Recent Posts - DAFNE Online

Jun 16, 2017

Simon Quinnell 16 posts

Topic: General Discussion / DAFNE Follow-Up Course - No Help?

Thanks for your replies!

Warwick, what you've suggested is what I'm doing, but as you say it doesn't always work, but it's the best I can do.

Jos2, I've tried varying my basal dose however, if I increase it on a Friday for a quiet weekend for example, there's too long a delay before the BI builds up (2-3 days) by that time it's Monday and I need reduced doses again. Also, I'm quite sensitive to insulin so have low BI doses. (Before breakfast 7.5U and 8U before bed).

I have two boys in their 20s that have type 1 diabetes too, one has a pump and the other a pump and a CGMS. My diabetes nurse said I don't qualify for a pump because my HBA1C isn't high enough.

I do have 33 years of diabetes experience though, of which 10 applying DAFNE principles. I guess I'll have to get my thinking hat on!

Simon.

Jun 16, 2017

Joanne Oag 3 posts

Topic: General Discussion / CGM / Libre - Employer Tax Break who provide CGM / Libre to employees

Hi
I am not sure if the details below and the link are widely known to many people.

"For adult CGM / Libre users who are employed by helpful employers: there may be a tax break for employers who supply CGM / Libre to their employees.
This information is from a professional tax adviser. It should work, but as far as we know it has only been tested by one person (who succeeded in getting CGM provided by their employer)".

http://www.inputdiabetes.org.uk/cgm/tax-break/

I use the Libre and find it very helpful in managing my diabetes. I am very fortunate by showing this link to my employer and writing to HMRC that I am now able to have this funded by my employer. My employer also looks at this as a good way to help improve my health and therefore have less sick days etc. Hopefully this will become more widely spread throughout companies willing to help their staff, but it can't hurt to have this discussion with your employer / HR department.

Jun 15, 2017

Jos2 8 posts

Topic: General Discussion / DAFNE Follow-Up Course - No Help?

Warning - writing as a parent of two children with diabetes (diagnosed at 7 and 12, now adults), neither of whom have done DAFNE. Self taught carb counting and insulin dose adjustment 15+ years ago, one currently using an Omnipod pump and Dexcom CGM, the other using MDI.

Further to Warwick's excellent suggestion, could you categorise your days and give them labels to help spot patterns and set ratios for each type? So days where you walk 5-6 hours could be type A, meeting days could be type B, etc. How predictable are your days? Do you know in the morning if you will have a type A or B day, for instance?

Also, does DAFNE include varying basal insulins? After an active day my son will reduce his night time basal insulin, sometimes the following morning too. If insulin resistance has become an issue, he might increase the basal insulin. If you know you are going to have a type A day and walk lots, would you reduce your basal insulin in the morning?

Best wishes,
Jos

Jun 15, 2017

Warwick 423 posts

Topic: General Discussion / DAFNE Follow-Up Course - No Help?

Hi Simon,

I'd suggest recording your BGLs and CPS, and QA and Basal doses using the BG diary, and then using past history to see what worked and what didn't. This can give some idea of how to adjust for days in the future that are similar to the past. It won't be perfect, as there are always random results, but hopefully it gives some pointers into how to make adjustments.

Jun 14, 2017

pjc21 8 posts

Topic: Site Development / intrusive predictions

Thanks for reply. I'm using a MacBook laptop, with OSX 10.7.5. The browser is Safari, version 6.1.6. But I haven't had this problem with any other applications, or documents or attachments.

Jun 14, 2017

Simon Quinnell 16 posts

Topic: General Discussion / DAFNE Follow-Up Course - No Help?

HI Everyone,

Yesterday I attended a DAFNE follow-up course at my local hospital. I have been to a number of them since I graduated in 2007. However, on this occasion I was able to participate in the Q&A session at the end of the course. I raised a question about how I can use DAFNE principles to achieve good BG levels with a variable routine. To my surprise one of the DAFNE Diabetes Nurses replied, "Sorry I can't answer that question, because DAFNE principles are not designed for variable routines!"

Let me explain my variable routine. I read water meters (Mon-Fri) for a living. That means sometimes I can be walking for up to six hours day. On another occasion I could be walking for three hours and driving for three hours. Also, I could be in a team meeting most of the day, and getting no exercise. If it's the weekend, it changes again, perhaps with some activity Saturday, and a quiet day Sunday.

At the moment, I use a combination of ratios (0.5:1, 0.67:1, 1:1, and 1.5:1) and take into account my previous days exercise, and the activity level I anticipate for the day ahead. However, I often select the wrong ratios because I don't know how my body will react to the previous days exercise or lack of it! There are no consistent patterns with my BGs. Sometimes they're high (13-15), sometimes too tight (3-4).

I know my lifestyle is complex, but I was surprised that no help was forthcoming. So now I'm thinking, what's the point of using DAFNE principles? I'm just doing a guessing game!

Some background info. I have daily injections of Humalog before meals, and Levemir before bed, and before breakfast.

Doers anyone have any suggestions as to what I might do?

Thanks for your help!

Simon.

Jun 13, 2017

Peter 109 posts

Topic: General Discussion / Wanted: DAFNE Graduate to participate in professional DAFNE conference

As part of the annual healthcare professional DAFNE conference Dr Helen Hopkinson is looking for a DAFNE graduate local to Manchester who would be willing to address the conference for 5 minutes maximum on the topic of the DAFNE insulin regimen and the benefits it has brought for them. In particular she is looking for someone who has switched from once daily to twice daily background insulin either for the start or after the DAFNE course and has some thoughts and experiences to express on the benefits of this. This will be a small slot on the podium as part of a plenary presentation that Dr Hopkinson will be delivering to over 120 attendees entitled "is the DAFNE insulin regimen fit for the future?”

The date is Tuesday June 20th 2017. You would be asked to attend the University of Manchester at 9am. Dr Hopkinson's talk begins at 09.40 for 30 minutes, of which part would be your contribution. There are then 10 minutes for questions. You would be free to leave after that, or we would be delighted to host you for the rest of the day if you are interested in staying for the rest of the meeting which will include a number of other presentations and workshops on a variety of topics e.g. the use of Libre in DAFNE.

If you are interested, please respond by e-mail to [email protected] including your name, when and where you completed your DAFNE course and a daytime contact phone number to allow Dr Hopkinson to have a telephone chat with you before confirming your participation.

Many thanks.

Jun 12, 2017

Jos2 8 posts

Topic: General Discussion / Basal/bolus insulin proportions

Hi Marke,

Glad to hear that DAFNE were misquoted in the article (may be worth a comment from someone who's done the course), but I've not heard of anything taught in DAFNE that my daughter isn't already doing. She tests basal rates periodically by fasting and sets carb and BG correction ratios through the day in a similar way and matches her insulin to carbs, taking BG, exercise, insulin on board, timing of insulin/food, and insulin resistance into account as necessary.

I can see that DAFNE is valuable for someone who stuck with what we were originally taught (mixed insulin with set meal sizes, snacks and times), and also if someone is burnt out and needs a boost through meeting others in a similar situation (been there and benefited from a clinic course), but we've not heard anything yet that convinces my daughter of the need to take a DAFNE course. Thanks though for all the feedback to our previous question Smile

kind regards,
Jos

Jun 10, 2017

alturn 78 posts

Topic: General Discussion / Basal/bolus insulin proportions

I ignore all these surveys as they are usually of a very small numbers involved, and a new one will be along next week.

If her HBA1C is ok and DSNs' are ok with treatment, then I would say all is Ok.

For interest, my basal is currently 24 units (but has varied between 22 and 2 Cool

which is about 65% of my TDD.

Regds,
J

Jun 9, 2017

marke 681 posts

Topic: Site Development / intrusive predictions

Sorry but this is nothing to do with the site, its a function of the browser you are using. What browser are you using ? and is this on a PC or a mobile device. We might be able to suggest something if we understand these things.

Jun 9, 2017

marke 681 posts

Topic: General Discussion / Basal/bolus insulin proportions

Your daughter is not unusual , none of us are usual. Also DAFNE advises nothing of the kind. What it teaches us is to adjust our Basal levels to what is right for US. It is probably true that often people take too much Basal before DAFNE, as part of the course is to teach you how to work out the correct level of basal for you and also to realise this is not something that will remain the same for ever more. It's hard to explain the DAFNE approach without doing the course as its a collection of things and doing parts in isolation may cause more harm than good.

Jun 8, 2017

Jos2 8 posts

Topic: General Discussion / Basal/bolus insulin proportions

Hi,

How do DAFNE advise basal insulin levels are set? I'm interested because of a quote in this article, http://www.diabetes.co.uk/news/2017/jun/study-provides-new-insight-into-insulin-dosing-for-adults-with-type-1-diabetes-92312051.html. It states:

"The findings support the view of the DAFNE course, which also states that many people take too high levels of basal insulin. DAFNE advises that most people with type 1 diabetes will benefit from 24 units of TBD per day."

Most people? Are people that similar? My daughter is average height and weight but only needs about 14 units of basal insulin (about 30% of her TDD). Hopefully they have been misquoted. Or maybe my daughter's unusual?

Jos

Jun 8, 2017

Warwick 423 posts

Topic: General Discussion / Weight Loss

My ideas are to either:

1) Reduce your Levemir dosage by 10% or so the night before and morning before the exercise.

or

2) Change your exercise to the morning before breakfast so that QA isn't a factor, and most of your basal insulin is gone.

or

3) Make lunch as low-carb as possible so you only need very small amounts of QA.

Hope that helps.

Jun 8, 2017

ChloeTate1993 3 posts

Topic: General Discussion / Weight Loss

Yeah mine too, and apparently I must be "sensitive to exercise" because of the amount that I drop in just half an hour's exercise 😣. I'm on levemir twice daily then novorapid when eating.

Jun 8, 2017

Warwick 423 posts

Topic: General Discussion / Weight Loss

Bleck. I cycle home around that time and I usually need to have some carbs first, usually a glass of milk, to avoid going low on the trip home. For some reason my QA from lunch seems to still have potency to send me low then.

What basal are you on, and do you inject once per day or twice a day?

Jun 8, 2017

ChloeTate1993 3 posts

Topic: General Discussion / Weight Loss

Between 5pm and 6pm usually as I don't finish work until 5pm.

Jun 8, 2017

Warwick 423 posts

Topic: General Discussion / Presetting diary times

+1 on the ratio idea. If we had a profile where we could state the periods of times where we are each ratio or even if we could select a default ratio which we would change when required, then that would be awesome.

Thanks,
Wariwck.

Jun 8, 2017

Warwick 423 posts

Topic: General Discussion / newbie

Hello Allison,

Welcome. Feel free to ask any questions that you have and we'll be happy to try and help.

Warwick.

Jun 8, 2017

Warwick 423 posts

Topic: General Discussion / Weight Loss

When are you exercising? At 5 pm?

Jun 5, 2017

torana 53 posts

Topic: General Discussion / Presetting diary times

Is it possible to preset the diary with blood glucose testing times, ratios and before breakfast etc so it doesn't have to be such a tedious task every day. My routines are the same on most days and it would save time when completing the multiple entries.

Jun 4, 2017

allison_71 1 post

Topic: General Discussion / newbie

Hey everyone, last week I just finished my dafne course, worth the wait attending it. I love it and much much to take in but I managed to get a grasp of it.
So I am shopping by to say hello.

May 31, 2017

ChloeTate1993 3 posts

Topic: General Discussion / Weight Loss

Hi All,

I completed DAFNE July 2016 and have managed to get my HbA1c from 97 to 76. Unfortunately as a side effect from this i have gained almost a stone !

I wont lie i definitely used my higher hbA1c to my advantage to keep my weight at bay particularly as i managed to lose a stone and a half back in 2015 (more from not eating and high bloods Sad

-bad i know)

The weight gain is really affecting me as i am a keen exerciser which is where my problem lies! As i work 8:30am to 5pm most weeks and have lunch at 1pm i have to do what is known as 'unplanned exercise'. Due to this i am having to snack at 4pm ish at least 3cps(usually 1 or 2 bananas) as i drop by approx 10mmols during exercise so have to go with a reading of about 16 Sad

.

I could lower my lunchtime QA or take none instead of eating CPs however i will then be sitting for 4-5 hours on a high blood reading - and if i exercise more i will have to eat more cps so that also wont help lose weight Sad

Any advice would be grateful. Any dietary advice also that people have found works?

Thanks in advance

Jun 16, 2017 Simon Quinnell 16 posts	Topic: General Discussion / DAFNE Follow-Up Course - No Help? Thanks for your replies! Warwick, what you've suggested is what I'm doing, but as you say it doesn't always work, but it's the best I can do. Jos2, I've tried varying my basal dose however, if I increase it on a Friday for a quiet weekend for example, there's too long a delay before the BI builds up (2-3 days) by that time it's Monday and I need reduced doses again. Also, I'm quite sensitive to insulin so have low BI doses. (Before breakfast 7.5U and 8U before bed). I have two boys in their 20s that have type 1 diabetes too, one has a pump and the other a pump and a CGMS. My diabetes nurse said I don't qualify for a pump because my HBA1C isn't high enough. I do have 33 years of diabetes experience though, of which 10 applying DAFNE principles. I guess I'll have to get my thinking hat on! Simon.

Jun 16, 2017 Joanne Oag 3 posts	Topic: General Discussion / CGM / Libre - Employer Tax Break who provide CGM / Libre to employees Hi I am not sure if the details below and the link are widely known to many people. "For adult CGM / Libre users who are employed by helpful employers: there may be a tax break for employers who supply CGM / Libre to their employees. This information is from a professional tax adviser. It should work, but as far as we know it has only been tested by one person (who succeeded in getting CGM provided by their employer)". http://www.inputdiabetes.org.uk/cgm/tax-break/ I use the Libre and find it very helpful in managing my diabetes. I am very fortunate by showing this link to my employer and writing to HMRC that I am now able to have this funded by my employer. My employer also looks at this as a good way to help improve my health and therefore have less sick days etc. Hopefully this will become more widely spread throughout companies willing to help their staff, but it can't hurt to have this discussion with your employer / HR department.

Jun 15, 2017 Jos2 8 posts	Topic: General Discussion / DAFNE Follow-Up Course - No Help? Warning - writing as a parent of two children with diabetes (diagnosed at 7 and 12, now adults), neither of whom have done DAFNE. Self taught carb counting and insulin dose adjustment 15+ years ago, one currently using an Omnipod pump and Dexcom CGM, the other using MDI. Further to Warwick's excellent suggestion, could you categorise your days and give them labels to help spot patterns and set ratios for each type? So days where you walk 5-6 hours could be type A, meeting days could be type B, etc. How predictable are your days? Do you know in the morning if you will have a type A or B day, for instance? Also, does DAFNE include varying basal insulins? After an active day my son will reduce his night time basal insulin, sometimes the following morning too. If insulin resistance has become an issue, he might increase the basal insulin. If you know you are going to have a type A day and walk lots, would you reduce your basal insulin in the morning? Best wishes, Jos

Jun 15, 2017 Warwick 423 posts	Topic: General Discussion / DAFNE Follow-Up Course - No Help? Hi Simon, I'd suggest recording your BGLs and CPS, and QA and Basal doses using the BG diary, and then using past history to see what worked and what didn't. This can give some idea of how to adjust for days in the future that are similar to the past. It won't be perfect, as there are always random results, but hopefully it gives some pointers into how to make adjustments.

Jun 14, 2017 pjc21 8 posts	Topic: Site Development / intrusive predictions Thanks for reply. I'm using a MacBook laptop, with OSX 10.7.5. The browser is Safari, version 6.1.6. But I haven't had this problem with any other applications, or documents or attachments.

Jun 14, 2017 Simon Quinnell 16 posts	Topic: General Discussion / DAFNE Follow-Up Course - No Help? HI Everyone, Yesterday I attended a DAFNE follow-up course at my local hospital. I have been to a number of them since I graduated in 2007. However, on this occasion I was able to participate in the Q&A session at the end of the course. I raised a question about how I can use DAFNE principles to achieve good BG levels with a variable routine. To my surprise one of the DAFNE Diabetes Nurses replied, "Sorry I can't answer that question, because DAFNE principles are not designed for variable routines!" Let me explain my variable routine. I read water meters (Mon-Fri) for a living. That means sometimes I can be walking for up to six hours day. On another occasion I could be walking for three hours and driving for three hours. Also, I could be in a team meeting most of the day, and getting no exercise. If it's the weekend, it changes again, perhaps with some activity Saturday, and a quiet day Sunday. At the moment, I use a combination of ratios (0.5:1, 0.67:1, 1:1, and 1.5:1) and take into account my previous days exercise, and the activity level I anticipate for the day ahead. However, I often select the wrong ratios because I don't know how my body will react to the previous days exercise or lack of it! There are no consistent patterns with my BGs. Sometimes they're high (13-15), sometimes too tight (3-4). I know my lifestyle is complex, but I was surprised that no help was forthcoming. So now I'm thinking, what's the point of using DAFNE principles? I'm just doing a guessing game! Some background info. I have daily injections of Humalog before meals, and Levemir before bed, and before breakfast. Doers anyone have any suggestions as to what I might do? Thanks for your help! Simon.

Jun 13, 2017 Peter 109 posts	Topic: General Discussion / Wanted: DAFNE Graduate to participate in professional DAFNE conference As part of the annual healthcare professional DAFNE conference Dr Helen Hopkinson is looking for a DAFNE graduate local to Manchester who would be willing to address the conference for 5 minutes maximum on the topic of the DAFNE insulin regimen and the benefits it has brought for them. In particular she is looking for someone who has switched from once daily to twice daily background insulin either for the start or after the DAFNE course and has some thoughts and experiences to express on the benefits of this. This will be a small slot on the podium as part of a plenary presentation that Dr Hopkinson will be delivering to over 120 attendees entitled "is the DAFNE insulin regimen fit for the future?” The date is Tuesday June 20th 2017. You would be asked to attend the University of Manchester at 9am. Dr Hopkinson's talk begins at 09.40 for 30 minutes, of which part would be your contribution. There are then 10 minutes for questions. You would be free to leave after that, or we would be delighted to host you for the rest of the day if you are interested in staying for the rest of the meeting which will include a number of other presentations and workshops on a variety of topics e.g. the use of Libre in DAFNE. If you are interested, please respond by e-mail to [email protected] including your name, when and where you completed your DAFNE course and a daytime contact phone number to allow Dr Hopkinson to have a telephone chat with you before confirming your participation. Many thanks.

Jun 12, 2017 Jos2 8 posts	Topic: General Discussion / Basal/bolus insulin proportions Hi Marke, Glad to hear that DAFNE were misquoted in the article (may be worth a comment from someone who's done the course), but I've not heard of anything taught in DAFNE that my daughter isn't already doing. She tests basal rates periodically by fasting and sets carb and BG correction ratios through the day in a similar way and matches her insulin to carbs, taking BG, exercise, insulin on board, timing of insulin/food, and insulin resistance into account as necessary. I can see that DAFNE is valuable for someone who stuck with what we were originally taught (mixed insulin with set meal sizes, snacks and times), and also if someone is burnt out and needs a boost through meeting others in a similar situation (been there and benefited from a clinic course), but we've not heard anything yet that convinces my daughter of the need to take a DAFNE course. Thanks though for all the feedback to our previous question kind regards, Jos

Jun 10, 2017 alturn 78 posts	Topic: General Discussion / Basal/bolus insulin proportions I ignore all these surveys as they are usually of a very small numbers involved, and a new one will be along next week. If her HBA1C is ok and DSNs' are ok with treatment, then I would say all is Ok. For interest, my basal is currently 24 units (but has varied between 22 and 2 which is about 65% of my TDD. Regds, J

Jun 9, 2017 marke 681 posts	Topic: Site Development / intrusive predictions Sorry but this is nothing to do with the site, its a function of the browser you are using. What browser are you using ? and is this on a PC or a mobile device. We might be able to suggest something if we understand these things.

Jun 9, 2017 marke 681 posts	Topic: General Discussion / Basal/bolus insulin proportions Your daughter is not unusual , none of us are usual. Also DAFNE advises nothing of the kind. What it teaches us is to adjust our Basal levels to what is right for US. It is probably true that often people take too much Basal before DAFNE, as part of the course is to teach you how to work out the correct level of basal for you and also to realise this is not something that will remain the same for ever more. It's hard to explain the DAFNE approach without doing the course as its a collection of things and doing parts in isolation may cause more harm than good.

Jun 8, 2017 Jos2 8 posts	Topic: General Discussion / Basal/bolus insulin proportions Hi, How do DAFNE advise basal insulin levels are set? I'm interested because of a quote in this article, http://www.diabetes.co.uk/news/2017/jun/study-provides-new-insight-into-insulin-dosing-for-adults-with-type-1-diabetes-92312051.html. It states: "The findings support the view of the DAFNE course, which also states that many people take too high levels of basal insulin. DAFNE advises that most people with type 1 diabetes will benefit from 24 units of TBD per day." Most people? Are people that similar? My daughter is average height and weight but only needs about 14 units of basal insulin (about 30% of her TDD). Hopefully they have been misquoted. Or maybe my daughter's unusual? Jos

Jun 8, 2017 Warwick 423 posts	Topic: General Discussion / Weight Loss My ideas are to either: 1) Reduce your Levemir dosage by 10% or so the night before and morning before the exercise. or 2) Change your exercise to the morning before breakfast so that QA isn't a factor, and most of your basal insulin is gone. or 3) Make lunch as low-carb as possible so you only need very small amounts of QA. Hope that helps.

Jun 8, 2017 ChloeTate1993 3 posts	Topic: General Discussion / Weight Loss Yeah mine too, and apparently I must be "sensitive to exercise" because of the amount that I drop in just half an hour's exercise 😣. I'm on levemir twice daily then novorapid when eating.

Jun 8, 2017 Warwick 423 posts	Topic: General Discussion / Weight Loss Bleck. I cycle home around that time and I usually need to have some carbs first, usually a glass of milk, to avoid going low on the trip home. For some reason my QA from lunch seems to still have potency to send me low then. What basal are you on, and do you inject once per day or twice a day?

Jun 8, 2017 ChloeTate1993 3 posts	Topic: General Discussion / Weight Loss Between 5pm and 6pm usually as I don't finish work until 5pm.

Jun 8, 2017 Warwick 423 posts	Topic: General Discussion / Presetting diary times +1 on the ratio idea. If we had a profile where we could state the periods of times where we are each ratio or even if we could select a default ratio which we would change when required, then that would be awesome. Thanks, Wariwck.

Jun 8, 2017 Warwick 423 posts	Topic: General Discussion / newbie Hello Allison, Welcome. Feel free to ask any questions that you have and we'll be happy to try and help. Warwick.

Jun 8, 2017 Warwick 423 posts	Topic: General Discussion / Weight Loss When are you exercising? At 5 pm?

Jun 5, 2017 torana 53 posts	Topic: General Discussion / Presetting diary times Is it possible to preset the diary with blood glucose testing times, ratios and before breakfast etc so it doesn't have to be such a tedious task every day. My routines are the same on most days and it would save time when completing the multiple entries.

Jun 4, 2017 allison_71 1 post	Topic: General Discussion / newbie Hey everyone, last week I just finished my dafne course, worth the wait attending it. I love it and much much to take in but I managed to get a grasp of it. So I am shopping by to say hello.

May 31, 2017 ChloeTate1993 3 posts	Topic: General Discussion / Weight Loss Hi All, I completed DAFNE July 2016 and have managed to get my HbA1c from 97 to 76. Unfortunately as a side effect from this i have gained almost a stone ! I wont lie i definitely used my higher hbA1c to my advantage to keep my weight at bay particularly as i managed to lose a stone and a half back in 2015 (more from not eating and high bloods -bad i know) The weight gain is really affecting me as i am a keen exerciser which is where my problem lies! As i work 8:30am to 5pm most weeks and have lunch at 1pm i have to do what is known as 'unplanned exercise'. Due to this i am having to snack at 4pm ish at least 3cps(usually 1 or 2 bananas) as i drop by approx 10mmols during exercise so have to go with a reading of about 16. I could lower my lunchtime QA or take none instead of eating CPs however i will then be sitting for 4-5 hours on a high blood reading - and if i exercise more i will have to eat more cps so that also wont help lose weight Any advice would be grateful. Any dietary advice also that people have found works? Thanks in advance