So I spent the whole of last week on the Type 1 carb-fest AKA DAFNE. I've come away with very mixed feelings about the course.
On the one hand, most of the participants had had diabetes for most of their lives and had very poor diabetes control. For first time, they were given some information that would help them take control of their condition. For example, some didn't know what a carb was. Some were on fixed doses of bolus regardless of what they ate. None of them had the basic information that 10g carb would raise their BG by about 2 - 3 mmol and 1 unit insulin would drop it by about the same. Only one participant other than me had done any carb counting at all and yet all were on the basal/bolus regime. Most of these people really had been left to fend for themselves without much support and without the basic information and skills to even start managing their condition. The HbA1cs were dire and really did re-emphasise the appalling statistics of Type 1s failing to manage safe BG. By the end of the course, these people all knew what a carb was, what effect it had on their BG, how to estimate the carb content of their meals and how to calculate and adjust their insulin. I have no doubt that for some of them, their HbA1cs will improve as a result of the course - but the bar was so low that the course could hardly fail to bring about some sort of improvement.
On the other hand, the course started with the stated objective of enabling us to eat what we liked and jab to cover it and there was absolutely no attempt throughout the first four days to discuss healthy eating, portion control or the elephant in the room - carb reduction. Only on the last hour of the last day did we cover healthy eating where the dietician talked us through the dreaded eatwell plate, encouraging us to cut visible fat from meat and eat plenty of starchy carbs with each meal - explaining that carbs should make up 50% of each meal. I expected the eatwell plate and the NHS high carb low-fat mantra, but I was absolutely shocked by the attitude of the course trainers to the clearly unsuitable food and portion choices being made by the participants throughout the course and by their encouragement of poor choices. For example, the trainers provided a big tin of chocolate biscuits for tea breaks and packets of mini biscuits etc as prizes. The Thursday lunch out was to a pub where the food was virtually all carb and the portions were enormous - everybody had double-figure fasting levels on Friday morning. One guy brought two packets of jam doughnuts back to the hospital for the afternoon tea break. Not once did the trainers (a nurse and a dietician) object or advise at all. Friday lunch time was a buffet containing sausage rolls, ham rolls, cakes, crisps etc etc. There was not a single mention of reducing carb portions as a means of diabetes control - just the premise that you can eat anything and jab to cover it. Some people were snacking on foods containing 30 - 40g carb and had chips with every meal. One guy had a Chinese takeaway for his tea one night consisting of large portion chowmein, egg fried rice and chips - his BG was at 17 the next morning and we discussed that he had underestimated the carb content and therefore undercalculated his insulin requirement. We worked out his meal had contained 250g carb and he should have injected 50 units whereas he only injected 32 units - not a word about the unsuitability of that meal. It truly was a carb-fest.
For me though, the worst apsect of the course was that much of the factual information given out was just plain wrong and some of the advice was ridiculous. They told us that we were not to test after meals - we should only test before meals and if our BG was in range at that time we had bolused correctly for the previous meal. We were told protein does not raise BG and requires no insulin. We were told snacks up to 10g carb require no insulin and we were given a list of suitable snacks that we would not need to jab for including a nectarine or peach, an apple, 100ml fruit juice, a yoghurt, a hobnob or two rich tea biscuits, a large rice cake or an oatcake and so on. We were told to test our basal levels by eating a carb-free lunch - this should show if our basal was holding us level (presumably they based this gem on the incorrect assumption that protein does not raise BG). We were told that we should not bolus for vegetables (except peas and a couple of other particularly carby veggies). Neither should we bolus for tomatoes, onion etc. Beans and pulses require no bolus. Baked beans should only be bolused for the sugar content of the sauce, not the beans themselves. HbA1cs should be kept between 6.5 and 7.5. A normal non-diabetic HbA1c would be about 6.5 - this was then contradicted by the consultant who came to answer questions on Thursday. The whole course was just so full of misinformation.
By the end of the course, my BG was constantly in double-figures - and those who know me know that I usually keep tight control of my BG. Luckily for me, I'm not relying on this course and this information to manage my BG, but others are. Although the course will be shown to be successful in that it will have helped reduce the double-figure HbA1cs to single figures, it will not enable 7s and 8s to reduce those to normal or near-normal HbA1cs and quite frankly, that means a greater risk of complications. All the other participants were undoubtedly happy with what they'd learnt as they went away knowing much more than when they started, and they were undoubtedly happy to be told they can eat what they like and jab to cover it, so the course will get very positive feedback. Maybe my experience of this course was a one-off, but I have a bad feeling that the positive feedback DAFNE gets is due to telling people what they want to hear rather than telling them what they need to hear.
Smidge
