DAFNE week & Levemir help please

[trophywench]

Well - fancy changing everything at once - your carb ratio AND your basal. The first ruke always is never change more than one thing at a time - potherwise how can you possibly assess what is right and what is wrong?

The Lantus won't be out of your body for 3 days after you start the Levemir for starters - nence why when you start pumping you just go with the intelligent guesses and calculations the DSN makes for ewach person for 3 days, and only then start intensively basal testing to try and start fine tuning them (you stay on the same short acting insulin so keep the bolus rates that work for you anyway).

NRB - if you are on 1u to 7g you never use CPs - just divide total carbs by 7 and inject that number of units - so if you eat 50g CHO you inject 7u, if you eat 45g CHO you inject 6.5u, 20g 3u; whatever.

My consultant said when my ratio was 1u to 11g 'Oh - doesn't that make your bolus doses terribly difficult to calculate?' and I burst out laughing and said 'No - firstly because I use the pump everyone in your clinic has ie the Roche Spirit Combo so I'm using the Aviva Expert meter/remote and the meter calculates it anyway - but secondly even if it didn't, I can both multiply and divide by 11 cos they taught me up to my 12 x table when I was about 7 years old !' LOL

So Laura we conclude - OK go along with it this week then next week revert immediately to your previous bolus ratios and concentrate on getting your Levemir doses right.

Battily although lantus wore out for me sometime just after dinner - Levemir actually lasted me a bit longer than 12 hours if the dose was bug enough. So from 18u of Lantus at night I went on a 50/50 split of Levemir 12 hours apart which was clearly never right from the day I started it - and landed up in the finish taking 14u when I got up and a further 4u at about 9.30 pm at night. Worked for ages.

Batty cos when I went on the pump I actually found I really need almost as much insulin per hour all night as I do in the day - except my TDD after 15 months(and has been so for the last 8 months) I'm now under 10u ......

What I'm saying is, just 'learn' the theories and the strategies. Fine tune it yourself once you are out from under the microscope!

 

[novorapidboi26]

On a pump, yes, the option is there to use smaller ratios, but on MDI ,and DAFNE, I do believe keeping the 1:10g as a standard is wise, at least at the start...........calculating the dose isn't hard with the likes of 1:7, but it is easier with 1:10 I am sure you would agree.....😉

You mentioned Lantus staying in your body for 3 days. Is that true, I though it was a 24 hour insulin but that it takes 3 days for any dose change to be recorded....🙂

 

[randomange]

On a pump, yes, the option is there to use smaller ratios, but on MDI ,and DAFNE, I do believe keeping the 1:10g as a standard is wise, at least at the start...........calculating the dose isn't hard with the likes of 1:7, but it is easier with 1:10 I am sure you would agree.....😉

You mentioned Lantus staying in your body for 3 days. Is that true, I though it was a 24 hour insulin but that it takes 3 days for any dose change to be recorded....

Have to disagree on keeping it as CP on MDI, I'm afraid! I actually found CPs quite frustrating, as for me I felt it was too simple, particularly as my ratios were more like the 1:7 Laura has. It's easy enough to just add up the carbs in grams instead of CP - you're pretty much doing the same work, just not in batches of 10 - and then dividing that by whatever your ratio is. Even if you're not that good at maths, you can always use the calculator on your phone, or have a "cheat sheet" with simple doses worked out. Everybody varies, but I used this quite successfully on MDI. 🙂

And yes, Lantus might be a 24 hour insulin, but some of it hangs around a bit longer, which is why you have to wait 3 days between changing doses.

Laura, I had a similar experience to you in DAFNE - I had to change all my ratios and really didn't like it. However, if you have a good team, then they should be telling you that DAFNE is a starting point and that it is simply giving you the tools to be able to make changes yourself, so that when you leave you can alter ratios and doses on your own. They should *not* be making you stick to the starting off rules if they're not working for you. I also agree with Sofaraway - I was told snacks should be the ratio closest to your next meal. Hang in there, it'll get better and settle down 🙂

 

[novorapidboi26]

I understand what your saying, and for folk who are that little bit more sensitive to insulin they MUST use the insulin/carb ratios that work for them, I am just saying that in order to teach DAFNE, from my experience, it needs to be by using the 10 grams to every unit method as the whole course is catered towards it...

If what you say about Lantus is true, then I have learned something new today......😉

ramdomange, how did you get on with the 1:10 method on DAFNE, what problems did you face, how did you overcome them?

🙂

 

[trophywench]

NRB - I honestly thought the 3 days was common knowledge amongst the intelligensia by which I mean us LOL what have had D for a while and read stuff and that!

The reason it takes 3 days to see if you have it right is so you've defo lost everything by then, that was different doses (up or down) so after 3 days you know it's just the NEW dose that's doing whatever to your BG. I never saw an effect the first day or 2 with any change to Lantus and I got terribly frustrated by this. With Levemir well it still might hang round for a while but generally the effect of any change one way or t'other would be apparent after about 12 hours.

OK Lan or Lev - you'd then still leave it alone for another couple of days to make sure it wasn't a fluke - before making any other change - but because of Lan's nature (crystalline thingy) it just DOES hang around for ages. Whereas Lev doesn't seem half - well not even a tenth - as bad for that.

 

[MaryPlain]

Your original post took me back to when I did DAFNE. I also found it very frustrating to have to use a ratio which I knew to be wrong, and felt unwell the first day because I ran high. However by following the rules I was able to demonstrate conclusively that my original ratios were correct. Thankfully I'm quite good at mental arithmetic so I was able to continue using my own ratios but translate them into CPs, and ironically my ratios several years later on the pump have more or less settled to 1:10 anyway!

If you think about it, using CPs is actually doing an extra unnecessary calculation - first to work out how many CPs it is, then calculate the bolus. I very rapidly abandoned CPs at the end of DAFNE which made it a lot easier to adapt to the pump.

I suspect that changing to Levermir at the same time as doing DAFNE is going to make it very difficult for you to get everything adjusted by the end of the week, but what you will have is a systematic technique for testing and adjusting, which is what I gleaned from it. I also found that looking at all my readings under a microscope for a week with no distractions enabled me to discover some basic things about my condition which were easily missed in the busy-ness of daily life.

I had to experiment for a while with my Levermir doses when I first started on it and I eventually landed with a split which was the complete opposite of the one which I was recommended in an attempt to control my Dawn Phenomenon. I suppose the lesson here is to try different approaches until you find the one that works best for you.

Roll on the pump as it helped with so many of these issues! Good luck.

 

[randomange]

I understand what your saying, and for folk who are that little bit more sensitive to insulin they MUST use the insulin/carb ratios that work for them, I am just saying that in order to teach DAFNE, from my experience, it needs to be by using the 10 grams to every unit method as the whole course is catered towards it...

If what you say about Lantus is true, then I have learned something new today......😉

ramdomange, how did you get on with the 1:10 method on DAFNE, what problems did you face, how did you overcome them?

🙂

Do you mean 10 grams to every CP...? If so, then I agree for DAFNE that it certainly makes it easier for some - there were a couple of people on my course who really struggled with the maths and I'm sure it made it easier on them to think in tens. I just personally find it easier to count in grams, and my DSN is happy for me to do whatever works for me. 🙂

The issues I had with the ratios were that I knew that I was 1unit:5grams carb (or 1 unit:2CP in DAFNE lingo), so going to 1:10 just ended up with me being high. Same with lunch, where I was at 1:8 (not so easy to change into DAFNE terms), and dinner was fine at 1:10. I was just frustrated at ending up high and feeling like c**p when I knew my ratios. I know the reasoning behind the decision, and I understand that there are people who go on DAFNE who don't really know much about carb counting or ratios, but I personally found that aspect irritating.

Like Maryplain says, DAFNE is all about giving you a structured way of managing your diabetes and troubleshooting problems, and I think that is one of its real strengths. I agree that everyone has to start somewhere, and it makes sense that everyone starts from the same place, but I think it's bad to dogmatically say that everyone has to stick to those particular ratios or ways of carb counting. The teachers on my course were very adamant about the course being the place for us to learn how to make those decisions for ourselves, and I agree wholeheartedly with that idea. 🙂

 

[trophywench]

Well I didn't do DAFNE - I did the local version of BERTIE and as a few people were already successfully carb counting they just went with more or less what those people were doing to begin with.

I had started to have a go at carb counting but as I hadn't been able to see anyone at a hospital diabetic clinic for around two years or discuss it with anyone medically qualified who was ensible and knew what they were doing with it by that stage - as Cov just kept cancelling all my appts! - the DSN's running the course at Rugby FOR the whole Cov area - said just try 1u for 10g for now and we'll see. In fact I was also actually having a nervous breakdown at that very moment and so I'd already said to the DSN that this ould be an exercise in futility as far as the next month and my own BGs were concerned over the 4 weeks (1 day a week for 4 weeks) but at least we'd all know I knew the theory at the end of it!

In fact 1u to 10g works very well at most times except like for the past month when the weather has been around 40 degrees - one night at 12.30 AM ie half past midnight when we were still sitting outside the motorhome as it was just too flipping hot to go to bed, the Frenchman next door to us - also still sat outside - showed us his thermometer - 38 degrees .... I mean not at all lovely really and of course verything you thought you knew about your ratios is a pile of baloney and it always just goes straight out the window, Your only exercise might well be staggering to the swimming pool thrice a day, but your body thinks you've run a marathon ....

Anyway I digress LOL - usually my ratio actually is 1u to one of them there CP's, in 1972 in Kidderminster we called 10g of carb 'one Exchange' and I took 11 marks of 80u/ml UltraLente pig insulin every night and was allowed 11 exchanges every day.

 

[lauraw1983]

Well - fancy changing everything at once - your carb ratio AND your basal. The first ruke always is never change more than one thing at a time - potherwise how can you possibly assess what is right and what is wrong?

The Lantus won't be out of your body for 3 days after you start the Levemir for starters - nence why when you start pumping you just go with the intelligent guesses and calculations the DSN makes for ewach person for 3 days, and only then start intensively basal testing to try and start fine tuning them (you stay on the same short acting insulin so keep the bolus rates that work for you anyway).

NRB - if you are on 1u to 7g you never use CPs - just divide total carbs by 7 and inject that number of units - so if you eat 50g CHO you inject 7u, if you eat 45g CHO you inject 6.5u, 20g 3u; whatever.

My consultant said when my ratio was 1u to 11g 'Oh - doesn't that make your bolus doses terribly difficult to calculate?' and I burst out laughing and said 'No - firstly because I use the pump everyone in your clinic has ie the Roche Spirit Combo so I'm using the Aviva Expert meter/remote and the meter calculates it anyway - but secondly even if it didn't, I can both multiply and divide by 11 cos they taught me up to my 12 x table when I was about 7 years old !' LOL

So Laura we conclude - OK go along with it this week then next week revert immediately to your previous bolus ratios and concentrate on getting your Levemir doses right.

Battily although lantus wore out for me sometime just after dinner - Levemir actually lasted me a bit longer than 12 hours if the dose was bug enough. So from 18u of Lantus at night I went on a 50/50 split of Levemir 12 hours apart which was clearly never right from the day I started it - and landed up in the finish taking 14u when I got up and a further 4u at about 9.30 pm at night. Worked for ages.

Batty cos when I went on the pump I actually found I really need almost as much insulin per hour all night as I do in the day - except my TDD after 15 months(and has been so for the last 8 months) I'm now under 10u ......

What I'm saying is, just 'learn' the theories and the strategies. Fine tune it yourself once you are out from under the microscope!

Yes that's why I wanted to keep my 1:7 at the start of the course and not go to 1:10 AND change my basal. Hey ho.🙄

I said the exact same thing about working it out divided by 7 - no it's not really hard - with CP's you are just doing the same number of sums but simplifying it more which gives a less accurate dosage. Doesn't make sense to me really.

I've found using 1:1.5 of their CP's is almost what the 1:7 is anyway. I am using that again and had to split my Levemir 7u and 7u, 12 hours apart (10.30am and 10.30pm) I think this will need tweaked but I can only do that after testing. I am going to do the proper basal testing in the next couple of weeks, I need to plan it into my work days etc!

I was on 13u Lantus so I don't know if I need more Levemir but will see. The DSN originally split the Levemir 10u at 22.30 and 4u at 12.30 but that didn't work....the theory was I need more when I rise but I just went slightly hypo at night (3.9 at 3am)

Thank you for your reply as ever!

 

[lauraw1983]

Have to disagree on keeping it as CP on MDI, I'm afraid! I actually found CPs quite frustrating, as for me I felt it was too simple, particularly as my ratios were more like the 1:7 Laura has. It's easy enough to just add up the carbs in grams instead of CP - you're pretty much doing the same work, just not in batches of 10 - and then dividing that by whatever your ratio is. Even if you're not that good at maths, you can always use the calculator on your phone, or have a "cheat sheet" with simple doses worked out. Everybody varies, but I used this quite successfully on MDI. 🙂

And yes, Lantus might be a 24 hour insulin, but some of it hangs around a bit longer, which is why you have to wait 3 days between changing doses.

Laura, I had a similar experience to you in DAFNE - I had to change all my ratios and really didn't like it. However, if you have a good team, then they should be telling you that DAFNE is a starting point and that it is simply giving you the tools to be able to make changes yourself, so that when you leave you can alter ratios and doses on your own. They should *not* be making you stick to the starting off rules if they're not working for you. I also agree with Sofaraway - I was told snacks should be the ratio closest to your next meal. Hang in there, it'll get better and settle down 🙂

For the bold bit - EXACTLY!

Yes they said exactly what you did, it is a starting point for me to then work with and my team are great - can get in touch at any time! I will now attend the DAFNE clinics too and only annually so in between I can see them whenever.

Thank you for being my brain (and carb ratio) twin on this issue! Lol.

 

[lauraw1983]

The issues I had with the ratios were that I knew that I was 1unit:5grams carb (or 1 unit:2CP in DAFNE lingo), so going to 1:10 just ended up with me being high. Same with lunch, where I was at 1:8 (not so easy to change into DAFNE terms), and dinner was fine at 1:10. I was just frustrated at ending up high and feeling like c**p when I knew my ratios. I know the reasoning behind the decision, and I understand that there are people who go on DAFNE who don't really know much about carb counting or ratios, but I personally found that aspect irritating.

SNAP!

(Oh it won't let me post til I write more, so, um, hi!)

 

[lauraw1983]

Your original post took me back to when I did DAFNE. I also found it very frustrating to have to use a ratio which I knew to be wrong, and felt unwell the first day because I ran high. However by following the rules I was able to demonstrate conclusively that my original ratios were correct. Thankfully I'm quite good at mental arithmetic so I was able to continue using my own ratios but translate them into CPs, and ironically my ratios several years later on the pump have more or less settled to 1:10 anyway!

If you think about it, using CPs is actually doing an extra unnecessary calculation - first to work out how many CPs it is, then calculate the bolus. I very rapidly abandoned CPs at the end of DAFNE which made it a lot easier to adapt to the pump.

I suspect that changing to Levermir at the same time as doing DAFNE is going to make it very difficult for you to get everything adjusted by the end of the week, but what you will have is a systematic technique for testing and adjusting, which is what I gleaned from it. I also found that looking at all my readings under a microscope for a week with no distractions enabled me to discover some basic things about my condition which were easily missed in the busy-ness of daily life.

I had to experiment for a while with my Levermir doses when I first started on it and I eventually landed with a split which was the complete opposite of the one which I was recommended in an attempt to control my Dawn Phenomenon. I suppose the lesson here is to try different approaches until you find the one that works best for you.

Roll on the pump as it helped with so many of these issues! Good luck.

Most definitely the bold bit, totally agree.

Do you mind if I ask what your Levemir doses were and when, and what helped with your DP? That is my biggest problem area and so far it doesn't look like Levemir is helping it though I still have things I can change with it of course!

A pump is looking far far away right now, it's VERY frustrating up here in Scotland trying to get one, not good.

 

[lauraw1983]

Anyway I digress LOL - usually my ratio actually is 1u to one of them there CP's, in 1972 in Kidderminster we called 10g of carb 'one Exchange' and I took 11 marks of 80u/ml UltraLente pig insulin every night and was allowed 11 exchanges every day.

There were two people on my course who talked a lot about exchanges, and just about how much everything has changed over the years - it really was so prescriptive wasn't it? I'm so glad how things have changed for everyone with this blasted condition!

 

[lauraw1983]

Sorry I hope I have managed to reply to individual points now that I have a minute.

By the end of the week I was sad to say goodbye to the people I met, it was a great week in a lot of ways - just chatting to and meeting people with type 1 too in itself was great. People who understand what it's like eh....much like this place!

I'm very glad I did it, I got a lot out of the bits about adjusting for exercise and I am glad I am now on Levemir as it's much more flexible for me, even if it is an additional jab!

Thank you for all the replies, off to read more posts now too x

 

[Northerner]

Glad to hear you enjoyed the course and got a lot out of it 🙂

 

[MaryPlain]

Most definitely the bold bit, totally agree.

Do you mind if I ask what your Levemir doses were and when, and what helped with your DP? That is my biggest problem area and so far it doesn't look like Levemir is helping it though I still have things I can change with it of course!

A pump is looking far far away right now, it's VERY frustrating up here in Scotland trying to get one, not good.

It was a while ago, but I seem to remember being on very small doses of background. I found that it was much easier to cope with things like exercise by keeping my background insulin low and varying my fast acting to cope. I think I was on 3 at night and 4 in the morning, or vice versa. I had limited success with swapping. One thing I did try was to have my bolus on waking even though it was 45 minutes before I would eat. I found that Humalog didn't kick in much before that anyway.

 

[AJLang]

I'm glad to hear you enjoyed the course as well. I also did DAFNE this week. For me it was great to see that I knew most of what was taught. In overall terms I thought that the course was fantastic. For me the best bit was having a complete week to study the patterns in my BG levels which has led to some fine tuning that have made a big difference.

 

[trophywench]

That's good to hear too Amanda, and next time you see the DSN make sure you tell her that, however minor the changes themselves have been. I say this because it demonstrates your ability in responding to tennsy weensy changes - which you need to do to be successful (or more successful) on a pump.

We are dealing with basal rates to 2 decimal places on a pump, and 0.01u insulin over a couple of hours can make soooo much difference!

 

[MaryPlain]

That's good to hear too Amanda, and next time you see the DSN make sure you tell her that, however minor the changes themselves have been. I say this because it demonstrates your ability in responding to tennsy weensy changes - which you need to do to be successful (or more successful) on a pump.

We are dealing with basal rates to 2 decimal places on a pump, and 0.01u insulin over a couple of hours can make soooo much difference!

I wasn't aware you could do that kind of fine control. My pump only lets me do one decimal place - not that I've found this to be a problem. Is the newer Accuchek able to make these fine adjustments, does anyone know? Mine is 4 years old.

 

[trophywench]

To basals - yes, otherwise only to 1 decimal place.