Recent Posts - DAFNE Online

Oct 26, 2009

marke 681 posts

I agree with Katy B, there is no rule that says you cannot use a 0.5:1 ratio. Any ratio is valid if it works for you ! I would say though its
worth you re-reading the section of the course on exercise ( either online or on paper). The effects of exercise can last a long time easily into the next day. I would suggest drop to 0.5/1 see how it goes, then adjust BI as well ( seperately of course, not at the same time !). Its problably worth you running high for a few days, just to ensure you keep your hypo warning signs and to try to fix the issue. Its not going to cause you a problem to run high for a week and then you can wind down your BG's and increase your insulins to get things back in line. How you adjust for days when you don't do exercise I guess is going to be tricky, it will be the next day most likely when you see the effects of no exercise NOT the same day. Unfortuantely I think its just trial and error, just like the rest of life :-)

Oct 26, 2009

marke 681 posts

Topic: General Discussion / Dawn Phenomenon

Hi,
Just to prove the people running the site, are just the same as you ;-) I am having a similiar issue to you regarding my BG being too high in the morning. Last nights 'fast' proved that its not my BI as I hypo-ed in the night, so I will now lower it slightly and investigate other options. As a point of interest when I went to the DAFNE Collaborative this year ( see User Group forum), there was a presentation by Prof Simon Heller about the dawn phenomeon. The relavent extract is
'The next two speakers gave a presentation relating to background insulin and its capability to last over 24 hours and probably more interestingly the misconceptions surrounding the Somogyi effect or rebound Hyperglycemia. It has been suggested that many high blood sugars in the morning are caused by night-time hypos. The presenters contended that this is generally NOT the case, the night time hypos only result in a relatively small rise in blood sugar. So if this is not the cause then what is ? It was suggested that the cause is a form of the Dawn Phenomenon where the body releases hormones. The factors that cause this rise are length of sleep, duration that a person has had diabetes and horizontal posture. The biggest issue with this hormone release is it occurs from 5am onwards. This means using an increase of background insulin the night before is not a good way to treat it, since a hypo would occur in the hours before the increase in hormones. The only effective way to treat it is by injecting fast acting insulin, which is a bit of an issue since most people are not awake at 5am. One method would be the use of insulin pumps, but since these are still not widely available to all Diabetics there is no easy solution.'

That doesn't provide a solution I'm afraid but it might provide an insight into what is happening to you as well as me. Unfortunately I have not seen any follow up to this, if I see any follow ups I will post on this site.

Oct 26, 2009

Daphne 2 posts

Topic: Questions for HCPs / BG Parameters

Hope it's working out for you. My experience is ancient (daughter now 23) but had best availble pregancy care, was great, my adice is carry lucozade at all times, thank goodness for modern test equipment, you'll get more hypos so be careful but the hassle is all worth it, it's a fabulous thing to do, go for it.

Oct 26, 2009

Daphne 2 posts

Topic: General Discussion / Help, am panicking

hello pump panicker - I don't have one, and as a new user of this web forum am a bit scared by the fact that quite a lot of people seem to have hb1ac levels lower than mine - never mind. So far so good, no major complicatons after 41 years on insulin, the first 15 years or so with no idea what by blood sugar or hb1ac was at all. Anyway I thought I'd mention that a couple of years ago I met an American swimmer on a swimming holiday who was a pump user. Pumps are much more widely used there. He was aged about 30, on insulin for about 5 years, had been a collegiate swimmer. We did long open water swims, some took 2 hours or more. (We were fed sugary drinks every half hour, has safety boats, etc). He disconnected the pump beforehand and reconnected afterwards. He carried little sachets of glocose everywhere, had them secreted in his speedos. It was great that there were two of us in the group on insulin. I can't put you directly in touch with him but can assure you that he was unconcerned about disconnecting for those periods of time while doing exercise. Made me think. Have discussed it with doc lately, not being particularly encouraged to do it at the moment but I suppose that could change. Good luck
Daphne (yes, really..)

Oct 26, 2009

Tracey Bond 14 posts

Topic: General Discussion / Dawn Phenomenon

Hi Sam

If you are having hypos you need to ask yourself why? Too much insulin, CPs not counted correctly. If you test your BG 5 hours after your supper you will know that the only insuling working is your BI. If you are confident that your BI's are working and holding you stable (both am and pm) and your ratio's are correct and your BG is still rising through the night (3am upto 11am) the next day it could well be that our friend 'Dawn' is knocking.

It is really important to establish a repeated pattern and eliminate all other possibilities, ie. exercise and alcohol before acting. I personally act to quickly then live to regret it, so believe me when I say' slowly slowly catchie monkey'!!

Tracey x

Oct 26, 2009

Katy B 8 posts

Topic: General Discussion / New Job

Hi Claire, don't worry about dropping to a 0.5:1 ratio. I've been using that ratio for the past two months and its worked brilliantly for me. 1:1 was given as a starting point, some people need more, some people need less. I take 0.5:1 on most days but if its my day off and im just watching tv and being really lazy then i can use 1:1. I find i dont need to adjust the BI. I think you still might need to lower your BI as you should be able to go to bed on that 7-8 that you mentioned and wake up somewhere in target. Don't worry about trying the lower ratio. If it doesnt work, you'll find out at the next meal and you can correct it, if it does work then you've avoided your lows!! x

Oct 26, 2009

Tracey Bond 14 posts

Topic: Questions for HCPs / Rising morning BG'S with/without breakfast.

Hi, thank you for replying. I have come to think that what you are saying is right. I'm afraid I'm a bit of a perfectist, I don't want 'Dawn' to keep knocking at my door. I just want my Lantus to work effectively and to have the freedom that I thought Dafne could offer without messing around with insulin etc. Once again thank you.

Oct 26, 2009

sphillips 24 posts

Topic: Questions for HCPs / Rising morning BG'S with/without breakfast.

Hi It sounds to me like what you're describing is the dawn rise in BG that happens as your body is waking up and can go on through to mid morning ( eg 4am-11am ish). It's quite common for people to notice a rise this is why we often need a higher ratio in the morning if we have breakfast and why you would have been advised to have morning QA even without breakfast. I've noticed that because the profile of lantus is so flat it can be difficult to manage the dawn rise, even on a split dose. I would suggest you speak to your DAFNE educator about the options and possibly changing your BI. Meantime you could try some cautios corrective doses at breafast maybe a couple of units, make sure you monitor the affects and I wouldn't do this and then drive, perhaps try it on a morning when you're mostly at home or when you could safely manage a hypo.

Oct 26, 2009

sphillips 24 posts

Topic: Carbohydrate Counting / Parsnips

Hi. How did it work out when you counted the same as pots? If you count them I'd be tempted to only count half the cp value as they may only have a limited affect on your BG due to their low GI value.

Oct 26, 2009

copperline 2 posts

Topic: General Discussion / Least painful lancet??

Since being diagnosed nearly 3 years ago I must have performed at least 5000 BG tests - resulting in quite sore fingers. I originally used the lancet system that came with the Bayer Contour meter I was given at diagnosis. This only worked if I used it at is highest setting. I have recently been using an Accu-Chek Multiclix pen (encourages you to use a new lancet for every BG test) but this is quite brutal. I would be interested to hear what other system would be recommended - or maybe I am just soft! Thanks

Oct 26, 2009

Sue R 3 posts

Topic: Carbohydrate Counting / Glucotabs: Where they can be found?

Hi
Are Glucotabs not available on prescription?

Oct 26, 2009

Sue R 3 posts

Topic: General Discussion / Introductions

Hi
I'm Sue, Diagnosed with Type 1 in April 1979. So have had diabetes for over 30 years with control problems.
Graduated DAFNE course at Aberdeen Royal Infirmary in October 2008.
Bi is Lantus - 30 units at 11pm
QA is NovoRapid - on a 2:1 ratio at mealtimes with correction for dawn phenomenon at breakfast.
Last HbA1c was 8.2, down from 9.8 before course (and striving for better!!).
Much happier in myself nowadays because DAFNE highlighted some issues (dawn phenomenon), but now i understand them i can deal with them better.
Looking forward to sharing experiences.
Cheers
Sue

Oct 26, 2009

Sue R 3 posts

Topic: General Discussion / Needle Bins

Hi all,
Just joined the site, and this seems to be quite an issue for some areas of the country.
I am rather lucky in that i am supplied with a sharps bin by my local surgery and when it's full i hand it back in and they give me another one.
No messing about with local council or having to get one on prescription. Smile

Oct 25, 2009

Sam 64 posts

Topic: General Discussion / Dawn Phenomenon

thanks Tracey. I'll certainly give it a go. If it is hypos I'm having what can be done to prevent them, do you know?

29 years is a long time you must have a lot of different experiences behind you and just goes to show all that time and still no steady cures! Maybe one day.

Thanks for the advice.

Sam x

Oct 25, 2009

Simon 578 posts

Topic: Site Development / Online BG Diaries

Wow, sounds complicated - but as long as it works for you that's all that matters! Will look into uploading via CSV/XML and post progress here.

Are there any features in your current setup that you'd like to see in the DAFNE Online diary?

Simon

Oct 25, 2009

Alann 12 posts

Topic: Site Development / Online BG Diaries

Actually Simon my data is currently backed up / duplicated in four different locations, one on-line, on a pocket-pc device and then backup on two computers. All sync'd from a master source. I see the main reason / aim for using the online diary is to easily share the data with other for support and advice. I know other who use a spreadsheet to record there result.

I haven't written by own software as i don't believe in re-inventing the wheel. I use sidiay (german software) which meets all my needs and more. (this is a personal preference and by no means a recommendation).

Kindest regards,

Alan

Oct 25, 2009

Simon 578 posts

Topic: Site Development / Online BG Diaries

Hi Alan,

Yes the data is stored in an SQL database, and I'm sure we could implement some sort of functionality that could parse an XML file and add the results to your DAFNE Online Diary. I guess I'd have to publish the XML format we needed for you to export from your database (I assume this is Access or similar).

One question on this though - would you want the data duplicated in two places? Obviously there's benefits to both - you don't have to be online to access your own database, and its backed up locally for you, however with the DAFNE Online diary, you can access anywhere, and share with other users, etc. Is there functionality you have set up in your local Database that is missing from DAFNE Online which could be useful to other people? If so we'd like to hear about it with a view to adding it to our Diary/Graphs.

Thanks,

Simon

Oct 25, 2009

Tracey Bond 14 posts

Topic: General Discussion / Needle Bins

Hi Everyone

Sharps bins are now being given out by local authorities. Just telephone the 'Enviornmental Health Department' of your local authority and they will then arrange delivery and collection.

Tracey Bond

Oct 25, 2009

Tracey Bond 14 posts

Topic: General Discussion / Dawn Phenomenon

Hi Sam

I have been diabetic for 29 years and have only just completed my Dafne course In Norwich. I know how frustrating your situation is but I have a suggestion rather than you just inceasing your BI as I don't think it's the cause.

Test your BG AT 03.00 am to see if you are suffering from either 'hypo rebound' or the 'dawn phenomenon'.

It could well be that your BI need increasing but before you do that it is important to rule out all other possibilities first.

Just one other thing 'ratios' are different for everyone, 1:1 is only a starting point for Dafne it is by no means the 'norm', so please don't think it is a place that needs to be attained.

Hope this helps if it doesn't you haven't lost anything.

Tracey x

Oct 25, 2009

Alann 12 posts

Topic: Site Development / Online BG Diaries

Hi Simon and all,

Not really sure if this is appropriate here for within the thread regarding meter download. But here goes, feel free to move it if you think it would be better placed in the other thread.

As a user who doesn't use a paper diary but a database (much to the disapproval of my HCPs) it's a pain to have constantly entering data in one system then another. The ability to import results via csv, or xml would be an real bonus. I'm assuming the data held on the site is sorted in an SQL database therefore it should not be too complex import from these format.

As an IT professional if I can assist please feel free to contact me.

Kindest regards,

Alan

Oct 24, 2009

hankypanky 18 posts

Topic: General Discussion / Hello!!

hi shazz
lets hope your a1c keeps coming down as mine has improved since the "DAFNE" cool course, i think loads of us are in denial at times but we gotta be strong and live with it Smile

ive been diagnosed since feb 95 and been in denial loads but there are loads of risks etc if you go down that line, thats why im never going there again but me having diabetes since 95 im stilll learning there is loads more stuff that i/we dont know,
good luck with your a1c
take care steve Smile

Oct 24, 2009

Vince 2 posts

Topic: Carbohydrate Counting / Parsnips

Hi

First post. Does anyone know the CP value of roasted parsnips? I've assumed the same as a roast potato but not sure....any ideas please?

Oct 26, 2009 marke 681 posts	Topic: General Discussion / New Job I agree with Katy B, there is no rule that says you cannot use a 0.5:1 ratio. Any ratio is valid if it works for you ! I would say though its worth you re-reading the section of the course on exercise ( either online or on paper). The effects of exercise can last a long time easily into the next day. I would suggest drop to 0.5/1 see how it goes, then adjust BI as well ( seperately of course, not at the same time !). Its problably worth you running high for a few days, just to ensure you keep your hypo warning signs and to try to fix the issue. Its not going to cause you a problem to run high for a week and then you can wind down your BG's and increase your insulins to get things back in line. How you adjust for days when you don't do exercise I guess is going to be tricky, it will be the next day most likely when you see the effects of no exercise NOT the same day. Unfortuantely I think its just trial and error, just like the rest of life :-)

Oct 26, 2009 marke 681 posts	Topic: General Discussion / Dawn Phenomenon Hi, Just to prove the people running the site, are just the same as you ;-) I am having a similiar issue to you regarding my BG being too high in the morning. Last nights 'fast' proved that its not my BI as I hypo-ed in the night, so I will now lower it slightly and investigate other options. As a point of interest when I went to the DAFNE Collaborative this year ( see User Group forum), there was a presentation by Prof Simon Heller about the dawn phenomeon. The relavent extract is 'The next two speakers gave a presentation relating to background insulin and its capability to last over 24 hours and probably more interestingly the misconceptions surrounding the Somogyi effect or rebound Hyperglycemia. It has been suggested that many high blood sugars in the morning are caused by night-time hypos. The presenters contended that this is generally NOT the case, the night time hypos only result in a relatively small rise in blood sugar. So if this is not the cause then what is ? It was suggested that the cause is a form of the Dawn Phenomenon where the body releases hormones. The factors that cause this rise are length of sleep, duration that a person has had diabetes and horizontal posture. The biggest issue with this hormone release is it occurs from 5am onwards. This means using an increase of background insulin the night before is not a good way to treat it, since a hypo would occur in the hours before the increase in hormones. The only effective way to treat it is by injecting fast acting insulin, which is a bit of an issue since most people are not awake at 5am. One method would be the use of insulin pumps, but since these are still not widely available to all Diabetics there is no easy solution.' That doesn't provide a solution I'm afraid but it might provide an insight into what is happening to you as well as me. Unfortunately I have not seen any follow up to this, if I see any follow ups I will post on this site.

Oct 26, 2009 Daphne 2 posts	Topic: Questions for HCPs / BG Parameters Hope it's working out for you. My experience is ancient (daughter now 23) but had best availble pregancy care, was great, my adice is carry lucozade at all times, thank goodness for modern test equipment, you'll get more hypos so be careful but the hassle is all worth it, it's a fabulous thing to do, go for it.

Oct 26, 2009 Daphne 2 posts	Topic: General Discussion / Help, am panicking hello pump panicker - I don't have one, and as a new user of this web forum am a bit scared by the fact that quite a lot of people seem to have hb1ac levels lower than mine - never mind. So far so good, no major complicatons after 41 years on insulin, the first 15 years or so with no idea what by blood sugar or hb1ac was at all. Anyway I thought I'd mention that a couple of years ago I met an American swimmer on a swimming holiday who was a pump user. Pumps are much more widely used there. He was aged about 30, on insulin for about 5 years, had been a collegiate swimmer. We did long open water swims, some took 2 hours or more. (We were fed sugary drinks every half hour, has safety boats, etc). He disconnected the pump beforehand and reconnected afterwards. He carried little sachets of glocose everywhere, had them secreted in his speedos. It was great that there were two of us in the group on insulin. I can't put you directly in touch with him but can assure you that he was unconcerned about disconnecting for those periods of time while doing exercise. Made me think. Have discussed it with doc lately, not being particularly encouraged to do it at the moment but I suppose that could change. Good luck Daphne (yes, really..)

Oct 26, 2009 Tracey Bond 14 posts	Topic: General Discussion / Dawn Phenomenon Hi Sam If you are having hypos you need to ask yourself why? Too much insulin, CPs not counted correctly. If you test your BG 5 hours after your supper you will know that the only insuling working is your BI. If you are confident that your BI's are working and holding you stable (both am and pm) and your ratio's are correct and your BG is still rising through the night (3am upto 11am) the next day it could well be that our friend 'Dawn' is knocking. It is really important to establish a repeated pattern and eliminate all other possibilities, ie. exercise and alcohol before acting. I personally act to quickly then live to regret it, so believe me when I say' slowly slowly catchie monkey'!! Tracey x

Oct 26, 2009 Katy B 8 posts	Topic: General Discussion / New Job Hi Claire, don't worry about dropping to a 0.5:1 ratio. I've been using that ratio for the past two months and its worked brilliantly for me. 1:1 was given as a starting point, some people need more, some people need less. I take 0.5:1 on most days but if its my day off and im just watching tv and being really lazy then i can use 1:1. I find i dont need to adjust the BI. I think you still might need to lower your BI as you should be able to go to bed on that 7-8 that you mentioned and wake up somewhere in target. Don't worry about trying the lower ratio. If it doesnt work, you'll find out at the next meal and you can correct it, if it does work then you've avoided your lows!! x

Oct 26, 2009 Tracey Bond 14 posts	Topic: Questions for HCPs / Rising morning BG'S with/without breakfast. Hi, thank you for replying. I have come to think that what you are saying is right. I'm afraid I'm a bit of a perfectist, I don't want 'Dawn' to keep knocking at my door. I just want my Lantus to work effectively and to have the freedom that I thought Dafne could offer without messing around with insulin etc. Once again thank you.

Oct 26, 2009 sphillips 24 posts	Topic: Questions for HCPs / Rising morning BG'S with/without breakfast. Hi It sounds to me like what you're describing is the dawn rise in BG that happens as your body is waking up and can go on through to mid morning ( eg 4am-11am ish). It's quite common for people to notice a rise this is why we often need a higher ratio in the morning if we have breakfast and why you would have been advised to have morning QA even without breakfast. I've noticed that because the profile of lantus is so flat it can be difficult to manage the dawn rise, even on a split dose. I would suggest you speak to your DAFNE educator about the options and possibly changing your BI. Meantime you could try some cautios corrective doses at breafast maybe a couple of units, make sure you monitor the affects and I wouldn't do this and then drive, perhaps try it on a morning when you're mostly at home or when you could safely manage a hypo.

Oct 26, 2009 sphillips 24 posts	Topic: Carbohydrate Counting / Parsnips Hi. How did it work out when you counted the same as pots? If you count them I'd be tempted to only count half the cp value as they may only have a limited affect on your BG due to their low GI value.

Oct 26, 2009 copperline 2 posts	Topic: General Discussion / Least painful lancet?? Since being diagnosed nearly 3 years ago I must have performed at least 5000 BG tests - resulting in quite sore fingers. I originally used the lancet system that came with the Bayer Contour meter I was given at diagnosis. This only worked if I used it at is highest setting. I have recently been using an Accu-Chek Multiclix pen (encourages you to use a new lancet for every BG test) but this is quite brutal. I would be interested to hear what other system would be recommended - or maybe I am just soft! Thanks

Oct 26, 2009 Sue R 3 posts	Topic: Carbohydrate Counting / Glucotabs: Where they can be found? Hi Are Glucotabs not available on prescription?

Oct 26, 2009 Sue R 3 posts	Topic: General Discussion / Introductions Hi I'm Sue, Diagnosed with Type 1 in April 1979. So have had diabetes for over 30 years with control problems. Graduated DAFNE course at Aberdeen Royal Infirmary in October 2008. Bi is Lantus - 30 units at 11pm QA is NovoRapid - on a 2:1 ratio at mealtimes with correction for dawn phenomenon at breakfast. Last HbA1c was 8.2, down from 9.8 before course (and striving for better!!). Much happier in myself nowadays because DAFNE highlighted some issues (dawn phenomenon), but now i understand them i can deal with them better. Looking forward to sharing experiences. Cheers Sue

Oct 26, 2009 Sue R 3 posts	Topic: General Discussion / Needle Bins Hi all, Just joined the site, and this seems to be quite an issue for some areas of the country. I am rather lucky in that i am supplied with a sharps bin by my local surgery and when it's full i hand it back in and they give me another one. No messing about with local council or having to get one on prescription.

Oct 25, 2009 Sam 64 posts	Topic: General Discussion / Dawn Phenomenon thanks Tracey. I'll certainly give it a go. If it is hypos I'm having what can be done to prevent them, do you know? 29 years is a long time you must have a lot of different experiences behind you and just goes to show all that time and still no steady cures! Maybe one day. Thanks for the advice. Sam x

Oct 25, 2009 Simon 578 posts	Topic: Site Development / Online BG Diaries Wow, sounds complicated - but as long as it works for you that's all that matters! Will look into uploading via CSV/XML and post progress here. Are there any features in your current setup that you'd like to see in the DAFNE Online diary? Simon

Oct 25, 2009 Alann 12 posts	Topic: Site Development / Online BG Diaries Actually Simon my data is currently backed up / duplicated in four different locations, one on-line, on a pocket-pc device and then backup on two computers. All sync'd from a master source. I see the main reason / aim for using the online diary is to easily share the data with other for support and advice. I know other who use a spreadsheet to record there result. I haven't written by own software as i don't believe in re-inventing the wheel. I use sidiay (german software) which meets all my needs and more. (this is a personal preference and by no means a recommendation). Kindest regards, Alan

Oct 25, 2009 Simon 578 posts	Topic: Site Development / Online BG Diaries Hi Alan, Yes the data is stored in an SQL database, and I'm sure we could implement some sort of functionality that could parse an XML file and add the results to your DAFNE Online Diary. I guess I'd have to publish the XML format we needed for you to export from your database (I assume this is Access or similar). One question on this though - would you want the data duplicated in two places? Obviously there's benefits to both - you don't have to be online to access your own database, and its backed up locally for you, however with the DAFNE Online diary, you can access anywhere, and share with other users, etc. Is there functionality you have set up in your local Database that is missing from DAFNE Online which could be useful to other people? If so we'd like to hear about it with a view to adding it to our Diary/Graphs. Thanks, Simon

Oct 25, 2009 Tracey Bond 14 posts	Topic: General Discussion / Needle Bins Hi Everyone Sharps bins are now being given out by local authorities. Just telephone the 'Enviornmental Health Department' of your local authority and they will then arrange delivery and collection. Tracey Bond

Oct 25, 2009 Tracey Bond 14 posts	Topic: General Discussion / Dawn Phenomenon Hi Sam I have been diabetic for 29 years and have only just completed my Dafne course In Norwich. I know how frustrating your situation is but I have a suggestion rather than you just inceasing your BI as I don't think it's the cause. Test your BG AT 03.00 am to see if you are suffering from either 'hypo rebound' or the 'dawn phenomenon'. It could well be that your BI need increasing but before you do that it is important to rule out all other possibilities first. Just one other thing 'ratios' are different for everyone, 1:1 is only a starting point for Dafne it is by no means the 'norm', so please don't think it is a place that needs to be attained. Hope this helps if it doesn't you haven't lost anything. Tracey x

Oct 25, 2009 Alann 12 posts	Topic: Site Development / Online BG Diaries Hi Simon and all, Not really sure if this is appropriate here for within the thread regarding meter download. But here goes, feel free to move it if you think it would be better placed in the other thread. As a user who doesn't use a paper diary but a database (much to the disapproval of my HCPs) it's a pain to have constantly entering data in one system then another. The ability to import results via csv, or xml would be an real bonus. I'm assuming the data held on the site is sorted in an SQL database therefore it should not be too complex import from these format. As an IT professional if I can assist please feel free to contact me. Kindest regards, Alan

Oct 24, 2009 hankypanky 18 posts	Topic: General Discussion / Hello!! hi shazz lets hope your a1c keeps coming down as mine has improved since the "DAFNE" cool course, i think loads of us are in denial at times but we gotta be strong and live with it ive been diagnosed since feb 95 and been in denial loads but there are loads of risks etc if you go down that line, thats why im never going there again but me having diabetes since 95 im stilll learning there is loads more stuff that i/we dont know, good luck with your a1c take care steve

Oct 24, 2009 Vince 2 posts	Topic: Carbohydrate Counting / Parsnips Hi First post. Does anyone know the CP value of roasted parsnips? I've assumed the same as a roast potato but not sure....any ideas please?