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Jun 17, 2011
Athena
52 posts
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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 |
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Jun 17, 2011
Welshmapleleaf
19 posts
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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. |
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Jun 17, 2011
Carolin
83 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP
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. |
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Jun 17, 2011
novorapidboi26
1,819 posts
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Topic: General Discussion / Hb1Ac results
Do you not do this anyway? |
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Jun 17, 2011
novorapidboi26
1,819 posts
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Topic: General Discussion / Hb1Ac results you can find the conversion here |
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Jun 17, 2011
Carolin
83 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP
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. |
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Jun 17, 2011
Aneirin
15 posts
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Topic: General Discussion / Hb1Ac results I've never mentioned in percentages. What is 6.7% compared to mmol? |
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Jun 17, 2011
novorapidboi26
1,819 posts
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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.....
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Jun 17, 2011
Welshmapleleaf
19 posts
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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! |
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Jun 17, 2011
novorapidboi26
1,819 posts
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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..... |
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Jun 17, 2011
Welshmapleleaf
19 posts
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Topic: General Discussion / Advice if possible.
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! |
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Jun 17, 2011
Welshmapleleaf
19 posts
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Topic: General Discussion / Advice if possible.
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. |
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Jun 17, 2011
novorapidboi26
1,819 posts
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Topic: General Discussion / Advice if possible. very good point about the honeymoon period, can potentially last a good few years.......... |
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Jun 17, 2011
Athena
52 posts
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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. |
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Jun 17, 2011
Athena
52 posts
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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 |
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Jun 17, 2011
novorapidboi26
1,819 posts
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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......... |
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Jun 17, 2011
novorapidboi26
1,819 posts
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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..... |
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Jun 17, 2011
JayBee
587 posts
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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). |
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Jun 17, 2011
Garry
328 posts
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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 |
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Jun 17, 2011
Brum_Taffy
13 posts
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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. |