DAFNE Help!

[Tumble]

Hi,

It's been awhile since I did DAFNE and I no longer see a DAFNE trained diabetes nurse (long story). I was always taught that if your levels were higher than 7 then you should take a correction, however my DN now says that unless my levels are over 10 then I do not need to take a correction. Is this true as I don't see how I would ever get my levels between 4-7.

Also I was told that I should be injecting 10-20 minutes before I eat? Do other people do this? I weigh my food so do not see how this is possible for most meals?

 

[Emmotha]

Hi. My DAFNE which I've just done said going up to 10 or 12 after a meal is ok as long as u r back down after the 4 hour period.
I don't like this idea myself

 

[Tumble]

So if you were 9.2 - 4 hours after, would you take a correction with your next meal?

 

[Engineer88]

Yes in the 9.2 instance you should be taking correction. I think your nurse is worried youll be giving constant corrections and accumulate a stack up.
If at the next meal (or 4 hours later) your higher than target (7) then you should take a correction.

Your nurse talking about prebolusing works for some (it allows insulin to start working as soon as the food is starting digestion) however like you say it wont always work. also shouldnt be used if your BG are on the lower side.
If for instance you had the same breakfast every morning and knew what you were injecting for that can work out quite well for instance.

 

[Micky25]

If you are 9.2, 4hrs after eating something is wrong. Either your insulin to carb ratio is wrong, you underestimated the carbs, or your basal is too low and you were too high prior to eating.

 

[CarbsRok]

Hi,

It's been awhile since I did DAFNE and I no longer see a DAFNE trained diabetes nurse (long story). I was always taught that if your levels were higher than 7 then you should take a correction, however my DN now says that unless my levels are over 10 then I do not need to take a correction. Is this true as I don't see how I would ever get my levels between 4-7.

Also I was told that I should be injecting 10-20 minutes before I eat? Do other people do this? I weigh my food so do not see how this is possible for most meals?

The simple solution for bolusing 20 or 30 mins before a meal is to decide how many carbs you are going to eat for that meal inject for it then eat the meal 30 mins later. I went out to a Sunday carvery and did this and it worked very well. I was always brought up this way as have injected or bloused insulin for almost 50 years and it works very well.

 

[Tumble]

Thank you very much for your responses. Engineer88 I thought I was doing it right!

Micky, I have gone back to basics and am writing everything down to see patterns. At the moment I believe it's a miss calculation of carbs (not every meal is easy to judge) and exercise which is proving troublesome. Some days work perfectly and just when I think everything is correct I get it wrong the next day even if I eat the same thing. Very frustrating!

I'll try and inject 10 minutes before some of my meals but generally I don't know what I'm having for lunch or dinner until it's in front of me.

 

[Micky25]

It's a learning curve Tumble but it sounds like you're doing the right things.

 

[CarbsRok]

I'll try and inject 10 minutes before some of my meals but generally I don't know what I'm having for lunch or dinner until it's in front of me.

This is what I was trying to explain to you, if you don't know what's on the menu then bolus for a set amount of carbs then work out the carb value as it goes on the plate. So if you have for instance bloused for 40 carbs then you know what carb value food is add it up as it goes on your plate until you have your carb bolus amount and or if you are having sweet/pud after decide how much of the pud you want in carb value and leave enough carbs from the total to cover it all.

 

[Micky25]

Tumble, regarding timing of insulin, it can depend on the GI value of the carbs. It can get a little confusing so may be better to Google it but basically, the lower the GI, the slower the release. If you were to have carbs with high GI ( glycemic index ), you may want to consider taking insulin earlier so it is in your system ready to counteract the spike. Low GI, the opposite. Gets confusing eh ?

 

[noblehead]

So if you were 9.2 - 4 hours after, would you take a correction with your next meal?

If it's only another hour or two before I next ate then I wouldn't take a correction dose, I'd wait until you next ate then include the correction dose in the meal calculation, if the same pattern happens the following day then I'd be looking at my previous meal insulin-to-carb ratio or checking that my basal insulin is running out or set at the wrong dose, for an explanation on basal testing have a look at the following:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

As for injecting ahead of your food, I do this most of the time and noticed a big improvement in the reduction of postprandial spikes, I did so after reading Scheiners book as he mentions this in what he refers to as Strike the Spike. He says QA insulins like Novo & Apidra take 15 mins to work and as food begins to digest after 10 of eating it makes sense to give your insulin a head start, but you do have to be careful and much depends on the gi value of the meal and whether the meal is high in fat, injecting ahead of a high-fat meal will result in hypo's.

I usually inject around 15 mins before, if the meal is high-fat then I inject just before eating and sometimes split-dose (depending on what the meal consists of).

 

[Engineer88]

If it's only another hour or two before I next ate then I wouldn't take a correction dose, I'd wait until you next ate then include the correction dose in the meal calculation, if the same pattern happens the following day then I'd be looking at my previous meal insulin-to-carb ratio or checking that my basal insulin is running out or set at the wrong dose, for an explanation on basal testing have a look at the following:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

As for injecting ahead of your food, I do this most of the time and noticed a big improvement in the reduction of postprandial spikes, I did so after reading Scheiners book as he mentions this in what he refers to as Strike the Spike. He says QA insulins like Novo & Apidra take 15 mins to work and as food begins to digest after 10 of eating it makes sense to give your insulin a head start, but you do have to be careful and much depends on the gi value of the meal and whether the meal is high in fat, injecting ahead of a high-fat meal will result in hypo's.

I usually inject around 15 mins before, if the meal is high-fat then I inject just before eating and sometimes split-dose (depending on what the meal consists of).

I understand its a bit different as i'm now on a pump but it can also depend on how your insulin works for YOU. when on novorapid I physically couldnt inject early enough because it wouldnt work for two hours , but with humalog it works much quicker and I can often get away with injecting before eating.

 

[noblehead]

I understand its a bit different as i'm now on a pump but it can also depend on how your insulin works for YOU. when on novorapid I physically couldnt inject early enough because it wouldnt work for two hours , but with humalog it works much quicker and I can often get away with injecting before eating.

Good point Engineer, much will depend on the insulin taken and of course whether the person has any injection site problems too.