Recent Posts - DAFNE Online

Mar 19, 2012

DebbieS 9 posts

Topic: General Discussion / Ineffective BI?

Thats great sjohno - everyone is different - thats what makes it so complicated! If it works for you then that is brill - 6.2 is a great result!

Mar 19, 2012

DebbieS 9 posts

Topic: General Discussion / When is best to take BI Levemir

Just what is convinient for me, and my BG levels are stable with this regime. I think it also has to fit around your lifestyle!

Mar 19, 2012

SimonC 78 posts

Topic: General Discussion / Ineffective BI?

Marke

Manufacturers make many claims - in all walks of life, and most of them fall far short of reality. HCP's may claim that Lantus lasts for 24hrs, but that is based on what the manufacturer tells them - my reality is that it only lasts 18 - 20hrs at best.

I'm afraid I did not discuss it with them, I noticed it wasn't lasting, changed, noted the vast improvement in BG, then presented them with the evidence. In my experience this is always the best way, although I am not advocating this as a method for all, but I get sick of HCP telling me what to do when they have only read a text book. I am the only HCP when it comes to my body, and whilst I will listen to their advice, it does not mean I will follow it. Having totted up my Hbc1A over the past 10 years and averaged them I get a figure of 6.3, and so clearly I am doing something right. I have never been over 6.9, and did get down to 5.9 - once, but have hovered around 6.4 - both pre and post Dafne.

Dafne has helped me enormously, and the general principal is something I can relate to, but it is down to me to put it into practice and fine tune it, based on my experiences and the reality of working shifts, not based on a text book or some manufacturers blurb

In my experience, and clearly that of others, is that Lantus does not last. When I told the team I had made the change the nurse stated she had long suspected that it didn't last in the majority of cases. I suspect that HCP's are legally bound to only state what is on the manufacturer's box, as if they deviated from this, and something went wrong, the manufacturer would point to the fact that the HCP had deviated from their specifications. HCP's have to be very careful about what they say when prescribing these products for fear of being sued.

Sorry if this seems to be a rant - it isn't, its just the way I type.

Mar 19, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Correction dose ratios?

As does any basal insulin, I think at least in the handbook it said 12-18, all non pumpers should definitely try it out though.....

Mar 19, 2012

jgibson1962 29 posts

Topic: Carbohydrate Counting / White Bread or Brown?

Marmite is disgusting yuk yuk yuk.........

Long live Brown Bread.... Very Happy

Mar 19, 2012

MARIER 42 posts

Topic: General Discussion / When is best to take BI Levemir

Hi Debbie
How do you know that taking it at 11 pm and 8am works for you ????

Mar 19, 2012

DebbieS 9 posts

Topic: General Discussion / Ineffective BI?

One of my reasons for prefering Levemir over Lantus is that you can change your dose if you are going to be doing something that is particularly energy intensive for a long period of time (going on a hike for example) and it has an imediate effect and you can not do this with Lantus as it can take upto 3 days for a change to take effect. As a female at a certain time of the month I can reduce my dose by 20% and it will stop be going low all the time. I also used to wake up low on Lantus because the dose I needed to work in the day sent me low overnight - this has not happened since I have changed to split dose Levemir. I know that what worked for me may not work for someone else, but I think that the dose splitting and ability to alter dose with imediate effect is a great imrovement.

Mar 19, 2012

DebbieS 9 posts

Topic: General Discussion / When is best to take BI Levemir

I have been told that Levemir must be at least 7hrs apart (obviously a 12 hour split will give you an even coverage) it just depends how long it lasts for you and if you like your doses to cross a little to help with dawn phonomen. But I would say as long as they are between 7 - 12 hrs apart - whatever works best for you, I do my evening about 11pm and morning at about 8am - so 9 hrs gap.

Mar 19, 2012

DebbieS 9 posts

Topic: General Discussion / Correction dose ratios?

I was told by my DSN that it was approx 12hrs so the 2 doses cover 24 hrs.

Mar 19, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Change of BI

I vote for Levemir also, I started on Lantus, then Levemir, then Humulin I [strategy for the dawn phenomenon, that failed], then back to Levemir.......

I hear stories of people not getting on with it, this may be true, but its more likely they haven't got to grips with it yet...........

For you the pros will definitely out weigh the cons.......

Mar 19, 2012

Garry 328 posts

Topic: General Discussion / daily average of QA

In your online DAFNE diary beneath the title
Blood Glucose Diary for _____
click the link Show Summary View

and you can get your totals for QA (plus corrections) in any week or period you select, divide by days and you have your QA average.

Regards
Garry

Mar 19, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Correction dose ratios?

Is Levemir marketed as 24 hour, I thought it was 12-18.............?

Mar 19, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Ineffective BI?

So is the overlap giving you reasonable waking levels then?

What problems is your daytime dose of Lantus giving you.....?

Mar 19, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / daily average of QA

I average about 21-22 CPs ans then my ratios on top of that, which are 1.5:1 apart from breakfast which is 3:1, so a lot of insulin.......

Mar 19, 2012

Nicky B 5 posts

Topic: General Discussion / daily average of QA

Hi - I use the DAFNE app on my iPhone and in the Diary Section - View Diary Summary there are some averages on how much insulin you are taking on a daily basis (it includes both BI+QA) - thought that might help Very Happy

Nicky

Mar 18, 2012

Wolf 3 posts

Topic: General Discussion / A Petition Regarding Changes to the NHS

Hello, Blue Labour wasted all the tax bucks paying high wage adminstrators, the NHS has to come to terms with the real world now.

Mar 18, 2012

thebatoutofhull 60 posts

Topic: General Discussion / daily average of QA

25 years ago I was asked to say how much QA I used by my car insurance company. They actually set a ceiling amount! I remember the forms. Thank goodness we don't do that anymore. Oo, I now have 1-30 units a day.

Mar 18, 2012

thebatoutofhull 60 posts

Topic: General Discussion / Ineffective BI?

Thanks Marke. Lantus lasts a little over 17 hrs from when I inject it. I have been using it for 18 months. I did very strict testing to discover this. I approached my diabetes team but was asked nicely to persevere. My control went out of the window not long after going onto it. I was correcting with QA. I now have two injections of Lantus at different times. The more I have of Lantus the longer it lasts in my system. The two injections are roughly the same but I am still evaluating. I tend to have elevated BG in the morning, most times after I have got up. I am trying to lower this morning peak by injecting the second dose of Lantus before the first has finished thus overlapping creating a shorter Lantus boost. Tiny carbs at the mo whilst eval.. Lantus works really well overnight for me. It's just not doing the doo in the day time. It would be nice for once to have BG results I can be proud of.

Mar 18, 2012

marke 681 posts

Topic: General Discussion / Ineffective BI?

Simon, presumably your Diabetes team agreed to your splitting your Lantus dose ? I ask because the HCP's I have spoken to insist that Lantus IS a 24hr insulin and that Levemir is better for splitting your dose. That said, in agreement with the original theme of this thread, one size does NOT fit all and Lantus may work better for you. I agree with your description of a normal bodies operation, although hopefully in years to come if we all get CDM's then we might have the feedback mechanism to allow us to control insulin release in our bodies to simulate a 'normal' pancreas.

The normal way of caclulating your BI needs is to not eat, monitor you BG and adjust your BI accordingly. It is supposed to provide your non-eating insulin requirement which largely should be 'relatively' stable, of course I say largely because life just isn't that simple unfortunately. As you have found there are variations and the only way you can tackle these really is QA adjustments. Its not perfect but then any insulin regime is just a rough simulation and thats the best we can do.

Mar 18, 2012

marke 681 posts

Topic: General Discussion / daily average of QA

Well I'm an IT person but if you put certain types of computer in front on me I wouldn't know where to start. The same goes for medical people, just becasue they have studied medicine doesn't mean they understand Diabetes. The good ones will openly admit this, the bad ones will make bland comments like 'that seems a bit high' without explination or justification. I would just ignore it, if they didn't provide a sound and clear explination as to why it is high then they shouldn't have said it in the first place. My daily dose varies all over the place and I see no reason to work out an average since I don't see what benefit knowing it would provide. Laughing

Mar 18, 2012

marke 681 posts

Topic: General Discussion / Correction dose ratios?

Hi, according to 'experts' at the DAFNE Collaborative lasy year, Lantus IS a 24hr insulin and so it is not working for you if it runs out, I would agree with Debbie that you should try Levemir. Although this is marketed as a 24hr insulin it is definately not and most of us take it in a split dose. It may be that it works better with you anyway as we all react differently to different Insulins. Obviously you would need to do this in co-ordination with your diabetes team so they can monitor and assist in the changeover. It may not fix your issue but you won't know unless you try.

Mar 18, 2012

DebbieS 9 posts

Topic: General Discussion / Correction dose ratios?

I used to have a similar issue with Lantus - was always going low in morning (was only doing 1 dose before bed) but since I changed to Levimir I have not had this happen, I do it before bed and when I wake and it really has made a difference. It might be worth talking to your DSN about changing to this. Once your BI is sorted your QA and correction ratio will be so much easier to get right. Good Luck x

Mar 19, 2012 DebbieS 9 posts	Topic: General Discussion / Ineffective BI? Thats great sjohno - everyone is different - thats what makes it so complicated! If it works for you then that is brill - 6.2 is a great result!

Mar 19, 2012 DebbieS 9 posts	Topic: General Discussion / When is best to take BI Levemir Just what is convinient for me, and my BG levels are stable with this regime. I think it also has to fit around your lifestyle!

Mar 19, 2012 SimonC 78 posts	Topic: General Discussion / Ineffective BI? Marke Manufacturers make many claims - in all walks of life, and most of them fall far short of reality. HCP's may claim that Lantus lasts for 24hrs, but that is based on what the manufacturer tells them - my reality is that it only lasts 18 - 20hrs at best. I'm afraid I did not discuss it with them, I noticed it wasn't lasting, changed, noted the vast improvement in BG, then presented them with the evidence. In my experience this is always the best way, although I am not advocating this as a method for all, but I get sick of HCP telling me what to do when they have only read a text book. I am the only HCP when it comes to my body, and whilst I will listen to their advice, it does not mean I will follow it. Having totted up my Hbc1A over the past 10 years and averaged them I get a figure of 6.3, and so clearly I am doing something right. I have never been over 6.9, and did get down to 5.9 - once, but have hovered around 6.4 - both pre and post Dafne. Dafne has helped me enormously, and the general principal is something I can relate to, but it is down to me to put it into practice and fine tune it, based on my experiences and the reality of working shifts, not based on a text book or some manufacturers blurb In my experience, and clearly that of others, is that Lantus does not last. When I told the team I had made the change the nurse stated she had long suspected that it didn't last in the majority of cases. I suspect that HCP's are legally bound to only state what is on the manufacturer's box, as if they deviated from this, and something went wrong, the manufacturer would point to the fact that the HCP had deviated from their specifications. HCP's have to be very careful about what they say when prescribing these products for fear of being sued. Sorry if this seems to be a rant - it isn't, its just the way I type.

Mar 19, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Correction dose ratios? As does any basal insulin, I think at least in the handbook it said 12-18, all non pumpers should definitely try it out though.....

Mar 19, 2012 jgibson1962 29 posts	Topic: Carbohydrate Counting / White Bread or Brown? Marmite is disgusting yuk yuk yuk......... Long live Brown Bread....

Mar 19, 2012 MARIER 42 posts	Topic: General Discussion / When is best to take BI Levemir Hi Debbie How do you know that taking it at 11 pm and 8am works for you ????

Mar 19, 2012 DebbieS 9 posts	Topic: General Discussion / Ineffective BI? One of my reasons for prefering Levemir over Lantus is that you can change your dose if you are going to be doing something that is particularly energy intensive for a long period of time (going on a hike for example) and it has an imediate effect and you can not do this with Lantus as it can take upto 3 days for a change to take effect. As a female at a certain time of the month I can reduce my dose by 20% and it will stop be going low all the time. I also used to wake up low on Lantus because the dose I needed to work in the day sent me low overnight - this has not happened since I have changed to split dose Levemir. I know that what worked for me may not work for someone else, but I think that the dose splitting and ability to alter dose with imediate effect is a great imrovement.

Mar 19, 2012 DebbieS 9 posts	Topic: General Discussion / When is best to take BI Levemir I have been told that Levemir must be at least 7hrs apart (obviously a 12 hour split will give you an even coverage) it just depends how long it lasts for you and if you like your doses to cross a little to help with dawn phonomen. But I would say as long as they are between 7 - 12 hrs apart - whatever works best for you, I do my evening about 11pm and morning at about 8am - so 9 hrs gap.

Mar 19, 2012 DebbieS 9 posts	Topic: General Discussion / Correction dose ratios? I was told by my DSN that it was approx 12hrs so the 2 doses cover 24 hrs.

Mar 19, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Change of BI I vote for Levemir also, I started on Lantus, then Levemir, then Humulin I [strategy for the dawn phenomenon, that failed], then back to Levemir....... I hear stories of people not getting on with it, this may be true, but its more likely they haven't got to grips with it yet........... For you the pros will definitely out weigh the cons.......

Mar 19, 2012 Garry 328 posts	Topic: General Discussion / daily average of QA In your online DAFNE diary beneath the title Blood Glucose Diary for _____ click the link Show Summary View and you can get your totals for QA (plus corrections) in any week or period you select, divide by days and you have your QA average. Regards Garry

Mar 19, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Correction dose ratios? Is Levemir marketed as 24 hour, I thought it was 12-18.............?

Mar 19, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Ineffective BI? So is the overlap giving you reasonable waking levels then? What problems is your daytime dose of Lantus giving you.....?

Mar 19, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / daily average of QA I average about 21-22 CPs ans then my ratios on top of that, which are 1.5:1 apart from breakfast which is 3:1, so a lot of insulin.......

Mar 19, 2012 Nicky B 5 posts	Topic: General Discussion / daily average of QA Hi - I use the DAFNE app on my iPhone and in the Diary Section - View Diary Summary there are some averages on how much insulin you are taking on a daily basis (it includes both BI+QA) - thought that might help Nicky

Mar 18, 2012 Wolf 3 posts	Topic: General Discussion / A Petition Regarding Changes to the NHS Hello, Blue Labour wasted all the tax bucks paying high wage adminstrators, the NHS has to come to terms with the real world now.

Mar 18, 2012 thebatoutofhull 60 posts	Topic: General Discussion / daily average of QA 25 years ago I was asked to say how much QA I used by my car insurance company. They actually set a ceiling amount! I remember the forms. Thank goodness we don't do that anymore. Oo, I now have 1-30 units a day.

Mar 18, 2012 thebatoutofhull 60 posts	Topic: General Discussion / Ineffective BI? Thanks Marke. Lantus lasts a little over 17 hrs from when I inject it. I have been using it for 18 months. I did very strict testing to discover this. I approached my diabetes team but was asked nicely to persevere. My control went out of the window not long after going onto it. I was correcting with QA. I now have two injections of Lantus at different times. The more I have of Lantus the longer it lasts in my system. The two injections are roughly the same but I am still evaluating. I tend to have elevated BG in the morning, most times after I have got up. I am trying to lower this morning peak by injecting the second dose of Lantus before the first has finished thus overlapping creating a shorter Lantus boost. Tiny carbs at the mo whilst eval.. Lantus works really well overnight for me. It's just not doing the doo in the day time. It would be nice for once to have BG results I can be proud of.

Mar 18, 2012 marke 681 posts	Topic: General Discussion / Ineffective BI? Simon, presumably your Diabetes team agreed to your splitting your Lantus dose ? I ask because the HCP's I have spoken to insist that Lantus IS a 24hr insulin and that Levemir is better for splitting your dose. That said, in agreement with the original theme of this thread, one size does NOT fit all and Lantus may work better for you. I agree with your description of a normal bodies operation, although hopefully in years to come if we all get CDM's then we might have the feedback mechanism to allow us to control insulin release in our bodies to simulate a 'normal' pancreas. The normal way of caclulating your BI needs is to not eat, monitor you BG and adjust your BI accordingly. It is supposed to provide your non-eating insulin requirement which largely should be 'relatively' stable, of course I say largely because life just isn't that simple unfortunately. As you have found there are variations and the only way you can tackle these really is QA adjustments. Its not perfect but then any insulin regime is just a rough simulation and thats the best we can do.

Mar 18, 2012 marke 681 posts	Topic: General Discussion / daily average of QA Well I'm an IT person but if you put certain types of computer in front on me I wouldn't know where to start. The same goes for medical people, just becasue they have studied medicine doesn't mean they understand Diabetes. The good ones will openly admit this, the bad ones will make bland comments like 'that seems a bit high' without explination or justification. I would just ignore it, if they didn't provide a sound and clear explination as to why it is high then they shouldn't have said it in the first place. My daily dose varies all over the place and I see no reason to work out an average since I don't see what benefit knowing it would provide.

Mar 18, 2012 marke 681 posts	Topic: General Discussion / Correction dose ratios? Hi, according to 'experts' at the DAFNE Collaborative lasy year, Lantus IS a 24hr insulin and so it is not working for you if it runs out, I would agree with Debbie that you should try Levemir. Although this is marketed as a 24hr insulin it is definately not and most of us take it in a split dose. It may be that it works better with you anyway as we all react differently to different Insulins. Obviously you would need to do this in co-ordination with your diabetes team so they can monitor and assist in the changeover. It may not fix your issue but you won't know unless you try.

Mar 18, 2012 DebbieS 9 posts	Topic: General Discussion / Correction dose ratios? I used to have a similar issue with Lantus - was always going low in morning (was only doing 1 dose before bed) but since I changed to Levimir I have not had this happen, I do it before bed and when I wake and it really has made a difference. It might be worth talking to your DSN about changing to this. Once your BI is sorted your QA and correction ratio will be so much easier to get right. Good Luck x