What is the secret about Dafne..?

[bennyg70]

I've never been offered the oportunity to do the Dafne course.

I was put on the basal bolus regime about 8 year ago, and told to match carbs to insulin. And that was that.

Over the years Ive leant to count carbs using scales, reading packets and from experience. Im not saying Im always great at it, but I feel my understanding is as good as it could be.

I test before I eat, and 2 hours afterwards. So I always know where I am. I have a good idea of where my bloods are heading at most times. For example, I pretty much can guarentee that i will be 2mmol lower before my next meal than I was at my 2 hour test for the meal before.

I have read lots of blogs, comments and reviews of DAFNE, and All of them start out with similar to what I am saying here... "I thought I knew it all but then I went to DAFNE". But No body ever says what these things are that helps them take the guesswork out of it.

So Dafne graduates... Tell me something I dont know? (This isnt meant to sound as cocky as it does btw!!! Just sounded cool 😉) 🙂

Cyber Trophy for the person who offers me the most revolutionary peice of DAFNE based advice!

 

[novorapidboi26]

It basically teaches you what 10grams of carbs do to the blood sugar and what 1 unit of QA [bolus] insulin does to the blood sugar............this then allows you to accurately match up the carbs and insulin......

It also gives you the skills to adjust your insulin through writing your results down, spotting patterns, and making educated dose adjustment decisions......

Our basal and bolus needs can change quite regularly, so being able to identify these changes quickly and make adjustments is brilliant and what DAFNE would strive for......

The course has many more topics within it and it is being updated and improved all the time....this is maybe why these people you talk about dont say much, as there is just too much....

Currently I would say its the most widely available 'structured' education programme for type 1 diabetics.....

How do you personally match up 60g of carbs with insulin.....?

 

[bennyg70]

For your example 60 g carbs... Through experimenting base don information gained on forums etc.. all depends.

I use differnt rations for different times of day. I subtract 20% if I have been drinking the night before. If my activity levels in the next few hours, I would consider a minus %. If the foods are fatty then I will consider splitting (Something Im currently trying to figure out). I will also take into account what my BG currently is and try to determine a correction dosage either way if required. I will also take this into consideration for rounding up, if my ration leaves me at the half unit point. IE for breakfast 60g carbs on an average day I would take 60 / 8.5 = 7 unit. Great. However if it were 65g - would equal 7.6u, and on my fast acting I can only do whole units so I would consider whether I need to roun up, or round down.

Believe me I dont always get it right what so ever, althoguh I feel Im gettign closer.

It would be great to know if there is information on offer which would truely benifit me - hence the post! Please dont think Im knocking Dafne what so ever!!

 

[novorapidboi26]

I dont think your knocking it, honestly, I hope it didn't come across that way.......

From the sounds of it you seem to be quite knowledgeable........

DAFNE starts everyone on a 1unit:10grams ratio, so that makes life a lot easier in terms of the rounding up and down, although DAFNE graduates do develop their insulin/carb ratios further and so can get more complex if needed....

I chop off Levemir units for alcohol as opposed to Novorapid, this is made easier as its split....

I asked about the 60g of carbs to see what you said about ratios etc, which you did.....

What ratios are you on at the moment......?

 

[trophywench]

Am gonna ask two questions.

When did you last actually test your basal? and could you explain that to another diabetic?

Can you actually explain to someone else how the kidneys work, in terms of what actually happens to them when your BG is too high for too long, which then explains why they get knackered and fail? (you don't have to explain, I just want to know if you COULD write it down LOL)

Those are just two of the things I learned about.

And I'd had D for 35 years by then and been on MDI for yonks ........

 

[everydayupsanddowns]

Benny

I suspect the *big difference* many people find is breaking things down into units and ratios which you seem to be doing already - ie an understanding of 10g of CHO needs x units insulin, 10g CHO raises BG by y much, 1 unit lowers BG by z much rather than just a more general if I'm *this* high I'll need a unit or two, and another one if higher...

I have been offered a place if I want it at any point, but my DSN didn;t seem to think it was a high priority because of the way I approach things.

I found this account of DAFNE very interesting and it gave me a lot more info as to what was involved, and the general structure of the course. http://www.diabetes-support.org.uk/info/?page_id=294

 

[Lizzzie]

I too was fully capable of carb counting before I went of Daphne, although this improved (I had never twigged on to splitting doses for low GI value foods, such as large quantities of beans e.g. Dahl (I'd been blaming my problems in India on the chipatti) or how to handle grapefruit etc).

To give you a summary of what else It covers:

Physiological / pharmacological stuff

I think it depends a bit where you're starting from, but I have a degree in physiology - related things and still managed to learn a fair amount about the physiology of diabetes and more crucially the action of insulin. If you can explain what diabetes is, what insulin and glycogen do, how long your insulin acts for and at what point it is most effective, then you stand more chance of being able to control your own diabetes. A lot of diabetics either don't know this or - like me - think they know and are missing some key bits of the jigsaw.

How to assess basal levels and insulin: carb ratios to make sure you're using the right one for you.

How to get control right in the face of exercise, boozey nights out (there is a set of guidelines for both of these, i cant quote the alcohol one off my head but it's different to yours, but most importantly you learn HOW alcohol / exercise affects your body / metabolism).

Illness - how it affects / what to do / ketone testing and why it's important
Pregnancy (huge one for women)


Side effects ESP separating myth from fact, what for eg retinopathy or reduced kidney function mean practically

That said, places on DAFNE are very limited. If your control is already excellent and you do have fantastic understanding, then great.


Saying all that, places on the DAPHNE courses are limited and if you are

 

[Lizzzie]

Sorry about that last but. I'm on a smartphone sO seeing what I've written is tricky.

The even bigger thing for me was, MEETING OTHER PEOPLE WITH DIABETES. from all walks of life. That alone was inspiring and helped me to feel a lot better about it.

 

[bennyg70]

Really interesting stuff guys... Im asking this because I don't know whether its something I should push my DSN for or not.

my control is OK. But Im striving for excellence. At the same time, moneys tight time are hard, could I afford a week off if I wasn't going to get full benefit.

My current ratios NRB are 8 / 1 in the morning, 8 / 1 lunch and 10 to 1 evening. But like I say this some weeks can change two or three times depending on what im up too.

The funny thing is, everything ive learnt as of late has been from forums, the people who post in forums have probably learnt from dafne and the like.

Mike Ill check that out it sounds interesting.

Lizzie, that sounds like a major point actually meeting other diabetics.. and going through the process with them. I've only ever in my years met 1 other T1 diabetic.

Trophy wench, I could bang on about basal testing for hours, but only because I recently discovered about it through forums, which probably came from dafne. I had no idea what my lantus was actually doing, or the point of it, I used to just adjust it on a daily basis for god knows what reason, because I thought of it as unimportant...stupid I know

Id also be interested in dafne guidelines for boozy nights out!! 😉

 

[Lizzzie]

Edited out cos reading ur last post it doesn't really apply to you.

 

[MaryPlain]

For me, it just gave me a much more systematic way of testing and adjusting ratios. It seems so obvious now, but I tended to want to get everything sorted at once so would frequently adjust more than one thing at a time and not always check to see whether it had worked.

I also found the most useful and interesting thing on the course was meeting the others. I disagreed fundamentally with a few of the things the dietician and nurse who ran the course said, and those things haven't changed, but I still felt empowered by having attended.

Another good effect is that now when I go to my check-ups I only need to show my consultant my records if I want to - the dynamic of the relationship has changed because I am a DAFNE graduate and since I was trained in DAFNE by them, they now trust me to get on with it!

 

[everydayupsanddowns]

For me, it just gave me a much more systematic way of testing and adjusting ratios. It seems so obvious now, but I tended to want to get everything sorted at once so would frequently adjust more than one thing at a time and not always check to see whether it had worked.

I also found the most useful and interesting thing on the course was meeting the others. I disagreed fundamentally with a few of the things the dietician and nurse who ran the course said, and those things haven't changed, but I still felt empowered by having attended.

Another good effect is that now when I go to my check-ups I only need to show my consultant my records if I want to - the dynamic of the relationship has changed because I am a DAFNE graduate and since I was trained in DAFNE by them, they now trust me to get on with it!

Very interesting points Mary, especially about the change in dynamic at subsequent appointments!

 

[trophywench]

That's exactly what I meant when I said 'They know what you know' LOL They skip the bull pooh LOL

Actually Benny, that article was originally written by someone who hasn't done DAFNE, did another course, and then checked over and tidied up by a DAFNE graduate who hardly altered a word of the nitty gritty part.

But the person who originally wrote it and the DAFNE graduate, learned most of it before their courses from - FORUMS - or rather to begin with - Newsgroups ! But I spect you aren't quite elderly enough to remember such things .....

 

[bennyg70]

Correct, I am very very very young, and ages and ages and ages away from 30!!!

 

[Phil65]

Really interesting stuff guys... Im asking this because I don't know whether its something I should push my DSN for or not.

my control is OK. But Im striving for excellence. At the same time, moneys tight time are hard, could I afford a week off if I wasn't going to get full benefit.

My current ratios NRB are 8 / 1 in the morning, 8 / 1 lunch and 10 to 1 evening. But like I say this some weeks can change two or three times depending on what im up too.

The funny thing is, everything ive learnt as of late has been from forums, the people who post in forums have probably learnt from dafne and the like.

Mike Ill check that out it sounds interesting.

Lizzie, that sounds like a major point actually meeting other diabetics.. and going through the process with them. I've only ever in my years met 1 other T1 diabetic.

Trophy wench, I could bang on about basal testing for hours, but only because I recently discovered about it through forums, which probably came from dafne. I had no idea what my lantus was actually doing, or the point of it, I used to just adjust it on a daily basis for god knows what reason, because I thought of it as unimportant...stupid I know

Id also be interested in dafne guidelines for boozy nights out!! 😉

Benny I attended a 'DAFNE' type course ran by my DSN and a dietician, it lasted 6 weeks one Wednesday afternoon per week. It was a pre-requisite to be considered for a pump....such is the importance of carb counting. The course was SAILING (Self Adjustment Insulin Learning In Groups). There were 6 Type 1s on it, all very different people from different walks of life, some had been diagnosed 35 years ago! For me.....meeting other Type 1s was the best part of the course and sharing issues and seeking advice from each other and helping each other was really interesting. From what I can gather you will not learn that much yourself...you seem well versed....but you will learn 'something' for sure. My biggest problem (i'm not backwards in coming forwards) was I had the tendency to almost take over the course....and I could see that this was a bit of an issue for the two 'specialists'. I was shocked about how uneducated and dependent most of them were with their own diabetes! Despite the long length of time most had had D.

 

[bennyg70]

Cheers for the insight Phil,

The course you went on sounds much more up my street! It might be something I look into and see if they run a longer running course like that in my local area.

Id love to meet a group of T1's ... The difference its made to me participating in forums and the reassurences and learning of others experiences has helped me both manage my diabetes better and also probably physcologically, as when things started to come to a head and I ended to get things back on track, I did start to feel very alone, and like the only diabetic in the world.

You neever know, maybe one day ill even attend a meet!

 

[Northerner]

I didn't do DAFNE either, but had a shorter course which was one day a week over three weeks. This was around 3 months after I was diagnosed - a couple of the other people had been even more recently diagnosed and one chap had been T1 for about 5 years. I was the oldest by at least 20 years! 😱 What was interesting was that the person with 5 years experience appeared to have quite a lot of misconceptions, chief of which was that he only ever looked for the sugar content, not carb content, of food. He also treated hypos with Mars bars and didn't know what lantus was for. It was good for me to meet other T1s, plus we had talks from a podiatrist, a dietician and an eye specialist.

This forum was set up originally by a lady who had never met another T1 despite having it for over 35 years - it's actually quite rare, and a reason why a lot of GPs rarely encounter them. If you would like to meet other people with diabetes you should come along to one of our forum meets for an informal get-together 🙂

 

[bennyg70]

Hi Northener, Again, really interesting and thanks.

Id like to get on one of these 1 day a weeke courses, and now knowing they are out there ill talk to the dsn next time i see her.

I saw there is one in birmingham toward the end of next year, Maybe ill aim for that one! 🙂

 

[PhilT]

I did the X-Pert Insulin Course in Sept/Oct which is similar in content to DAFNE but for Type 2's on insulin. I found it very helpful as I'd only recently started on MDI. It was interesting to meet other diabetics and hear about issues they were having with their BG's etc.

I would recommend it to anyone who's Type 2 and on Insulin.

 

[Robster65]

Just to pitch in. I've never done any courses. All I know about carb counting and adjusting is about 10% from the blundering along for 30 odd years in the dark and 90% from this forum and other T1s on twitter etc.

The thing I don't like about DAFNE (purely hearsay) is the concept of only adjusting before meals. So if you test at +2 hours and you're maybe 15mmol/l, their regime seems to suggest that you wait until your next meal (maybe 3 or 4 hours away?) before correcting. By which time you may be 20+.

I may have misunderstood, and obviously their methods are a brilliant way to learn the basics, but I wouldn't want to follow them rigidly. The are partly responsible for GPs thinking we don't need to test more than 4x per day. They see no point in extra tests if you don't make corrections.

Just my thoughts. 🙂

Rob