DAFNE Myths

40 posts, 12 contributors

August 05, 2011 16:27 NikkiAllen South West Essex PCT 3 posts	Interesting as I haven't seen this yet. The only one that I would just need to check is that the 4 is the floor slide is the misconception and the treat/eat slide is the correct DAFNE prinicple. (We teach treat/eat so hope it's correct). The hardest misconception to change peoples idea on is the unrecognised hypos during the night cause high morning readings. This is something that lots of DSN's do still believe in and teach.
August 10, 2011 18:31 bib27 1 post	hello all, I was told about DAFNE today as my control is slipping and making me a little depressed. I'm really keen to start this course hopfully in the next 3 months, i just wanted to hear about other people's stories and how much better my control can be. I'm willing to work hard.
August 11, 2011 07:45 novorapidboi26 DAFNE Graduate NHS Lanarkshire 1,819 posts	bib27 said: hello all, I was told about DAFNE today as my control is slipping and making me a little depressed. I'm really keen to start this course hopfully in the next 3 months, i just wanted to hear about other people's stories and how much better my control can be. I'm willing to work hard. Hey and welcome to the site, you should think about starting a new thread so you can get more responses..... For me personally, and I can probably speak for the majority of folk, DAFNE has changed everything for the better, doesn't mean it inst a struggle, as the human body is ever changing.... For me just being able to finally understand blood sugars, how carbohydrate effects them and how the insulin we use effects blood sugars is all I needed to take control. There is so much more information provided than those three basics just mentioned. Most importantly for me, the effort to make it work doesn't seem a lot, when I know it is, that's the beauty of it, being able to understand in clear detail whats going on makes controlling the condition seem effortless, for the most part anyway..... Once you have done it, you will never look back to the old ways, you just physically couldn't do it....... Enjoy it when the time comes, and be prepared for unexpected hypos..................good luck.......
August 11, 2011 13:32 Welshmapleleaf DAFNE Graduate Betsi Cadwaladr University Health Board 19 posts	'Once you have done it, you will never look back to the old ways, you just physically couldn't do it.......' Having been on too many courses with work than I care to remember, I can truly say that DAFNE is the only course I've ever been on that I am still sticking to 8 weeks later. Not only that, but it becomes more interesting as time goes by as you have more results to look at and analyse! I know a course about your health is more important than any old 'work' course, but it would be easy to slip back into bad habits - except as novorapidboi says- you just physically can't let yourself do it! I don't profess to know everything I need about my diabetes management - it's an ongoing education, and I am still battling with my BGs, but let me tell you going on DAFNE is like having the 'sack pulled off your head'. 'Enlightenment' is not an overstatement!
August 29, 2011 12:27 Peter DUAG Committee Member University College London Hospitals (UCLH) 109 posts	marke said: On the 10th June the Annual DAFNE Collaborative was held. This is the DAFNE get-together of all educators, programme management etc. I was fortunate enough to be there as a DAFNE User Action Group rep. One presentation that really caught my ear that I can now share with you was about DAFNE Myths and Misconceptions. If you click here you can read the presentation in PDF form. Remember it is being said that ALL the things in the presenation are myths. Have a read and post your views here ! Its bound to cause some controversy, which is why I'm posting it here to see what peoples views are. Like Mark I was also lucky enough to be present at the Collaborative when Carolin Taylor gave this presentation. I'm not sure whether everyone is aware, but as part of the process to ensure that all DAFNE training meets the required standard, and that the graduates are taught the "right" thing (i.e. what's in the handbook) each DAFNE Centre is regularly audited by an experienced DAFNE Educator from elsewhere in the country. The purpose of this presentation was to educate the Educator's on some of the myths and misconceptions that are still, wrongly, being taught. Carolin herself is a highly experienced DAFNE Educator and leads the DAFNE Educator Group which is responsible for DAFNE training. It would be great if every Centre could provide consistent training that completely matches the DAFNE Handbook, but that is never going to be possible, and so the audit process is in place to do as much as possible to ensure consistency of education for all graduates, but there is always a possibility that something incorrect slips through. I, was taught, and still treat hypos more than 2 hours before a meal with 2+2 CPs. It works for me, at least most of the time, and that is the key message in my view. We are all different. The training and the handbook give a good foundation, but it is then necessary to add personal experience on top of that. It takes time to get that knowledge, but it's worth a few mistakes along the way to discover what works for you. Finally, DAFNE is an evolving course. The section of the presentation on insulin types is an example of this. The handbook and course have been updated a number of times, and so that things that were taught a few years ago (e.g. 4's the floor) are no longer used. In these cases the course and handbook are updated, but that leaves a gap for those who have already been trained and don't necessarily read the new handbook cover to cover. There is probably a role for DUAG and dafneonline to get these updates to all existing graduates, and that is something that we will look into.
September 01, 2011 14:07 Lizzie DAFNE Graduate Guy's and St Thomas' Hospital 87 posts	I have looked at this again and still don't understand it. I was taught many of these on my DAFNE course and most have been proven by my own experience. Can someone who was there please go through these and explain what the truth apparently is and why we were misinformed so comprehensively? Not just on the DAFNE course but by our specialist doctors, nurses and dietitians for many years - at least in my case many of these things have been passed on to me as facts. For example: If BI doses should not be 12 hours apart, what is the ideal length between doses? If 4u is not the maximum correction dose, what is? If high BG prior to exercise should not always be corrected with QA, how should it be treated? If you do not need a 1:1 ratio for snacks, what is the correct ratio? If alcohol does not raise and then lower your blood sugar what effect does it have? And what is it that coincidentally causes the raising and lowering of blood sugars in people who have drunk alcohol if it is not the alcohol itself? If an overnight hypo does not cause high morning BGs what is the cause? What is the "floor" if it isn't 4? And what is that "treat or eat" thing all about? The treatment for a hypo IS eating. With regard to this one "BG should be tested at 3am to make sure a hypo isnâ€™t the cause of high fasting BGLs" - does that mean you should never check your BGLs during the night? Surely this is a sensible action to take to find out what is happening? Why is it a myth or misconception that you need to do it? "A 2-hr post-prandial BG is helpful to assess QA:CP ratio" - why not? Is this reading any use at all? If so what for? If not why have doctors been advising us to check it for so many years? "High GI foods are in & out of the bloodstream very rapidly" and "Low GI foods can still be affecting your BG up to 5hrs after eating" - I thought that was the point of GI - it was a measure of how fast the food reacted in our bloodstream. These slides seem confusing without the accompanying explanation.
September 01, 2011 14:32 novorapidboi26 DAFNE Graduate NHS Lanarkshire 1,819 posts	Lizzie said: I have looked at this again and still don't understand it. I was taught many of these on my DAFNE course and most have been proven by my own experience. Can someone who was there please go through these and explain what the truth apparently is and why we were misinformed so comprehensively? Not just on the DAFNE course but by our specialist doctors, nurses and dietitians for many years - at least in my case many of these things have been passed on to me as facts. For example: If BI doses should not be 12 hours apart, what is the ideal length between doses? If 4u is not the maximum correction dose, what is? If high BG prior to exercise should not always be corrected with QA, how should it be treated? If you do not need a 1:1 ratio for snacks, what is the correct ratio? If alcohol does not raise and then lower your blood sugar what effect does it have? And what is it that coincidentally causes the raising and lowering of blood sugars in people who have drunk alcohol if it is not the alcohol itself? If an overnight hypo does not cause high morning BGs what is the cause? What is the "floor" if it isn't 4? And what is that "treat or eat" thing all about? The treatment for a hypo IS eating. With regard to this one "BG should be tested at 3am to make sure a hypo isnâ€™t the cause of high fasting BGLs" - does that mean you should never check your BGLs during the night? Surely this is a sensible action to take to find out what is happening? Why is it a myth or misconception that you need to do it? "A 2-hr post-prandial BG is helpful to assess QA:CP ratio" - why not? Is this reading any use at all? If so what for? If not why have doctors been advising us to check it for so many years? "High GI foods are in & out of the bloodstream very rapidly" and "Low GI foods can still be affecting your BG up to 5hrs after eating" - I thought that was the point of GI - it was a measure of how fast the food reacted in our bloodstream. These slides seem confusing without the accompanying explanation. If BI doses should not be 12 hours apart, what is the ideal length between doses? Background insulin's dont always last 12 hours, and some even last longer, its effects are different in everyone...........its perfectly acceptable to have it 12 hours apart, i personally have mine 9 hours apart, one at night, one in early in the morning, this is to help combat the dawn phenomenon......... If 4u is not the maximum correction dose, what is? The possibilities are endless really, it all boils down to insulin sensitivity..............if my blood is over 17mmol/l, I have established that 1 unit drops me by 1mmol/l...........so if I was 20mmol/l which isn't that often... ], to get down to 5.5mmol/l I would take 15 units [14.5]........this is a long way off 4 units maximum....... If high BG prior to exercise should not always be corrected with QA, how should it be treated? Depends when the exercise is taking place, if it was within 5 hours of CP/QA then you would have no need to do so... If you do not need a 1:1 ratio for snacks, what is the correct ratio? If its closer to your lunch, use your lunch ratio, if dinner, use dinner, if not........somewhere in between, its all about trial and error....... If alcohol does not raise and then lower your blood sugar what effect does it have? And what is it that coincidentally causes the raising and lowering of blood sugars in people who have drunk alcohol if it is not the alcohol itself? Depends on what you are drinking, if its just alcohol [spirits] then your BG will not go up, it will however go down either at the time of drinking, overnight and/or into the next day, everyone is different.........and by different I mean everyone's liver has different response times to dealing with the toxin....... If its beer, cider, alcopops, some wines, then they will have carbs in them, to which you should account for...............in this case and the previous one a reduction in BI that night and sometimes into the next day are required......... If an overnight hypo does not cause high morning BGs what is the cause? I would say overnight hypos can be the cause of morning highs, but the next obvious one which myself and many others suffer from is dawn phenomenon, where a cocktail of hormones are released in order to raise blood sugar levels to assist in starting the day off............ What is the floor; if it isn't 4? And what is that treat or eat thing all about? The treatment for a hypo IS eating. I would say 4 is fine for verging on hypo............... Not sure about the treat or eat thing, its been a while since i looked at the myths and misconceptions, it may be referring to, if your hypo immediately before a meal, and then the question would be, do you treat it, or just eat your meal with a reduced QA.........I would always treat, then eat........just in case i was dropping quickly and there was no quick acting carbs on my dinner plate...........safety first and all that......................
September 01, 2011 18:50 marke Site Administrator South East Kent PCT 681 posts	lizzie, The point of posting the presentation was to provoke discussion which is has done I'm sorry but I don't think I agree with what I perceive is your view that doctors know best and always have the answer. The truth is, with something like diabetes there are no correct answers because everyone is different and have differing experiences. In addition different studies and research are revealling things that were thought to be true are not necessarily. Hence this thread gives people a chance to discuss if they ARE myths and what their experiences are. Not a scientific study but an interesting experiement just the same, what are graduates experiences on these things ? Personally I don't believe that night-time lows cause high's in the morning. If I was low in the night I would know and have often woken in the night when my BG is too low. I think I far more likely culprit is dawn phenomeon, like a number of people I find my insulin ratio is higher in the morning than later in the day. I think the point about alcohol was it was taught that it always lowered BG and as said at the collaborative if that was true why bother with insulin when alcohol was a far more attractive alternative
September 02, 2011 10:15 Lizzie DAFNE Graduate Guy's and St Thomas' Hospital 87 posts	novorapidboi26 said: If high BG prior to exercise should not always be corrected with QA, how should it be treated? Depends when the exercise is taking place, if it was within 5 hours of CP/QA then you would have no need to do so... But I have always been told to correct for BSLs higher than 13 before exercise. When I did not my BSL kept rising and was 18 after exercising. I don't know what would have happened if I had left it but 18 is too high for me so I had to correct. It certainly did not seem like it would be going down any time soon, the only effect exercise had was to make it higher.
September 02, 2011 11:06 novorapidboi26 DAFNE Graduate NHS Lanarkshire 1,819 posts	Its a tricky science that I am not completely clued up on, but I personally would not start exercise with a BG over 12....... If the 12 was a spike 1-2 hours after eating I would wait till it came back down, however in theory if I started exercise 1-2 hours after eating my BG should not go up as all the energy I just put in from my dinner is accounted for and can be passed on to the cells of my body with the insulin I injected........its only when you dont have enough insulin to process the higher requirement of glucose during exercise that your BG would rise.......... So it really depends on what time your doing the activity, I wouldn't put in more insulin 1-2 hours after a meal, as then I would have too much and I would go low.......unless I covered that insulin with carbs......which is not what I want to do if maintaining/losing weight......