has DAFNE done more damage than good?

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DanW81

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Type 1
had been really pleased with my sugars recently and had a HbA1c of 7.1%, so was happy with things. Went on DAFNE about 3 weeks ago and basically it seems to have messed up everything! I used to be able to quite accurately predict what level i was going to be at what time and they were the levels i wanted to, now I just cant do that! a lot of the time they just dont make sense.

I know people will say i need time to adjsut to it & get used to the DAFNE way, but after nearly a month im not sure its done much good. I did change insulin frorom humulin s to humalog after the course, so maybe this hasnt helped, but i cant see it making much of a differerence.

im begining to think DAFNE has done more damage than good :(
 
I'm on tablets so can't advise. I have heard some people have problems with DAFNE and the whole carb counting thing.

Is there any way you cn get back to them and ask for support or advice, or have you got a DSN who can help?
 
Hi Dan
I'm not sure what you were doing before DAFNE? Perhaps if similar to me, "own method of carb counting" (not mentioned by you), resulting in reasonable HbA1c (as you have stated), then I can see how you would be frustrated. I haven't done DAFNE, because of (a) difficulties getting time off for course when it happens (juggling 2 weekday jobs, 1 full-time, 1 part-time, plus 2 weekend part-time jobs), and (b) doing OK without it.
I guess change in short-term insulin from Humalin S (short acting) to Humalog (rapid or very short acting) could be a part of the story. Humalog (which I use) is so rapid acting, that you can inject immediately before or even after eating, and it's all out you system within about 4 hours.
 
I would think a lot of this is down to changing insulins. The profiles of the insulins are very different.

The humalog is rapid and the Humalin S short acting. One is out of your system after 5 hours and the other still has some action after 8.

Call your DSN and explain how things have gone a bit mad since the change and see what they can advise.
 
I agree with Copepod and Margie, I think the change of insulin is probably responsible for some of the issues you're having as the activity profiles of humulin S and humalog are different, and it may take a while to get used to the change.

If it were me, I'd probably try to get in touch with the DSN that ran the course and explain the problems you're having and see if she can suggest anything. I think it can take a while to adjust to doing things in the DAFNE way, and sometimes you have to tweak things to suit you, and your DSN should be supportive of that.

What kind of problems are you having? Is it your fasting levels? Post meal numbers? Is there anything we could specifically help with?
 
yeah before DAFNE i was doing my 'own method of carb counting' and it seemed to be working well, as with the nice HbA1c like you said.

I think the insulin change could well be whats causing the problems, but not really sure. We have got the follow up meeting in september to see how everyone has been going, but bit long to wait really if things arent working out isnt it. maybe i shall give them a call before that then....
 
Hi Dan

I reckon you are right. The difference in the activity-profiles between the insulins will mean that 'none of the old rules apply', or at least not exactly. I switched from NovoRapid to Humalog recently (apparently chemically very similar) and even that meant a significant adjustment in terms of my understanding of the onset/peak/duration of my boluses.

How much post-meal testing are you doing? I began keeping a diary of meal carbs/doses/level of activity etc and it really helped to have stuff written down to compare and contrast sort of... "Ah... x units for y carbs... and then hypo there 2 hours after... hmmm gym day, so next time I should try a lower ratio" type thing. It also meant that when things really didn't make sense (liver dumps, hot weather etc) I had data to fall back on in black and white rather than what I thought I remembered.

Hope it steadies down soon.
M
 
DanW81 said:
yeah before DAFNE i was doing my 'own method of carb counting' and it seemed to be working well, as with the nice HbA1c like you said.

I think the insulin change could well be whats causing the problems, but not really sure. We have got the follow up meeting in september to see how everyone has been going, but bit long to wait really if things arent working out isnt it. maybe i shall give them a call before that then....
Click to expand...

I tend to agree with the others. They do say to change only one thing at a time, and you have effectively changed two quite significant things - the type of insulin with a very different action to the one you are used to predicting, plus the way you calculate your doses/ratios. There is a DAFNE forum that might be able to give you some specific DAFNE-related help and support, although your DSN is the best person to advise - don't wait until September or you'll be tearing your hair out! 😱

http://www.dafneonline.co.uk/
 
Hello,

I've done DAFNE and it's helped me a lot. I agree with what the others have said that the two changes combined will be causing issues.

Northener has already mentioned www.dafneonline.co.uk which is a forum specifically for DAFNE (I use it too). It has a facility where you can post your DAFNE diary so others can see it and hopefully point you in the right direction.

Hope you get it all sorted soon,

NiVZ
 
thansk for all the advice guys.

i do quite a lot of testing (or 'did', cause dafne says i shouldnt do that much!) and have been keeping a diary ever since i did the DAFNE course and some trends can be spotted, but to be honest there are some strange levels throughout all parts of the day and some i just do not have answers for! but if i had to pin point one it would be the post evening meal level.

during the course where we were using a 1:1 ratio you could see the trends and the impact changes would make. but in the 'real world' after trying to adjust these ratios things seem to have gone a bit out the window.
 
What are you getting after eve meals? Highs or lows?

If you are anything like me you'll need more insulin in the mornings so keeping to the same ratio all day would have me either high at lunch or hypo 2-3h after evening meal.

Not sure of the profile of Humulin S, but I believe it's peak activity is less marked and overall duration longer. Humalog is supposed to just rush in, do its stuff and leave. Published profile suggests that after about 4h it's pretty much on its way out. This can be longer or shorter though, depending on the size of the dose (bigger doses typically act over longer periods).

Sooooooooo many variables! 😱

Making adjustments is a tricky business, and till you know how your body is handling Humalog it might be worth tweaking less often and waiting a few (possibly frustrating) days to make sure you understand what's happening before you tweak again (this is advice I should take myself!)

M
 
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i seem to be getting higher readings after eve meal. i also seem to need a bit more in the mornings to. At the moment i seem to be doing 1:1.25 in morn, 1:1 at lunch, 1:1.5 in eve, but depending on what im eating these ratios can easily change. e.g. eve can become 1:2 very easily say if i was having a pizza. but shouldnt these ratios stay the same whatever your eating?

yeah im begining to think i might have been more suited to the humulin s rather than the humalog, something to discuss with dsn i guess...
 
Well... not always unfortunately I'm afraid :(

In fact pizza is an absolute classic. Any food with high levels of fat can have significantly slower absorption (often called the 'pizza effect'). It's not impossible to inject the correct dose, go hypo (as the carbs are being too slowly for the insulin activity), correct for the hypo, then end up going high as the delayed carbs eventually work their way through your system.

One frustrating evening...

I get the same thing when eating significantly carbier meals than usual (the occasional fish & chip blowout for example, curry night celebrations, that sort of thing). Sometimes the most successful strategy for me is to split the dose and have some, say 60%-70% at the start of the meal, and follow up with the remainder and hour or two after. Kind of like a dual-wave bolus on a pump. It's a bit more to remember, and does involve an extra jab (sometimes a 3-way split!) but it has been very successful in the past.
 
yeah ive heard about things like pizza & fish&chips and splitting the doseage to deal with the slow release of carbs. But before i had worked out how much i needed to take for these kind of foods in 1 injection and it seemed ok for whole night. Thats another thing im not too keen on, dafne's thinking of throughout the day you should inject for anything extra you might want to eat. i dont want to have to be doing anymore injecions throughout the day than i need to, i didnt really have to do this before.

maybe that was one of the benefits on humulin s, cause its lasts a bit longer and peaks later on.
 
Sorry to hear your having a rough time Dan, no idea but it must have something to do with change in insulin?

But yeah I think what you/others say is the reason I haven't tried to go on any course, I seem to be bumbling along okayish and I'm not one to rock the boat, I have a system but couldn't write it down or explain it too well, a lot of gut feeling into my formula I!

Take care

Rossi 🙂
 
Hi I went on the DAFNE course and I found some bits of it just did not work for me, so I know do my own tailored version of it. For example humalog takes quite a long time to work in me so I always inject before eating. Also I definitely do need to inject for some veg, there is no way I could eat a bowl of lentil soup without it affecting my blood sugar.

I use the dafne website and on-line diary which I find fantastic.The graphs are great, and you can let your DSN your diary so they can help you out.

I hope you manage to get things a bit more stable soon.
 
I think with DAFNE most people take what they wnat and leave the rest. What it gives you is a structured way to adjust things.
I haven't done DAFNE but I know they do not encourage after meal testing, I think it can at times be useful to work out the best way to time injections.
If you can't get used to humalog, then I don't see why they wouldn't let you go back to t he humalin s.
 
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