Recent Posts
Search the DAFNE Online Forums
15,718 posts found
|
Jun 17, 2011
Athena
52 posts
|
Topic: General Discussion / Advice if possible. Oh Forgot to say that yur increase need in insulin is probably because you are past the 2 year mark now. Some beta cell production goes on for a while before all the cells are destroyed by the disease. You may just have lost more now which is what happens to us all as time goes on.If you ahve gained weight or cut down on exercise that might also cause it. Take care. Hope you get things sorted. |
|
Jun 17, 2011
Athena
52 posts
|
Topic: General Discussion / Advice if possible. I would go for tryng to improve the DAwn Phenomena . 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.good luck |
|
Jun 17, 2011
novorapidboi26
1,816 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP I though Lantus was not suitable as adjusting it for exercise wasn't very flexible as the effects are not noticed for days..........Interesting points about the liver during exercise etc.....I didn't think it played a huge part during exercise, but after when trying to replenish the muscles stores......... |
|
Jun 17, 2011
novorapidboi26
1,816 posts
|
Topic: General Discussion / Advice if possible. Your ratios changing is normal and can happen often or not so often, that's the beauty of actually knowing your ratios and being able to change them.........Needing more or less insulin for every 10g of carbohydrate is down to insulin resistance I suppose, and so the more active you are the more chance you will be on a 1:1 or less as your muscles are at there most sensitive.......obviously hormones and other bodily wonders can effect them too....... If you lived your life to a strict routine I suppose your body would be used to the same food, activity levels, stress levels and so on and you could expect ratios to stay the same for the most part, but the majority of people aren't that strict....... As far as side effects are concerned, you may find these symptoms are present because you are not getting enough insulin.... Your morning highs are likely the dawn phenomenon, which I believe everyone experiences, its just some of us cant deal with it.....like me...... 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.... Headaches and nausea are common symptoms to many minor conditions, but could be due to high readings...... Best to see the doc if it is worrying you..... |
|
Jun 17, 2011
JayBee
582 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP 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). |
|
Jun 17, 2011
Garry
328 posts
|
Topic: General Discussion / Advice if possible. Almost certainly sickness affecting your Diabetes.On your exercise query:  on the opening Forum page - use the search facility to search for Exercise. Brings up about six threads to have a look at.These have helped me better understand the sometimes puzzling effect of exercise and BGs. Regards Garry |
|
Jun 17, 2011
Brum_Taffy
13 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP 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. |
|
Jun 17, 2011
deanna
8 posts
|
Topic: General Discussion / Advice if possible. Thanks Garry, im trying to keep at it, i usually do notice differences in my BG when im sick but at the moment i (or the doctors) dont know whats causing what first, the sickness affecting my diabeties or my diabeties resulting in my sickness Oh and while ive got you, do you have any idea why exercise wouldnt be lowering me BG significantally as it has in the past. I have noticed this over the past couple of weeks and i cant think of any reason for it. hi dafne-dude i think your morning increasing in insulin could be like mine any many others ive heard from. Hormones on the morning that wake you up and get you started, interfere i think is the right word, with your insulin intake. not sure theres much else it could be but id still ask around if it worries you. The weekend variations could be something as simple as you sleeping in latter or your body jst knowing, dont ask me how that your not going to work that day. The burning - the only way i can describe it to others is like, if you have ever accidently touched your hand to something burning hot like an oven. That is how it feels to me  Its not the needles but the insulin when it enters, and it sometimes doesnt even go by high doses like ive given myself too much at one time, as this can happen. Ive tried 3 QA insulins now in less than a year with varying affects. Ive now devised as somewhat successfull method for injecting myslef. Insert needle, inject 3-4 units, hold, count to 5, and so on etc. Seems to work for the most part. x |
|
Jun 16, 2011
Carolin
83 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Hi JWoIt's a bit complicated, but in simple terms when you exercise your liver needs to release glucose into your bloodstream from the glycogen stores. It's thought that the analogue BIs suppress this to a greater extent / for longer than NPH. There may be more detail on the www.runsweet.com website Or you could try to Google E Perry/I Gallen as they're the docs who have done the studies. Carolin |
|
Jun 16, 2011
JayBee
582 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Why is Lantus not suitable for Type1s who exercise regularly? Is it because it responds stronger to exercise compared to the other two?That might explain the trouble I had possibly... it's weird how a very busy working environment can affect your body without you realising. 
|
|
Jun 16, 2011
Welshmapleleaf
19 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Yes, on my DAFNE course last week, they explained Lantus was less suitable to those who exercise regularly, and indeed one of the other delegates had changed to levimir for that very reason. It was also deemed to be better for those who found that the effectiveness of Lantus was running out too early every day. |
|
Jun 16, 2011
chrisinbrum
41 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP
Thanks Carolin - that's really interesting and helpful! I'd not heard anything like that before about hypos and exercise. On my DAFNE course, and i think in the course manual, it just says that hypos might be a problem after exercise, but doesn't link that to any particular insulin so i assumed they were all the same. The manual also says that Lantus users might manage better with twice daily Isophane or Levemir. |
|
Jun 16, 2011
Carolin
83 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP 1. is there research evidence of an improved safety record for analogues compared with old NPH/soluble insulins, from the DAFNE database? [one for DAFNE top brass!]I can tell you that an audit of the DAFNE database around 4yrs ago asked just that question. And the reuslts?....... Traditional NPH (Humulin I or Insulatard) used twice daily as per DAFNE regimen resulted in better HbA1c than the modern analogue Background Insulins, however ANY type of BI taken twice daily was better than analogue taken just once daily. There was no difference in terms of severe hypos (needing 3rd party assistance), however analogue BI showed a trend towards slightly lower rates of minor, symptomatic hypos. The DAFNE stance therefore is still to default to NPH twice daily as it is still a very effective and proven insulin and this has nothing to do with cost! If people have problems with night-time hypos and/or uncontrollable Dawn Phenomenon on NPH, twice daily Levemir or Lantus is an option. In addition, much of the work done by Dr Ian Gallen's team at Wycombe has shown an increased risks of prolonged hypos during/following exercise with analogue BIs and they recommend switching back to NPH or using a pump if you're a serious exerciser. Hope this info helps? Carolin |
|
Jun 16, 2011
chrisinbrum
41 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP I think it's useful to remember that a lot of the clinical information and other info online might originally come from the companies that make insulin, so they might be putting their 'spin' on the findings they publish, and just because a large trial shows lower risk of hypo with insulin A rather than insulin B, it doesn't mean that it's the same for everyone. I think it's just safe to say that different peope react differently to different types of insulin, and we should all be allowed to decide which one we want to use, with support and advice from GPs and other diabetes specialists.Brum-taffy, i'm in South Birm PCT, which one are you in? QIPP stands for Quality, Innovation, Productivity and Prevention...so any QIPP plan from a PCT would need to consider all of these areas and they're not just about saving money in the short-term. So if there is evidence that newer analogue insulins reduce hypos and complications, improve control and reduce weight gain (for example) that would all support the widespread use of newer insulins - this could make people that prefer older insulins unhappy! I know that asking your local PCT for their plans isn't going to make them suddenly think about reducing people's access to insulin, that's not how it works (luckily!). |
|
Jun 16, 2011
JayBee
582 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP
I find this bit particularly interesting because I chose to change to Levemir because I was suffering from hypos a lot more on Lantus! I don't know about the whole Hypo arguement, but considering the more up to date insulins work a lot more effiently in comparison to the older types (in terms of timing - particularly how long it takes for them to start working and how long they last for), it does make sense to move on from them. Edit: Almost feels like the hypo arguement is just them looking for excuses to me... I mean, hypos can be influenced by so many different life effects not just insulin alone. |
|
Jun 16, 2011
Brum_Taffy
13 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Thanks for those last 2 posts- I'm aware there is scant 'hard' evidence in this area.Personal experiences and anecdote/stories are what I am keen to hear. It's an area where cost:benefit is not easy to calculate. I suspect the traditional way of calculating this (quality adjusted life years) does not do justice to issues like fear of hypoglycaemia and confidence in your medicines/treatment plan. DAFNE originally had higher target ranges, especially overnight, because of greater worry about hypos with older insulins. I'm hoping DAFNE data will tell us if there is any difference in the experiences of people on analogs vs. human insulin. Please keep the stories and experiences coming!
|
|
Jun 16, 2011
JayBee
582 posts
|
Topic: General Discussion / Carbs v Cals I agree! I don't see veganism as a diet either because it's more based on how you want to live, rather than something you're doing just to "lose weight only" like a lot of diets are. Temporary food courses are not a good way to go if you want long term benefits. I find it absolutely amazing/horrifying what some of these diets suggest you do!This is now reminding me of my partner. He's Pescetarian because he just simply hates the taste of all meat! ^_^; Considering I'm happy to eat most stuff, I don't know what I am... omnivore of some kind? lol. It's like with DAFNE this weight loss stuff really, it's very easy to get frustrated when you're trying so very hard to get results as quick as you can.
|
|
Jun 16, 2011
Welshmapleleaf
19 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP But on the other hand, Lantus IS apparently better for you....International clinical studies have confirmed the advantages of insulin glargine in the treatment of heavy hypoglycaemia compared to standard NPH insulin. Insulin glargine reduces the risk of severe nocturnal hypoglycaemia. Extensive clinical studies (ACCORD) have confirmed the higher risk of mortality with higher incidence of severe hypoglycaemia.[3][4] A comparison trial of insulin detemir and glargine proved that subjects randomized to detemir used slightly higher daily insulin doses, but gained less weight on average than glargine-treated subjects.[5] Other systematic reviews corroborate the results of benefit of insulin glargine regarding lower incidence of severe hypoglycaemia.[6] On June 13, 2009, Diabetologia, the journal of European Association for the Study of Diabetes (EASD), published the results of a 5 year long-term observational, retrospective analysis. During the study no other safety issues, such as unexpected adverse events for either insulin emerged. However, insulin glargine was associated with a lower incidence of severe hypoglycaemia compared with NPH insulin. I guess there's two sides to every argument and you can make it fit your own standpoint. Personally, I think that analogues were developed as a result of a progression in Diabetic research, and I for one would prefer the latest available drugs that treat my disease. |
|
Jun 16, 2011
Welshmapleleaf
19 posts
|
Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Found this on Wikipedia re Analogue Insulins......'A meta-analysis of numerous randomized controlled trials by the international Cochrane Collaboration found "only a minor clinical benefit of treatment with long-acting insulin analogues (including two studies of insulin detemir) for patients with diabetes mellitus type 2"[6] while others have examined the same issue in type 1 diabetes. Subsequent meta-analyses undertaken in a number of countries and continents have confirmed Cochrane's findings. In July 2007, Germany's Institute for Quality and Cost Effectiveness in the Health Care Sector (IQWiG) reached a strikingly similar conclusion. In its report, IQWiG concluded that there is currently "no evidence" available of the superiority of rapid-acting insulin analogs over synthetic human insulins in the treatment of adult patients with type 1 diabetes. Many of the studies reviewed by IQWiG were either too small to be considered statistically reliable and, perhaps most significantly, none of the studies included in their widespread review were blinded, the gold-standard methodology for conducting clinical research. However, IQWiG's terms of reference explicitly disregard any issues which cannot be tested in double-blind studies, for example a comparison of radically different treatment regimes. IQWiG is regarded with skepticism by some doctors in Germany, being seen merely as a mechanism to reduce costs. But the lack of study blinding does increase the risk of bias in these studies. The reason this is important is because patients, if they know they are using a different type of insulin, might behave differently (such as testing blood glucose levels more frequently, for example), which leads to bias in the study results, rendering the results inapplicable to the diabetes population at large. Numerous studies have concluded that any increase in testing of blood glucose levels is likely to yield improvements in glycemic control, which raises questions as to whether any improvements observed in the clinical trials for insulin analogues were the result of more frequent testing or due the drug undergoing trials. More recently, the Canadian Agency for Drugs and Technology in Health (CADTH) found in its 2008 comparison of the effects of insulin analogues and biosynthetic human insulin that insulin analogues failed to show any clinically relevant differences, both in terms of glycemic control and adverse reaction profile' |