The DSN has already told me that DAFNE is going to do nothing for me. I have been already explained everything, which the course is supposed to.
Put it in writing that you are struggling with your diabetes management and would like a referral onto a DAFNE (Dose Adjustment For Normal Eating) course and send a copy to your GP and a copy to your Consultant. Your DSN has no right to exclude you from an education course because he/she feels it will not help you.
in your opinion, what are the best times to take Basal and Bolus injections? I am willing to try everything. According to Dr Bernstein, morning and night time should be 8½ hours apart in oder to tackle Dawn Phenomenon. I am following his advice these days.
There is no "best time" to take basal and bolus insulin, only what is best for your body. You have to experiment to find what works for you. That involves keeping records and spending some time going through them to figure it out. Once you figure it out, then you may need a bit of tweaking every now and then but mostly you find a routine which works well most of the time for your body and the insulin you use and the food you eat.
For me, that is injecting my morning basal and breakfast bolus (usually + 1-2 units) as soon as I wake up and before I get out of bed. Usually around 7am but if I wake up earlier and I am getting up then it might be 6am or if I have a lie in it might be 8 or even 9am. My evening basal is usually before bed but sometimes I go through spells where my levels start to drift upwards on a night and I need to take it at 7 or 8pm instead of the usual 11pm-12midnight. My evening basal dose needs regular tweaking depending upon what I have done during the day, so a mostly sedentary day will mean I need 1-2 units more at night, a very active day will mean less. 2 physically active days in a row and I don't need any evening basal..... but my average evening dose is 2-3units so dropping to zero isn't a massive drop.
I need about 45mins prebolus time with Fiasp before my usual yoghurt and berries low carb breakfast and 10-20 mins at other times of day. If my levels are 8 or above when I inject I will need to wait longer, if they are in the 4s I will need to wait less time or can sometimes eat straight away.
These timings and adjustments work well for me but it has taken me 4 years to understand how my body and insulin works and fine tune this regime to fit. I can almost guarantee that it will not work for your body, because you eat different food and have a different gut biome and metabolism and different lifestyle and different insulin.
I have no idea what you mean about Dr Bernstein suggesting that morning and evening doses being 8.5 hours apart although if you mean 8.5 hours between evening Levemir and morning, I suppose that is pretty much what I do.... when I need an evening dose, but often I don't need any evening basal. Exercise the previous day takes care of Dawn Phenomenon for me and I inject the +1-5-2 units of bolus insulin mentioned above before I get out of bed to deal with Foot on the Floor Syndrome.
I have watched the occasional You Tube video by Dr Bernstein and it is interesting.... and he is very impressive, but I "follow" what my body tells me rather than anybody else.... and that includes my consultant. I will bounce thoughts and ideas off my consultant but ultimately I make the decisions because I have to live with my diabetes and I know it and my lifestyle far better than he does. I think it is dangerous to take guidance from any one person, which is why this forum works so well, because it gives you an array of answers to choose from and then you experiment to find what works for you personally. It is one of the reasons I didn't offer to mentor you a month or so ago when you were asking. Discussing things on the open forum is where you have checks and balances to ensure that if I say something incorrect, someone else will spot it and correct me or say "that might work for you but it could be dangerous for someone else to try".
Taking advice from a range of sources and then figuring out if it will work for you is always better than just following one person's advice.
I take 14u Levemir before breakfast and 13u before bed time.
If these doses keep your levels relatively steady in the absence of food, day and night (I note you only mention overnight basal testing... which is really only half the picture and I assure you you will not starve if you skip a meal once a day to test daytime levels), then Tresiba may well be a good choice for you BUT I very much doubt it will solve your diabetes management issues. Learning about how your body works will.... and DAFNE will help you to understand that.
I understand it is only the Basal insulin which requires 0.5 units. You may think that I am a complete idiot who is wired to the moon. In truth, this is how this ailment has effected me.
Good that you are enquiring about a half unit pen but I don't understand your comment about only basal insulin needing it. I find half unit pens useful for bolus and basal and use the half unit option regularly. One of the main benefits of these pens though is that they tell you roughly how long ago your last dose was and how much you injected. This is incredibly useful for those "Did I or Didn't I" inject my insulin before this meal or before bed or whatever. After a while injecting becomes so automatic, I can do it whilst I am half asleep (if my high alarm wakes me in the night) and I can be back to deep sleep in minutes afterwards and not even need to put the light on and plenty of times I decide on a dose and then have a change of heart and add a bit more or less and then 5 mins later when I come to record it on my Libre reader I can't remember which dose I settled on in the end, but my Novo Pen Echo has it recorded, so it is a function that I use regularly.... and perhaps it is partl;y old age that I forget what I decided or if I injected when I got my pen case out or if I got distracted by that phone call and actually didn't inject as intended. I doubt I am alone in having these "senior" moments and being able to check the pen and see what I did really helps me keep on the straight and narrow..... Especially the time I injected 24 units of Fiasp before I got out of bed instead of 24 units of Levemir one morning!!
😱 Then I had to inject the 24 unts of Levemir correctly and then start eating carbs to soak up the Fiasp like my life depended on it.
🙄.... which of course it did!
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Anyway, I am very aware that I have typed too much as usual.
🙄 Hopefully you will be able to follow most of my ramblings. If you have any questions, just ask.
If you want to post some photos of your Libre showing particular problems then do so, but first and foremost, you need to establish that your basal dose is correct during the day as well as the night, so perhaps do some basal testing as your basal dose is key to everything else making sense.... and log as much info on Libre as you can at least for the time being whilst you are having problems.
Keep asking for a DAFNE course and put it in writing to make it difficult for them to say "NO" and ask for a written explanation of why they will not refer you onto it if they keep saying "NO" Make it easier for them to just say YES and chase it up if you don't hear anything afterwards.
Focus on just one aspect of your diabetes at a time. So basal first. Get that reasonably well sorted and maybe take at least a week just to work on that and just go through the motions with everything else and then look at individual meal times and ratios, maybe one week to get breakfast sorted and then next week lunch and then evening meal. Then move on to working out corrections. Then move on to timing of your bolus doses. Gradually once you start to get things ironed out a bit, you will start to not just see the wood for the trees but be able to identify the species of tree. You need to approach it slowly and systematically though.
