Recent Posts - DAFNE Online

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 1,819 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 1,819 posts

Topic: General Discussion / Advice if possible.

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

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 1,819 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 1,819 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 587 posts

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

Thanks Carolin, I will look more into it. Smile

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:
Idea

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 Confused

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 Smile

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 Crying or Very sad

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 JWo

It'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 587 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. Sad

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

Carolin said:
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

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!). Confused

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 1,819 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 1,819 posts	Topic: General Discussion / Advice if possible. very good point about the honeymoon period, can potentially last a good few years..........

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 1,819 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 1,819 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 587 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 JWo It'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 587 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 Carolin said: 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 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!).