Can DAFNE consider changing from the use of CP’s to g of carbohydrate?

This is a question posed by the DAFNE Educator network, please add your responses and thoughts below:

What this would mean would be stopping using CPs but using carbohydrate grammes instead, there are 2 options

1. Using 1 unit to 10g without further conversion to CPs
or
2. Changing the ratios so that they are reversed (as in some pump use) so that 1 unit is fixed and the grammes of carbohydrate vary to one unit of insulin e.g.
0.5 to 1 ratio becomes a ratio of 20g carbs to 1 unit insulin
1.0 to 1 ratio becomes a ratio of 10g carbs to 1 unit insulin
1.5 to 1 ratio becomes a ratio of 7g carbs to 1 unit insulin
2.0 to 1 ratio becomes a ratio of 5g carbs to 1 unit insulin
2.5 to 1 ratio becomes a ratio of 4g carbs to 1 unit insulin
3.0 to 1 ratio becomes a ratio of 3g carbs to 1 unit insulin

The argument against is that variable grammes to 1 unit of insulin makes the calculation of doses much more difficult without a calculator, we are aware of difficulties with working out the maths using the simpler CP approach and are unsure if a more complex approach would benefit graduates or put people off.

The arguments for the variable grammes to 1 unit approach rest with common practice in children’s diabetes services of using grammes to 1 unit as the ratios tend to be smaller e.g. 20g to 1 unit, and common practice in pump use as some bolus advisors cannot work in carbohydrate portions. The use of a grammes approach would make it easier for some educators as it would be in line with approaches used in other areas of work, it may also benefit some users who have previously been taught this approach.


We would like your views as DAFNE users on the approach to dose calculation that you feel would be of most benefit. Responses by 15/01/16 please.

My poor old brain wouldn't be able to cope with these changes, I'm afraid. My control is quite good at the moment using the current method, so I would prefer it not to change.

Oh I agree with Alan my control is great too so I'm happy for it not to change

My mental arithmetic is not good but I cope very well with 1 unit - 1 CP or 10g CP and the differing ratios 1:1.5, 1:2 etc.

My feelings are as above - why change, the maths is much easier saying 1 unit of CP is 10g of CP - can't get much easier than that, and my ratios are straight forward to work out, except I have a 1.5 to 1, but again, that is fairly easy to work out.

The above appears much harder to work out, esp for those of us who are comfortable working the other way round. I personally don't see any benefit at all, and can only see downsides - the maths is harder, the risks associated with the change will lead to loss of control.

I realise many aren't happy unless they are introducing change, but this appears to be change for changes sake, so no doubt it will be introduced and ignore those that disagree, because we will be seen as backward and refusing to adapt.

It's not broken, please don't fix it!

Have just joined Dafne and am slightly surprised to read above that "some bolus advisors cannot work in carbohydrate portions" and "the grammes approach would make it easier for some educators".
The changes that advisors/educators would like reads as very confusing and I do agree that it could, for some diabetics, lead to more risk of error with insulin requirements and the consequences therein.
I'd prefer things to stay as they are.

I wonder if any of these clever people suggesting this are actually diabetic, and having to work out ratios on a daily basis. Leave it alone

Personally I find the whole CP thing pointless. I would rather the 1 unit to 10g etc. You have to count the carbs first so not sure what the point of then converting them to CP's is. LOVE DAFNE

As a pumper I actually still struggle with setting ratios to grams:unit and actually like the CPs or unit:grams, with the grams fixed.....

Ultimately I can manage OK, its just trying to remember that for more insulin, you need to reduce the gram value.....

I'd agree that a switch to carbohydrate grammes rather than CPs is probably a good idea given that in the real world that's how all foods are labelled. However I'd also prefer to stick with units to CPs rather than the reverse. I am lucky enough to be a pumper and have to do the conversion from time to time when changing insulin ratios, but on a daily basis I still think in terms of units to CPs. Secondly, unless there is some radical change in NHS policies, in the short term pumpers will be the minority in the UK and, in my opinion, the current ratio is much simpler to use for everyone else unless they have access to a device that does the conversion automatically and, unfortunately as we've seen with the the DAFNE app, calculators can't be made widely available as they have to be linked to an approved medical device rather than being readily available e.g. on a phone.