DIABETICS!!: whats your HBA1c???

tbh

smccarrick wrote: »

Just remember that the GI of the carbs, is as important as the carbs themselves.

No - not according to Dafne. They say the GI is irrelevant except for nuts, mushy peas, sweetcorn and a few others whose GI is so low you don't have to take insulin. but according to DAFNE, it doesn't matter whether you're eating low or high GI, you take the same amount of insuling.

CathyMoran

Just from personal experience I find GI important - I would tend to avoid high GI foods, they give me a sugar rush and a headache (if my blood sugar is above 10 I feel ill). I am pregnant so my guidelines are to have a blood sugar of 7 or less an hour after a meal but I have always followed low GI (I do have treats of course ). The dietician in the hospital really is the best person to give advice here.

The_Conductor

tbh wrote: »

No - not according to Dafne. They say the GI is irrelevant except for nuts, mushy peas, sweetcorn and a few others whose GI is so low you don't have to take insulin. but according to DAFNE, it doesn't matter whether you're eating low or high GI, you take the same amount of insuling.

Hi tbh,

DAFNE is really great when the person, recognises that they can assign a value to carbohydrate such as the CP counts in the DAFNE handbook, and take an appropriate amount of insulin (aka for 10g of Carbohydrate (1CP)= 6 units (for example- this will vary from person to person) of novorapid........)

With this approach you get a nice overall average- however some people will get excited about the spikes from high GI foods (and in some cases give themselves extra insulin to knock it on the head, percipitating a yo-yo effect, where they've taken more insulin than is strictly necessary in order to avert a high blood sugar, subsequently crashing because they have little slow absorption carbohydrate to maintain their levels later on, and possibly having to correct with lucozade etc)

The big thing with DAFNE is that the person not get excited when they have a high test after a high GI food- as it will come down given the appropriate amount of insulin for that carb has been taken- and the lower GI foods will be dealt with via the long acting Lantis (or similar). People have to accept however that they will test low if they've just eaten a low GI food- or high after something with readily available sugars- which is why testing should probably happen a reasonable period after finishing eating and taking insulin.

It really is a shame that DAFNE courses (and refreshers) aren't as widely available- they really would make life a lot easier for many people (and perhaps people who are inclined to over-test might be a little more relaxed in their regimes also!)

I'm terrified of hypos (mental note to self, order more glucagel)

Shane

CramCycle

smccarrick wrote: »

Hi tbh,

DAFNE is really great when the person, recognises that they can assign a value to carbohydrate such as the CP counts in the DAFNE handbook, and take an appropriate amount of insulin (aka for 10g of Carbohydrate (1CP)= 6 units (for example- this will vary from person to person) of novorapid........)

With this approach you get a nice overall average- however some people will get excited about the spikes from high GI foods (and in some cases give themselves extra insulin to knock it on the head, percipitating a yo-yo effect, where they've taken more insulin than is strictly necessary in order to avert a high blood sugar, subsequently crashing because they have little slow absorption carbohydrate to maintain their levels later on, and possibly having to correct with lucozade etc)

The big thing with DAFNE is that the person not get excited when they have a high test after a high GI food- as it will come down given the appropriate amount of insulin for that carb has been taken- and the lower GI foods will be dealt with via the long acting Lantis (or similar). People have to accept however that they will test low if they've just eaten a low GI food- or high after something with readily available sugars- which is why testing should probably happen a reasonable period after finishing eating and taking insulin.

It really is a shame that DAFNE courses (and refreshers) aren't as widely available- they really would make life a lot easier for many people (and perhaps people who are inclined to over-test might be a little more relaxed in their regimes also!)

I'm terrified of hypos (mental note to self, order more glucagel)

Shane

As you said though it is an average of what works. IIRC I think CathyMorgan mentioned if its a high GI food take your insulin a few minutes before but if its very low GI maybe split it half and half (before and a few minutes after). I don't myself but it seems like logical advice.

Personally I do alter my insulin levels and timings a little based on the GI and what work I'll be doing afterwards but thats what I know works for me after a quarter of a century of diabetes. This won't work for everyone but it works for me and thats all I care about. I do have my patches where my control goes out of whack but this is never due to the way I treat myself but other reasons which make me not care for short periods, thankfully not for to long though

CathyMoran

Was also diagnosed 25 years ago. I do think that with time you get into a pattern but the early years (especially if you are diagnosed as a child) are tough. I work hard on looking after myself but I still fail at times. My blood sugars tend to be on the low side though.

CramCycle

CathyMoran wrote: »

I do think that with time you get into a pattern but the early years (especially if you are diagnosed as a child) are tough

I used to steal change from my dad so I could buy penny sweets and those cartons of bubble gum you'd get for 10p, admittedly I grew out of it I also remember the nurse telling me how the syringes weren't sore and proceeded to inject an orange to show how easy it was at which point I pointed out I wasn't stupid and oranges have no feelings. In the end, she had to inject my mother (who had a tremendous fear of needles) to prove it wasn't that bad as I wouldn't believe the nurse doing it as I didn't know her. I was not a good child.

I work hard on looking after myself but I still fail at times. My blood sugars tend to be on the low side though.

Mine too but i don't think i work as hard as you do after reading some of your other posts about pregnancy etc. I have a nice balance of attempting to work hard but not getting to stressed if it's not perfect, bloods are rarely perfect in the average joe soap nowadays either so I won't get stressed if they're slightly off. That said when I fail, I do it spectacularly well, posting on boards, talking to the OH, telling certain people/friends/work colleagues my precise feelings towards them in a very articulate but inappropriate fashion. :eek:

tbh

I take your point about the spikes, but another fundamental of DAFNE is that you don't test between meals for exactly the reasons you outline

CathyMoran

tbh wrote: »

I take your point about the spikes, but another fundamental of DAFNE is that you don't test between meals for exactly the reasons you outline

When you are pregnant you do not have that option Mine is wierd in any case - the oesophaectomy messed my "control".

cynder

I've never heard of dafne, thats one for the future. must google it sometime.

Just googled dafne, and its not suitable for children only for adults with type 1, suppose she will do a dafne course when she is 18 +.

tbh

grindelwald wrote: »

I've never heard of dafne, thats one for the future. must google it sometime.

Just googled dafne, and its not suitable for children only for adults with type 1, suppose she will do a dafne course when she is 18 +.

Based on what you've told us, the carb counting, corrections - you're already following the DAFNE plan

tbh

smccarrick wrote: »

It really is a shame that DAFNE courses (and refreshers) aren't as widely available- they really would make life a lot easier for many people (and perhaps people who are inclined to over-test might be a little more relaxed in their regimes also!)

I'm terrified of hypos (mental note to self, order more glucagel)

Shane

This is very true - I'm finding it hard to test less to be honest. What worked for me last week doesn't seem to work for me this week and it's wrecking my head

It's hard to understand, post parandial sugars only affecting pregnant women doesn't make sense to me, to be honest. But I'm going to give it a shot. The doc did stress how difficult it was to be pregnant and diabetic, I think her exact words were "no-one could do It for more than nine months"

CathyMoran

tbh wrote: »

This is very true - I'm finding it hard to test less to be honest. What worked for me last week doesn't seem to work for me this week and it's wrecking my head

It's hard to understand, post parandial sugars only affecting pregnant women doesn't make sense to me, to be honest. But I'm going to give it a shot. The doc did stress how difficult it was to be pregnant and diabetic, I think her exact words were "no-one could do It for more than nine months"

How about me having only 5 months break before becoming pregnant again I have gone through harder things but it is different when another person's life is dependant on you.

tbh

CathyMoran wrote: »

How about me having only 5 months break before becoming pregnant again .

would it not be easier just to get your telly fixed

graflynn

grindelwald wrote: »

I've never heard of dafne, thats one for the future. must google it sometime.

Just googled dafne, and its not suitable for children only for adults with type 1, suppose she will do a dafne course when she is 18 +.

Galway have "BRUCIE" which is for kids.

yungwan

grindalwald - I am sorry to hear you are having a hard time with your daughter at the moment. I hope things calm down a little for you.

I personally am dreading Xmas. It will be my sons first Xmas since diagnosis (Aug) and I know it is going to be difficult with slower paced days and treats EVERYWHERE!! I dont want to be saying "No" all the time but understand he needs to monitor his sugar and carb intake etc. How do others handle this period with their children?

He is on novomix twice daily and while this works great while he is in school etc, at weekends and holidays his sugar rockets and I find it very difficult to know what amounts of insulin to give him. (For eg. his diabetic nurse told me not to increase his weeken doses by more than 1 unit but he seems to need way more insulin) This isnt because he eats loads of crap or anything, we might be eating fairly healthy food etc (Although he dos get some treats at weekends) but because he is less active at weekends his reads are just very high (lately in 20s)

Oh and ps as someone mentioned above what works one week doesnt seem to work the nixt (might be too little/much) so its a nightmare trying to gaige it. We havent started carb counting yet as it is such a new diagnosis.
Maybe a different regime at weekends might be a better option? Anyone have experience of this?

tbh

On DAFNE (two weeks ago!) my bloods were good as gold, I was on 22 Lantus and ratio of 1:1. Since then I've had to go to 28 Lantus and 3:1 ratio and I'm eating hardly any carbs and my bloods are always ten +. What the hell is going on??!?

cynder

yungwan wrote: »

grindalwald - I am sorry to hear you are having a hard time with your daughter at the moment. I hope things calm down a little for you.

I personally am dreading Xmas. It will be my sons first Xmas since diagnosis (Aug) and I know it is going to be difficult with slower paced days and treats EVERYWHERE!! I dont want to be saying "No" all the time but understand he needs to monitor his sugar and carb intake etc. How do others handle this period with their children?

He is on novomix twice daily and while this works great while he is in school etc, at weekends and holidays his sugar rockets and I find it very difficult to know what amounts of insulin to give him. (For eg. his diabetic nurse told me not to increase his weeken doses by more than 1 unit but he seems to need way more insulin) This isnt because he eats loads of crap or anything, we might be eating fairly healthy food etc (Although he dos get some treats at weekends) but because he is less active at weekends his reads are just very high (lately in 20s)

Oh and ps as someone mentioned above what works one week doesnt seem to work the nixt (might be too little/much) so its a nightmare trying to gaige it. We havent started carb counting yet as it is such a new diagnosis.
Maybe a different regime at weekends might be a better option? Anyone have experience of this?

You will find that this is going to happen a lot, and sometimes you cant put your finger on it, its just the way it is..... after saying that there can only be a few reasons why blood sugars rise/fall

insulin too much/too little
exercise too much/too little
food too much/too little
and illness also stress (and if your like my lady the summer sun makes her go high)
You will find no 2 days are the same for one reason or another.

Seems like you son may be pigging out a little (eating too much) while he is at home ( my lady went through phases where she did that, and lied about it).

As for xmas dont buy too many treats,if he does have treats make sure its with his main meal and not as a snack.

Does he inject himself?

She was diagnosed in the feb and we did are first carb counting in the June as no other method was controlling her. They stopped the carb counting after 3 months and we were put on a sliding scale (dublin was not impressed) but that worked for 3 years, its not working anymore thats why we are back to carb counting, yesterday was bad but today is going well.

She came in at 6.3 this morning took 5 units for 50 carbs and at 11 she was 6.7 had a cheese string and now she is 8.8.

My keyboard is playing up and not typing the letters i press:(

its now 6pm and she hasnt gone above 8.8, she was 5.5 at tea time, so all good today, if we can keep this up for the next 3 months her hba1c should be around 7 or under.

cynder

Carb couting going well,

however the lantus needs to be increased she had 0.2 ketones again this morning with blood sugars at 19.6, yesterday morning she was 18.4 both nights before bed her blood sugars were under 10 so tonight im giving her a bit extra lantus.

CramCycle

grindelwald wrote: »

Carb couting going well,

however the lantus needs to be increased she had 0.2 ketones again this morning with blood sugars at 19.6, yesterday morning she was 18.4 both nights before bed her blood sugars were under 10 so tonight im giving her a bit extra lantus.

Depending on how much she is eating it might be worth trying increasing her novo by one unit if the increase in Lantus has no effect. Another question is what time of day is she taking her lantus, it may sound stupid but i know plenty of people who say the time of day they take it makes a difference, I've always found first thing in the morning to be the most effective for myself despite the doctors recommending taking it in the evening.

tbh

Doctors recommend you tak it in the evening because for some people it doesn't last 24 hours, and bloods start to get higher in the last few hours before a jab. For some people that is. The thinking is that the effects of this can be spotted and dealt with more easily if you are awake than if you're asleep. Whatever about adjusting the dose, I certainly wouldn't adjust the time without speaking to your care team.

If the sugars are running high, then adjust the lantus dose by 10% ~ 20% each day till you get it right. For me, 26 units had my bloods really high but 30 has them perfect. 4 units eh?! Anyway remember as well that with lantus you wont see the effects of a change in dose until the second day.

tbh

Also meant to say, the recomendation from DAFNE is you change the novorapid dose by ratio, not unit, if you are carb counting. However, I wouldn't change the novorapid value until you're sure the bi is right. The BI really is the key, in my experience.

CramCycle

tbh wrote: »

Whatever about adjusting the dose, I certainly wouldn't adjust the time without speaking to your care team.

Definitely, they were just ideas from me to mull over and that can discuss with your specialist nurse.

It was something that worked for me as i found its alot easier to ensure I kept to almost the same time everyday. whereas when I was a teenager and taking it in the evening, my times would change daily as I got distracted with life as teenagers do. Whereas in the morning it was always before school, so it helped me a good bit.

You are definitely right about the action time though and this definitely won't work with everyone, there are wide variances between patients on the action time, it seems to last about 26-28 hours with me but I know from other sources that it can in some cases it only lasts for 18 hours.

As for the adjusting the novorapid, ratio or unit, I don't think it makes any difference unless you are talking a huge amount, it would work out by unit most of the time anyway but getting the basal rate right is more important first.

cynder

Hi

She was taking them every morning has been for the last 3.5 years, the top up worked the other day so i spoke with the diabetic nurse and we decided to give it too her at 9pm at night, we have given her the lantus at 9pm for the last 2 nights. She had her first night time hypo x2 on the first night, we gave her 28 lantus last night and she came in at 2.7 at 7.30 this morning so reducing it again tonight to 26.


Altering her lantus too pm has also changed her insulin carb ratio for her breakfast as she is now having more hypos during the day(can we ever win!!!!) so reducing the insulin carb ratio to 1:12 instead of 1:10.

she had 2 lows at 11am and was 20.3 at lunch with 0.2 ketones. A few more days and i think we will have it sorted, for the time being at least.

5live

6.5 on Dec 4th. Delighted as the number of hypos was down a lot and it is the first time in over 18 years that i slept without worrying about hypos. But.... the number of times with bloods over 10 has risen too so i am swinging high and low(obviously?) but maintaining my mid 6s average. I am getting confused as i was expecting mid 7s due to trying to run higher sugars

tbh

When you say the hypos are down, are you hypo aware? Is it possible you're going hypo but not realising, with the consequent rise afterwards contributing to the over tens?

5live

I am still fairly aware of hypos being present but my OH(and, funnily enough, my dog) spot it coming on. But like i said ,the hypos have decreased in numbers but have had a very bad one last week. A whole-cadburys-caramel-bar one with my bloods at 5.1 2 hours after. Oh god it is almost worth the hypo to get the bar:P. Sorry. Just clearing drool from the keyboard:D. Its the whole week where i can eat anything at all and my bloods ok followed by a week of high bloods while just being in the presence of food that does my head in. My work is generally the same and my diet is fairly regular so i am very lucky in that respect but i reduced my novorapid for the last few months and was a bit more relaxed about a bit of chocolate every now and then(chocolate:D:D) so i was very surprised to see it still the same. It still mystifies me. (did i mention i am a chocolate addict for about 18 years too:))

CathyMoran

5live wrote: »

I am still fairly aware of hypos being present but my OH(and, funnily enough, my dog) spot it coming on. But like i said ,the hypos have decreased in numbers but have had a very bad one last week. A whole-cadburys-caramel-bar one with my bloods at 5.1 2 hours after. Oh god it is almost worth the hypo to get the bar:P. Sorry. Just clearing drool from the keyboard:D. Its the whole week where i can eat anything at all and my bloods ok followed by a week of high bloods while just being in the presence of food that does my head in. My work is generally the same and my diet is fairly regular so i am very lucky in that respect but i reduced my novorapid for the last few months and was a bit more relaxed about a bit of chocolate every now and then(chocolate:D:D) so i was very surprised to see it still the same. It still mystifies me. (did i mention i am a chocolate addict for about 18 years too:))

Chocolate is lowish GI as a rule so not the best for getting you over that initial extreme low blood sugar phase (well from my experience). I had bloods that were at their highest 2.1 all night - not easy.

eilo1

CathyMoran wrote: »

Chocolate is lowish GI as a rule so not the best for getting you over that initial extreme low blood sugar phase (well from my experience). I had bloods that were at their highest 2.1 all night - not easy.

I think the caramel bit makes up for the chocolate low gi (at least thats what I tell myself! )

2.1 my god you must feel awful??!?!?!?

tbh

5live wrote: »

I am still fairly aware of hypos being present but my OH(and, funnily enough, my dog) spot it coming on. But like i said ,the hypos have decreased in numbers but have had a very bad one last week. A whole-cadburys-caramel-bar one with my bloods at 5.1 2 hours after. Oh god it is almost worth the hypo to get the bar:P.

I woke up the other night with a hypo, on the night we did the big christmas shop. two words for you 5live: happy. days. The story about the dog is fascinating, I know a girl who has a dog trained to alert her if she's about to have an epileptic fit!

CathyMoran

eilo1 wrote: »

I think the caramel bit makes up for the chocolate low gi (at least thats what I tell myself! )

2.1 my god you must feel awful??!?!?!?

I can go down to 1.2 and be reasonably aware...is hard with the pregnancy.

tbh wrote: »

I woke up the other night with a hypo, on the night we did the big christmas shop. two words for you 5live: happy. days. The story about the dog is fascinating, I know a girl who has a dog trained to alert her if she's about to have an epileptic fit!

They do the same for diabetics in other countries.