What is the secret about Dafne..?

[Phil65]

Just to pitch in. I've never done any courses. All I know about carb counting and adjusting is about 10% from the blundering along for 30 odd years in the dark and 90% from this forum and other T1s on twitter etc.

The thing I don't like about DAFNE (purely hearsay) is the concept of only adjusting before meals. So if you test at +2 hours and you're maybe 15mmol/l, their regime seems to suggest that you wait until your next meal (maybe 3 or 4 hours away?) before correcting. By which time you may be 20+.

I may have misunderstood, and obviously their methods are a brilliant way to learn the basics, but I wouldn't want to follow them rigidly. The are partly responsible for GPs thinking we don't need to test more than 4x per day. They see no point in extra tests if you don't make corrections.

Just my thoughts. 🙂

Rob

....that is not what I experienced....they were very keen on individuals taking control of their own diabetes and making one's own informed decisions. .....courses will vary I suppose....as does peoples' diabetes!

 

[novorapidboi26]

DAFNE is just the basics, you can then go on to develop it further to suit your own personal needs......

If you were high 2 hours after the meal and you suspected you would rise further....(which is unlikely unless you have mad a serious mistake)..........then you could correct, providing you were aware of what insulin was on board at the time.......

not correcting at this time is encouraged while learning how to spot patterns and then make adjustments, reducing the variables if you like......🙂

 

[Robster65]

Ok, in which case, I've done them a disservice.

It is certainly good for anyone starting out with carb counting. 🙂

Rob

 

[bennyg70]

Ok, in which case, I've done them a disservice.

It is certainly good for anyone starting out with carb counting. 🙂

Rob

I dont think I could go that long without correcting, The worry on my mind and the way it makes me feel. A lot of people I have read say they dont feel anything when high, but it makes me feel as bad as been low and takes longer to correct. And whenever my bloods go high, I worry about the consequences of complication for days to come.

Id rather be lower than higher any day of the week if I had to make a choice.
Not that I enjoy being low of course.

I dont think Ive ever had a severe hypo, but I do tend to dip into the 3.5 - 4 zone probably daily which I need to work on cutting out of my diabetes.

 

[novorapidboi26]

If you found yourself correcting regularly at mid meal times then you would need to rethink things.........

If you were looking for patterns over a 3 day testing period then it would be wise not to correct so you can make an accurate change...

But yeah, going high can be rather uncomfortable for people and in the short term you should correct at mid meal, but if not done correctly you run the risk of going low later, which brings with it yo yoing blood sugar level and the damage that comes with it.....

🙂

When are these hypos occurring benny

 

[bennyg70]

NRB,

Argh I just wrote a load, and then I clicked the close button for no reason whatso ever!!!! ARgh!!!!

Any way...

Im doing some extensive ratio testing at the momrnt starting with the morning, see attached for how they are coming along so far. Im not happy with my 1 hour mark results,but my 2 hour results seems OK. On some days Ill go low if I have a bigger breakfast by the looks using the same ratio of 8/1, means more insulin. I possibly need to switch my ratio depending on size of meal ? What do you think? Is this common?

My lows do come on sometimes from over correcting, but I think im getting better now that I know where my bloods are heading 2 hours after post prandrials. I get a lot of 9mmols after meals I dont feel happy with it, but I dont know how to get it down.I know its just adjusting my ratios I think, but If i tweak them too high then I end up with low post prandrials. Its such a delicate balance.

Let me know your thoughts.

...Should be noted on the 17th results, Id been drinkin at the german market the day before.. recipe for disaster!

 

[trophywench]

Benny - if you are going to eat carbs, then being a T1 you WILL have a spike of some sort. Esp faster-acting carbs.

If you eat slow acting carbs, then there's a chance the insulin peak will be before the carb rush. = hypo.

This is why in the main, nobody bats an eyelid up to say 10 or 11, at +2hrs.

Ideally of course no-one would ever do it. But practically it's quite hard to achieve.

You could learn from pregnant T1s here! I have!

What they do is have enough QA at a long enough time before they eat (up to 45 mins when their IR is mega) to ensure the post prandial spike doesn't happen. Then they snack just after the 2 hour mark, to prevent the 3+ hour hypo!

Well frankly my dear Benny, that might be OK when you are incubating a baby since it's a relatively short time out of a life - and usually not the whole 9 months anyway - but it's not something I would want to have to do for the rest of my life.

One thing that struck me immediately reading your spreadsheet - if you have 3u for 22g carbs (2 slices Burgen, day 1) to me that says you need 1.5u ish to 10g insulin. So I expected you on Day 2, when you had 32g carbs to take 4.5u, and you only took 4u .......

I know you took Burgen at face value and the packet says 11.9 a slice so that's 24 - divide by 8 = 3u and ditto the Cheerios - but I have said elsewhere, bread packets lie. Normal white bread 2 slices is well over 30g but if I call it 40g or even 35g, then I'll hypo. It's 30g for 2 pieces of medium sliced. And Burgen is the same ......

Go forth and get a half unit pen, and try 1.5u to 10g .......

 

[bennyg70]

TW, Im going to read that over and over again, as I think your onto something, however Im not very quicjk and its not quite sinking in!!!

Id love a half unit pen, I cry out for one, and if I go back to nova rapid, ill be getting one. But im told that there isnt one available for apidra...

Why would the packets lie!! Damn packets!!

"One thing that struck me immediately reading your spreadsheet - if you have 3u for 22g carbs (2 slices Burgen, day 1) to me that says you need 1.5u ish to 10g insulin. So I expected you on Day 2, when you had 32g carbs to take 4.5u, and you only took 4u ......."

The reason is I wanted to see if 8 to 1 is right for me int he morning..

Taking packet values, 2 burgen breads is 24g., so 24g / 8 = 3u. (Ive purposely chosen multiples of 8 to make the testing easier for me) so id have taken that as 1.25u insulin to 10g carbs. 32g carbs 32g @ 1.25u per 10g would be 4u. And I ended up going low..!!

Im so confused...! However packets lieing would explain a lot.. How do you get around this?

 

[trophywench]

Only for leavened bread Benny - eg pita is a PITA cos if you knock a bit off as per normal bread, you'll be high LOL Which is why it was hard for me to spot - pita or chapatti or a wrap, packet is gospel. (ish) Yeast - forget it !

Well once I had battened down the hatches on my basal and got into the swing of - well - dafne! LOL - ie doing it as opposed to the course itself, I was regularly going hypo late afternoon - 5pm ish to before dinner ish. If I changed my ratio at lunchtime, that didn't really seem to work, 1u for 10g was working 100% fine mostly ...... So discussed with DSN, who shot how many carbs in ... questions at me and she said - Were you eating bread at these lunchtimes? - Yup. What bread how much bread what do you count for it? Err, 2 slices, it's 17.6g a slice, therefore .... NOPE she says, 15 a slice.

Husband says But the packet defo says 17.6.

She laughed and said, Well the packet might, but I say it's different. And my guinea pig* agrees wholeheartedly with me!

* Her husband is T1.

(Further comments about Wow that makes a change and I'll take his word for it then - rather than hers, and was she earning too much and should she pay him half her salary etc LOL)

So I tried it and it's only ruddy right - for me anyway! ...... I hadn't identified it was the yeast content, it never occurred to me. Whether it's summat that happens when you develop the gluten in the flour as you do in yeast cookery - the kneading process - I have not the slightest idea.

I don't touch other yeasty things - Chelsea Buns etc and that would be skewed by the sugar, fruit, icing etc anyway.

Try it and see if it works. If it doesn't you've lost nowt !

 

[novorapidboi26]

My ratios are as follows:

Breakfast: 2.5:1 or 2.5 units for every 10 grams of carbs

Lunch: 1:0 or 1 unit for every 10 grams of carbs

Dinner/Evening: 1.5:1 or 1.5 units for every 10 grams of carbs

DAFNE teach you to change the insulin you need for every 10 grams of carbs as opposed to changing the carbs that 1 unit of insulin tackles, this makes it much easier I think, on MDI anyway, to work out your insulin doses.......obviously there will be some rounding down and up from the .5s that are flying around, but it works really well.....

You could try this approach........some folk will argue against and others wont, but for me, its seems to be the simplest way, at least until you have a got a sound understanding of what you will be needing....

In terms of the mid meal spikes.......trophywrench is right, getting these numbers down is down to insulin dose timing, not insulin/carb ratio.......so lots of trial and error.....

 

[DeusXM]

I think I'd freak out if I was regularly getting 2 hour pps in the 10s and 11s. I can't see how you could possibly get a sub-7 A1C if for two hours after every meal your BG is that high.

However, I recognise this isn't always easy. My 'trick' for this is to bolus maybe 15-30 minutes prior to eating, and also do intramuscular injections. The insulin gets into your system quicker and I don't need a snack afterwards (the relentless insistence on doctors that 'diabetics need lots of snacks is pretty much the reason why so many people with diabetes end up being overweight with complications).

Another option is to simply cut out the carbs - you won't get a spike to 10 or 11 with a good salad, or steak and veg, and you might not even need to bolus for them either.

 

[bennyg70]

I think my HBA1c is probably a tad off at 6.4 because i dip into the 3.5 - 4s quite often possibly masking my post meal 9s. I always do try now to inject at least 15 - 30 mins before, dependant upon my bg, and what im eating. Sound daft but what do you mean by intramuscular - I take it into a muscle. I currently inject into my stomach, and lets just say, I wouldnt consider it muscle! Also worth noting, I still do take a pinch of fat which I inject into, Is this method outdated?

Trophy wench... What is leavened bread?

Ok so Ill eat mainly...

Wraps, Seeded variety from hovis (7 Seeds) labelled at about 14.5g. Burgen bread ive recently discovered @ 12g on the packet.

How would you calculate what to knock off for these?

 

[Northerner]

...Sound daft but what do you mean by intramuscular - I take it into a muscle. I currently inject into my stomach, and lets just say, I wouldnt consider it muscle! Also worth noting, I still do take a pinch of fat which I inject into, Is this method outdated?
...

No, you're doing it right, insulin is intended to be injected just below the skin - injecting into a muscle is not recommended, you should inject into fatty tissue, not the muscle that lies below. This is why I do not inject into my thighs, because I have no significant fat there. Injecting into a muscle will speed the release of the insulin into your bloodstream and can be dangerous.

 

[bennyg70]

No, you're doing it right, insulin is intended to be injected just below the skin - injecting into a muscle is not recommended, you should inject into fatty tissue, not the muscle that lies below. This is why I do not inject into my thighs, because I have no significant fat there. Injecting into a muscle will speed the release of the insulin into your bloodstream and can be dangerous.

As in Hypoing before your food hits your system!? Hopefully with my testing i have done recently etc Ill be able to get my timings better. Ive done some corrections testing recently and have found out some useful info.

It seems as though I use 40% within the first hour, 35% second hour and 25% 3rd hour before its out of my system. This is a whole new spreadsheet though, and was done for a high correction, so im guessing it works different when in normal range.
Sorry Northener if this thread has gone a little off the original topic and turned into my own personal get help advice group..!

 

[bennyg70]

"I think I'd freak out if I was regularly getting 2 hour pps in the 10s and 11s. I can't see how you could possibly get a sub-7 A1C if for two hours after every meal your BG is that high."

The way I look at it, and dont get me wrong Id love to get them down...

for a third of my 24 hour day im usually OK - good between 5 and 7mmol/l, I go to sleep at say 11pm, wake at 7am - thats 8 hours in range.

A bad day for me seems to be, I eat, let say that from a half hour after eating (Because the sugararnt suddenly increasing) till and hour and a half after eating (Then they start to come down, so for 1 hour im out of range, at 2 hours, im usually 9 or under. So x 3 times a day (Actually is truggle much more with breakkie and lunch, dinners are usually much better) im out of range for 1 hour up to 10 / 11mmol/l which isnt a million miles away from the debated guidelines of 10 (Although we all strive for tighter than this) and maybe 2 - 3 hours hovering around 8 or 9.

thats 3/4s of a day in range, 1/8 out, and 1/8 so so.

Surely worth a 7 in my book... But been able to deal with the 10s and 11s may be the key to improving a little further..

 

[novorapidboi26]

turned into my own personal get help advice group..!

Those are the best type of threads.......🙂

 

[novorapidboi26]

If I get a 10 mid meal I am happy, single figures are brilliant.......its not that easy though in my opinion.........every meal is different and could benefit from a completely different timing than the last.....

 

[Northerner]

...Sorry Northener if this thread has gone a little off the original topic and turned into my own personal get help advice group..!

Not a problem Benny, it's called 'thread drift' 🙂 If it happens and it's not your thread then sometimes the Mods will split out into a new thread so the original poster doesn't wonder what has happened to their original question! 🙂

 

[DeusXM]

Intramuscular injecting is not dangerous if you know what you're doing. If I'm eating something that I know will affect my blood sugar very quickly, then it makes sense to match my insulin usage to what I'm eating. Generally yes, I'll do sub-cue injections but if I'm eating sweets or correcting from a significant high, then I'll do an IM jab to get me back on track quicker. There could be a risk of hypos but if you're doing the job properly, the risk is no more than from a normal injection. Furthermore, a hypo is extremely easy to treat. For me it's a simple trade off. Say my BG is at 13 or 14 because I made a mistake. I can either do a correction dose and basically be at a high BG level for 3 hours and enjoy all the damage that'll do to my eyes and kidneys and feel like rubbish the whole time...or, I can put up with a very small risk of having a hypo and being back to normal in an hour. For me, it's a no brainer.

But been able to deal with the 10s and 11s may be the key to improving a little further..

Precisely, particularly if you feel your (good) A1C comes from a wider standard deviation rather than better overall control. The important thing to remember is BGs over 7 broadly cause damage, but with meter error it's probably not worth stressing over the 8s.

 

[robofski]

Deus,

Do you use the same dose for an IM and a sub-cue correction just the action happens over a shorter time for the IM (e.g. if 1u brings you down by 3mmols for a sub-cue injection is it the same IM it just happens in an hour versus 3 for the same dose sub-cue)? It's an interesting approach and I think I'd agree that getting back from that high quicker must be a good thing!