Recent Posts - DAFNE Online

Aug 7, 2013

Kittycat789 10 posts

Topic: General Discussion / receeding gums

I only have one that is, i have an appointment on
27th so i will ask there and let you know on here what they say :-)

Aug 7, 2013

JayBee 587 posts

Topic: General Discussion / Insulin Pump Bug

You generally find you have to do the same for your blood testing kit too... What a silly (could even say lazy) person. :/

Stay safe y'all.

Aug 7, 2013

davidcragg 17 posts

Topic: General Discussion / Insulin Pump Bug

For a slightly more measured article on the issue, see http://www.bloomberg.com/news/2013-07-22/medical-device-hackers-find-government-ally-to-pressure-industry.html

In his complaint to the FDA, Radcliffe claims his Animas pump inaccurately calculates the amount of insulin to dispense after the battery is changed. The pump does not automatically factor in the amount of insulin it dispensed immediately before the battery was removed, he said.

That issue led to dosing errors that caused him to experience two low-blood-sugar episodes, which can be fatal, Radcliffe said.

The pump is designed to reset insulin levels following a battery change, said Brian Levy, medical director at Animas. The patient's insulin history is still stored on the device, and instructions for recalibrating the machine are in the owner's manual, he said. The company does not plan to make any changes.

Radcliffe said he's unsatisfied with the response and intends to push the company in public and private to fix the issue.

Essentially it seems Radcliffe didn't follow the manufactures instructions correctly and thinks the user shouldn't have to do the recalibration step after changing the batteries.

So in this case I would say it was more a case of user error than equipment malfunction, however I agree with you that checking your diabetes equipment is an important aspect to consider.

Aug 7, 2013

Plumcious 11 posts

Topic: General Discussion / receeding gums

Hi Kittycat,

My gums seem to be receding but it's been a problem for years so it's happening very slowly -- I didn't realise it could be diabetes related til I saw your message and I've just looked it up on www.diabetes.co.uk
My dentists have always said use a soft/sensitive brush and gently stroke downwards from gum to the biting edge. One once said to "scrub" or brush ulcers hard - this led to me losing a lot of gum over one tooth when I did it.
I hope other people reply - or have you tried phoning Diabetes UK - here's a link to their dental advice http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/Other_associated_conditions/Dental-health/
It might be worth asking your GP or Consultant for advice...
Sorry none of this is conclusive - I'm sharing!

Aug 7, 2013

Adrienne 14 posts

Topic: General Discussion / Advice welcomed!

Hi Garry,
Yes that entry should have been for BI. My BI is Lantus, split dose because it wasn't lasting the full 24 hrs. I increased the dose this morning to 11 so I'll see how it's looking in a couple of days. Thanks

Aug 6, 2013

marke 686 posts

Topic: General Discussion / Insulin Pump Bug

Yes, but the article does not provide any details of what actually happened, it sensationalises the issue without providing any real details. All medical devices do go through a lot of testing and its hard to believe as you say they did not test for this, Without all the facts its easy to look at the worst case scenario. As
you say having an kind of technology doesn't move the responsibility away from the user to ensure correct operation. The article says HE mistakenly infused himself with the wrong dose, unless it gave a completely wrong BG reading why did he do this ? It makes no mention of this.

Aug 6, 2013

Garry 328 posts

Topic: General Discussion / Advice welcomed!

Take it that entry 03/08 18:40 should read BI 8?
Looking from afar, the majority of your entries are in the red. Personally speaking, I always see that as BI adjustment needed. If you need make lots of + compensation doses...that seems to say that BI needs upping.
What BI do you use?
Regards
Garry

Aug 6, 2013

Adrienne 14 posts

Topic: General Discussion / Advice welcomed!

I'm struggling to keep my readings in the green and was wondering whether anyone could offer me any advice please.
I've been doing different ratios on the weekends because I'm more active then. I'm not sure about my lunch ratio during the week and also my morning lantus dose. I did a carb free lunch on 1/8 which showed that my BI needs increasing but I guess I've been reluctant to do this. Also I thought it might be possible my high reading after the carb free lunch was due to a hypo reaction so my BI doses are still 10 (am) and 8 (pm). I do take my BI at the same time (8am and 8pm) even though my diary may say otherwise.
Any help would be greatly appreciated, thanks :-)

Aug 5, 2013

Kittycat789 10 posts

Topic: General Discussion / receeding gums

Hi just wandering he anyone else has suffered complication with gums from diabetes? And do you know if we can get help with this from specialist as my dentist sent me away advising me to buy corsodyl mouthwash don't think its helping

Aug 5, 2013

Garry 328 posts

Topic: General Discussion / Increase of Lantus/BI

What happened Sunday Gill. Where did the morning go?
9.2 Sunday night and you list 3.5 CP. Your comment seems to suggest you consumed 2 x 1.7 CPs. But you take no QA and no BI. There must be info missing as how did you get to 3.4 BG at 08:18?
Difficult to comment rationally without all necessary information.
Take your time and wait to see a distinct pattern emerging. Once you are sure, you can confidently make needed changes.
Don't rush. We are all individuals and I think others have talked of Lantus changes taking longer for them to be sure about the outcome.
I think an unbalanced split BI may help you overcome your morning hypos and help you flatten out your food intake pattern.
Regards
Garry

Aug 5, 2013

mum2westiesGill 502 posts

Topic: General Discussion / Increase of Lantus/BI

So up to day 6 of the BI increase so have now had 3 days to let things settle, and 3 days to see the full effect - what does anyone think?

Aug 5, 2013

mum2westiesGill 502 posts

Topic: General Discussion / Increase of Lantus/BI

Your corrections can just be listed as 07:14 2.5, 07:31 1.5 and 10:12 1.5.
- These weren't corrections they were the amount of carbs I'd had for the hypos (jelly babies)

Any thoughts about having breakfast earlier?
- I don't really do breakfast until about 10am ish

Cheers
Gill

Aug 5, 2013

Garry 328 posts

Topic: General Discussion / Increase of Lantus/BI

Your corrections can just be listed as 07:14 2.5, 07:31 1.5 and 10:12 1.5.
Any thoughts about having breakfast earlier?
Your BI is of course working throughout this early daytime.
Regards
Garry

Aug 5, 2013

Garry 328 posts

Topic: Site Development / Message Inbox

Already do that marke with the HCPs at the hospital...but I would prefer not to share my whole diary in a more open forum.
The format below, with it's restricted date range, gives the opportunity to focus in and perhaps emphasise points to others.
Regards
Garry

Aug 5, 2013

Yorky 1 post

Topic: General Discussion / Insulin Pump Bug

G'day All,
As an IT geek, I know the possibility of "bugs" in software is always present (especially as I get paid to find them!) The article below is from a security website:

http://www.scmagazine.com.au/News/352073,diabetic-researcher-finds-insulin-pump-memory-glitch-that-almost-killed-him.aspx?eid=7&edate=20130805&utm_source=20130805&utm_medium=newsletter&utm_campaign=daily_newsletter

The big concern is this type of bug should have been tested for, as changing batteries is a basic user function of the device.

I guess the moral of the story is check, double-check, and just to be safe, check again. We all put our faith in devices (pumps/ BG monitors) - and we all assume they're working fine. How often do we all check our BG monitor is actually reading correctly with control liquid? Your devices may not ever experience a problem, but that doesn't mean it will never happen...

Aug 4, 2013

davidcragg 17 posts

Topic: DAFNE Online Mobile / Can you download to a Blackberry

Although I'm an Android user and not a Blackberry developer, I am aware that Android apps can be "repackaged" using the Blackberry developer tools available here: http://developer.blackberry.com/android/tools/. Is that an option?

Aug 3, 2013

marke 686 posts

Topic: Site Development / Message Inbox

You can already share your diary with another user, the instructions for doing this are here

Aug 3, 2013

mum2westiesGill 502 posts

Topic: General Discussion / Increase of Lantus/BI

Thanks Garry for sharing your BG diary.

Here's the next few days of mine, also day 4 of the BI increase so maybe another 2 days to see if things have settled, somehow I don't think so Crying or Very sad

Aug 3, 2013

NuMo 28 posts

Topic: General Discussion / A bit of escapism - some fun

I hope that the recent publicity will help to highlight LADA (Latent Autoimmune Diabetes in Adults) as it is frequently overlooked and poorly understood.

It seems as if when a person above a certain age presents with diabetes associated symptoms they are automatically assumed to have type 2. If LADA was better understood, care could be more tailored to the person's needs more quickly.

I appreciate that the majority of mature people presenting with diabetes do indeed have type 2, but if there is a doubt a test would find type 1 tendencies. This would save years of unnecessary drugs, rising HBA1c levels and associated health problems. I speak from experience here.

Aug 2, 2013

Garry 328 posts

Topic: Site Development / Message Inbox

Would it be possible to add the facility to include diary entries when sending messages direct to one another using the Message Inbox?
Regards
Garry

Aug 2, 2013

Garry 328 posts

Topic: General Discussion / Increase of Lantus/BI

Gill. Here is my last 10 days. I am unable to include a BG Diary other than here. I'll ask if this facility can be added when creating a direct message through Message Inbox.
Regards
Garry

Aug 1, 2013

marke 686 posts

Topic: DAFNE Graduate Group (DGG) / DAFNE Collab 2013

A report on the DAFNE Collaborative held in Manchester on 14th June 2013 is available below. If you are wondering why it took so long to put it on the site, welcome to the wonderful world of the NHS, a couple of days to write then weeks and weeks to get approval for publication. Cest La Vie, hopefully it will be of interest to some of you !!

Once again the DUAG was present at the DAFNE Collaborative to bring you all the news and views of what is going on in the DAFNE Programme. For those that donâ€™t know what it is, the DAFNE Collaborative is the annual event at which representatives of all DAFNE Centres, gather to receive updates on audit and research. They also attend workshops to promote best practice. The DUAG which is the user representative body on the DAFNE programme are also invited to attend the meeting..
The first set of presentations for the day were about the research database and results that have been taken from it. The first two focused largely on the data collected and how it will be used to compare centres. This will provide a means to identify which centres/areas get the best results and then to look for patterns as to why. It was clear that the initial improvements in HbA1c are not fully maintained over the longer term. This is a major concern as one of the â€˜selling pointsâ€™ of DAFNE is improved HBA1c, of course there are many other factors and things that improve after doing DAFNE but there needs to be a way to identify these so that they can be measured. Another issue identified is how to get the HbA1c of more graduates after 1 year, everyone who goes on the course has an HbA1c test just before the course and in theory another test after 1 year, however itâ€™s much harder to arrange after a year. The final presentation in the set focused on the improvements in severe hypos and DKA, these are both dramatically reduced by doing DAFNE which could present both a cost saving to the NHS and an improved quality of life for the DAFNE graduate. These are areas that have not really been emphasised in the past as the focus was largely on reductions in HbA1c.
The next set of presentations were on the DAFNE HART pilot study. This was a 6 week, 1 day a week, study focused on restoring Hypo awareness based on DAFNE principles. One of the key aspects of the pilot was the psychology around hypoâ€™s, the 3 basic types of thinking about hypoâ€™s were identified and these types were highlighted during the course in an attempt to â€˜break the cycleâ€™ causing behaviours that stopped the changes needed to improve hypo awareness. The course helps participants make small changes over the length of the course and reinforces the changes to move participants in the right direction. Although this was just a pilot study with 24 participants the results showed a definite improvement in hypos and psychological measures. The last of this group of presentations was probably the most â€˜hard-hittingâ€™ of the day. It focused on the results of discussions with the partners and family members of those approached to attend the HART pilot i.e those people living with someone experiencing hypo unawareness. As a Diabetic it really made you think about what itâ€™s like to be on the â€˜outsideâ€™ of a hypo and it is not a pleasant experience. It was certainly a sobering and though provoking presentation.
The first workshops of the day then occurred. This related to the collection of data at one year refreshers and how to increase the number of graduates data was gathered about. This is crucial to DAFNE because without post-course data about graduates itâ€™s hard to show that the course really does have an effect on a graduates management of their diabetes. At many DAFNE Centres there is a large reduction in the number of graduates providing the data. A lot of discussion focused on how to address this and get the data needed.
Lunch was followed by the second workshop of the day. This focused on various studies, including the DUAGâ€™s, on what follow-up graduates wanted after the course. It seems there is quite a lot of variation in what various centres offer as follow-ups and refreshers, The ultimate conclusion of this workshop is itâ€™s still not clear what graduates want as follow-up and what the best methods of providing follow-up are. A number of options are being considered and some more research and studies will most likely be done to work out what should be offered as follow-up.
The final set of presentations focused on the results of various research studies. The first was on the DAFNE 5 x 1 day study, that was looking to compare the outcome of doing DAFNE over 5 weeks , 1 day a week rather than a 5 day course over 1 week. The result was that ultimately there is very little difference between the two courses in terms of results. The most interesting result was that in the study where you could randomly end up on either type of course all participants thought that their version of the course was the best regardless of the preference they expressed before the courses began. The second presentation looked at the type of background insulin recommended for use during and after the course and the correlation with outcomes of HbA1c. Ultimately it seems that those on twice daily background injections get better HbA1c results in the long term. The next presentation focused on people on pumps after doing DAFNE it showed that DAFNE reduced the need to go onto a pump by reducing HbA1C and the number of disabling Hypoâ€™s. Unfortunately due to train time bookings the end of this presentation and the last presentation on the next phase of DAFNE research was missed and will have to be reported when the information is released.

Aug 1, 2013

marke 686 posts

Topic: Questions for HCPs / Help

As Warwick points out the thing you have to understand is the effect of exercise. It has a number of effects both shortish term and longer term. The shortish is exercise can have an effect for 24-48 hours after you do it. It does vary from person to person but will definitely have an effect the day after you exercise. You need to bear this in mind when adjusting both pre-exercise and after it. There is not really a magic formula although the handbook does give some guidance.
In the longer term exercise will help your body in the process of converting sugar into energy with less insulin. Regular exercise should mean you need less insulin overall. Again there is no magic formula you just need to keep monitoring you BG and looking for changes. Your description of going low mid-morning the day after exercise is exactly my experience when doing a gym session the night before, however knowing what might happen I tended to check mid-morning the next day as well as making adjustments because I knew what might happen and so was ready to treat it if necessary.

Aug 7, 2013 Kittycat789 10 posts	Topic: General Discussion / receeding gums I only have one that is, i have an appointment on 27th so i will ask there and let you know on here what they say :-)

Aug 7, 2013 JayBee 587 posts	Topic: General Discussion / Insulin Pump Bug You generally find you have to do the same for your blood testing kit too... What a silly (could even say lazy) person. :/ Stay safe y'all.

Aug 7, 2013 davidcragg 17 posts	Topic: General Discussion / Insulin Pump Bug For a slightly more measured article on the issue, see http://www.bloomberg.com/news/2013-07-22/medical-device-hackers-find-government-ally-to-pressure-industry.html In his complaint to the FDA, Radcliffe claims his Animas pump inaccurately calculates the amount of insulin to dispense after the battery is changed. The pump does not automatically factor in the amount of insulin it dispensed immediately before the battery was removed, he said. That issue led to dosing errors that caused him to experience two low-blood-sugar episodes, which can be fatal, Radcliffe said. The pump is designed to reset insulin levels following a battery change, said Brian Levy, medical director at Animas. The patient's insulin history is still stored on the device, and instructions for recalibrating the machine are in the owner's manual, he said. The company does not plan to make any changes. Radcliffe said he's unsatisfied with the response and intends to push the company in public and private to fix the issue. Essentially it seems Radcliffe didn't follow the manufactures instructions correctly and thinks the user shouldn't have to do the recalibration step after changing the batteries. So in this case I would say it was more a case of user error than equipment malfunction, however I agree with you that checking your diabetes equipment is an important aspect to consider.

Aug 7, 2013 Plumcious 11 posts	Topic: General Discussion / receeding gums Hi Kittycat, My gums seem to be receding but it's been a problem for years so it's happening very slowly -- I didn't realise it could be diabetes related til I saw your message and I've just looked it up on www.diabetes.co.uk My dentists have always said use a soft/sensitive brush and gently stroke downwards from gum to the biting edge. One once said to "scrub" or brush ulcers hard - this led to me losing a lot of gum over one tooth when I did it. I hope other people reply - or have you tried phoning Diabetes UK - here's a link to their dental advice http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/Other_associated_conditions/Dental-health/ It might be worth asking your GP or Consultant for advice... Sorry none of this is conclusive - I'm sharing!

Aug 7, 2013 Adrienne 14 posts	Topic: General Discussion / Advice welcomed! Hi Garry, Yes that entry should have been for BI. My BI is Lantus, split dose because it wasn't lasting the full 24 hrs. I increased the dose this morning to 11 so I'll see how it's looking in a couple of days. Thanks

Aug 6, 2013 marke 686 posts	Topic: General Discussion / Insulin Pump Bug Yes, but the article does not provide any details of what actually happened, it sensationalises the issue without providing any real details. All medical devices do go through a lot of testing and its hard to believe as you say they did not test for this, Without all the facts its easy to look at the worst case scenario. As you say having an kind of technology doesn't move the responsibility away from the user to ensure correct operation. The article says HE mistakenly infused himself with the wrong dose, unless it gave a completely wrong BG reading why did he do this ? It makes no mention of this.

Aug 6, 2013 Garry 328 posts	Topic: General Discussion / Advice welcomed! Take it that entry 03/08 18:40 should read BI 8? Looking from afar, the majority of your entries are in the red. Personally speaking, I always see that as BI adjustment needed. If you need make lots of + compensation doses...that seems to say that BI needs upping. What BI do you use? Regards Garry

Aug 6, 2013 Adrienne 14 posts	Topic: General Discussion / Advice welcomed! I'm struggling to keep my readings in the green and was wondering whether anyone could offer me any advice please. I've been doing different ratios on the weekends because I'm more active then. I'm not sure about my lunch ratio during the week and also my morning lantus dose. I did a carb free lunch on 1/8 which showed that my BI needs increasing but I guess I've been reluctant to do this. Also I thought it might be possible my high reading after the carb free lunch was due to a hypo reaction so my BI doses are still 10 (am) and 8 (pm). I do take my BI at the same time (8am and 8pm) even though my diary may say otherwise. Any help would be greatly appreciated, thanks :-)

Aug 5, 2013 Kittycat789 10 posts	Topic: General Discussion / receeding gums Hi just wandering he anyone else has suffered complication with gums from diabetes? And do you know if we can get help with this from specialist as my dentist sent me away advising me to buy corsodyl mouthwash don't think its helping

Aug 5, 2013 Garry 328 posts	Topic: General Discussion / Increase of Lantus/BI What happened Sunday Gill. Where did the morning go? 9.2 Sunday night and you list 3.5 CP. Your comment seems to suggest you consumed 2 x 1.7 CPs. But you take no QA and no BI. There must be info missing as how did you get to 3.4 BG at 08:18? Difficult to comment rationally without all necessary information. Take your time and wait to see a distinct pattern emerging. Once you are sure, you can confidently make needed changes. Don't rush. We are all individuals and I think others have talked of Lantus changes taking longer for them to be sure about the outcome. I think an unbalanced split BI may help you overcome your morning hypos and help you flatten out your food intake pattern. Regards Garry

Aug 5, 2013 mum2westiesGill 502 posts	Topic: General Discussion / Increase of Lantus/BI So up to day 6 of the BI increase so have now had 3 days to let things settle, and 3 days to see the full effect - what does anyone think?

Aug 5, 2013 mum2westiesGill 502 posts	Topic: General Discussion / Increase of Lantus/BI Your corrections can just be listed as 07:14 2.5, 07:31 1.5 and 10:12 1.5. - These weren't corrections they were the amount of carbs I'd had for the hypos (jelly babies) Any thoughts about having breakfast earlier? - I don't really do breakfast until about 10am ish Cheers Gill

Aug 5, 2013 Garry 328 posts	Topic: General Discussion / Increase of Lantus/BI Your corrections can just be listed as 07:14 2.5, 07:31 1.5 and 10:12 1.5. Any thoughts about having breakfast earlier? Your BI is of course working throughout this early daytime. Regards Garry

Aug 5, 2013 Garry 328 posts	Topic: Site Development / Message Inbox Already do that marke with the HCPs at the hospital...but I would prefer not to share my whole diary in a more open forum. The format below, with it's restricted date range, gives the opportunity to focus in and perhaps emphasise points to others. Regards Garry

Aug 5, 2013 Yorky 1 post	Topic: General Discussion / Insulin Pump Bug G'day All, As an IT geek, I know the possibility of "bugs" in software is always present (especially as I get paid to find them!) The article below is from a security website: http://www.scmagazine.com.au/News/352073,diabetic-researcher-finds-insulin-pump-memory-glitch-that-almost-killed-him.aspx?eid=7&edate=20130805&utm_source=20130805&utm_medium=newsletter&utm_campaign=daily_newsletter The big concern is this type of bug should have been tested for, as changing batteries is a basic user function of the device. I guess the moral of the story is check, double-check, and just to be safe, check again. We all put our faith in devices (pumps/ BG monitors) - and we all assume they're working fine. How often do we all check our BG monitor is actually reading correctly with control liquid? Your devices may not ever experience a problem, but that doesn't mean it will never happen...

Aug 4, 2013 davidcragg 17 posts	Topic: DAFNE Online Mobile / Can you download to a Blackberry Although I'm an Android user and not a Blackberry developer, I am aware that Android apps can be "repackaged" using the Blackberry developer tools available here: http://developer.blackberry.com/android/tools/. Is that an option?

Aug 3, 2013 marke 686 posts	Topic: Site Development / Message Inbox You can already share your diary with another user, the instructions for doing this are here

Aug 3, 2013 mum2westiesGill 502 posts	Topic: General Discussion / Increase of Lantus/BI Thanks Garry for sharing your BG diary. Here's the next few days of mine, also day 4 of the BI increase so maybe another 2 days to see if things have settled, somehow I don't think so

Aug 3, 2013 NuMo 28 posts	Topic: General Discussion / A bit of escapism - some fun I hope that the recent publicity will help to highlight LADA (Latent Autoimmune Diabetes in Adults) as it is frequently overlooked and poorly understood. It seems as if when a person above a certain age presents with diabetes associated symptoms they are automatically assumed to have type 2. If LADA was better understood, care could be more tailored to the person's needs more quickly. I appreciate that the majority of mature people presenting with diabetes do indeed have type 2, but if there is a doubt a test would find type 1 tendencies. This would save years of unnecessary drugs, rising HBA1c levels and associated health problems. I speak from experience here.

Aug 2, 2013 Garry 328 posts	Topic: Site Development / Message Inbox Would it be possible to add the facility to include diary entries when sending messages direct to one another using the Message Inbox? Regards Garry

Aug 2, 2013 Garry 328 posts	Topic: General Discussion / Increase of Lantus/BI Gill. Here is my last 10 days. I am unable to include a BG Diary other than here. I'll ask if this facility can be added when creating a direct message through Message Inbox. Regards Garry

Aug 1, 2013 marke 686 posts	Topic: DAFNE Graduate Group (DGG) / DAFNE Collab 2013 A report on the DAFNE Collaborative held in Manchester on 14th June 2013 is available below. If you are wondering why it took so long to put it on the site, welcome to the wonderful world of the NHS, a couple of days to write then weeks and weeks to get approval for publication. Cest La Vie, hopefully it will be of interest to some of you !! Once again the DUAG was present at the DAFNE Collaborative to bring you all the news and views of what is going on in the DAFNE Programme. For those that donâ€™t know what it is, the DAFNE Collaborative is the annual event at which representatives of all DAFNE Centres, gather to receive updates on audit and research. They also attend workshops to promote best practice. The DUAG which is the user representative body on the DAFNE programme are also invited to attend the meeting.. The first set of presentations for the day were about the research database and results that have been taken from it. The first two focused largely on the data collected and how it will be used to compare centres. This will provide a means to identify which centres/areas get the best results and then to look for patterns as to why. It was clear that the initial improvements in HbA1c are not fully maintained over the longer term. This is a major concern as one of the â€˜selling pointsâ€™ of DAFNE is improved HBA1c, of course there are many other factors and things that improve after doing DAFNE but there needs to be a way to identify these so that they can be measured. Another issue identified is how to get the HbA1c of more graduates after 1 year, everyone who goes on the course has an HbA1c test just before the course and in theory another test after 1 year, however itâ€™s much harder to arrange after a year. The final presentation in the set focused on the improvements in severe hypos and DKA, these are both dramatically reduced by doing DAFNE which could present both a cost saving to the NHS and an improved quality of life for the DAFNE graduate. These are areas that have not really been emphasised in the past as the focus was largely on reductions in HbA1c. The next set of presentations were on the DAFNE HART pilot study. This was a 6 week, 1 day a week, study focused on restoring Hypo awareness based on DAFNE principles. One of the key aspects of the pilot was the psychology around hypoâ€™s, the 3 basic types of thinking about hypoâ€™s were identified and these types were highlighted during the course in an attempt to â€˜break the cycleâ€™ causing behaviours that stopped the changes needed to improve hypo awareness. The course helps participants make small changes over the length of the course and reinforces the changes to move participants in the right direction. Although this was just a pilot study with 24 participants the results showed a definite improvement in hypos and psychological measures. The last of this group of presentations was probably the most â€˜hard-hittingâ€™ of the day. It focused on the results of discussions with the partners and family members of those approached to attend the HART pilot i.e those people living with someone experiencing hypo unawareness. As a Diabetic it really made you think about what itâ€™s like to be on the â€˜outsideâ€™ of a hypo and it is not a pleasant experience. It was certainly a sobering and though provoking presentation. The first workshops of the day then occurred. This related to the collection of data at one year refreshers and how to increase the number of graduates data was gathered about. This is crucial to DAFNE because without post-course data about graduates itâ€™s hard to show that the course really does have an effect on a graduates management of their diabetes. At many DAFNE Centres there is a large reduction in the number of graduates providing the data. A lot of discussion focused on how to address this and get the data needed. Lunch was followed by the second workshop of the day. This focused on various studies, including the DUAGâ€™s, on what follow-up graduates wanted after the course. It seems there is quite a lot of variation in what various centres offer as follow-ups and refreshers, The ultimate conclusion of this workshop is itâ€™s still not clear what graduates want as follow-up and what the best methods of providing follow-up are. A number of options are being considered and some more research and studies will most likely be done to work out what should be offered as follow-up. The final set of presentations focused on the results of various research studies. The first was on the DAFNE 5 x 1 day study, that was looking to compare the outcome of doing DAFNE over 5 weeks , 1 day a week rather than a 5 day course over 1 week. The result was that ultimately there is very little difference between the two courses in terms of results. The most interesting result was that in the study where you could randomly end up on either type of course all participants thought that their version of the course was the best regardless of the preference they expressed before the courses began. The second presentation looked at the type of background insulin recommended for use during and after the course and the correlation with outcomes of HbA1c. Ultimately it seems that those on twice daily background injections get better HbA1c results in the long term. The next presentation focused on people on pumps after doing DAFNE it showed that DAFNE reduced the need to go onto a pump by reducing HbA1C and the number of disabling Hypoâ€™s. Unfortunately due to train time bookings the end of this presentation and the last presentation on the next phase of DAFNE research was missed and will have to be reported when the information is released.

Aug 1, 2013 marke 686 posts	Topic: Questions for HCPs / Help As Warwick points out the thing you have to understand is the effect of exercise. It has a number of effects both shortish term and longer term. The shortish is exercise can have an effect for 24-48 hours after you do it. It does vary from person to person but will definitely have an effect the day after you exercise. You need to bear this in mind when adjusting both pre-exercise and after it. There is not really a magic formula although the handbook does give some guidance. In the longer term exercise will help your body in the process of converting sugar into energy with less insulin. Regular exercise should mean you need less insulin overall. Again there is no magic formula you just need to keep monitoring you BG and looking for changes. Your description of going low mid-morning the day after exercise is exactly my experience when doing a gym session the night before, however knowing what might happen I tended to check mid-morning the next day as well as making adjustments because I knew what might happen and so was ready to treat it if necessary.