DAFNE confusion

[Bluemarine Josephine]

So, here I am, at the diabetes department waiting room, for my appointment with the nutritionist who will teach the DAFNE course which I will attend next week, deliriously happy that I will finally know how to handle my condition instead of shooting blindly and rather aimlessly.

Having done my homework (“Think like a pancreas” and “Dr. Bernstein’s Diabetes solution”) and with my carbohydrate and calorie counter app in hand (a trusted tool for the last 2 years) I waltz in the room confident that I will prove myself to be a good diabetic! I have googled my 500 rule, my 1800 rule and I keep a very consistent food diary.

“Show me your food diary” my nutritionist says.
Now… I add up the carbs content in everything I eat (other than the teaspoon of single milk which I use in my coffee).
I also have a diabetic friend who gave me a suggestion on how to calculate carbohydrates in protein so I add these too.

She looks at my diary which mostly consists of salads and meat/fish.
She gets this annoyed look…
“No, no, no, no, no” she says. ‘We do not calculate these as carbohydrates!”

I am like… “huh??”

She continues “anyway, keep doing what you are already doing and we will correct it next week.”
I ask her “so we do not add up the carbs content in vegetables and meat/fish?”
“No” she responds.
“No even in tomatoes?” I ask
“No” she replies.
“How about cheese?”
“Nope!” she replies.
“And what about legumes and fruits?” I ask
“We do not add up the carbs in legumes because they have very low GI and GL so the carbs break down very slowly and, as a result, they do not create a blood sugar rise. We calculate fruits except grapefruit.” She replies.

‘So do we only calculate pasta, rise, bread, cereals, sugar and flour basically?” I asked.
“Pretty much…” she replied…

Confused enough I went home…

On the next morning, I decided to have a grapefruit for breakfast without bolusing.
I went from a 9 to a 16… I sat on this 16 like an elephant for about 5 hours…

I am feeling rather weird about the DAFNE course…
Any suggestions are very welcomed.

Thank you
Regards
Josephine

 

[Engineer88]

basically its a smile and nod exercise. I went through the same, and learned very little. it was a tick box exercise (an expensive one i must add) to get a pump.

The only really useful thing is the sick day rules.

 

[tim2000s]

Welcome to the weird world of DAFNE, where carbs are only carbs if they look like carbs (although not counting a Grapefruit is criminal).

If you eat a diet where you major on rubbish carbs, which make up more than 80% of the overall amount of your food, then the impact of protein and veg is much lower, so can mostly be be ignored (look in one of the pump calculation posts where the Polish method that allocates Normal and Square bolusing dependent on Carb/Protein/Fat ratios can be found). If you have elected to eat a lower carb diet, this isn't true and the DAFNE course doesn't take it into account.

If I was you, I would make a fuss about it in today's session and show off your readings with Grapefruit, being very clear you think their approach is totally wrong and backing it up with evidence!

BTW, I've not done DAFNE. 1. Five days is a waste of my time and NHS money; 2. This kind of thing will result in huge fights with the "Educators".

 

[Juicyj]

If I was you, I would make a fuss about it in today's session and show off your readings with Grapefruit, being very clear you think their approach is totally wrong and backing it up with evidence!

Completely agree - unless diabetics with more knowledge than DAFNE nutritionists speak up then they will continue shooting blindly with this misleading carb information.

Well done for doing so well, you are already more knowledgeable than most healthcare professionals - you are the expert on your condition, please remember this

 

[Bluemarine Josephine]

basically its a smile and nod exercise. I went through the same, and learned very little. it was a tick box exercise (an expensive one i must add) to get a pump.

The only really useful thing is the sick day rules.

Thank you for your reply.
Honestly, I am starting to feel exactly the same way.
I really want to know how to handle insulin intake in case of a cold, a virus or a food poisoning (where the body cannot hold food but, there might be insulin on board.)

Regards
Josephine.

 

[Deleted member 83869]

How bizarre....never had that trouble when I did DAFNE but that was back in 2012! Good luck! x

 

[noblehead]

You can still do the course whether you low-carb or not, when I did my course I was eating between 90-120g a day and there was another person on the course who was eating around 150g a day.

 

[Bluemarine Josephine]

Welcome to the weird world of DAFNE, where carbs are only carbs if they look like carbs (although not counting a Grapefruit is criminal).

If you eat a diet where you major on rubbish carbs, which make up more than 80% of the overall amount of your food, then the impact of protein and veg is much lower, so can mostly be be ignored (look in one of the pump calculation posts where the Polish method that allocates Normal and Square bolusing dependent on Carb/Protein/Fat ratios can be found). If you have elected to eat a lower carb diet, this isn't true and the DAFNE course doesn't take it into account.

If I was you, I would make a fuss about it in today's session and show off your readings with Grapefruit, being very clear you think their approach is totally wrong and backing it up with evidence!

BTW, I've not done DAFNE. 1. Five days is a waste of my time and NHS money; 2. This kind of thing will result in huge fights with the "Educators".

Thank you for your reply Tim,
I very much prefer a low (to ultra low) carbs diet. It helps me control my weight, I need less insulin hence less risk for a mistake and, frankly, I can live without all these heavy carbs foods, I am okay with it (on the other hand, my nutritionist isn’t and insists on trying to persuade me to go on a diet of at least 180 grs of carbs per day, to which I do not agree, of course.)

But, the thing is, you see, I do not want to fight against anyone… I just want to learn a few (or preferably a lot of) things about my condition and go on my merry way… And, I would feel embarrassed to be in a room where everyone is there to learn except myself who will look like trying to teach…

By the way, I suspect you, as well, add up carbs in all foods, correct?

Regards
Josephine.

 

[Juicyj]

You can still do the course whether you low-carb or not, when I did my course I was eating between 90-120g a day and there was another person on the course who was eating around 150g a day.

Agree with Noblehead - there are many other advantages to the course besides carb counting, so to get this knowledge is incredibly useful.

I liked the fact that they could monitor my results all week and tweak things so i felt like I was making progress, I didn't enjoy being the only woman on my course as had to listen to all the viagra jokes..

 

[Bluemarine Josephine]

Completely agree - unless diabetics with more knowledge than DAFNE nutritionists speak up then they will continue shooting blindly with this misleading carb information.

Well done for doing so well, you are already more knowledgeable than most healthcare professionals - you are the expert on your condition, please remember this

Juicyj, thanks ever so much for your encouraging message.
I hardly know what I am doing though…
I either run too high or low… there are no in-betweens…
Theoretically, I have done well, I have always been a good student when in school but, as with other areas in life… It is practice where I mess up…

Regards
Josephine

 

[Bluemarine Josephine]

How bizarre....never had that trouble when I did DAFNE but that was back in 2012! Good luck! x

Thank you for your message.
That puzzles me even more as, theoretically, we are all been taught the same principles everywhere in the U.K….?

Regards
Josephine

 

[noblehead]

I liked the fact that they could monitor my results all week and tweak things so i felt like I was making progress, I didn't enjoy being the only woman on my course as had to listen to all the viagra jokes..

We had a good mix on our course, 5 women and 4 men.

 

[Bluemarine Josephine]

Agree with Noblehead - there are many other advantages to the course besides carb counting, so to get this knowledge is incredibly useful.

I liked the fact that they could monitor my results all week and tweak things so i felt like I was making progress, I didn't enjoy being the only woman on my course as had to listen to all the viagra jokes..

Here is what puzzles me.
Let’s assume they do monitor my results but, the results are on the basis of carbs counting and bolusing for pasta… without including meat/cheese/salad carbs… wouldn’t this produce a different insulin to carbs ratio than if everything was added as carbs?

What I mean is, will the ratio be correct?

P.S. There are Viagra jokes?

 

[Engineer88]

Thank you for your message.
That puzzles me even more as, theoretically, we are all been taught the same principles everywhere in the U.K….?

Regards
Josephine

No unfortunately not, basically its a generalised course but varies depending on who is giving it.

Go on the course see what you learn and then come here and ask any questions you have. You're much more likely to get a better answer.

 

[Bluemarine Josephine]

So... please... a question to all of you.
How do you count your carbs??
Do you add up carbs in everything that you eat?

 

[Dillinger]

“We do not add up the carbs in legumes"

She sounds like Buffalo Bill from The Silence of the Lambs; if she says, at any point, "it puts the lotion in the bucket" Run!

In my humble but correct opinion nutritionists are wholly removed from the real life of diabetics.

Just sit and nod; life's too short to try and take on their magical thinking. But if you'd like to try this one; ask them if carbohydrates are essential. They will say yes, perhaps they will say you 'need' at least 120 grams of carbohydrate a day. They are wrong. 'Essential' has a technical meaning in nutrition and that is that the body cannot manufacture the particular item by itself. We can produce glucose from protein and fat via gluconeogenesis, therefore carbohydrates are not essential. I rarely eat more than 30 grams of carbs a day and my brain is ticking along ok.

With what you've read you have an excellent grounding in how to manage carbs; keep doing what you are doing (your nutritionist was at least right in that).

Best

Dillinger

 

[noblehead]

So... please... a question to all of you.
How do you count your carbs??

From experience or using kitchen scales and referring to the book Calorie Carb & Fat Bible.

 

[Bluemarine Josephine]

From experience or using kitchen scales and referring to the book Calorie Carb & Fat Bible.

What I mean is, do you add up the carbs in cheese. meat, fish, eggs, vegetables etc? Or do you only consider the carbs in starchy foods as the valid ones?

 

[Bluemarine Josephine]

No unfortunately not, basically its a generalised course but varies depending on who is giving it.

Go on the course see what you learn and then come here and ask any questions you have. You're much more likely to get a better answer.

Thank you for your reply.
I thought we were all taught the same principles regarding our diabetes management...
I am more worried now...

 

[Dillinger]

So... please... a question to all of you.
How do you count your carbs??
Do you add up carbs in everything that you eat?

Yes, you need to know your insulin to carb ratios and then all carbs are factored in. People have different approaches to protein and bolusing for that and you should be aware that high fat foods (by which I mean low-carb pizzas and the like) will cause a long delay in glucose spikes so you have to watch that.

If you have a standard type of ratio i.e. 1 unit of insulin to 10 grams of carb then it is unlikely that you would be eating enough fish, eggs or cheese to get you up to 1 unit of insulin.

Protein in say steak might make up enough; but you need to test it yourself. I don't see a direct correlation between amount of protein and the insulin requirements (weirdly enough) but if I had a largish steak and a green salad I'd bolus 1-2 units for that (you may not have to).

Keep in mind that your ratios may change throughout the day (I need twice the insulin in the morning that I would take in the evening for the same carbs) and that your liver will release glycogen whenever you eat so that on a full on low-carb diet there may not be such a thing as a 'no insulin' meal. It depends on your sensitivity to insulin of course.

Best

Dillinger