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Apr 12, 2011 Athena 52 posts	Topic: Questions for HCPs / Information on menstrual cycle Thanks to tweety endtherapies and JWo for replying. It was interesting to know that the pill by the sounds of it causes the same problems as not being on the pill and that it is just as much work to try to sort doses throughout the month . It was also useful to hear that taking the pill back to back with no break is considered dangerous. I think charting each month is the only thing that will be useful. Does anyone know of pre-menopausal females who are managing to get control using the one BI throughtou the month and the same ratios like it is supposed to be? MAybe we are the exceptions and most people's insulin requirements are not upset by hormones.Otherewise why would it not be part of the training course or why would women of child-bearing age be allowed on DAFNE courses at all if it is a waste of time. I am going to try the altering QA ratios on the part of the month that I cannot get sorted. I suspect that sorting the dose during menstruation and when requirements peak is the easy bit and it is the inbetween bits that are difficult. I will try to see if I can find any research on DAFNE and this problem via the DAFNE site.If I do I will let you know. good luck to all with this challenge!

Apr 12, 2011 Athena 52 posts	Topic: General Discussion / Mesntrual Cycle thanks to JWo, tweety and endtherapies for replying to this. I was really interested in hearing your ecperiences with the pill. It doesn't sound much better than being off the pill to be honest. I do find that natural hormones cause a drop of bg just prior to menstruation, down to that low dose which then lasts throughout that week. It then starts to edge up and I have to increase BI until about 10 days before menstruation where it reaches a peak and stays there. I have the level for this peak sorted, I have the dropping down to menstruation sorted ( no gradual change just have to go straight to the low dose)i.e. not follow the step wise approach as like tweety, to not turn it straight down causes nightime and daytime hypos , and the remaining on the low does during my period sorted so it is gettting there. It is the rise over the coming weeks leading up to the peak dose that is causing the trouble. Think the idea of a chart is great. I just realised that something funny was going on as I kept ending up at the same dose and then crashing down to the same dose and I started recognising these as familiar. I luckily keep a record of my periods so when I then notice d that this was a montly pattern I did wonder. Then of course I saw tha t there were 2 distinct BI's a high one and a low one. At the highest does that I use, my BI is double that of the lowest one that I use just prior and during my period, so you can see why it causes so much trouble as it is not a couple of units here and there. Think I will psot to see if any girls of menstruating age are using the on BI throuoghout the month. See what people reply. I did say to other women on my course with whom I have kept in touch to look to see wha t they noticed as none of them had thought of this and had given up on DAFNE as being no use for them.There is no doubt that charting and tracking is the only way to learn about the patterns. I expect to end up with a ready reccknor thing writeen into the front of the diary with the dose for each day of the month once I get it sorted. It is exasperating how long this is taking especially as meantime we are feeling dreadful. I am interested in the QA ratios as a method to sort this as I suppose the alternative is to pick a BI and alter the QA to sort it. I think I may give this a try on the rising bit of the month seeing as I have the BI sorted for 2 times a month. Great to hear from you all and good luck.

Apr 11, 2011 Edentherapies 8 posts	Topic: General Discussion / Mesntrual Cycle Hi JWo, I too seem to go up and down around my cycle. Since I did my DAFNE course I have been trying to log my levels re my cycle. So far nothing major but I have recently also changed my pill to Micronor (a mini pill) I had alot of trouble with going very low usualy the week before and during my cycle though when I used to be on Microgynon. Just wondering if it may have been because of the type of pill as I don't seem to go AS up and down as I used to? I cant say for sure as this has only been my first cycle since the DAFNE course (having more info) but thinking back I definately haven't Hypo'd as much since changing the pill. Might be totaly different for you but thought i'd let you know. I will be keeping an eye on the changes through my cycle, see if I can make sense of it too! The hormone changes definately seem to make a difference!

Apr 11, 2011 novorapidboi26 1,819 posts	Topic: Site Development / Online Diary......... Currently the online diary provides you with 7, 14 and 30 day blood glucose averages. Would it be possible to also include the 90 day average, this will make predicting the HbA1c more accurate, for me anyway.........

Apr 11, 2011 novorapidboi26 1,819 posts	Topic: General Discussion / sick day rules I think the majority of folk feel the same as you, me being one of them. Its hard to think back on your diabetes treatment not knowing what we know now, the sad thing is there are still a lot of people out there just not knowing whats really going on. What surprised me when doing my course was that the majority of people were already on an MDI regime but were just guessing what to take, madness.......

Apr 11, 2011 novorapidboi26 1,819 posts	Topic: General Discussion / Getting better I am glad your happier and are getting better results, there does seem to be a lot hypos there, and by hypo I mean 4 or below.........do you think your are having a lot........? Some days your low by lunch or even before it, and others you are higher at lunch, can you pin point reasons for that....?

Apr 11, 2011 novorapidboi26 1,819 posts	Topic: General Discussion / Ideas I think fractional ratios are good too, provides you with more accurate carb counting and therefore better BGs, I personally dont require high levels of accuracy, I usually always round up my carbs anyway........

Apr 10, 2011 Neil Brown 28 posts	Topic: General Discussion / Getting better Perhaps DAFNE makes sense after all !!

Apr 10, 2011 HelenP 218 posts	Topic: General Discussion / Ideas In defence of fractional ratios! My endocrinologist was most supportive of fractional ratios. It was his idea and I was skeptical but he convinced me to give it a try. As I lived on fairly regular meals I was able to achieve these for breakfast and lunch but often had problems with evening meals (more difficult to count carbs). You need a demipen and the ability to multiply in decimals. Or, you have the same things for breakfast everyday and calculate once. It does smack of obsession but I found it fine. Helen

Apr 9, 2011 tweety 13 posts	Topic: General Discussion / Ideas Hey Neil, your correction should depend on your BG level and your sensitivity to the insulin, I mean for me 1unit brings my BG down by 4. I can see where novorapidboi is coming from though, there is no consistency with amounts of corrections, therefor I wouldn't want to comment on how to fix those high BG results. If in this position i would prob have tried adjustin BI b4 changing any ratios. Hope you've been able to gain a little control now :-)

Apr 9, 2011 tweety 13 posts	Topic: General Discussion / Mesntrual Cycle Although my nurse has pointed out to me that hormonal changes due to TOTM could be causing some hypo's with me, (I went through a phase that I was hypoing continuously and had to stay with my parents for a few days) I still havent thought about how to get a pattern, I just assumed it would sort itself out, in thinkin about it I guess I do still hypo quite often around my TOTM but now I certainly will try n find out exactly when and how my 3wks on and 1wk of pill will affect my BG and how to control it better.

Apr 9, 2011 tweety 13 posts	Topic: General Discussion / sick day rules Thanks soooo much for all the info on ketones every1, I'm feeling a whole lot better now and eating normally although I still seem to have a trace of ketones I'm not really worried about them now. I had no idea about most of this stuff, similar to yourself JWo I was diagnosed when I was 7 so didnt really know much about anythin, gosh I didnt even know how to change my insulin b4 dafne. I would always wait till my 6 month app at hosp n the dr there would change things and ratios I thought that was stuff I did back at school till I went on the dafne course. Didnt know how the drs were changing things I just knew when I went to hosp my insulin dosages would always change for some reason. Lookin back now I think how mad it was I could have been on a wrong ratio for 6/7 months at a time n didnt even realise as I had never been taught!!

Apr 9, 2011 JayBee 587 posts	Topic: General Discussion / sick day rules Thanks. ^_^; ...and I've had my nap too now. Bit of a siesta, with the sunshine blazing from the window! You're already expressing more deeper knowledge than I do about ketones, I just know what I've discovered each day - perhaps I should look at doing more research, a habit I've not really started considering you can't always trust what you read online. ;) How did you learn what you've come to understand? I had no idea that ketones bodies were used for energy for example! It's so easy to misinterpret information, which is a shame. Taking stuff at face value, typical attitude of a child really now that I think about it. I do really wish I was diagnosed later on than 5 years of age sometimes. What I've grown up with is wrong sometimes - ketones are a great example considering not all of them are bad (as you're telling me now as well as my nurse helping me to realise). I do wonder sometimes that it's because since DAFNE I've started testing for ketones a lot more (because I used to be very bad for not testing at all, ill or otherwise), that I never became more aware sooner... but oh well, you live and learn. Its for stuff like this that I'm so glad DAFNE is in my life. My diabetes was in such a guess cloud before. -_-;;

Apr 9, 2011 novorapidboi26 1,819 posts	Topic: General Discussion / sick day rules Dont worry about it, coming across the wrong way is bound to happenm with me quite often, mentioning my "opinion" is just my way of emphasising thats its what I believe with the information I have been given up to this point, but I could be wong or not know the full science of the ketone...... I wouldnt say ketones are the cause of illnes, as they are a natural ocurance and are processed even in a non diabetic, when illness occurs extra glucose is provided to help in fighting the infection or virus or healing of a wound, so for diabetics this can be hard to estimate what we need to compensate, and therefore ketones are more likely.... During the night the brain actually depends on ketone bodies for energy DKA obviously occurs when the bodies functions cant cope with the acidity and lack of fuel, and will shut down eventually............... As we alaways have some ketones in our blood, I wouldnt think that it would prevent a hypo after a hypo, unless however there are elevated levels of them then obviously there is not engouh insulin to get even glusoce to the bodies cells, so the likelyhood of the BG dropping is low.......

Apr 9, 2011 JayBee 587 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 1,819 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 587 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 587 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 587 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.