hale710
Well-Known Member
It's already been binned in Aberdeen for lack of staff
Blogging at drivendiabetic.wordpress.com
Desidiabalum - I agree entirely that there is always room for improvement and that we should strive for it.
However, my argument is that people should be grabbing the bull by the horns themselves and stop looking for all the responsibility to come from the NHS. There are two main reasons I believe this:
1. The NHS do not know everything and never will as our bodies are unique.
2. The resources simply won't be there for a second course. We have a national debt heading towards £1.5TN - the DAFNE course will be binned before it is extended.
Ahem! Reading your earlier post noblehead wouldn't it be fair to say in response that your mind was made up before you read Smidge's post? I’m surprised that you agree with a number of her points yet still adopt a very defensive, protective posture towards DAFNE. No one is denying that it achieves some good with some diabetics. But what is wrong with correcting or improving something? How do you think any sort of improvement ever happens? If this is the one time that the NHS is giving detailed advice to diabetics, why settle for the lowest common denominator, and tell T1 diabetics that 'they can eat Mars bars all day and it is fine' (an actual quote from a DAFNE course, endlessly repeated by an experienced T1 HCP of my acquaintance, who continues to have bad control). There is no second-stage DAFNE course where people who have been enticed in by the promise of 'normal eating' can have this glossed more responsibly. For many of those taking it, the course is gospel-truth,. delivered once for all time by the all-knowing NHS. What is wrong with suggesting that this opportunity, stretching over a full 5 days, should be used more responsibly? Surely you agree with this really? I think that you do, but that is why I find the tone of your response puzzling and unnecessary. You have a balanced viewpoint on many things – why not on this?
Desidiabalum - I agree entirely that there is always room for improvement and that we should strive for it.
However, my argument is that people should be grabbing the bull by the horns themselves and stop looking for all the responsibility to come from the NHS. There are two main reasons I believe this:
1. The NHS do not know everything and never will as our bodies are unique.
2. The resources simply won't be there for a second course. We have a national debt heading towards £1.5TN - the DAFNE course will be binned before it is extended.
Not at all, as I said I figured Smidges response to the course wouldn't be positive going by a post she made yesterday, I give an honest account of what she wrote and that is why I agreed with her in part but emphasised that it has turned 100's of peoples lives around on the forum who have posted to say so, nothing is perfect in life and there could be more added to the course on nutrition but like many things there's a cost value.
I don't think any diabetes educator would be telling anyone to ''eat a Mars Bars all day'' as you have suggested as that would be plain stupid and they'd be no reason for doing so.
Hi Scardoc -I agree entirely with you. I wasn't suggesting having a second course, for precisely the reasons that you give -- that is why the one course needs improving. You are exactly right that the key to effective diabetic management for all diabetics -not just insulin-dependent ones -- lies in taking independent control and responsibility, but people need proper guidance and information (and test strips!) to use that independence effectively, especially those whose personal circumstances leave them less able to assert vigorous independence in managing their health.
The problem, as i see it is that the course is supposed to be one for Ds who have no background knowledge.
Maybe but what checks are done to check that the D has "got a handle on things" and what could be done to remedy any deficienciesThe mission statement for DAFNE does not stipulate this and I wasn't offered it until after being diabetic for a year. I was told to get a handle on things before taking the next step.
Shocking, but not unexpected.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
Maybe but what checks are done to check that the D has "got a handle on things" and what could be done to remedy any deficiencies
Almost all the well-controlled Type 1s on this site eat well below the carb level recommended to non-diabetics. I know there are a few who manage to eat the recommended level of carb and keep good levels, but that is not common.
Most of the well controlled on here are on 100-200g per day. The GDA for carbs is around 300g per day, there aren't many people on here with that amount of carb consumption and maintain an HbA1c < 6.5%.I think it is a lot more common than you think and certainly don't believe it to be "a few". I'd also disagree that it is the "most powerful tool in managing diabetes". What about exercise?
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