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Feb 1, 2016
VHDLMan
2 posts
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Topic: General Discussion / Insulin types and doses - Basel/Bolus doses - Novapen 5 HiThanks for the input - I was suffering from quite a few exercise induced, medium hypo's in a week however the Libre has been a great help to spotting them coming and doing something about them before they happen. I would say that around 50% of the time, I am able to do some kind of post meal exercise to combat the spike however 50% of the time I can't and the down side of the Libre is that I can now see how high my BGL gets and for how long in these cases. I shall push for a Novapen + Novarapid and see if this has any effect - If it does, gerat - If not, I will stop using it. Thanks again JD |
Feb 1, 2016
Warwick
425 posts
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Topic: General Discussion / Injections and prescriptions It's happening here in Australia too. T1Ds are getting letters if they order more than a certain number of needles. They then need to produce a letter from their GP stating that they require them. Given that reused needles become blunt very quickly which causes brusing and can affect the dose injected, it does seem ridiculous.Still, better than New Zealand where needles have to be bought with no subsidy :-( |
Feb 1, 2016
Warwick
425 posts
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Topic: General Discussion / Insulin types and doses - Basel/Bolus doses - Novapen 5 I had never heard of Insulatard InnoLet, I had to look it up. It's a long-acting insulin that starts acting after about 1.5 hours, peaks between 3-12 hours, and lasts up to 24 hours.When I was diagnosed 5 years ago, I was put on a long-acting insulin twice a day for the first 14 months. The reason for this is that at the time of diagnosis, we are usually still in the honeymoon period where our pancreas is still making insulin, so to avoid lots of hypos, basal insulin is prescribed, and that can work well. I was getting HbA1Cs below 7 while I did this with a very careful diet, avoiding anything sugary, and foods like white rice which would send my BGLs into orbit. Like you, I also saw lots of spikes after the meals, but before each meal time, I was usually in a good range, so my endo was quite happy. Once your honeymoon period is over, you are much more likely to be prescribed basal and bolus together. That certainly helps with the post-meal spikes, but also can lead to more hypos. Do you know if your honeymoon period is over? As the beta cells slowly die, you go from needing a small amount of insulin to needing more to get the same BGL levels as previously. Once the honeymoon period ends, your need to make changes stops as you'll reach a state where because all of the beta cells are now dead, the amount of insulin you need to inject stays largely the same from day to day. If it is over, then it could be worth looking at quick acting insulin. If it isn't, then you may be fine to stay as you are for now. That will be a decision for your endo, but it would be worth asking them. It sounds like you are doing fabulously well though, so don't stress about it too much. While quick acting insulin certainly helps, especially when you want to get down from high levels quickly, it can still be frustrating to manage BGLs and hypos tend to occur more often and more rapidly than with just basal insulin. While most T1Ds will use a mixture of short and long acting insulin if injecting (and just short-acting if on a pump), there is a growing number of T1Ds who are successfully switching to a low-carb diet to avoid the need to worry about large shifts in BGLs due to lower insulin doses. There are articles about this such as http://www.dietdoctor.com/low-carb-manage-type-1-diabetes and also some books which are helpful are: The Art and Science of Low Carbohydrate Living by Jeff S. Volek and Stephen D. Phinney. The authors, both doctors, promote cutting carbohydrates down to a minimum and using fat in place of carbohydrate as a fuel source. Both authors have implemented this diet for several decades with no ill effects. The second book is Dr Bernstein’s Diabetes Solution. Dr Bernstein promotes a low carbohydrate diet for diabetics and is type 1 himself. His reasoning is that lowering the intake of carbohydrate requires much less insulin and therefore errors in the amount injected are much smaller leading to much less serious consequences. Hope that helps. |
Feb 1, 2016
Warwick
425 posts
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Topic: General Discussion / Help with BI Hi Derek,Follow the DAFNE principles for changing BI and see how that helps. Only increase by 1 unit or 10% of the dose given. Wait three days before making any further changes. If it leads to hypos, then cut the dose back. In practise, I think it may depend a bit on the type of basal insulin. When I was on Levemir, I found that changes were very quick to filter through and I didn't need to worry about the three day principal. With Lantus which I am on at the moment though, changes can easily take three days before any noticeable changes are visible. Also, hypos may occur as a result of a QA dose, so I try and work out whether a hypo could be because of my QA before I change my BI dosing. I wouldn't rely on a formula to work out your BI dose. It's works to get a starting value, but my BI doses change all year around. This time last year, I was on 6 in the morning and 6 at night. Now I am on 10 in the morning and 12 at night. Who knows where I will be in a couple of months :-) All the best with it. Warwick. |
Jan 31, 2016
derekh1965
95 posts
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Topic: General Discussion / Help with BI hi alturnthanks for your reply and help. I will try your suggestion and take my BI at 10:30 tonight and then 10:30 tomorrow morning. I took 8 units BI this morning and will take 12 this evening, giving a total of 20 units. Hope my BS isn't high tomorrow.. Iwill post my results in a couple of days. Derek |
Jan 31, 2016
alturn
78 posts
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Topic: General Discussion / Help with BI I would suggest not calculating your BI. It may take a while, but try to find the number of units to keep you stable, and one of the DSNs suggested minimising difference between am and pm units. After a BI change, don't alter it for a while (I try 3 days). QA should be calculated for meals and corrections. You may need to correct until BI is correct. May also need to try fasting (no carbs) to get BI correct.The formula (Weight * 0.5) is a rough guide to your total (QA + BI) per day, so your range would be 38 up to about 60 (based on DAFNE manual). Assuming 38, about 1/2 is BI so maybe try 10 am and 10 pm. For comparison, I weigh 65Kg and currently take 11 Levemir am and pm and about 12 Novorapid so I am nowhere near 50/50 BI/QA. Hope this helps. |
Jan 31, 2016
derekh1965
95 posts
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Topic: General Discussion / Help with BI HiI am strugglig with my BI dosage. I take levermir and when calculating I am using the formula for calculatig the total insulin dose, 0.5 x weight in kilos and I weigh 77k = 38/ /2 = 19 total BI. So I inject half or less upon waking and the rest in the evening. But I always wake up high no matter what time I inject my evening BI. I hope I am correct in my calculating if not please correct me. As you see from my diary There are a lot of high sugars although my HBA1C has been excellent for the past year according to the HCP. |
Jan 30, 2016
VHDLMan
2 posts
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Topic: General Discussion / Insulin types and doses - Basel/Bolus doses - Novapen 5 Hi AllNew to the forum so I hope the following question is OK - Been a T1 for just over a year having had serious necrotic pancreatitis at Xmas 2014. I am on Innolet Insultard, one jab in the morning and one at night if my BG is high. I have done a lot of reading, the latest on basel/bolus dose insulin. One thing I suffer with is post meal, BG spikes. I eat the best 'diabetic' meals I can (Shredded wheat, Livlife bread, no mash or chips or pizza but the odd gingernut) but I still spike from 6.0 to 11.0, typically, and it takes a few hours or a good 2 mile, post meal walk to get it back down below 7.0. I am committed to 'doing my best' and walk 5 to 7 miles a day, kayak, swim, ride a bike, have lost 7.5 stone in 2015 (I was VERY overweight) and have even purchased a Freestyle Libre to monitor my numbers. The question: Should I be using a bolas dose 'pen' before meals to combat the spikes or should the Innolet be enough? I have been reading about Novapen 4 or 5 and NovaRapid cartridges and I have an appointment with my GP next week to discuss getting one. Thoughts? Thanks |
Jan 30, 2016
Peter
109 posts
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Topic: General Discussion / freestyle libra NB. The new factory seems to have come on stream now, and availability is much better if you want to buy it. |
Jan 30, 2016
Popey81
5 posts
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Topic: General Discussion / Injections and prescriptions If you need to inject then you need to inject. Not really sure how they can say your using to many needles. Maybe try having your sachets half hour after a meal that way you could inject for a snack the same time as you inject for a meal?? Save on a few needles that way but not really sure why GPs are moaning about it.As for testing every time you dont need too. Test the 4 times a day. But for snacks just cover the CP's dont worry about testing. I try to keep my snacks with meals. Otherwise you will nearly always get a high BG reading. 2.5 hours after any meal i eat shows high BG readings. Then 4-5 hours they are back to normal. Snacking between will keep them high and you will never get a true reading. GP's dont like spending money so maybe thats why they moaning about to many needles?? |
Jan 30, 2016
Popey81
5 posts
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Topic: Questions for HCPs / 2 Hour rise after a meal and HbA1c results Thanks all for the replies. Keep doing what im doing until my next HbA1c test![]() |
Jan 29, 2016
AMcD
38 posts
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Topic: Questions for HCPs / 2 Hour rise after a meal and HbA1c results Novo Nordisk who manufacturer novorapid fast acting insulin have completed stage 3a clinical trials on a modified version of their fast acting insulin that achieves a faster rate of absorption and than novorapid. .. They applied to the FDA for a NDA (new drug application) in December 15.... They have called it onset 1 for type 1 use... if successful in getting to market this insulin will peak quicker than current fast acting insulin and hopefully make some further improvement on reducing post meal spikes. .. Andy |
Jan 29, 2016
derekh1965
95 posts
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Thought I would add my diary to this post |
Jan 29, 2016
derekh1965
95 posts
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Topic: General Discussion / Injections and prescriptions Hi, Hope everyone is well. I wanted to ask about needles and injecting. I am being told by my GP I am ordering too many needles.I order needles on 19th November and then again on the 30th December as it was close to the weekend, and I got a phone cal from the GP asking me why I needed more needles so soon. I got them, but ordered more on 27th January and never received them. If you are to use a new needle for every injection that is upto 9 injections a day. 2 BI, 4 meals, Breakfast,Lunch,Dinner and supper and 3 - 4 snacks. Snacks are nescafe sachets of latte which have between 10 and 15 g carbs each. Am I using too many needles. They also said I was testing too often. I test before I have carbs. Thanks for reading. Kind regards Derek |
Jan 29, 2016
HelenP
218 posts
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Topic: General Discussion / Pump death? Hi,I am wondering if anyone has experienced a "pump death". My health fund (I'm in Australia) has denied a replacement pump as my current pump is "fully functional" even though it is 12 months out of warranty. I am wondering whether pumps have a slow and painful demise or they just stop being fully functional! The pump is working but I can not use the clip as after years of wearing it on my right hip I have somewhat distorted the area where the clip slide in. As a consequence I am carrying it in my pocket (not clipped in) and it does have a tendency to bungee jump especially when exiting the car. I have tried various systems without the clip and have resorted to pinning a child's sock to pyjamas etc but it is far from convenient. Helen |
Jan 28, 2016
JohnCook
3 posts
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Topic: Questions for HCPs / Johncook Many thanks Helen. Very helpful. I will also refrain from my evening BI due to very high overdose this morning. Regular monitoring is essential as you say and adjust QA to suit. John |
Jan 28, 2016
HelenP
218 posts
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Topic: General Discussion / Pump failure. Hi,I am in Australia and the system here is that your private health fund buys your pump and then a Diabetic Educator (often in private practice) teaches you how to use it. About 15 months ago I received a letter from my pump manufacturers saying that my pump was now out of warranty (3 years). At Christmas time I asked my endocrinologist to put in an application on my behalf to my health fund for a new pump. I received notification yesterday saying that the replacement pump had been denied as it was "fully functional"! Has anyone had a pump fail? What were the signs of approaching death? How old was the pump? Currently the clip is unable to be put back onto the pump so I am carrying it in a pockets where it regularly bungees to the floor/pavement etc and I wear it in a sock pinned to PJs. This is causing damage to the outer skin but all appears to be working... Helen |
Jan 28, 2016
HelenP
218 posts
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Topic: Questions for HCPs / Johncook I did something similar but you will be very careful and do lots of tests and make decisions based on the readings you get. Be vigilant! I ended up running towards the low teens until the danger period was over. Then had to bring it down. I have only done it once I think it makes you less complacent...more careful. Helen. |
Jan 28, 2016
Ben in the Stow
3 posts
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Topic: General Discussion / mySugr app Just wondering if anybody else has had experience good or bad with the mySugr logbook app. I've been using it for the last month and have found it pretty helpful, especially the bolus calculator (it's got the certified medical device status going on). Not sure if the HbA1c estimator is gimmick or not yet.Anyway I'd just love a way to export my data from it to this site. Can you do that with a csv file? |
Jan 28, 2016
JohnCook
3 posts
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Topic: Questions for HCPs / Johncook Accidentally dosed 21 units BI instead of 0 at breakfast. Then used reduced QA of 8units instead of 12. Not sure how to proceed for rest of day? Location is Adelaide SA |
Jan 27, 2016
Gdorean
3 posts
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Topic: General Discussion / Dosage auto-calculation in apps Hello all, I've just logged onto this site for the first time and am a bit dizzy at how good the iPhone app and info on here are. Brilliant, but obviously not having the calc thing sucks big time.Nevertheless, finally seeing what's going on here has reinvigorated me. Cheers |
Jan 27, 2016
Trish Skidmore
18 posts
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Topic: General Discussion / freestyle libra Thank you |
Jan 27, 2016
marke
686 posts
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Topic: General Discussion / freestyle libra yes a number of people, there is a long thread on this forum, about it. search for freestyle libre. Secondly no its not available on the NHS, Abbott the manufacturer are in discussions with the NHS but don't hold your breath :-( |