Recent Posts - DAFNE Online

Aug 18, 2015

Nidge 4 posts

Topic: Carbohydrate Counting / Jelly Babies

I reckon on 4 jelly babies being 2 CP's. I used to get through loads when treating hypos in the early days, but now on a lchf lifestyle, I very very rarely get hypos, although still carry them with me in case.
The lchf lifestyle has given me a huge amount of freedom, more energy, far tighter BG control, and much reduced need for insulin.

Aug 18, 2015

Nidge 4 posts

Topic: General Discussion / Half unit pens

Hi all. I use a half unit pen (NovoPen Echo) which has made a huge difference in keeping my BG's under control. Like others on here, I have found I am extremely sensitive to insulin and am currently on a ratio of 1 unit of insulin to 3 CP"s. (Or as my DAFNE team would say; 1/2 to 1 1/2 ratio)

Having recently had a pen malfunction (not its fault), I had to revert back to a full unit pen for a few days until my GP got a replacement - more problematic than you would think, and I nearly has a mishap and overdosed!

Glad now to be back on half units. My other saving grace has been going low carb - I'll post this on another post.

Aug 18, 2015

Simon 574 posts

Topic: General Discussion / Dosage auto-calculation in apps

I agree with all of the above comments, we are severely disappointed too as all we are in it for is to help people who've done the DAFNE course, as we have. The MHRA is the regulatory body but it is the European Commission who sets this rule for all of Europe. Anything which performs a calculation must be labelled as a medical device and suitably certified. Penalties can be hard for non-compliance and as much as I love working on DAFNE Online I'm not willing to pay a massive fine/go to prison (I'm sure you'll understand).

John as you rightly say both Keith, Mark and I are UK based so are subject to the EC and UK law. Unfortunately there is no way to go back to a previous version (if there was I would have had to remove them from the app store as I'd still be non-compliant in the eyes of the MHRA).

If anyone knows of anybody who can help with the certification process please do let us know, as we would really like to get this feature back in.

If you want to get in touch with the MHRA then the gentleman who has been in touch with us is Leo Syron and he has said that I can share his information here: [email protected]

Aug 18, 2015

John Syer 19 posts

Topic: General Discussion / Dosage auto-calculation in apps

I was a BETA tester for the development of this app and have used it continuously since then. I found that particular feature very useful, especially as I have varying QA:CP ratios throughout the day.
As far as I can see the change forced on you by the MHRA makes it more likely that a dosage mistake will happen.

What makes this foolish on many levels is that (and it is not an exhaustive list);
a) It is a app for recording values, it does not administer or control any equipment and there is always a person between the calculated value and the administration of dosage. As far as my reading of Directive 93/42/EEC goes, I can't see how this qualifies as a "medical device". (although I'm happy to be corrected on this).

b) I'm based in Australia, the MHRA is the designated competent authority (CA) responsible for medical devices for the UK. The app is available worldwide, not just within the MHRA CA jurisdiction. (As an aside, I imagine that both Keith and Simon are residents of the UK, so that if a court case were to be raised for some form of dosage related problem, under Article 2 of the Brussels Regulation, the the claimant(s) would sue in the domicile of the defendant(s), in this case the UK court systems - perhaps that is why the MHRA gets a look in on this app)

Now that I've vented my spleen, is there anyway to roll back to the previous version?

Regards, John

Aug 17, 2015

Denver 1 post

Topic: General Discussion / Dosage auto-calculation in apps

Simon ,
firstly many thanks for your work on the daphne app I have used it for many years and find it a very valuable tool. Really disappointed with the removal of the auto calc insulin function being removed from the app. Is there anyone at MHRA i can write too and voice my disgust at this stupid decision.

Regards
Mike

Aug 17, 2015

Phil Maskell 194 posts

Topic: General Discussion / Cyborg Times (new BG meter)

Anyone else having issues with Abbot not being able to produce/deliver sensors.

I think they are a victim of their own success, I don't think they can keep up with demand. Who would have thought a cheap alternative CGM for T1 diabetics would be popular?

I am out of sensors, keen cyclist and feel lost without it on rides now!

Aug 17, 2015

JayBee 582 posts

Topic: General Discussion / Dosage auto-calculation in apps

I noticed the change first thing this morning.
Not impressed.

Aug 14, 2015

Simon 574 posts

Topic: General Discussion / Dosage auto-calculation in apps

Unfortunately we will have to remove the auto-calculation of insulin dosage from the iOS and Android apps in the next update. By including a calculation function it means the app is classed as a "medical device" and as such needs to be regulated by the MHRA. This involves a long and expensive certification process (thousands of pounds) which as DAFNE Online is done in our spare time as DAFNE graduates is something we simply cannot afford to do. We were approached by the MHRA who in no uncertain terms told us to either remove the apps from sale or get them certified; we did however manage to agree with them that by removing the calculation function from the apps then it would declassify them as medical devices so the rest of the functions can remain and they can stay on sale in the app stores.

I know this was a useful feature for many of you, so I apologise that it will be disappearing from the apps. We will work with the NHS DAFNE team to see what is possible regarding certification, but in the short term we needed to get the apps back under compliance to allow them to continue to be available for DAFNE Graduates.

Simon

Aug 14, 2015

Phil Maskell 194 posts

Topic: General Discussion / Night time Hypo - Depression!

novorapidboi26,

From the freestyle website:

Sensor water resistance IP27: Can withstand immersion into one metre (3 ft) of water for up to 30 minutes

https://www.freestylelibre.co.uk/freestyle-libre-sensor-kit-en-gb-es.html

I've had baths/showers with it on, but not been swimming yet, holiday next week will be a good test Very Happy

I honestly think they should be on NHS, I forgot to order new one quick enough and feel lost without it at the moment, HbA1c gone from 7.9 to 6.7, purely due to seeing that I was running high overnight. I also feel happier running lower as I know the trend, if I test and am 4, I don't know if I'm going up or down based on this, but with Libre I get an arrow to tell me.

Hope this helps.

Phil

Aug 14, 2015

Warwick 434 posts

Topic: General Discussion / Burnout

Also, please look at getting some professional counselling, preferably from someone who has experience with burnout from diabetes management. It is incredibly common to experience burnout from managing diabetes. Here in Australia, diabetics are twice as likely as the general population to experience depression. Your GP should be able to refer you to a good counsellor, and sharing your issues with someone who can help with strategies to overcome the burnout is likely to be very helpful in escaping from this.

Managing T1D is hard enough without dealing with burnout too, so please get some help in tackling this, and everything else will get easier.

Aug 14, 2015

Warwick 434 posts

Topic: Questions ? / morning BI

Hi Ruth,

That would be completely up to you. If your BGs are high at 6 am, you may want to inject your BI a bit earlier. If (like me) you tend to hypo when having a nap, then you might not. It is completely up to you depending on how your body responds to an earlier basal injection.

Aug 13, 2015

novorapidboi26 1,818 posts

Topic: Questions ? / morning BI

rising and retiring............. Very Happy

is this a new slogan?

I say new but I graduated in 2009, so a while back now......

Aug 13, 2015

dunkers7 24 posts

Topic: General Discussion / Burnout

Yeah, if you've been diabetic for long enough, you've been there. I'm 22 years in.

My experience is this is just a temporary state caused by elevated BGs. You need to do what you can to get out of that situation.

It sounds like carb counting isn't working too well just now, I'd suggest going back to basics. Simplify the problem. Test your basal insulin, this needs to be right before the carb counting can work as intended. Take notes so you know what works and what doesn't.

The main point of all this effort is to be able to look back years from now and know you did good.

Good luck.

Aug 12, 2015

novorapidboi26 1,818 posts

Topic: General Discussion / Night time Hypo - Depression!

Is the Libre sensor water proof?

Aug 11, 2015

lucy1gus2 13 posts

Topic: General Discussion / Apple Cider Vinegar

Hi Pippa,

Apparently it's an old fashioned folk remedy which I read about. Then I found victoriahealth.com were also suggesting the benefits were worth considering. The theory is that the acetic acid found in Apple Cider Vinegar slows the digestion of starch leading to low sugar levels in the bloodstream.I purchase Organic Apple Cider Vinegar with mother from Higher Nature. Â£6-70/350ml

I take 5ml in 250ml of water as I start eating before meals and then use the Dafne regime with regards to CP and insulin..

Admittedly its early days but there does seem to be some sort of effect ( for the better ) on my blood glucose levels. I am using a 1 to !0CP ratio and am on Novorapid at meals and Lantus at bed ( but also on Metformin 850 x3 times day )

Need to fine tune but looking good. Also look up apple cider vinegar on the internet

Aug 11, 2015

Pippa Mc 4 posts

Topic: General Discussion / Apple Cider Vinegar

Hi Lucy,

No, I haven't heard of it before, what is the science behind it? Where did you hear of it from?

How is it working?

Aug 9, 2015

hypo 18 posts

Topic: General Discussion / Needle Bins

I order my sharps bin on my repeat prescription and return it to the pharmacy when full.

Aug 9, 2015

lucy1gus2 13 posts

Topic: General Discussion / Apple Cider Vinegar

Has anybody tried using this vinegar before meals and bed to reduce their BG. I'm Type 1 and have been trying it for the past week. Getting some good readings but also some lows which as usual is a pain.

Regards

Aug 7, 2015

Warwick 434 posts

Topic: General Discussion / Low Carb

Unfortunately everyone is different, and what works for me may or may not work for you. Prior to low carb, I'd have a couple of Weetbix with milk prior to a half ironman, but before the last one I didn't have anything at all except water to ensure I was not going to dehydrate. That was after a period of acclimatisation though. When keto-adapted, you don't need to fuel up as you do when you are used to when on a high-carb diet. The body can store 2000 KCal from carbs which can be used up quickly during a long event hence the need for constant replenishment. The body can store 40,000 KCal using fat, so there is far less need to fuel up when keto-adapted.

I did a half marathon the weekend before last, and had scrambled eggs prior to the event and had no issues during the event. It was my 42nd half marathon though, so my stomach got used to shutting up about discomfort a while ago :-)

It is very common for insulin needs to increase initially over the first few weeks. Most people trying this do experience that. I don't know the science behind it, I just know that it happens and that it does settle down after a few weeks.

I find that when I eat a low carb meal that has protein in it, I have to bolus for the protein. Other T1Ds have no such trouble, again it is all individual. If your body is used to using carbs as fuel and you suddenly limit the amount of carb you are eating, then if your body can make carbs from protein (and it can), then it probably will.

Oh, and if you start getting headaches, read the section of the book about broth. It is VERY common to get headaches in the transition period but very easily treated.

Aug 7, 2015

Phil Maskell 194 posts

Topic: General Discussion / Low Carb

Warwick,

I went for a 10+ hour bike ride last weekend on no carbs, had spinach and cheese omelette for breakfast, cooked in butter for fat content. After 2 to 3 hours this didn't sit very well, felt sooo sick.

I have since read that eggs on a low carb diet are not the best idea before alot of exercise, what do you eat prior to ironman training?

I have also found going low carb this week that for some strange reason my BGs have risen and I seem to be injecting quite alot of QA for nuts and salad, is this just me needing some QA anyway, is this normally included in my carb QA? Did you notice anything similar?

Phil

Aug 7, 2015

HelenH 9 posts

Topic: Questions ? / High BG's after fracture

Thanks all,
Starting to get back on track; think it was a combination of everything! I have increased my qa:carb ratios & that seems to be working. Also now getting a bit more mobile - injuries other than the fracture have made crutches very difficult!

Aug 5, 2015

Warwick 434 posts

Topic: Carbohydrate Counting / Beans and lentils

I experimented with doing two half doses, 3 hours apart which worked better than a single dose of the full amount which led to hypos. I am also experimenting with a slower-acting insulin (not basal and not QA) which has an action time of about 6-8 hours but the jury is still out on that.

Aug 4, 2015

Pippa Mc 4 posts

Topic: Carbohydrate Counting / Beans and lentils

Hello,

I have a similar query related to butter beans - I had them in quesadillas mashed up and didn't account for these, as per DAFNE guidelines.. I just accounted for the tortillas. However at nighttime my BG was sky high.. whilst I haven't been very well so my BG readings have been slightly high I don't think that it would account for this.

I suspect that mashing these up has impacted upon the way they are digested - has anyone else experienced this? I am thinking of trying half insulin dosage, unless anyone else has any ideas that have worked for them.

Thanks,

Aug 3, 2015

michaelj 45 posts

Topic: Questions ? / High BG's after fracture

Broke my foot on 1st July and my BS were all over the place for 2 days. Now moving around on crutches and thanks to the extra effort to get anywhere, bloods have more or less gone back to normal. Stick with it, it'll come right in the end. The body does all sorts of weird things in times of stress.

Aug 18, 2015 Nidge 4 posts	Topic: Carbohydrate Counting / Jelly Babies I reckon on 4 jelly babies being 2 CP's. I used to get through loads when treating hypos in the early days, but now on a lchf lifestyle, I very very rarely get hypos, although still carry them with me in case. The lchf lifestyle has given me a huge amount of freedom, more energy, far tighter BG control, and much reduced need for insulin.

Aug 18, 2015 Nidge 4 posts	Topic: General Discussion / Half unit pens Hi all. I use a half unit pen (NovoPen Echo) which has made a huge difference in keeping my BG's under control. Like others on here, I have found I am extremely sensitive to insulin and am currently on a ratio of 1 unit of insulin to 3 CP"s. (Or as my DAFNE team would say; 1/2 to 1 1/2 ratio) Having recently had a pen malfunction (not its fault), I had to revert back to a full unit pen for a few days until my GP got a replacement - more problematic than you would think, and I nearly has a mishap and overdosed! Glad now to be back on half units. My other saving grace has been going low carb - I'll post this on another post.

Aug 18, 2015 Simon 574 posts	Topic: General Discussion / Dosage auto-calculation in apps I agree with all of the above comments, we are severely disappointed too as all we are in it for is to help people who've done the DAFNE course, as we have. The MHRA is the regulatory body but it is the European Commission who sets this rule for all of Europe. Anything which performs a calculation must be labelled as a medical device and suitably certified. Penalties can be hard for non-compliance and as much as I love working on DAFNE Online I'm not willing to pay a massive fine/go to prison (I'm sure you'll understand). John as you rightly say both Keith, Mark and I are UK based so are subject to the EC and UK law. Unfortunately there is no way to go back to a previous version (if there was I would have had to remove them from the app store as I'd still be non-compliant in the eyes of the MHRA). If anyone knows of anybody who can help with the certification process please do let us know, as we would really like to get this feature back in. If you want to get in touch with the MHRA then the gentleman who has been in touch with us is Leo Syron and he has said that I can share his information here: [email protected]

Aug 18, 2015 John Syer 19 posts	Topic: General Discussion / Dosage auto-calculation in apps I was a BETA tester for the development of this app and have used it continuously since then. I found that particular feature very useful, especially as I have varying QA:CP ratios throughout the day. As far as I can see the change forced on you by the MHRA makes it more likely that a dosage mistake will happen. What makes this foolish on many levels is that (and it is not an exhaustive list); a) It is a app for recording values, it does not administer or control any equipment and there is always a person between the calculated value and the administration of dosage. As far as my reading of Directive 93/42/EEC goes, I can't see how this qualifies as a "medical device". (although I'm happy to be corrected on this). b) I'm based in Australia, the MHRA is the designated competent authority (CA) responsible for medical devices for the UK. The app is available worldwide, not just within the MHRA CA jurisdiction. (As an aside, I imagine that both Keith and Simon are residents of the UK, so that if a court case were to be raised for some form of dosage related problem, under Article 2 of the Brussels Regulation, the the claimant(s) would sue in the domicile of the defendant(s), in this case the UK court systems - perhaps that is why the MHRA gets a look in on this app) Now that I've vented my spleen, is there anyway to roll back to the previous version? Regards, John

Aug 17, 2015 Denver 1 post	Topic: General Discussion / Dosage auto-calculation in apps Simon , firstly many thanks for your work on the daphne app I have used it for many years and find it a very valuable tool. Really disappointed with the removal of the auto calc insulin function being removed from the app. Is there anyone at MHRA i can write too and voice my disgust at this stupid decision. Regards Mike

Aug 17, 2015 Phil Maskell 194 posts	Topic: General Discussion / Cyborg Times (new BG meter) Anyone else having issues with Abbot not being able to produce/deliver sensors. I think they are a victim of their own success, I don't think they can keep up with demand. Who would have thought a cheap alternative CGM for T1 diabetics would be popular? I am out of sensors, keen cyclist and feel lost without it on rides now!

Aug 17, 2015 JayBee 582 posts	Topic: General Discussion / Dosage auto-calculation in apps I noticed the change first thing this morning. Not impressed.

Aug 14, 2015 Simon 574 posts	Topic: General Discussion / Dosage auto-calculation in apps Unfortunately we will have to remove the auto-calculation of insulin dosage from the iOS and Android apps in the next update. By including a calculation function it means the app is classed as a "medical device" and as such needs to be regulated by the MHRA. This involves a long and expensive certification process (thousands of pounds) which as DAFNE Online is done in our spare time as DAFNE graduates is something we simply cannot afford to do. We were approached by the MHRA who in no uncertain terms told us to either remove the apps from sale or get them certified; we did however manage to agree with them that by removing the calculation function from the apps then it would declassify them as medical devices so the rest of the functions can remain and they can stay on sale in the app stores. I know this was a useful feature for many of you, so I apologise that it will be disappearing from the apps. We will work with the NHS DAFNE team to see what is possible regarding certification, but in the short term we needed to get the apps back under compliance to allow them to continue to be available for DAFNE Graduates. Simon

Aug 14, 2015 Phil Maskell 194 posts	Topic: General Discussion / Night time Hypo - Depression! novorapidboi26, From the freestyle website: Sensor water resistance IP27: Can withstand immersion into one metre (3 ft) of water for up to 30 minutes https://www.freestylelibre.co.uk/freestyle-libre-sensor-kit-en-gb-es.html I've had baths/showers with it on, but not been swimming yet, holiday next week will be a good test I honestly think they should be on NHS, I forgot to order new one quick enough and feel lost without it at the moment, HbA1c gone from 7.9 to 6.7, purely due to seeing that I was running high overnight. I also feel happier running lower as I know the trend, if I test and am 4, I don't know if I'm going up or down based on this, but with Libre I get an arrow to tell me. Hope this helps. Phil

Aug 14, 2015 Warwick 434 posts	Topic: General Discussion / Burnout Also, please look at getting some professional counselling, preferably from someone who has experience with burnout from diabetes management. It is incredibly common to experience burnout from managing diabetes. Here in Australia, diabetics are twice as likely as the general population to experience depression. Your GP should be able to refer you to a good counsellor, and sharing your issues with someone who can help with strategies to overcome the burnout is likely to be very helpful in escaping from this. Managing T1D is hard enough without dealing with burnout too, so please get some help in tackling this, and everything else will get easier.

Aug 14, 2015 Warwick 434 posts	Topic: Questions ? / morning BI Hi Ruth, That would be completely up to you. If your BGs are high at 6 am, you may want to inject your BI a bit earlier. If (like me) you tend to hypo when having a nap, then you might not. It is completely up to you depending on how your body responds to an earlier basal injection.

Aug 13, 2015 novorapidboi26 1,818 posts	Topic: Questions ? / morning BI rising and retiring............. is this a new slogan? I say new but I graduated in 2009, so a while back now......

Aug 13, 2015 dunkers7 24 posts	Topic: General Discussion / Burnout Yeah, if you've been diabetic for long enough, you've been there. I'm 22 years in. My experience is this is just a temporary state caused by elevated BGs. You need to do what you can to get out of that situation. It sounds like carb counting isn't working too well just now, I'd suggest going back to basics. Simplify the problem. Test your basal insulin, this needs to be right before the carb counting can work as intended. Take notes so you know what works and what doesn't. The main point of all this effort is to be able to look back years from now and know you did good. Good luck.

Aug 12, 2015 novorapidboi26 1,818 posts	Topic: General Discussion / Night time Hypo - Depression! Is the Libre sensor water proof?

Aug 11, 2015 lucy1gus2 13 posts	Topic: General Discussion / Apple Cider Vinegar Hi Pippa, Apparently it's an old fashioned folk remedy which I read about. Then I found victoriahealth.com were also suggesting the benefits were worth considering. The theory is that the acetic acid found in Apple Cider Vinegar slows the digestion of starch leading to low sugar levels in the bloodstream.I purchase Organic Apple Cider Vinegar with mother from Higher Nature. Â£6-70/350ml I take 5ml in 250ml of water as I start eating before meals and then use the Dafne regime with regards to CP and insulin.. Admittedly its early days but there does seem to be some sort of effect ( for the better ) on my blood glucose levels. I am using a 1 to !0CP ratio and am on Novorapid at meals and Lantus at bed ( but also on Metformin 850 x3 times day ) Need to fine tune but looking good. Also look up apple cider vinegar on the internet

Aug 11, 2015 Pippa Mc 4 posts	Topic: General Discussion / Apple Cider Vinegar Hi Lucy, No, I haven't heard of it before, what is the science behind it? Where did you hear of it from? How is it working?

Aug 9, 2015 hypo 18 posts	Topic: General Discussion / Needle Bins I order my sharps bin on my repeat prescription and return it to the pharmacy when full.

Aug 9, 2015 lucy1gus2 13 posts	Topic: General Discussion / Apple Cider Vinegar Has anybody tried using this vinegar before meals and bed to reduce their BG. I'm Type 1 and have been trying it for the past week. Getting some good readings but also some lows which as usual is a pain. Regards

Aug 7, 2015 Warwick 434 posts	Topic: General Discussion / Low Carb Unfortunately everyone is different, and what works for me may or may not work for you. Prior to low carb, I'd have a couple of Weetbix with milk prior to a half ironman, but before the last one I didn't have anything at all except water to ensure I was not going to dehydrate. That was after a period of acclimatisation though. When keto-adapted, you don't need to fuel up as you do when you are used to when on a high-carb diet. The body can store 2000 KCal from carbs which can be used up quickly during a long event hence the need for constant replenishment. The body can store 40,000 KCal using fat, so there is far less need to fuel up when keto-adapted. I did a half marathon the weekend before last, and had scrambled eggs prior to the event and had no issues during the event. It was my 42nd half marathon though, so my stomach got used to shutting up about discomfort a while ago :-) It is very common for insulin needs to increase initially over the first few weeks. Most people trying this do experience that. I don't know the science behind it, I just know that it happens and that it does settle down after a few weeks. I find that when I eat a low carb meal that has protein in it, I have to bolus for the protein. Other T1Ds have no such trouble, again it is all individual. If your body is used to using carbs as fuel and you suddenly limit the amount of carb you are eating, then if your body can make carbs from protein (and it can), then it probably will. Oh, and if you start getting headaches, read the section of the book about broth. It is VERY common to get headaches in the transition period but very easily treated.

Aug 7, 2015 Phil Maskell 194 posts	Topic: General Discussion / Low Carb Warwick, I went for a 10+ hour bike ride last weekend on no carbs, had spinach and cheese omelette for breakfast, cooked in butter for fat content. After 2 to 3 hours this didn't sit very well, felt sooo sick. I have since read that eggs on a low carb diet are not the best idea before alot of exercise, what do you eat prior to ironman training? I have also found going low carb this week that for some strange reason my BGs have risen and I seem to be injecting quite alot of QA for nuts and salad, is this just me needing some QA anyway, is this normally included in my carb QA? Did you notice anything similar? Phil

Aug 7, 2015 HelenH 9 posts	Topic: Questions ? / High BG's after fracture Thanks all, Starting to get back on track; think it was a combination of everything! I have increased my qa:carb ratios & that seems to be working. Also now getting a bit more mobile - injuries other than the fracture have made crutches very difficult!

Aug 5, 2015 Warwick 434 posts	Topic: Carbohydrate Counting / Beans and lentils I experimented with doing two half doses, 3 hours apart which worked better than a single dose of the full amount which led to hypos. I am also experimenting with a slower-acting insulin (not basal and not QA) which has an action time of about 6-8 hours but the jury is still out on that.

Aug 4, 2015 Pippa Mc 4 posts	Topic: Carbohydrate Counting / Beans and lentils Hello, I have a similar query related to butter beans - I had them in quesadillas mashed up and didn't account for these, as per DAFNE guidelines.. I just accounted for the tortillas. However at nighttime my BG was sky high.. whilst I haven't been very well so my BG readings have been slightly high I don't think that it would account for this. I suspect that mashing these up has impacted upon the way they are digested - has anyone else experienced this? I am thinking of trying half insulin dosage, unless anyone else has any ideas that have worked for them. Thanks,

Aug 3, 2015 michaelj 45 posts	Topic: Questions ? / High BG's after fracture Broke my foot on 1st July and my BS were all over the place for 2 days. Now moving around on crutches and thanks to the extra effort to get anywhere, bloods have more or less gone back to normal. Stick with it, it'll come right in the end. The body does all sorts of weird things in times of stress.