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Oct 3, 2012
Simon I
1 post
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Topic: General Discussion / What are you reading? Just joined this site though went through DAFNE a few years ago, graduated from North ManchesterCurrently reading Dodger - Pratchett on form, a cracking read. Best e-reader Kindle IMHO, I have an ipad too but preferred reading device is the kindle Simonish |
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Oct 1, 2012
JayBee
587 posts
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Topic: General Discussion / What are you reading? Bit of a zombie/phoenix thread, but hey, what have you been reading lately these days?I've been trying out some Dean Koontz lately, currently reading The Good Guy. I've been really enjoying his writing style and look forward to checking out more of his books.  While we're here, can anyone recommend an e-reader? Thanks! |
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Oct 1, 2012
JayBee
587 posts
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Topic: General Discussion / Result. I'm only reading and drawing conclusions from the BG diary results in front of me.It was not my intention to make you feel like an idiot. Sorry. As requested and promised, I will leave your situation completely alone now. |
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Oct 1, 2012
JayBee
587 posts
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Topic: General Discussion / Result.
(Let's not be specific to 1:1 because that is only the suggested starting point of DAFNE) This rule of consistency applies for ANY RATIO you try after looking for patterns. What ratios you need are personal to you so you need to find them out. If you didn't change the meal ratio (or in your case every meal ratio) the every day then yes, you would then be being consistent - you are pattern searching after all. You need consistency to see patterns and your body needs a minimum of 48 hours to tell you what it needs through monitoring. Does this make sense? I'm getting the impression you're confused about how DAFNE works which is a bit worrying. 
26/09? The latest entry I can see on that day is 21:45.
Why are you not applying DAFNE exercise rules if that is the case? Edit: If you need to know what the exercise rules are, they're here (re-posting):
When it says reducing QA, it means minus-ing off your meal total dose, not outright adjusting a meal ratio. eg, say you ate 5CPs and you were on 1:1 meal ratio and then you decided you would do Prolonged/intense - up to 4 hours. Looking at the DAFNE exercise rules, this usually asks for 30% - 50% decrease before exercise so in this example: Say in this case, your BGs were about 4.5... consider the 50% in light of this BG... so... 5QA - 50% = 2.5QA. 2.5QA is what you'd take for your food and your body being exercised will do the rest to keep your BGs okay. If you don't exercise tomorrow, then in this case, you'd go back to 1:1 as normal. Whatever your basic needs (which at the moment we're trying to work out), you will need to work out your requirements for the exercise and minus off what you need and your meal ratios will stay the same because the exercise rules are short term adjustments. Also keep in mind that exercise, especially prolonged, can effect your sugar levels for over 24 hours afterwards so be wary of hypos and be careful of corrections (this is because exercise temporarily increases insulin sensitivity). |
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Oct 1, 2012
JayBee
587 posts
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Topic: General Discussion / Result. Let's see what the break down is...
This is good.
You were testing 20BI then. You now need to check on 18BI.
I cannot see this entry (a 3am check, right?) on the BG diary. Was it deleted?
When I was still fluctuating with my doses a while back, my symptoms were not weakened either. I think this is because on average we've still been around 8-9BG so our body manages to keep them, thank goodness.
I can send again if you like. They're both responses to your most recent message regarding this thread, subject: Ratios.
I hate to break it to you vic but that is not consistent - it completely undermines the DAFNE rules, especially the 48 hour one. You should not have to adjust stuff that much. It's making your life harder needlessly. What do you do during the day for those changes to even be considered? I did ask about exercise and stress in my PM too which I'll post here:
The suggested arrangement was the one I posted earlier:
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Oct 1, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Result. from the diary visible above, its only the 25th that is there, out of the 2 dates you have given.......even still that particular date doesn't show anything with regards to your dose of 18 being correct. 1. you had a hypo at 3 am which would suggest the 18 BI is too much, or the supper ratio isn't right. 2. you took 4 units correction at 21:08pm, what was you BG after this dose expired [4-5hours, 2:10am]?, not long after that time you took your 3:15am test and you were low! was this down to the 4 units correction ie. too sensitive, or was it your 18BI? All explorable avenues in determining your 3:15 am hypo........ that's your problem at this stage, too many variables..... you really want to pin down your overnight BI needs, so that means no QA insulin or carbs working in your system at the time of the pre bed blood sugar....repeat that 2-3 times......I apologize if you know this and have done this test.... having the carb free meal is OK though, needs to be repeated though to confirm a dose change, so once is not enough.... the thing about the carb free meal though is that it can only tell you what you daytime BI need might be, not your overnight need, which for most is significantly different from the day.....so you need to consider each portion of the day separately, which is a nuisance I know as your only on one dose of BI, but you could split it if your testing shows you need more in the AM than PM and vice versa......... it makes managing the AM/PM much easier....... |
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Oct 1, 2012
JayBee
587 posts
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Topic: General Discussion / Result.
Agreed. I can't see any evidence either because the 48 hours rule is still not being applied, or any carb free meal, or over night checking. My PM to vic yesterday:
With 48 hour rule still not being applied, I will withdraw from advising vic any further until it does start getting applied properly. It's plain as day that changing so frequently is not helping anyone. Ball is in your court, vic. |
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Oct 1, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Result. wow that's a lot of hypos, at least one a day, how are the hypo warning symptoms, still strong....?You mentioned your Lantus holding well, when? There is no evidence of it that I can see... changing ratios and BI on a day to day basis is obviously not the way its meant to be done but I realize its a daily battle and hard, especially when you are having lots of hypos.... 
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Sep 30, 2012
marke
681 posts
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Topic: General Discussion / Levemir Going Off Hi Rich is correct you should report this to your pharmacy. Every batch of any prescription drug can be traced from manufacturer all the way through to the dispensing pharmacy. If you suspect a batch is 'faulty' you should report it to the pharmacist. They can then get it investigated and ideentify if there is anissue. You can find the Batch Number and Expiry Date on every pen near the base. In the case of Insulin it should be transported and stored at all stages in temperature controlled storage. It makes no difference if you get 2 boxes and keep them in the fridge or one since you are storing them in the temperature range required. |
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Sep 29, 2012
novorapidboi26
1,819 posts
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Topic: Questions for HCPs / Help Have you used the sick day rules when you have ketones? It's hard to faith in them if you haven't used them but they do work......It's ver likely that you 6 units correction was no where near enough for a level of 17, for me personally, and this doesn't mean you too, I need 1 unit for every mmol over target....the higher you are, the more resistant you become, at least temporarily..... Hang in there.... Not being as active as you normally are may mean adding on a few units of BI here and there, just take it back to basics, carb free background checks should get your dose to what you need it at..... |
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Sep 29, 2012
SteveRowland
10 posts
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Topic: Questions for HCPs / Help Thanks to everyone for their comments. I am grateful. I am really starting to despair. I have increased both my morning and evening levemir (BI). I am correcting on the basis of 1 unit QA for 2 mmols (as opposed to the 3 we were taught). I was 17.5 this morning and so corrected heavily. I gave myself 14 units for my usual 8 CP breakfast (that's an eye watering correction of 6 units). I deliberately waited before eating to get the insulin into my blood stream. Three hours after this I was 15.4. I am at my wits end. I have changed my insulin in case it has gone off. Hasn't made any difference. It feels as if I have become immune to insulin. My last HbA1c was 6.7 and I am known for my sensitivity to insulin. I usually do a lot of exercise but haven't for the past week as I feel so rough. I'm terrified of developing ketones as I fear that my sick day rules won't work.Feels better to get that off my chest! I don't know what's happening and I'm starting to feel desperate! |
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Sep 28, 2012
novorapidboi26
1,819 posts
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Topic: Questions for HCPs / Help Usually if I was ill, I would be using my QA to compensate for the higher readings......But this would be assuming it would not last for more than a few days, but it is lasting longer for you yeah? In this case there might be need for dose adjustment in the general/permanent sense as well as for the illness/temporary..... So as others have advised, increasing your BI would be wise, and once your feeling better, start testing your new BI dose and establish what its doing..... Get well soon.......
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Sep 28, 2012
JayBee
587 posts
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Topic: Questions for HCPs / Help Oh I see! Glad you're feeling a bit better. Hopefully things will start returning to how things were before illness soon.
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Sep 28, 2012
SteveRowland
10 posts
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Topic: Questions for HCPs / Help Thanks, JWo. I agree that I need to get the BG down! I should have said that I give myself 9 units of BI in addition to the 4 in the morning. I am just rubbish at recording the night BI as it is not done at a meal time. I have just increased the night dose to 10. I've had a few better readings but still have highs. Feeling a bit better so I'm optimistic. |
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Sep 28, 2012
JayBee
587 posts
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Topic: Questions for HCPs / Help Based on the results posted, I think it's a good idea to raise something because you need to get those numbers down across the day.Are you normally okay on 4BI? I only ask because it seems to be a tiny amount... I think a carb free meal here and there will help spread some more light in regard to the BI situation should be done first before adjusting it. Tough call though when you say you are technically ill. Get well soon! |
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Sep 28, 2012
RichFreed
51 posts
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Topic: DAFNE Online Mobile / Bug - Time-Zone Download enties issue At 9am my time the 28th Morning entries downloaded. On checking time zones I'm actually +9 at the moment so the theory stands up. |
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Sep 27, 2012
RichFreed
51 posts
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Topic: General Discussion / Levemir Going Off It would seem to me that if you have followed the storage specs and are within the expiry date then this issue needs to be reported (since it's not the first time - could be any number of issues outside of your control eg a transport & storage procedure that has broken down prior to reaching you in the first place). At the very least the unused ones should be replaced for you (each time it happens).Gleened this off Google for you. RECOMMENDED ECOMMENDED STORAGE Unused LEVEMIR should be stored between 2° and 8°C (36° to 46°F). Do not freeze. Do not use LEVEMIR if it has been frozen. Vials: After initial use, vials should be stored in a refrigerator, never in a freezer. If refrigeration is not possible, the in-use vial can be kept unrefrigerated at room temperature, below 30°C (86°F), for up to 42 days, as long as it is kept as cool as possible and away from direct heat and light. Unpunctured vials can be used until the expiration date printed on the label if they are stored in a refrigerator. Keep unused vials in the carton so they will stay clean and protected from light. PenFill cartridges, FlexPen , or InnoLet : After initial use, a cartridge (PenFill ) or a prefilled syringe (including FlexPen or InnoLet ) may be used for up to 42 days if it is kept at room temperature, below 30°C (86°F). In-use cartridges and prefilled syringes in-use must NOT be stored in a refrigerator and must NOT be stored with the needle in place. Keep all cartridges and prefilled syringes away from direct heat and sunlight. Not in-use (unopened) LEVEMIR PenFill , FlexPen or InnoLet can be used until the expiration date printed on the label if they are stored in a refrigerator. Keep unused cartridges and prefilled syringes in the carton so they will stay clean and protected from light. |
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Sep 27, 2012
RichFreed
51 posts
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Topic: DAFNE Online Mobile / Bug - Time-Zone Download enties issue It seem that the 'Download entries from the site' process is also not tied to the phone's local time-zone rather it seems to be hard tied to this DAFNE online homebase time-zone.For example, I left my iPhone at work last night. So I used my iPad at home to enter my diary enties for everything after 5:30pm 27 Sept 2012 including today's morning entries. When I got to work I started the 'Download entries from the site' process it only downloaded the entries I added for 27 Sept & not this morning. I am GMT+10 so I'm confident that at 10am my time the missing enties will be downloadable. This is a similar issue to which was brought up recently about the diary not being local browser time-zone aware (sorry can't find the thread) Cheers RF |
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Sep 27, 2012
JayBee
587 posts
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Topic: General Discussion / Result. vic, L has taken a look at your 20th and 21st September BG diary entries.First off, he wants to emphasise that it is a very small sample for him to work with but he'll do the best he can (he's used to staring at least a few week's worth of BG results with me lol). He does have a suggestion: 19BI with meal ratios (QA:CP): Breakfast: 1:1 Lunch: 1:1 Dinner: 1.5:1 Have you tried this arrangement before or anything similar? If you have, how did it work out at the time? Can you show any results? Don't panic if you can't find any. It's good that you've gone back to 18BI for now.. if it needs raising, we'll get to that when it's safe to. Edit: I'm going to leave my results for a few days before posting again. Have a nice weekend all! |
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Sep 27, 2012
Simon Quinnell
16 posts
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Topic: General Discussion / Levemir Going Off Thanks for the idea novorapidboi. It's worth a try! I'll request my GP to send only one 5 pack next time, and see what happens. |
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Sep 27, 2012
JayBee
587 posts
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Topic: General Discussion / Result. vic, I've noticed on page 8 of this thread that you've posted your diary dates for 20th and 21st September and they're near enough the same ratios and what not... I will get L to look at those entries when he gets back home later this evening or tomorrow and see if he can work anything out from the numbers. If not, if you've attempted a pattern search couple of days recently, feel free to post those too.Hope its all going okay on that note. I'm quite happy with today's results and can't wait to see what happens when I put my BI down! I find it remarkable that the difference gap between my BI doses is shrinking!
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Sep 27, 2012
JayBee
587 posts
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Topic: General Discussion / Levemir Going Off Funny this has come up - I've very recently started monitoring my usage of both insulins after someone I follow on Twitter expressed some concerns about Lantus' life time once out of the fridge. I'm also on Levemir so this is interesting to know. I will see what happens with me too.Doesn't say too much on the paper that comes in the box (Under 5. How to Store Levemir): ~Do not use Levemir after the expiry date which is stated on the cartridge label and carton are EXP. The expiry date refer to the last day of that month. ~You can carry it with you and keep it at room temperature (below 30C) for up to 6 weeks. Does 6 weeks sound about right? :/ I'm not sure. |
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Sep 27, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Levemir Going Off What is the shelf/fridge life of Levemir........It might be losing its potency nearer the 8 month mark........ This is because you are getting 2 packs of Levemir at once...... I use the disposable flex-pen for my Levemir, and I only get one pack, so 5 x 300ml injections [300 units], I use 60 a day, so including priming/wastage, your looking at about 3 days use, so just over 2 weeks for one pack..... so your not that far off me, but it might be wise to just get one pack a time........ |
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Sep 27, 2012
Simon Quinnell
16 posts
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Topic: General Discussion / Levemir Going Off I have a perplexing problem. Over the past 3-4 weeks my blood sugars have been very high (15-1 most of the time. Applying DAFNE principles made no difference. I was not unwell, and had no ketones. My routines and eating habits have not changed. After a process of elimination I discovered that changing to a new batch of Levemir cartridges solved the problem, however, I am at a loss as to why it appears to be going off. When I get the cartridges from the pharmacy I put them straight in the fridge, and they stay there until I need them. The cartridge in my pen is at room temperature. I have a digital thermometer in my lounge. The temperature rarely exceeds 25C, and the insulin packaging says Levemir in use will stay fresh for up to 6 weeks, up to 30C. I don't leave the pen anywhere hot. The expiry date on the pack reads 05/2013. The insulin is crystal clear in the cartridge.When I get a repeat prescription, I get 2 packs (10 cartridges). Each cartridge lasts me approx 20 days, so I will get through all 10 in about 8 months. This is not the first time this has happened, and always seems to occur when I get to the last couple of cartridges. I have run out of ideas. Am I overlooking something? Thanks for your help. Simon. |
