Recent Posts - DAFNE Online

Jun 17, 2011

Jenny 27 posts

Topic: Questions for HCPs / Menstrual Cycle, BI

I'm glad I'm not the only one. I think those insulin pumps with the continuous glucose monitors are the only way to solve the problem! I've tried to predict changes but can never get it right. Everything changes week by week so by the time you have gathered evidence to talk to someone everything has changed again.

Jun 17, 2011

marke 643 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

since I know at least one of the DAFNE 'top brass' read this forum I will let them give a 'full' answer if they wish too. However at last weeks DAFNE Collaborative I attended a workshop that contended that NPH could well be preferrable to newer analogue insulins. Indeed the original DAFNE program was and still is based on NPH insulin NOT the newer insulins.
One of the problems with new analogues is there is not the long term evidence and experience of using them like there is NPH. It was said at the DAFNE workshop that if they had known years ago what they now know about NPH insulins they would use them differently and more effectively. Newer is not always best ! Although all new insulins have obviously been safety tested before being generally available that is not the same as years of experience of using them over a very wide range of people who are all different. Perhaps QIPP is just trying to trying to avoid the 'newer is better' syndrome, or maybe not, I can't really comment on that.

Jun 17, 2011

Karen Westwood 38 posts

Topic: General Discussion / Hb1Ac results

novorapidboi26 said:
Karen Westwood said:
I am back to blood testing before each meal in the quest to reduce my HbA1 further and become 'normal' again lol!

Do you not do this anyway?

Been a little off track of late and not done the testing that I should have been and my HbA1 has increased from my previous post DAFNE 6.7% to 8.1%,

So I am now back to testing before each meal again .... back on track ..... onwards and upwards from here!!!! Laughing

Jun 17, 2011

marke 643 posts

Topic: General Discussion / iPhone BG Meter

nothing on their websites, just press releases at various other sites so I guess its not acutally available commercially yet. It looks potentially interesting but why plug it directly into an iphone, a bit of a strange decision. The connector looks weird sticking out of the side, presuming its not retractable its likely to potentially get battered in use. Also using something like bluetooth would mean you could connect it to any device that you wrote the software to talk to it on, opening up a bigger market with android, windows mobile etc. Anyway as I said it looks interesting, would be very interest to hear if anyone gets their hands on one.

Jun 17, 2011

marke 643 posts

Topic: General Discussion / How can you work out HBA1c by using your BG averages? Is it possible?

Carolin has asked me to post the table below from the new handbook ( available online shortly) that she thinks will help. It basically what she posted on this thread previously but laid-out in the same way as the handbook.

(if you are reading this in an email, it won't display properly. You can only view it on the site)

Jun 17, 2011

Ray O'Toole 4 posts

Topic: General Discussion / iPhone BG Meter

Does anybody know where can I purchase the iBGStar iPhone meter?

Regards,

Ray.

Jun 17, 2011

Athena 52 posts

Topic: General Discussion / Advice if possible.

Welshmapleleaf said:
I'm on Lantus - as it is supposed to be a 24hr ish BI, can you split it or would I need to consider going on to levemir?

Think you would need to think of Levemir or Insulatard. Lantus can be split but I know at our centre, they are not finding this to be successful as it is really meant to be used as a one off once daily injection. I would e-mail your DSN and ask for advice.
levemir is supposed to be one of the worst for reactions, so it may be a problem for you. We have been told that old-fashioned insulatard works well with DAFNE so you could ask about that too. Good luck, you really need to get something sorted out with this.

Jun 17, 2011

Athena 52 posts

Topic: Questions for HCPs / Menstrual Cycle, BI

Hi All,

Just to update you that I did not hear back from the DAFNE folk. No reply to my e-mail about including this aspect of control on future courses so no luck there. I also think that lots of gals won't realise what the problem is and so when DAFNE Extra becomes available no -one will include this in the course. I said to people on my course that maybe this was why they couldn't get control. They had not recognised the problem and now see a pattern to their BI changes. I have told my DSN's but nothing is mentioned in our follow up meetings. i wish they would address this. Why would they keep pretending that one BI is what you should aim for and will do you?
It seems such an oversight.
Anywya, hwo are we all getting on? I am not much fourther forward. I can predict the time of rise but not how much to raise it. I am now trying doses for one day only and changing the next day if not working. This is because I know when I am on the way up, and when I am on the way down. I think changes are required more quickly thatn the step- wise approach allows, especially on the way down of course when menstruation occurs and the insulin has to be whacked right down right away. I suspeact as other says that DAFNE jsut can't help with this and we all need to find our own pattern.

Good luck all!

Jun 17, 2011

Athena 52 posts

Topic: General Discussion / Hb1Ac results

sjohno said:
I have been lucky enough to have a copy of all my medical records, after reading them I discovered recordings of my Hb1Ac results. I was diagnised with T1 diabetes in 1979, I was 11yrs old, I have had T1 diabetes for 32yrs.
I graduated from DAFNE in November 2009 and my next Hb1Ac test is booked for the end of this month. The worst time of my diabetic life is when I was taken off Actrapid/Monotard and put on Humulin between 2006-2009.

I thought these results were a matter of fact and thought I'd share them with you.
1984 is when I discovered alcohol lol!

MONTH YEAR %
October 1980 12.6 Insulin October 1980 44 units Monotard am x 1 a day
1981 Insulin Nov 1980 AM PM
1982 Actrapid 16 8
1983 Monotard 12 8
October 1984 13.0
November1984 13.1
August 1987 9.5
March 1988 10.9
July 1988 10.5
April 1990 6.1
June 1990 6.7
February1991 7.2
June 1991 6.8
February1992 7.2
April 1992 7.2
July 1992 5.4
November1992 6.6
March 1993 5.9
October 1993 12.3
1994
March 1995 7.3
November1995 7.6
1997-1999 In the majority of Clinical Settings Hb1Ac of less than 6.8% is acceptable control.
April 1997 7.4
February1998 7.9
May 1999 8.9
November1999 8.2
July 2001 8.7
June 2002 8.5
July 2002 8.5
November2002 8.0
July 2003 9.1
October 2003 8.4
November2003 8.0
May 2004 8.4
August 2004 7.8
October 2004 7.6
January 2005 7.6
July 2005 8.2
April 2006 7.6 Insulin 2005/2006 Humulin
2007 February 2007 no Background Retinopathy
2008 February 2008 no Background Retinopathy
September2009 7.2 April 2009 Left eye Background Retinopathy
April 2010 6.8
December2010 6.1

Thanks for reading.

Sarah

That's interesting Sara. I thought I would point out to patients in Scotland that they can register to get their results on - line.
Google My diabetes myway if interested. Once registered all HBa1C, blood pressure, cholesterol etc, results from previous years are available to you , and like SAra you can see trends over the years.

Jun 17, 2011

Athena 52 posts

Topic: General Discussion / Stimulants

Anyone got any advice/ experience of using herbal or pharmecutical stimulants to stay awake with diabetes? I have looked into this and found a few rememdies. I am about to try Guarana and then other stuff like diet pills. Coffee is just not strong enough to deal with diabeteic tiredness especially with DAFNE where bg's seems to be higher than on normal MDI. Just not getting used to the higher levels so need to do something about it until I get my doses sorted. Any advice welcome.

thanks

Jun 17, 2011

Welshmapleleaf 19 posts

Topic: General Discussion / Advice if possible.

I'm on Lantus - as it is supposed to be a 24hr ish BI, can you split it or would I need to consider going on to levemir?

Jun 17, 2011

Athena 52 posts

Topic: General Discussion / Advice if possible.

IAS for the dawn phenomena, I am the same. i wake up okay, but if I don't take a QA with my BI first thing, at 7am by 8am I have gone high. I would also do what novorapid boi suggests try an uneven split on BI. I do this as well taking BI at 10pm and 7am. it is a really sensible suggestion. You need to try one thing and then the other, and then the two in combination though.
If you wake up ok, you may get away with just a small QA dose as soon as you wake up. If not, I would try the uneven split.

Good luck

Jun 17, 2011

Welshmapleleaf 19 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

Having only graduated last week, I am still grappling with normalising my BGs at a stable and consistent level. My own attitude whilst I was learning the DAFNE principles, and still is this week, is that at the moment, exercise is another complicating factor which would make it more difficult for me to 'get in tune' with how my body is reacting to CPs, ratios of QA etc etc.

I hope within the next few weeks, I'll get the confidence to build some exercise into my regime. I don't know whether any further information on this subject wouldn't have 'muddied the waters' on the course itself, but it would definately be welcome by the time of the six week reunion.

Jun 17, 2011

Carolin 83 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

JWo said:
Thanks Carolin, I will look more into it.

I agree with Brum_Taffy on things like exercise and alcohol not being covered enough on the DAFNE course (I'm more particularly interested in exercise considering I don't drink)... I mean it's quite common for people to speak up about the effects of exercise on this forum (at least 6 topics).

Hi,

This is a very important point and has been noted by DAFNE nationally. The consensus is that the vast majority of people need the basics during their DAFNE week so they can at least tackle exercise more safely & effectively.

The DAFNE Collaborative ran an 'exercise masterclass' for Educators and Doctors late last year, partly to help Educators to think about different ways of delivering that part of the 5-day course, but also to think about developing an 'advanced module' for DAFNE graduates.

It may be worth approaching your local Educators to find out if they're planning anything along these lines. In Sheffield we've provided 2 additional sessions this year in our 'RefresherClinics', aimed at people who do regular exercise and sports and incorporating more detail on exercise physiology and sports nutrition.

Jun 17, 2011

novorapidboi26 1,816 posts

Topic: General Discussion / Hb1Ac results

Karen Westwood said:
I am back to blood testing before each meal in the quest to reduce my HbA1 further and become 'normal' again lol!

Do you not do this anyway?

Jun 17, 2011

novorapidboi26 1,816 posts

Topic: General Discussion / Hb1Ac results

you can find the conversion here

Jun 17, 2011

Carolin 83 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

Brum_Taffy said:
I heard from some colleagues who were at the recent DAFNE collaborative that twice daily Levemir was suggested as the favoured BI. They didn't mention NPH being a favoured option. Do you think, Carolin, that they got only half the message?

I'll look into what you said about Ian Gallen's approach, very interesting! I'm always concerned that failure to adequately resuspend cloudy NPH will be an issue for many people, maybe I shouldn't be so worried if the 4 yr old DAFNE data is to believed.

I believe that exercise and safe enjoyment of alcohol don't get as much attention in our local DAFNE courses as they should.

Hi,

Yes, I think your colleagues may have got hold of the wrong end of the stick regarding BI use. Analogue BIs are certainly used almost exclusively in some DAFNE centres, however the evidence still comes out very favourably for NPH and is what Michael Berger's algorithms were developed around (the ITTP programme in Dusseldorf on which DAFNE is based).

But the audit data show that the important thing is taking the BI twice daily, whichever it is. So many centres prefer to keep patients on analogue and just split the dose.

Jun 17, 2011

Aneirin 15 posts

Topic: General Discussion / Hb1Ac results

I've never mentioned in percentages. What is 6.7% compared to mmol?

Jun 17, 2011

novorapidboi26 1,816 posts

Topic: General Discussion / Advice if possible.

If you are just outside the targets then it shouldn't take much effort to pin down, a later evening dose perhaps, I was in the high teens constantly, was really fed up, and really tired, I just didn't want to get up..... Crying or Very sad

Jun 17, 2011

Welshmapleleaf 19 posts

Topic: General Discussion / Advice if possible.

I agree with you novorapidboi that it's not worth a mid night alarm call! I don't fancy the pump at all - a couple of people specifically went on my DAFNE course so they could be considered for it. I was wondering whether my BI needed some adjustment to counter it. What I plan to do is monitor it for a while and discuss it with my DSn at the six week follow up, but it certainly needs addressing as I am already getting fed up of waking up with BGs within or close to targets, and having to correct at breakfast to set myself straight for the rest of the day!

Jun 17, 2011

novorapidboi26 1,816 posts

Topic: General Discussion / Advice if possible.

Although waking in the early hours may tackle the DP, I would never settle with doing it, that is just too much in terms of quality of life being destroyed.............

I tackle mine, not totally successfully, with the highest dose of BI AT 2230pm I can take without going low overnight, the closer to bed time you take it the more you will have left inside by the morning, this strategy gets me down to single figures at least................previously I had been on a 12 hr split of BI, for full coverage, but the increased amount left in the morning is what helps me.............

So definitely need a split BI to tackle it....................

But if this doesn't work then the pump is the only solution, and DP is one of the criteria that will make you eligible, still might need to fight for it in some parts of the country.....

Jun 17, 2011

Welshmapleleaf 19 posts

Topic: General Discussion / Advice if possible.

Most of us are taking an extra dose of QA( witih nothing to eat)in the early hours. Times range from 3am to 7am. Thsi does cover the dawn phenomena though but of course you need totry to find what time to take your extra jag, and work out how much you need.

Thats very interesting as I am currently suffering from the Dawn Effect, but my bloods seem to shoot up from a normal level when I first wake, to about 3-4 mmol higher within an hour! Evil or Very Mad

I was going to ask what everyone does about this - I just don't fancy waking myself up in the early hours to take a couple of units!

Jun 17, 2011

Welshmapleleaf 19 posts

Topic: General Discussion / Advice if possible.

Burning under the skin must be a pain, is that both types of insulin?I know Levemir is slightly acidic and can sting and give rashes

I know the pH of Lantus is slightly acidic (4.5 ish) which can create a slight sting, whereas Novorapid, for example, is nearer pH 7 so is more neutral to the body.
That may explain why it hurts when the insulin is physically injected rather than the needle being inserted into the skin.

The reason why the BI s have to be slightly acidic is because when they are injected, the body reacts to raise the pH nearer to 7, releasing the insulin in a more stable and prolonged way - a process that's not needed in the QA insulins.

Jun 17, 2011

novorapidboi26 1,816 posts

Topic: General Discussion / Advice if possible.

very good point about the honeymoon period, can potentially last a good few years..........

Jun 17, 2011 Jenny 27 posts	Topic: Questions for HCPs / Menstrual Cycle, BI I'm glad I'm not the only one. I think those insulin pumps with the continuous glucose monitors are the only way to solve the problem! I've tried to predict changes but can never get it right. Everything changes week by week so by the time you have gathered evidence to talk to someone everything has changed again.

Jun 17, 2011 marke 643 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP since I know at least one of the DAFNE 'top brass' read this forum I will let them give a 'full' answer if they wish too. However at last weeks DAFNE Collaborative I attended a workshop that contended that NPH could well be preferrable to newer analogue insulins. Indeed the original DAFNE program was and still is based on NPH insulin NOT the newer insulins. One of the problems with new analogues is there is not the long term evidence and experience of using them like there is NPH. It was said at the DAFNE workshop that if they had known years ago what they now know about NPH insulins they would use them differently and more effectively. Newer is not always best ! Although all new insulins have obviously been safety tested before being generally available that is not the same as years of experience of using them over a very wide range of people who are all different. Perhaps QIPP is just trying to trying to avoid the 'newer is better' syndrome, or maybe not, I can't really comment on that.

Jun 17, 2011 Karen Westwood 38 posts	Topic: General Discussion / Hb1Ac results novorapidboi26 said: Karen Westwood said: I am back to blood testing before each meal in the quest to reduce my HbA1 further and become 'normal' again lol! Do you not do this anyway? Been a little off track of late and not done the testing that I should have been and my HbA1 has increased from my previous post DAFNE 6.7% to 8.1%, So I am now back to testing before each meal again .... back on track ..... onwards and upwards from here!!!!

Jun 17, 2011 marke 643 posts	Topic: General Discussion / iPhone BG Meter nothing on their websites, just press releases at various other sites so I guess its not acutally available commercially yet. It looks potentially interesting but why plug it directly into an iphone, a bit of a strange decision. The connector looks weird sticking out of the side, presuming its not retractable its likely to potentially get battered in use. Also using something like bluetooth would mean you could connect it to any device that you wrote the software to talk to it on, opening up a bigger market with android, windows mobile etc. Anyway as I said it looks interesting, would be very interest to hear if anyone gets their hands on one.

Jun 17, 2011 marke 643 posts	Topic: General Discussion / How can you work out HBA1c by using your BG averages? Is it possible? Carolin has asked me to post the table below from the new handbook ( available online shortly) that she thinks will help. It basically what she posted on this thread previously but laid-out in the same way as the handbook. (if you are reading this in an email, it won't display properly. You can only view it on the site)

Jun 17, 2011 Ray O'Toole 4 posts	Topic: General Discussion / iPhone BG Meter Does anybody know where can I purchase the iBGStar iPhone meter? Regards, Ray.

Jun 17, 2011 Athena 52 posts	Topic: General Discussion / Advice if possible. Welshmapleleaf said: I'm on Lantus - as it is supposed to be a 24hr ish BI, can you split it or would I need to consider going on to levemir? Think you would need to think of Levemir or Insulatard. Lantus can be split but I know at our centre, they are not finding this to be successful as it is really meant to be used as a one off once daily injection. I would e-mail your DSN and ask for advice. levemir is supposed to be one of the worst for reactions, so it may be a problem for you. We have been told that old-fashioned insulatard works well with DAFNE so you could ask about that too. Good luck, you really need to get something sorted out with this.

Jun 17, 2011 Athena 52 posts	Topic: Questions for HCPs / Menstrual Cycle, BI Hi All, Just to update you that I did not hear back from the DAFNE folk. No reply to my e-mail about including this aspect of control on future courses so no luck there. I also think that lots of gals won't realise what the problem is and so when DAFNE Extra becomes available no -one will include this in the course. I said to people on my course that maybe this was why they couldn't get control. They had not recognised the problem and now see a pattern to their BI changes. I have told my DSN's but nothing is mentioned in our follow up meetings. i wish they would address this. Why would they keep pretending that one BI is what you should aim for and will do you? It seems such an oversight. Anywya, hwo are we all getting on? I am not much fourther forward. I can predict the time of rise but not how much to raise it. I am now trying doses for one day only and changing the next day if not working. This is because I know when I am on the way up, and when I am on the way down. I think changes are required more quickly thatn the step- wise approach allows, especially on the way down of course when menstruation occurs and the insulin has to be whacked right down right away. I suspeact as other says that DAFNE jsut can't help with this and we all need to find our own pattern. Good luck all!

Jun 17, 2011 Athena 52 posts	Topic: General Discussion / Hb1Ac results sjohno said: I have been lucky enough to have a copy of all my medical records, after reading them I discovered recordings of my Hb1Ac results. I was diagnised with T1 diabetes in 1979, I was 11yrs old, I have had T1 diabetes for 32yrs. I graduated from DAFNE in November 2009 and my next Hb1Ac test is booked for the end of this month. The worst time of my diabetic life is when I was taken off Actrapid/Monotard and put on Humulin between 2006-2009. I thought these results were a matter of fact and thought I'd share them with you. 1984 is when I discovered alcohol lol! MONTH YEAR % October 1980 12.6 Insulin October 1980 44 units Monotard am x 1 a day 1981 Insulin Nov 1980 AM PM 1982 Actrapid 16 8 1983 Monotard 12 8 October 1984 13.0 November1984 13.1 August 1987 9.5 March 1988 10.9 July 1988 10.5 April 1990 6.1 June 1990 6.7 February1991 7.2 June 1991 6.8 February1992 7.2 April 1992 7.2 July 1992 5.4 November1992 6.6 March 1993 5.9 October 1993 12.3 1994 March 1995 7.3 November1995 7.6 1997-1999 In the majority of Clinical Settings Hb1Ac of less than 6.8% is acceptable control. April 1997 7.4 February1998 7.9 May 1999 8.9 November1999 8.2 July 2001 8.7 June 2002 8.5 July 2002 8.5 November2002 8.0 July 2003 9.1 October 2003 8.4 November2003 8.0 May 2004 8.4 August 2004 7.8 October 2004 7.6 January 2005 7.6 July 2005 8.2 April 2006 7.6 Insulin 2005/2006 Humulin 2007 February 2007 no Background Retinopathy 2008 February 2008 no Background Retinopathy September2009 7.2 April 2009 Left eye Background Retinopathy April 2010 6.8 December2010 6.1 Thanks for reading. Sarah That's interesting Sara. I thought I would point out to patients in Scotland that they can register to get their results on - line. Google My diabetes myway if interested. Once registered all HBa1C, blood pressure, cholesterol etc, results from previous years are available to you , and like SAra you can see trends over the years.

Jun 17, 2011 Athena 52 posts	Topic: General Discussion / Stimulants Anyone got any advice/ experience of using herbal or pharmecutical stimulants to stay awake with diabetes? I have looked into this and found a few rememdies. I am about to try Guarana and then other stuff like diet pills. Coffee is just not strong enough to deal with diabeteic tiredness especially with DAFNE where bg's seems to be higher than on normal MDI. Just not getting used to the higher levels so need to do something about it until I get my doses sorted. Any advice welcome. thanks

Jun 17, 2011 Welshmapleleaf 19 posts	Topic: General Discussion / Advice if possible. I'm on Lantus - as it is supposed to be a 24hr ish BI, can you split it or would I need to consider going on to levemir?

Jun 17, 2011 Athena 52 posts	Topic: General Discussion / Advice if possible. IAS for the dawn phenomena, I am the same. i wake up okay, but if I don't take a QA with my BI first thing, at 7am by 8am I have gone high. I would also do what novorapid boi suggests try an uneven split on BI. I do this as well taking BI at 10pm and 7am. it is a really sensible suggestion. You need to try one thing and then the other, and then the two in combination though. If you wake up ok, you may get away with just a small QA dose as soon as you wake up. If not, I would try the uneven split. Good luck

Jun 17, 2011 Welshmapleleaf 19 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Having only graduated last week, I am still grappling with normalising my BGs at a stable and consistent level. My own attitude whilst I was learning the DAFNE principles, and still is this week, is that at the moment, exercise is another complicating factor which would make it more difficult for me to 'get in tune' with how my body is reacting to CPs, ratios of QA etc etc. I hope within the next few weeks, I'll get the confidence to build some exercise into my regime. I don't know whether any further information on this subject wouldn't have 'muddied the waters' on the course itself, but it would definately be welcome by the time of the six week reunion.

Jun 17, 2011 Carolin 83 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP JWo said: Thanks Carolin, I will look more into it. I agree with Brum_Taffy on things like exercise and alcohol not being covered enough on the DAFNE course (I'm more particularly interested in exercise considering I don't drink)... I mean it's quite common for people to speak up about the effects of exercise on this forum (at least 6 topics). Hi, This is a very important point and has been noted by DAFNE nationally. The consensus is that the vast majority of people need the basics during their DAFNE week so they can at least tackle exercise more safely & effectively. The DAFNE Collaborative ran an 'exercise masterclass' for Educators and Doctors late last year, partly to help Educators to think about different ways of delivering that part of the 5-day course, but also to think about developing an 'advanced module' for DAFNE graduates. It may be worth approaching your local Educators to find out if they're planning anything along these lines. In Sheffield we've provided 2 additional sessions this year in our 'RefresherClinics', aimed at people who do regular exercise and sports and incorporating more detail on exercise physiology and sports nutrition.

Jun 17, 2011 novorapidboi26 1,816 posts	Topic: General Discussion / Hb1Ac results Karen Westwood said: I am back to blood testing before each meal in the quest to reduce my HbA1 further and become 'normal' again lol! Do you not do this anyway?

Jun 17, 2011 novorapidboi26 1,816 posts	Topic: General Discussion / Hb1Ac results you can find the conversion here

Jun 17, 2011 Carolin 83 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Brum_Taffy said: I heard from some colleagues who were at the recent DAFNE collaborative that twice daily Levemir was suggested as the favoured BI. They didn't mention NPH being a favoured option. Do you think, Carolin, that they got only half the message? I'll look into what you said about Ian Gallen's approach, very interesting! I'm always concerned that failure to adequately resuspend cloudy NPH will be an issue for many people, maybe I shouldn't be so worried if the 4 yr old DAFNE data is to believed. I believe that exercise and safe enjoyment of alcohol don't get as much attention in our local DAFNE courses as they should. Hi, Yes, I think your colleagues may have got hold of the wrong end of the stick regarding BI use. Analogue BIs are certainly used almost exclusively in some DAFNE centres, however the evidence still comes out very favourably for NPH and is what Michael Berger's algorithms were developed around (the ITTP programme in Dusseldorf on which DAFNE is based). But the audit data show that the important thing is taking the BI twice daily, whichever it is. So many centres prefer to keep patients on analogue and just split the dose.

Jun 17, 2011 Aneirin 15 posts	Topic: General Discussion / Hb1Ac results I've never mentioned in percentages. What is 6.7% compared to mmol?

Jun 17, 2011 novorapidboi26 1,816 posts	Topic: General Discussion / Advice if possible. If you are just outside the targets then it shouldn't take much effort to pin down, a later evening dose perhaps, I was in the high teens constantly, was really fed up, and really tired, I just didn't want to get up.....

Jun 17, 2011 Welshmapleleaf 19 posts	Topic: General Discussion / Advice if possible. I agree with you novorapidboi that it's not worth a mid night alarm call! I don't fancy the pump at all - a couple of people specifically went on my DAFNE course so they could be considered for it. I was wondering whether my BI needed some adjustment to counter it. What I plan to do is monitor it for a while and discuss it with my DSn at the six week follow up, but it certainly needs addressing as I am already getting fed up of waking up with BGs within or close to targets, and having to correct at breakfast to set myself straight for the rest of the day!

Jun 17, 2011 novorapidboi26 1,816 posts	Topic: General Discussion / Advice if possible. Although waking in the early hours may tackle the DP, I would never settle with doing it, that is just too much in terms of quality of life being destroyed............. I tackle mine, not totally successfully, with the highest dose of BI AT 2230pm I can take without going low overnight, the closer to bed time you take it the more you will have left inside by the morning, this strategy gets me down to single figures at least................previously I had been on a 12 hr split of BI, for full coverage, but the increased amount left in the morning is what helps me............. So definitely need a split BI to tackle it.................... But if this doesn't work then the pump is the only solution, and DP is one of the criteria that will make you eligible, still might need to fight for it in some parts of the country.....

Jun 17, 2011 Welshmapleleaf 19 posts	Topic: General Discussion / Advice if possible. Most of us are taking an extra dose of QA( witih nothing to eat)in the early hours. Times range from 3am to 7am. Thsi does cover the dawn phenomena though but of course you need totry to find what time to take your extra jag, and work out how much you need. Thats very interesting as I am currently suffering from the Dawn Effect, but my bloods seem to shoot up from a normal level when I first wake, to about 3-4 mmol higher within an hour! I was going to ask what everyone does about this - I just don't fancy waking myself up in the early hours to take a couple of units!

Jun 17, 2011 Welshmapleleaf 19 posts	Topic: General Discussion / Advice if possible. Burning under the skin must be a pain, is that both types of insulin?I know Levemir is slightly acidic and can sting and give rashes I know the pH of Lantus is slightly acidic (4.5 ish) which can create a slight sting, whereas Novorapid, for example, is nearer pH 7 so is more neutral to the body. That may explain why it hurts when the insulin is physically injected rather than the needle being inserted into the skin. The reason why the BI s have to be slightly acidic is because when they are injected, the body reacts to raise the pH nearer to 7, releasing the insulin in a more stable and prolonged way - a process that's not needed in the QA insulins.

Jun 17, 2011 novorapidboi26 1,816 posts	Topic: General Discussion / Advice if possible. very good point about the honeymoon period, can potentially last a good few years..........