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Dafne question

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ebony321

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Hi,

Question about correctives without food..

At my DAFNE course it was made clear if your bedtime reading was out of target it was a good idea to have a few correctives of QA insulin alongside your BI (if thats when you take it)

..............

Say my BG was 8.9... Ideally i want this between 5.5-7 (my target) DAFNE says between 6.5-8 (bedtime targets)

One unit of insulin brings you down 2-3 mmols. which i find is accurate with myself.

now.. i'd like to bring this down to my target.. so i shoul take one unit of insulin to bring my level down to (let's say an inbetween of 2.5) so i would be 6.4 Which personally i am happy with.

So my question is.... Is it viable to take just one unit of insulin by itself? Or will it not work as it's only one unit?

It may be easier not to take this unit as one unit for an extra injection seems alot, but to me this is high and i wouldnt like to go all night and wake up with above target reading...

hmmmm...

thanks
 
ebony,

The answer to your question about a 1 unit correction dose before bed depends on a number of things prior to sleep, which could effect your diabetes control in the early hours. First would be when did you last have your evening QA insulin, is it still active or has the time now lapsed, if it is still active it may well be working to bring your levels down further and a 1 unit corrective may lead to a early morning hypo. Alternatively, if you are sure your insulin has expired, it is purely your choice whether to give a corrective or not, but on the DAFNE course we are told not to give QA insulin before bed.

My advice would be to refrain from using correctives before bed, but look at your previous mealtime insulin/carb ratio to prevent your post-meal highs, but should you do decide to give correctives before bed, always set your meter alarm to go off a few hours later and test your bg then, this way it will prevent you having night-time hypo's. As always, just be careful using QA insulin before bedtime, night-time hypo's are not very pleasant!

Nigel
 
Hmmm,

I was definately told it was okay to correct before bed time!

It certainly helped in the first few days getting things down so i had a reasonable level to start with in the morning as at first my big problem was high readings in the morning,

which at first i thought were night time hypos i was sleeping through but when i set an alarm for 2am then 4am my sugar was consistently high if it was high before i went to bed. so a few units always helped me!!

I usually have tea no later than 6pm as i've finished work at 5 i'm usually to hungry to eat any later! :lol:

I'm also weary as you say of using more insulin if i can't be sure the pervious dose is out my system.



Its just a few times i've thought to myself 'i could use a unit to bring me down to my target'

especially as sometimes i wake up with 1-1.5 difference in my BG's so that on top of say an 8.9 isn't good! well to me anyway

.....

I'm already on a 3:1 ratio and i've been thinking about trying 31/2:1 but i'd rather consuly my DN first as on DAfne it was discussed that if you need to go higher than 3:1 then it may be wise to look at the insulin you take so thats a very good point

The only time i've ever had a night time hypo (well when it's woken me) is when i've had alcohol, which is now not a problem as i don't plan to drink in the future due to personal reasons.

Thanks for taking the time to reply and you've given me more to think of that i bargained for but thats a good thing
 
ebony321 said:
Hmmm,

I was definately told it was okay to correct before bed time!
Click to expand...

ebony, it must depend on who is teaching on the course, because I was told not to, with the exception that bg was in double figures.

I use to regularly inject (pre-DAFNE) prior to bedtime to reduce my night-time bg's, and would often awake at 3-4am sweating and totally disorientated, now I prefer to keep tight control and correctly match my insulin to the carbs I eat on a evening, not always possible I'll admit, but I much prefer to do this than rely on correction doses before bed.

I try and aim for anywhere between 5.5 - 7 before bed, but if I was 8 to 8.5, I wouldn't worry myself to much, and I certainly wouldn't inject a correction dose to bring this down, like you I normally wake with a 1mmol difference, but I tend to be lower than higher.

Its good that you are keeping tight control of your bg's and are within range, did you feel the DAFNE course was worthwhile and improved your overall control ?

Nigel
 
My dafne course said to do correction with mealtime insulins. I have to agree with Nigel's very thorough explanation really, but obviously it's your personal choice.
When I was on lantus my bg tended to drop during the night if it was below 10 when I went to bed, but tended to go up if it was already high. So I would correct if it was above 10 and not bother if it was below. Obviously 8.9 was out of target but I really hate night time hypos! Mostly cos they give me hangovers - which is hardly fair considering I rarely drink
 
Hello again

I guess the dafne course does differ slightly with each teacher.. if that's what they are called?

Correcting at night does work for me definately when i'm over ten, i haven't yet tried out my theory/question if that makes sense..

It doesn't always happen that i'm out of range at bedtime though now hearing your guys opinions i agree that i'd rather stay a little high than have a night-time hypo! especially if i didn't wake and my sugar re-bounded to the sky!

I definately think Dafne has improved my control by a million times and more... i wish i could have done it sooner!

in 5 weeks my Hba1c has dropped from 12.1 to 8.7 which knocked my socks off.

I'm aiming to get a pump so i'm trying super super hard to get things as good as i can!

again thanks for your replies, just shows how helpful this little forum can be when total strangers are so willing to help and it may be strange but i like that not everyone has the same view and opens your eyes to different ways around things
 

I too wish I had done DAFNE earlier................

Good luck with the pump, let us know how you get on!

Nigel
 

I hear quite a few people have that feeling but at least we got there in the end

i definately will do, i have two appointments, my first dafne review and my 6 month review with my very lovely big diabetes boss man at the hospital so hopefully he will approve as we discussed a pump back in feb and he said come back in july looking healthy, with a much lower HBA1c and dafne skills and we'll talk more..

he's a no nonsense man and i like that but is willing to sit with you for hours if you'd wish so fingers crossed thanks alot nigel
 
I too was told its ok to correct at bedtime as long as your level is 2-3 out of target.
I have to say that everyone is different and reacts differently to 1 unit of insulin. It might be worth seeing what your level is like in the morning without a correction.
I would agree that the DAFNE course is the best thing i ever did and its very unfortunate that people dont get the offer of a place early on in their diagnosis. I had to wait nearly 3yrs for a place. Its all down to funding. It would save the NHS so much money in the longrun if people were made aware of what they can and cant do to help themselves control their diabetes.
 
Hi ya, with a pump you will probably find is easier to correct (when needed, hopefully your daily ratio's will be calculated such that if you count your carbs well, you won't need to correct!) but the pump allows you to deliver 0.1 or 0.2 units so you lower the risk of hypoing later if you do this without eating before bed. But, as already said, getting your dosage right at the meal time will prevent the following highs so once that's nailed, it will be a non issue, I hope!
 
Thought you'd find this site useful
http://www.dafneonline.co.uk
Online community of DAFNE Graduates, Health Care Professionals, Management and friends and family of those with Type 1 diabetes.
You have to sign up for access to forums
Once signed up and logged in, you can access an Online Blood Glucose Diary. This Diary allows you to enter information in a similar format to the paper-based DAFNE Diary, as well as providing you with graphical views of trends in your Blood Glucose readings

For those users who are verified DAFNE Graduates, the course handbook is available online once signed in.
 

Hi,

i've tried going on there but when i go to the graduates section it says it's currently under construction,

i like the idea of the graphs and trends though definately i'll pop there now and see if it works

thanks!
 
Hi Ebony

One unit of fast acting insulin can certainly work if you need to bring down your blood glucose but don't try to go too low at bedtime in case you go hypo during the night. I also correct by upping my long acting night time insulin by 2 units if I need to so I ensure my morning BG is <5.5. Diabetic nurses don't like you doing this but admitted that I had it under control and my HBA1C is 6.6 which is pretty good for a Type 1 diabetic on 4 injections daily.

Lynne C
 

That is my main worry going low at night! it rarely happens but when it does i can't sleep for hours so i'm not a happy chappy in the morning! :lol:

I think different things work for different people.

i'm trying to get my HBA1c down so to me every B reading counts in getting it down and i hate going to bed out of range because it's a long time to have a higher reading!

i'm also altering my ratios at the minute due o frequent hypo's and the heat is taking its toll at the min so i'm trying my best!

thanks for advice
 
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