Recent Posts by marke - DAFNE Online

Oct 22, 2012

marke 657 posts

Topic: DAFNE Online Mobile / readings gone! :(

Sarah, I have gone back through our logs to 12-Aug-2012 and can find no connections from you at all. This means that your Android app was not syncing to the website. That is why the entries are not on the site.When was the last time you checked the entries on the site before today ? We would like to help but if the entries never reached the site there is not much we can do. I will raise the issue with the developer to see if he has any suggestions but if they were only on the
phone and the phone is not backed up it could be a bit tricky.

Oct 9, 2012

marke 657 posts

Topic: General Discussion / 7 Steps to Health

The great thing about the Internet is it gives anyone the opportunity to make money from everyone else.... I think you can guess my opinion of the site and the people behind it.
The front page says it will elimiate Diabetes what it actually does is provide a diet-only 'solution' to type 2, basically what your GP will try and do when you are diagnosed with T2. It isn't
going to cure any form of Diabetes it may reduce BG and thus reduce the risk of complications etc, but that relies on you following the 7 steps religously.

Oct 9, 2012

marke 657 posts

Topic: General Discussion / Flu Jabs

had mine and as usual no real reaction. As they tell you if you get a reaction it is most likely not to the 'strain' as it is inert, its the suspension that it is in. If you get a cold its not the jab that caused it. Thats not suggesting that people don't react to what's 'pushed' into their bodies though Very Happy

Sep 30, 2012

marke 657 posts

Topic: General Discussion / Levemir Going Off

Hi Rich is correct you should report this to your pharmacy. Every batch of any prescription drug can be traced from manufacturer all the way through to the dispensing pharmacy. If you suspect a batch is 'faulty' you should report it to the pharmacist. They can then get it investigated and ideentify if there is an
issue. You can find the Batch Number and Expiry Date on every pen near the base. In the case of Insulin it should be transported and stored at all stages
in temperature controlled storage. It makes no difference if you get 2 boxes and keep them in the fridge or one since you are storing them in the temperature range required.

Sep 25, 2012

marke 657 posts

Topic: General Discussion / Bayer Contour USB meters

Hi Nikki, which regulations ? I am just curious to know how they are supposed to be improving the accuracy and what that accuracy should be Smile

Obviously mine need to be improved since they show my readings to high all the time Wink

You can bet they will cost more though even if it is for regulatory reasons, we are not talking about charities here after all....

Sep 21, 2012

marke 657 posts

Topic: Questions ? / Has anyone else had this happen?

Hi,
Since this is most likely an allergic reaction it won't make any difference what part of your body you inject it in surely. You are not less allergic to it in your
stomach than your thigh. Its not a major reaction since it sounds like its confined to the injection site, none the less its probably major to you ! NovaCare do have a helpline listed in Oz but the reality is they will be trained in Insulin not allergies. You need to see your diabetes team/doctor really and see what your options are.
Suprisingly (or not) Levemir doesn't just contain Insulin but a number of other ingredients, they are listed here and chances are your body is reacting to one of these things. As others have said you can inject both QA and BI in most sites however the rate of absorbtion does vary so if you do try swapping you probably need to test a bit more to ensure what effect the change has had, remembering that changes may not be immediate but occur over a couple of days.
Sorry I know I haven't helped much, you can try the number on the site I quoted, they should have someone available most of the time if the rules are the same as the UK and they may at least be able to offer some useful advice.

Aug 13, 2012

marke 657 posts

Topic: Carbohydrate Counting / Quorn and vegetarian substitutes

I can create a vegetarian section on the site for you to add entries to. However I don't think the paper Carb Lists will have a vegetarian section added unless dieticians understand what foods you want entries added for. From what you say the values on the packaging are not that helpful anyway due to the low GI of these foods which make them difficult to 'cover' with QA insulin.
So if you want to create your own list on the site we can do that and since I submit these 'added' entries to the DAFNE Dieticians we may even get a section added to the Carb Counting book in future.

Aug 10, 2012

marke 657 posts

Topic: DAFNE Online Mobile / Port mobile app to desktop?

This is something I have looked at starting work on but have not got very far. The idea being we can interface to your blood glucose meter and import its readings so they can be transfered to the website. This could include some desktop functionality to do similiar things to the apps. However I am just not getting time to work on this at the moment, we do this in our spare time and sometimes there isn't much spare time Sad

Aug 10, 2012

marke 657 posts

Topic: Site Development / Data Analysis

Hi, What format would you need the data in ? It looks like Splunk is designed to process files or logs of data, DAFNEONline holds the data in the background in a mysql database, Most data oriented websites use a database in the background to store information in. We can extract the data from the site in a number of forms and indeed the iphone and android apps use a method called REST to input and extract data from the database, So basically we need to know what format you need the data in.
The best option would be to email us using the 'contact DAFNE online' at the bottom of the page and we can work out how to provide the data.

Aug 10, 2012

marke 657 posts

Topic: General Discussion / Hypo correction

my understanding, and I stress this is my understanding, is that you should not treat a post hypo high because if you overdo the treatment your liver cannot response as well the second time. It only has a finite store of glucagon and if you keep 'hitting' it without letting it fully recover its response will be reduced. To be honest a short term high is a lot better than a low. You can still function pretty much when high, so although its not a perfect scenario its not doing you a great deal of harm. Well thats my take on it anyway Smile

Aug 9, 2012

marke 657 posts

Topic: General Discussion / NHS Medication Changes: Are you affected?

This sounds like a major step backwards to me. Yes the test strips do seem to be a lot cheaper, but why ? Being naturally suspicious I would question the motivation both of you doctors and the company that makes the meters/strips in singapore. What happened to freedom of choice in the NHS ? So will they put in place the infrastructure to support this equipment, rather than the current very basic website with no support and only one phone number for the UK. What happens if you lose or have problems with the meter ? Do all the chemists in your area stock these test strips and can they get supplies easily. You would hope that the PCT/consortium would have put all that in place before forcing you to use the meter, but have they ?

I will put up a real battle if they try to change my meter, especially as my GP does not and is not going to be reponsible for my Diabetes treatment.

Jul 30, 2012

marke 657 posts

Topic: General Discussion / Blood Testing........

I'm afraid meters are just not that accurate, They give you an approximation of your BG and can be affected by a range of factors. If you take a reading from two different points on the body you will most likely get variances in readings. You will definately get variances from different meters. The idea is the meter gives you a guide to your current BG NOT a scientific, laboratory reading. Look at the brightside, not so long ago all you could do was dip a strip in urine and get a colour change that gave you an even more vague reading. Technology moves forward and testing is getting better but its still not and probably never will be an exact science. But then your body is not an exact science, hence the fact it can cope with your BG's fluctuating all over the place without any major problems.
I can't comment on an 'expert' meter since I have never seen one let along used one. I guess they just make suggestions based on a set of parameters and given the 'source' is a variable baseline i.e your body, getting accurate results must be quite a challenge.

Jul 26, 2012

marke 657 posts

Topic: General Discussion / Motion Sickness: Hypo cause or just symptom?

To echo Novapidboi, my understanding was that the belly is one of the areas that has a quicker absorbtion rate so it is NOT the area to inject BI. However the best area is what works for you. I have never seen a study that backs up the idea of injecting BI in the belly.

Jul 20, 2012

marke 657 posts

Topic: Questions ? / Long Acting Insulin

Because QA is for a completely different purpose than BI. The QA covers the period that your body is digesting your meal after which your body requires insulin to cover the background sugar requirements. The BI is for this period. What happens if you don't eat anything for 6 hours ? Your 2 - 5 hour insulin is all gone but your body needs insulin. Our QA dose is based on the carbs for the meal not our background needs.
The reason for splitting the humilin is beyond me as I'm not a HCP. I split Levemir because it doesn't last 24 hours so I need 2 doses to cover 24 hours but humilin will have a different profile so I'm not sure if the same issues apply.

Jul 9, 2012

marke 657 posts

Topic: General Discussion / DAFNE Collaborative 2012

You can find a report on the DAFNE Collaborative 2012 here : collab report
Be warned it contains a 'shocking' revelation about night time hypo's. I know I shouldn't cross post between forums but the bit on night time hypo's is very interesting and likely to cause a 'degree of discussion' Wink

so I wanted to make sure people didn't miss it !!

Jul 9, 2012

marke 657 posts

Topic: General Discussion / Levemir clogging needles

as this is a confession thread, forgive me I have sinned. I also re-use needles and have never had an issue, certainly never had a problem like Alan. I have to say basic physics suggests the pressure exerted by the plunger on the needle to expel insulin should be such that when priming it should be pretty difficult for it to clog, any crystalised Levemir would be pushed out of the needle. This all suggests that it is the pen and not the needle that is the root cause of the problem.

Jun 29, 2012

marke 657 posts

Topic: General Discussion / Any help please?

Hi Jackie, sorry for the delayed reply. When I say you are sensitive to insulin I mean your ratio is 0.5:1 where as a lot of people are 2:1 or sometime 3:1 in the mornings. This is typical, as I understand it, in the newly diagnosed because they are still producing 'some' insulin as the last of the islet cells bite the bullet. Do I feel 'normal' ? pretty much, but I am lucky in that I never seem to suffer adverse reactions to any drug. I've had a few over the last 10 years since my immune system went nuts and have not had a problem with anything. I was diagnosed at 34 and like you was probably told you were 'odd' for not developing Diabetes until that age. It IS possible you are reacting to the insulin you are on, its unusual but that doesn't mean its not possible.
With regards to the OPA, I ALWAYS see a consultant and a very good one he is to ! If your GP/registrar don't think its the insulin then they should investigate further not just dismiss your explination without providing an alternative explination.
As we said before if you can fill in the blanks in your diary it will help a lot. To pick up a pattern you need all the data Smile

it sounds like you have all the data it just needs adding in.

Jun 27, 2012

marke 657 posts

Topic: General Discussion / Any help please?

hi, sorry I didn't mean to suggest that you shouldn't test OR record the tests. Better to much than to little ! I was just pointing out they you shouldn't do something like apply a correction dose for one of these readings, that was all. Looking at your diary it seems that you are sensitve to insulin, have you been a diabetic for a while ? Have you always been this sensitve to insulin, It also seems unless you have missed out data there are a number of days where you didn't eat any carbs, is this normal ? Personally would feel pretty rubbish if I didn't eat anything but thats just me Very Happy

One last thing, if you don't see a consultant at the hospital who do you see ? I always see a consultant so I'm curious

Jun 27, 2012

marke 657 posts

Topic: General Discussion / Any help please?

There are a few things to say aboutthese results. The most important being you don't reecord your BI insulin most of the time. This is important and it is important that you take it at around the same time every day. What type of BI is it , latus or Levemir maybe ? The second is you test an awful lot quite often with 2 hours of eating. This is not necessarily a good idea since high readings at this point could be down to the timing of your injection ( before or after food) and the GI of the food. That is why it is recommended that you test before meals generally 4 times a day. I'm not criticising you for testing so much its just that high readings can cause oyu to get stressed which will compound the high readings.
Is your reduced level of warning signs what is causing you to test so much ? If you want to help restore your warning signs you should run a bit high for a few days maybe a bit longer to help restore them.
These are just initial impressions, hopefully I and others can look at the readings in more detail and come up with some suggestions

May 28, 2012

marke 657 posts

Topic: General Discussion / Hypo Awareness

Hi, as far as I am aware Ketones are caused by the abscence of insulin to transport blood sugar into cells resulting in 'fat' being used for energy. Therefore a carb free meal cannot result in ketones, it can result in a hypo if you BI is too high which is exactly what you are trying to establish. If you do have a carb free meal to test your BI its a good idea to test a bit more regularly just to ensure what IS happening to your BG.

May 23, 2012

marke 657 posts

Topic: General Discussion / Hypos

if you are on Lantus you may not be able to split the dose. Medical opinion I have heard is that Lantus really is a 24 hour insulin and can't be easily split ( thats not to say this is a 100% rule) where as Levemir can be split because it does not last for 24 hours even though it is marketed as a 24 hour insulin. Again its best to speak to your local experts to decide what is best for you, since we are just graduates like you.

Oct 22, 2012 marke 657 posts	Topic: DAFNE Online Mobile / readings gone! :( Sarah, I have gone back through our logs to 12-Aug-2012 and can find no connections from you at all. This means that your Android app was not syncing to the website. That is why the entries are not on the site.When was the last time you checked the entries on the site before today ? We would like to help but if the entries never reached the site there is not much we can do. I will raise the issue with the developer to see if he has any suggestions but if they were only on the phone and the phone is not backed up it could be a bit tricky.

Oct 9, 2012 marke 657 posts	Topic: General Discussion / 7 Steps to Health The great thing about the Internet is it gives anyone the opportunity to make money from everyone else.... I think you can guess my opinion of the site and the people behind it. The front page says it will elimiate Diabetes what it actually does is provide a diet-only 'solution' to type 2, basically what your GP will try and do when you are diagnosed with T2. It isn't going to cure any form of Diabetes it may reduce BG and thus reduce the risk of complications etc, but that relies on you following the 7 steps religously.

Oct 9, 2012 marke 657 posts	Topic: General Discussion / Flu Jabs had mine and as usual no real reaction. As they tell you if you get a reaction it is most likely not to the 'strain' as it is inert, its the suspension that it is in. If you get a cold its not the jab that caused it. Thats not suggesting that people don't react to what's 'pushed' into their bodies though

Sep 30, 2012 marke 657 posts	Topic: General Discussion / Levemir Going Off Hi Rich is correct you should report this to your pharmacy. Every batch of any prescription drug can be traced from manufacturer all the way through to the dispensing pharmacy. If you suspect a batch is 'faulty' you should report it to the pharmacist. They can then get it investigated and ideentify if there is an issue. You can find the Batch Number and Expiry Date on every pen near the base. In the case of Insulin it should be transported and stored at all stages in temperature controlled storage. It makes no difference if you get 2 boxes and keep them in the fridge or one since you are storing them in the temperature range required.

Sep 25, 2012 marke 657 posts	Topic: General Discussion / Bayer Contour USB meters Hi Nikki, which regulations ? I am just curious to know how they are supposed to be improving the accuracy and what that accuracy should be Obviously mine need to be improved since they show my readings to high all the time You can bet they will cost more though even if it is for regulatory reasons, we are not talking about charities here after all....

Sep 21, 2012 marke 657 posts	Topic: Questions ? / Has anyone else had this happen? Hi, Since this is most likely an allergic reaction it won't make any difference what part of your body you inject it in surely. You are not less allergic to it in your stomach than your thigh. Its not a major reaction since it sounds like its confined to the injection site, none the less its probably major to you ! NovaCare do have a helpline listed in Oz but the reality is they will be trained in Insulin not allergies. You need to see your diabetes team/doctor really and see what your options are. Suprisingly (or not) Levemir doesn't just contain Insulin but a number of other ingredients, they are listed here and chances are your body is reacting to one of these things. As others have said you can inject both QA and BI in most sites however the rate of absorbtion does vary so if you do try swapping you probably need to test a bit more to ensure what effect the change has had, remembering that changes may not be immediate but occur over a couple of days. Sorry I know I haven't helped much, you can try the number on the site I quoted, they should have someone available most of the time if the rules are the same as the UK and they may at least be able to offer some useful advice.

Aug 13, 2012 marke 657 posts	Topic: Carbohydrate Counting / Quorn and vegetarian substitutes I can create a vegetarian section on the site for you to add entries to. However I don't think the paper Carb Lists will have a vegetarian section added unless dieticians understand what foods you want entries added for. From what you say the values on the packaging are not that helpful anyway due to the low GI of these foods which make them difficult to 'cover' with QA insulin. So if you want to create your own list on the site we can do that and since I submit these 'added' entries to the DAFNE Dieticians we may even get a section added to the Carb Counting book in future.

Aug 10, 2012 marke 657 posts	Topic: DAFNE Online Mobile / Port mobile app to desktop? This is something I have looked at starting work on but have not got very far. The idea being we can interface to your blood glucose meter and import its readings so they can be transfered to the website. This could include some desktop functionality to do similiar things to the apps. However I am just not getting time to work on this at the moment, we do this in our spare time and sometimes there isn't much spare time

Aug 10, 2012 marke 657 posts	Topic: Site Development / Data Analysis Hi, What format would you need the data in ? It looks like Splunk is designed to process files or logs of data, DAFNEONline holds the data in the background in a mysql database, Most data oriented websites use a database in the background to store information in. We can extract the data from the site in a number of forms and indeed the iphone and android apps use a method called REST to input and extract data from the database, So basically we need to know what format you need the data in. The best option would be to email us using the 'contact DAFNE online' at the bottom of the page and we can work out how to provide the data.

Aug 10, 2012 marke 657 posts	Topic: General Discussion / Hypo correction my understanding, and I stress this is my understanding, is that you should not treat a post hypo high because if you overdo the treatment your liver cannot response as well the second time. It only has a finite store of glucagon and if you keep 'hitting' it without letting it fully recover its response will be reduced. To be honest a short term high is a lot better than a low. You can still function pretty much when high, so although its not a perfect scenario its not doing you a great deal of harm. Well thats my take on it anyway

Aug 9, 2012 marke 657 posts	Topic: General Discussion / NHS Medication Changes: Are you affected? This sounds like a major step backwards to me. Yes the test strips do seem to be a lot cheaper, but why ? Being naturally suspicious I would question the motivation both of you doctors and the company that makes the meters/strips in singapore. What happened to freedom of choice in the NHS ? So will they put in place the infrastructure to support this equipment, rather than the current very basic website with no support and only one phone number for the UK. What happens if you lose or have problems with the meter ? Do all the chemists in your area stock these test strips and can they get supplies easily. You would hope that the PCT/consortium would have put all that in place before forcing you to use the meter, but have they ? I will put up a real battle if they try to change my meter, especially as my GP does not and is not going to be reponsible for my Diabetes treatment.

Jul 30, 2012 marke 657 posts	Topic: General Discussion / Blood Testing........ I'm afraid meters are just not that accurate, They give you an approximation of your BG and can be affected by a range of factors. If you take a reading from two different points on the body you will most likely get variances in readings. You will definately get variances from different meters. The idea is the meter gives you a guide to your current BG NOT a scientific, laboratory reading. Look at the brightside, not so long ago all you could do was dip a strip in urine and get a colour change that gave you an even more vague reading. Technology moves forward and testing is getting better but its still not and probably never will be an exact science. But then your body is not an exact science, hence the fact it can cope with your BG's fluctuating all over the place without any major problems. I can't comment on an 'expert' meter since I have never seen one let along used one. I guess they just make suggestions based on a set of parameters and given the 'source' is a variable baseline i.e your body, getting accurate results must be quite a challenge.

Jul 26, 2012 marke 657 posts	Topic: General Discussion / Motion Sickness: Hypo cause or just symptom? To echo Novapidboi, my understanding was that the belly is one of the areas that has a quicker absorbtion rate so it is NOT the area to inject BI. However the best area is what works for you. I have never seen a study that backs up the idea of injecting BI in the belly.

Jul 20, 2012 marke 657 posts	Topic: Questions ? / Long Acting Insulin Because QA is for a completely different purpose than BI. The QA covers the period that your body is digesting your meal after which your body requires insulin to cover the background sugar requirements. The BI is for this period. What happens if you don't eat anything for 6 hours ? Your 2 - 5 hour insulin is all gone but your body needs insulin. Our QA dose is based on the carbs for the meal not our background needs. The reason for splitting the humilin is beyond me as I'm not a HCP. I split Levemir because it doesn't last 24 hours so I need 2 doses to cover 24 hours but humilin will have a different profile so I'm not sure if the same issues apply.

Jul 9, 2012 marke 657 posts	Topic: General Discussion / DAFNE Collaborative 2012 You can find a report on the DAFNE Collaborative 2012 here : collab report Be warned it contains a 'shocking' revelation about night time hypo's. I know I shouldn't cross post between forums but the bit on night time hypo's is very interesting and likely to cause a 'degree of discussion' so I wanted to make sure people didn't miss it !!

Jul 9, 2012 marke 657 posts	Topic: General Discussion / Levemir clogging needles as this is a confession thread, forgive me I have sinned. I also re-use needles and have never had an issue, certainly never had a problem like Alan. I have to say basic physics suggests the pressure exerted by the plunger on the needle to expel insulin should be such that when priming it should be pretty difficult for it to clog, any crystalised Levemir would be pushed out of the needle. This all suggests that it is the pen and not the needle that is the root cause of the problem.

Jun 29, 2012 marke 657 posts	Topic: General Discussion / Any help please? Hi Jackie, sorry for the delayed reply. When I say you are sensitive to insulin I mean your ratio is 0.5:1 where as a lot of people are 2:1 or sometime 3:1 in the mornings. This is typical, as I understand it, in the newly diagnosed because they are still producing 'some' insulin as the last of the islet cells bite the bullet. Do I feel 'normal' ? pretty much, but I am lucky in that I never seem to suffer adverse reactions to any drug. I've had a few over the last 10 years since my immune system went nuts and have not had a problem with anything. I was diagnosed at 34 and like you was probably told you were 'odd' for not developing Diabetes until that age. It IS possible you are reacting to the insulin you are on, its unusual but that doesn't mean its not possible. With regards to the OPA, I ALWAYS see a consultant and a very good one he is to ! If your GP/registrar don't think its the insulin then they should investigate further not just dismiss your explination without providing an alternative explination. As we said before if you can fill in the blanks in your diary it will help a lot. To pick up a pattern you need all the data it sounds like you have all the data it just needs adding in.

Jun 27, 2012 marke 657 posts	Topic: General Discussion / Any help please? hi, sorry I didn't mean to suggest that you shouldn't test OR record the tests. Better to much than to little ! I was just pointing out they you shouldn't do something like apply a correction dose for one of these readings, that was all. Looking at your diary it seems that you are sensitve to insulin, have you been a diabetic for a while ? Have you always been this sensitve to insulin, It also seems unless you have missed out data there are a number of days where you didn't eat any carbs, is this normal ? Personally would feel pretty rubbish if I didn't eat anything but thats just me One last thing, if you don't see a consultant at the hospital who do you see ? I always see a consultant so I'm curious

Jun 27, 2012 marke 657 posts	Topic: General Discussion / Any help please? There are a few things to say aboutthese results. The most important being you don't reecord your BI insulin most of the time. This is important and it is important that you take it at around the same time every day. What type of BI is it , latus or Levemir maybe ? The second is you test an awful lot quite often with 2 hours of eating. This is not necessarily a good idea since high readings at this point could be down to the timing of your injection ( before or after food) and the GI of the food. That is why it is recommended that you test before meals generally 4 times a day. I'm not criticising you for testing so much its just that high readings can cause oyu to get stressed which will compound the high readings. Is your reduced level of warning signs what is causing you to test so much ? If you want to help restore your warning signs you should run a bit high for a few days maybe a bit longer to help restore them. These are just initial impressions, hopefully I and others can look at the readings in more detail and come up with some suggestions

May 28, 2012 marke 657 posts	Topic: General Discussion / Hypo Awareness Hi, as far as I am aware Ketones are caused by the abscence of insulin to transport blood sugar into cells resulting in 'fat' being used for energy. Therefore a carb free meal cannot result in ketones, it can result in a hypo if you BI is too high which is exactly what you are trying to establish. If you do have a carb free meal to test your BI its a good idea to test a bit more regularly just to ensure what IS happening to your BG.

May 23, 2012 marke 657 posts	Topic: General Discussion / Hypos if you are on Lantus you may not be able to split the dose. Medical opinion I have heard is that Lantus really is a 24 hour insulin and can't be easily split ( thats not to say this is a 100% rule) where as Levemir can be split because it does not last for 24 hours even though it is marketed as a 24 hour insulin. Again its best to speak to your local experts to decide what is best for you, since we are just graduates like you.