Recent Posts - DAFNE Online

Sep 20, 2016

Yelekreb 11 posts

Topic: General Discussion / Is the honeymoon over?

Yes, the very helpful team at the local hopsital saw me quickly. Really I'm doing all the right things....which simply means applying the DAFNE principles! Pancreas still being random...why be dull.

Sep 20, 2016

Susanf 29 posts

Topic: General Discussion / Is the honeymoon over?

Hi, Have you spoken to your healthcare professionals to see what they suggest. Smile

Sep 13, 2016

HelenP 218 posts

Topic: General Discussion / free style libre sensor problem

Mans, Just had an email from the "educator" apparently the Medtronic sensors occasionally fail but they are working on changing the algorithm so that they fail less frequently. I suggest you try and get a replacement/refund. The company needs to know about the "fails". Helen

Sep 12, 2016

Mans 2 posts

Topic: General Discussion / free style libre sensor problem

Thanks for everybody.
I think the only alternative solution is to replace the sensor, I hope it will work this time. I will updating you with the latest.

Sep 12, 2016

HelenP 218 posts

Topic: General Discussion / free style libre sensor problem

OK Update...I rang Medtronic and after they quizzed me and verified my complaint by the data that was in my pump, they are replacing the sensor...it will be here within 24 hours. They did ask me to send them the old sensor but I had already thrown it out...so advice keep the sensor and send it in with the complaint.

Helen

Sep 12, 2016

HelenP 218 posts

Topic: General Discussion / free style libre sensor problem

I just had a second "fail...replace sensor". Tried four to five times to "reconnect" but nothing worked.

I am in the process of seeing what I can do. Ought we not be given a refund..."not fit for purpose"? Or at least a replacement.

Currently I purchase them on a 5 per month scheme for $AUD250. As they last six days If you have a fail it costs $50 but then if you use another sensor you will not have enough to last the month. Currently having it on for 6 days (the life of one sensor) have it off for sundays and replace on the Monday morning.

Helen

Sep 10, 2016

HelenP 218 posts

Topic: General Discussion / free style libre sensor problem

I use the Medtronic sensor and had a similar "fail". Tried everything but ended up replacing sensor...expensive exercise! Helen

Sep 10, 2016

Mans 2 posts

Topic: General Discussion / free style libre sensor problem

Hi,
Hi,
I used the free style libre for the first time since 7 days. It works fine and gives readings. Yesterday, I received the following message to replace the current sensor by new one. Accordingly, I replaced the old sensor with the new one, when the reader scan for new sensor, it gives following message
"Please check sensor. If it is loose from your skin, please remove the sensor and start a new one. If it is applied properly, try starting sensor again."
After that, the reader requesting new sensor to scan it, gives a normal message to wait for 60 minutes, when scan the sensor to get reading, it gives the earlier message and started 60 minutes waiting again. This happened until now 4 - 5 times with the same attitude. I am quite sure that new sensor is fixed well on the arm but i do not know what is going on? any clues? Thanks

Mans

Aug 29, 2016

marke 643 posts

Topic: General Discussion / NICE Guidance on Diabetes

hhmmm, seems medical staff are the same the world over :-( They mean well but think their training equips them to have understanding of stuff they don't fully grasp. As I said all you need is a firm attitude and they do as they are told usually ;-)

Aug 29, 2016

Warwick 430 posts

Topic: General Discussion / Hypo Awareness

No problem Richard. I just wanted to be sure rather than assume something that wasn't actually correct.

You keep a very detailed diary, so well done on that.

Is the above fairly typical for you with mainly high values or was that week different from usual?

Do you feel hypos occasionally or do you have no symptoms at all?

Would you be able to post your diary for this week? I think that your basal (or at least your night time basal) is correct.

Your blood sugars rise significantly between early morning and when you take breakfast about 10 am. There are two possibilities that I can think of to account for this:

1) You are suffering from Dawn Phenomenon which most T1Ds do suffer from. You will notice that most of your overnight (1 am readings) are pretty good, but during the night they rise and then keep on rising from 7ish in the morning until you have breakfast around 10.

2) Your basal insulin runs out overnight. This could well be a possibility as you are injecting very early evening, and then waiting until mid-morning to inject again so there is about a 16 hour interval between your evening dose and your morning one, and then only about 8 hours between morning and evening dose. Can I suggest that you change the timing of the basal insulin doses so they are almost exactly 12 hours apart? That would then allow me to see if it is the basal insulin running out, or the Dawn Phenomenon that is the issue.

What QA and basal insulin are you on? If you are on Lantus which generally lasts 18-24 hours, then it probably isn't the second possibility above, but if you are on something like Levemir which has a shorter action time, then it could well be.

Thanks,
Warwick.

Aug 29, 2016

RichoDemo 3 posts

Topic: General Discussion / Hypo Awareness

Thanks Warick. Yes that's right about the carbs. and portions just the way I write it and my memory is bad so the nurse said she can put up with it. I asked my ex wife about my severe hypo years ago and it was probably more than 6 years ago. I was only seeing a endo. for about 6 mths after that. The start of this year or late last year I have just seeing one again. They are thinking in all that time 6yrs. or more that I have probably lost my hypo awareness. That is probably right. I haven't worked for 12 months because I can't get a medical clearance. I'm working hard on getting it write but some days I have had enough a lot of ups and downs. I don't no weather I'm Auther or Martha some days any way enough of my problems it's a beautiful sunny dayðŸ˜Ž Thanks Warick. I'm bloody hopeless with computers and writing as you have noticed and that why basal entry's are wrong. Am and Pm it should be of 8 units levemir.
Thanks Richard

Aug 25, 2016

Warwick 430 posts

Topic: General Discussion / Hypo Awareness

I can see why you are feeling frustrated. There seems to be large swings from hight to low and back again with not a lot of readings in the desired range.

Can I ask why the number of basal injections vary so much from day to day? i.e Sunday 1 basal injection, Monday 4, Tuesday 2, Wednesday 4, Thursday 6, Friday 3, Saturday 5 and Sunday 4.

When I look at others' diaries, usually they inject basal insulin only once or twice per day, and it tends to largely be the same amount each day at the same time(s). If this isn't just a diary input error, then it would explain why your BGLs are so unpredictable.

One of the DAFNE principles is to only make small changes (10%) to basal insulin doses and then wait a couple of days to see how BGLS respond.

Also, not particularly important, but a CP is 10g of carb. I suspect that you are entering grams of carbs instead of CPs. So for example on Monday, your 126 CPs would equal 1.26 kg of carbohydrate which would be a fairly significant achievement Very Happy

Just in terms of making the diary more readable for others, if it is in fact 126 grams of carb, then divide by 10 and round to the nearest CP so it becomes 13 CPs. Or if it is more helpful for you to leave it in grams, then leave it that way and we'll figure it out. Wink

Thanks,
Warwick.

Aug 24, 2016

RichoDemo 3 posts

Topic: General Discussion / Hypo Awareness

Warwick said:
Hypo unawareness usually develops from having too many hypos. I attended an excellent presentation by Professor Stephanie Amiel recently on fighting hypos:

https://youtu.be/jV1ta51w5J4

https://www.diabetesvic.org.au/See-all-news-detail?content_id=a1R9000000JPHzjEAH

I found it very helpful and I'd highly recommend viewing it.

My understanding of regaining hypo awareness is to avoid having hypos for a period of time. This can be achieved by raising your target BG levels for a period of about 6 weeks, so rather than aiming to keep BGs between 4.5-8, you would look at keeping them between 6.5 -10. The risk of diabetic complications over such a short period of time is extremely low, and usually some hypo awareness will return by the end of the 6 weeks.

An alternative (if you can afford it) is to wear a continuous glucose monitor (CGM). I wear a Dexcom G4 which alerts me when my BGLs drop below a set BGL reading that I have specified as being low for me. Prior to wearing the CGM, I was confident that I had excellent hypo awareness, but once I was wearing it, I discovered that I was having multiple hypos, especially during the night, that I had no idea about. My hypo awareness is now much better as I have avoided having as many hypos as previously. The Abbot Freestyle Libre is a popular choice on this forum and is certainly cheaper than the Dexcom. However, unlike the Dexcom it does not alert you when you are hyper or hypo, so is not as useful for avoiding hypos (although it can be excellent for detecting patterns).

Hope that helps.

Aug 24, 2016

Warwick 430 posts

Topic: General Discussion / NICE Guidance on Diabetes

Hello Helen, I have ICE in my phone, and I also wear a RoadID except when I sleep - https://www.roadid.com/c/roadid-wrist-sale I have not needed it yet, but I am sure that I will need it one day.

Aug 24, 2016

HelenP 218 posts

Topic: General Discussion / NICE Guidance on Diabetes

Warwick,
Re the hospital admission for the blood infection (above post). The ambos came...I had been conscious enough to ring but had passed out before they got there. They were standing around as I regained consciousness and had read a "sign" I keep on the fridge ..."I am a diabetic etc etc". They had checked my BG and it was fine. They collected the insulin stuff I keep in a bag similar to yours with everything I would need for a week as well as the insulin from the fridge. I think if you are in a private hospital you have much more say but as I had arrived less than 6 hours ago from Korea they wanted to put me in an infectious ward until they found out what it was...hence the big public hospital.

The ambos also check for next of kin details etc in a purse or wallet. Do you have an ICE number in your phone? I was encouraged to put (my son's name as an ICE (In Case of Emergency) number. Have never needed it but it is there. Ambos are trained to look fro it apparently.

Trust we can stay out of hospital!!! Helen

Aug 24, 2016

Warwick 430 posts

Topic: General Discussion / Hypo Awareness

Hypo unawareness usually develops from having too many hypos. I attended an excellent presentation by Professor Stephanie Amiel recently on fighting hypos:

https://youtu.be/jV1ta51w5J4

https://www.diabetesvic.org.au/See-all-news-detail?content_id=a1R9000000JPHzjEAH

I found it very helpful and I'd highly recommend viewing it.

My understanding of regaining hypo awareness is to avoid having hypos for a period of time. This can be achieved by raising your target BG levels for a period of about 6 weeks, so rather than aiming to keep BGs between 4.5-8, you would look at keeping them between 6.5 -10. The risk of diabetic complications over such a short period of time is extremely low, and usually some hypo awareness will return by the end of the 6 weeks.

An alternative (if you can afford it) is to wear a continuous glucose monitor (CGM). I wear a Dexcom G4 which alerts me when my BGLs drop below a set BGL reading that I have specified as being low for me. Prior to wearing the CGM, I was confident that I had excellent hypo awareness, but once I was wearing it, I discovered that I was having multiple hypos, especially during the night, that I had no idea about. My hypo awareness is now much better as I have avoided having as many hypos as previously. The Abbot Freestyle Libre is a popular choice on this forum and is certainly cheaper than the Dexcom. However, unlike the Dexcom it does not alert you when you are hyper or hypo, so is not as useful for avoiding hypos (although it can be excellent for detecting patterns).

Hope that helps.

Aug 24, 2016

Warwick 430 posts

Topic: Questions for HCPs / Why ketones with low blood sugars?

The body will produce ketones when it can't use blood glucose as an energy source. There are a number of reasons why the body will produce them including severe dehydration, lack of insulin, fasting, or a ketogenic diet (low-carb diet).

Ketone build up becomes dangerous if there is a lack of insulin present as it can quickly lead to Diabetic Ketoacidosis which will make you ill very quickly.

I was on a conference on exercising with diabetes recently, and one of the speakers there is one of the world's leading researchers into exercising with diabetes. His view is that as long as insulin is present, ketones should not usually cause an issue, but if insulin is not present, then it becomes a big issue.

From talking with others who have experienced DKA, it seems much more common amongst T1Ds who pump than use MDI. Pumpers who experience a blocked cannula, can be without any insulin after about 4 hours, whereas as those who inject usually have basal insulin in their body which lasts 12-24 hours and therefore doesn't cause so much of an issue. That isn't to say that MDI can't lead to DKA - it definitely can, but it appears to be more rare.

I honestly don't know why you would have low blood sugars and high ketones. Do your medical team believe that you are still in the honeymoon period where your pancreas is still producing some insulin? I imagine that it could be possible for the pancreas in this case to produce some insulin which lowers BGLs, but then stop, and for ketones to then build up. I am not medically trained though and the one thing I have learned from T1D is that there are so many factors, some of which are completely unknown that can have an influence on my diabetes management.

Did having high ketones lead to an issue such as DKA, or are you otherwise fine?

Aug 24, 2016

Warwick 430 posts

Topic: General Discussion / NICE Guidance on Diabetes

I have a spare kit containing BG meter, jelly beans, needles and an insulin pen. It has instructions inside on what insulin to take from the fridge. If I end up in hospital, my wife will bring it to me, and I will not be telling the medical staff about it. It will be my backup for if they take my primary kit off me. I have heard too many horror stories of well meaning staff putting our lives at risk from their ignorance and I am taking no chances.

Thinking about it, I might also get my excellent GP to write me a letter stating that I have excellent blood glucose control and am fully aware of how to make necessary changes to my insulin doses and that can be included in the kit.

I have also made my wife a medical power of attorney so that if I am in no state to make decisions, she can make them on my behalf.

Aug 19, 2016

HelenP 218 posts

Topic: General Discussion / NICE Guidance on Diabetes

Hi Mark, On the hospital situation...here in Australia I was told by the doctor that it was my responsibility and the nurses would not be involved...great! I took my pump off to have a shower and left it on the bed as I do at home only to find out the nurse had taken it because I was not a diabetic or in need of insulin.

It was a shared room and my room mate was quite happy to report this. Tried to get it back by going to the nurses station but no luck. Ended up getting a message to the doctor who "fixed" the situation. I was without it for over an hour!!!! The nursing staff then took an extraordinary interest in my insulin doses and wanted to record every time I took some insulin...pump users will know how ridiculous this is!

I was in an infectious diseases ward!

Helen

Aug 19, 2016

Julie Meehan 1 post

Topic: DAFNE Online Mobile / DAFNE Excel Spreedsheat

Could I please please please get a copy sent to me at [email protected]. Thanks!!!

Aug 19, 2016

marke 643 posts

Topic: General Discussion / NICE Guidance on Diabetes

The DAFNE Programme team have asked us to publish this information on our news page. It relates to a new document issued by NICE ( UK medical body) regarding Diabetes. If I sound a bit cynical in the news article its because NICE publish lots of guidance but none of it is actually mandatory and so the NHS is free to do what it wants. The idea of people being given structured education within 12 months of Diagnosis would be great if it wasn't for the fact that in my area the waiting list to do a course is about 18 months, So even if you are referred for a course within 12 months you won't actually do one. They also say that Diabetics should be allowed to manage their own diabetes if admitted to hospital, someone needs to tell nurses this Sad

I had to be very firm, borderline rude when they tried to take over my management when I was in hospital. However not everyone is a 'difficult' person like me and will accept their management being taken over on the grounds that the nurse knows best ( not unless they are a Diabetes nurse and even then sometimes no Wink

)

Anyway have a read and see what YOU think......

Aug 11, 2016

rose_02 1 post

Topic: Questions for HCPs / Why ketones with low blood sugars?

Hi,

I was recently diagnosed with type 1 and taken off insulin straight away as my bloods were so low. However, while they remained low off the insulin, I was still developing ketones. My team have no idea why and no tips on what to do, other than keep checking and retaking my insulin but if anyone could give me more advice that would be great!

Aug 11, 2016

RichoDemo 3 posts

Topic: General Discussion / Hypo Awareness

Had diabetes for 32 years. New to Dafne but have been counting carbs. for about 6 years. Is there anyone that's has had hypo awareness. I haven't worked for about 8 months because of this and have been trying all of this time to get it back. Does anyone have any advice. I have just about had enough of diabetes

Sep 20, 2016 Yelekreb 11 posts	Topic: General Discussion / Is the honeymoon over? Yes, the very helpful team at the local hopsital saw me quickly. Really I'm doing all the right things....which simply means applying the DAFNE principles! Pancreas still being random...why be dull.

Sep 20, 2016 Susanf 29 posts	Topic: General Discussion / Is the honeymoon over? Hi, Have you spoken to your healthcare professionals to see what they suggest.

Sep 13, 2016 HelenP 218 posts	Topic: General Discussion / free style libre sensor problem Mans, Just had an email from the "educator" apparently the Medtronic sensors occasionally fail but they are working on changing the algorithm so that they fail less frequently. I suggest you try and get a replacement/refund. The company needs to know about the "fails". Helen

Sep 12, 2016 Mans 2 posts	Topic: General Discussion / free style libre sensor problem Thanks for everybody. I think the only alternative solution is to replace the sensor, I hope it will work this time. I will updating you with the latest.

Sep 12, 2016 HelenP 218 posts	Topic: General Discussion / free style libre sensor problem OK Update...I rang Medtronic and after they quizzed me and verified my complaint by the data that was in my pump, they are replacing the sensor...it will be here within 24 hours. They did ask me to send them the old sensor but I had already thrown it out...so advice keep the sensor and send it in with the complaint. Helen

Sep 12, 2016 HelenP 218 posts	Topic: General Discussion / free style libre sensor problem I just had a second "fail...replace sensor". Tried four to five times to "reconnect" but nothing worked. I am in the process of seeing what I can do. Ought we not be given a refund..."not fit for purpose"? Or at least a replacement. Currently I purchase them on a 5 per month scheme for $AUD250. As they last six days If you have a fail it costs $50 but then if you use another sensor you will not have enough to last the month. Currently having it on for 6 days (the life of one sensor) have it off for sundays and replace on the Monday morning. Helen

Sep 10, 2016 HelenP 218 posts	Topic: General Discussion / free style libre sensor problem I use the Medtronic sensor and had a similar "fail". Tried everything but ended up replacing sensor...expensive exercise! Helen

Sep 10, 2016 Mans 2 posts	Topic: General Discussion / free style libre sensor problem Hi, Hi, I used the free style libre for the first time since 7 days. It works fine and gives readings. Yesterday, I received the following message to replace the current sensor by new one. Accordingly, I replaced the old sensor with the new one, when the reader scan for new sensor, it gives following message "Please check sensor. If it is loose from your skin, please remove the sensor and start a new one. If it is applied properly, try starting sensor again." After that, the reader requesting new sensor to scan it, gives a normal message to wait for 60 minutes, when scan the sensor to get reading, it gives the earlier message and started 60 minutes waiting again. This happened until now 4 - 5 times with the same attitude. I am quite sure that new sensor is fixed well on the arm but i do not know what is going on? any clues? Thanks Mans

Aug 29, 2016 marke 643 posts	Topic: General Discussion / NICE Guidance on Diabetes hhmmm, seems medical staff are the same the world over :-( They mean well but think their training equips them to have understanding of stuff they don't fully grasp. As I said all you need is a firm attitude and they do as they are told usually ;-)

Aug 29, 2016 Warwick 430 posts	Topic: General Discussion / Hypo Awareness No problem Richard. I just wanted to be sure rather than assume something that wasn't actually correct. You keep a very detailed diary, so well done on that. Is the above fairly typical for you with mainly high values or was that week different from usual? Do you feel hypos occasionally or do you have no symptoms at all? Would you be able to post your diary for this week? I think that your basal (or at least your night time basal) is correct. Your blood sugars rise significantly between early morning and when you take breakfast about 10 am. There are two possibilities that I can think of to account for this: 1) You are suffering from Dawn Phenomenon which most T1Ds do suffer from. You will notice that most of your overnight (1 am readings) are pretty good, but during the night they rise and then keep on rising from 7ish in the morning until you have breakfast around 10. 2) Your basal insulin runs out overnight. This could well be a possibility as you are injecting very early evening, and then waiting until mid-morning to inject again so there is about a 16 hour interval between your evening dose and your morning one, and then only about 8 hours between morning and evening dose. Can I suggest that you change the timing of the basal insulin doses so they are almost exactly 12 hours apart? That would then allow me to see if it is the basal insulin running out, or the Dawn Phenomenon that is the issue. What QA and basal insulin are you on? If you are on Lantus which generally lasts 18-24 hours, then it probably isn't the second possibility above, but if you are on something like Levemir which has a shorter action time, then it could well be. Thanks, Warwick.

Aug 29, 2016 RichoDemo 3 posts	Topic: General Discussion / Hypo Awareness Thanks Warick. Yes that's right about the carbs. and portions just the way I write it and my memory is bad so the nurse said she can put up with it. I asked my ex wife about my severe hypo years ago and it was probably more than 6 years ago. I was only seeing a endo. for about 6 mths after that. The start of this year or late last year I have just seeing one again. They are thinking in all that time 6yrs. or more that I have probably lost my hypo awareness. That is probably right. I haven't worked for 12 months because I can't get a medical clearance. I'm working hard on getting it write but some days I have had enough a lot of ups and downs. I don't no weather I'm Auther or Martha some days any way enough of my problems it's a beautiful sunny dayðŸ˜Ž Thanks Warick. I'm bloody hopeless with computers and writing as you have noticed and that why basal entry's are wrong. Am and Pm it should be of 8 units levemir. Thanks Richard

Aug 25, 2016 Warwick 430 posts	Topic: General Discussion / Hypo Awareness I can see why you are feeling frustrated. There seems to be large swings from hight to low and back again with not a lot of readings in the desired range. Can I ask why the number of basal injections vary so much from day to day? i.e Sunday 1 basal injection, Monday 4, Tuesday 2, Wednesday 4, Thursday 6, Friday 3, Saturday 5 and Sunday 4. When I look at others' diaries, usually they inject basal insulin only once or twice per day, and it tends to largely be the same amount each day at the same time(s). If this isn't just a diary input error, then it would explain why your BGLs are so unpredictable. One of the DAFNE principles is to only make small changes (10%) to basal insulin doses and then wait a couple of days to see how BGLS respond. Also, not particularly important, but a CP is 10g of carb. I suspect that you are entering grams of carbs instead of CPs. So for example on Monday, your 126 CPs would equal 1.26 kg of carbohydrate which would be a fairly significant achievement Just in terms of making the diary more readable for others, if it is in fact 126 grams of carb, then divide by 10 and round to the nearest CP so it becomes 13 CPs. Or if it is more helpful for you to leave it in grams, then leave it that way and we'll figure it out. Thanks, Warwick.

Aug 24, 2016 RichoDemo 3 posts	Topic: General Discussion / Hypo Awareness Warwick said: Hypo unawareness usually develops from having too many hypos. I attended an excellent presentation by Professor Stephanie Amiel recently on fighting hypos: https://youtu.be/jV1ta51w5J4 https://www.diabetesvic.org.au/See-all-news-detail?content_id=a1R9000000JPHzjEAH I found it very helpful and I'd highly recommend viewing it. My understanding of regaining hypo awareness is to avoid having hypos for a period of time. This can be achieved by raising your target BG levels for a period of about 6 weeks, so rather than aiming to keep BGs between 4.5-8, you would look at keeping them between 6.5 -10. The risk of diabetic complications over such a short period of time is extremely low, and usually some hypo awareness will return by the end of the 6 weeks. An alternative (if you can afford it) is to wear a continuous glucose monitor (CGM). I wear a Dexcom G4 which alerts me when my BGLs drop below a set BGL reading that I have specified as being low for me. Prior to wearing the CGM, I was confident that I had excellent hypo awareness, but once I was wearing it, I discovered that I was having multiple hypos, especially during the night, that I had no idea about. My hypo awareness is now much better as I have avoided having as many hypos as previously. The Abbot Freestyle Libre is a popular choice on this forum and is certainly cheaper than the Dexcom. However, unlike the Dexcom it does not alert you when you are hyper or hypo, so is not as useful for avoiding hypos (although it can be excellent for detecting patterns). Hope that helps.

Aug 24, 2016 Warwick 430 posts	Topic: General Discussion / NICE Guidance on Diabetes Hello Helen, I have ICE in my phone, and I also wear a RoadID except when I sleep - https://www.roadid.com/c/roadid-wrist-sale I have not needed it yet, but I am sure that I will need it one day.

Aug 24, 2016 HelenP 218 posts	Topic: General Discussion / NICE Guidance on Diabetes Warwick, Re the hospital admission for the blood infection (above post). The ambos came...I had been conscious enough to ring but had passed out before they got there. They were standing around as I regained consciousness and had read a "sign" I keep on the fridge ..."I am a diabetic etc etc". They had checked my BG and it was fine. They collected the insulin stuff I keep in a bag similar to yours with everything I would need for a week as well as the insulin from the fridge. I think if you are in a private hospital you have much more say but as I had arrived less than 6 hours ago from Korea they wanted to put me in an infectious ward until they found out what it was...hence the big public hospital. The ambos also check for next of kin details etc in a purse or wallet. Do you have an ICE number in your phone? I was encouraged to put (my son's name as an ICE (In Case of Emergency) number. Have never needed it but it is there. Ambos are trained to look fro it apparently. Trust we can stay out of hospital!!! Helen

Aug 24, 2016 Warwick 430 posts	Topic: General Discussion / Hypo Awareness Hypo unawareness usually develops from having too many hypos. I attended an excellent presentation by Professor Stephanie Amiel recently on fighting hypos: https://youtu.be/jV1ta51w5J4 https://www.diabetesvic.org.au/See-all-news-detail?content_id=a1R9000000JPHzjEAH I found it very helpful and I'd highly recommend viewing it. My understanding of regaining hypo awareness is to avoid having hypos for a period of time. This can be achieved by raising your target BG levels for a period of about 6 weeks, so rather than aiming to keep BGs between 4.5-8, you would look at keeping them between 6.5 -10. The risk of diabetic complications over such a short period of time is extremely low, and usually some hypo awareness will return by the end of the 6 weeks. An alternative (if you can afford it) is to wear a continuous glucose monitor (CGM). I wear a Dexcom G4 which alerts me when my BGLs drop below a set BGL reading that I have specified as being low for me. Prior to wearing the CGM, I was confident that I had excellent hypo awareness, but once I was wearing it, I discovered that I was having multiple hypos, especially during the night, that I had no idea about. My hypo awareness is now much better as I have avoided having as many hypos as previously. The Abbot Freestyle Libre is a popular choice on this forum and is certainly cheaper than the Dexcom. However, unlike the Dexcom it does not alert you when you are hyper or hypo, so is not as useful for avoiding hypos (although it can be excellent for detecting patterns). Hope that helps.

Aug 24, 2016 Warwick 430 posts	Topic: Questions for HCPs / Why ketones with low blood sugars? The body will produce ketones when it can't use blood glucose as an energy source. There are a number of reasons why the body will produce them including severe dehydration, lack of insulin, fasting, or a ketogenic diet (low-carb diet). Ketone build up becomes dangerous if there is a lack of insulin present as it can quickly lead to Diabetic Ketoacidosis which will make you ill very quickly. I was on a conference on exercising with diabetes recently, and one of the speakers there is one of the world's leading researchers into exercising with diabetes. His view is that as long as insulin is present, ketones should not usually cause an issue, but if insulin is not present, then it becomes a big issue. From talking with others who have experienced DKA, it seems much more common amongst T1Ds who pump than use MDI. Pumpers who experience a blocked cannula, can be without any insulin after about 4 hours, whereas as those who inject usually have basal insulin in their body which lasts 12-24 hours and therefore doesn't cause so much of an issue. That isn't to say that MDI can't lead to DKA - it definitely can, but it appears to be more rare. I honestly don't know why you would have low blood sugars and high ketones. Do your medical team believe that you are still in the honeymoon period where your pancreas is still producing some insulin? I imagine that it could be possible for the pancreas in this case to produce some insulin which lowers BGLs, but then stop, and for ketones to then build up. I am not medically trained though and the one thing I have learned from T1D is that there are so many factors, some of which are completely unknown that can have an influence on my diabetes management. Did having high ketones lead to an issue such as DKA, or are you otherwise fine?

Aug 24, 2016 Warwick 430 posts	Topic: General Discussion / NICE Guidance on Diabetes I have a spare kit containing BG meter, jelly beans, needles and an insulin pen. It has instructions inside on what insulin to take from the fridge. If I end up in hospital, my wife will bring it to me, and I will not be telling the medical staff about it. It will be my backup for if they take my primary kit off me. I have heard too many horror stories of well meaning staff putting our lives at risk from their ignorance and I am taking no chances. Thinking about it, I might also get my excellent GP to write me a letter stating that I have excellent blood glucose control and am fully aware of how to make necessary changes to my insulin doses and that can be included in the kit. I have also made my wife a medical power of attorney so that if I am in no state to make decisions, she can make them on my behalf.

Aug 19, 2016 HelenP 218 posts	Topic: General Discussion / NICE Guidance on Diabetes Hi Mark, On the hospital situation...here in Australia I was told by the doctor that it was my responsibility and the nurses would not be involved...great! I took my pump off to have a shower and left it on the bed as I do at home only to find out the nurse had taken it because I was not a diabetic or in need of insulin. It was a shared room and my room mate was quite happy to report this. Tried to get it back by going to the nurses station but no luck. Ended up getting a message to the doctor who "fixed" the situation. I was without it for over an hour!!!! The nursing staff then took an extraordinary interest in my insulin doses and wanted to record every time I took some insulin...pump users will know how ridiculous this is! I was in an infectious diseases ward! Helen

Aug 19, 2016 Julie Meehan 1 post	Topic: DAFNE Online Mobile / DAFNE Excel Spreedsheat Could I please please please get a copy sent to me at [email protected]. Thanks!!!

Aug 19, 2016 marke 643 posts	Topic: General Discussion / NICE Guidance on Diabetes The DAFNE Programme team have asked us to publish this information on our news page. It relates to a new document issued by NICE ( UK medical body) regarding Diabetes. If I sound a bit cynical in the news article its because NICE publish lots of guidance but none of it is actually mandatory and so the NHS is free to do what it wants. The idea of people being given structured education within 12 months of Diagnosis would be great if it wasn't for the fact that in my area the waiting list to do a course is about 18 months, So even if you are referred for a course within 12 months you won't actually do one. They also say that Diabetics should be allowed to manage their own diabetes if admitted to hospital, someone needs to tell nurses this I had to be very firm, borderline rude when they tried to take over my management when I was in hospital. However not everyone is a 'difficult' person like me and will accept their management being taken over on the grounds that the nurse knows best ( not unless they are a Diabetes nurse and even then sometimes no ) Anyway have a read and see what YOU think......

Aug 11, 2016 rose_02 1 post	Topic: Questions for HCPs / Why ketones with low blood sugars? Hi, I was recently diagnosed with type 1 and taken off insulin straight away as my bloods were so low. However, while they remained low off the insulin, I was still developing ketones. My team have no idea why and no tips on what to do, other than keep checking and retaking my insulin but if anyone could give me more advice that would be great!

Aug 11, 2016 RichoDemo 3 posts	Topic: General Discussion / Hypo Awareness Had diabetes for 32 years. New to Dafne but have been counting carbs. for about 6 years. Is there anyone that's has had hypo awareness. I haven't worked for about 8 months because of this and have been trying all of this time to get it back. Does anyone have any advice. I have just about had enough of diabetes