios

You should wait to see what that recent change has done to your blood sugars, even if you think you should of went for more or less.......

Its a good habit to get in to, its methodical and helps.........

Nov 20, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Lantus - decreasing

If you are confident enough then yeah, add on the additional units and then proceed with the 3 days testing (3 am etc...)........

Have you been ill........?

Any alcohol......?

Nov 20, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Lantus - decreasing

I'm having hypos all over the place ie waking up to them plus having them during the day.
One week ago on Monday evening 12/11/2012 I reduced my lantus (BI) by 6u so from 42u to 36u (on a say so from my DSN). I decreased it again last night by 2u so from 36u to 34u. I can't help thinking I should've maybe reduced it by 4u. I know lantus should be left for 3 / 4 days / 1 week before making any more changes. Is it too late after just 1 night be reducing it once more then stick with this change for the next few days?

Thanks in advance for any replies Smile

Nov 19, 2012

paulj 36 posts

Topic: Questions for HCPs / exercise query

this morning i decided to go for a 5 mile walk after breakfast.
my BG reading when igot up before breakfast was -11.3
i had 7cps for breakfast and had 3.5 units of q/a insulin plus 1.0 correction i.e. total 4.5 q/a units ratio= half to one
i also took my BI of 7 units
before i started my walk an hour later my BG was-20.8
halfway through the walkmy BG level was-9.9
i then ate 2CP'S of carbohydrates and at the end of my walk one and a half hours later my BG level was 5.8

my questions are -
1.should i have taken my normal 1/1 ratio for breakfast and started with a lower BG level and taken on extra cp's as and when needed?
2.with the high BG level i started with should i have tested for KETONES ?

which option in your opinion would be best for me in the future?the goods thing about this for me was i didnt develop a HYPO as i would have normally done starting with a lower BG level and exercising afterwards.
my ulitimate aim for the next three months is to have as few hypo's as possible to develop in the future better awareness of the onset of hypo's

i realise everyone reacts differently to exercise butr i am a little bit confused at the moment as what would have been and will be the best option in the future

your anticipated advice is greatly appreciated

Nov 19, 2012

paulj 36 posts

Topic: Questions for HCPs / FASTING TARGET

what is a FASTING TARGET and what is the difference between this and a BEFORE MEAL TARGET

Nov 19, 2012

Laurenjayne123 1 post

Topic: General Discussion / Insulin Pens for NovoRapid & Lantus

I found the clickstar to be a much better pen and I do believe its more recent. It looks alot nicer and is a similar style to the nova pens. As for the nova echo pen I have one and it's great and I heard they last a long while too.

Nov 18, 2012

SA2010 69 posts

Topic: General Discussion / Ratios

Hi. I believe you wait for indication to show consistency over 2 days before increasing the QA ratio but if dealing with hypos then can change the ratio for the next time you have that meal, be it breakfast, lunch or evening meal.

This assumes that the BI doses are not being changed at the same time. When making a BI change, I normally wait 2-3 days at least before making any further changes

Simon

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / BG Diary entries I would still test at bedtime, if I was was wanting to see what my BI was doing........ I don't always test before bed though as I know my BI is right, at least for now... So not all the time, but definitely if your going through a stage of adjustment, which you are at the moment......

Nov 20, 2012 mum2westiesGill 502 posts	Topic: General Discussion / BG Diary entries If your last insulin dose of the day is BI (background insulin) and you take this early evening but you don't go to bed until much later would you - put the BI amount into your diary and the time then - test at your actual bedtime ie when you get into bed and mark this as BED Thanks for any replies

Nov 20, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Lantus - changing time I normally take my lantus (BI) at 11:00pm or an hour or so either side. This is usually also my bedtime. I take humalog (QA) at around 08:00pm ish when I have my evening meal. I'm going to start taking my lantus earlier in the evening. Any votes on my new time please?

Nov 20, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Lantus - decreasing novorapidboi26 said: Lol, I realise that must of sound wrong, but I was referring to adding on a few more units to your reduction total.... Ahh I see lol . Anyway It's no too late to reduce it again tonight (after already reducing last night) by another 2u so from 34u to 32u (in total from 36u to 32u). I'm also going to start taking it much earlier in the evening. I usually take it about 11:00pm or within an hour either side. Then I'm going to wait 4/5 days / 1 week to see what changes it brings. I did actually phone my DSN & she confirmed together with me all of the above. DSN also said I could maybe even reduce it to 30u.

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Lantus - decreasing Lol, I realise that must of sound wrong, but I was referring to adding on a few more units to your reduction total....

Nov 20, 2012 SA2010 69 posts	Topic: General Discussion / Insulin Pens for NovoRapid & Lantus Thanks Lauren for the feedback. I have put my request for 'Novopen Echo' to the GP. Will research the clickmaster further before asking to switch to it. In any case I would need to get to the end of my current Lantus batch of 5 pens. Simon

Nov 20, 2012 SA2010 69 posts	Topic: General Discussion / Ratios Spot on. You round up or down depending on where your BG is at within the target range. You take that into account also if outside target range. I have switched to a half-unit pen because I am very sensitive to insulin Simon

Nov 20, 2012 SA2010 69 posts	Topic: General Discussion / Lantus - decreasing Hi Surely you need to be more aggressive with your Lantus reductions with so low and persistent BG readings and below 3.0. The stepwise chart in the DAFNE Handbook says BI reduction of 1-2 units but also says 10%-20% so in your case I would say that would be a reduction of 4 to 7 units from 36 rather than 1 to 2. Over time I have come down from a peak of 20 units Lantus day now to just 8 split as 4 and 4 Probably still not my optimum level - I probably need to bring it up to 9 - But each person is different so in your case you need a much higher level PS: Should get in the habit of putting the Fast Acting CPs in the BG Diary CP fields as it would make it easier to see the action taken on hypos and what effect it had on the BG subsequently.

Nov 20, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Lantus - decreasing novorapidboi26 said: If you are confident enough then yeah, add on the additional units and then proceed with the 3 days testing (3 am etc...)........ Have you been ill........? Any alcohol......? Hi novorapidboi26 Thank you for your reply but I was asking about decreasing units.

Nov 20, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Ratios How many units of insulin would you have on a 0.5:1 ratio for example 5 CPs / being 52.0g of carbs? would it be 0.5 times 5 = 2.5? Then with a one unit pen (I don't have a half unit pen) & taking into consideration bs levels being low or high it would be rounded down to 2u or rounded up to 3. I've never done DAFNE so am I right with my workings out please?

Nov 20, 2012 Gibsjoh 2 posts	Topic: General Discussion / Levemir Yes been using pens for a good few years and had no problems, thought it was maybe the way I have been carrying the spare insulin with me but for some reason just the Levemir vials have been faulty.

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: Questions for HCPs / FASTING TARGET Well, all targets are specific to each individual, but ultimately we want to be between 4-7 at the before meal occasions and the fasting time........ Fasting target is the range of blood sugar your at when you wake up, most people find they are higher at this time, due to an increased increased insulin resistance [glucagon] and glucose secretion from the liver. These two processes are happening because of the fact you have been fasting and there is no fuel on board......

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: Questions for HCPs / insulin pump Not an HCP or Pump user yet however I can explain.......... The corrections are programmed into the pump..... However corrections can change as you know, so in the morning 1 unit could drop you by 3 mmol/l and at night that may go down to 1 mmol/l..... The pump can accommodate for these varying levels of resistance to corrections at different times of the day. So by using the information that the user had given it, together with the specified blood sugar targets for that time of the day, its purely a simple arithmetic calculation...

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: Questions for HCPs / exercise query I think with long periods of light to moderate activity levels you should actually decrease your BI dose, this will deal with a slower dropping blood sugar level and can accommodate for the hours after the activity also.... Now, I am not a great fan of too much exercise so my advice may not be very good, however I would say that option 1 would be good. Take your normal 1:1 ratio, and also consider increasing the time from injection to actually eating breakfast. This will help you avid hitting the 20+ blood sugar readings..... As you would have reduced your BI you would find that you may not need extra CPs during or after.........best to test this approach with caution, as you would with any new approach, as we are all different...

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: Questions for HCPs / exercise query I think with long periods of light to moderate activity levels you should actually decrease your BI dose, this will deal with a slower dropping blood sugar level and can accommodate for the hours after the activity also.... Now, I am not a great fan of too much exercise so my advice may not be very good, however I would say that option 1 would be good. Take your normal 1:1 ratio, and also consider increasing the time fro injection to actually eating breakfast. This will help you avid hitting the 20+ blood sugar readings..... As you would have reduced your BI you would find that you may not need extra CPs during or after.........best to test this approach with caution, as you would with any new approach, as we are all different...

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Insulin Pump approval Leigh, Can I ask what kind of numbers you get in the morning......? I also suffer from this however its not bad enough to get me up out of bed at that time....!! I assume your on a split dose of BI and your PM one is as late as possible......[before bed]...

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Levemir I take it you use actual pens as opposed to disposables?

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Ratios You should wait to see what that recent change has done to your blood sugars, even if you think you should of went for more or less....... Its a good habit to get in to, its methodical and helps.........

Nov 20, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Lantus - decreasing If you are confident enough then yeah, add on the additional units and then proceed with the 3 days testing (3 am etc...)........ Have you been ill........? Any alcohol......?

Nov 20, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Lantus - decreasing I'm having hypos all over the place ie waking up to them plus having them during the day. One week ago on Monday evening 12/11/2012 I reduced my lantus (BI) by 6u so from 42u to 36u (on a say so from my DSN). I decreased it again last night by 2u so from 36u to 34u. I can't help thinking I should've maybe reduced it by 4u. I know lantus should be left for 3 / 4 days / 1 week before making any more changes. Is it too late after just 1 night be reducing it once more then stick with this change for the next few days? Thanks in advance for any replies

Nov 19, 2012 paulj 36 posts	Topic: Questions for HCPs / exercise query this morning i decided to go for a 5 mile walk after breakfast. my BG reading when igot up before breakfast was -11.3 i had 7cps for breakfast and had 3.5 units of q/a insulin plus 1.0 correction i.e. total 4.5 q/a units ratio= half to one i also took my BI of 7 units before i started my walk an hour later my BG was-20.8 halfway through the walkmy BG level was-9.9 i then ate 2CP'S of carbohydrates and at the end of my walk one and a half hours later my BG level was 5.8 my questions are - 1.should i have taken my normal 1/1 ratio for breakfast and started with a lower BG level and taken on extra cp's as and when needed? 2.with the high BG level i started with should i have tested for KETONES ? which option in your opinion would be best for me in the future?the goods thing about this for me was i didnt develop a HYPO as i would have normally done starting with a lower BG level and exercising afterwards. my ulitimate aim for the next three months is to have as few hypo's as possible to develop in the future better awareness of the onset of hypo's i realise everyone reacts differently to exercise butr i am a little bit confused at the moment as what would have been and will be the best option in the future your anticipated advice is greatly appreciated

Nov 19, 2012 paulj 36 posts	Topic: Questions for HCPs / FASTING TARGET what is a FASTING TARGET and what is the difference between this and a BEFORE MEAL TARGET

Nov 19, 2012 Laurenjayne123 1 post	Topic: General Discussion / Insulin Pens for NovoRapid & Lantus I found the clickstar to be a much better pen and I do believe its more recent. It looks alot nicer and is a similar style to the nova pens. As for the nova echo pen I have one and it's great and I heard they last a long while too.

Nov 18, 2012 SA2010 69 posts	Topic: General Discussion / Ratios Hi. I believe you wait for indication to show consistency over 2 days before increasing the QA ratio but if dealing with hypos then can change the ratio for the next time you have that meal, be it breakfast, lunch or evening meal. This assumes that the BI doses are not being changed at the same time. When making a BI change, I normally wait 2-3 days at least before making any further changes Simon