Recent Posts - DAFNE Online

Jun 16, 2011

JayBee 587 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

Welshmapleleaf said:
But on the other hand, Lantus IS apparently better for you....

International clinical studies have confirmed the advantages of insulin glargine in the treatment of heavy hypoglycaemia compared to standard NPH insulin. Insulin glargine reduces the risk of severe nocturnal hypoglycaemia.

I find this bit particularly interesting because I chose to change to Levemir because I was suffering from hypos a lot more on Lantus!

I don't know about the whole Hypo arguement, but considering the more up to date insulins work a lot more effiently in comparison to the older types (in terms of timing - particularly how long it takes for them to start working and how long they last for), it does make sense to move on from them.

Edit: Almost feels like the hypo arguement is just them looking for excuses to me... I mean, hypos can be influenced by so many different life effects not just insulin alone.

Jun 16, 2011

Brum_Taffy 13 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

Thanks for those last 2 posts- I'm aware there is scant 'hard' evidence in this area.
Personal experiences and anecdote/stories are what I am keen to hear.

It's an area where cost:benefit is not easy to calculate. I suspect the traditional way of calculating this (quality adjusted life years) does not do justice to issues like fear of hypoglycaemia and confidence in your medicines/treatment plan.
DAFNE originally had higher target ranges, especially overnight, because of greater worry about hypos with older insulins. I'm hoping DAFNE data will tell us if there is any difference in the experiences of people on analogs vs. human insulin.

Please keep the stories and experiences coming! Smile

Jun 16, 2011

JayBee 587 posts

Topic: General Discussion / Carbs v Cals

I agree! I don't see veganism as a diet either because it's more based on how you want to live, rather than something you're doing just to "lose weight only" like a lot of diets are. Temporary food courses are not a good way to go if you want long term benefits. I find it absolutely amazing/horrifying what some of these diets suggest you do! Sad

This is now reminding me of my partner. He's Pescetarian because he just simply hates the taste of all meat! ^_^; Considering I'm happy to eat most stuff, I don't know what I am... omnivore of some kind? lol.

It's like with DAFNE this weight loss stuff really, it's very easy to get frustrated when you're trying so very hard to get results as quick as you can. Sad

Jun 16, 2011

Welshmapleleaf 19 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

But on the other hand, Lantus IS apparently better for you....

International clinical studies have confirmed the advantages of insulin glargine in the treatment of heavy hypoglycaemia compared to standard NPH insulin. Insulin glargine reduces the risk of severe nocturnal hypoglycaemia. Extensive clinical studies (ACCORD) have confirmed the higher risk of mortality with higher incidence of severe hypoglycaemia.[3][4] A comparison trial of insulin detemir and glargine proved that subjects randomized to detemir used slightly higher daily insulin doses, but gained less weight on average than glargine-treated subjects.[5] Other systematic reviews corroborate the results of benefit of insulin glargine regarding lower incidence of severe hypoglycaemia.[6]

On June 13, 2009, Diabetologia, the journal of European Association for the Study of Diabetes (EASD), published the results of a 5 year long-term observational, retrospective analysis. During the study no other safety issues, such as unexpected adverse events for either insulin emerged. However, insulin glargine was associated with a lower incidence of severe hypoglycaemia compared with NPH insulin.

I guess there's two sides to every argument and you can make it fit your own standpoint. Personally, I think that analogues were developed as a result of a progression in Diabetic research, and I for one would prefer the latest available drugs that treat my disease.

Jun 16, 2011

Welshmapleleaf 19 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

Found this on Wikipedia re Analogue Insulins......

'A meta-analysis of numerous randomized controlled trials by the international Cochrane Collaboration found "only a minor clinical benefit of treatment with long-acting insulin analogues (including two studies of insulin detemir) for patients with diabetes mellitus type 2"[6] while others have examined the same issue in type 1 diabetes. Subsequent meta-analyses undertaken in a number of countries and continents have confirmed Cochrane's findings.

In July 2007, Germany's Institute for Quality and Cost Effectiveness in the Health Care Sector (IQWiG) reached a strikingly similar conclusion. In its report, IQWiG concluded that there is currently "no evidence" available of the superiority of rapid-acting insulin analogs over synthetic human insulins in the treatment of adult patients with type 1 diabetes. Many of the studies reviewed by IQWiG were either too small to be considered statistically reliable and, perhaps most significantly, none of the studies included in their widespread review were blinded, the gold-standard methodology for conducting clinical research. However, IQWiG's terms of reference explicitly disregard any issues which cannot be tested in double-blind studies, for example a comparison of radically different treatment regimes. IQWiG is regarded with skepticism by some doctors in Germany, being seen merely as a mechanism to reduce costs. But the lack of study blinding does increase the risk of bias in these studies. The reason this is important is because patients, if they know they are using a different type of insulin, might behave differently (such as testing blood glucose levels more frequently, for example), which leads to bias in the study results, rendering the results inapplicable to the diabetes population at large. Numerous studies have concluded that any increase in testing of blood glucose levels is likely to yield improvements in glycemic control, which raises questions as to whether any improvements observed in the clinical trials for insulin analogues were the result of more frequent testing or due the drug undergoing trials.

More recently, the Canadian Agency for Drugs and Technology in Health (CADTH) found in its 2008 comparison of the effects of insulin analogues and biosynthetic human insulin that insulin analogues failed to show any clinically relevant differences, both in terms of glycemic control and adverse reaction profile'

Jun 16, 2011

JayBee 587 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

I haven't a clue for the first question lol. Smile

Brum_Taffy said:
2. do people with type 1 diabetes generally believe/feel they get extra benefits with modern analogues, compared to older human and/or animal insulins? What is your experience?

With the lack of education I had when I was on Humalin I before DAFNE, it is difficult for me to compare it now. Sad

That was a very very long time ago.

With how well Lantus and Levemir respond though in comparison to some of the results I've seen from other diabetics on this forum, I feel that it would be a good thing to move on from the older insulins because they don't seem to perform as well as more up to date insulins (which makes sense really).

The key thing that gets in the way of this logic is knowing that if someone has found something works for them, then they do - no, should - have the right to stick at it if they want to.

3. If someone tried to take away your 'Daz' and give you 2 packets of another soap powder, how would you react? How important is choice of insulin to you?

Freedom is very important to me. I would not be a happy bunny if my medication was changed just because it suited the funds better now. I have changed insulin at least once since starting DAFNE (changed from Lantus to Levemir). It was not a straight forward change for my condition's control but very worthwhile - but it was a choice I made, not something that was forced on me.

As for soap stuff... well, I'd give it a go lol. That example just doesn't compare well really for me. ;)

Jun 16, 2011

Brum_Taffy 13 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

I guess they should be public. As it is a gov agenda such plans could be said to be 'only following orders'.
Which PCT do you come under?

On my patch (west of Brum) I have heard rumblings that restrictions may be coming, but have seen no documents to that effect. I have taken the view it is better not to ask, in case this moves into the cross-hairs!

Jun 16, 2011

chrisinbrum 41 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

Are PCT QIPP plans publically available documents or would you need a freedom of information request to get hold of them and check what's going on?

Jun 16, 2011

Brum_Taffy 13 posts

Topic: Questions for HCPs / Newer Insulins under pressure from QIPP

A government programme aimed at cutting costs (Quality Innovation Prevention and Productivity, or QIPP) means that many PCTs and commissioners are scrutinising the use of insulin analogues.

In particular, the use of Lantus in type 2 diabetes is under the microscope- the suggestion is that professionals should use older, cheaper long-acting insulin and then only switch to the more expensive choice if/when people get hypoglycaemia.

This could have knock on effects for people with type 1 diabetes- we know not all 1e care teams think differently in type 1 vs type 2!

I've observed published safe DAFNE target levels coming down over the years, I believe because modern analog insulins are more 'predictable' [some may say as predictable as a teenager, rather than old NPH being as predictable as a toddler Surprised

].

My questions are:

1. is there research evidence of an improved safety record for analogues compared with old NPH/soluble insulins, from the DAFNE database? [one for DAFNE top brass!]
2. do people with type 1 diabetes generally believe/feel they get extra benefits with modern analogues, compared to older human and/or animal insulins? What is your experience?
3. If someone tried to take away your 'Daz' and give you 2 packets of another soap powder, how would you react? How important is choice of insulin to you? Cool

Each PCT has a QIPP programme- attacking analog insulins may not feature in them all, but if you have had your choice of insulin questioned, it would be interesting to hear about it.

Ta Smile

Jun 16, 2011

Michaela 13 posts

Topic: General Discussion / Carbs v Cals

All very sensible JWO. For me veganism isn't a diet like say low-carb was. It was a little bit of a lifestyle change but actually it hasn't changed much except what I eat and how I feel. Which is the important part. It seems to fit in with my lifestyle so far. And because I am not doing it as die-hard as people who might do it for the animal reasons I am a little bit more flexible.

However, I do stick to the principles as much as possible because I do actually believe that there is too much industrialisation, environmental damage and cruelty in our food production these days. Even though it wasn't my main reason for going vegan. That was to help my health. The weight loss is an added bonus. I don't see it as a diet at all. It's a 'way of eating' and as I've said before I am not deprived.

I have a much healthier relationship with food in general than I did many years ago and it's because of the right mindset I am able to do it without it being a chore or difficult for me. If you have food issues any change is going to cause you problems.

Jun 16, 2011

novorapidboi26 1,819 posts

Topic: Questions for HCPs / DAFNE and Retinopathy

I hope so too.......

Well explained Simon.....

Jun 16, 2011

Welshmapleleaf 19 posts

Topic: Questions for HCPs / DAFNE and Retinopathy

Thanks Simon. It's almost a week sice I graduated, and although I can't say all my readings are within target yet, they will most certainly be lower than pre-DAFNE, hence my concerns. Hopefully in the longer term, sticking to DAFNE principles will preclude the need for further treatment. Very Happy

Jun 16, 2011

novorapidboi26 1,819 posts

Topic: Carbohydrate Counting / Jacket Potato

I thought the OP was having problems with hypos early on after eating one............as opposed to counting the CPs, thats the easy part..... Smile

Jun 16, 2011

Simon Heller 46 posts

Topic: Questions for HCPs / DAFNE and Retinopathy

Diabetic eye disease may worsen temporarily if someone improves their blood glucose control dramatically over a short time period. It is probably because high blood glucoses tend to lead to increased blood flow to various part of the body. Since improving control will result in reduced blood flow (a good thing in the longterm) this reduced oxygen delivery and so the affected area loses oxygen which can aggravate diabetes eye trouble. So if you have eye changes to start with they can get worse. By 12 months the good effect is outweighing the short-term bad effect. So the message is that it only affects people who already have significant changes and by 12 months the worsening effect has worn off and the trend towards progressive changes can be reduced or perhaps even reversed.
ATB
Simon

Jun 16, 2011

Simon Heller 46 posts

Topic: Questions for HCPs / Metformin /Type 1

The evidence that metformin makes a difference in Type 1 diabetes is not strong but some professionals use it to reduce insulin dose, weight gain etc There is some evidence of benefit for PCOS. It appears to be very safe but with some pretty unpleasant side effects of diarrhoea, abdo pain and anorexia for some people! The slow release preparation is better tolerated generally.
Simon

Jun 16, 2011

Garry 328 posts

Topic: Questions for HCPs / Metformin /Type 1

Don't get me wrong, Metformin hasn't had any laxative effect on me. But they do have another pretty common side effect.....they are nicknamed 'Metfartin' for good reason.
Regards
Garry

Jun 16, 2011

Karen Westwood 38 posts

Topic: Carbohydrate Counting / Jacket Potato

I agree with JWo on this one. Had the same problems with jacket spuds and asked at my DAFNE refresher course. I was told to weigh the potato raw and work out the carbs from that weight. This has worked for me since.

Good luck Smile

Karen x

Jun 16, 2011

novorapidboi26 1,819 posts

Topic: General Discussion / Great

Cooked weight would only apply if you were only have some,of what is there......so weighing the amount of fried rice from the Chinese your going to have for example.........

I always have the full amount so unlocked weights also suit me....

Jun 15, 2011

AllanR 15 posts

Topic: Carbohydrate Counting / Jacket Potato

Basically just going to keep on doing as at the beginning....half the normal dose for it, and anything need fixing, fix it later. Seems to work fine so far really with very little fixing needed. Not a perfect fix, but a good enough one which works for me and you don't have a set of scales when your in town getting lunch.

Jun 15, 2011

Linda S123 8 posts

Topic: Questions for HCPs / Metformin /Type 1

Wow ! Im beginning to think that the reason it is used for weight loss is because nothing stays inside for long enough !!! The weight loss side would be of benefit, but Insulin resistance has been suggested as I have been IDD for coming up for 40 years and have highs where I shouldnt have. I appear to have the dawn phenomenon around lunch ( always was a late starter ! )

Jun 15, 2011

JayBee 587 posts

Topic: Carbohydrate Counting / Jacket Potato

Have either of you actually looked at weighing the spud raw and going on that like Carolin was saying?
I have and it works out great for me. No problem (even eating the jacket to make sure). Why are you over complicating it?

Jun 15, 2011

JayBee 587 posts

Topic: General Discussion / Great

We are not talking about the CPs changing - it's the weight that is changing due to the water absorption (or loss)!

If you usually cannot weigh stuff like pasta or rice before cooking then you're going to be looking at risk every time. I've found cooked weight to be so very unreliable so I always trust the uncooked weight. You just don't know how much the water it was cooked in is effecting the weight so it is a risk every time. This is why so many have so much trouble with these foods!

In another discussion about jacket potatoes in particular on this forum (Please take particular note of what Carolin the HCP says), they are also something to be wary of because they're not processed before hand.... therefore, when the water content changes when it's prepared in whatever way it is, you just cannot rely on the idea that it will be the same every time after cooking. Best to weigh it before cooking to get the more reliable CP total.

On the note of already processed stuff - like a microwavable pasta meal - I would believe the labelling on the packaging personally because it's likely that the water has already been sorted out for you.

Jun 15, 2011

JayBee 587 posts

Topic: General Discussion / Carbs v Cals

Sorry, I wasn't able to add the links earlier... I remembered wrong - it was how active fat can cause Type 2 diabetes... Here's a link to the clip I meant (From Diabetes UK). When I watched all four episodes, it was just frightening to see it in action. Sad

I think when you try to apply life style changes, you really have to work out what is best for you as an individual. I do have suggestions but most of them are summarised by simply remembering "small goals work towards the main goal". You do not have to cut anything completely out of your life (unless it's stuff like smoking of course) - you just have to remember that moderation is key (even for things like exercise - as I learnt while trying to do push ups with no prior training! I do not recommend this lol, start with wall pushes definitely lol). ^_^;

Jun 15, 2011

dafne-dude 11 posts

Topic: General Discussion / Advice if possible.

Hi Deanna,
Yeah i've noticed some changes in my ratio but only at breakfast and only at the w/end normally i'am 1:1 ratio for all meals but just recently i've had to up that to a 1:2 for breakfast but like i say only at w/ends?? it's weird...

When you say burning- do you mean while injecting or after?? i've noticed some injections sting a little more than others...

Jun 16, 2011 JayBee 587 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Welshmapleleaf said: But on the other hand, Lantus IS apparently better for you.... International clinical studies have confirmed the advantages of insulin glargine in the treatment of heavy hypoglycaemia compared to standard NPH insulin. Insulin glargine reduces the risk of severe nocturnal hypoglycaemia. I find this bit particularly interesting because I chose to change to Levemir because I was suffering from hypos a lot more on Lantus! I don't know about the whole Hypo arguement, but considering the more up to date insulins work a lot more effiently in comparison to the older types (in terms of timing - particularly how long it takes for them to start working and how long they last for), it does make sense to move on from them. Edit: Almost feels like the hypo arguement is just them looking for excuses to me... I mean, hypos can be influenced by so many different life effects not just insulin alone.

Jun 16, 2011 Brum_Taffy 13 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Thanks for those last 2 posts- I'm aware there is scant 'hard' evidence in this area. Personal experiences and anecdote/stories are what I am keen to hear. It's an area where cost:benefit is not easy to calculate. I suspect the traditional way of calculating this (quality adjusted life years) does not do justice to issues like fear of hypoglycaemia and confidence in your medicines/treatment plan. DAFNE originally had higher target ranges, especially overnight, because of greater worry about hypos with older insulins. I'm hoping DAFNE data will tell us if there is any difference in the experiences of people on analogs vs. human insulin. Please keep the stories and experiences coming!

Jun 16, 2011 JayBee 587 posts	Topic: General Discussion / Carbs v Cals I agree! I don't see veganism as a diet either because it's more based on how you want to live, rather than something you're doing just to "lose weight only" like a lot of diets are. Temporary food courses are not a good way to go if you want long term benefits. I find it absolutely amazing/horrifying what some of these diets suggest you do! This is now reminding me of my partner. He's Pescetarian because he just simply hates the taste of all meat! ^_^; Considering I'm happy to eat most stuff, I don't know what I am... omnivore of some kind? lol. It's like with DAFNE this weight loss stuff really, it's very easy to get frustrated when you're trying so very hard to get results as quick as you can.

Jun 16, 2011 Welshmapleleaf 19 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP But on the other hand, Lantus IS apparently better for you.... International clinical studies have confirmed the advantages of insulin glargine in the treatment of heavy hypoglycaemia compared to standard NPH insulin. Insulin glargine reduces the risk of severe nocturnal hypoglycaemia. Extensive clinical studies (ACCORD) have confirmed the higher risk of mortality with higher incidence of severe hypoglycaemia.[3][4] A comparison trial of insulin detemir and glargine proved that subjects randomized to detemir used slightly higher daily insulin doses, but gained less weight on average than glargine-treated subjects.[5] Other systematic reviews corroborate the results of benefit of insulin glargine regarding lower incidence of severe hypoglycaemia.[6] On June 13, 2009, Diabetologia, the journal of European Association for the Study of Diabetes (EASD), published the results of a 5 year long-term observational, retrospective analysis. During the study no other safety issues, such as unexpected adverse events for either insulin emerged. However, insulin glargine was associated with a lower incidence of severe hypoglycaemia compared with NPH insulin. I guess there's two sides to every argument and you can make it fit your own standpoint. Personally, I think that analogues were developed as a result of a progression in Diabetic research, and I for one would prefer the latest available drugs that treat my disease.

Jun 16, 2011 Welshmapleleaf 19 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Found this on Wikipedia re Analogue Insulins...... 'A meta-analysis of numerous randomized controlled trials by the international Cochrane Collaboration found "only a minor clinical benefit of treatment with long-acting insulin analogues (including two studies of insulin detemir) for patients with diabetes mellitus type 2"[6] while others have examined the same issue in type 1 diabetes. Subsequent meta-analyses undertaken in a number of countries and continents have confirmed Cochrane's findings. In July 2007, Germany's Institute for Quality and Cost Effectiveness in the Health Care Sector (IQWiG) reached a strikingly similar conclusion. In its report, IQWiG concluded that there is currently "no evidence" available of the superiority of rapid-acting insulin analogs over synthetic human insulins in the treatment of adult patients with type 1 diabetes. Many of the studies reviewed by IQWiG were either too small to be considered statistically reliable and, perhaps most significantly, none of the studies included in their widespread review were blinded, the gold-standard methodology for conducting clinical research. However, IQWiG's terms of reference explicitly disregard any issues which cannot be tested in double-blind studies, for example a comparison of radically different treatment regimes. IQWiG is regarded with skepticism by some doctors in Germany, being seen merely as a mechanism to reduce costs. But the lack of study blinding does increase the risk of bias in these studies. The reason this is important is because patients, if they know they are using a different type of insulin, might behave differently (such as testing blood glucose levels more frequently, for example), which leads to bias in the study results, rendering the results inapplicable to the diabetes population at large. Numerous studies have concluded that any increase in testing of blood glucose levels is likely to yield improvements in glycemic control, which raises questions as to whether any improvements observed in the clinical trials for insulin analogues were the result of more frequent testing or due the drug undergoing trials. More recently, the Canadian Agency for Drugs and Technology in Health (CADTH) found in its 2008 comparison of the effects of insulin analogues and biosynthetic human insulin that insulin analogues failed to show any clinically relevant differences, both in terms of glycemic control and adverse reaction profile'

Jun 16, 2011 JayBee 587 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP I haven't a clue for the first question lol. Brum_Taffy said: 2. do people with type 1 diabetes generally believe/feel they get extra benefits with modern analogues, compared to older human and/or animal insulins? What is your experience? With the lack of education I had when I was on Humalin I before DAFNE, it is difficult for me to compare it now. That was a very very long time ago. With how well Lantus and Levemir respond though in comparison to some of the results I've seen from other diabetics on this forum, I feel that it would be a good thing to move on from the older insulins because they don't seem to perform as well as more up to date insulins (which makes sense really). The key thing that gets in the way of this logic is knowing that if someone has found something works for them, then they do - no, should - have the right to stick at it if they want to. 3. If someone tried to take away your 'Daz' and give you 2 packets of another soap powder, how would you react? How important is choice of insulin to you? Freedom is very important to me. I would not be a happy bunny if my medication was changed just because it suited the funds better now. I have changed insulin at least once since starting DAFNE (changed from Lantus to Levemir). It was not a straight forward change for my condition's control but very worthwhile - but it was a choice I made, not something that was forced on me. As for soap stuff... well, I'd give it a go lol. That example just doesn't compare well really for me. ;)

Jun 16, 2011 Brum_Taffy 13 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP I guess they should be public. As it is a gov agenda such plans could be said to be 'only following orders'. Which PCT do you come under? On my patch (west of Brum) I have heard rumblings that restrictions may be coming, but have seen no documents to that effect. I have taken the view it is better not to ask, in case this moves into the cross-hairs!

Jun 16, 2011 chrisinbrum 41 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Are PCT QIPP plans publically available documents or would you need a freedom of information request to get hold of them and check what's going on?

Jun 16, 2011 Brum_Taffy 13 posts	Topic: Questions for HCPs / Newer Insulins under pressure from QIPP A government programme aimed at cutting costs (Quality Innovation Prevention and Productivity, or QIPP) means that many PCTs and commissioners are scrutinising the use of insulin analogues. In particular, the use of Lantus in type 2 diabetes is under the microscope- the suggestion is that professionals should use older, cheaper long-acting insulin and then only switch to the more expensive choice if/when people get hypoglycaemia. This could have knock on effects for people with type 1 diabetes- we know not all 1e care teams think differently in type 1 vs type 2! I've observed published safe DAFNE target levels coming down over the years, I believe because modern analog insulins are more 'predictable' [some may say as predictable as a teenager, rather than old NPH being as predictable as a toddler ]. My questions are: 1. is there research evidence of an improved safety record for analogues compared with old NPH/soluble insulins, from the DAFNE database? [one for DAFNE top brass!] 2. do people with type 1 diabetes generally believe/feel they get extra benefits with modern analogues, compared to older human and/or animal insulins? What is your experience? 3. If someone tried to take away your 'Daz' and give you 2 packets of another soap powder, how would you react? How important is choice of insulin to you? Each PCT has a QIPP programme- attacking analog insulins may not feature in them all, but if you have had your choice of insulin questioned, it would be interesting to hear about it. Ta

Jun 16, 2011 Michaela 13 posts	Topic: General Discussion / Carbs v Cals All very sensible JWO. For me veganism isn't a diet like say low-carb was. It was a little bit of a lifestyle change but actually it hasn't changed much except what I eat and how I feel. Which is the important part. It seems to fit in with my lifestyle so far. And because I am not doing it as die-hard as people who might do it for the animal reasons I am a little bit more flexible. However, I do stick to the principles as much as possible because I do actually believe that there is too much industrialisation, environmental damage and cruelty in our food production these days. Even though it wasn't my main reason for going vegan. That was to help my health. The weight loss is an added bonus. I don't see it as a diet at all. It's a 'way of eating' and as I've said before I am not deprived. I have a much healthier relationship with food in general than I did many years ago and it's because of the right mindset I am able to do it without it being a chore or difficult for me. If you have food issues any change is going to cause you problems.

Jun 16, 2011 novorapidboi26 1,819 posts	Topic: Questions for HCPs / DAFNE and Retinopathy I hope so too....... Well explained Simon.....

Jun 16, 2011 Welshmapleleaf 19 posts	Topic: Questions for HCPs / DAFNE and Retinopathy Thanks Simon. It's almost a week sice I graduated, and although I can't say all my readings are within target yet, they will most certainly be lower than pre-DAFNE, hence my concerns. Hopefully in the longer term, sticking to DAFNE principles will preclude the need for further treatment.

Jun 16, 2011 novorapidboi26 1,819 posts	Topic: Carbohydrate Counting / Jacket Potato I thought the OP was having problems with hypos early on after eating one............as opposed to counting the CPs, thats the easy part.....

Jun 16, 2011 Simon Heller 46 posts	Topic: Questions for HCPs / DAFNE and Retinopathy Diabetic eye disease may worsen temporarily if someone improves their blood glucose control dramatically over a short time period. It is probably because high blood glucoses tend to lead to increased blood flow to various part of the body. Since improving control will result in reduced blood flow (a good thing in the longterm) this reduced oxygen delivery and so the affected area loses oxygen which can aggravate diabetes eye trouble. So if you have eye changes to start with they can get worse. By 12 months the good effect is outweighing the short-term bad effect. So the message is that it only affects people who already have significant changes and by 12 months the worsening effect has worn off and the trend towards progressive changes can be reduced or perhaps even reversed. ATB Simon

Jun 16, 2011 Simon Heller 46 posts	Topic: Questions for HCPs / Metformin /Type 1 The evidence that metformin makes a difference in Type 1 diabetes is not strong but some professionals use it to reduce insulin dose, weight gain etc There is some evidence of benefit for PCOS. It appears to be very safe but with some pretty unpleasant side effects of diarrhoea, abdo pain and anorexia for some people! The slow release preparation is better tolerated generally. Simon

Jun 16, 2011 Garry 328 posts	Topic: Questions for HCPs / Metformin /Type 1 Don't get me wrong, Metformin hasn't had any laxative effect on me. But they do have another pretty common side effect.....they are nicknamed 'Metfartin' for good reason. Regards Garry

Jun 16, 2011 Karen Westwood 38 posts	Topic: Carbohydrate Counting / Jacket Potato I agree with JWo on this one. Had the same problems with jacket spuds and asked at my DAFNE refresher course. I was told to weigh the potato raw and work out the carbs from that weight. This has worked for me since. Good luck Karen x

Jun 16, 2011 novorapidboi26 1,819 posts	Topic: General Discussion / Great Cooked weight would only apply if you were only have some,of what is there......so weighing the amount of fried rice from the Chinese your going to have for example......... I always have the full amount so unlocked weights also suit me....

Jun 15, 2011 AllanR 15 posts	Topic: Carbohydrate Counting / Jacket Potato Basically just going to keep on doing as at the beginning....half the normal dose for it, and anything need fixing, fix it later. Seems to work fine so far really with very little fixing needed. Not a perfect fix, but a good enough one which works for me and you don't have a set of scales when your in town getting lunch.

Jun 15, 2011 Linda S123 8 posts	Topic: Questions for HCPs / Metformin /Type 1 Wow ! Im beginning to think that the reason it is used for weight loss is because nothing stays inside for long enough !!! The weight loss side would be of benefit, but Insulin resistance has been suggested as I have been IDD for coming up for 40 years and have highs where I shouldnt have. I appear to have the dawn phenomenon around lunch ( always was a late starter ! )

Jun 15, 2011 JayBee 587 posts	Topic: Carbohydrate Counting / Jacket Potato Have either of you actually looked at weighing the spud raw and going on that like Carolin was saying? I have and it works out great for me. No problem (even eating the jacket to make sure). Why are you over complicating it?

Jun 15, 2011 JayBee 587 posts	Topic: General Discussion / Great We are not talking about the CPs changing - it's the weight that is changing due to the water absorption (or loss)! If you usually cannot weigh stuff like pasta or rice before cooking then you're going to be looking at risk every time. I've found cooked weight to be so very unreliable so I always trust the uncooked weight. You just don't know how much the water it was cooked in is effecting the weight so it is a risk every time. This is why so many have so much trouble with these foods! In another discussion about jacket potatoes in particular on this forum (Please take particular note of what Carolin the HCP says), they are also something to be wary of because they're not processed before hand.... therefore, when the water content changes when it's prepared in whatever way it is, you just cannot rely on the idea that it will be the same every time after cooking. Best to weigh it before cooking to get the more reliable CP total. On the note of already processed stuff - like a microwavable pasta meal - I would believe the labelling on the packaging personally because it's likely that the water has already been sorted out for you.

Jun 15, 2011 JayBee 587 posts	Topic: General Discussion / Carbs v Cals Sorry, I wasn't able to add the links earlier... I remembered wrong - it was how active fat can cause Type 2 diabetes... Here's a link to the clip I meant (From Diabetes UK). When I watched all four episodes, it was just frightening to see it in action. I think when you try to apply life style changes, you really have to work out what is best for you as an individual. I do have suggestions but most of them are summarised by simply remembering "small goals work towards the main goal". You do not have to cut anything completely out of your life (unless it's stuff like smoking of course) - you just have to remember that moderation is key (even for things like exercise - as I learnt while trying to do push ups with no prior training! I do not recommend this lol, start with wall pushes definitely lol). ^_^;

Jun 15, 2011 dafne-dude 11 posts	Topic: General Discussion / Advice if possible. Hi Deanna, Yeah i've noticed some changes in my ratio but only at breakfast and only at the w/end normally i'am 1:1 ratio for all meals but just recently i've had to up that to a 1:2 for breakfast but like i say only at w/ends?? it's weird... When you say burning- do you mean while injecting or after?? i've noticed some injections sting a little more than others...