Dafne - should l split dosage? (low carber)

[claridge]

Hi all,

Im have been diabetic for 2 years and have been a low carber for the whole time (fish/meat/veg/salad) and on 10 (ish) units of Levemir a day (7pm) and about 2-3 units of Novorapid per meal (as long as l remain strict).

I have had my second day on Daphne and l have been told that l should not need any Novorapid for 0 carb meals (ie only NR for bread/pasta/pots/rice/cakes etc - not veg or salad though) if my background in sufficient - so they are thinking that my current background insulin is running out early which is why l am having to have NR with meals.

Im quite confused as to whether this is correct or not - it sort of makes sense but on the other hand lm not sure it would work...
THe other diabetics who all eat carbs have almost the same NR insulin as me with meals but they are eating carbs and lm not.... which confuses me. Now l know they go low a lot more than me so there's is perhaps not correct. So the correct way to do it is to have the background to cover you and any negligable food and the NR only for the bread etc...

I was wondering if anyone else was a low carber and moved to a split regime and they dont have to take NR for their meals? Or if anyone has any experince in this area it would be MUCH appreciated.

Jo

 

[jopar]

I'm assuming that you mean novorapid when you say NR...

Your background insulin it just for tackling what is coming off the liver, not for handling any food you may eat..

It's not unusual to split the background insulin either that it isn't lasting 24 hours or for Dawn phanonmon...

Meal times you are better off working out the effect of protien and the very small amounts and covering with quick acting, you may find that you will need to due the injection after you've eaten rather than before as protien is slow release to avoid hypo's

Two other alternitives

Using a mid range insulin one of the older anlogues the profile may suit better, a lot of exteme low carbers use this method, Bernstein uses it so perhaps looking at his book will give you a better idea..

There an insulin pump would make a very good alterntive, as you can deliver very small amounts of insulin over a changable spam of time...

 

[the_anticarb]

Hi Claridge

I don't low carb anymore due to pregnancy but low carbed for about a year last year, and kept going hypo when I started off (as I was on novorapid as well as lantus) so I dropped the novorapid (reduced at first, then cut out completely) and had lantus 20u per day plus 1 metformin with meals and this was enough to keep my blood sugars under control. I had to be quite strict with the carbs though, less then 15g per meal.

Hope that helps

 

[janabelle]

Hi Jo
the key to good diabetes control is a basal insulin that does at it should. It's beomingly abundantly clear that Levemir, despite being marketed as a 24 hour flat-profile basal insulin, is clearly not. Many people have posted on this forum saying their doc has suggested splitting the dose, whiich begs the question what is the point of it- if it is no more effective than any previous insulin types?. As for Lantus, let's not go there .
I have absolutely no faith in anlogue insuulins, following many years on humalog and 4 horrendous years on Lantus. While we waste years wondering what we are doing wrong, the damage is being done.
You have a choice of 3 different insulin-types available in the UK. Animal(porcine & bovine)-available since the 1920s and still available in highly purified form; synthetic human insulins- available since the 80s,;and analogue insulins-introduced in the late 90s.
Since summer '08, following 4 1/2 years of yo-yo-ing BG levels and ill health, I changed to animal insulin and it has the flattest, most reliable profile of any insulin I've ever used. I'd previously been on synthetic human insulins since the 80s with fairly brittle control.
You can try splitting your dose of Levemir,but If it doesn't work for you, then you could consider trying a different insulin type.
I didn't eat much in the way of carbs when I first changed to porcine insulin, so I could guage how it worked and adjust my dose accordingly. Took a bit of time, but I've been on roughly the same doses for 2 1/2 years now, and wish I'd tried it, or being offered it years sooner.
What do your diabetes clinic think of you're low-carbing? I find it difficult to stick to continuous low-carbing, but can completely see the sense in it though. Eveytime I see the dietician, she tells me I must NOT miss an insulin injection- she doesn't seem to comprehend that I can have a low-ish carb lunch(eg homemade leek soup) and need no insulin, especially if I'm exercising shortly after. If I followed her advice, it would result in a hypo, but she looks at me like I'm nuts!
Best of luck
Jus

 

[shedges]

It doesn't surprise me that you may need some insulin to cover the protein and vegetables in your meal. When I low carb, my insulin requirement goes right up... almost doubles sometimes. I think you need to keep monitoring your levels after meals and work out the right strategy for you.

Courses like DAFNE and other carb counting courses are very good for the situation they're prescribing, but don't necessarily apply if your situation is very different to that which they are addressing.

Sam.

 

[jopar]

One should never use background insulin to cover food intake whether they using Animal or human insulin, it can lead to many problems with control.

It is permissible to miss a quick acting injection if factors are right, such if you are eating a small snack with very limited carb content, when you know that you are able to burn off the carbs eaten i.e for exercise purposes or the amount of protein you’ve taken on board isn’t going to have an impact on your blood glucose levels...

As to transferring over to Animal Insulin, well I’ve used both Animal and Human insulin had no problems with either, you really need more than I’m a low carber or I’ve got to split Levimer!!!
There is a down side to animal insulin that the likes of Janabelle don’t tell you about...

You need to inject 30 minutes before eating, but you can work with the profile though for low carbing..

A correction dose will take longer to start to reduce the blood glucose due to the 30 minutes delay
And you are likely to use a split background insulin, most people who split there human background insulin do so due to Dawn phenomenon rather than it not lasting 24 hours. Same with Animal insulin

You can also be allergic to it..

You can over time build anti-bodies to the insulin rendering it useless...

Is it purer than Human, well you’ve got to remember it takes a bunch of chemicals to extract the insulin from the pancreas, another batch to process it and then preservatives to ensure it remains safe for injecting. This leads onto a simple fact the argument that it’s tested by time well the animal insulin produced today is very different process than when it was first produced in reality the make up of today’s insulin isn’t any more timed proved than human insulin...

Does Animal Insulin give better more stable control than human not really, diabetics still had control issues with Animal Insulin, and Brittle diabetes was about a long time before Human Insulin was introduced along side many other diabetic problems..

To give an example, my husband a long serving diabetic, was allergic to some of the animal insulin’s or over time he would produce anti-bodies to them rendering them useless, he was swapped to Human Insulin just over 10 years ago, improved control he’s only changed his background insulin once and that was because he went from 2 injections a day to MDI the only downside for him when he swapped was he had to learn the different hypo signals given, but didn’t take long to readjust...

 

[claridge]

Hi thanks all - although still very confused some of you think l wont need to use Novorapid for meals that are low carb yet some of you do... why cant l have one solid answer
Very confusing.e

I am thinking of giving myself a little levemir tomorrow morning in addition to tonights dose and less Novorapid... is this wrong? If the docs are saying background should cover negligable carbs (veg/salad etc) then should l not be doing this way and the insulin would be working as it was meant to? What are the arguments for not doing this? why would this be bad for you?

They are not tooo bad about my low carb situation - l havent pushed it and they havent said anything at all - although some of the others in my class (lm the only low carber) l think are a little defensive.

One guy had a low carb meal with me at lunch (steak and egg) and required no insulin and he takes 30 units of background a day! So it sounds like his background is correct. Also lm on very similar (slightly less) novo rapid to all the others and they are eating sandwiches chips etc - that sort of says something to me.
Just looking for as much information as possible on this

 

[claridge]

PS.... l found out today that the reason why they say not to count veg and salad is because...you background should remain stable through the day and all food's you eat if no carb - Veg and salad are considered no carb for this purpose becuase they have a carb content of less than 10g and the background will cover this. One of the guys's on my course is on 30 units of background a day and is injects teh same as the others 1-1 (10g carbs=1unit of Novorapid) whcih is what Daphne state it should be with the correct insulin regime - and he tried a test of steak and egg for lunch and his Blood sugar completely unchanged! And he told me he rarely hypo's!

 

[noblehead]

PS.... l found out today that the reason why they say not to count veg and salad is because...you background should remain stable through the day and all food's you eat if no carb - Veg and salad are considered no carb for this purpose because they have a carb content of less than 10g and the background will cover this. One of the guys's on my course is on 30 units of background a day and is injects teh same as the others 1-1 (10g carbs=1unit of Novorapid) which is what Daphne state it should be with the correct insulin regime - and he tried a test of steak and egg for lunch and his Blood sugar completely unchanged! And he told me he rarely hypo's!

Claridge,

I am sure your friend will find that his steak and egg lunch will raise his bg 2-3 hours later, as I said earlier in the absence of carbs protein will convert to 60% glucose, so a small rise would be expected. Basal insulin isn't there to cover meals, it is a background insulin there to deal with the slow release of glucose from the liver, and even the most stringent low-carbers have to inject 1or 2 units of QA insulin to cover meals.

The amount of novorapid people use to cover meals will vary with each individual, so seeing someone use a similar dose to you for a medium/high carb meal matters not, there are many factors involved and what counts is that you inject enough to meet the carb content of your food and keep within your own personal target. Best wishes.

Nigel

 

[claridge]

Thank you for that... just reading up on Dr B.... Page 290 'Prior to our use of low doses of log or intermidiate activing insulins to cover the fasting state, most physicians described 1 or 2 large daily dses of long-acting insulin to cover bother the fasting state adn meals (most still do). Such regimes never succeed in controlling blood sugars and hypoglycemia is an ever present threat.' Finally explained! Shame the docs/nurses tell you one thing with no explanations of why! Grrr...

 

[janabelle]

Jopar, Please refrain from referring to me as you did in your previous posting! - There is a down side to animal insulin that the likes of Janabelle don’t tell you about...
You need to inject 30 minutes before eating, but you can work with the profile though for low carbing..
It's rude to behave like this on an open forum and creates an atmsphere.
I don't know anyone else on this forum who sits like a vulture waiting to slate the previous poster's opinion as you do, but it is what I have come to expect. ALL opinions are valid on this forum, can you please keep the personal tone out of it Jopar,it does you no favours.
Jus
.

 

[hazyclaire]

I am a DAFNE graduate and what you have been told sounds right to me. Your background insulin should be at the correct dosage so that if you didn't eat anything all day it keeps your BS at a constant level, although this is often easier said than done with things like hormones, illness, exercise etc getting in the way, but that is the theory behind it. I did low carb diet last year for a few months, I was consuming 10-30g of carbs per day, but because I was also doing a lot of exercise most days I didn't require any Novorapid and remained level on a split dosage of Levemir, 14 units at 9am and 9pm.

Now I am doing less exercise I find I require two doses of 19 units of Levemir in addition to 1:1 Novorapid with meals, but I do lower this amount on the days I drag myself to the gym!

Unfortunately the dosages are different for everyone so no one can tell you the amounts you should be taking and you will be on a totally different dosage to those you are on the course with. It's all down to good old trial and error, and even when you think you've got it sussed something is likely to come along and change your requirements again!

Good luck and enjoy the course. It changed my life, I can't praise it more highly.

 

[noblehead]

I

Unfortunately the dosages are different for everyone so no one can tell you the amounts you should be taking and you will be on a totally different dosage to those you are on the course with. It's all down to good old trial and error, and even when you think you've got it sussed something is likely to come along and change your requirements again!

Very true hazy, insulin ratios are constantly changing and this is a mistake most people make.

Good luck and enjoy the course. It changed my life, I can't praise it more highly.

Me too! As a DAFNE graduate myself I can fully recommend it to anyone who wants to tighten their diabetes control.

Nigel