Are our diabetes courses adequate and balanced ?

[everydayupsanddowns]

The silly thing is the course was only 5 hours. By the time we had gone round the circle of 8 introducing ourselves and why we were there, then nearly an hour spent on that activity, a coffee break and a lunch break I felt it was poor use of the time. Had it been a course spread over several days, like the DAPHNE course seems, to be then an 'ice breaker' like that may have been a good idea.

Sounds very frustrating for you!

 

[Deleted member 21371]

No asked wife she said no high carb foods were pushed, she still ate them but in reduced portions, but as said before loads of salad veg protein made up meals. Obviously low fat was as its weight loss group so needed to reduce calories, still follows principles loosely & maintaining weight.

That is the way I did it, still doing the same

 

[daducky88]

I have to say that the Type 1 education (DAFNE) and it's equivalents, is great. Whilst I was reticent because of the title... Dose Adjustment For Normal Eating, when I was following a low carb, higher fat way of eating, I am so pleased I attended. Yes there was a rather infantile section on food and assessing carbs, but to be fair that is an important aspect of insulin usage and it needs to be taught at a basic level to ensure that everyone understands. The main thing about the course was that the educators are trained to a very high level and being open and non judgmental is a key part of their training and the course is all about helping people to keep themselves safe regardless of their food (or drink) choices. The course is also based on learning from each other almost more than being text book/syllabus taught.

You would think that the education courses for Type 2 diabetics would be worth investing more in, because there are so many more Type 2 diabetics and with the right information and perhaps input from a motivational speaker who has improved their HbA1c through dietary/lifestyle changes like people on this forum... even if it was just a video presentation.... it might help people feel more uplifted and ready to tackle the challenge rather than disappointed and discouraged by the course and of course given inappropriate dietary advice.

It would be good if Diabetes UK could be a bit braver and embrace the new dietary options which are clearly shown to be working for so many people on the forum and perhaps lead the NHS away from the old outdated advice instead of hanging onto it's apron strings in this respect. Perhaps they could coordinate some motivational presentations from everyday members of the forum who have done extraordinary things with improving their HbA1c, which could be included in the Desmond course.

I see @helli has posted similar about Type 1 education whilst I was unable to send my post due to forum dropping out.

Apart from DIPHNOI, as Mike from Neighbours used to say, can ask you what difference Fiasp made compared to Novorapid? I'm on Humalog so may benefit/ suffer in the same ways from a change. I'm also using a pump, which has the *basal shut off if your going low though its not automatic, though i dont have sensors anyway.


( *instead of MDI long acting insulin injections)

 

[daducky88]

I haven’t done DAFNE and the only attraction for me would be meeting other Type 1s. I’ve done no courses about Type 1 at all. I’ve done the training for each different pump I’ve had but that’s it.

When i was a child, not sure how old, the BDA (Brit Diab Assoc), before it was rebranded to DiabUK because 1 more word Association was less catchy? - why was it rebranded? Anyway, i digress. The BDA ran a residential camp for kids at some stately home come scout camp. I think parents paid for the course. But it taught kids to become independent in their diabetes, carb counting, varying your dose according to your estimate, checking how you doing intermeals, making corrections, adjusting ratios and making lifelong enemy of GP's prescribing habits, having moved from 4 tests a day to anywhere between generally 6 and 8. I think it lasted 5 or 10 days. It was quite fun with cooked breakfasts 🙂, grilled and portion.controlled :-( , although i think they had more modern injections with 0.5U doses, ooh! It was difficult changing instruments as i'd been brought up on my chunky glass and steel injection with a spare stored in violet tinged methanol and general could find my way to fridge pre-meal to burrow to its safe storage box and dial a dose. They had horribly thick needles when i was very young. Thank goodness tech improvements, yeah engineers and scientists. We love ya! Yaaay. Things like that. U hmm

Oh i remember countless digestive biscuits as the means of recuperation. Perhaps the bda had shares in McVities. But digestives generally make me feel a bit nauseous. I managed to get a packet fruit shortcake biscuits which were difficult to resist 🙂

 

[daducky88]

When i was a child, not sure how old, the BDA (Brit Diab Assoc), before it was rebeanded to DiabUK because 1 more word Association was less catchy?. Any i digress. The BDA ran a residential for kids at some stately home come scout camp. I think parents paid for the course. But anyway it taught kids to become independent in their diabetes, carb counting, varying your dose according to your estimate, checking how you doing intermeals, making corrections, adjusting ratios and making lifelong enemy of GP's prescribing habits, having moved from 4 tests a day to anywhere between generally 6 and 8. I think it lasted 5 or 10 days. It was quite fun with cooked breakfasts 🙂, although i think they had more modern injections with 0.5U doses, ooh! It was difficult changing instruments as been brought up on my chunky glass and steel injection and burrowed into its safes in the fridge pre-meals.

It was also nice meeting other fellow diab children who had the same queries and calculations to make. Fair play to the BDA for running the course. It was very good and well supervised without removing ones developing autonomy.

 

[rebrascora]

Apart from DIPHNOI, as Mike from Neighbours used to say, can ask you what difference Fiasp made compared to Novorapid? I'm on Humalog so may benefit/ suffer in the same ways from a change. I'm also using a pump, which has the *basal shut off if your going low though its not automatic, though i dont have sensors anyway.


( *instead of MDI long acting insulin injections)

No idea what DIPHOI stands for but Fiasp knocked 15-20+ mins off my pre-bolus time at breakfast so it's just 30-45mins now instead of over an hour with NR, but I seem to need more Fiasp to do the same job, although it could just be that my ratios have changed and I would now need a similarly higher amount of NR. Hard to tell when you only use one at any given time. Pre bolus timing at other meals is just about 5 mins faster (15-20mins instead of 20-25mins).
I feel I need to be braver (more generous) with my correction doses with Fiasp but unless I swap back to NR to see if I need less of it, it is hard to tell.
My diabetes management is much more intuitive than following guidance because of my low carb way of eating as I have to use the Fiasp to cover protein as well, so I tend not to weigh and calculate units or think about ratios other than using a standard 1:10 for the few carbs I eat, but just use my Libre to give me guidance on what I need to do and trust my instinct, which is definitely getting better. TIR is currently 96% on the Libre so this approach is clearly working for me. I guess this means that I don't really follow the DAFNE principles at all, but the course gave me a good grounding in how to keep myself safe with insulin and most importantly, it gave me the confidence to adjust my basal insulin which can vary quite frequently. Getting your basal doses right makes all the difference in the world.

I believe that some people have problems with "skanky sites" when using Fiasp with a pump but obviously that isn't a problem with me on MDI.

6-7 months ago (3 months into the change over) I was very frustrated and ready/keen to change back to NR but I seem to have found my way with it now. I said I would give it a full year's trial this time and I think it was a good decision to push on through the difficulties. I may go back to NR at some point in the future just to compare, but I am happy ticking over with the Fiasp for now. I am more ambivalent about the Fiasp than my Levemir which I absolutely love and would fight tooth and nail to keep, particularly over some of the very long acting insulins. My lifestyle needs the flexibility that Levemir provides.

 

[daducky88]

DIPHNOI is Australian pronunciation for Daphne as quoted by Mike the mechanic in Neighbours.

 

[SB2015]

Good morning @daducky88

I used FIASP in my pump for about 6 months. As @rebrascora found it shortened my pre-bo,us time by quite a bit, and made corrections more quickly, BUT for me it was so painful and I am someone who ended up with some horrid skanky cannula sites. I went back to NR.

If you would like more info on this it would be worth you starting a separate thread on this.

Which Pump are you currently using?

 

[daducky88]

W

No idea what DIPHOI stands for but Fiasp knocked 15-20+ mins off my pre-bolus time at breakfast so it's just 30-45mins now instead of over an hour with NR, but I seem to need more Fiasp to do the same job, although it could just be that my ratios have changed and I would now need a similarly higher amount of NR. Hard to tell when you only use one at any given time. Pre bolus timing at other meals is just about 5 mins faster (15-20mins instead of 20-25mins).
I feel I need to be braver (more generous) with my correction doses with Fiasp but unless I swap back to NR to see if I need less of it, it is hard to tell.
My diabetes management is much more intuitive than following guidance because of my low carb way of eating as I have to use the Fiasp to cover protein as well, so I tend not to weigh and calculate units or think about ratios other than using a standard 1:10 for the few carbs I eat, but just use my Libre to give me guidance on what I need to do and trust my instinct, which is definitely getting better. TIR is currently 96% on the Libre so this approach is clearly working for me. I guess this means that I don't really follow the DAFNE principles at all, but the course gave me a good grounding in how to keep myself safe with insulin and most importantly, it gave me the confidence to adjust my basal insulin which can vary quite frequently. Getting your basal doses right makes all the difference in the world.

I believe that some people have problems with "skanky sites" when using Fiasp with a pump but obviously that isn't a problem with me on MDI.

6-7 months ago (3 months into the change over) I was very frustrated and ready/keen to change back to NR but I seem to have found my way with it now. I said I would give it a full year's trial this time and I think it was a good decision to push on through the difficulties. I may go back to NR at some point in the future just to compare, but I am happy ticking over with the Fiasp for now. I am more ambivalent about the Fiasp than my Levemir which I absolutely love and would fight tooth and nail to keep, particularly over some of the very long acting insulins. My lifestyle needs the flexibility that Levemir provides.

Thanks Rebs.
What flexibility does levemir provide which others dont?

 

[SB2015]

What flexibility does levemir provide which others dont?

I was switched to Levemir for my Basal insulin before switching to a pump.

With Levemir it is possible to split the basal insulin to a morning and evening dose. You can then adjust one without impacting the other. This helped when life was less consistent so I wanted to be able to reduce my day time basal because I had a more active day, but still wanted the same dose overnight. Or If I started to get night hypos I was able to reduce the night dose and keep the daytime one consistent. With this a half unit pen was also a big benefit as I was able to make finer adjustments.

I hope that helps.

 

[daducky88]

Good morning @daducky88

I used FIASP in my pump for about 6 months. As @rebrascora found it shortened my pre-bo,us time by quite a bit, and made corrections more quickly, BUT for me it was so painful and I am someone who ended up with some horrid skanky cannula sites. I went back to NR.

If you would like more info on this it would be worth you starting a separate thread on this.

Which Pump are you currently using?

Medisense 640g

 

[daducky88]

I was switched to Levemir for my Basal insulin before switching to a pump.

With Levemir it is possible to split the basal insulin to a morning and evening dose. You can then adjust one without impacting the other. This helped when life was less consistent so I wanted to be able to reduce my day time basal because I had a more active day, but still wanted the same dose overnight. Or If I started to get night hypos I was able to reduce the night dose and keep the daytime one consistent. With this a half unit pen was also a big benefit as I was able to make finer adjustments.

I hope that helps.

Thats what i used to do on mdis. People always argued there was no point in splitting long acting but i found a single daily dose also had some peak fx which were lowered by splitting the dose. I was on something else b4 Levimir. Insulatard ive certainly used. Cant quite remember when.

 

[SB2015]

Medisense 640g

If you are not using sensors, how do you get alarms or cut off when going low?

 

[daducky88]

No idea what DIPHOI stands for but Fiasp knocked 15-20+ mins off my pre-bolus time at breakfast so it's just 30-45mins now instead of over an hour with NR, but I seem to need more Fiasp to do the same job, although it could just be that my ratios have changed and I would now need a similarly higher amount of NR. Hard to tell when you only use one at any given time. Pre bolus timing at other meals is just about 5 mins faster (15-20mins instead of 20-25mins).
I feel I need to be braver (more generous) with my correction doses with Fiasp but unless I swap back to NR to see if I need less of it, it is hard to tell.
My diabetes management is much more intuitive than following guidance because of my low carb way of eating as I have to use the Fiasp to cover protein as well, so I tend not to weigh and calculate units or think about ratios other than using a standard 1:10 for the few carbs I eat, but just use my Libre to give me guidance on what I need to do and trust my instinct, which is definitely getting better. TIR is currently 96% on the Libre so this approach is clearly working for me. I guess this means that I don't really follow the DAFNE principles at all, but the course gave me a good grounding in how to keep myself safe with insulin and most importantly, it gave me the confidence to adjust my basal insulin which can vary quite frequently. Getting your basal doses right makes all the difference in the world.

I believe that some people have problems with "skanky sites" when using Fiasp with a pump but obviously that isn't a problem with me on MDI.

6-7 months ago (3 months into the change over) I was very frustrated and ready/keen to change back to NR but I seem to have found my way with it now. I said I would give it a full year's trial this time and I think it was a good decision to push on through the difficulties. I may go back to NR at some point in the future just to compare, but I am happy ticking over with the Fiasp for now. I am more ambivalent about the Fiasp than my Levemir which I absolutely love and would fight tooth and nail to keep, particularly over some of the very long acting insulins. My lifestyle needs the flexibility that Levemir provides.

So it seems useful for pre- bolusers. I dont use that approach.

 

[daducky88]

If you are not using sensors, how do you get alarms or cut off when going low?

I dont get alarms. I use hypo awareness.

 

[rebrascora]

W


Thanks Rebs.
What flexibility does levemir provide which others dont?

You can adjust the morning and evening doses independently, so keep the daytime one the same, and adjust the evening one if you are going low overnight.... or vice versa.

You can adjust the timing, so instead of taking it exactly 12 hours apart, you can experiment with longer through the day and less at night or vice versa, so the overlap means you get more activity at particular times of day..... so for me I take my morning dose as soon as I wake up at 7am (22units) and the evening dose at bedtime which is usually 11pm-12 (currently 8 units). Levemir has an activity profile of about 18 hours but it tails off quite a lot after 12. I seem to need less on an evening and overnight, particularly if I have been active during the day but I need much more in the morning, so the morning dose has pretty well run out in the evenig and no real overlap with the nighttime dose, whereas the overlap in the morning with the night time dose helps to reduce the effect of Foot on the Floor (FOTF) syndrome.

Thirdly, you can change Levemir on a day by day basis and see the results straight away, whereas most other basal insulins, particularly the longer acting ones like Tresiba and Toujeo, need 3 days after any adjustment to see the full effect of the change before you can think about changing them again. I might need to change my Levemir back in that 3 day period to keep things level, or change it some more in the same direction, depending upon what I have been up to. I do not have a regular routine, so my basal needs change quite significantly from day to day.

I can go weeks on the same basal dose sometimes and then need to change it every day or other day for a week or two to keep it balanced. Love, love, love my Levemir for all those reasons. Before my DAFNE course, I would have frustrating spells where my levels would just not follow the rules because I didn't understand that it needed to be adjusted. Now that I have the understanding and confidence to adjust my basal doses and the LIbre to see what is happening, I can adjust my basal doses to keep things so much better balanced. Not perfect of course but nothing is with diabetes. The Levemir allows me to get a very good fit for what my body needs though and I am so grateful that I was started off on it.

 

[rebrascora]

So it seems useful for pre- bolusers. I dont use that approach.

If I didn't pre-bolus my levels would spike up really high after each meal and then crash back down into range. Before I extended my prebolus time on a morning I would regularly go up to 15 and then be back down at 5 an hour or 2 later which made me feel rough like I was hypoing every day due to the sudden and extreme drop. Now that I pre-bolus at the right time, my levels stay below 10, usually below 8 and I feel much better physically and mentally.

 

[MarkGeordie]

Ive never attended one. I was diagnosed T1 when I was younger and was on the “older” regime where I injected mixed insulin twice a day and this went right through until my late 20s.

I moved and the consultant questioned why I wasn’t on MDI and my response was “what’s that?”. That’s when things changed and I changed across.

I’ve never been offered a course to attend, from what I can see from what I’ve been told from the DSN I work with she doesn’t like the one offered by my trust and I just learnt from the forums and online.

 

[rebrascora]

Ive never attended one. I was diagnosed T1 when I was younger and was on the “older” regime where I injected mixed insulin twice a day and this went right through until my late 20s.

I moved and the consultant questioned why I wasn’t on MDI and my response was “what’s that?”. That’s when things changed and I changed across.

I’ve never been offered a course to attend, from what I can see from what I’ve been told from the DSN I work with she doesn’t like the one offered by my trust and I just learnt from the forums and online.

I am pretty sure DAFNE is available in most of the North East area. It would almost certainly benefit you and they have been starting up recently because @Spozkins (also North East/Newcastle area I believe) was going on DAFNE a couple of months ago, so it would be well worth you enquiring again. Even if the nurse herself doesn't like the one offered, it is up to you as to whether to go on it and you might find it useful. I really don't think a DSN should be advising against an education course. I would urge you to make enquiries. Just spending time with other Type 1 diabetics is a massive benefit. There was a lady on my course who had been diabetic for 50 years and found it helped her a lot. She is now on an insulin pump as a result of attending the course and her diabetes management and quality of life for her and her family (who were having to deal with serious nocturnal hypos), is significantly improved.

 

[MarkGeordie]

I am pretty sure DAFNE is available in most of the North East area. It would almost certainly benefit you and they have been starting up recently because @Spozkins (also North East/Newcastle area I believe) was going on DAFNE a couple of months ago, so it would be well worth you enquiring again. Even if the nurse herself doesn't like the one offered, it is up to you as to whether to go on it and you might find it useful. I really don't think a DSN should be advising against an education course. I would urge you to make enquiries. Just spending time with other Type 1 diabetics is a massive benefit. There was a lady on my course who had been diabetic for 50 years and found it helped her a lot. She is now on an insulin pump as a result of attending the course and her diabetes management and quality of life for her and her family (who were having to deal with serious nocturnal hypos), is significantly improved.

Yeah I fully understand. I just know from speaking to others that have done the course that their are aspects that don’t appeal to me.

One was the fact they commented the individuals running it were talking down to them, that wouldn’t go down well with me and would more than likely lead to me leaving.

The second bit was on the information sheet it said they expect you to engage in eating whilst your there to aid understanding of impact, I don’t eat in front of strangers, so that doesn’t appeal either.

Personally there doesn’t seem to be too much flexibility in these courses.