Recent Posts - DAFNE Online

Nov 15, 2010

marke 681 posts

Topic: Questions for HCPs / Levemir issues

Hi Melissa, to get access to the handbook you need to be registered as a graduate. Your DAFNE Centre should be able to give you a code for this and then you just enter it in the settings on the menu bar at the top. If you cannot get a code from your DAFNE Centre then we can get DAFNE Central to verify you as a graduate and then we can change your account to be a graduate. This is necessary because DAFNE Central don't want non-graduates accessing the course handbook and trying a DIY DAFNE Course of their own.....

Nov 15, 2010

grandma carol 61 posts

Topic: General Discussion / help please

yes and my BGs stayed at 5.0 5.7 5.3 in that range from 4.30 untill 9.30 and that is when Iwas on 19BI but they are still telling me to drop it. I am going to get a blood monitor put on for a week when it is free to see how bloods are going every 10mins . Thank you

Nov 15, 2010

novorapidboi26 1,819 posts

Topic: General Discussion / help please

Have you tried carb free meals......

Nov 15, 2010

MelissaF 56 posts

Topic: Questions for HCPs / Levemir issues

My DM team recommend staying with the Levemir but it's been 5 months now and I'm still not getting the results that I want. I'm not sure that I need so much flexibility - I'd settle for stability!

Nov 15, 2010

grandma carol 61 posts

Topic: General Discussion / help please

thanks for your reply I think I am doing it right but have just had a test and its 2.7 at 4.00 so had to do aorange juce now. to day i had toast 4 cp at 1.5 to 1 unit so had at breakfast 6+2 BG10.4 and at 12.00 had 4.5 CPs at 2-1 so had 9QA and BGs 4.8 and have just had hypo at 4.00 BGs 2.7 this is driving me mad

Nov 15, 2010

MelissaF 56 posts

Topic: Questions for HCPs / Levemir issues

Hi,

I see what you're saying - I will try to have breakfast as soon as possible and make corrective doses at the same time.

In an ideal world I would rather wake up with a good BG reading and not have to correct as it worries me waking with such high readings.

I will check back to my diaries when I was on Lantus. If my evening readings were in target then does that mean that the Lantus was lasting OK for me (I took it before bed)?

I can't seem to access the "Graduate" section with the handbook link. Is there something that I need to do first?

Nov 15, 2010

diet_79 8 posts

Topic: Questions for HCPs / Levemir issues

Levemir can give you more flexibilty, particulary adjusting for exercise. It takes longer to see chnges in bg levels when adjusting Lantus.

BI needs to suit your needs , would discuss it with your DM team.

Nov 15, 2010

diet_79 8 posts

Topic: Questions for HCPs / Levemir issues

I can understand you are concerned about high morning bg levels. Trying looking for patterns , if you find that you are always needing a corrective dose QA before breakfast BI and rations may to be changed. I would suggest only to give corrective dose at Breakfast if you are unable to have CPs, otherwise use your B//fast ration and correct.
If you are correcting every morning bedtime ration or BI should be adjusted. Hope this helps.

For some Lantus does not last for 24hrs, taking Levelmir bd ensures you have 24hr cover, ideally taken 12hrs apart.

Nov 15, 2010

MelissaF 56 posts

Topic: Questions for HCPs / Levemir issues

So do you think that, so long as Lantus spanned the 24 hours OK for me then there wouldn't be any advantage using Levemir instead? My DAFNE educator told me that it gave me more flexibility which I guess it does as you have two different doses to play with but I just find that makes things more complicated.

I will check the handbook - thanks for the tip.

Nov 15, 2010

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Levemir issues

I am acutally on Humilin I now, trying to tackle dawn phenomonon, but if it wasnt that it would be levemir as lantus does not last 24 hours in me.

The exact time it runs out (levemir) is different in everyone, think it 12-18 hours.

You can check the handbook on here, click on insulin when your in and it shows you the action graphs

Nov 15, 2010

MelissaF 56 posts

Topic: Questions for HCPs / Levemir issues

Thank you Diet (if I can call you that!). I take QA when I wake up as I'm usually so concerned by my BG levels that I feel the need to reduce them asap so that dose is a corrective dose. I don't always manage to eat breakfast straight away otherwise I would take the corrective dose with that. The breakfast dose is based on the CP portions I'm eating, assuming that the corrective dose will be working on correcting the high sugar levels.

You're absolutely right, I always feel like I'm chasing my tail. I would love to feel that I could stabilise things a bit more.

Do you have any feedback on Levemir versus Lantus?

Thanks again.

Nov 15, 2010

MelissaF 56 posts

Topic: Questions for HCPs / Levemir issues

I've never been told that about Levemir - how annoying! I've always taken it at those times and no-one's told me any different. Thank you, I will try that from now on.

I was told that Levemir lasted for 18 hours. Is it definitely 12?

I also didn't know that about correcting high blood sugar but that makes a lot of sense. I usually calculate to 1 unit dropping 3 mmol/l but I have wondered why this doesn't seem to work when my BG is very high.

Thank you for that. I will try both of those things and see what happens.

Did you change from Lantus to Levemir? Do you find that Levemir is the best option for you do you think?

Nov 15, 2010

novorapidboi26 1,819 posts

Topic: General Discussion / help please

Hey,

Your results seem all over the place, some morning you hold steady, or, not hold steady , but wake up roughly as you went to sleep.

I am tempted to say either try your background dose in the morning, to see th effects and maybe also to split the dose to see if its a coverage issue. On one injection so assuming Lantus which takes 2-3 days to see any effect of dose change. You have been changing the dose by the day, you cant do that, you need to change and observe for a few days, thats if its Lantus.

The problem is it works some days and doesnt other.

How would you say your carb counting skills are......could you give an example of one of the meals displayed...I hope that doesnt sound cheecky.

Nov 15, 2010

diet_79 8 posts

Topic: Questions for HCPs / Levemir issues

HI Melissa,

A few things to remember, dont correct high bg after hypo otherwise you will be chasing your bg levels. Is there any reason you take QA when you wake up and with CP's at breakfast. You may be building up your insulin, QA peaks around 90mins and this is when you are taking another dose.

Nov 15, 2010

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Levemir issues

I can see it, well done.........

My observations:

You are not giving your Levemir doses 12 hours apart, this is important as it only last that long, give or take....

It would be hard to say when the best time is, you need routine. I get up at 6.30am during the week, so I take my AM dose then and then at about 5 when dinner is served, 11 hours but close......

Make sure you get the timings right to within an hour, that means you wont run out at night which sends you high, and you wont overlap in the afternoon sending you low.

Another thing is corrections, my course didnt mention this and I had to find out for myself.

The higher you blood sugar is the more insulin you need (insulin resistance). Everyones different, but the rule I am followong is as follows;

<10mmol/l - correction = 1 unit drops 2.5 mmol/l
10-15mmol/l - correction = 1 unit drops 2 mmol/l
15+mmol/l - correction = 1 unit drops 1.5 mmol/l

I think you should adopt similar rules for correctionm, see what happens, you might get positive results there. And definetly try and get your BI dose 12 hours apart, it makes a difference.

See what the results are like with those two ideas, I think you might see some change.....

If there isnt then you can look at the doses again.......

Nov 15, 2010

grandma carol 61 posts

Topic: General Discussion / help please

I was told to drop BI agen by DAFNE nurse as I was still geting low in the mornings I had put BI back up because I had high reading all the time and was realy unwell. SO I have droped it agen and up they are going anybody got any idears what to do thanks

Nov 15, 2010

MelissaF 56 posts

Topic: Questions for HCPs / Levemir issues

They were down to a reasonable level a few weeks ago (under 10) and now they're back up again to 15/16.

I've put the last 4 days into a diary. I think I've attached it. Can you let me know?

Nov 15, 2010

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Levemir issues

You will probabvly find that if you on target before bed, you will stay like that till the early hours, 3,4,5 in the morning, the hormones kick in and the liver starts dumping glucose to help start the day, so if it is dawn phenomonon it wont be all night....

If you keep upping your night BI, there will be a point where you go low over night, 3am test needed, thats when you know its too much......

You say you have brought your morning reading s down, what are they at now.....?

Nov 15, 2010

MelissaF 56 posts

Topic: Questions for HCPs / Levemir issues

I would rather wake up with a decent result rather than use a higher ration or corrective dose at breakfast. My logic being that if I'm running too high overnight then that's making my BG readings dangerously high for 8 hours a day which presumably is having a bad effect both on my HbA1c as well as my general health.

I've not tried posting results yet but I'm sure that I can work out how to. I'll give it a go.

There don't seem to be any specific patterns other than the highs in the mornings. I've brought them down by upping my evening BI but then they come back again. I could really do with working out why this changes to such a degree. It's rather like what happened in the later stages of my pregnancy (when my body was presumably becoming more resistant to the insulin and my results were harder and harder to predict) but I'm definitely not pregnant.

Nov 15, 2010

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Levemir issues

So is there any patterns in your results.......sometimes there can be days like that, but it ususally gets better.

Antother thing could be the ratios, you say you wake up high, I bet you need more than the standard 1:1 at breakfast time....have you considered that.....

Is there any chance of you posting 3 day sworth of results, do you know how to do that....?

Nov 15, 2010

MelissaF 56 posts

Topic: Questions for HCPs / Levemir issues

1:1 for all 3 meals at the moment...

How long would you say that it would take to aclimatise to an insulin in your experience? I thought that, after 5 months or so, I'd given it a pretty good shot! I've been testing regularly, writing everything down and reviewing it all for all that time as well which is why it's a bit disheartening. The problem is that fairly often I can't find any reason for things happening or things seem to change from day to day which makes finding patterns and applying DAFNE really difficult. Things seem to be a lot more unpredictable on the Levemir and it makes it hard to analyse.

Nov 15, 2010

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Levemir issues

If you think it was purely just your commitment then you should maybe ask to go back, or tell them your going back to Lantus......

Lantus and Levemir are the same pretty much in that they have almost no peaking time and hold your blood sugars steady........the difference is that Lantus doesnt always last for the 24 hours you need it to last in everyone..........hence the split.......its not un heard of to actually split lantus too...

I wouldnt give up so easily though......its all about testing and writing things down, then you can see whats going on and can give reasons for the results......

As I said previously, start with your overnight test, 3AM, make sure you dont eat or take quick acting and see what happens, do an hourly one if you need to, then you will know if its right or wrong....

What ratios are you on throughout the day on QA....?

Nov 15, 2010

MelissaF 56 posts

Topic: Questions for HCPs / Levemir issues

Hi,

Many thanks for your response - much appreciated.

I understand that it's hard adjusting to a new insulin but it's been months now and it seems to be getting worse rather than better. Surely it should have settled down by now?

Also, I thought that I had managed to stabilise my levels - for a few weeks my readings were good at a dose of 7 at night and 2 in the morning. Then it all changed again. Why would I constantly need to keep changing my BI doses when everything else is consistant? Surely they should be more regular? Otherwise it starts having to be as flexible as the QA. I know that you can alter the dose if necessary but surely it shouldn't have to be all the time? Otherwise you're just juggling all the time and your levels are constantly all over the place.

I think the reason that Levemir was suggested was because my control wasn't good. But the reason for that was that I had been taking less care of myself. My control is better now but I think that's purely because I'm spending a lot more time on it rather than because of the change of insulin. I can't help thinking that my control might be even better if I reverted to Lantus and spent all this time on it still.

Do you know what advantages Levemir has over Lantus? As I mentioned I find the 2 doses really hard to manage as well.

Thanks again,

Melissa

Nov 15, 2010

novorapidboi26 1,819 posts

Topic: Questions for HCPs / BGL's prior to menstration

I cant speak from experience but from talking to other diabetics they confirmed that the menstrual cycle does effect thier BGLs, some for a day or two, some for longer....

Talk to you DAFNE team about it....

I think its all about getting to know how you respond at this time, by testing etc...eventually you will be able to predict your BGL behaviour and compensate accordingly.

Good Luck...

Nov 15, 2010 marke 681 posts	Topic: Questions for HCPs / Levemir issues Hi Melissa, to get access to the handbook you need to be registered as a graduate. Your DAFNE Centre should be able to give you a code for this and then you just enter it in the settings on the menu bar at the top. If you cannot get a code from your DAFNE Centre then we can get DAFNE Central to verify you as a graduate and then we can change your account to be a graduate. This is necessary because DAFNE Central don't want non-graduates accessing the course handbook and trying a DIY DAFNE Course of their own.....

Nov 15, 2010 grandma carol 61 posts	Topic: General Discussion / help please yes and my BGs stayed at 5.0 5.7 5.3 in that range from 4.30 untill 9.30 and that is when Iwas on 19BI but they are still telling me to drop it. I am going to get a blood monitor put on for a week when it is free to see how bloods are going every 10mins . Thank you

Nov 15, 2010 novorapidboi26 1,819 posts	Topic: General Discussion / help please Have you tried carb free meals......

Nov 15, 2010 MelissaF 56 posts	Topic: Questions for HCPs / Levemir issues My DM team recommend staying with the Levemir but it's been 5 months now and I'm still not getting the results that I want. I'm not sure that I need so much flexibility - I'd settle for stability!

Nov 15, 2010 grandma carol 61 posts	Topic: General Discussion / help please thanks for your reply I think I am doing it right but have just had a test and its 2.7 at 4.00 so had to do aorange juce now. to day i had toast 4 cp at 1.5 to 1 unit so had at breakfast 6+2 BG10.4 and at 12.00 had 4.5 CPs at 2-1 so had 9QA and BGs 4.8 and have just had hypo at 4.00 BGs 2.7 this is driving me mad

Nov 15, 2010 MelissaF 56 posts	Topic: Questions for HCPs / Levemir issues Hi, I see what you're saying - I will try to have breakfast as soon as possible and make corrective doses at the same time. In an ideal world I would rather wake up with a good BG reading and not have to correct as it worries me waking with such high readings. I will check back to my diaries when I was on Lantus. If my evening readings were in target then does that mean that the Lantus was lasting OK for me (I took it before bed)? I can't seem to access the "Graduate" section with the handbook link. Is there something that I need to do first?

Nov 15, 2010 diet_79 8 posts	Topic: Questions for HCPs / Levemir issues Levemir can give you more flexibilty, particulary adjusting for exercise. It takes longer to see chnges in bg levels when adjusting Lantus. BI needs to suit your needs , would discuss it with your DM team.

Nov 15, 2010 diet_79 8 posts	Topic: Questions for HCPs / Levemir issues I can understand you are concerned about high morning bg levels. Trying looking for patterns , if you find that you are always needing a corrective dose QA before breakfast BI and rations may to be changed. I would suggest only to give corrective dose at Breakfast if you are unable to have CPs, otherwise use your B//fast ration and correct. If you are correcting every morning bedtime ration or BI should be adjusted. Hope this helps. For some Lantus does not last for 24hrs, taking Levelmir bd ensures you have 24hr cover, ideally taken 12hrs apart.

Nov 15, 2010 MelissaF 56 posts	Topic: Questions for HCPs / Levemir issues So do you think that, so long as Lantus spanned the 24 hours OK for me then there wouldn't be any advantage using Levemir instead? My DAFNE educator told me that it gave me more flexibility which I guess it does as you have two different doses to play with but I just find that makes things more complicated. I will check the handbook - thanks for the tip.

Nov 15, 2010 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Levemir issues I am acutally on Humilin I now, trying to tackle dawn phenomonon, but if it wasnt that it would be levemir as lantus does not last 24 hours in me. The exact time it runs out (levemir) is different in everyone, think it 12-18 hours. You can check the handbook on here, click on insulin when your in and it shows you the action graphs

Nov 15, 2010 MelissaF 56 posts	Topic: Questions for HCPs / Levemir issues Thank you Diet (if I can call you that!). I take QA when I wake up as I'm usually so concerned by my BG levels that I feel the need to reduce them asap so that dose is a corrective dose. I don't always manage to eat breakfast straight away otherwise I would take the corrective dose with that. The breakfast dose is based on the CP portions I'm eating, assuming that the corrective dose will be working on correcting the high sugar levels. You're absolutely right, I always feel like I'm chasing my tail. I would love to feel that I could stabilise things a bit more. Do you have any feedback on Levemir versus Lantus? Thanks again.

Nov 15, 2010 MelissaF 56 posts	Topic: Questions for HCPs / Levemir issues I've never been told that about Levemir - how annoying! I've always taken it at those times and no-one's told me any different. Thank you, I will try that from now on. I was told that Levemir lasted for 18 hours. Is it definitely 12? I also didn't know that about correcting high blood sugar but that makes a lot of sense. I usually calculate to 1 unit dropping 3 mmol/l but I have wondered why this doesn't seem to work when my BG is very high. Thank you for that. I will try both of those things and see what happens. Did you change from Lantus to Levemir? Do you find that Levemir is the best option for you do you think?

Nov 15, 2010 novorapidboi26 1,819 posts	Topic: General Discussion / help please Hey, Your results seem all over the place, some morning you hold steady, or, not hold steady , but wake up roughly as you went to sleep. I am tempted to say either try your background dose in the morning, to see th effects and maybe also to split the dose to see if its a coverage issue. On one injection so assuming Lantus which takes 2-3 days to see any effect of dose change. You have been changing the dose by the day, you cant do that, you need to change and observe for a few days, thats if its Lantus. The problem is it works some days and doesnt other. How would you say your carb counting skills are......could you give an example of one of the meals displayed...I hope that doesnt sound cheecky.

Nov 15, 2010 diet_79 8 posts	Topic: Questions for HCPs / Levemir issues HI Melissa, A few things to remember, dont correct high bg after hypo otherwise you will be chasing your bg levels. Is there any reason you take QA when you wake up and with CP's at breakfast. You may be building up your insulin, QA peaks around 90mins and this is when you are taking another dose.

Nov 15, 2010 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Levemir issues I can see it, well done......... My observations: You are not giving your Levemir doses 12 hours apart, this is important as it only last that long, give or take.... It would be hard to say when the best time is, you need routine. I get up at 6.30am during the week, so I take my AM dose then and then at about 5 when dinner is served, 11 hours but close...... Make sure you get the timings right to within an hour, that means you wont run out at night which sends you high, and you wont overlap in the afternoon sending you low. Another thing is corrections, my course didnt mention this and I had to find out for myself. The higher you blood sugar is the more insulin you need (insulin resistance). Everyones different, but the rule I am followong is as follows; <10mmol/l - correction = 1 unit drops 2.5 mmol/l 10-15mmol/l - correction = 1 unit drops 2 mmol/l 15+mmol/l - correction = 1 unit drops 1.5 mmol/l I think you should adopt similar rules for correctionm, see what happens, you might get positive results there. And definetly try and get your BI dose 12 hours apart, it makes a difference. See what the results are like with those two ideas, I think you might see some change..... If there isnt then you can look at the doses again.......

Nov 15, 2010 grandma carol 61 posts	Topic: General Discussion / help please I was told to drop BI agen by DAFNE nurse as I was still geting low in the mornings I had put BI back up because I had high reading all the time and was realy unwell. SO I have droped it agen and up they are going anybody got any idears what to do thanks

Nov 15, 2010 MelissaF 56 posts	Topic: Questions for HCPs / Levemir issues They were down to a reasonable level a few weeks ago (under 10) and now they're back up again to 15/16. I've put the last 4 days into a diary. I think I've attached it. Can you let me know?

Nov 15, 2010 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Levemir issues You will probabvly find that if you on target before bed, you will stay like that till the early hours, 3,4,5 in the morning, the hormones kick in and the liver starts dumping glucose to help start the day, so if it is dawn phenomonon it wont be all night.... If you keep upping your night BI, there will be a point where you go low over night, 3am test needed, thats when you know its too much...... You say you have brought your morning reading s down, what are they at now.....?

Nov 15, 2010 MelissaF 56 posts	Topic: Questions for HCPs / Levemir issues I would rather wake up with a decent result rather than use a higher ration or corrective dose at breakfast. My logic being that if I'm running too high overnight then that's making my BG readings dangerously high for 8 hours a day which presumably is having a bad effect both on my HbA1c as well as my general health. I've not tried posting results yet but I'm sure that I can work out how to. I'll give it a go. There don't seem to be any specific patterns other than the highs in the mornings. I've brought them down by upping my evening BI but then they come back again. I could really do with working out why this changes to such a degree. It's rather like what happened in the later stages of my pregnancy (when my body was presumably becoming more resistant to the insulin and my results were harder and harder to predict) but I'm definitely not pregnant.

Nov 15, 2010 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Levemir issues So is there any patterns in your results.......sometimes there can be days like that, but it ususally gets better. Antother thing could be the ratios, you say you wake up high, I bet you need more than the standard 1:1 at breakfast time....have you considered that..... Is there any chance of you posting 3 day sworth of results, do you know how to do that....?

Nov 15, 2010 MelissaF 56 posts	Topic: Questions for HCPs / Levemir issues 1:1 for all 3 meals at the moment... How long would you say that it would take to aclimatise to an insulin in your experience? I thought that, after 5 months or so, I'd given it a pretty good shot! I've been testing regularly, writing everything down and reviewing it all for all that time as well which is why it's a bit disheartening. The problem is that fairly often I can't find any reason for things happening or things seem to change from day to day which makes finding patterns and applying DAFNE really difficult. Things seem to be a lot more unpredictable on the Levemir and it makes it hard to analyse.

Nov 15, 2010 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Levemir issues If you think it was purely just your commitment then you should maybe ask to go back, or tell them your going back to Lantus...... Lantus and Levemir are the same pretty much in that they have almost no peaking time and hold your blood sugars steady........the difference is that Lantus doesnt always last for the 24 hours you need it to last in everyone..........hence the split.......its not un heard of to actually split lantus too... I wouldnt give up so easily though......its all about testing and writing things down, then you can see whats going on and can give reasons for the results...... As I said previously, start with your overnight test, 3AM, make sure you dont eat or take quick acting and see what happens, do an hourly one if you need to, then you will know if its right or wrong.... What ratios are you on throughout the day on QA....?

Nov 15, 2010 MelissaF 56 posts	Topic: Questions for HCPs / Levemir issues Hi, Many thanks for your response - much appreciated. I understand that it's hard adjusting to a new insulin but it's been months now and it seems to be getting worse rather than better. Surely it should have settled down by now? Also, I thought that I had managed to stabilise my levels - for a few weeks my readings were good at a dose of 7 at night and 2 in the morning. Then it all changed again. Why would I constantly need to keep changing my BI doses when everything else is consistant? Surely they should be more regular? Otherwise it starts having to be as flexible as the QA. I know that you can alter the dose if necessary but surely it shouldn't have to be all the time? Otherwise you're just juggling all the time and your levels are constantly all over the place. I think the reason that Levemir was suggested was because my control wasn't good. But the reason for that was that I had been taking less care of myself. My control is better now but I think that's purely because I'm spending a lot more time on it rather than because of the change of insulin. I can't help thinking that my control might be even better if I reverted to Lantus and spent all this time on it still. Do you know what advantages Levemir has over Lantus? As I mentioned I find the 2 doses really hard to manage as well. Thanks again, Melissa

Nov 15, 2010 novorapidboi26 1,819 posts	Topic: Questions for HCPs / BGL's prior to menstration I cant speak from experience but from talking to other diabetics they confirmed that the menstrual cycle does effect thier BGLs, some for a day or two, some for longer.... Talk to you DAFNE team about it.... I think its all about getting to know how you respond at this time, by testing etc...eventually you will be able to predict your BGL behaviour and compensate accordingly. Good Luck...