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Feb 18, 2011
JayBee
587 posts
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Topic: General Discussion / DAFNE news on Twitter ..and now Google Plus! Personally, I hoped to see general news articles relating to DAFNE, success stories from DAFNE diabetics... that sort of thing. People's thoughts of "what is DAFNE?" and the like as well - to emphasize on how worthwhile it is.Knowing what restrictions are exercised here when it comes to DAFNE guidelines, I don't think it'll be a suitable medium for overall advice giving. It's too risky for that side of things - so a more general news feed seemed the better idea. If anyone does ask for advice, I think we could however direct them to this forum or advise they speak to their DAFNE team possibly. I know we'd also be able to take advantage of re-tweeting from other diabetic streams as well - such as @DiabetesUK for example. Obviously, the maintainer would need to check the article before re-tweeting to make sure it's not misleading. Hopefully this would then lead to more interest being developed and it slowly maintaining itself... perhaps. Thanks for posting your thoughts everyone. Half tempted to just give it a go and see what happens (though what username to use? Just "DAFNE" to keep it short?)!  Edit: Nope, DAFNE is taken. DAFNEnews? |
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Feb 18, 2011
marke
686 posts
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Topic: General Discussion / DAFNE Research News The following article has been sent to us by the DAFNE Research programme. It contains all the developments in DAFNE. It is important to undertstand that this is research so the trials detailed below might never be rolled out nationwide. It does however show that things like 5 x 1 day courses verses 5day courses are being considered. Some of it is a bit 'technical', so if you have any questions let us know and we will try to get them answered. DAFNE Research Update January 2011 The DAFNE Collaborative is committed to the continued improvement and development of DAFNE through Research and Development. The DAFNE programme provides a unique test-bed to conduct research not only to improve Type 1 diabetes management but also to learn more about educational interventions in diabetes and long-term conditions more generally. The DAFNE Research group are currently involved in 3 research programmes: 1. National Institute for Health Research Grant The £1.7 million research grant will fund a varied programme of research (A to F below) over a 5 year period, which will be underpinned by economic analyses to establish its cost effectiveness. 1A Research Database Further development of the DAFNE web-based database to examine the relationship between biomedical and psychosocial outcomes. We will record important health events to calculate cost-effectiveness. Update: Recruitment is ongoing until September 2011. Pre course data has been entered for the 1081 participants recruited to date and one year post course follow up data collection for 404 patients so far. Research investigators are already planning and developing protocols for the utilisation of this data to answer a range of questions regarding the impact of DAFNE. We are now actively encouraging DAFNE researchers to make use of the valuable data resource held within the DAFNE Research Database. It is anticipated that the publications using the data will commence in 2011. There will be an oral presentation on the Research Database at the Diabetes UK Annual Professional Conference 2011. 1B Mixed methods study Undertake a combined quantitative and qualitative approach to understand factors which facilitate/impede self-management to help explain patterns and predictors of successful outcomes not only in type 1diabetes but will also inform programmes in Type 2 diabetes. Update: Recruitment completed. Follow-up data collection at 3, 6 and 12 months post course has been completed. Interim analysis of the 3 & 6 month data has been performed with 12 month analysis currently underway. A subgroup of 30 patients and 12 educators from 5 of the 11 DAFNE centres took part in an in-depth interview (Qualitative) study. Results from the Qualitative study will be presented as a poster at Diabetes UK Annual Professional Conference 2011. Some findings have already been published. 1C Comparison between DAFNE + MDI and DAFNE + CSII Pilot study Develop and conduct pilot study comparing DAFNE training plus continuous subcutaneous insulin infusion (CSII; pump) against DAFNE plus multiple daily injections (MDI). DAFNE curriculum developed to use with patients new to insulin pumps and training given to DAFNE educators.
Update: 5 CSII courses and 4 MDI courses were completed. All follow up data , at 6 months post course, have been collected. Preliminary analysis of the results are underway. The experiences of this pilot have informed the development of a major RCT now funded by the NIHR HTA. 1D DAFNE delivered over 5 consecutive days and 1-day / week for 5 weeks Undertake a trial to establish whether intermittent training is as good as the 5 day course. This has the potential to allow those who cannot attend for 1 week to benefit from training and permit more flexible delivery where educators work part-time. Update: 5-week course curriculum and resources have been developed. Educator training sessions completed in May/June 2010. 12/14 of the 5 week courses and 12/14 standard 1 week courses as control group have been run upto Feb 2011. Follow up data is collected at 6 weeks, 6 months and 12 months post course with data collection to be completed by May 2012. 1E Repeaters intervention Develop and pilot an intervention, incorporating research described in study B above, for those DAFNE graduates needing additional input. In January 2011 an inaugural meeting was held for development of intervention
1F User involvement Resource and develop our existing user group, who will contribute to all aspects of this programme. Update: 15 DAFNE Graduates elected by the DAFNE User Group to form an active group – DAFNE User Action Group (DUAG). Training in how users can be involved with health research was provided in July 2009. Two DUAG representatives sit on each of the research groups. Work to assess the impact of DUAG involvement in research has commenced with observations of research group meetings attended by DUAG and interviews with DUAG representatives and researchers. 2. REPOSE : Relative Effectiveness of Pumps over MDI and Structured Education An NIHR HTA funded trial comparing optimised multiple insulin injection therapy (using rapid and twice daily long-acting insulin analogues) with continuous subcutaneous insulin infusion (CSII) in adult type-1 diabetic patients provided with high quality structured DAFNE. 3. The Irish DAFNE Study In 2005 the Health Research Board in Ireland awarded the Irish DAFNE Study Group a five year programme grant under their Health Services R&D award. Randomised controlled trial evaluating 2 methods of follow-up care post-DAFNE training, comparing structured group follow-up care with a return to usual clinical care.
Update: All baseline, 6, 12 and 18 month follow-up data has now been collected. International Comparison Study A cross country comparison study among people with Type 1 diabetes in Ireland, the UK and Germany who have completed a structured education programme. Quantitative study A common dataset is being collected across ten centres in Germany who deliver the precursor of DAFNE, the Insulin Training and Teaching Programme (ITTP), ten DAFNE research centres in the UK and seven DAFNE centres in Ireland. Follow up data to be collected at 12 months post-DAFNE or post-ITTP training. Qualitative study Interview 16 patients and 4 educators from each country before DAFNE or ITTP with repeat interviews within 6 months following the course to explore their experiences, behaviours and opinions. Courses in all three countries will also be observed in their entirety with in-depth field notes accompanying the observations.
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Feb 18, 2011
JohnRigby
1 post
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Topic: DAFNE Online Mobile / Mobile site released Works great on my Blackberry. Is there an easy way to zoom in? |
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Feb 18, 2011
Simon
578 posts
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Topic: General Discussion / DAFNE news on Twitter ..and now Google Plus! Great idea JWo - Twitter is a good place to put 'Latest News' - I'm not sure how you'd get the information to feed into it though - I'd be happy for you to take a feed from the news we have here on the site, however it is quite sporadic. With regard to the DAFNE Site, again I'm not sure how frequently news occurs on that one. It would be great if we could get each individual DAFNE Centre tweeting to the same account, though as you mentioned it's usually only one user logging into an account, and the DAFNE Centre HCP's may not have the time to tweet.I guess an open question is - what would people like to see on such a feed? |
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Feb 18, 2011
JayBee
587 posts
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Topic: General Discussion / DAFNE news on Twitter ..and now Google Plus! It does seem that we are looking at one feed that only one person can access - multiple people accessing one twitter account appears to be something third parties are looking at offering (for free at the moment).I'm looking around for ideas for the first tweets... if we do set one up, do we want this site to be associated with it - eg, it's website to be this site? Edit; How interesting - the DAFNE main site has a "latest news" section. |
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Feb 18, 2011
JayBee
587 posts
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Speaking as another who had to work out that they needed to split Lantus, if you cannot manage a carb free day, I found adjusting my lunchtime ratio was another way of determing if it was running out. I found that I hypo'd before it ran out which meant that the background was letting me down after around 2pm. Lantus, when I was still on it, worked for 16 hours and I had the split dose over lap in the morning (apparently I need more insulin over that period). I changed to Levemir because I was not getting on well with Lantus as a split dose. |
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Feb 18, 2011
JayBee
587 posts
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Topic: General Discussion / DAFNE news on Twitter ..and now Google Plus! Im now wondering if multiple people can post to a main feed account... Shall have to have a look next time Im on a PC. Im happy to be a news scout or something if we think its a good idea...
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Feb 18, 2011
JayBee
587 posts
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Topic: General Discussion / Exercise - personal observations on not going high I think how your body responds, aka how well it uses the insulin you take, depends highly on how active you are. Another, very active, member of my DAFNE group found his body could work okay on BI alone when he exercises (still taking on CPs). I, on the other hand, seem to need the assistance of QA so I tend to try and take my exercise fuel off my meals, or if I know my meal QA has finished working, inject a bit of QA with a snack (applying DAFNE exercise rules at the same time). If I dont, I tend to hit 20 BG after exercise. HOWEVER, I dont correct after because my body will then use the next batch of food QA to bring it down (because body will still be affected by the exercise so using your insulin more effectively for some time afterwards). Correcting can result in hypo. Its all a little hit and miss though, sometimes taking off 2QA isnt enough but we learn!
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Feb 18, 2011
novorapidboi26
1,819 posts
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Topic: General Discussion / DAFNE news on Twitter ..and now Google Plus! I like that idea actually, well done.......... |
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Feb 18, 2011
JayBee
587 posts
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Topic: General Discussion / DAFNE news on Twitter ..and now Google Plus! Hi all, For sometime now I have been interested in following a DAFNE Twitter account or, before I quit Facebook, joining a DAFNE group. Obviously, this great site stands in for the FB side, so what are our thoughts on a Twitter feed with the latest news about DAFNE and the research behind it? I know this site gets news and I think a stream would not only promote DAFNE but this very website! I think this would work well if news can be gathered related to DAFNE - including success stories (okay'd by the diabetic of course)! What do we think? |
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Feb 18, 2011
Simon Heller
46 posts
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Sorry not to have replied to this before but I am sure that your Lantus is running out. For most people it is not a true 24h insulin and in my view most people should use it as Levemir and take it twice daily, probably bedtime and before breakfast. Probably lasts about 18h in most cases, its just that it has been marketed as a once a day insulin by the company that make it so most HCPs believe this. |
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Feb 17, 2011
novorapidboi26
1,819 posts
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Topic: General Discussion / Exercise - personal observations on not going high I don't exercise that much unfortunately but reducing the QA for the previous meal would be the choice I would take, it all depends on the duration and severity of the exercise as well....I found this some where, cant remember where: Short Moderate Long Low 0.90 0.80 0.70 Moderate 0.75 0.67 0.50 High 0.67 0.50 0.33 The horizontal is the duration and the vertical is the intensity..............I wouldn't use these figures as I cant confirm the source but it gives you an idea of what you could try........these numbers are multiplied with your QA dose if exercising within 1-2 hours of the meal..... The dafne handbook also has some stuff on exercising/activity you could look at......... I would also not excercise if my BGs were above 13, but that number can vary for everyone..... |
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Feb 17, 2011
chrisg9
7 posts
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Topic: General Discussion / Exercise - personal observations on not going high I exercise 5 evenings a week (a bit excessive, but I am trying to lose some weight). Traditional wisdom had always been to make sure to take carbs before hand. Whether I did or didnt, the result was often a >15 BG at the end. Following the DAFNE course (last month) and some good advice elsewhere on this site, last night I was 15 before I started (supper had been 90 minutes previous when BG was 10 - I still cant explain the 15 level.) Ignoring guidelines not to exercise with high BG, I took QA8. At the end of 40 minutes, my BG was 7 and it hasnt really budged from that 16 hours later.Would be very interested to know what others do to stop the highs after exercise. regards Chris |
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Feb 17, 2011
Garry
328 posts
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Topic: General Discussion / Whats happening? Good to see your diary up and running Jo Penn. Good move.I find that everything seems much clearer to me when I go back and review my own results retrospectively…especially after things have gone awry! Helps me correct my mistakes and missing entries too. How many times have I seen QA 11.3…must have a very clever and accurate pen…Doh...entered my BG in the wrong field again. You have a different approach to me in recording. I only make one entry for breakfast as I take both my QA and BI during breakfast...and again only one entry at tea. In doing that I find that it helps keep my split dose BI 12 hours apart and good consistent flowing overlap between them. During the week I normally have breakfast at 06:45 and dinner 18:00 to 19:00 and then breakfast again at 06:45 - so give or take an hour it remains at 12 and 12. If I get up late on a weekend it normally moves all mealtimes on - and so it tends to stay at 12 and 12 albeit with errors weekend start and finish - but still not too inaccurate. I see your BI split is around 14 hours during the day and 10 at night. At your new, higher BI, you might try even it up if at all possible. With recording in the OnLine diary, I hope you gain confidence in making your own decision about BI dose changes too. After all, you change one type of insulin every meal, so why should your BI be any different? I try to take a steady view of this over 3 or 4 days results though – in the vain hope that I see a clear pattern before making BI changes. It is complicated enough without bringing another factor into play, making it too difficult to recognise the pattern. I use the graph feature on the diary all the time to help me see emerging patterns. I now realise that I have only tinkered with BI units in the past...1u up or down, but my consultant has just told me to change 10 to 20% if I wanted to change BI and that way to see quick direct effects. He promptly advised me to knock 4u off my 28u BIs which I have done with little adverse effect. Low dose Metformin has so far not helped my ratios but it is only 8 days. I live in hope. Regards Garry |
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Feb 17, 2011
Simon
578 posts
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Topic: Site Development / DAFNE Online iPhone application - help with content/design needed Hi John,Good point - I should have said only follow point 1, and they will automatically get sent to me by Apple. Please don't post your crash reports to the MapMyFitness Forum! If you have an archive already please email them to me ([email protected]) Thanks, Simon |
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Feb 16, 2011
John Stevens
9 posts
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Topic: Site Development / DAFNE Online iPhone application - help with content/design needed Hi Simon,Thanks for all the work. I have it and will give you feedback next week. In the meantime, I have an archive of crash reports to send to you, but I am not sure if posting it to MapMyFitness forum will get to you. Let me precisely how to get it to you, and I will. Thanks again, and Cheers |
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Feb 16, 2011
Jo Penn
24 posts
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Topic: General Discussion / Whats happening? Well DSN got back to me after a moany email.. (really needed to do it!) and got to up basal to 28 on both doses and do a 2am check... and then try a carb free meal (like you suggested NRBoi) at the weekend...Mmm and asked about insulin pump/CGM - need to ask at clinic in 5 weeks Will give it a go x |
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Feb 16, 2011
Simon
578 posts
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Topic: Site Development / DAFNE Online iPhone application - help with content/design needed Tony, Mike - you are most welcome.A number of users have reported crashes - unfortunately I can't diagnose and fix these unless I can see your device crash logs. Most people turn these off as they don't want to submit information to Apple, however it's the only real way I can access crash logs and fix the crashes. Don't worry about turning this on - none of your private data will be shared with Apple, only the logs for each application, if it crashes. To do this, follow the instructions in the following link: How can I send you a crash report Thanks, Simon |
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Feb 16, 2011
MikeH
9 posts
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Topic: Site Development / DAFNE Online iPhone application - help with content/design needed thanks i just cant say thanks enough. |
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Feb 16, 2011
Megs
1 post
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Topic: General Discussion / accu-check I've had no end of problems with Lloyds pharmacy from losing my prescription to giving me th wrong insulin and then telling me that I was wrong and they were right with th insulin that they gave me so much so that I now refuse to use them and now use superdrug or boots who so far have been great but will never recommend lloyds again after th service I received |
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Feb 16, 2011
Tony
3 posts
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Topic: Site Development / DAFNE Online iPhone application - help with content/design needed Cheers simon, thats brill |
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Feb 16, 2011
Simon
578 posts
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Topic: Site Development / DAFNE Online iPhone application - help with content/design needed Hi all - the latest version of the app (1.4) is now on the app store, with the following new features:
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Feb 16, 2011
chrisg9
7 posts
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Topic: Questions for HCPs / Cant stop BG Levels going up Many thanks to both of you for those posts - the encouragement is much appreciated. The only ratio below 1:1 has been 0.5:1 prior to badminton. But as mentioned, will now up to 1:1 given high reading after. Garry, thanks for the Alan Constable details. I will see if it offers any advice for mitigating the effects of the glucagon release. For the moment, it appears to be an unavoidable evil.Regards Chris |
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Feb 16, 2011
Jo Penn
24 posts
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Topic: General Discussion / Whats happening? Hi thereHeres my BG Diaries for the past couple of days - my DSN is on holiday again :-( and getting frustrated with it all... Thanks NRBoi - will try that with the no carb meal - lunch is easier in the week; but will try at weekend as its easier to have a fry up lol |
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Feb 16, 2011
Garry
328 posts
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Topic: Questions for HCPs / Cant stop BG Levels going up Please remember that your (hard) badminton session may cause an 'adrenalin rush' leading to liver glucagon release and cause BG rise as a consequence. Think insulin resistance is increased by most hormone changes. Alan Constable shared information with us in a thread called exercise within General Discussion back in November 2010 which could be of interest to you. Sounds like you are getting back on track. Well done.Regards Garry |