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Apr 9, 2011 JayBee 582 posts	Topic: General Discussion / sick day rules novorapidboi26 said: I wasn't responding to anyhing you said.....just explaining my understanding of them......... Did one get out the wrong side of the DAFNE targets this morning.......lol....... LOL considering you kept saying "in my opinion" it came across as you felt you were being careful not to offend! To be honest though, today hasn't been great. Not had a good morning/night really, I hypo'd yesterday afternoon (around 3pm), and after forgetting about my new ratio 1:1.5 for my evening meal, I didn't take the rest for the pizzahut (totalled 23 CPs) I had last night because I felt I was going to hit a low mid meal after taking the initial dose of 19.5.... naturally, my sugar levels were high this morning and instead of eating anything, I decided to risk taking 1.5 QA to get myself down (going against hypo rules). Not long after my last edit of that post, I did a blood test (this is after the 5 hours to let my correction finish) I'd only gone from 19.2 to 15.1 (I have experienced 1 QA taking me down 9 BG, so I'm surprised if I'm honest but oh well, we learn!). I did also check for ketones (were 0.1) considering 19.2 is pretty darned high! ;P Explains the rubbish mood anyway. Sorry. I've eaten now so hopefully I'll be a bit more sane lol. May even consider a nap as well. Would you say that ketones are the cause of illness rather than the other way around? I thought of that a couple of times in the past year or so when learning more about ketones... Also, do we think that if we have ketones present, ill or not, does this affect the chances of a hypo after another hypo? Take my day today for an example... very strange not to drop so drastically!

Apr 9, 2011 novorapidboi26 1,816 posts	Topic: General Discussion / sick day rules I wasn't responding to anyhing you said.....just explaining my understanding of them......... Did one get out the wrong side of the DAFNE targets this morning.......lol.......

Apr 9, 2011 JayBee 582 posts	Topic: General Discussion / sick day rules novorapidboi26 said: My opinion is that ketones occur when there is no fuel for the body to use through lack of food, which can happen overnight when fasting or when to ill to eat anything. So being ill in a sense is not the direct cause of them.................in my opinion..... Excuse me, who said they were caused by illness only? That wasn't what I said in my post at all, if you read it.

Apr 9, 2011 JayBee 582 posts	Topic: Questions for HCPs / Information on menstrual cycle I think when I first started working out my new lantus doses when I first split, I was not aware of how drastic the changes are, and it's only been since I came on to Levemir that the full extent of the problem actually came to light and the penny dropped that I would need to work hard on this problem. Working it out progress: I've still not quite worked out what is going on exactly, but while I am, I've found that if I draw myself up a chart, I've found it has helped me remember for next month instead of checking back in my DAFNE diary. I find that my highs start before the pill has even finished being taken (which (unsurprisingly) surprised one of my DAFNE nurses!)! It goes like this (roughly) considering I don't have a photo handy of it (written in pencil so it's easy to edit): Firstly, please note that I start my pill taking on a wednesday so it finishes on a tuesday. I am also on a split dose of Levemir so each change will be marked MORN or EVE. I take my insulin MANUALLY. Thursday (before the pill finishing tuesday) EVE: 16-18 BI (I'm still unsure which it is because of mixed signals ) Friday MORN: 10 BI Leave it until... Thursday (first thurs after pill is finished) EVE: 11 BI Friday MORN: 9 BI Period starts late sat/early sun - only lasts a few days (due to pill). Leave it until... Monday MORN: 7 BI (If I don't do this change, I have very serious hypos - so bad that I hypo twice again after treating the first hypo again! Had to fix that ASAP! This happens EVERY TIME without fail if I don't put it down from 9 BI!) Monday EVE: 9 BI Then when the pill starts again Wednesday EVE I'm back to "normal routine" of 6 MORN BI and 11 EVE BI. Pill talk I am on the Microgynon pill currently - I do believe this has helped because patterns seem to have been consistent, but I do not want to remain on this pill. I have been considering a hormone free coil but considering the shifts of non-pill users that have been brought up in the Information on menstrual cycle thread found in the HCP section of the forum, I have been a bit afraid to proceed with the change considering I don't yet understand what's happening while on a pill. At the moment during the time of the month (TOTM), I am only adjusting my BI. Recently though, I'm beginning to doubt that my 'off TOTM' insulin is still not quite right, but I have been very stressed lately with work changing my environment again and the like, so results have been messed up yet again. I have also done a new adjustment of putting my evening meal ratio up to 1:1.5 but considering I've been 1:1 for such a long time and currently under stress, I will be keeping an eye out for hypos. This TOTM stuff used to frustrate me no end, but it's slowly got easier... but the fact I don't understand it all is keeping the annoyance there. Back to back pills Before I forget, I recently went on holiday and I was expecting to have to take two pill backs back to back to prevent period... but I knew that my hormones kicked in before the end of my pill taking so I was very concerned about what would happen if I did take pills back to back. I did ask one of my DAFNE nurses and she said that instead of risking a hypo from my body going straight back to normal doses straight away. Thankfully, I didn't have to in the end because my TOTM didn't start until after I got home so I didn't back to back in the end. With this, has anyone established what happens? I know the doctors recommend that you only do pack to pack once or twice a year at most (because it mucks up your hormone patterns - I can vouch - I was stupid enough to do it one on, one off, for a few months) so it's not likely it will get much attention as the straight forward pill taking.

Apr 9, 2011 JayBee 582 posts	Topic: General Discussion / Mesntrual Cycle (I will post this in both threads considering I've already posted in that HCP thread you mention) I think when I first started working out my new lantus doses when I first split, I was not aware of how drastic the changes are, and it's only been since I came on to Levemir that the full extent of the problem actually came to light and the penny dropped that I would need to work hard on this problem. Working it out progress: I've still not quite worked out what is going on exactly, but while I am, I've found that if I draw myself up a chart, I've found it has helped me remember for next month instead of checking back in my DAFNE diary. I find that my highs start before the pill has even finished being taken (which (unsurprisingly) surprised one of my DAFNE nurses!)! It goes like this (roughly) considering I don't have a photo handy of it (written in pencil so it's easy to edit): Firstly, please note that I start my pill taking on a wednesday so it finishes on a tuesday. I am also on a split dose of Levemir so each change will be marked MORN or EVE. I take my insulin MANUALLY. Thursday (before the pill finishing tuesday) EVE: 16-18 BI (I'm still unsure which it is because of mixed signals ) Friday MORN: 10 BI Leave it until... Thursday (first thurs after pill is finished) EVE: 11 BI Friday MORN: 9 BI Period starts late sat/early sun - only lasts a few days (due to pill). Leave it until... Monday MORN: 7 BI (If I don't do this change, I have very serious hypos - so bad that I hypo twice again after treating the first hypo again! Had to fix that ASAP! This happens EVERY TIME without fail if I don't put it down from 9 BI!) Monday EVE: 9 BI Then when the pill starts again Wednesday EVE I'm back to "normal routine" of 6 MORN BI and 11 EVE BI. Pill talk I am on the Microgynon pill currently - I do believe this has helped because patterns seem to have been consistent, but I do not want to remain on this pill. I have been considering a hormone free coil but considering the shifts of non-pill users that have been brought up in the Information on menstrual cycle thread found in the HCP section of the forum, I have been a bit afraid to proceed with the change considering I don't yet understand what's happening while on a pill. At the moment during the time of the month (TOTM), I am only adjusting my BI. Recently though, I'm beginning to doubt that my 'off TOTM' insulin is still not quite right, but I have been very stressed lately with work changing my environment again and the like, so results have been messed up yet again. I have also done a new adjustment of putting my evening meal ratio up to 1:1.5 but considering I've been 1:1 for such a long time and currently under stress, I will be keeping an eye out for hypos. This TOTM stuff used to frustrate me no end, but it's slowly got easier... but the fact I don't understand it all is keeping the annoyance there. Back to back pills Before I forget, I recently went on holiday and I was expecting to have to take two pill backs back to back to prevent period... but I knew that my hormones kicked in before the end of my pill taking so I was very concerned about what would happen if I did take pills back to back. I did ask one of my DAFNE nurses and she said that instead of risking a hypo from my body going straight back to normal doses straight away. Thankfully, I didn't have to in the end because my TOTM didn't start until after I got home so I didn't back to back in the end. With this, has anyone established what happens? I know the doctors recommend that you only do pack to pack once or twice a year at most (because it mucks up your hormone patterns - I can vouch - I was stupid enough to do it one on, one off, for a few months) so it's not likely it will get much attention as the straight forward pill taking.

Apr 8, 2011 Pat N 12 posts	Topic: Site Development / Sending diary as an E-mail (ipod touch) Hello Simon, Thank you it works a treat. I really appreciate the many long hours of work that you must be putting in to developing and making these great improvements. I have also just noticed that you have had a recent app update on apple. It too was well worth downloading. Many improvments. Thanks again, Pat

Apr 8, 2011 Karl 83 posts	Topic: DAFNE Online Mobile / Bug with iPhone app (& site diary) Hi Simon yes it does show in the correction - my mistake.

Apr 8, 2011 Simon 574 posts	Topic: Site Development / Sending diary as an E-mail (ipod touch) Hi Pat, Finally got round to doing this - if you look at the site diary, above the table of entries, there is an option to 'Export as CSV for Excel' which will give you a .csv file which can then be opened up in Excel. Apologies for the delay! Simon

Apr 8, 2011 Simon 574 posts	Topic: DAFNE Online Mobile / Bug with iPhone app (& site diary) Karl - you raise an interesting point. The app doesn't take away negative corrections from the TDD at the moment (something for us to fix), however it should show the total number of negative corrections given - does this work for you? RobT - Yes we are using an open source stack. The app and diary have been based on the DAFNE Paper Diary, where (at least when I took the course) you entered the QA and BI dose under the same entry. Indeed, the Injection Site logging has only been implemented as a user request on this site. Would it be acceptable to add Injection Site (QA) and Injection Site (BI) as options in the app/site? We want to stay as faithful to the DAFNE way of doing things as possible.Finally, re the Injection Sites - we got the list of sites by canvsssing users for what they wanted in the list. Simon

Apr 8, 2011 RobT 7 posts	Topic: DAFNE Online Mobile / Bug with iPhone app (& site diary) OK, I have worked out that you can enter units of insulin of the form a+/-b. The system correctly identifies corrective entries in this case. However, the assumption must be that a is the usual amount of insulin and b is the corrective value. Which I can cope with. BUT As the system only allows entry of a single site for injection I cannot record separate locations for BI and QA. Additionally I would like to say that you have successfully identified that humans have left and right legs but no left and right buttocks, it appears! My original, and actually more important bug report, is that I cannot make contemporaneous entries... I don't wish to come across as complaining, but as I write software for part of my living (i.e. Professionally) I do feel reasonably qualified to suggest improvements. I fully appreciate the time and effort that has gone into creating the website, the apps and the synchronisation of the data between the two is just the right thing to do. I have an iPad and an iPhone which appear to work seamlessly with it all. Congratulations, well done, I dearly hope that you are not hosting under IIS and that you are using open source database ( e.g. MySQL) and other open source platforms ... ? Finally, Is there a user manual for the app?

Apr 8, 2011 emmahope 17 posts	Topic: General Discussion / POST HYPO HIGHS Hi novorapidboi26 Gastro paresis is the pits.its unpredictable too but im ever hopeful that the more i watch things the more i'll understand what affects what. This week still working on BI and am trying for usual targets after having been intentionally high for a bit for hypo unawareness. My bi has not been right and now think this has been more a cause of highs and lows than thought before. its a struggle to see patterns (they dont last-brittle diabetes and gastro-paresis). i will bring question to renal-diabetology consultant re tablets for Gastro-P. when i see him. I'm going to a pump open-evening soon also, Some of your suggestions i may try. its encouraging to see you be so on top of things and aware,and how helpful you are to people on the site Thank you, emma

Apr 8, 2011 Athena 52 posts	Topic: General Discussion / Mesntrual Cycle Dear All, For those of you who are struggling to get control, and are seeing patterns linked to female hormones, there is a topic link about this in the questions for Healthcare professionals forum. You can follow advice etc. there. If you are female and are struggling to get BI sorted, you may wish to consider that the problem might be related to your cycle and you may be able to chart the pattern which is a starting point for sorting it.However, you may also find that the step wise approach doesn't cope with this. For a lot of us, it seems to be too slow and lags behind the hormonal variations throughout the month. It would be good to hear from females who have got this sorted and from females who got their BI and ratios worked out no problem i.e have found that the DAFNE step wise approach worked just fine and you use one BI throughout the month. If you do, can you also let us know if you are on the pill? This could be helpful for others who could try this. Similarly, if you are struggling, it would be great if you could post too so that we can get an idea of the extent of the problem. Thank you.

Apr 8, 2011 Athena 52 posts	Topic: Questions for HCPs / Information on menstrual cycle Hi Jackie, Thanks so much for getting back o n this one. An irregular cycle must have made it more difficult. I don't know how you coped! I do think that they should mention it on the course. It took me about 6 months to realise that there was a pattern going on and then for the penny to drop. Why can't they just tell us? I wonder if it is because the step wise approach doesn't work for this. It is far too slow to keep up with the hormonal c hanges and, like you, I thought that it was me who was doing things incorrectly, but I couldn't work out where I was going wrong. However, I suppose if we work outside the step wise approach, it isn't DAFNE is it? But then there is no alternative or no DAFNE educatior is suggesting one. If I follow theDAFNE approach I spend one week a month hypo, both during the day and at night. I canonly take the night itme BI down by 1 per night and of course am not allowed to change the BI during the day at the same time so have to wait until the night time one is down low enough before starting on the day time one. No diabetic in their right mind would delibereatley spend a week hypo every month, but this si what the step -wise approach dictates. tTere seems to be no way out of it but to abandon DAFNE. thena s a patient you don't know what to do as you could be deemed non-compliant is you don't stick to the DAFNE rules. If anyone else is finding difficulties and has not yet posted, please do so as this site is the only way to raise these issues on a nation-wide basis and maybe they will eventually change it. Interestingly, on our course, there were 7 young women and 1 man. Only the man managed to get control, the rest of us still have not managed to work out our BI and it is well after the magical year. We have only succeeeded in making ourselves ill and our quality of life is much worse now, one girl having to give up work and me being on the brink of having to give up. we are all miserable and I just feel there is no point in being alive anymore, it is just horrible having to drag yourself through another exhausting day to collapse in bed and push yourself through it all again tommorrow. I was wonering about asking for hormone tablet to shut off female hormones or perhaps ovary removal. I am so desperate.If anyone has managed to get any of these interventions then please please let us know. take care JAckie. Igood luck with your pump JAckie. I am curious to know if this helps with tackling the hormone problem or not. It sounds as if it would be just as difficult on a pump as not on one. I think you will easily get the dawn phenomenon sorted on a pump as they will programme your insulin to automatically rise at the right time. itis just finding the right timing and the correct rise . Please let us knwo how it goes with the hormone thing though as I would love a pump but do wonder if this would not work well because of the hormonal variations. If anyone else is on a pump and has this sorted via it,pleaselet us all know.

Apr 8, 2011 novorapidboi26 1,816 posts	Topic: General Discussion / sick day rules Ketones are processed by insulin just as glucose is so the more you have, the more insulin you need.....the thing with ketones is that is a bi product of a bodily function, so unlike eating, we have no control of them. I can actually confess that I dont check for ketones unless I am unwell or have not eaten in some stupidly long time, which very very rarely occurs. I am only really high in the morning, and i will defo has a small amount then, and even if I have went really high, the insulin correction I take deals with the glucose, processes any ketones and dumps the surplus into the bog...........

Apr 8, 2011 Karl 83 posts	Topic: DAFNE Online Mobile / Bug with iPhone app (& site diary) I think its that it doesn't total up in the correction etc - if you do 8-1, the correction total is 0 and the tdd is 8 should they not be 1 and 7 ?

Apr 8, 2011 Simon 574 posts	Topic: DAFNE Online Mobile / Bug with iPhone app (& site diary) P.S. Hope you are enjoying the course!

Apr 8, 2011 Simon 574 posts	Topic: DAFNE Online Mobile / Bug with iPhone app (& site diary) RobT, not sure what you're getting at here - the app lets you enter mealtime correctives in the format x+y, or even x-y if that's what you do. It then syncs them up to the site - what is the particular bug? If I remember correctly on the DAFNE course they teach us to enter correctives with the mealtime dose in the above format, which has always been the guiding principle of how the app/site work.