Type 2 and Dafne

moyesy said:

Though I have Type 2 diabetes two years ago I went on a DAfne course on recommendation from the DSN.

I was then discharged from appointments at my local hospital back by a Locum Consultant to the GP surgery. I attended a follow up to the Dafne at the hospital and was told by the DSN that I should not have been referred back as the GP surgery has not got the expertise to cope with Dafne.

The GP surgery now seem reluctant to refer me back no doubt for cost reasons. I would welcome suggestions as to how I can force their hand in this matter

Click to expand...

I'm surprised a type 2 was allowed anywhere nr DAFNE, are you sure you wern't miss diagnosed?
As to referal back to the clinic then yes you are entitled to be refered back there. If your GP wont do so then complain to the practice manager.
Bottom line is it's your health and life not theirs.

That seems a bit unlikely as DAFNE is very keen to point out that their course is "not appropriate for people with type 2 diabetes". There are other courses for type 2 diabetics though.

How does anyone that they have been misdiagnosed ?

Click to expand...

If I had to venture a guess I'd say by noticing that their medication stops working. There are tests but they're not commonly used at diagnosis; in practise, every adult that's not obviously type 1 (weight loss, ketones, etc) gets diagnosed as T2.

why isnt Dafne suitable for insulin users who are type 2? dont they need to know how to use their insulin as effectively as possible too?

dafne is only suitable for diabetics that are on the basal and bolus regime. Basal being a long acting taken in the AM where bolus is taken at meal times.

I use insulin, but my regime is a twice daily mixed regime. As a result, the dafne course is of no use to me as i dont adjust based on what i eat.

Type two individuals will benefit from the desmond course which teaches you about foods. what to avoid etc.

its very good

lucylocket61 said:

why isnt Dafne suitable for insulin users who are type 2? dont they need to know how to use their insulin as effectively as possible too?

Click to expand...

Yes T2's do need to work out how much insulin to inject but the reasons are different I guess as T1's have no usable insulin of their own and most T2's have perfectly good insulin production but are insulin resistant due to visceral fat. Maybe all the time a T2 has usable insulin of their own even when on a basal/bolus regime the ratios can never be pre worked out.

I did ask about a DAFNE course when I was on insulin but was told that DAFNE was not designed for T2's even for those Ts on basal/bolus insulin regimes as I was.

I must say that my insulin was purely a guestimate and had to be reduced as I lost weight, and I could only have done that on my own if I had relied on a SDN I would have been hypo all the time as they needed adjusting every day for every meal to keep my levels level.

I would assume that insulin resistance is not easily measurable and will/can change as weight is lost or put on and will be different foe each individual, you dont need to be overweight to have visceral fat as I understand it, where as a non functioning pancreas is a non functioning pancreas and once any honeymoon period is over the ratios of insulin to carbs will remain fairly stable with other factors taken into account naturally, I'm NOT saying that T1 is easier.

I would be interested to know if anyone has a definitive answer to this one????

why isnt Dafne suitable for insulin users who are type 2?

Click to expand...

Because it was developed for T1 diabetics. They've done clinical studies on the effectiveness in T1 diabetics only, etc.

For T2, there are different structured eduction programmes, developed for T2 and tested in T2 patients, such as X-PERT and DESMOND. (Both are linked to in the DAFNE FAQ I linked to earlier).

I would assume that insulin resistance is not easily measurable

Click to expand...

Well, they use a glucose clamp for that. A ballpark estimate (assuming you don't have IV glucose & insulin at home) is the amount of insulin one needs to take for food - there's a reason Humalog pens go up to 60u (Lantus: 80u)