DAFNE BS level query

[Emmotha]

During the DAFNE course we were taught that 2 hours after meal your blood sugar level can be 10-12 two hours after food as long as it's back to 4-7 four hours after food (before next meal).

I thought the idea was to aim for blood sugar between 4-7 (or 4-8) as much as possible???

Please help I'm confused

 

[noblehead]

It's some time since I did the course so not sure what they said about bg levels 2 hours after, if bg level are between 10-12 mmol then I would be inclined to look at the timing of insulin injection, getting this right can help prevent postprandial spikes.

 

[SamJB]

I think anything in double figures, at any time, is too high. A lot of **** info comes out of DAFNE, this being a prime example. The aim should be to have BGs closely matching non-diabetics and they definitely won't be 10-12 after a typical meal. Regular excursions, after each meal, into those kinds of numbers will do harm.

 

[nikkid]

Surely you are always going to see a post meal rise in blood glucose? Unless you are low carbing. I have always been told the same as you even though I haven't been on the DAFNE course! My target for two hours post meal is 10mmol/l

 

[ElyDave]

In some areas DAFNE talks a load of ****, your pre and post meal target shoudl be your own.

I was told that we should not be testing post meal in case it encouraged us to over correct, for example.

The guidline I use personally is a 2mmol/l rise at +2 hours and less than 8mmol/l, of course that could mean that I have gone over 8 at some point in that two hours.

 

[smidge]

At my DAFNE course there was no discussion of the 2hour PP levels because we were forbidden to test after meals. I certainly never want to see double figures on my meter, but I'd like my levels not to be in double figures rather than not see them because I'm not looking!

Smidge

 

[Emmotha]

Yep I didn't think it sounded correct. Why would u want to go high so that u r normal after 4 hours? Plus, I just hypo before 4 hours is up. Can anyone else get from lunch time to dinner without a little snack? It seems silly

 

[noblehead]

May well be that your basal dose is too high if your having to snack between meals, try doing some basal checks to see if this is the case, if it's not then you need to look at your insulin-to-carb ratio's:

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

On basal/bolus there should be no need to snack between meals if you don't want to.

 

[jack412]

Yep I didn't think it sounded correct. Why would u want to go high so that u r normal after 4 hours? Plus, I just hypo before 4 hours is up. Can anyone else get from lunch time to dinner without a little snack? It seems silly

did they give you a good set of workbooks?

Workbook 1http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb listhttp://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diaryhttp://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf

Overnight and miss a meal Basal testinghttp://www.diabetes-support.org.uk/info/?page_id=120

Sick day ruleshttp://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf
Sick day rules flowcharthttp://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf


A workbook with USA numbers and math rules, but it has a good trouble shoot at the endhttp://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf

 

[Emmotha]

Hadn't thought of my basal being too high. I'm still pretty sensitive to insulin. My ratio seems to be 1:18 / 1:20 ish, I usually have 9 bolus through the day then 10 basal at night

 

[ElyDave]

Yep I didn't think it sounded correct. Why would u want to go high so that u r normal after 4 hours? Plus, I just hypo before 4 hours is up. Can anyone else get from lunch time to dinner without a little snack? It seems silly

yes, very easily.
have you got your basal adjusted correctly?

If so you should be easily able to miss meals with no adverse blood sugar consequences

 

[Kelsie]

Hadn't thought of my basal being too high. I'm still pretty sensitive to insulin. My ratio seems to be 1:18 / 1:20 ish, I usually have 9 bolus through the day then 10 basal at night

I would suggest as well possibly reducing your background insulin. I too am v insulin sensitive....I only have two units of basal in the morning and nothing in the evening. I felt quite daft telling everyone on the Dafne course my basal amount, I was about 15 units less than the next lowest person! Ha

 

[AlexMBrennan]

Surely you are always going to see a post meal rise in blood glucose? Unless you are low carbing. I have always been told the same as you even though I haven't been on the DAFNE course! My target for two hours post meal is 10mmol/l

If you find the correct insulin doses then it's very possible to keep 2h pp readings <7.8mmol/l which is the NHS recommendation.

 

[ElyDave]

I would suggest as well possibly reducing your background insulin. I too am v insulin sensitive....I only have two units of basal in the morning and nothing in the evening. I felt quite daft telling everyone on the Dafne course my basal amount, I was about 15 units less than the next lowest person! Ha

I'm the same, nearly 18 months in and I'm still only on 3.5U levemir in the morning and 4.5 in the evening, and reduce it from there for heat, exercise etc.

For a day with a long morning ride or run, I'll take that down to 0.5U levemir AM and no breakfast bolus. Last week in ALgeria I was 20% lower just due to the heat.

We had one lady on my DAFNE course on half a unit basal per day.