DAFNE bedtime corrections

[sololite]

In an effort to refocus on my BS control following a Pancrectomy 6 months ago I just started to re-read my DAFNE course notes and something leapt out at me that I either missed or wasn't told about regarding my fast acting Novorapid.

I have only ever injected before my three meals of the day and make corrections at the following meal if necessary. I eat at roughly 9am 1pm and 7pm and am tucked up in bed by 10pm.

The DAFNE course book says I should also apply a correction before going to bed if necessary. Is this something that other type 1's regularly do? Obviously I would prefer to have everything under control by bed time and not need a correction but my BS seems to generally be high overnight and I always wake up with a 10, something I understand to be the dawn effect.

Thanks for any advice and tips.

 

[Robin]

I do tend to correct if I’m above 10.0 at bedtime, but I say this with caveats. If you ate at 7pm and did your insulin then, you will still have insulin active in the system at 10pm, so you may come down a bit without a correction. I also tend to drop once I’m asleep, until about 4am, when I start to rise ready for the morning, so I always make sure that any correction allows for the fact that 4am is my lowest ebb. I then tend to act cautiously in any case, and will give myself half the amount of correction dose that I might give at other times of the day.

 

[rebrascora]

I am naughty and don't follow DAFNE guidance at all really (not that I didn't find the course incredibly useful, because I did) and inject whenever I need a correction be it before bed or through the night or in between meals or just after a meal. Following a low carb way of eating I know how my levels should behave and if they hit 8 with a vertical upwards arrow or 10 with a sloping arrow or 8 between meals which is drifting upwards due to protein release, I hit it with a correction.

I definitely would not go to sleep on a 10 without a correction if there is no active bolus insulin in my system and I knew my basal was holding me steady overnight.

 

[helli]

I often correct. At bedtime or during the day.
My bg is sensitive to more than food so I may find my levels riding after a stressful presentation at work or when doing resistance training at the gym. I certainly do not restrict my corrections to meal times.

I have a pump.so this is easier than when.injecting.
The pump also allows me to adjust my basal for stressful meetings. However, that is only useful if I know in advance as a basal change takes about 45 minutes to take effect.Hence the need for correction bolus.

 

[SB2015]

In an effort to refocus on my BS control following a Pancrectomy 6 months ago I just started to re-read my DAFNE course notes and something leapt out at me that I either missed or wasn't told about regarding my fast acting Novorapid.

I have only ever injected before my three meals of the day and make corrections at the following meal if necessary. I eat at roughly 9am 1pm and 7pm and am tucked up in bed by 10pm.

The DAFNE course book says I should also apply a correction before going to bed if necessary. Is this something that other type 1's regularly do? Obviously I would prefer to have everything under control by bed time and not need a correction but my BS seems to generally be high overnight and I always wake up with a 10, something I understand to be the dawn effect.

Thanks for any advice and tips.

Just reading through your post, and if you are regularly waking with a higher BG than you would like it could be:

Dawn phenomenon where BG rises as soon as we get up as the body dumps some glucose to get you going. You can sometimes con your body by eating a small somethings (Nuts) to prevent this.

A rise after a hypo during the night. Are you using a Libre, and can you see any dips at a specific time overnight, orr without that you could do a spot check during the night.

That your basal is not correct overnight and you are high through the night. Have you done a basal test recently. If you start to change things it is always good to make sure that your basal insulin is correct. Are you on one injection of basal a day, or do you have a split basal, such as Levemir. This can give you more flexibility to make adjustments to overnight basal leaving the daytime basal unchanged.

Back to your original questions - good that you eat early giving your body time to process your meal and use up the bolus insulin before you go to bed. With that in mind I would want to correct If I was 10 at bed time. I have my sensitivity factors (which calculates the correction dose) more conservative at night.

let us know ho you get on.

 

[Amity Island]

In an effort to refocus on my BS control following a Pancrectomy 6 months ago I just started to re-read my DAFNE course notes and something leapt out at me that I either missed or wasn't told about regarding my fast acting Novorapid.

I have only ever injected before my three meals of the day and make corrections at the following meal if necessary. I eat at roughly 9am 1pm and 7pm and am tucked up in bed by 10pm.

The DAFNE course book says I should also apply a correction before going to bed if necessary. Is this something that other type 1's regularly do? Obviously I would prefer to have everything under control by bed time and not need a correction but my BS seems to generally be high overnight and I always wake up with a 10, something I understand to be the dawn effect.

Thanks for any advice and tips.

I'm a DAFNE "graduate" too. However, I make adjustments whenever I see blood sugars going a way I don't expect (years of watching how different foods and meals react).

I try not to eat after 6pm, as I don't want to be making corrections over another bolus already running. Things can get mixed up when stacking insulin. I find my bolus of humalog can last about 6 hrs.

Yes I would make a correction at night provided enough time (4hrs min) since meal time insulin.

 

[Proud to be erratic]

Hello @sololite,
You've had a lengthy transition from Lada (2014?) to T3c in 2023 and I suspect you know far more about managing D than I do. At least it was reassuring to see that your Consultant has clearly changed your type to T3c.

Your total panc'y will have changed your body's ability to recognise and/or respond to what is going on metabolically. You are now missing all of the various pancreatic hormones and since (thanks to a throwback from our evolution) your brain could never communicate directly with your liver, but sent messages to your panc'y to pass instructions to the liver store (!) your new world is unquestionably now more complicated. Your liver will still be responding to other (non pancreatic) hormones, such as adrenaline and cortisol, but there is now none of the "balancing" that your pancreas was, possibly, previously doing in the background.

From my relatively newcomer status, I certainly do a BG check last thing and will always apply a correction if needed before I go to sleep - with the caveat of trying to make sure I have left enough time since my earlier bolus to make sure I'm not still "carrying insulin on board". I still often get the dawn phenomenon or foot on the floor syndrome (but perversely not always!) and so could otherwise start my sleep highish and wake up even higher. It could be argued that at my age of 73 my vulnerability to lengthy periods of high BG is not so serious in the long term - but I choose to do the best that I can and consequently expect to live another 40 years!

I am curious to know if you are now back into your cycling and if so how quickly you were able to recover from your major surgery at the start of this year. It broadly took me a year to work through (heal) the internal changes as various bits had been reorganised, along with sufficient trauma to disrupt my previous well behaved prostate and then an incisional hernia to add to my ailments - almost certainly self inflicted by doing too much too early. My pancy was described as pylorus preserving; I should be grateful it wasn't less preserving! I am now described as having 'brittle diabetes' since my BG can alter extremely rapidly - presumably because there are no pancreatic functions, so none of the helpful pancreatic 'checks and balances' for BG regulation.

Good luck.

 

[khskel]

Yep, another correct as required bod here.

 

[SimonP]

I've not done DAFNE, would be interested but it's quite a long time to take off work.

To answer the question, yes I correct before bed, and throughout the day as well. During the day I typically over-correct if it's needed and use the extra as (pre-)bolus for the next meal/snack (morning coffee/afternoon tea) too.

I note the comment about stacking insulin before bed - I almost invariably split my evening meal bolus (sometimes I don't need the second part, depending on activity level, or I do but later, depending on meal composition) and will correct with the second dose if possible. So I am definitely stacking at that point but I also want to do my correction early so that I know which way things are heading and can eat if necessary before I actually go to bed.

If (when, most nights!) I (also) correct at bed time I am reluctant to have more IoB (from stacking + correction - as displayed in XDrip+ which seems reasonably accurate re insulin duration when not exercising) than would drive me too low (below say 3.5mmol/l) from my blood glucose at that point - I sometimes see an effect whereby as soon as I lie down in bed, any upward trend vanishes and then it's all downhill from there, however, sometimes I'll wake up in the middle of the night (usually because the alarm has gone off telling me readings have been missed) and my 2 or 3U correction dose has simply kept my blood sugar stable at 10mmol/l (which is not what I was hoping for!) rather than dropping it the expected amount.

Confusing/annoying, and a relatively new thing for me (as previously I'd always run low overnight, so would need a pre-bed snack). Exercise does help though, I must be more consistent.

 

[sololite]

I do tend to correct if I’m above 10.0 at bedtime, but I say this with caveats. If you ate at 7pm and did your insulin then, you will still have insulin active in the system at 10pm, so you may come down a bit without a correction. I also tend to drop once I’m asleep, until about 4am, when I start to rise ready for the morning, so I always make sure that any correction allows for the fact that 4am is my lowest ebb. I then tend to act cautiously in any case, and will give myself half the amount of correction dose that I might give at other times of the day.

Thanks Robin, that is very helpful. I do feel I'm much more on a tightrope than I used to be. I will maybe try and move my evening meal forward a bit and stay up a bit later to avoid stacking if I do put in a bedtime correction.

 

[sololite]

I am naughty and don't follow DAFNE guidance at all really (not that I didn't find the course incredibly useful, because I did) and inject whenever I need a correction be it before bed or through the night or in between meals or just after a meal. Following a low carb way of eating I know how my levels should behave and if they hit 8 with a vertical upwards arrow or 10 with a sloping arrow or 8 between meals which is drifting upwards due to protein release, I hit it with a correction.

I definitely would not go to sleep on a 10 without a correction if there is no active bolus insulin in my system and I knew my basal was holding me steady overnight.

Thank you Barbara. I too strayed from the path shortly after the course but the insights it gave me were invaluable. I am insulin resistant and seem to be able to handle a lot of mealtime insulin and active so able to correct too little with a brisk walk and too much with fruit or a biscuit.

 

[sololite]

I often correct. At bedtime or during the day.
My bg is sensitive to more than food so I may find my levels riding after a stressful presentation at work or when doing resistance training at the gym. I certainly do not restrict my corrections to meal times.

I have a pump.so this is easier than when.injecting.
The pump also allows me to adjust my basal for stressful meetings. However, that is only useful if I know in advance as a basal change takes about 45 minutes to take effect.Hence the need for correction bolus.

Hi Helli, thank you for your insight. I feel a bit of a fool for not thinking of bedtime corrections before. I guess it's a legacy from my initial LADA diagnosis. I will check in with my Diabetes Team to make sure they explain that this is an option when following DAFNE.

 

[Inka]

I’m much more sensitive to insulin at bedtime so if in any doubt I don’t correct. If I do, I half my correction dose. Do what works safely for you rather than what DAFNE says.

 

[sololite]

Just reading through your post, and if you are regularly waking with a higher BG than you would like it could be:

Dawn phenomenon where BG rises as soon as we get up as the body dumps some glucose to get you going. You can sometimes con your body by eating a small somethings (Nuts) to prevent this.

A rise after a hypo during the night. Are you using a Libre, and can you see any dips at a specific time overnight, orr without that you could do a spot check during the night.

That your basal is not correct overnight and you are high through the night. Have you done a basal test recently. If you start to change things it is always good to make sure that your basal insulin is correct. Are you on one injection of basal a day, or do you have a split basal, such as Levemir. This can give you more flexibility to make adjustments to overnight basal leaving the daytime basal unchanged.

Back to your original questions - good that you eat early giving your body time to process your meal and use up the bolus insulin before you go to bed. With that in mind I would want to correct If I was 10 at bed time. I have my sensitivity factors (which calculates the correction dose) more conservative at night.

let us know ho you get on.

Thank you for this sound advice. I do use Libre and split my levemir does but haven't done a basal test since I left hospital when they balanced everything for me as best they could. For the last six months I've been focused on putting back the weight and strength I lost so the idea of fasting was a bit of a stretch for me. Now I am recovering I am going to do one soon. Thanks once again

 

[sololite]

I'm a DAFNE "graduate" too. However, I make adjustments whenever I see blood sugars going a way I don't expect (years of watching how different foods and meals react).

I try not to eat after 6pm, as I don't want to be making corrections over another bolus already running. Things can get mixed up when stacking insulin. I find my bolus of humalog can last about 6 hrs.

Yes I would make a correction at night provided enough time (4hrs min) since meal time insulin.

Thanks Amity . I will be sure to time my last meal and any correction to avoid stacking.

 

[sololite]

Hello @sololite,
You've had a lengthy transition from Lada (2014?) to T3c in 2023 and I suspect you know far more about managing D than I do. At least it was reassuring to see that your Consultant has clearly changed your type to T3c.

Your total panc'y will have changed your body's ability to recognise and/or respond to what is going on metabolically. You are now missing all of the various pancreatic hormones and since (thanks to a throwback from our evolution) your brain could never communicate directly with your liver, but sent messages to your panc'y to pass instructions to the liver store (!) your new world is unquestionably now more complicated. Your liver will still be responding to other (non pancreatic) hormones, such as adrenaline and cortisol, but there is now none of the "balancing" that your pancreas was, possibly, previously doing in the background.

From my relatively newcomer status, I certainly do a BG check last thing and will always apply a correction if needed before I go to sleep - with the caveat of trying to make sure I have left enough time since my earlier bolus to make sure I'm not still "carrying insulin on board". I still often get the dawn phenomenon or foot on the floor syndrome (but perversely not always!) and so could otherwise start my sleep highish and wake up even higher. It could be argued that at my age of 73 my vulnerability to lengthy periods of high BG is not so serious in the long term - but I choose to do the best that I can and consequently expect to live another 40 years!

I am curious to know if you are now back into your cycling and if so how quickly you were able to recover from your major surgery at the start of this year. It broadly took me a year to work through (heal) the internal changes as various bits had been reorganised, along with sufficient trauma to disrupt my previous well behaved prostate and then an incisional hernia to add to my ailments - almost certainly self inflicted by doing too much too early. My pancy was described as pylorus preserving; I should be grateful it wasn't less preserving! I am now described as having 'brittle diabetes' since my BG can alter extremely rapidly - presumably because there are no pancreatic functions, so none of the helpful pancreatic 'checks and balances' for BG regulation.

Good luck.

Hi Roland,
Thanks for this great information. It shows how little I know about the Whipple I've had. I chose to blank pretty much everything out leading up to it and after. It was rough in hospital and for a couple of months after. Physically challenging but more so mentally. I lost a stone from the operation and loss of appetite in hospital but have gradually recovered it one week at a time over the last 5 months. I've been back on my road bike in the last 2 weeks and already managing 25 miles with one or two steep hills. The aching and pulling sensations in my stomach have dramatically reduced in last month. Thank you so much for your positivity and inspiration.

 

[sololite]

I've not done DAFNE, would be interested but it's quite a long time to take off work.

To answer the question, yes I correct before bed, and throughout the day as well. During the day I typically over-correct if it's needed and use the extra as (pre-)bolus for the next meal/snack (morning coffee/afternoon tea) too.

I note the comment about stacking insulin before bed - I almost invariably split my evening meal bolus (sometimes I don't need the second part, depending on activity level, or I do but later, depending on meal composition) and will correct with the second dose if possible. So I am definitely stacking at that point but I also want to do my correction early so that I know which way things are heading and can eat if necessary before I actually go to bed.

If (when, most nights!) I (also) correct at bed time I am reluctant to have more IoB (from stacking + correction - as displayed in XDrip+ which seems reasonably accurate re insulin duration when not exercising) than would drive me too low (below say 3.5mmol/l) from my blood glucose at that point - I sometimes see an effect whereby as soon as I lie down in bed, any upward trend vanishes and then it's all downhill from there, however, sometimes I'll wake up in the middle of the night (usually because the alarm has gone off telling me readings have been missed) and my 2 or 3U correction dose has simply kept my blood sugar stable at 10mmol/l (which is not what I was hoping for!) rather than dropping it the expected amount.

Confusing/annoying, and a relatively new thing for me (as previously I'd always run low overnight, so would need a pre-bed snack). Exercise does help though, I must be more consistent.

Hi Simon, thanks for this invaluable information. So much for me to take in from yours and other posts. DAFNE did take up a chunk of time and luckily for me was already retired so could do it. Many of the young people on the course were possibly in denial or not engaging with their condition properly and I could see that DAFNE was helping them. I hope you find it useful if you get on it one day

I’m much more sensitive to insulin at bedtime so if in any doubt I don’t correct. If I do, I half my correction dose. Do what works safely for you rather than what DAFNE says.

Thanks Inka. I will be sure to take baby steps

 

[Lucyr]

In an effort to refocus on my BS control following a Pancrectomy 6 months ago I just started to re-read my DAFNE course notes and something leapt out at me that I either missed or wasn't told about regarding my fast acting Novorapid.

I have only ever injected before my three meals of the day and make corrections at the following meal if necessary. I eat at roughly 9am 1pm and 7pm and am tucked up in bed by 10pm.

The DAFNE course book says I should also apply a correction before going to bed if necessary. Is this something that other type 1's regularly do? Obviously I would prefer to have everything under control by bed time and not need a correction but my BS seems to generally be high overnight and I always wake up with a 10, something I understand to be the dawn effect.

Thanks for any advice and tips.

I correct any time I need one, including between meals (remember to account for any bolus on board from previous meal) and before bed.

 

[Eternal422]

I correct whenever needed, if around 10 at bedtime I would definitely correct for that and have also corrected in the middle of the night if I wake up and see that my BG is still high. Luckily the Libre really helps giving an idea of whether BG is rising or dropping, so I can judge how much correction to make.

 

[trophywench]

@Simon P - please please DO invest your time and effort into a DAFNE (or similar) course if you are offered it. It is like the human equivalent of this forum! As far as employers are concerned, making reasonable adjustments for all employees covered by Disability Employment Legislation (ie you and I) is a legal requirement so they just better okay it!

And - you NEVER need to do 24hrs basal testing in huge chunks either! see thread (go back to the start of it)

https://forum.diabetes.org.uk/boards/threads/basal-testing-made-easy.19060/page-3#post-1280248