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Jan 26, 2012
sarahlou
7 posts
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Topic: General Discussion / Redoing DAFNE??? Hi Lizzie,As a nutrition undergraduate and a type 1 diabetic, from my experience I think why your doctors focus on your weight is because being overweight can cause insulin resistance and metformin is a drug designed to overcome insulin resistance. I understand why you seem frustrated with doctors advice, I feel the same sometimes especially when it is clear that they have learnt diabetes from a text book and in real life its not always like that! I have a group of doctors treating me at the moment however that are great. I don't know your weight (and you dont have to tell me  ) but keeping your weight as normal as possible ,and you can do this with exercise, both will help the resistance and you may hopefully see a change in your sugars although they look better than you think! Please don't worry too much about the complications, you are trying to look after yourself and that is the important thing, and attending regular checkups will highlight any problems (should any arise) so they are treated immediately. Stay positive
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Jan 26, 2012
novorapidboi26
1,816 posts
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Topic: General Discussion / Redoing DAFNE??? If I had my way everyone would be on a split BI dose............................Unfortunately, many HCPs just cant see past it, and many patients cant see how a split dose would benefit them.................. If you were on a pump it is likely you would have many more than 2 different delivery rates throughout a 24 hour period.......... |
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Jan 26, 2012
Anele46
108 posts
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Topic: General Discussion / Redoing DAFNE???
Totally agree Simon, have heard that many times from people on Lantus and on my DAFNE course, I'm still in my "Honeymoon" phase (two years on...) so luckily my 1 Injection of Lantus at 22:00 seems to pretty much last me but looks as though it may be running out for Lizzie. Well spotted Cheers, Anele. |
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Jan 26, 2012
SimonC
78 posts
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Topic: General Discussion / Redoing DAFNE??? If I can add another thought for you - I am on Lantus and Humalog, and I found that whilst the claims for Lantus were that it would last the 24hrs, and so 1 injection a day would suffice, I found that having the 1 and only Lantus injection at 2100hrs every night, resulted in higher readings from about 5pm onwards, and for a while it was causing a bit of confusion. I then split the 9pm dose equally and now have 2 injections, 1 at 0900 and the other at 2100.I think the reason for this raising, is that, for me, the Lantus was not lasting the 24hrs, it was only lasting 18 or 19 hours which meant that towards the end of the 24hr period the sugar levels were rising. They would continue to rise even after the 2100 inject, as it has a slow rate of absorption, and so would not get working for a few hours. By splitting it there is always some in the system, and for me it was the answer. |
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Jan 26, 2012
novorapidboi26
1,816 posts
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Topic: General Discussion / Need a second opinion No problem,I just try to keep things simple, as it was taught to me..................sometimes its easy to get bogged down with all your readings when you sit down to look at them............ I fear I sometimes sound like a broken record regarding the BI testing I keep going on about, but peoples BI needs change quite often and when this is out, its all out....... Your plan sounds like a good one................ Pop back in when you have you more results..................... 
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Jan 26, 2012
Derek Brown
32 posts
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Topic: General Discussion / Need a second opinion Thanks Novarapidboi26, you should be an honorary DAFNE consultant with all the good advice you give on here I'll check the overnight basal for a few days and adjust and continue testing if necessary. After that I'll do a couple of carb -free days to monitor the daytime basal. Derek |
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Jan 26, 2012
novorapidboi26
1,816 posts
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Topic: General Discussion / Redoing DAFNE??? I have included some of my diary entries from last week to show you I get some high too..............Monday was terrible, Wednesday much better...........Dont be so hard on yourself, you are doing your best, but its apparent that your doses are not right somewhere, so you need to investigate them and while doing the investigating you are not going to get perfect results, in fact you will never get perfect results, its diabetes after all............a 10 and 11 are not that bad................. My first observation is that you corrected your 11.7 overnight and woke up spot on, so you can assume your 22:20 BI dose of 28 is right, this was the case yesterday as well, so that is looking good........... My second observation is that your blood sugar held steady from 14:30 to 19:00, which would also suggest your BI needs during the day are also being satisfied, which is again good news for your single BI dose. If it wasn't good enough during the day you might want to consider a split BI dose...........I take 32 in the morning, and 38 at night because of my different needs from night to day..........but as I say, it seems all is well for you at first glance......... This means its likely your QA insulin/carb ratios that are out, which is normal, these can change from week to week in some folk unfortunately............. So, your low at 10:00 yesterday may be down to your 2.5:1 ratio, which I see you dropped to 2:1 in an attempt to stop it again, so well done, however, if following the DAFNE principals, you should really wait till you see a pattern of lows before changing your ratio, as the hypo might of just been one of those things...................so I would recommend going back to 2.5:1 and just be prepared for a hypo.........if you get 2-3 days going low, you can be sure to drop it to 2:1........... Today you were high at 10:49 at 2:1, again one reading cant confirm whats really going on................ Yesterday by 23:45, when your 19:00 dose of 12 should of been finished, you were high, which could suggest your tea time ratio of 2:1 is wrong, so that will need changed, only after you see a pattern [2-3 days] and only after you have finished with the morning ratio............. You dont necessarily need to get your morning ratio right before you tackle the evening ratio, but you should only focus on one thing at a time to eliminate as many variables as you can....... Your control is not bad at all, it very reasonable actually, just a few things to tweak, but you need to realize that your whole life will be like this, constantly tweaking your insulin to cater for your ever changing needs................we all have to do it, and that's why getting into the habit of writing everything down is so important........... |
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Jan 26, 2012
Lizzie
87 posts
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Topic: General Discussion / Redoing DAFNE??? So more of my usual levels are creeping back even though I am doing my best, I thought it was too good to be true I have no sense of why they were so good yesterday or why they are bad today at all. I ate virtually the same things and measured everything carefully. This is why I can't do this, I can't rely on others to make sense of it but it makes no sense to me |
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Jan 26, 2012
novorapidboi26
1,816 posts
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Topic: DAFNE Online Mobile / Mobile use question The best HbA1c I have got so far is 7.9, and this is with 110% effort on the testing/DAFNE front............................this may be down to my lack of discipline at the weekend and/or my carb intake as a whole......................so dont be too disheartened..............The best place to start is with pen and paper, start writing everything down, if you can remember back to the course, you should remember this as being vital..........being able to do DAFNE is built on blood glucose readings and carb portions before each of your main meals, without this you just cant do it properly............... Everyone loses motivation from time to time, but as long as we can back on it you will be fine, and it seems you are willing to do so...............
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Jan 26, 2012
novorapidboi26
1,816 posts
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Topic: General Discussion / Evening and late night snacking Because your not testing before bed you will never know if it is a problem with your BI or QA or both................If you could refrain a few night to carry out tests to confirm your doses are right, you can then go back to the snacking in the knowledge that your taking the right amount of insulin for them............ Remember that you could stack your insulin by taking multiple doses within a 5 hour period, this could result in a hypo, which could manifest overnight, then result in a high in the morning............ Obviously the times you said you have snacks is estimated and wont be the same every night, but if your having snack within an hour of each other, you can inject just one dose for that..............so eat your crisps, but then inject for them with the toast dose............ |
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Jan 26, 2012
thebatoutofhull
60 posts
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Hey Cathy, I snack in the evening too. I try to eat peanuts with little carbs. I think it could be something to do with running around all day after everyone else, then just wanting to have something just for me in the evening. Food tends to fill the gap. I know change is needed. Not really motivated. Good luck with it all. |
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Jan 25, 2012
CathySbd
7 posts
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Pre tea is on average 5 to 9. I am on 15 units levimir which i have 10pm. I do 1.5 to 1 ratio for tea. Am a terrible snacker in evenings. An hour or two after tea i might have say a packet of crisps (take say 2 units) , often dont test bg then cos is not long enough after tea. Then hour later might have 2 toast, take 3 units, again dont always test cos is not far from previous snack. Take 15 levimir 10-10.30 pm. Test bg say midnight, is often around 12. Wake up with bg's of 12. I realise i am doing stuff wrong but it's become a bad habit. Funnily enough I rarely snack in the day. |
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Jan 25, 2012
CathySbd
7 posts
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Topic: DAFNE Online Mobile / Mobile use question Hi, I see now yes of course! I went on the week DAFNE course about 5 years ago at my local hospital. Funding for it was withdrawn not long after. I think I am a bit rusty and perhaps lazy is not quite the word but I could do with getting to grips with it properly to get my HBA1c lower as it's sneaking up to the high 8's. I feel on the whole, alone in looking after my health, dont get me wrong, I get my check-ups at the hosp but I often wish there was more. Glas I've found this online and especially use on the ifone as I use that a lot. Pre-dafne my hba1c's were always 12+ then went briefly to 7.3 then up to 8's where they have stayed. Cathy |
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Jan 25, 2012
Anele46
108 posts
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Topic: General Discussion / Redoing DAFNE???
Hi Lizzie, I can totally understand why you use your stomach and I certainly don't inject through my clothes and wouldn't recommend it so the tum is often the most convenient and least painful place. Just out of interest, what size of needles do you use? I started on 6mm when I was first diagnosed and then was offered 5mm at my DAFNE course which has really helped with the pain and was also offered 4mm which can be useful for injecting in your arms. I haven't tried my arms yet and don't fancy it to be honest so right now I switch between both thighs and my tum for my QA and my buttocks for my Lantus (BI) as I remember from my DAFNE course that it is recommended to inject your BI in a different site to your QA but in real life this isn't always possible. Hope this helps in some way Cheers, Anele x |
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Jan 25, 2012
novorapidboi26
1,816 posts
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Topic: General Discussion / Redoing DAFNE??? Your carb count seems to be fine..................People are more resistant in the morning through lack of activity in the muscles, so its quite common to have a higher ratio, I am on 3:1......... If you unsure just do the tests, 2-3 days results, make a decision.......... Theoretically you should only be injecting once when out at work, for lunch...............I personally wear short sleeved t shirts most of the time so can inject into my arms no problem at work, but also use my stomach, and if I happen to need the toilet at the same time I will do it in there on my legs, I cant really see how its anymore unhygienic than outside the toilet.............it could be argued, but no one could provide any significant evidence to suggest its less hygienic to do it in there.......... You dont really inject on the outside or inside of the leg, its on the front, so the front facing part of the the thigh at the top.................another great location is your bum cheeks, I often inject there also..................I am quite fortunate to be in a good routine regards my sites, a habit I adopted from my younger diabetic brother when he was a child, he was diagnosed at 2, me 15........... It can be significant though in terms of absorption and so can effect your dose adjustment decisions too.............. Dont beat yourself up about your results, the other alternative to it is not testing, and then you wouldn't know if they were good or bad, but it seems they are better than you expected, would you not agree?. |
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Jan 25, 2012
Lizzie
87 posts
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Topic: General Discussion / Redoing DAFNE??? Novorapidboi, that is a good point about waiting longer before correcting. Like I mentioned before, I tend to panic.The numbers are not representative though, I am trying hard atm as I know I will be sharing these results with others. I think a large part of the problem as I mentioned is my eating and in order to monitor insulin I have needed to cut down on the CPs a little. For breakfast I had 2 slices of toast (16g per slice according to bread packet), and a glass of fruit juice (200ml, 20g) so total 5CPs and I estimated 2.5:1 as I have been told people are more resistant in the mornings. Anelo26, you are right about injecting in my stomach. It is the easiest place as I can just inject quickly under the table, I am not confident injecting through my clothes to my legs or arms and I don’t want to go into a toilet to inject really either, it isn’t hygienic. But I will try to use my thighs when I inject at home. When injected in my thigh before it has hurt, I think I must be doing it wrong somehow. The diagrams I see online say it should be done on the outside of the leg but it seemed less painful on the inside to me. I will try again. Thanks both of you for your helpful comments. |
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Jan 25, 2012
Anele46
108 posts
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Topic: General Discussion / Redoing DAFNE???
Thanks Novorapidboi26 Lizzie, Just another thing that I forgot to mention about injection sites, if you do change your injection sites and use one that hasn't been used before or in a long time you may see quite different results as the Insulin could be absorbed more quickly. Cheers, Anele. |
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Jan 25, 2012
novorapidboi26
1,816 posts
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Topic: General Discussion / Redoing DAFNE??? Excellent observation Anele................ |
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Jan 25, 2012
Anele46
108 posts
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Topic: General Discussion / Redoing DAFNE???
Hi Lizzie, Just wanted to say well done for your results so far They look really good. The only thing I would like to mention that may help (but hopefully not confuse matters) is I see from your diary that you have always injected in your stomach. Do you inject anywhere else or is it only in your Stomach? If the same site is used over and over you can develop lumps (Lipo's) and these can cause the absorption rate for the Insulin to be different which may explain some unsual results. I could be totally off the mark and this could well not be the case with you but just something to bear in mind that rotating injection sites is a good idea but I unserstand that (for me anyway) I find that the stomach is the least painful so I tend to inject maybe once or twice a day or when I am out-side as this is quite a discete place to inject. Like I say, just a wee thought but well done for all your efforts so far and as Simon said earlier, when you see the good results written down it is a confidence boost that things are going well and helps explain why some readings may not be as good. I wish you all the very best Cheers, Anele. |
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Jan 25, 2012
novorapidboi26
1,816 posts
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Topic: DAFNE Online Mobile / Mobile use question The app or the online site does not work out correction doses, as these can be different for everyone at different times of the day.......For example, I would take 6 units to come down from 14 to 5.5, on the assumption that at that specific level, 1 unit drops me by 1.5 mmol/l... On both the app and website/mobile website you enter in your corrections within the QA field, represented by +2 for 2 units correction etc........ Basically just the same way as you would write it down, which is taught in the course........... Have you done the course? I only ask as it does not say you are a graduate next to your name................
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Jan 25, 2012
novorapidboi26
1,816 posts
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Topic: General Discussion / Evening and late night snacking What are your pre bed test results, and by pre bed I mean a maximum of 5 hours after you have the snack................?If this is on target, then you would assume that it would be; 1. Not enough background insulin 2. Dawn Phenomenon What BI insulin are you on and when?
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Jan 25, 2012
novorapidboi26
1,816 posts
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Topic: General Discussion / Need a second opinion You should only change one thing at a time..................that is the most effective way to do it.....................From the majority of your results it seems as though your 8 units of Levemir in the evening is doing its job and keeping you pretty much stable overnight...............I would confirm this by testing overnight for 3 nights consecutively, without any insulin or carbs going in 5 hours prior to the pre bed test................. As far as your breakfast ratio of 3:1 is concerned, the results [last 3 days] would suggest that this dose is OK too due to being on target at lunchtime for the majority of the time.................the hypos are not regular enough in my opinion to warrant changing that ratio....... However you may want to check your breakfast Levemir dose with a missed meal or carb free meal................ If you are planning to check both basal and bolus doses, the basal should always comes first, as this insulin dose is the foundation for the quicker acting insulin............ So to conclude, confirm your evening dose of 8 is holding you steady till morning, remember no carbs or QA going in 5 hours prior to pre bed test............... Then miss some meals/have some carb free meals and test you daytime Levemir dose for 2-3 days in a row.............you may find you need more during the day and this might bring down your QA ratios............ |
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Jan 25, 2012
CathySbd
7 posts
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I have found over time that I simply cannot snack after about 7pm. My blood sugars are always high in the mornings if I eat late. I have the correct short acting, I have adjusted the long acting but no matter what I do I cant keep good control with any late eating. Anyone else find this? Thanks, Cathy |
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Jan 25, 2012
CathySbd
7 posts
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Topic: DAFNE Online Mobile / Mobile use question Am enjoying entering my daily info onto DAFNE online via my iphone3. It's great. Tookme a while to figure out a few things. Does it work out your correction dose of short acting depending on your blood sugar, not sure about this? Eg: If I tested my blood sugar before tea and it was 14 I would have an extra 2 units on top of whatever I was injecting for my tea. Where do other people add this into their diary? Thanks. Cathy |