Recent Posts - DAFNE Online

Jul 27, 2010

Ffi010 8 posts

Topic: Questions for HCPs / Insulin resistace and Alergy?

Hi,

Since doing Dafne my blood sugars have come down but I am concerned that I may be building a resistance. I was on Solostar and wasthen put onto Levemir and have found that it stings alot when i inject. Also I have small (little smaller than a ping pong ball) lumps where I inject, i have changed to longer needles (and changing sites) and this hasnt helped.

could I be alergic? could my body be storing the insulin in that one area? and could these lumps prevent my novorapid from absorbing properly?

THank you

Jul 26, 2010

Judith23 7 posts

Topic: General Discussion / Target range?

Hi Jo, yes thats right - i think thats probably why you are struggling to get a clear reading for any of your bloods, as you seem to snack regularly throughout the day and dont have a clear 4 hours between food / QA in order to see if you can hit the target range - so I would presume that you ain't gonna hit it - but your HCP should be able to advise better than I.

Just on the subject of split BI - Paul is right the tide seems to be turning, I was encouraged to split on my dafne course; but more recently my dafne nurse advised that I may want to go back to just one dose at night (wont bore with all the details, but basically was hypo at 16:30 for a few days so reduced my BI to only 2 units at 10am, leaving me with 8u at 10pm - she suggested to see how it went but I may find it more hassel than its worth to give that 2 in the morning). She said that younger people may need the split due to their growth hormones - and unfortunatley I aint that young anymore!! Not sure whether this applies to you Jo or not??

Jul 26, 2010

marke 686 posts

Topic: Questions for HCPs / Humilin I and morning sugars

Hi, the best person to reply to this is Simon Heller, but I know hes a busy chap. Hopefully he will be able to respond to you at some stage as I know he knows a lot about this.
As I understand it, Dawn starts at about 4-5am when your body starts preparing itself for waking up. It should be around this time that your BG starts to rise as loads of hormones start bouncing around your body. Therefore, changing your BI injections will NOT give the sugars less time to rise. In an ideal world you would magically inject QA at about 4-5am when the hormonal activity starts, however since you are asleep this is not easy. In addition I would guess that if you regularly woke up at 4-5am the hormonal process would just start earlier.
This I appreciate doesn't provide an answer, but then I only understand the basics ( just about) rather than the details of the process and how it affects BG. Hopefully someone with a more detailed understanding can provide advice on the best course of action.

Jul 26, 2010

Jo Penn 24 posts

Topic: General Discussion / Target range?

Judity - you and Paul have a valid point re- BG before bed.. but my DAFNE educator also stated that... but sometimes I go to bed early and it less than 3-4 hours after QA injection (or peak) so inaccurate reading...

Jul 26, 2010

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Humilin I and morning sugars

I experience dawn phenomonon........and I am constanlty trying to find a way to beat it......

Started of of Lantus, then split it with Levemir, then finally moved to humlilin I to take advantage of its peak two hours after injecing so as to drop me enough over night that I would wake up as close to target as possible.

9 times out of 10 I am in double figures still.

My question is this. At 6.30 in the morning I take my morning BI dose, and then 12 hours later at dinner I take my evening dose, would it be better to take my evening dose as close to bedtime as possible so as to reduce the time my sugars have to climb, this would also mean bringing my morning dose forward.

Jul 25, 2010

GR156 3 posts

Topic: Carbohydrate Counting / Sultanas

Cheers for that.

The next time they turn up in a recipe I'll give it a try.

Jul 25, 2010

Simon 578 posts

Topic: DAFNE Online Mobile / Mobile Feature Requests

Hi Alex,

What phone do you have? We're currently working on an iPhone app which contains a diary and carb list.

Thanks,

Simon

Jul 25, 2010

AlexLawson 2 posts

Topic: DAFNE Online Mobile / Mobile Feature Requests

Would it be possible to get a diary app so you could keep a note pf your blood sugars on the move then transfer th to your paper diary at a later date

Jul 25, 2010

PNThompson 57 posts

Topic: General Discussion / Target range?

I was unsure whether or not to suggest splitting the Lantus, but I did prior to attending DAFNE, as the hospital felt that my Lantus might be running out too early. During DAFNE I went back to just one injection.

As Judith mentioned, I have found that if I snack, I have trouble ensuring that I get the ration right, as sometimes I hypo, sometimes my BGs goes high.

Jul 25, 2010

Judith23 7 posts

Topic: General Discussion / Target range?

Hi Jo,

I use Lantus and split my dose to take it at a gap fo 12 hours, which has helped me, as I felt it was running out too.

As Paul, I wonder what is happening to your bloods at night - do you do any tests before you go to sleep so you get a view on what your bloods are up to - compared to what you wake up on?

I have noticed if I have a snack, and inject, when its time for my lunch or other main meal my QA wont always have had time to work so if I also corrected at lunch /dinner etc I would hypo later on? Don't know if anyone else has found this?

Judith

Jul 25, 2010

Jo Penn 24 posts

Topic: General Discussion / Target range?

I am doing 3am checks and about 10-12 ish...
Am on Lantus at the moment, have been thinking it is running out for a while....

Will try 2:1 for lunch from tomo...

Correction is 2u if below 12; 3u if 12.9-14; 6 if over 15

Will call diabetic team for some ideas... maybe levemir might solve some of the issues

Jul 25, 2010

PNThompson 57 posts

Topic: General Discussion / Target range?

Jo,

Looking at these readings, I wonder if the BI is correct, as you are always high in the morning, though at times my readings are high before bed, but drop over the night, so mine, at times seem too high.
Try having a 03:00am test, as you may be having a hypo overnight which is generating the high readings first thing.
What Background Insulin are you on, as it may be running out at the end of the 24 Hours.
I have now change the time of the Background Insulin to the same time as Dinner to make things a little easier.
A lot of the lunch-time reading are only just out of range, so it seems that the morning injection is close to being spot on.
Some of the corrections may not be high enough, and what factor are you using when calculating the correction.
1 unit per 2-3mmol. When correcting, do you calculate to the middle of the range?
Your lunch-time reading on the 20th was 7.6, and is just out of range, and at a ratio of 1:1.5, I feel your injection should have been 7+1.

I use a computerised spreadsheet to calculate my injections, based on meal, ratio, and any adjustment.
Are you counting the CPs correctly? Maybe you are not counting some foods that do contain carbs?

If you have access to a computer, I could send you a copy of this spreadsheet if you think it might help.
See, sometimes I found that when calculating the Insulin, I found that manually I sometimes had some issues with rounding up or down the figures.
i.e, the calculation may consist of a figure of 6.39 and required an adjustment of 1.4, but where some of the calculations would round these down to 7, the figure would be closer to 8 (7.79).
Manually this isn't that clear, as calculating the CPs, you know the correct figures, but calculating the adjustment is what I originally found difficult.

The spreadsheet is in both Windows and Apple Mac formats, so if you would like to try let me know.

Paul

Jul 25, 2010

Jo Penn 24 posts

Topic: General Discussion / Target range?

Here

Jul 25, 2010

Jo Penn 24 posts

Topic: General Discussion / Target range?

Here you go

Jul 24, 2010

Harry1974 1 post

Topic: General Discussion / How good is dafne

Hi everyone,

This is my first post. I just completed my DAFNE week this Friday. I have been diabetic for 13 years and it was a real revelation to undergo the training. Nobody had ever taught me about Dose adjustment before. I can understand now why it is a legal requirement (as someone posted earlier) in Germany for diabetics to train in DAFNE.

I am very positive about the future. My QA insulin is now anything between 25% to 50% of what I would have taken before DAFNE week and my BG seems to be within target with only an occasional correction required.

I now feel full of energy compared to just 8 days ago and am increasing my activity which is only going to help my diabetes control.

In my view DAFNE is GREAT!!!

Regards

Harry

Jul 24, 2010

Edhoare 1 post

Topic: General Discussion / Changeable basal insulin rates

I've been diabetic for 28 years now and have been on a pump now for about 9 months. I find that I can be reasonably stable for about a week on one basal rate and then something causes my glucose levels to go right up (19 without any problem) and I find I have to keep raising my basal rate until I find a new level at which I'm stable.
A week or so later my glucose level will be low and then I'll have to keep dropping my basal rate back down again until it stabilises again. I find my basal rate can vary between about 15 units a day to 22 units a day.
This has always been the case for me so its not just because I'm on a pump.
My lifestyle is pretty predictable particularly on work days - I work 5 days a week. I have the same breakfast every day and then cycle 5 miles to work. I typically work about 9 hours a day mainly behind a desk. I have a lunch of sandwiches made by me (very similar every day). I then cycle home at about 6.00-7.00pm. My evening meal is mainly rice and is again very similar every day (a boring life, I know!)
I very rarely get stressed at work but when I do, I haven't noticed any change in the insulin requirements.
I'm hardly ever ill (never had a day off work in 25 years).
There may be some hang over from weekends where my exercise and food is less predictable and I might have a few drinks as well. As my routine is pretty much the same every working day, I think my basal insulin should be pretty much the same - every working day at least.
Does anyone else have similar changes in basal requirement...or can anyone think of anything that might cause the basal to change that I can predict.

Jul 24, 2010

PNThompson 57 posts

Topic: General Discussion / Target range?

Jo,

Would suggest using the on line diary, and posting some of your readings, as you haven't detailed the problems with your BG readings. You mention they are out of the range, but haven't explained whether they are high or low. If the readings are regularly high, you should look at changing the ratio for the appropriate injection.
i.e. if lunch time ratio is 1:1, and your dinner ratio is always high, change it to 1.5:1.
Today, my BG have just been outside the ideal range, but wouldn't look to change any ratios, until I was sure that they needed changing.

Paul

Jul 24, 2010

Jo Penn 24 posts

Topic: General Discussion / Target range?

Really struggling atm... stress with family and other bits....
Any ideas on how to keep them in the "range"?

Jul 22, 2010

Caroline 29 posts

Topic: Carbohydrate Counting / Iphone Apps

Hi

My partner found an app for me called Insulin Dose Calculator (G C E =). It cost just over a Â£. I have found this a useful tool. Its been handly to carry around with me. You simply set your correction factor, carb factor, target glucose. Its gives you accurate insulin to take and bears in mind any exercise, none light or heavy you may then think about undertaking. Its helped me to lower my blood sugars without going to low.

Jul 22, 2010

amandab 11 posts

Topic: DAFNE Online Mobile / Rationale - Please read

I have a blackberry bold and would b happy to test. In fact I posted this from mobile.

Jul 22, 2010

amandab 11 posts

Topic: DAFNE Online Mobile / Rationale - Please read

I have a blackberry bold and would b happy to test. In fact I posted this from mobile.

Jul 21, 2010

PNThompson 57 posts

Topic: General Discussion / Bayer Contour USB

As a meter it's quite good, though Bayer, as a company do not seem to be as helpful as Lifescan.
When I first got this (as a test through the diabetic clinic) I was impressed with it, but after a while I found things difficult as the software was not available for download.

I use both Mac and Windows computers, but found that creating a diary in the Apple Numbers software a lot better, as I have used the conditional formatting to colour code the readings. Numbers allows more than three conditions, so i've got four colours to highlight anything outside the ideal range.

Jul 21, 2010

PNThompson 57 posts

Topic: General Discussion / Target range?

Have you noticed any pattens on your BG readings i.e. morning, lunch, dinner or bed high or low most of the time.
I found it easier to notice pattens when I started colour coding the BG readings when they were not in range.
Also I use a Spreadsheet (Windows Excel or Apple Numbers) to calculate my insulin needs to bring my BG readings back to mid range. Tonight (after exercise) by BG reading was 4.3, which means I needed an adjustment of -0.85 plus the count for the meal. Currently my adjustment factor is 0.5 unit of insulin per mmol i'm outside the range.
You may need to adjust your ratio to get them in range, but would suggest only work on one at a time.

Jul 21, 2010

PNThompson 57 posts

Topic: General Discussion / Which Blood Meter

No I would not recommend against it, but I am just unhappy with the Bayer company.
So far the device works well, and once you get the software downloaded it is easy to update the diary, though I think I will stick to a manual diary.

Jul 27, 2010 Ffi010 8 posts	Topic: Questions for HCPs / Insulin resistace and Alergy? Hi, Since doing Dafne my blood sugars have come down but I am concerned that I may be building a resistance. I was on Solostar and wasthen put onto Levemir and have found that it stings alot when i inject. Also I have small (little smaller than a ping pong ball) lumps where I inject, i have changed to longer needles (and changing sites) and this hasnt helped. could I be alergic? could my body be storing the insulin in that one area? and could these lumps prevent my novorapid from absorbing properly? THank you

Jul 26, 2010 Judith23 7 posts	Topic: General Discussion / Target range? Hi Jo, yes thats right - i think thats probably why you are struggling to get a clear reading for any of your bloods, as you seem to snack regularly throughout the day and dont have a clear 4 hours between food / QA in order to see if you can hit the target range - so I would presume that you ain't gonna hit it - but your HCP should be able to advise better than I. Just on the subject of split BI - Paul is right the tide seems to be turning, I was encouraged to split on my dafne course; but more recently my dafne nurse advised that I may want to go back to just one dose at night (wont bore with all the details, but basically was hypo at 16:30 for a few days so reduced my BI to only 2 units at 10am, leaving me with 8u at 10pm - she suggested to see how it went but I may find it more hassel than its worth to give that 2 in the morning). She said that younger people may need the split due to their growth hormones - and unfortunatley I aint that young anymore!! Not sure whether this applies to you Jo or not??

Jul 26, 2010 marke 686 posts	Topic: Questions for HCPs / Humilin I and morning sugars Hi, the best person to reply to this is Simon Heller, but I know hes a busy chap. Hopefully he will be able to respond to you at some stage as I know he knows a lot about this. As I understand it, Dawn starts at about 4-5am when your body starts preparing itself for waking up. It should be around this time that your BG starts to rise as loads of hormones start bouncing around your body. Therefore, changing your BI injections will NOT give the sugars less time to rise. In an ideal world you would magically inject QA at about 4-5am when the hormonal activity starts, however since you are asleep this is not easy. In addition I would guess that if you regularly woke up at 4-5am the hormonal process would just start earlier. This I appreciate doesn't provide an answer, but then I only understand the basics ( just about) rather than the details of the process and how it affects BG. Hopefully someone with a more detailed understanding can provide advice on the best course of action.

Jul 26, 2010 Jo Penn 24 posts	Topic: General Discussion / Target range? Judity - you and Paul have a valid point re- BG before bed.. but my DAFNE educator also stated that... but sometimes I go to bed early and it less than 3-4 hours after QA injection (or peak) so inaccurate reading...

Jul 26, 2010 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Humilin I and morning sugars I experience dawn phenomonon........and I am constanlty trying to find a way to beat it...... Started of of Lantus, then split it with Levemir, then finally moved to humlilin I to take advantage of its peak two hours after injecing so as to drop me enough over night that I would wake up as close to target as possible. 9 times out of 10 I am in double figures still. My question is this. At 6.30 in the morning I take my morning BI dose, and then 12 hours later at dinner I take my evening dose, would it be better to take my evening dose as close to bedtime as possible so as to reduce the time my sugars have to climb, this would also mean bringing my morning dose forward.

Jul 25, 2010 GR156 3 posts	Topic: Carbohydrate Counting / Sultanas Cheers for that. The next time they turn up in a recipe I'll give it a try.

Jul 25, 2010 Simon 578 posts	Topic: DAFNE Online Mobile / Mobile Feature Requests Hi Alex, What phone do you have? We're currently working on an iPhone app which contains a diary and carb list. Thanks, Simon

Jul 25, 2010 AlexLawson 2 posts	Topic: DAFNE Online Mobile / Mobile Feature Requests Would it be possible to get a diary app so you could keep a note pf your blood sugars on the move then transfer th to your paper diary at a later date

Jul 25, 2010 PNThompson 57 posts	Topic: General Discussion / Target range? I was unsure whether or not to suggest splitting the Lantus, but I did prior to attending DAFNE, as the hospital felt that my Lantus might be running out too early. During DAFNE I went back to just one injection. As Judith mentioned, I have found that if I snack, I have trouble ensuring that I get the ration right, as sometimes I hypo, sometimes my BGs goes high.

Jul 25, 2010 Judith23 7 posts	Topic: General Discussion / Target range? Hi Jo, I use Lantus and split my dose to take it at a gap fo 12 hours, which has helped me, as I felt it was running out too. As Paul, I wonder what is happening to your bloods at night - do you do any tests before you go to sleep so you get a view on what your bloods are up to - compared to what you wake up on? I have noticed if I have a snack, and inject, when its time for my lunch or other main meal my QA wont always have had time to work so if I also corrected at lunch /dinner etc I would hypo later on? Don't know if anyone else has found this? Judith

Jul 25, 2010 Jo Penn 24 posts	Topic: General Discussion / Target range? I am doing 3am checks and about 10-12 ish... Am on Lantus at the moment, have been thinking it is running out for a while.... Will try 2:1 for lunch from tomo... Correction is 2u if below 12; 3u if 12.9-14; 6 if over 15 Will call diabetic team for some ideas... maybe levemir might solve some of the issues

Jul 25, 2010 PNThompson 57 posts	Topic: General Discussion / Target range? Jo, Looking at these readings, I wonder if the BI is correct, as you are always high in the morning, though at times my readings are high before bed, but drop over the night, so mine, at times seem too high. Try having a 03:00am test, as you may be having a hypo overnight which is generating the high readings first thing. What Background Insulin are you on, as it may be running out at the end of the 24 Hours. I have now change the time of the Background Insulin to the same time as Dinner to make things a little easier. A lot of the lunch-time reading are only just out of range, so it seems that the morning injection is close to being spot on. Some of the corrections may not be high enough, and what factor are you using when calculating the correction. 1 unit per 2-3mmol. When correcting, do you calculate to the middle of the range? Your lunch-time reading on the 20th was 7.6, and is just out of range, and at a ratio of 1:1.5, I feel your injection should have been 7+1. I use a computerised spreadsheet to calculate my injections, based on meal, ratio, and any adjustment. Are you counting the CPs correctly? Maybe you are not counting some foods that do contain carbs? If you have access to a computer, I could send you a copy of this spreadsheet if you think it might help. See, sometimes I found that when calculating the Insulin, I found that manually I sometimes had some issues with rounding up or down the figures. i.e, the calculation may consist of a figure of 6.39 and required an adjustment of 1.4, but where some of the calculations would round these down to 7, the figure would be closer to 8 (7.79). Manually this isn't that clear, as calculating the CPs, you know the correct figures, but calculating the adjustment is what I originally found difficult. The spreadsheet is in both Windows and Apple Mac formats, so if you would like to try let me know. Paul

Jul 25, 2010 Jo Penn 24 posts	Topic: General Discussion / Target range? Here

Jul 25, 2010 Jo Penn 24 posts	Topic: General Discussion / Target range? Here you go

Jul 24, 2010 Harry1974 1 post	Topic: General Discussion / How good is dafne Hi everyone, This is my first post. I just completed my DAFNE week this Friday. I have been diabetic for 13 years and it was a real revelation to undergo the training. Nobody had ever taught me about Dose adjustment before. I can understand now why it is a legal requirement (as someone posted earlier) in Germany for diabetics to train in DAFNE. I am very positive about the future. My QA insulin is now anything between 25% to 50% of what I would have taken before DAFNE week and my BG seems to be within target with only an occasional correction required. I now feel full of energy compared to just 8 days ago and am increasing my activity which is only going to help my diabetes control. In my view DAFNE is GREAT!!! Regards Harry

Jul 24, 2010 Edhoare 1 post	Topic: General Discussion / Changeable basal insulin rates I've been diabetic for 28 years now and have been on a pump now for about 9 months. I find that I can be reasonably stable for about a week on one basal rate and then something causes my glucose levels to go right up (19 without any problem) and I find I have to keep raising my basal rate until I find a new level at which I'm stable. A week or so later my glucose level will be low and then I'll have to keep dropping my basal rate back down again until it stabilises again. I find my basal rate can vary between about 15 units a day to 22 units a day. This has always been the case for me so its not just because I'm on a pump. My lifestyle is pretty predictable particularly on work days - I work 5 days a week. I have the same breakfast every day and then cycle 5 miles to work. I typically work about 9 hours a day mainly behind a desk. I have a lunch of sandwiches made by me (very similar every day). I then cycle home at about 6.00-7.00pm. My evening meal is mainly rice and is again very similar every day (a boring life, I know!) I very rarely get stressed at work but when I do, I haven't noticed any change in the insulin requirements. I'm hardly ever ill (never had a day off work in 25 years). There may be some hang over from weekends where my exercise and food is less predictable and I might have a few drinks as well. As my routine is pretty much the same every working day, I think my basal insulin should be pretty much the same - every working day at least. Does anyone else have similar changes in basal requirement...or can anyone think of anything that might cause the basal to change that I can predict.

Jul 24, 2010 PNThompson 57 posts	Topic: General Discussion / Target range? Jo, Would suggest using the on line diary, and posting some of your readings, as you haven't detailed the problems with your BG readings. You mention they are out of the range, but haven't explained whether they are high or low. If the readings are regularly high, you should look at changing the ratio for the appropriate injection. i.e. if lunch time ratio is 1:1, and your dinner ratio is always high, change it to 1.5:1. Today, my BG have just been outside the ideal range, but wouldn't look to change any ratios, until I was sure that they needed changing. Paul

Jul 24, 2010 Jo Penn 24 posts	Topic: General Discussion / Target range? Really struggling atm... stress with family and other bits.... Any ideas on how to keep them in the "range"?

Jul 22, 2010 Caroline 29 posts	Topic: Carbohydrate Counting / Iphone Apps Hi My partner found an app for me called Insulin Dose Calculator (G C E =). It cost just over a Â£. I have found this a useful tool. Its been handly to carry around with me. You simply set your correction factor, carb factor, target glucose. Its gives you accurate insulin to take and bears in mind any exercise, none light or heavy you may then think about undertaking. Its helped me to lower my blood sugars without going to low.

Jul 22, 2010 amandab 11 posts	Topic: DAFNE Online Mobile / Rationale - Please read I have a blackberry bold and would b happy to test. In fact I posted this from mobile.

Jul 22, 2010 amandab 11 posts	Topic: DAFNE Online Mobile / Rationale - Please read I have a blackberry bold and would b happy to test. In fact I posted this from mobile.

Jul 21, 2010 PNThompson 57 posts	Topic: General Discussion / Bayer Contour USB As a meter it's quite good, though Bayer, as a company do not seem to be as helpful as Lifescan. When I first got this (as a test through the diabetic clinic) I was impressed with it, but after a while I found things difficult as the software was not available for download. I use both Mac and Windows computers, but found that creating a diary in the Apple Numbers software a lot better, as I have used the conditional formatting to colour code the readings. Numbers allows more than three conditions, so i've got four colours to highlight anything outside the ideal range.

Jul 21, 2010 PNThompson 57 posts	Topic: General Discussion / Target range? Have you noticed any pattens on your BG readings i.e. morning, lunch, dinner or bed high or low most of the time. I found it easier to notice pattens when I started colour coding the BG readings when they were not in range. Also I use a Spreadsheet (Windows Excel or Apple Numbers) to calculate my insulin needs to bring my BG readings back to mid range. Tonight (after exercise) by BG reading was 4.3, which means I needed an adjustment of -0.85 plus the count for the meal. Currently my adjustment factor is 0.5 unit of insulin per mmol i'm outside the range. You may need to adjust your ratio to get them in range, but would suggest only work on one at a time.

Jul 21, 2010 PNThompson 57 posts	Topic: General Discussion / Which Blood Meter No I would not recommend against it, but I am just unhappy with the Bayer company. So far the device works well, and once you get the software downloaded it is easy to update the diary, though I think I will stick to a manual diary.