Recent Posts - DAFNE Online

Sep 28, 2010

Simon Heller 46 posts

Topic: Questions for HCPs / wound healing

Hi Helen
I am no surgeon but Marke is right. Longstanding diabetes doesn't affect healing unless your blood glucose control is uneven with lots of high glucose values. The cells which fight infection (and those leading to healing and the formation of scar tissue), unsurprisingly work most effectively at a glucose of 5-8 mmol/l. I guess a poor blood supply might also increase the chances of infection but not in the site you mention. If you had impaired kidney function from diabetes that might also add to susceptibility but I guess that isn't an issue there. the low grade infection could be adding to your insulin requirements as well as a bit of emotional stress but as you say insulin doses should fall as things resolve, indeed, this might be the first sign that the infection is improving. I think you are doing all the right things. ATB Simon

Sep 28, 2010

Luggerz 10 posts

Topic: Carbohydrate Counting / Iphone Apps

I've got the Carbs and Cals app and the Dafne app. Just started to load results into the Dafne App and when I try to load results for yesterday it crashes.

Marc

Sep 27, 2010

marke 643 posts

Topic: Questions for HCPs / wound healing

Helen, i would say your altered insulin requirement is almost certainly do to what you are going through. The stress both emotionally and physically is bound to be having an effect. Its good to hear you GP is supportive but it would be good to hear a Diabetes Consultants take on all of this. There are a lot of factors involved here and its an area where someone with a deep understanding of Diabetes and the effects of things like surgery etc could provide valuable input. They could also probably give you an idea how long the effects on your insulin requirements might last. Perhaps your DAFNE Educator can help with some information ?
I can only wish you well with your recovery and ask that you keep us posted on your progress.

Sep 27, 2010

marke 643 posts

Topic: Site Development / DAFNE Online iPhone application - help with content/design needed

now come on Karl, your just being silly now. I rate Simons abilties but more than angry birds ? Its just not possible to use anything more than
that unless of course you have completed ALL the levels ;^)

Sep 27, 2010

SimonC 78 posts

Topic: Carbohydrate Counting / Iphone Apps

I bought the book about 4 months ago - and used it a load when on holiday - eating out a lot, it was very useful.

Sep 27, 2010

marke 643 posts

Topic: Carbohydrate Counting / Iphone Apps

there is, if you want to spend Â£4.99 for something you will be able to get free in the near future (without the pictures of course) feel free too.
Personally I think Â£4.99 for an iphone app is more than a little excessive.

Sep 27, 2010

Becki 1 post

Topic: Carbohydrate Counting / Iphone Apps

Hi, there's an app called carbs and cals it's based on a book of the same name, the app is Â£4.99 and I highly recommend it......if u r not sure have a nose at the actual book in whs or waterstones

Sep 27, 2010

Karl 83 posts

Topic: Site Development / DAFNE Online iPhone application - help with content/design needed

Have to congratulate you on this app - by far the most used app on my phone (even more than angry birds :-)) - the keypad entry changed it totally for me. Not using my written diary anymore.

Sep 27, 2010

Jennifer Iden 11 posts

Topic: Site Development / DAFNE Online iPhone application - help with content/design needed

Upgrade to the the iPhone ap makes recording so much simpler, thanks! Although like Karl, I have found that if I change my insulun intake the ratio doesn't update unless I delete the entry and submit a second time...

Sep 27, 2010

Steven 18 posts

Topic: Site Development / Online BG Diaries

Having said that, the second page of readings were accepted without complaint! :-/

Sep 27, 2010

Steven 18 posts

Topic: Site Development / Online BG Diaries

Hi Simon,

I don't seem to be able to leave the date field blank in the diary any more - has something broken?!!?

Thanks
Steven

Sep 27, 2010

Dr Jez McCole 11 posts

Topic: Site Development / DAFNE Online iPhone application - help with content/design needed

Developments and updates really making the app quicker and easier to use thanks Simon. The recalculation of the ratio would be a good tweak.
The summary stats are really nice. Any chance of average by entry type, such as average before lunch, average before tea etc? Thanks. I'm DAFNE'ing again!!
Jez

Sep 26, 2010

Simon 574 posts

Topic: Carbohydrate Counting / Iphone Apps

Hi Brien, thanks for letting me know about that - it's already been raised by other users, so I've submitted a fix to the Apple store, should be appearing on shelves in the next couple of days.

Sep 26, 2010

Peter 103 posts

Topic: Questions for HCPs / High bgl in the morning.

Paula,
I would suggest that your evening dose of Levemir is beginning to run out before your morning dose becomes effective, especially when the eveing does is taken between 20:00 and 21:00 (as in most days above) but the morning dose varies between 08:00 and 12:00. That combined with the dawn effect is causing yo to have insufficient insulin available in the early morning. You say that you've increased the evening Levemir, but that resulkts in low sugars, but don't explain when. The one example shown has a low(ish) reading at 12:30 which could be more to do with the correction at 09:30 than too much Levemir.
I know that I found it much easier to achivee more consistent control if I kept the timing of my morning dose of Levemir consistent on weekdays and weekends. It is a bit of a pain having to set the alarm to get up early on Saturday and Sunday just to have an injection, but the resuklts have made it worthwhile, and going back to sleep afterwards is not too difficult.
If it were me, I'd stick with the increased Levelmir does in the evening, and find a consistent time to inject in the morning to see if that helps. NB. That would be nearer 08:00 than 12:00 as, for me, it's effects do reduce after 12 hours.
Good luck.

Sep 26, 2010

HelenP 218 posts

Topic: Questions for HCPs / wound healing

Thanks, Marke,
I don't see anyone at the hospital but I do have a private endocrinologist. When the surgery was scheduled I was between endocrinologists (the old one...I had had him for thirty two years, retired!) I have seen the new one since the surgery and he (Dafne supporter) was happy to leave "the pit" to the surgeon. I understand that the absolute last resort is a surgical repair but according to the surgeon (saw him a week ago and am scheduled to see him in another 3 weeks) says we are a long way from that. He said that what the GP was doing was what he would do!

I really like my GP. He is a bit rattled by Dafne and my propensity to fiddle with doses but other than that he asks appropriate questions and seems happy to leave it to me and the endocrinologist. The GP has not suggested I go back to the endocrinologist for advice over the "pit". (Do you detect my absolute frustration?)

My need for insulin seems to vary quite a bit. Two weeks after surgery (eating as usual) my TDD was 85-88 currently it is over 105! I have about 10CPs a day. I was relieved and confident. I trust it will drop back to somewhere around 90 in the not too distant future.

The GP is supportive of the Dafne protocols and I suspect he has done his homework since taking me on. Currently I am attending his surgery twice a week and under his supervision/direction it (the pit) is being attended to by a nurse. I can't do it at home...not enough hands. His assessment is that it is not getting any better but it is also not getting worse. It is not infected. Any advice I get from here I will discuss with the GP.

Emotionally this is throwing me. The surgery was for cancer (no radiation/no chemotherapy) and the diagnosis was followed a week later by the surgery. It is probably more complicated than just "the pit". This situation is also probably not helping my BGs.

I have just reread this and it looks a bit like a dog's breakfast but I hope it is all there.

Thanks for the psychotherapy!

Helen

Sep 26, 2010

oilly 2 posts

Topic: Carbohydrate Counting / porridge

I have porridge oats every morning for breakfast, my counting and dose works well for me, 40 grams of dried oats is 3 CPs, throw in a handful of raisins (25g to be precise) and that's another 1.5 CPs, add half an apple and half a nectarine another 1 CP, a dollop of natural yogurt another 1/2 CP, a teaspoon honey, 1/2 Cp and your milk another 1/2 CP, total value='s 7CPS and yummy

Sep 26, 2010

oilly 2 posts

Topic: Carbohydrate Counting / Sultanas

i am a sultana/raisin addict, every morning i have a good handful with my muesli, i've since had to start weighing them to get my CPs and dose right, 25g of raisins, which would scantily cover the bottom of a breakfast bowl is worth 1.5 cps

Sep 26, 2010

marke 643 posts

Topic: General Discussion / Split background insulin

I'm glad to hear you will be seeing the hospital thursday, just because I would like them to confrim what you are doing in case you have
any problems. Not that I'm suggesting you will. I am on Levemir which it now seems commonly accepted does not last 24 hours in a lot
of people and so a lot of people are on a split dose. Less people on Lantus split their dose I think, but I'm happy to be corrected by others.
As I said before, I think you will need to give it a few more days before you can spot any patterns and it will probably take a couple of days
before the changes you have made will have full effect. There is nothing wrong with making changes, thats part of what DAFNE is about.
Its just always a good idea to ensure those that support you at the hospital etc, know you have made these changes. Let us know if
the change works for you, since I'm sure others have considered it but not felt confident enough to do it.

Sep 26, 2010

Caroline 29 posts

Topic: General Discussion / Split background insulin

Thanks for getting back to me. Yes I should have perhaps posted this to the medical staff; being the weekend. Im on lantus. Thanks for your input, I will monitor it closely and see what happens. Think there is alot to take in from the course and maybe im just a bit bamboozled by it all! I will speak to the hosp as I have an appointment on Thursday.

Sep 26, 2010

marke 643 posts

Topic: Questions for HCPs / wound healing

Helen, Do you see anyone at a Hospital for your Diabetes or just your GP. The issue for me is GP's are NOT Diabetes experts and generally seem to think any issue that could be diabetes related IS diabetes related. I had another condition 2 years ago that has re-occured since. The GP's reaction was its caused by your Diabetes, my Diabetes consulant and the consultant I see for the condtion both say, it had nothing to do
with your Diabetes. Since both of these are experts rather than 'General Practioners' I tend to go with their opinions. I have absolutely no
issues with GP's doing what they normally do, its just I don't trust mine to manage my Diabetes.
As a non medical person, I would say that generally if your diabetes is reasonably well controlled it should have no impact on the healing process. You should heal just like a non-diabetic. Hopefully a HCP on the site can confirm this or give some guidance as to why this is not the
case.

Sep 26, 2010

marke 643 posts

Topic: General Discussion / Giving Blood

I think mines going to give them plenty to work on, well my immune system is anyway. It certainly seems to be challenging the medical profession whilst I am still alive ;^)

Sep 26, 2010

marke 643 posts

Topic: General Discussion / Split background insulin

Caroline, I think you should talk to yuor DAFNE Educator and/or Diabetes support team ( Diabetes Nurse/Consultant). I don't think you should rely on advice from this site when changing to split doses.
I also don't think there is enough info above to give much advice anyway. You need at least a few more days before a pattern can emerge.
The main thing to remember is that your BI is supposed to keep your blood sugar fairly constant in the absence of food. Therefore you need to look for patterns where it increases either overnight or during they day when you don't have carbs. Your QA is what should take care of food. Therefore if a hypo/hyper occurs within an hour of eating it should be down to QA and NOT BI.
You don't say what type of BI you are taking either, the profiles of all BI's are not the same and they can behave slightly differently. This is another reason for speaking to your Educator. They might suggest switching BI to another type, which again is not something anyone on
here can recommend. We are all happy to help and advise, however you probably need more detailed avice than we can provide.

Sep 26, 2010

Brien Molloy 4 posts

Topic: Carbohydrate Counting / Iphone Apps

Simon great update much much better one snag impossible to tick corrective box and before driving. Well done again.

Sep 26, 2010

Caroline 29 posts

Topic: General Discussion / Split background insulin

Hi, I have just graduated on the Dafne course. We did not cover the impact of split background insulin. I have split mine as my BI seems to run out early afternoon and I seem to go higher as the day goes on even though Im doing corrections at Breakfast lunch and dinner. Can someone please advise how I would know what needs changing should hypos/hypers show thoroughout the day. Would I change the BI if the hypo/hyper is within an hour of eating for instance, or is there any other way to tell? ... Im a bit confused as to whether to change to BI or QA ratios. I hope this makes sense!

Any help would be greatly appreciated. Thanks

Sep 28, 2010 Simon Heller 46 posts	Topic: Questions for HCPs / wound healing Hi Helen I am no surgeon but Marke is right. Longstanding diabetes doesn't affect healing unless your blood glucose control is uneven with lots of high glucose values. The cells which fight infection (and those leading to healing and the formation of scar tissue), unsurprisingly work most effectively at a glucose of 5-8 mmol/l. I guess a poor blood supply might also increase the chances of infection but not in the site you mention. If you had impaired kidney function from diabetes that might also add to susceptibility but I guess that isn't an issue there. the low grade infection could be adding to your insulin requirements as well as a bit of emotional stress but as you say insulin doses should fall as things resolve, indeed, this might be the first sign that the infection is improving. I think you are doing all the right things. ATB Simon

Sep 28, 2010 Luggerz 10 posts	Topic: Carbohydrate Counting / Iphone Apps I've got the Carbs and Cals app and the Dafne app. Just started to load results into the Dafne App and when I try to load results for yesterday it crashes. Marc

Sep 27, 2010 marke 643 posts	Topic: Questions for HCPs / wound healing Helen, i would say your altered insulin requirement is almost certainly do to what you are going through. The stress both emotionally and physically is bound to be having an effect. Its good to hear you GP is supportive but it would be good to hear a Diabetes Consultants take on all of this. There are a lot of factors involved here and its an area where someone with a deep understanding of Diabetes and the effects of things like surgery etc could provide valuable input. They could also probably give you an idea how long the effects on your insulin requirements might last. Perhaps your DAFNE Educator can help with some information ? I can only wish you well with your recovery and ask that you keep us posted on your progress.

Sep 27, 2010 marke 643 posts	Topic: Site Development / DAFNE Online iPhone application - help with content/design needed now come on Karl, your just being silly now. I rate Simons abilties but more than angry birds ? Its just not possible to use anything more than that unless of course you have completed ALL the levels ;^)

Sep 27, 2010 SimonC 78 posts	Topic: Carbohydrate Counting / Iphone Apps I bought the book about 4 months ago - and used it a load when on holiday - eating out a lot, it was very useful.

Sep 27, 2010 marke 643 posts	Topic: Carbohydrate Counting / Iphone Apps there is, if you want to spend Â£4.99 for something you will be able to get free in the near future (without the pictures of course) feel free too. Personally I think Â£4.99 for an iphone app is more than a little excessive.

Sep 27, 2010 Becki 1 post	Topic: Carbohydrate Counting / Iphone Apps Hi, there's an app called carbs and cals it's based on a book of the same name, the app is Â£4.99 and I highly recommend it......if u r not sure have a nose at the actual book in whs or waterstones

Sep 27, 2010 Karl 83 posts	Topic: Site Development / DAFNE Online iPhone application - help with content/design needed Have to congratulate you on this app - by far the most used app on my phone (even more than angry birds :-)) - the keypad entry changed it totally for me. Not using my written diary anymore.

Sep 27, 2010 Jennifer Iden 11 posts	Topic: Site Development / DAFNE Online iPhone application - help with content/design needed Upgrade to the the iPhone ap makes recording so much simpler, thanks! Although like Karl, I have found that if I change my insulun intake the ratio doesn't update unless I delete the entry and submit a second time...

Sep 27, 2010 Steven 18 posts	Topic: Site Development / Online BG Diaries Having said that, the second page of readings were accepted without complaint! :-/

Sep 27, 2010 Steven 18 posts	Topic: Site Development / Online BG Diaries Hi Simon, I don't seem to be able to leave the date field blank in the diary any more - has something broken?!!? Thanks Steven

Sep 27, 2010 Dr Jez McCole 11 posts	Topic: Site Development / DAFNE Online iPhone application - help with content/design needed Developments and updates really making the app quicker and easier to use thanks Simon. The recalculation of the ratio would be a good tweak. The summary stats are really nice. Any chance of average by entry type, such as average before lunch, average before tea etc? Thanks. I'm DAFNE'ing again!! Jez

Sep 26, 2010 Simon 574 posts	Topic: Carbohydrate Counting / Iphone Apps Hi Brien, thanks for letting me know about that - it's already been raised by other users, so I've submitted a fix to the Apple store, should be appearing on shelves in the next couple of days.

Sep 26, 2010 Peter 103 posts	Topic: Questions for HCPs / High bgl in the morning. Paula, I would suggest that your evening dose of Levemir is beginning to run out before your morning dose becomes effective, especially when the eveing does is taken between 20:00 and 21:00 (as in most days above) but the morning dose varies between 08:00 and 12:00. That combined with the dawn effect is causing yo to have insufficient insulin available in the early morning. You say that you've increased the evening Levemir, but that resulkts in low sugars, but don't explain when. The one example shown has a low(ish) reading at 12:30 which could be more to do with the correction at 09:30 than too much Levemir. I know that I found it much easier to achivee more consistent control if I kept the timing of my morning dose of Levemir consistent on weekdays and weekends. It is a bit of a pain having to set the alarm to get up early on Saturday and Sunday just to have an injection, but the resuklts have made it worthwhile, and going back to sleep afterwards is not too difficult. If it were me, I'd stick with the increased Levelmir does in the evening, and find a consistent time to inject in the morning to see if that helps. NB. That would be nearer 08:00 than 12:00 as, for me, it's effects do reduce after 12 hours. Good luck.

Sep 26, 2010 HelenP 218 posts	Topic: Questions for HCPs / wound healing Thanks, Marke, I don't see anyone at the hospital but I do have a private endocrinologist. When the surgery was scheduled I was between endocrinologists (the old one...I had had him for thirty two years, retired!) I have seen the new one since the surgery and he (Dafne supporter) was happy to leave "the pit" to the surgeon. I understand that the absolute last resort is a surgical repair but according to the surgeon (saw him a week ago and am scheduled to see him in another 3 weeks) says we are a long way from that. He said that what the GP was doing was what he would do! I really like my GP. He is a bit rattled by Dafne and my propensity to fiddle with doses but other than that he asks appropriate questions and seems happy to leave it to me and the endocrinologist. The GP has not suggested I go back to the endocrinologist for advice over the "pit". (Do you detect my absolute frustration?) My need for insulin seems to vary quite a bit. Two weeks after surgery (eating as usual) my TDD was 85-88 currently it is over 105! I have about 10CPs a day. I was relieved and confident. I trust it will drop back to somewhere around 90 in the not too distant future. The GP is supportive of the Dafne protocols and I suspect he has done his homework since taking me on. Currently I am attending his surgery twice a week and under his supervision/direction it (the pit) is being attended to by a nurse. I can't do it at home...not enough hands. His assessment is that it is not getting any better but it is also not getting worse. It is not infected. Any advice I get from here I will discuss with the GP. Emotionally this is throwing me. The surgery was for cancer (no radiation/no chemotherapy) and the diagnosis was followed a week later by the surgery. It is probably more complicated than just "the pit". This situation is also probably not helping my BGs. I have just reread this and it looks a bit like a dog's breakfast but I hope it is all there. Thanks for the psychotherapy! Helen

Sep 26, 2010 oilly 2 posts	Topic: Carbohydrate Counting / porridge I have porridge oats every morning for breakfast, my counting and dose works well for me, 40 grams of dried oats is 3 CPs, throw in a handful of raisins (25g to be precise) and that's another 1.5 CPs, add half an apple and half a nectarine another 1 CP, a dollop of natural yogurt another 1/2 CP, a teaspoon honey, 1/2 Cp and your milk another 1/2 CP, total value='s 7CPS and yummy

Sep 26, 2010 oilly 2 posts	Topic: Carbohydrate Counting / Sultanas i am a sultana/raisin addict, every morning i have a good handful with my muesli, i've since had to start weighing them to get my CPs and dose right, 25g of raisins, which would scantily cover the bottom of a breakfast bowl is worth 1.5 cps

Sep 26, 2010 marke 643 posts	Topic: General Discussion / Split background insulin I'm glad to hear you will be seeing the hospital thursday, just because I would like them to confrim what you are doing in case you have any problems. Not that I'm suggesting you will. I am on Levemir which it now seems commonly accepted does not last 24 hours in a lot of people and so a lot of people are on a split dose. Less people on Lantus split their dose I think, but I'm happy to be corrected by others. As I said before, I think you will need to give it a few more days before you can spot any patterns and it will probably take a couple of days before the changes you have made will have full effect. There is nothing wrong with making changes, thats part of what DAFNE is about. Its just always a good idea to ensure those that support you at the hospital etc, know you have made these changes. Let us know if the change works for you, since I'm sure others have considered it but not felt confident enough to do it.

Sep 26, 2010 Caroline 29 posts	Topic: General Discussion / Split background insulin Thanks for getting back to me. Yes I should have perhaps posted this to the medical staff; being the weekend. Im on lantus. Thanks for your input, I will monitor it closely and see what happens. Think there is alot to take in from the course and maybe im just a bit bamboozled by it all! I will speak to the hosp as I have an appointment on Thursday.

Sep 26, 2010 marke 643 posts	Topic: Questions for HCPs / wound healing Helen, Do you see anyone at a Hospital for your Diabetes or just your GP. The issue for me is GP's are NOT Diabetes experts and generally seem to think any issue that could be diabetes related IS diabetes related. I had another condition 2 years ago that has re-occured since. The GP's reaction was its caused by your Diabetes, my Diabetes consulant and the consultant I see for the condtion both say, it had nothing to do with your Diabetes. Since both of these are experts rather than 'General Practioners' I tend to go with their opinions. I have absolutely no issues with GP's doing what they normally do, its just I don't trust mine to manage my Diabetes. As a non medical person, I would say that generally if your diabetes is reasonably well controlled it should have no impact on the healing process. You should heal just like a non-diabetic. Hopefully a HCP on the site can confirm this or give some guidance as to why this is not the case.

Sep 26, 2010 marke 643 posts	Topic: General Discussion / Giving Blood I think mines going to give them plenty to work on, well my immune system is anyway. It certainly seems to be challenging the medical profession whilst I am still alive ;^)

Sep 26, 2010 marke 643 posts	Topic: General Discussion / Split background insulin Caroline, I think you should talk to yuor DAFNE Educator and/or Diabetes support team ( Diabetes Nurse/Consultant). I don't think you should rely on advice from this site when changing to split doses. I also don't think there is enough info above to give much advice anyway. You need at least a few more days before a pattern can emerge. The main thing to remember is that your BI is supposed to keep your blood sugar fairly constant in the absence of food. Therefore you need to look for patterns where it increases either overnight or during they day when you don't have carbs. Your QA is what should take care of food. Therefore if a hypo/hyper occurs within an hour of eating it should be down to QA and NOT BI. You don't say what type of BI you are taking either, the profiles of all BI's are not the same and they can behave slightly differently. This is another reason for speaking to your Educator. They might suggest switching BI to another type, which again is not something anyone on here can recommend. We are all happy to help and advise, however you probably need more detailed avice than we can provide.

Sep 26, 2010 Brien Molloy 4 posts	Topic: Carbohydrate Counting / Iphone Apps Simon great update much much better one snag impossible to tick corrective box and before driving. Well done again.

Sep 26, 2010 Caroline 29 posts	Topic: General Discussion / Split background insulin Hi, I have just graduated on the Dafne course. We did not cover the impact of split background insulin. I have split mine as my BI seems to run out early afternoon and I seem to go higher as the day goes on even though Im doing corrections at Breakfast lunch and dinner. Can someone please advise how I would know what needs changing should hypos/hypers show thoroughout the day. Would I change the BI if the hypo/hyper is within an hour of eating for instance, or is there any other way to tell? ... Im a bit confused as to whether to change to BI or QA ratios. I hope this makes sense! Any help would be greatly appreciated. Thanks