Hi
@MickyFinn I think what's been said is a bit of a mishmash of changes and updates. It sounds as though your local group have taken the 2015 NICE guidelines and updated their own course based on the 2015 update, hence why there is discussion of updates to guidance.
On the topic of carb counting and insulin dosing, whoever said that doesn't sound like they fully understand using insulin. Carb absorption times tend to vary dependent on the macronutrient ratios that are eaten (as most of us know all too well), while the fast acting insulins have a reasonably predictable action profile, that takes (dependent on individual) typically somewhere between 3.5 and 5 hours to undergo (with the last 10% or so of action taking place from about 2-2.5 hrs on).
The only way you can really affect insulin action "period" and "peak" is by adjusting the time you take it. If you get the dose wrong, the amount of insulin you have won't be enough for the food, but if you get the timing wrong, while the bg may return to the starting point, there will be a spike or a drop.
The update in 2016 was: Recommendation 1.15.1 has been reworded to clarify the role of GPs in referring people for eye screening and also to add information on when this should happen.
I'm assuming with regard to the Libre, they've taken the output from the IMPACT study that Abbott did and incorporated that into the local course as well.
Again, it sounds like a local modification of the DAFNE course, and kind of adds to the issues that the APPG for diabetes has been concerned about with regard to variability of diabetes care.