DAFNE Myths

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.

Lizzie, I believe the point that Carolin was trying to get across is that in the early days of DAFNE the instruction was to treat any BG below 4 as a hypo - hence 4's the floor. That advice has now been changed, but the easy to remember phrase has lived on. Hence the attempt to explain the current advice, which says treat as a hypo below 3.5 with rapid acting carbs. In the range 4.5 - 3.6 then the treatment should be with a smaller dose of carbs (1 CP instead of 1.5-2) which should "normal" rather than fast acting.

Having said all that, this is yet another area that varies not only from person to person but on other factors. For me a rapidly dropping BG will prompt hypo symptoms above 4.5, and I will treat that with rapid acting carbs to stop the BG dropping below 3.5 maybe half an hour later. This works for me, but may be different for you.

These myths were aimed at the Educators, to try to ensure that the latest advice is passed on to people going through the DAFNE course for the first time. For those of us who were trained earlier, and were taught some of what are now considered myths, then I would suggest you should continue what you were doing if it worked for you, but consider changing if it didn't. As ever it has to be a case of trial and error to understand how any advice works for our unique metabolic system.

Finally, regarding you last comment "these slides seem confusing without the accompanying explanation", there is not much we can do to give access to the words used with the slides, but if there are one or two points which are still troubling you then post them here, and I will ask Carolin to provide the explanation.

Ok so the consensus seems to be that these things are not actually total myths or misconceptions since they differ for each person. If this is the case then I wish medical professionals would teach it that way rather than saying first of all "this is *always* the case" and later on "whoops in fact it is a myth and it *never* happens".

It might be helpful if people who had gone through DAFNE maybe 5 years ago or something like that could be automatically recalled. My clinic was OK on arranging updates directly after the course but these seem to have dried up. And even when offered, the number of places available was inadequate, they were snapped up almost immediately and by the time I had organised a day's leave and my manager got back to me approving it, there were no spaces left. And since it was one day only, you could only choose 2 sessions to attend so you did not get a thorough update on everything that had changed. I realise updates and suchlike are the responsibility of the individual clinic however it would be nice if there was some sort of central DAFNE mechanism to keep us updated if our own clinic does not do so. I just feel graduates of DAFNE should be kept updated with the latest knowledge and way of teaching the course. It is all very well going to it but after a few years the knowledge is old and begins to fade and is changed and updated and you are out of touch.

I agree with Lizzie in that it would be great if we could get updates on what is new. Things have changed with the DAFNE course over time and the educators get together once in a while and receive more updated info. My hospital is good at having DAFNE mornings which are basically a refresher of the course, but we did get told one time of a new thing. think it was the 12 hour split doesn't work for everyone thing. Anyway, it would be great if this new information was available to us all after each meeting. An alert could go out via this site and we could find out what the latest updates are. Otherwise a lot of us are never going to know the new information until a new hand book comes out and we can view it.

Lizzie said:

It might be helpful if people who had gone through DAFNE maybe 5 years ago or something like that could be automatically recalled. My clinic was OK on arranging updates directly after the course but these seem to have dried up. And even when offered, the number of places available was inadequate,

Lizzie said:
It might be helpful if people who had gone through DAFNE maybe 5 years ago or something like that could be automatically recalled. My clinic was OK on arranging updates directly after the course but these seem to have dried up. And even when offered, the number of places available was inadequate, they were snapped up almost immediately and by the time I had organised a day's leave and my manager got back to me approving it, there were no spaces left. And since it was one day only, you could only choose 2 sessions to attend so you did not get a thorough update on everything that had changed. I realise updates and suchlike are the responsibility of the individual clinic however it would be nice if there was some sort of central DAFNE mechanism to keep us updated if our own clinic does not do so. I just feel graduates of DAFNE should be kept updated with the latest knowledge and way of teaching the course. It is all very well going to it but after a few years the knowledge is old and begins to fade and is changed and updated and you are out of touch.

Further update on these discussions.....

Due to the amount of feedback to the original presentation on dafneonline, it has been decided by the DAFNE Executive that further information needs to be provided on each of the subject areas covered. As a result we can expect, over the coming months, more detail to be provided both to us as Graduates, but also to the HCPs (Health Care Professionals) who run the DAFNE courses. When the data becomes available (probably one topic at a time) we will get it loaded on dafneonline in the most suitable way. I have been told that the first topic to be covered will be Rebound Hyperglycemia.

Que? Rebound Hyperglycaemia?
Please remember, don't forget, plain English is best

hey it is in plain english, you just don't recognise the two words in tandem
But seriously rebound hyperglycemia is the idea that if you have a hypo in the night that in the morning you wake up with high blood sugars because of the Hypo. This is now considered to be unlikely and the idea is to look for other reasons. Thats a quick take on it, I'm sure when they send us the info to put on the site it will be explained a lot better than my feeble attempt.

I think a rebound hyper is perfectly possible in that context, as the liver will respond to a hypo, I think that it is made more noticeable in the morning with all the other factors involved, DP, insulin resistance.......

Testing through the night and analyzing the results should ultimately uncover the truth...........

I hope it gets simplified............

Like Novorapidboi I think the idea of a rebound hyper seems plausible and it is unclear why it is suddenly seen as 'unlikely'.

I have been requesting clarification on this and the other ideas on the slides ever since they appeared here as you can see, so it is nice to know someone has finally paid attention.