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Jan 24, 2012
Carolin
83 posts
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Topic: General Discussion / Dafne & sports nutrition. How does it work?
Hi Jenny. You're quite right that you will need the additional carbs during the training / event, as well as reductions in your insulin doses. The standard DAFNE curriculum and workbook doesn't go into this in great detail as it's meant to give people just the basics, but the runsweet website, or the Diabetic Athelete Handbook (available through Amazon) are fantastic in giving guidelines for the extra carbs required. 60g per hour does sound about right, so try to think of forms that you can easily keep in your swimming gear, e.g. Glucose gels. Good luck! Carolin |
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Jan 24, 2012
Lizzie
87 posts
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Topic: General Discussion / Redoing DAFNE??? Hi SimonThanks for mending the Handbook. I have entered a couple of tests in the Diary section already, did not realise how good it was. Thanks both for your help. Will try my best tonight and see how it goes. |
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Jan 24, 2012
Simon
578 posts
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Topic: General Discussion / Redoing DAFNE???
Apologies, Mark and I have been upgrading the site and some errors slipped through the net, the handbook is working again now  I think novorapidboi is giving some real sound advice to you here. Don't underestimate the power of writing your readings down - if you can see them on paper (or on the diary here) then you will be able to notice trends and see where adjustments in dosage might need to be made. If you use the diary on here, even if you aren't able to spot the trends in the diary, you can share with other people and ask for advice - there are so many people helping each other out here. One comment:
I'd say try and test more often, not only will it contribute to keeping a record of your sugars so that you can make adjustments; you may be pleasantly surprised and find that some readings are in range - which could show you that getting on-target readings is possible, and motivate you to keep track of and adjust your insulin doses. |
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Jan 24, 2012
Lizzie
87 posts
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Topic: General Discussion / Redoing DAFNE??? Thanks, I think the best thing is to set an alarm.I panic because I am so terrified of complications. I have been told many people panic when they get hypo but I have never worried about that. I am lucky to have good warning signs so all it is is a quick check to make sure I am indeed hypo, then 20g carbs and that's it. I panic because I hate the idea that all the highs are having an effect which I will feel in years to come, like a sword suspended over my head. I worry that although there is no immediate effect, my body is storing it all up to suddenly dump on me in the future. That small unnoticeable changes are happening to tiny cells in my eyes, kidneys and nerve endings, and these will become apparent at some future date when my body decides it is going to let me down again. This probably all sounds crazy to you. I know I worry too much. I know my weight has nothing to do with my blood sugars, but try telling them that. Everything seems to be about weight. I don't understand why they wanted me to take Metformin as I was losing weight and doing well anyway. The last time I checked I was on 3:1 but that was before the Metformin. At lunch I tried 2:1. |
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Jan 24, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Redoing DAFNE??? The reason for the 5 hours is because by then all QA insulin from dinner and Carbs from your dinner will be gone, leaving nothing but your Lantus in your system, this means you can accurately see how its doing overnight..............If you still had insulin and carbs working then your pre bed test would be different from the morning......................the 5 hours is the maximum the QA insulin works is all, I am Novorapid, but it doesn't last that long in me, so it could be the same for you, however when testing you want to eliminate all the variables....... You could set an alarm for 12:00 or after that, do a test, then back to bed.............. You could skip dinner or have a carb free dinner [meat, cheese, eggs, most vegetables], then you would not be taking QA insulin......... Whatever level you feel is uncomfortable would be the level to correct, but for test purposes you really need to be free of QA insulin. The low teens would be perfectly safe just for testing your background, but as I say, if you feel rough, just correct and try again another night.......why do you think you panic when your high, do you feel high? If you dont know you ratios its likely your on a 1:1 ratio, which equates to 1 unit of insulin for 10grams [1CP] of carbohydrates.................and this wont effect the test, as your not concerned with that insulin for now.....................how much insulin do you take before eating, just random guesses? You dont what insulin could be causing the problem, that's why you need to test your background, to make sure its correct..........then you know if there are any issues it will be your QA [Humalog].......... Dont feel stupid, I was in the dark also, at least until DAFNE...............................your course must not have been conducted very well............. All you are looking for from the nurses is advice on adjusting doses, your weight has nothing to do with your blood sugar control, I have sacrificed my weight for good blood sugar control, well, I eat too much, but my blood sugar has more of a priority.......... You can only ask, you need to, you have a right to the same care as everyone else................ You can get support on here, and over at www.diabetessupport.co.uk......................... I will help as much as I can................. |
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Jan 24, 2012
Lizzie
87 posts
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Topic: General Discussion / Redoing DAFNE??? Thanks for all the help.If I don't eat for 5 hrs before bed (11pm) I will need to have tea around 5pm, so that's not doable. Does it need to be 5 hours? What is the minimum length of time it could be? I usually go to bed around 11 and get in from work about 6pm, so I would need to get going immediately on tea and eat something that doesn't take long to make to have it early enough. Or should I skip tea altogether or would that affect the results? And how high would I need to be before bed to make it worrying enough for correction? I panic when I am high and often overcorrect. I would worry if I am high before bed. Would the fact that I don't know my QA ratios affect the results of the Lantus tests, if that makes any sense? I mean, if I am high/low, how do I know whether it is a result of the Lantus being wrong or a result of the QA ratio being wrong? I am sorry for being overcautious about all this. But like I said I am really afraid of doing something wrong and it makes me feel really stupid to not know any of this after nearly 20 years. Even thinking about it now makes me worried and frustrated and I feel like crying but I know I have to try. Tbh, I don't know if the nurses or doctors can help me. They are nice people but they are judgmental about my weight and cannot see past that to helping me sort out my diabetes. |
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Jan 24, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Redoing DAFNE??? OK....................So you need to start from the beginning, which is to test your Lantus dose..................so dont have any food or QA 5 hours before you go to bed, do a test before bed, record the result...........even if its high [use discretion] dont correct it..............test before breakfast, record the result............ If you are within 1-2mmol/l then the Lantus is doing its job. However, you should do about 3 consecutive days to make sure the results your seeing, whether there right, too much or too little, are consistent..............once your sure bump up your dose if your readings went up over night, and bump down if your reading went down, or do nothing if your blood sugar held steady.........when changing background doses its wise to do a 3am test to make sure your not going low overnight, which could result in a high and therefore possibly give the impression you need more when in fact you dont.......... Once this is right, you can move on to your QA ratios.............. REMEMBER that the effects of changing Lantus, as opposed to Levemir, take a day or 2 to show up, so you should be patient at first......... Explaining the next stages might just complicate things for you, so if you concentrate on you Lantus dose for now that would be good............ Try and contact the DAFNE trained nurses at your clinic and make an appointment, this should be possible as its not an official clinic appointment, they will be better equipped to get you back on track as they will be face to face........ Would you like me to email my excel spreadsheet to you..........? |
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Jan 24, 2012
Lizzie
87 posts
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Topic: General Discussion / Redoing DAFNE??? No I am not in contact with the nurses. I don't know why. Like I said doctors seem to lose interest in me.I am on Humalog and Lantus. The Lantus at the moment is 30u before bed but I am not sure if that is right. I kept increasing it until my blood sugars through the night were reasonable as I kept waking up high but during the day as I mentioned it gets confusing. Thanks for helping. |
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Jan 24, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Redoing DAFNE??? I think what you need is motivation, as opposed to the education, even though you may have forgot most of it. The best source of motivation is from yourself and your team. Are you not in contact with the nurses that done your DAFNE course?They can help you but not if your not testing on a regular basis. Its the regular testing and spotting of patterns which lets you change your doses confidently........ Start testing today, if you dont have a diary, just record it on paper, so blood sugar, carbs, quick acting insulin. I have a spreadsheet I could email you that I use for writing information on............ As soon as you get some results down on paper you can email me them back and I could make some comments, once the ball is moving it gets easier.............. What insulin are you on? How much background do you take and when? |
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Jan 24, 2012
Lizzie
87 posts
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Topic: General Discussion / Redoing DAFNE??? Thankyou for being so kind.The truth is, I will admit to you, I only really check my blood sugar when I feel high or low. I have stopped checking on a regular basis and stopped writing it down. I just feel low about it as every reading seems high or low and I don't know why. I seem to be always doing correction doses but I don't know where to start in working out what doses are right or wrong. I am Ok with carbs when eating prepackaged foods which have carbs per portion on them but am not so good with anything that does not have a carb value written on it or only has it per 100g rather than per portion. The problem was that on the course I could not afford to buy expensive food in the canteen every day so missed out on all the weighing and measuring parts of the course. It may not be that different doing DAFNE again. However I am resolved not to listen to my GP if they try and make me do anything I am not happy with. Also, I cannot overemphasise how world shattering DAFNE was for me. For some reason I seem to slip through the net and seem to have some sort of invisibility cape on so doctors cannot see me. I was never told how to count carbs or measure my insulin in 15 years. For several years I did not see any doctors at all and nobody said anything. I was at the point where I was terrified of my diabetes, thinking about it made me cry I was so terrified of complications and did not know how to make my blood sugars right. So when I got onto a DAFNE course I had to take in all the things that I missed in 15 years and it was a lot to absorb. On the day when I was trying to figure out my insulin dosage I ended up in hysterical tears as I was confronted by this massive fear I had been avoiding for so long. It was an intense emotional week. I was happy afterwards as my doctors were happy with me for the first time ever. But then I was forced into taking medication I did not want or need and that messed up my blood sugars and then I was comfort eating and since I had donned my invisibility cloak nobody noticed and here I am again, in a mess of problems and not knowing where to turn for help. I am pretty sure I am depressed and I am fighting to make myself do anything to be honest, I just don't care and want to ignore everything. I know I will feel better if my blood sugars are less erratic. But without help I can't make them right. The only time any nurse or doctor has taken an interest was when I was on DAFNE. What I really need is ongoing support from a nurse plus counselling but that is not likely. So I am stuck in this cycle of falling over and picking myself up again like a silent slapstick movie on a loop. |
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Jan 24, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Redoing DAFNE??? I would contact Marke or Simon who will help you access the handbook, it will help you..................To be successful in dose adjustment you need to get blood sugar readings consistently before meals, if this isn't happening then this needs to be addressed before anything else........... how bad is it when you say you often dont have time to check your blood sugars.....? Have you got a dairy/homemade sheet to write down your results? You dont need to look at numbers at work, or at least make any decisions on long term dose..........you can give a correction dose and a dose for your food, if the ratio is wrong, then you can analyze that later at home...... I would also say getting the carb count is important, as this would hinder your dose decisions if the count was wrong.......... What part of counting are you struggling with? I would try and get on another course if you can, however what will make it different this time round..........? In the mean time me and others on here will be happy to help you in any way we can...... 
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Jan 24, 2012
Lizzie
87 posts
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Topic: General Discussion / Redoing DAFNE??? There were some refreshers shortly after I did the course however they were in the day so I had some problems getting leave from work, by the time I had arranged this there was no space left. I wish they would do something in the evening or at the weekend. After about a year these stopped and I now get zero support - eye checks once a year and a consultant appointment with someone who I don't know from Adam once a year and that's the lot.What I need is to work through the process of finding out the ratios again with an educator. It worked on the course as it was isolated from 'real life' - the whole week was spent on the course so that was a big chunk of time I could devote to diabetes and only diabetes and there was nothing else to interfere. When I try it alone it does not work as real life interferes and I cannot work out which of the many confusing factors has caused a high or a low, and if I am at work I don't have time to look at numbers and plot graphs of what my blood sugar was through the day. I often don't even have time to check my blood sugar, I feel like I am always running to catch up. I also need help with sick day rules and carb counting so pretty much the whole lot. That is another reason why a refresher would not work - you have to choose only one or two things to work on. Also I need a similar level of supervision as I did on the course and the educators are far too busy to give that sort of help outside specifically arranged events like the DAFNE course. I did try to access the handbook however I only got an error message. I just don't know what to do. When I did DAFNE things seemed to work for the first time in 15 years. I was eating sensibly and had some understanding of my diabetes and started to lose weight. However after that I was forced into a bad decision by my GP and had family illness and everything fell apart. I just want to get back to how things were and DAFNE is the only thing that ever worked for me. I don't know what else to do since my doctors are not interested except to bully me into weight loss surgery or taking unecessary medications, and I am not able to get the counselling I desperately need. |
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Jan 24, 2012
novorapidboi26
1,819 posts
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Topic: Questions for HCPs / change of insulin With any change it will take time to get the dose/ratio of the insulin correct..................Start with overnight testing to see what your 6pm does to your BG with no food or QA working, the beauty with Levemir is you can see the effect straight away..........double check your findings with another day or 2, then make your adjustments up or down............dont be scared to up your dose, just do what you need to do to get your pre bed reading within +/-2mmol/l of your pre breakfast reading........... Once correct, move on to daytime testing................... As you know, until your background needs are satisfied, your QA doses wont be at their most effective.............. |
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Jan 24, 2012
novorapidboi26
1,819 posts
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Topic: Questions for HCPs / Ratios and compensating Welcome to the site Collete..................I hope you enjoy the rest of the course...............  |
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Jan 24, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Redoing DAFNE??? I wouldn't say its impossible, however taking the place of someone who has not done it before may seem not very cost effective to the local PCT...................You can ask I suppose........... Is there not a refresher you can go on.............? Have you went over the DAFNE handbook that you have access to on this website? Is there anything specific you are struggling with? Can we help? |
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Jan 24, 2012
novorapidboi26
1,819 posts
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Topic: General Discussion / Dafne & sports nutrition. How does it work?
Well I believe a reduction in your previous meal and/or your background dose would mean you would not need to eat anything during the training, as the energy stores of your muscles are depleted, the extra glucose you have swimming around because of your lower insulin dose, would be used whilst training and to re stock the muscles................ However you should always have hypo resolve to hand just in case............................its all trial and error really...............I dont train for events like this, so my experience is limited, this is just my understanding of the DAFNE approach to exercise.............. |
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Jan 24, 2012
Whyters
2 posts
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Topic: Questions for HCPs / change of insulin I have just changed from Lantus to Levemir and found no problems remember lantus is working 18-24 hours where as levemir is up to 18 hours and I was told to change from one to the other when my next long acting was due as both are in the system for similar times so one is finishing as the other is taking over in your system.I am also taking split amounts also. I suggest you contact your diabetes nurse for advice. |
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Jan 24, 2012
meltow
78 posts
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Topic: General Discussion / Dafne & sports nutrition. How does it work? http://www.steveredgrave.com/diabetes.htmlSteve Redgrave, our 5 times Olympic champion, also supports and advises to use the RunSweet website. He was diagnosed in 1997, and went on to win his 5th gold medal in 2000. A true champion in more ways than one! |
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Jan 24, 2012
tcmonkey80
41 posts
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Topic: Questions for HCPs / change of insulin I am taking 6pm and 6am, it doesn't seem to be having much effect tho....I feel worse now lol |
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Jan 24, 2012
JennyNZ
29 posts
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Topic: General Discussion / Dafne & sports nutrition. How does it work? thanks for that but how would you accomodate eating about 6 cp's per hour while training? |
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Jan 23, 2012
Collette
2 posts
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Hi, This is still quite new to me so I would always recommend checking with a diabetic nurse 1st but personally i started to correct over 10 1QA for 10 2QA for 13 etc over time by writing it down you will see how corrections work for you. I now correct over 8 and it normally corrects by 2 not 3 for me. If you find your always correcting at a particular mealtime it could be that you need a different ratio or slightly higher back ground insulin. These are the sorts of things covered by dafne course which I have only started today so im looking forward to learning more. I really wish all type 1 diabetics had the opportunity to attend the course as surely its beneficial for us all to have good self management and reducing the risk of complications will save money in the long run! |
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Jan 23, 2012
SimonC
78 posts
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Topic: Questions for HCPs / Ratios and compensating For me, I would take an extra 2 units for breakfast, but only 1 unit for lunch or evening. |
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Jan 23, 2012
Lizzie
87 posts
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Topic: General Discussion / Redoing DAFNE??? Is it possible to retake the DAFNE course? I did it a few years back and various things in the intervening period have meant that I am now confused and unclear about most of it. |
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Jan 23, 2012
Neil Ward
1 post
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Topic: Questions for HCPs / Diary info for Penny Jackson Hi PennyAs per my e-mail please see my readings over the last ten days. Regards Neil |