insulin dose adjustment

Just found this:

http://www.diabetes-support.org.uk/joom ... ne-account

Under 'Food basics' it says:

"And ALL vegetables (apart from the obvious starchy ones such as potato and sweet potato) are not counted at all. Neither are pulses – everything from chick peas (including pureed chick peas as in houmous) to lentils and beans are treated as free foods. This was explained by some talk of how carbs affected bg, explaining about low GI and how the fibre in veg and pulses slows down the carb release."

I think therefore that my dietitian was teaching me the DAFNE principles prior to sending me on the course! The photo in that section is of the same CP book that I've got.

So if you think my dietitian is wrong, you obviously think DAFNE is wrong too

So if you think my dietitian is wrong, you obviously think DAFNE is wrong too

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If you don't think that the advice you have been given here by myself and others, including Kegstore, who is an Insulin Pump user diagnosed Type 1 since 1982, who I think is the voice of experience here. Then whatever we tell you is going to be frankly wasted on you.

Many members of this site do not conform to established medical and dietary advice dished out by the NHS and DUK. That is why we have so many success stories on here from all types of Diabetics quoting improvements in glycaemic control, reversals of symptoms, and overall improvements in general health, which if you read them, speak volumes about this site and it's wealth of good advice.

If you want to go ahead and accept the dieticians advice then please do. I have had my say and it is now your decision what you do. I just hope you make the right one.

As for DAFNE being wrong, if that is their advice about carbs and vegetables then yes it is.
Rubbish in fact.

Steven,
Next time you see your dietician ask her if she is a diabetic and follows her own advice. Similarly ask the DAFNE course people if they are diabetics and follow the advice that they give out.

That is the difference .

We are all diabetics who had tested and researched and experimented till we found how to control our diabetes in our own different ways. If you choose to follow the advice from DAFNE etc and you then find that things do not work out then please remember the advice that you have been given here. Beyond that it is your choice to control your diabetes as best you can.

1 large ear corn - 27 carbs.
1/2 cup of peas - 7g carbs.
1 cup winter squash - 30G carbs.

No meds needed for 64g of carbs??

I know if i eat that, i will need insulin. It's hard to imagine any sort of meal where that many carbs can be 'ignored'.
Yes, if it is a high fibre / high fat meal i know i can reduce the insulin....
But that doesn't mean i can eat as much sweetcorn / squash as i like.

The type of carb (ref: GI) and what its eaten with (e.g. fat) are hugely significant for me, and others too. I find the amount of insulin required is the same whatever carb weight I'm eating, but what does vary is the period of time over which I dose the insulin:

So for potatoes (35g of carb) I would bolus 2.5 units immediately. But for the same carb value weight of pasta, I would need to bolus over 4 hours, because my blood sugar reacts much more slowly to the pasta. If I dosed 2.5 units immediately I'd be unconscious within an hour.

The only reason I can do this successfully is because it's a specific function of the insulin pump I have, using an extended or square wave bolus. I CAN do this successfully too - because I have CGM I can track exactly what happens post-meal, and only very rarely exceed my pre-meal bg level by more than 2 mmol/l, normally it stays flat.

The volume of work, research, testing and occasional mistakes required to get to this stage is enormous, but the alternative is to not bother, and we all know where that road leads.

I've posted this site before, but it's an excellent reference and definitely worth checking out: The Glycemic Index

cugila said:

So if you think my dietitian is wrong, you obviously think DAFNE is wrong too

Click to expand...

If you don't think that the advice you have been given here by myself and others, including Kegstore, who is an Insulin Pump user diagnosed Type 1 since 1982, who I think is the voice of experience here. Then whatever we tell you is going to be frankly wasted on you.

Many members of this site do not conform to established medical and dietary advice dished out by the NHS and DUK. That is why we have so many success stories on here from all types of Diabetics quoting improvements in glycaemic control, reversals of symptoms, and overall improvements in general health, which if you read them, speak volumes about this site and it's wealth of good advice.

If you want to go ahead and accept the dieticians advice then please do. I have had my say and it is now your decision what you do. I just hope you make the right one.

As for DAFNE being wrong, if that is their advice about carbs and vegetables then yes it is.
Rubbish in fact.

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It wasn't my intention to get into an argument or cause offence - all I was doing was pointing out what my dietitian had said about most (but not all) veg not needing QA insulin as per DAFNE guidelines.

I'd still be very interested to hear from anyone who's been on the DAFNE course what they were told, and whether the advice worked for them or not

If DAFNE is complete rubbish as you say, then it's a good job I don't eat LOADS of vegetables isn't it?!!? :lol:

I will of course raise your points with her when I have my appointment tomorrow!

After a stiff Whisky last night I can tell you that when I said that the advice you were given was rubbish. I meant it !! DAFNE - Daft Advice For No Expense. Except your health that is ?

If that is what they are telling Insulin users like yourself to do it is no wonder we get so many turn up here that are unable to control their Bg levels properly ?

List your meal and then leave out probably half the carbs, the Insulin will then not be sufficient to cover the food intake and so Bg will rise.....simple !! A metabolic process.

As for previous comments maybe I was a bit harsh on your Dietician ? I suppose we shouldn't shoot the messenger really. I say that often enough myself. But it is still rubbish advice to give any Diabetic.

BTW, I don't take things to heart. Life's too short.

I've just had a quick look at some DAFNE material and have to say I'm not overly impressed. Some of the assumptions and background are just plain wrong, and the idea that you can eat what you like and let the insulin deal, does oversimplify the reality.

Specifically on the veg carb issue, I reviewed the code manual for my nutrition scales (which I do trust), and counted nearly 30 different vegetables I would regularly eat, everything from Asparagus to Zucchini (sorry for the Americanism!), ALL of which contain carbohydrate. Some more and some less, but to ignore them in your total carb sums for a meal is very bad advice.

I believe DAFNE further advises that pulses/legumes can also be discounted in terms of carb content? Absolute rubbish! If anyone doesn't believe me just try eating some dall or lentil soup without insulin, and see what happens to your bg levels over the next 4 hours or so (note the extended time - these are lower GI foods).

I think the idea of DAFNE, in terms of teaching about how to match insulin to what you eat, is excellent. Sadly the method of achieving this - the course content - seems to fall way short.

I'm with Kegstore there. OK I'm not an insulin user but if I eat Lentil soup, which I love, my bg rises by as much as 4 points!! As I am diet controlled this is an unacceptable rise for me so sadly I have had to give up eating it.

PMFJI I was reading this thread with some interest, when I came across the link to the DAFNE account which was written by a good friend of mine. I do know that he went onto the course with a cynical mind, but came out reasonably impressed with some parts of the course. I cannot speak for him obviously, but I got the impression that his conclusion was that you take from it what you find useful and continue to apply what you know from experience works for you. I was querying some of the "over simplified" advice that I felt had been disseminated on DAFNE when I was reminded that some of the candidates, despite having been diabetic for decades, hadn't the first clue and that for them a lot of the course was a total revelation. It is, of course, regrettable that the advice is "dumbed down" but for a lot of people it's better than anything they had before.

For example I came across a 30 year diabetic, age 46, in a chat room earlier this week. He had multiple complications (retinopathy, neuropathy, several heart attacks and other heart issues et al) but hadn't the first clue that his complications were as a result of his poor BG control and not the other way round. In his mind his current Hba1c of 8.2 was as a result of his complications. I hadn't the heart to tell him that had he been well controlled a lot of his suffering need not necessarily have happened. If you look at it, it was hardly his fault that he didn't know, it was purely and simply lack of diabetic education. So in that light, DAFNE, whilst not being perfect, is better than a lot of people get.

Then again, I haven't had any education, but I have an enquiring mind and the ability to sort the wheat from the chaff on the internet... combined with a burning desire to retain my feet, kidneys and eyesight

Hi Patti

I think you make some really good points, and I agree with the "better than nothing" sentiment. But I do think that if you're going to educate people why not do it properly with the correct information? Otherwise the danger very rapidly becomes that people are so blown away by the revelatory nature of the course, it becomes their mantra and they're not prepared to listen to alternatives, such as believing the evidence of their blood meter several hours after a meal. That's my concern.

A very good friend of mine is 56 and has been T1 for 32 years. He is currently learning how to walk again having had a below-knee amputation earlier this year. He has no concept of carb counting, and has had 5 hypos throughout his entire experience of diabetes! All of which were in hospital (doubtless as a consequence of the nursing staff's efforts to get his bg levels down to single figures), so he "doesn't like hospitals because of this" - his quote. Scary. (What's even scarier is when we were comparing notes on our care I mentioned the name of my consultant, who has been genuinely brilliant with me, "Oh he's mine too" came the response. Eek!)

I haven't been on any of the courses either, but have similar motivations and sensibilities to yourself!

kegstore said:

Hi Patti

I think you make some really good points, and I agree with the "better than nothing" sentiment. But I do think that if you're going to educate people why not do it properly with the correct information? Otherwise the danger very rapidly becomes that people are so blown away by the revelatory nature of the course, it becomes their mantra and they're not prepared to listen to alternatives, such as believing the evidence of their blood meter several hours after a meal. That's my concern.

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I take your point and I am utterly convinced that BG meters are the best weapon in our armoury against this disease. I never set foot out of the house without mine, or, if very occasionally I forget it, I feel completely vulnerable, but it's amazing how many T1s don't test. I am of the opinion that a very easy way to get T2s to manage their condition is to give them a copy of "Jennifer's advice", a meter and enough strips to test everything they eat for an initial period. I know it's more complicated with T1s so it's doubly shocking that education is so pauce. Of course I shall never get a sniff, being a LADA with a T2 label stuck on me by the GPs practice nurse. Not that there's much education in my neck of the woods anyway. Personally I am of the opinion that the Bournemouth Diabetes and Endocrine Centre's course is far superior to the DAFNE one with far less arrogance about it. I have done the online version of that.

As to veggies, I tend to not count the "Free veggies" http://www.diabetes-support.org.uk/joomla/free-veggies but I do count all others when estimating a dose. I note that you count all veggies including the free ones mentioned there. Seems to work for me, but we are all different and YMMV.

A very good friend of mine is 56 and has been T1 for 32 years. He is currently learning how to walk again having had a below-knee amputation earlier this year. He has no concept of carb counting, and has had 5 hypos throughout his entire experience of diabetes! All of which were in hospital (doubtless as a consequence of the nursing staff's efforts to get his bg levels down to single figures), so he "doesn't like hospitals because of this" - his quote. Scary. (What's even scarier is when we were comparing notes on our care I mentioned the name of my consultant, who has been genuinely brilliant with me, "Oh he's mine too" came the response. Eek!)

I haven't been on any of the courses either, but have similar motivations and sensibilities to yourself!

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Abysmal, it really is. I also have a friend who totally ignores his D. Has now progressed from Metformin onto Met and a Sulf and is resigned to the fact that he will eventually go onto insulin. I have learned not to mention the subject, specially when we go out for a meal and he's eating Creme Brulee or Pavlova.

Why is'nt this website on the noticeboard in my diabetes clinic :?: It's pure luck that i found it through google

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Hi Sp.
Here's a link to a poster for this website. Download it and print some off. Then get that Clinic to display, in fact ANYWHERE you can get them to put one up. Promote this forum.

http://www.diabetes.co.uk/downloads/pos ... rum_a4.pdf