DAFNE did anyone feel like it didn't really help them?

[Spiker]

We were definitely told not to jab for beans, vegetables or for any carb up to 10g.

The no jab under 10gCH rule is one of the stupidest rules in DAFNE. For starters it should be based on your CP ratio, not a fixed number - it's not even consistent. So it would be slightly more sensible if it was stated as "ignore any jab less than 1.0u". But that would require us to do (gasp!) arithmetic before making a decision. And clearly we would all rather die of complications than learn to do simple arithmetic to save our lives. :-/

I asked the nurses teaching my course if that meant I could take an entire pack of biscuits, 9gCH each, and eat the whole pack while taking no insulin (I was holding the pack in my hand - all NHS diabetic events are catered with biscuits).

The nurses all squirmed, and had no answer. :-(

 

[Spiker]

During the course, based on evidence I reduced my basal and now use a 15:1 ratio.

Well, that is the sort of result DAFNE is supposed to deliver.

Though if your actual ratio is say 11, 12, 13 or 14 gCH to 1u, rather than 5 or 10 or 15 or 20, you are out of luck with the CP system. :-/

In summary, do DAFNE, ignore CPs, count all carbs if you low-carb.

 

[Spiker]

1) yes, the DSN called me ahead of the course adn told me to change my ratio from 20:1 to 10:1 with no evidence or discussion. I flat refused. At that point 10:1 woudl have left me with serious daily hypos.

This is insane and dangerous. As with @Engineer88 in Northampton this needs a formal complaint to the hospital and also to DAFNE certification. There is no excuse for this.

 

[Spiker]

2) they specifically told me to ignore carbs in lentils. Even when I told them that dinner that night was a bowl of lentil chilli. Nothing else, just lentils, kidney beans, tomatoes and veg. You don't need to bolus was the repeat mantra despite me telling them several times that my wife was Indian and that lentils are a major part of the diet.

Considering how the NHS diabetes dieticians go out of their way to accommodate British Asian and Afro-caribbean diets for diabetics, including on my DAFNE course, this is also inexcusable. :-(

 

[noblehead]

That's exactly what I was referring to with regards these foods........

I only started taking insulin for beans when pumping......when I injected I never.......

the way you described it there was as if the carbs in the pulses would kick in later, hence the need for insulin, but my understanding was that the whole carb load was absorbed evenly, just really slow.......so I wouldn't expect a rise later from them, as the background insulin would have sufficient activity to mop up the slow carbs...

No, the basal dose isn't there to mop up slow acting carbs, it's there to deal with the slow trickle of glucose from the liver, if it was set so high as to absorb slow acting carbs such as pulses what would happen if you didn't eat, that's the beauty of basal/bolus as it allows you to skip meals and eat when you want.

As I say, with pulses I need to inject after eating and may have to split-dose, much the same as eating a low-carb lunch of protein & fat.

 

[lins100]

Hi All

Just wondered if there is anyone who has been on the DAFNE course and felt like it did'nt really help them and they did'nt really get much out of it.
I went on a 5 week DAFNE course back in February 2014 and even though i learnt a few things about like what to do with your sugar level and insulin when you are sick, most of the stuff the nurse was talking about i have been doing since i had diabetes and learnt to carb count. I don't agree with not counting a HYPO above 3.5mmol i think this could be dangerous especially if like me you have lost your awareness, because some people me included,once you sugar reading reaches 4mmol it will start to drop like a brick. That is one of the things i can't afford to do. When we was having to do a weekly dairy of what we had been eating all week and how much insulin we had taken the diabetic nurse could'nt understand me having a tight control why and eating 3 meals a day and snacks and not really doing that much insulin as at the time my ratio was 0.8 to 10g carbs now is 0.7 to 10g carbs and was still having hypos.
Maybe its just me but i just felt that this course is brilliant for newly diagnosed type 1 diabetics but for people who have had it for many years like myself i did'nt really get what they had promised (less hypos) because all that they were talking about i already new and was already doing, and nothings changed with the amount of hypos i'm having.

Would be great to hear other peoples opions on there experience with DAFNE

tracey167

Yes there are irritating parts.
They shouldn't insist on using a particular logbook and definitely shouldn't make you change a ratio without evidence - my course didn't do either of these things.

The CP thing is stupid and seems to be based on the assumption that ordinary people can't do simple division even if their life literally depends on it. Lowest common denominator low expectations.

Not to mention the Eatwell Plate... but despite the irritations I still strongly recommend DAFNE to anyone. If you go on DAFNE and 19 things just irritate you but you learn one thing that improves your diabetic management, surely that's a win?

 

[lins100]

I was moved onto the pen and told to inject x4 times per day without any carb counting need for years before I asked to go on the DAFNE course. By then I had almost self learnt much of what I was learning on the course. I would recommend this course as an annual need for every diabetic who is carb counting and on insulin. I wished I had gone on it as soon as they moved me on to the pen as I would have done many things correctly rather than worry I was taking short cuts and often was.

When I went on the DAFNE course I was told any reading below 4 was a hypo and we were not told how to correctly handle them. They assumed we knew already so it was brushed over how to handle them correctly.

Now Nice guidelines are saying that readings in pregnant women below 3.5 should be treated as a hypo it would be worth teaching this across the board to each diabetic rather than keeping it as a nice guideline. Also calling sugars below 4 hypos I have always found it misleading as ppl assume I'm dropping unconscious each time. Text books which reinforce diabetic sugars should be 4 to 7 make each diabetic look uncontrolled as no diabetic type 1 runs at sugars within this range every minute of the day. It's virtually impossible even with well controlled management. We all know we peek to 8 sometimes more after we eat. So does that make me uncontrolled? To be honest it was never reinforced by DAFNE to check sugars after food but before we eat.

 

[Engineer88]

The started at a one size fits all to teach us the differences.

 

[Spiker]

The started at a one size fits all to teach us the differences.

Well that was pointless, unnecessary, and dangerous of them. They could have converted everyone's existing ratio to a CP ratio and started from there, and still taught everyone how to assess the evidence and change from there. For example by looking at different ratios for different times of day (as they did on my course). Not excusable. :-(

 

[novorapidboi26]

No, the basal dose isn't there to mop up slow acting carbs, it's there to deal with the slow trickle of glucose from the liver, if it was set so high as to absorb slow acting carbs such as pulses what would happen if you didn't eat, that's the beauty of basal/bolus as it allows you to skip meals and eat when you want.

As I say, with pulses I need to inject after eating and may have to split-dose, much the same as eating a low-carb lunch of protein & fat.

I realize the background isn't meant to be for slowly absorbed carbs, but when injecting it was 'mopping' up any glucose produced from it

the bolus insulin would still be too quickly used up and out of the system to process the glucose.....

because pumping insulin delivers the basal continuously, with novorapid or a similar QA insulin, the insulin peaks and leaves even quicker, leaving nothing extra for the slower carbs......

when you inject a basal it just sits there and the dose is not 100% used anyway.......

 

[noblehead]

I realize the background isn't meant to be for slowly absorbed carbs, but when injecting it was 'mopping' up any glucose produced from it

the bolus insulin would still be too quickly used up and out of the system to process the glucose.....

because pumping insulin delivers the basal continuously, with novorapid or a similar QA insulin, the insulin peaks and leaves even quicker, leaving nothing extra for the slower carbs......

when you inject a basal it just sits there and the dose is not 100% used anyway.......

I'm still not sure on your 'mopping up' analogy, but certainly insulin isn't used as effectively when injected as it is when delivered by a pump, I've heard this said many times before.

 

[Spiker]

If you are on a pump and you have a slow-delivery meal like pulses, or anything with fat, or anything that digests anaerobically (pulses?), or protein... you use a delayed bolus and/or wave function.

I agree with @noblehead, using basal insulin to mop up carbs defeats the point of basal-bolus. It eliminates the flexibility and also exposes you to highs and lows.

 

[Spiker]

I've not seen bolus insulin be any faster acting on a pump either. The onset time and duration are the same. The only thing that is different is that the "basal" effect stops much faster, if you stop it, than with long acting injected insulin. Generally this is a bad thing rather than a good thing - it makes pump users much more prone to DKA.

 

[AlexMBrennan]

The no jab under 10gCH rule is one of the stupidest rules in DAFNE. For starters it should be based on your CP ratio, not a fixed number - it's not even consistent. So it would be slightly more sensible if it was stated as "ignore any jab less than 1.0u". But that would require us to do (gasp!) arithmetic before making a decision. And clearly we would all rather die of complications than learn to do simple arithmetic to save our lives. :-/

I asked the nurses teaching my course if that meant I could take an entire pack of biscuits, 9gCH each, and eat the whole pack while taking no insulin (I was holding the pack in my hand - all NHS diabetic events are catered with biscuits).

The nurses all squirmed, and had no answer. :-(

OK, let me stop you there. The idea is obviously that a small amount of carbs will not significantly raise BG, and thus will not need insulin. Thus, eating a dozen small packets of carbs at the same will obviously require insulin; however, it is worrying that the nurse wasn't aware of this.

I suspect that you have difficulty understanding this concept because you are overcorrecting all the time, i.e. because you think that even a tiny increase in BG is totally unacceptable: Most BG guides suggest to aim for post postprandial BG that is <7 mmol/l or within 2 mmol/l of the pre-meal reading, whereas you think that postprandial glucose must be EXACTLY what it was before eating.
This is why DAFNE can say that you don't need insulin for small snacks that will not result in your BG exceeding those limits (that is to say, if my BG after eating a snack without insulin stays below 7 mmol/l then we'd conclude that taking zero insulin is the correct amount). Obviously you'd have to take into account stacking of meals like your biscuit example.

What's more, insulin sensitivity doesn't come into this - 10g of carbs increase your BG by an amount that's mostly fixed since your total volume of blood those 10g would be spread across remains relatively fixed whereas insulin sensitivity can vary widely if you, say, took up physical activity or lost weight.

 

[Spiker]

OK, let me stop you there. The idea is obviously that a small amount of carbs will not significantly raise BG, and thus will not need insulin. Thus, eating a dozen small packets of carbs at the same will obviously require insulin; however, it is worrying that the nurse wasn't aware of this.

I suspect that you have difficulty understanding this concept because you are overcorrecting all the time, i.e. because you think that even a tiny increase in BG is totally unacceptable: Most BG guides suggest to aim for post postprandial BG that is <7 mmol/l or within 2 mmol/l of the pre-meal reading, whereas you think that postprandial glucose must be EXACTLY what it was before eating.
This is why DAFNE can say that you don't need insulin for small snacks that will not result in your BG exceeding those limits (that is to say, if my BG after eating a snack without insulin stays below 7 mmol/l then we'd conclude that taking zero insulin is the correct amount). Obviously you'd have to take into account stacking of meals like your biscuit example.

What's more, insulin sensitivity doesn't come into this - 10g of carbs increase your BG by an amount that's mostly fixed since your total volume of blood those 10g would be spread across remains relatively fixed whereas insulin sensitivity can vary widely if you, say, took up physical activity or lost weight.

I was being ironic, Alex. Are you?

 

[Spiker]

I suspect that you have difficulty understanding this concept because you are overcorrecting all the time, i.e. because you think that even a tiny increase in BG is totally unacceptable: Most BG guides suggest to aim for post postprandial BG that is <7 mmol/l or within 2 mmol/l of the pre-meal reading, whereas you think that postprandial glucose must be EXACTLY what it was before eating.

You're completely wrong on all counts. Where do you get your zany ideas about me from? :-D

 

[noblehead]

I've not seen bolus insulin be any faster acting on a pump either. The onset time and duration are the same. The only thing that is different is that the "basal" effect stops much faster, if you stop it, than with long acting injected insulin. Generally this is a bad thing rather than a good thing - it makes pump users much more prone to DKA.

Pick your brains here Spiker being a pump user yourself. Does the small increments of insulin that a pump delivers not make the insulin more effective than on MDI, meaning it's absorbed better than larger doses administered by injection?

 

[Spiker]

What's more, insulin sensitivity doesn't come into this - 10g of carbs increase your BG by an amount that's mostly fixed since your total volume of blood those 10g would be spread across remains relatively fixed whereas insulin sensitivity can vary widely if you, say, took up physical activity or lost weight.

Ah so you also believe everyone has 'mostly' the same carb ratio! A job awaits you, teaching DAFNE (badly). ;-)

 

[Spiker]

Pick your brains here Spiker being a pump user yourself. Does the small increments of insulin that a pump delivers not make the insulin more effective than on MDI, meaning it's absorbed better than larger doses administered by injection?

I definitely find the insulin is more efficient, yes, i.e. less is required. But I don't find it acts faster.

 

[noblehead]

I definitely find the insulin is more efficient, yes, i.e. less is required. But I don't find it acts faster.

Thanks Spikes, that's what I thought, another pro for using a pump to deliver insulin.