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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. |
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Sep 27, 2012
JayBee
587 posts
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Topic: General Discussion / Result. Today's results! The next plan of action is to put my evening BI down to 15 now I've got solid evidence.
You're welcome. You're helping me too so it's the least I can do.
It's certainly a good start considering how dangerous the blues can be, and those green will come to you when they're ready, okay? We'll work through this!
Sounds good to me. What are the ratios you've decided to stick with for the 2-3 days?
Haha, this made my day! ^_^ I'm sure if we do a Foxtrot and throw in a Trick of a Tail, we shall reach our new Genesis! Just a Job to Do: best to keep in mind that We Can't Dance for now to save us from the Land of Confusion! ;P Sussudio!
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Sep 27, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Result. For me the benefit of Levemir is not its blood sugar reduction power, as its still a long acting insulin analogue just like Lantus and done the same job for me as Lantus done, its the flexibility of being able to cut your BI requirements in 2, am and pm while being able to make adjustments and see the effects straight away....[although you should always confirm dose change with 2-3 days results.... ].......allows you to concentrate on the overnight requirement and quickly establish the right dose as there are no carbs or QA working, leaving just your daytime dose to work out....Vic, I think your plan to get rid of the lows is a good one.........I have had days of all greens, but they are few and far between, I try to aim for readings less than 10 all day, so less than 10 for mid meal spikes, again, this is hard to achieve most of the time.......you will get above target readings all the time, its just the way it is, if you can accept that, life will be much easier.... |
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Sep 27, 2012
AshleyB
10 posts
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Topic: General Discussion / Result. Ive been on levemir for 36hrs and ive already seen a massive drop in my BG levels. I'm not high before bed and I'm waking up within the DAFNE tragets. I'm very impressed. I would consider "Vic" to change, I instantly feel i'm in control.
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Sep 27, 2012
vic demain
87 posts
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Topic: General Discussion / Result. JWo - Thank you for your considerable input into this thread and to helping me sort out my thoughts and future direction. That I have now done and whilst it doesn't include a pump, I may well ask my doctor about Levemir, next time I see him.I have been aiming for greens across the board, which is unachievable, now I know I need to eredicate all blues as they are the real danger. Will have to cope with reds. My BI is working well at 18 units, so will leave that and try to adjust the other with QA. There has been some Misunderstanding, although I Know What I Like, so I will Follow You will you Follow Me? Los Endos.
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Sep 26, 2012
SteveRowland
10 posts
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Topic: Questions for HCPs / Help Thanks, Nick. I may have misunderstood you but that sounds like the actions on a positive ketone test which I've not had. I'm increasing my BI by 10% and correcting as appropriate. I wonder if we mean the same thing? |
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Sep 26, 2012
JayBee
587 posts
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Topic: Site Development / Quote error. I'm not sure when it started doing it but whenever I go to edit my forum posts, " turn into " and I keep having to re-edit to correct them.If I fail to correct them, and edit again, it doubles up. Hope this issue isn't too difficult to fix... Sorry if it is.  Many thanks in advance! |
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Sep 26, 2012
JayBee
587 posts
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Topic: General Discussion / Result. In all honesty, what insulin you choose to be on, like with the pump, it is entirely up to you. It is your body after all and we won't know the impact like you will. I'm certainly not expecting you to just go on to Levemir just because I said so; it has just had a very positive effect on my control, worthy of a mention in my own opinion especially considering how similar our troubles have been. It is very possible to achieve control with Lantus but how long it takes will depend on how it is approached (Heck, wouldn't it be funny if you ended up split dosing Lantus like I did before!).Sometimes healthcare professionals are not always aware to make the suggestions I suppose but I cannot honestly speak on behalf of your healthcare team. You could ask them what they think of the idea of Levemir if you want their input into your decision. Sadly, money limits do seem to have quite a lot of say in what you're offered - I mean, heck, I was asked to change my blood testing machine, pen needles, finger pricking needles, etc, which I started a discussion about here: http://www.dafneonline.co.uk/forums/1/topics/1815 Hope you're doing okay vic. After you've had your next 48 hours with no changes, if you post your results up, I'll get L to look at the patterns too because he loves a challenge. He often reads my BG diary in a completely different way to me because he's a keen mathematician. ;) Best wishes. |
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Sep 26, 2012
JayBee
587 posts
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Topic: General Discussion / Top 5 Takeaways from DAFNE I was diagnosed age 5, back in 1990. I did DAFNE in May 2009.------ My top 5 significant lessons: 1) I have been given a lot more solid information to give to anyone who wants to help me as a Type 1 Diabetic. Knowledge is a very powerful thing when used right and not generalised. Be it my workplace, GP surgery, a friend or a loved one, having the DAFNE knowledge and guidebook has given me the opportunity and confidence to explain how I care for myself a lot better than ever before - and in turn, more confidence in say, a loved one taking care of me when I'm vulnerable because they are also DAFNE educated and understand my needs to a similar level to me. The best example I can give of this is my fiance. He cares about me very much clearly and I genuinely feel that him also learning the DAFNE rules has strengthen our relationship as a result. It is very common for a loved one, including parents, to be completely frustrated by the fact they don't understand the suffering of someone they love and this is often amplified by fear of the unknown. DAFNE has removed a lot of the frustration from this and has made me as a diabetic person a lot more understandable. He even carb counts for me sometimes! On a related note: A bonus is it is also possible to help a fellow graduate who has lost their way. DAFNE rules give a base to work from and provides information found from at least a decade of research. It makes me quite sad that across the world diabetics have to gain this knowledge alone. Having any kind of course is a very good thing for the majority; though pride can get in the way for some. Speaking of pride, it does get kind of embarrassing how much personal information may need to be disclosed for some situations (like some forms of exercise, for example *cough,cough*)... this can make it awkward to want to ask for help(!). 2) I understand what my body is trying to tell me now. Before DAFNE, I used to correct before giving my body a chance to use up the insulin I took from a meal. I would "boomerang" - where I'd correct, hypo, panic eat, go high, panic correct... etc - frequently and I would never learn from it. I see many others admit doing this and having no patience to let their body use the things they give it. Patience is a very valuable thing. My control is so much better now since DAFNE (as in it's a lot more stable) and I actually understand what the hell is going on as soon as I learnt to work with my body and not resort to self-depreciation because I was high or low. I can use the tool that is insulin a lot more effectively. I can understand what my body is trying to tell me ten fold. DAFNE gave me a lot of confidence back. 3) After 19 years of being diabetic, I was finally introduced to key carb counting information. In the past, I would pull dose numbers "out of my butt" after just looking at food, because I did not know about carb counting AT ALL. It was never even suggested to me, until I did DAFNE. I was told to "work it out myself" pretty much. Shortly before DAFNE I used to say to myself things like "If I'm 12, I'll take 2 units" or "I'm 13, I'll take 3 units". I can see now just how dangerous that logic was but I did not have base knowledge to work with because I was taught about "eating for my insulin" and not the other way around which DAFNE teaches. Adjusting your insulin for what you eat instead of eating for it is so much better for all. It's a shame this was not realised sooner. 4) I don't have to be afraid to live my life. When I was fairly young (early teens, I had been diabetic about 5-8 years by this point), I made a few decisions: 1. I was never going to drive (because it'll be too dangerous due to hypo potential). 2. I was probably never going to be a Mom (because I had no faith in my control, I don't think I could be a good full-time mom and I didn't want to have to have cesarean section due to baby big-ness). 3. I didn't care if I never got married. 4. I was going to live for happiness! Since DAFNE, it's been a bit of a mental rewiring thing: 1. I passed my driving test last year. 2. I'm engaged. 3. .. well how I think has started to change generally. I used to live in fear and having to challenge a lot of my feelings has been an emotional experience. Still no plans to be a mom though, but my reasons aren't exactly the same any more. If I want one, I'll go for it probably now. ;P Shall see! 5) More respect for ketones and a better routine in place for illness. Misunderstood knowledge or taken at face value advice is a very dangerous thing. An education based on opinion is not a good education. There is a very good reason why this site expects you to register your place of doing the course to then allow you access to the online guidelines - some of them can be potentially very dangerous and one of these is the sickday rules. My respect for ketones was very poor pre-DAFNE. I would not take my ketone urine sticks stock too seriously. If my ketone levels were high, it was time to consider a trip to the hospital. Post-DAFNE, I can now prevent myself from going into hospital. I can get those excessive ketone levels down myself using the rules. The last time I went into hospital wasn't because of ketones or my diabetes (my levels were lovely) - it was dehydration alone from not being able to keep fluids down. Definitely would have been a very different story pre-DAFNE. |
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Sep 26, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Top 5 Takeaways from DAFNE Post DAFNE, I have yet to meet an HCP that knows more than me with regards to my control. DAFNE taught me about the different insulins and I made decisions on what I thought I needed.....You don't have to wait for them to tell you to go on it.... I didn't mean to upset though.....DAFNE isn't a fix for anyone directly..., each individual needs to tweak for their own needs.....as you know......the people that teach it don't say it's a quick fix, still requires hard work on our part..... |
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Sep 26, 2012
vic demain
87 posts
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Topic: General Discussion / Top 5 Takeaways from DAFNE Sorry Novorapidboi but you couldn't be further from the truth. Having completed and enjoyed the course some 3 years ago, I have worked tirelessly to try and follow the general principal and thus improve my control. I have tested my blood at least 4 times everyday (would have done more if the doc would prescribe enough strips), weighed out food, done endless calculations to try and fit injections to what I am eating, have regularly attended clinics, been an active member of this site, all of which I still do. So no I have not given up.However DAFNE in my experience is not a one size fits all solution to every type1 diabetic. My Hb1ac has never improved since the course, I have suffered far more hyops than ever before and my control is no better than before the course. If DAFNE were perfect, we would all get green results every time we tested, yet that is not the case for many. In fact in 3 years I have never experienced a completely green day, have you? You are correct in thinking that I am not happy with what has gone on. If Levemir is so much better, why have my diabetic team never mentioned moving over to it? Their job is to help improve my control. I do not believe that my problem is the background as I know that by taking a certain amount, I will be in the right area yet if I increase it by 2 units, I will be hypo all over the place. Sorry to sound negative but your opening sentence sounded like every person I have sat across a desk from who tells me "if you improve your control, you will feel better".  |