DAFNE - spoilers please!

[mattrix]

Anyone want to spill the beans on the fervently guarded 'Secret DAFNE Knowlege'. Or even possibly point me to a smuggled copy of "The Handbook"?

I always figured DAFNE was essentially carb counting and insulin ratios. Besides, where I am, it is not cheap, about the same as 5000 test strips. Would I be better off with the course or the strips?

DAFNE graduates say the course is so much more than this and well worth doing if you keep an open mind. I read from one person that the course included lots of physiology giving, amongst other things, details of the role and operation of the liver and kidneys. I could certainly use that!

On the other hand, DAFNE seems somewhat rigid. Everyone must start with the same basal and the same bolus ratio, and use the same target PG's. Though, I admit I got all this from the one source, the only day by day account that I could find. I read it years ago and it has since disappeared from the net. That account also gave an indication of the 'free' foods, pulses were free and most vegies and vegie-fruits and, of course, meat, cheese eggs etc.

Many of my meals use only these free foods, or at least less than 1 CP of 'unfree' carb. If I stick to the rules I would not be able to bolus for these meals, nor, if I understand correctly, can I do an adjustment at the next meal if PG < 7.5+3, at the start of the meal.

I could see my routine degenerating during the course to the occasionally allowed adjustment dose of rapid acting and high basal insulin. This, by the way, is what you get when you are in hospital here. Nurses have control over your meds and are not allowed to do guesstimates or calculations.

So what is DAFNE about. Feel free to correct me if I've got something wrong, afterall it came from rumors and whispers.

 

[KK123]

Anyone want to spill the beans on the fervently guarded 'Secret DAFNE Knowlege'. Or even possibly point me to a smuggled copy of "The Handbook"?

I always figured DAFNE was essentially carb counting and insulin ratios. Besides, where I am, it is not cheap, about the same as 5000 test strips. Would I be better off with the course or the strips?

DAFNE graduates say the course is so much more than this and well worth doing if you keep an open mind. I read from one person that the course included lots of physiology giving, amongst other things, details of the role and operation of the liver and kidneys. I could certainly use that!

On the other hand, DAFNE seems somewhat rigid. Everyone must start with the same basal and the same bolus ratio, and use the same target PG's. Though, I got all this from one source, the only day by day account that I could find. I read it years ago and it has since disappeared from the net. That account also gave an indication of the 'free' foods, pulses were free and most vegies and vegie-fruits and, of course, meat, cheese eggs etc.

Many of my meals use only these free foods, or at least less than 1 CP of 'unfree' carb. If I stick to the rules I would not be able to bolus for these meals, nor, if I understand correctly, can I do an adjustment at the next meal if PG < 7.5+3, at the start of the meal.

I could see my routine degenerating during the course to the occasionally allowed adjustment dose of rapid acting and high basal insulin. This, by the way, is what you get when you are in hospital here. Nurses have control over your meds and are not allowed to do guesstimates or calculations.

So what is DAFNE about. Feel free to correct me if I've got something wrong, afterall it came from rumors and whispers.

Hi there, I have just competed the equivalent of a DAFNE course but it's called something else in the West Midlands (by my team anyway which is Birmingham & Solihull) It was nothing like you have described above really, it was definitely not a 'one size fits all', in fact they went to great efforts to explain that every single person is different. They started off by listening to us individually so we could tell them our circumstances, routines, what our current ratios were plus anything else we wanted to say. Then in the 4 days that followed (spread over a month so that they could offer suggestions on how to combat any tricky scenarios or concerns or problems and then see if they worked) they covered a variety of things. They spoke about different types of insulin and the 'science' behind it, how it worked, how to use it, how to make adjustments, when to make adjustments, how to tailor it to suit you and your lifestyle and so on. They did NOT judge at all but simply offered solutions. As for the food side, again they did not judge you on what you ate but said 'if you do eat that, maybe think of doing this' or 'you may find eating that tricky because of this, so try splitting doses', etc.

Honestly it was a really good course, a Consultant came in and answered any questions we had, and at least half the class by the end of the course were given libres depending on whether we fit the criteria obviously but they were VERY helpful on this aspect. Where are you by the way, none of us had to pay for anything??

Regarding targets, they helped each of us decide on a target that suited us (whilst keeping us as healthy as possible), definitely no do this, do that because you're all the same. Maybe it has improved over the years, I don't know but honestly I was very impressed and it was a lot of fun too. x

 

[mattrix]

Thanks for your thoughts KK. I'm glad your course went well.

DAFNE seems to be the only game in town here, but they are very secretive about the course, all you get from them is: if you are accepted, it is very comprehensive, it takes 5 days and costs this much, I think it runs like a franchise. I wouldn't take any thing I said in the last post as gospel, because I really don't know the details and no one is telling.

Does your course have a published curriculum, what did they fill up the 5 days with? It sounds like you had a lot of one-on-one time. I like the fact that it was over a month, gives you time to consider the new information and try a few things out. Whereas shorter courses tend to say this is what you will see, and by the time you don't its too late to ask.

 

[urbanracer]

Anyone want to spill the beans on the fervently guarded 'Secret DAFNE Knowlege'. Or even possibly point me to a smuggled copy of "The Handbook"?

I always figured DAFNE was essentially carb counting and insulin ratios. Besides, where I am, it is not cheap, about the same as 5000 test strips. Would I be better off with the course or the strips?

DAFNE graduates say the course is so much more than this and well worth doing if you keep an open mind. I read from one person that the course included lots of physiology giving, amongst other things, details of the role and operation of the liver and kidneys. I could certainly use that!

On the other hand, DAFNE seems somewhat rigid. Everyone must start with the same basal and the same bolus ratio, and use the same target PG's. Though, I admit I got all this from the one source, the only day by day account that I could find. I read it years ago and it has since disappeared from the net. That account also gave an indication of the 'free' foods, pulses were free and most vegies and vegie-fruits and, of course, meat, cheese eggs etc.

Many of my meals use only these free foods, or at least less than 1 CP of 'unfree' carb. If I stick to the rules I would not be able to bolus for these meals, nor, if I understand correctly, can I do an adjustment at the next meal if PG < 7.5+3, at the start of the meal.

I could see my routine degenerating during the course to the occasionally allowed adjustment dose of rapid acting and high basal insulin. This, by the way, is what you get when you are in hospital here. Nurses have control over your meds and are not allowed to do guesstimates or calculations.

So what is DAFNE about. Feel free to correct me if I've got something wrong, afterall it came from rumors and whispers.

Spending money ? !! Pah!

I think that most of the info you need is available on-line (even if it's not quite as good as a face to face course).
https://www.dafneonline.co.uk/

If you Google DAFNE On-Line you can find other resources.

@mattrix
Edit to add: you may also find this helpful.
https://www.knowdiabetes.org.uk/for-you/programmes/type-1/bertie-online/

 

[Daibell]

Anyone want to spill the beans on the fervently guarded 'Secret DAFNE Knowlege'. Or even possibly point me to a smuggled copy of "The Handbook"?

I always figured DAFNE was essentially carb counting and insulin ratios. Besides, where I am, it is not cheap, about the same as 5000 test strips. Would I be better off with the course or the strips?

DAFNE graduates say the course is so much more than this and well worth doing if you keep an open mind. I read from one person that the course included lots of physiology giving, amongst other things, details of the role and operation of the liver and kidneys. I could certainly use that!

On the other hand, DAFNE seems somewhat rigid. Everyone must start with the same basal and the same bolus ratio, and use the same target PG's. Though, I admit I got all this from the one source, the only day by day account that I could find. I read it years ago and it has since disappeared from the net. That account also gave an indication of the 'free' foods, pulses were free and most vegies and vegie-fruits and, of course, meat, cheese eggs etc.

Many of my meals use only these free foods, or at least less than 1 CP of 'unfree' carb. If I stick to the rules I would not be able to bolus for these meals, nor, if I understand correctly, can I do an adjustment at the next meal if PG < 7.5+3, at the start of the meal.

I could see my routine degenerating during the course to the occasionally allowed adjustment dose of rapid acting and high basal insulin. This, by the way, is what you get when you are in hospital here. Nurses have control over your meds and are not allowed to do guesstimates or calculations.

So what is DAFNE about. Feel free to correct me if I've got something wrong, afterall it came from rumors and whispers.

I would always insist on managing my own insulin when in hospital. My last two ops in private hospitals I asked to do my own insulin and the staff were very happy with that and they tested me whenever they wanted. Nurses can be very busy and many don't have specific diabetes knowledge. Also having Sliding Scale insulin can be high risk if the staff aren't around or mess up. But of course the NHS is rule bound....

 

[mattrix]

I would always insist on managing my own insulin when in hospital. My last two ops in private hospitals I asked to do my own insulin and the staff were very happy with that and they tested me whenever they wanted. Nurses can be very busy and many don't have specific diabetes knowledge. Also having Sliding Scale insulin can be high risk if the staff aren't around or mess up. But of course the NHS is rule bound....

I try to insist but there are rules .. and you can't blame the nurses for not wanting the responsibility. So the ward Dr has to approve each dose, this p's the Dr off so you are put on a sliding scale thats guaranteed to keep your PG's higher than you'd like. Game, set and match to hospital.
The best I've managed is to supply my own scale and get the Dr to approve it, they only have to do this once. A partial win.

 

[philly1991]

I loved the DAFNE course though they do still require you to test upon waking, before each meal and before bed. With regards to insulin dosage nobody had the same basal and bolus ratio, and they didn't ask anybody to change. What they did instead was make changes after the first 48 hours if they felt it was necessary but the changes were only minor for example I increased my ratio for my evening meal due to being out of target before bed. Alot of people do this themselves anyway.
I learnt alot about diabetes so have more background knowledge than when I went in which I feel has really helped me. I have also developed a more positive attitude towards my condition though I do still have the occasional lapse in motivation. I have alot more confidence though and if I needed to adjust my ratios I'd feel more confident doing so.
We also learnt about sick day rules, hypos and severe hypos, when to check for ketones, when to test, how to keep a diary and look for patterns then adjust accordingly, diabetes and exercise. Basically all sorts.
I'd definitely recommend it, I think they should give this to everyone when they're diagnosed.

 

[Hopeful34]

I found the DAFNE course really helpful when I did it in about 2008, I think it was. We did Tue-Fri, and the following Monday as well. The hospital team who took it were fantastic. To get a pump we had to do it, but I wish I'd been able to do it years before. Some people had done it before, and were already on pumps, others fairly newly diagnosed, and some of us long time type 1. We were able to encourage each other when we were having a bad day blood wise, and I learnt a lot from the other participants, as well as the team. Led by 2 nurses from Diabetes team, dietician came to some sessions, and Consultant came twice. Well worth doing!!
It was funny that on the first day nobody's packed lunch contained biscuits, crisps etc, but that changed on day 2!! Biscuits were provided for breaks, and hypo treatment was on the table if needed, but everyone had brought their own.

 

[MarkHaZ123]

I loved the Dafne course. My bloods were around 13-16 on a morning and 23+ on a night. I went onto insulin just before the course so my agreed aim on the week of the course was to get the night readings down to below 20 every night. Then set the goal for the next weeks after etc and bring it to where it should be.

I learnt so much on the course over the week it was great. From counting carbs in foods and learning about how different foods react differently with you.

Since I did the course in November 2019 Iv managed to bring average bloods right down to around 6. My hba1c has dropped from 79 to 54 which is great. I probably don't carb count as much as I should but I generally eat similar things so have remembered what things have in them

Learning about adjustment is good aswell. I'm a bathroom fitter so I'm active all day, I found on the first 4 days after the course I was having hypos at a similar time after dinner so I learned to knock my insulin with dinner down and I don't get issues now.

Iv also stayed in touch with about 4 others from the course and we chat about things if anyone has any issues so it's good for meeting people on the same boat as you

 

[mattrix]

Thank you @philly1991, @MarkHaZ123, @Hopeful34,
for your impressions of the course. hopeful, back in 2008 did they tell you to use standard ratios/basal before starting the course? Apparently they don't anymore.

Does the course still provide a lot of physiology information, such as the regulatory role of the liver?

How about a few details,
Do they still use CP's
What are the current targets, pre-meal, pre-bed etc? and what are the rules for dosing and correction doses?
And do they still use 'free' foods? which are they?

And anything else you care to share.
Much appreciated.

 

[philly1991]

Good morning @mattrix
Before the course I was a 1:1 ratio at each meal, others who attended the course had their own ratios and we were all able to continue with our individual ratios throughout the course though these were tweaked as the week went on but they certainly didn't tell us we all needed to be on the same ratios or basal/bolus. They emphasised instead that we are all different and our bodies will all react differently to all manner of things (insulin, food, exercise etc etc).
We did learn about the liver yes, and we learnt about the origins of diabetes and how insulin works which I found fascinating because I'd never been told anything about diabetes aside from how to treat it which I'd done a terrible job of until DAFNE.
Carb portions are still used, each carb portion is 10g
Targets as follows:
Pre breakfast 5.0 - 7.0
Other meals 4.0 - 7.0
Pre bed 5.0 - 9.0
With regards to correction, they ask that you only correct at meal times which irked alot of people. For most 1 unit of insulin will decrease their BG by 3 though yours might differ. I had to stop testing between meals because I'd unnecessarily correct then hypo later.
Free foods were basically alot of vegetables, eggs, nuts (because apparently they're too slow release to give insulin for).

 

[Rokaab]

The course I did (it wasn't DAFNE it was a local variant) we didn't use carb portions (I didn't even know what you meant by CP until I saw it written down), for a start what use is a carb portion of 10 if you're ratio is not divisor of 10, for instance my lunchtime ratio is 1:7, what use would portions of 10 be - we just got told to count carbs (in my 40+ years of T1 I've never used 'carb portions')
But yeah there were 7 people on the course I did, we all have different basal amounts, different carb ratios, different insulins - it would've been silly to tell us to all take the same amount as each other
The course I did was one day a week for 4 weeks, we had to fill in food, insulin and blood tests in a diary and each week we each got talked to individually about the results in the diary and got given suggestions how to change the ratios if needed or the basal amounts. 1 person got their basal changed to another between weeks 2 and 3. Lunch was provided by the course as it was seen as essential so you could learn how to carb count (ie. we got told not to bring your own lunch unless there were very particular circumstances - they provided gluten free stuff for me - though we were allowed to bring snacks if we wanted, and obviously hypo treatments, though they did provide those anyway)

 

[mattrix]

...we learnt about the origins of diabetes and how insulin works... I'd never been told anything about diabetes aside from how to treat it ...

Yes, that is a real pro from doing the course. None of my professionals want to talk about diabetes, either.

The course I did (it wasn't DAFNE it was a local variant) we didn't use carb portions (I didn't even know what you meant by CP until I saw it written down), for a start what use is a carb portion of 10 if you're ratio is not divisor of 10, for instance my lunchtime ratio is 1:7, ...

I guess 1:7 would be 1.4 units per CP.
I don't know, but I think the idea is that you only dose for whole 10g portions and if the correction is 1unit to 3 mmol/L you only correct for whole 3mmol measures above your target (???)

So, if your BG is 12.5, and your going to eat 36 grams, with upper limit before meals = 7

(12.5 - 7)/3 is less than 2 so 1 unit correction.
(36/10) is taken as 3CP *1.4 = 4.2 units
Insulin dose: 5 unit

What really throws a spanner in the works are the "free" foods.

Edit to say: I'm not justifying the technique just trying to understand it.

 

[Rokaab]

So, if your BG is 12.5, and your going to eat 36 grams, with upper limit before meals = 7

(12.5 - 7)/3 is less than 2 so 1 unit correction.
(36/10) is taken as 3CP *1.4 = 4.2 units
Insulin dose: 5 unit

Hmmm
I just divide the carbs by carbs ratio, so 36 would be 5.14, which is basically a unit different to the CP, which can make that difference, the CP seems a bit vague and has too much rounding for me

For instance if your carb ratio is something like 1:2 (one of the people on the course I went on had a ratio of 1:2) then there will be a much bigger difference - 18 using 1:2, but only 15 using the CP for that 36 grams

Also I know for myself I find it a lot simple to have a number x and just divide by 7 rather than take the multiples of 10 and then times by 1.4 - maybe that's just me though

Anyways you need to work out what works best for you, but I know my course certainly did not use CPs and I've never been told about them by doctors, DSNs or consultants