Recent Posts - DAFNE Online

Apr 8, 2011

Pat N 13 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 578 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 578 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 ... ? Wink

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 1,819 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........... Laughing

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 578 posts

Topic: DAFNE Online Mobile / Bug with iPhone app (& site diary)

P.S. Hope you are enjoying the course! Smile

Apr 8, 2011

Simon 578 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.

Apr 8, 2011

daviebear 19 posts

Topic: General Discussion / sick day rules

I agree with novorapidboi there.Again I woke up with ++ ketones this morning with a high BG.I am aware that my high sugar is needing to be brought down by increasing my BI at night.I have been told by my DSN that my ketones are "starvation ketones",but not to worry too much about them.I do start the sick day rules regime(as advised to by my DSN),and find that after one or too extra doses of the TDD regime,that my ketones are gone and my BG is back down.I am aware though that ketones caused by other causes are not soo easy to get rid of.

Apr 8, 2011

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Postop patients using DAFNE

My understanding of the sliding scale is that it is basically like a pump except IV. With monitoring of BGs every hour or two..............so for me any patient on this, whether they are on a mixed insulin regime or MDI have to be treated the same way.

A DAFNE patient will probably be more suited to a sliding scale as they will know what there insulin/carb ratios are, which in my opinion is essential information when on the sliding scale. A pumper would be even more suited as this has many similarities in the fact there is a continuous supply of insulin and also the option to correct a BG at any time.

A mixed insulin patient would not be aware of any insulin/carb ratios so may find themselves going high after meals, but fortunately checks are made every hour or two, so quick action can be taken.

So to conclude in my non professional opinion, I hope it helps, is that any patient regardless of regime will be getting the same accuracy of monitoring and blood glucose correction but the pumpers and DAFNE patients will be able to provide you and your colleagues with better information regarding there insulin/carb ratios, dose times etc making your job much more successful in terms of their control.

I babbled on a bit their, I apologize if I went off topic.........

If the patient is not on an IV supply then I think treatment is limited to the regime..........if a mixed 2 a day regime, you could test their BGs as much as you want, but you wont be able to do much if they are spiking or going high, or will you...?

If a DAFNE patient, they should have the information to help you do the job effectively, and as you also have DAFNE training, it should be no problem, teaching the other nurses may be a pain right enough......

I hope I didn't talk nonsense there........

Apr 8, 2011

novorapidboi26 1,819 posts

Topic: Site Development / Glossary of Terms

JWo said:
Can't honestly remember but that's a pretty good example of what I saw! Maybe it is!

Is it true you can buy a book with all these slang diabetic words and phrases? Would you buy it? I probably wouldn't. ^_^;

Internet sources are free and more likely to be updated on a regular basis, so I probably wouldnt purchase it......unless the proceeds went to DUK.......

Apr 8, 2011

novorapidboi26 1,819 posts

Topic: General Discussion / POST HYPO HIGHS

emma.nh said:
i have gastro-paresis so often i am stuffed with previous meals not properly digested and naturally find it difficult to eat occasionally.

Thats must be a real pain the ass.........establishing effective insulin/carb ratios must of been tricky........

I actually inject 30 minutes before I eat so as the insulin is starting to work by the time the digestion is under way. Kinda matching the insulin action curve with my foods digestion curve, it has proved really effective so far. For the last to weeks, Monday to Friday my BGs haven't been over 8, except the mornings. With your digestive condition, do you find that the food always takes much longer to digest or does it go both ways, sometimes normal, sometimes not. As there is a delay, injecting possible after you have eaten or splitting the dose may give you less hypos and actually help prevent spikes.

The liver is always secreting its glucose stores, this is what your background dose deals with but your muscles have their own store of fuel which can be used up first before the liver is asked to help out. So I would assume the liver isnt solely responsible for any highs directly, could be wrong though. I believe digestion may be the main problem in striking a good balance with the insulin and so can be tackled with your QA dose. I think dose times and possible splitting may be an avenue to explore.

Is there medication that helps empty the stomach...are you on it, and has it been reviewed recently.....?

Apr 8, 2011

novorapidboi26 1,819 posts

Topic: General Discussion / sick day rules

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.....

If you can compensate for the liver dumping extra fuel to fight infection or virus and keep eating then in theory you should keep ketone production under control........in the real world though getting this right quickly is often difficult........... Cool


Apr 8, 2011 Pat N 13 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 578 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 578 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 1,819 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 578 posts	Topic: DAFNE Online Mobile / Bug with iPhone app (& site diary) P.S. Hope you are enjoying the course!

Apr 8, 2011 Simon 578 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.

Apr 8, 2011 daviebear 19 posts	Topic: General Discussion / sick day rules I agree with novorapidboi there.Again I woke up with ++ ketones this morning with a high BG.I am aware that my high sugar is needing to be brought down by increasing my BI at night.I have been told by my DSN that my ketones are "starvation ketones",but not to worry too much about them.I do start the sick day rules regime(as advised to by my DSN),and find that after one or too extra doses of the TDD regime,that my ketones are gone and my BG is back down.I am aware though that ketones caused by other causes are not soo easy to get rid of.

Apr 8, 2011 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Postop patients using DAFNE My understanding of the sliding scale is that it is basically like a pump except IV. With monitoring of BGs every hour or two..............so for me any patient on this, whether they are on a mixed insulin regime or MDI have to be treated the same way. A DAFNE patient will probably be more suited to a sliding scale as they will know what there insulin/carb ratios are, which in my opinion is essential information when on the sliding scale. A pumper would be even more suited as this has many similarities in the fact there is a continuous supply of insulin and also the option to correct a BG at any time. A mixed insulin patient would not be aware of any insulin/carb ratios so may find themselves going high after meals, but fortunately checks are made every hour or two, so quick action can be taken. So to conclude in my non professional opinion, I hope it helps, is that any patient regardless of regime will be getting the same accuracy of monitoring and blood glucose correction but the pumpers and DAFNE patients will be able to provide you and your colleagues with better information regarding there insulin/carb ratios, dose times etc making your job much more successful in terms of their control. I babbled on a bit their, I apologize if I went off topic......... If the patient is not on an IV supply then I think treatment is limited to the regime..........if a mixed 2 a day regime, you could test their BGs as much as you want, but you wont be able to do much if they are spiking or going high, or will you...? If a DAFNE patient, they should have the information to help you do the job effectively, and as you also have DAFNE training, it should be no problem, teaching the other nurses may be a pain right enough...... I hope I didn't talk nonsense there........

Apr 8, 2011 novorapidboi26 1,819 posts	Topic: Site Development / Glossary of Terms JWo said: Can't honestly remember but that's a pretty good example of what I saw! Maybe it is! Is it true you can buy a book with all these slang diabetic words and phrases? Would you buy it? I probably wouldn't. ^_^; Internet sources are free and more likely to be updated on a regular basis, so I probably wouldnt purchase it......unless the proceeds went to DUK.......

Apr 8, 2011 novorapidboi26 1,819 posts	Topic: General Discussion / POST HYPO HIGHS emma.nh said: i have gastro-paresis so often i am stuffed with previous meals not properly digested and naturally find it difficult to eat occasionally. Thats must be a real pain the ass.........establishing effective insulin/carb ratios must of been tricky........ I actually inject 30 minutes before I eat so as the insulin is starting to work by the time the digestion is under way. Kinda matching the insulin action curve with my foods digestion curve, it has proved really effective so far. For the last to weeks, Monday to Friday my BGs haven't been over 8, except the mornings. With your digestive condition, do you find that the food always takes much longer to digest or does it go both ways, sometimes normal, sometimes not. As there is a delay, injecting possible after you have eaten or splitting the dose may give you less hypos and actually help prevent spikes. The liver is always secreting its glucose stores, this is what your background dose deals with but your muscles have their own store of fuel which can be used up first before the liver is asked to help out. So I would assume the liver isnt solely responsible for any highs directly, could be wrong though. I believe digestion may be the main problem in striking a good balance with the insulin and so can be tackled with your QA dose. I think dose times and possible splitting may be an avenue to explore. Is there medication that helps empty the stomach...are you on it, and has it been reviewed recently.....?

Apr 8, 2011 novorapidboi26 1,819 posts	Topic: General Discussion / sick day rules 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..... If you can compensate for the liver dumping extra fuel to fight infection or virus and keep eating then in theory you should keep ketone production under control........in the real world though getting this right quickly is often difficult...........