DAFNE bedtime corrections

[SimonP]

Thanks for the recommendation @trophywench, it's not that I'd not be allowed, it's simply that the work won't get itself done so it's my reluctance to have a backlog when I get back that stopped me. I'll have to see if they are still on offer and see if I can choose a quiet work week!

 

[Inka]

If it makes you feel any better @SimonP ] Ive never done a DAFNE course either and don’t plan to do one. It doesn’t appeal at all.

 

[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.

Hi SB2015. You mentioned conning your body with a few nuts. I want to try this. Please can you tell me what type and when I should have them? Regards, Chris

 

[Proud to be erratic]

Hi SB2015. You mentioned conning your body with a few nuts. I want to try this. Please can you tell me what type and when I should have them? Regards, Chris

Chris, for about 3 months I've been taking upstairs a couple of carb free snacks - one for if I need a bathroom trip in the small hours and one for as soon as I wake and start to move the next morning. Each snack could be nuts, only low carb nuts, such as 2 small brazils or 5 hazelnuts (at c.3% carbs) - but not cashew nuts at c.19% carbs. But also any small amount of meat (just whatever is available that evening) and/or a small lump of cheese - I find cheddar too dry and indigestible at that time, so I tend to have softer, moister brie. These snacks are really tiny.

In general, this conning seems to work. I must eat the tiny snack before getting out of bed, or it doesn't work. Sometimes I still get a small rise, but often the next reading has returned to where it was before I awoke. Certainly the DP or FoTF effect is reduced from previously. I've not tried a couple of strawberries, despite their relatively low carb content being wary of the moist sweetness AND I find it needs to be a no mess type of snack that can be quickly scoffed before becoming fully 'conscious'. If I lie still without eating, but definitely awake, it doesn't work for me. But overall I no longer need a correction for 2 mmol/L or greater each morning - most days. Just occasionally the con doesn't work.

 

[Proud to be erratic]

Chris, just tried to take a screenshot and found that on my Android phone Dexcom won't allow me to take a screenshot. Bit annoying; big brother watching?

 

[SB2015]

Hi SB2015. You mentioned conning your body with a few nuts. I want to try this. Please can you tell me what type and when I should have them? Regards, Chris

Like @Proud to be erratic i went for Brazil nuts, partly because I really like them.

I am now on a pump and sensor and they sort things out for me in the morning without my interaction.

 

[Sugarcoated]

I have never been offered a DAFNE course & always been told never to take insulin without food & never within 3 - 4 hrs of last dose. So how does correction doses work?

 

[Leadinglights]

I have never been offered a DAFNE course & always been told never to take insulin without food & never within 3 - 4 hrs of last dose. So how does correction doses work?

I think DAFNE is only offered to Type 1 folk but there is an online BERTIE course which many find helpful and people can self register.

 

[Robin]

I have never been offered a DAFNE course & always been told never to take insulin without food & never within 3 - 4 hrs of last dose. So how does correction doses work?

The problem is, that DAFNE is aimed at people with Type 1, who don’t have the added complication of possibly producing their own insulin alongside injected insulin, but where the insulin may not be working efficiently. The rules for Type 1 often don’t work for Type 2s on insulin, so it’s not really possible to tell how correction doses might work for you. Have you ever been given input by your diabetes nurse about how to cope if your levels are higher than you’d like? That would have to be your first port of call.

 

[Sugarcoated]

The problem is, that DAFNE is aimed at people with Type 1, who don’t have the added complication of possibly producing their own insulin alongside injected insulin, but where the insulin may not be working efficiently. The rules for Type 1 often don’t work for Type 2s on insulin, so it’s not really possible to tell how correction doses might work for you. Have you ever been given input by your diabetes nurse about how to cope if your levels are higher than you’d like? That would have to be your first port of call.

My diabetes is neither type 1 or type 2. Rather abit of both. Its now been identified as its own form of diabetes - cfrd (cystic fibrosis related diabetes). It has characteristics of both & brought on by taking high dose steroids & non working pancreas but some cf'ers don't go on to develop cfrd.
We're basically told eat what we want when we want but i prefer to keep my sugars low & stable & eat healthily, much to the chagrin of my cf team.

 

[rebrascora]

My diabetes is neither type 1 or type 2. Rather abit of both. Its now been identified as its own form of diabetes - cfrd (cystic fibrosis related diabetes). It has characteristics of both & brought on by taking high dose steroids & non working pancreas but some cf'ers don't go on to develop cfrd.
We're basically told eat what we want when we want but i prefer to keep my sugars low & stable & eat healthily, much to the chagrin of my cf team.

To me that suggests that you are a Type 3 of some sort, if you have damage to your pancreas from medication or disease and should probably be treated as a Type 1.

 

[Lucyr]

The rules for Type 1 often don’t work for Type 2s on insulin, so it’s not really possible to tell how correction doses might work for you.

I know several T2s on MDI insulin and all follow the same rules as T1s for calculating corrections and carb ratios etc. Literally the only difference is that it’s unpredictable slightly more often, you can’t go on DAFNE to learn and you’re unlikely to get a bg sensor to respond to the unpredictability. It’s wrong to say that T1 insulin dosing methods don’t work for T2 though.

 

[Robin]

My diabetes is neither type 1 or type 2. Rather abit of both. Its now been identified as its own form of diabetes - cfrd (cystic fibrosis related diabetes). It has characteristics of both & brought on by taking high dose steroids & non working pancreas but some cf'ers don't go on to develop cfrd.
We're basically told eat what we want when we want but i prefer to keep my sugars low & stable & eat healthily, much to the chagrin of my cf team.

Oh, I’m sorry, I saw the Type 2 under your avatar and made an assumption. You do have a lot of 'extras' to contend with.

 

[Robin]

It’s wrong to say that T1 insulin dosing methods don’t work for T2 though.

I’d thought it would be much more difficult. I do think Type 1s have it easy (provided their diabetes conforms to expectations ) compared with the struggles that some people with Type 2 on insulin have. I was thinking of one particular member who posts on the morning thread who is having to work out a whole new strategy to get her insulin resistance to play ball with her injected insulin, and assumed it was like that for everyone.

 

[sololite]

Chris, for about 3 months I've been taking upstairs a couple of carb free snacks - one for if I need a bathroom trip in the small hours and one for as soon as I wake and start to move the next morning. Each snack could be nuts, only low carb nuts, such as 2 small brazils or 5 hazelnuts (at c.3% carbs) - but not cashew nuts at c.19% carbs. But also any small amount of meat (just whatever is available that evening) and/or a small lump of cheese - I find cheddar too dry and indigestible at that time, so I tend to have softer, moister brie. These snacks are really tiny.

In general, this conning seems to work. I must eat the tiny snack before getting out of bed, or it doesn't work. Sometimes I still get a small rise, but often the next reading has returned to where it was before I awoke. Certainly the DP or FoTF effect is reduced from previously. I've not tried a couple of strawberries, despite their relatively low carb content being wary of the moist sweetness AND I find it needs to be a no mess type of snack that can be quickly scoffed before becoming fully 'conscious'. If I lie still without eating, but definitely awake, it doesn't work for me. But overall I no longer need a correction for 2 mmol/L or greater each morning - most days. Just occasionally the con doesn't work.

Thanks for this treasure trove of knowledge. Luckily we have some brazil nuts so will go with that tonight. Hopefully I won't choke ! I guess if you don't hear from me again....... ha ha. Do I remember that you take CREON? Do you take one with the snacks? Regards, Chris

 

[sololite]

Like @Proud to be erratic i went for Brazil nuts, partly because I really like them.

I am now on a pump and sensor and they sort things out for me in the morning without my interaction.

Thank you very much. I now have Brazils by my bedside. I sleep like a log normally but normally stir around 6am and doze so should be able to try it out

 

[SB2015]

Thank you very much. I now have Brazils by my bedside. I sleep like a log normally but normally stir around 6am and doze so should be able to try it out

I hope that it works for you. The joys/frustration of Diabetes is that we are all different and there is a bit of trial and improvement to find what works for each of us.

 

[nonethewiser]

Couldn't go to bed with high bg unless still had some active insulin to use up, I've always corrected since starting on mdi then using pump.

 

[helli]

I can’t get to sleep if my BG is too high. I seem to toss and turn and have an overly active mind when my levels are high.
If my levels rise overnight (thanks fatty curries), it will wake me.

My body hasn’t heard of some of the common high/low symptoms. For example, it does not understand hypo munches. The idea of emptying the fridge when low is completely alien. I have absolutely no interest in food when hypo. However, if I feel famished, it is a good indicator my levels are high and I have to resist the strong temptation to carb load.

 

[SimonP]

I can’t get to sleep if my BG is too high. I seem to toss and turn and have an overly active mind when my levels are high.
If my levels rise overnight (thanks fatty curries), it will wake me.

My body hasn’t heard of some of the common high/low symptoms. For example, it does not understand hypo munches. The idea of emptying the fridge when low is completely alien. I have absolutely no interest in food when hypo. However, if I feel famished, it is a good indicator my levels are high and I have to resist the strong temptation to carb load.

I also find it hard to sleep if I'm high, and will typically wake (and take a correction dose) if I go high overnight.

Conversely I do almost invariably get the hypo munchies (and sometimes act upon them and then kick myself when dealing with the later yo-yoing), though I wonder how much is to do with rate of change of blood glucose vs actual blood glucose - sitting stably at 4 all night is fine (in my book anyway), dropping rapidly through 4 is quite a different feeling, same for going high.