This is Day 3. You can return to the Start here > DAFNE Course Review
Individual Dose Adjustment / Action Plans
The day begins with the whole group viewing each individual’s blood glucose readings and insulin doses on an overhead projector.
This is the first opportunity to see 48 hour patterns emerging. For many, there are exceptional events such as estimating CPs badly or needing to treat a hypo which prevents a pattern but where patterns exist decisions can be made. This is the essence of using DAFNE to establish good control over Type 1 diabetes.
The analysis concentrates on getting the morning blood sugar reading right so that the rest of the day is not spent compensating with insulin adjustments.
Phone a friend.
Where there is a 48 hour pattern for morning readings we can see where there is a need to adjust the night-time background insulin. If the night-time insulin is adjusted then we need to set the alarm for 3am to measure and ensure the levels are not too low. You don’t want a hypo in the night.
Several of us had to awake at 3am so if we needed to “phone a friend” at 3am we would know who else is awake. “Phone a friend” became a euphemism for wake up and measure at 3am.
Topic: Insulin sensitivity.
Improved control tends to increased insulin sensitivity and that means you end up needing less insulin. My own impression is that taking lower amounts of insulin gives a lower impact on your body so it should result in better control. That sounds like a virtuous circle.
Athletes are often more sensitive to insulin and there is a difference between sporadic intense exercise and lower impact but continous exercise.
Topic: Hypoglycaemia – Hypos.
This session includes partners or friends who would help manage hypoglycaemic episodes.
There is a slight difference in the level that DAFNE takes to define Hypoglycaemia than generally accepted. That level enables the DAFNE technique to work.
We talk about feelings of being hypo or recognising the beginning of a hypo. The blood glucose level at which you first feel hypo varies from day to day and if you have a recent history of high blood sugar levels you could actually feel hypo even when your readings are as high as 7 to 8 mmol/l.
We learn that hypos are divided into mild and severe depending on blood glucose levels. Usually hypos are self managed but they can also be assisted where medical help is needed possibly because of a loss of consciousness.
We list the symptoms of hypoglcaemia and they are many. Some of us have symptoms that others haven’t had so it is interesting to hear the list. For example one person cites blurred vision yet I had never experienced that with low blood sugar. Blurred vision is something I associated with high blood sugar before being diagnosed.
Healthy people can be hypo too but the consequences are very different. When they get below a certain level their liver releases its store of glucose in an orderly way and it is unlikely to run out.
In Type 1 diabetes the cause of a hypo is too much insulin for the amount of food consumed and we discuss the range of situations that could cause that to occur.
We are told the correct way to deal with a hypo depending upon the situation and time before the next meal is due. It is good to see people pulling out their favorite source of rapid acting carbohydrate some of which I didn’t know existed.
In the case of a severe hypo we are told about glucagon and how to use it and what to do afterwards.
Topic: Physical Exercise for Diabetes
This is a basic guide about the benefits of exercise rather than specialist information for athletes. Our group has a full spectrum of individuals in terms of age and fitness. We range from sedentary to very athletic. For managing diabetes for athletic exercise we are recommended to take a look at www.runsweet.com.
First we are told of some benefits of physical activity: using less insulin, better blood pressure, increased HDL cholesterol (the beneficial one), happy homones that increase the sense of well-being.
The effect of exercise on blood glucose level varies hugely between individuals so each person should discover for themself the effect and what action to take.
Advice cannot be specific because for some a walk around the block is exercise whilst for others it means a workout on a treadmill. The intensity and duration is so different that we need to discover our own situation. Some of us find that BG levels increase a lot during more intense exercise and insulin needs to be taken before a workout.
Generally exercise increases your blood glucose levels initially but lowers them over a longer period even into the next day. It pays to work out your own situation.
If your blood glucose levels go above a certain level we are advised to check for ketones and cease exercising if they are present.
We are given examples of scenarios to read out and we discuss the action that should be taken for the best control.
Topic: Nutrition 3, a look at example foods.
We examine a range of foods products to see how we would go about working out the CP amounts. This ensures we are all familiar with weighing foods and checking food labels for carbohydrate quantities.
This includes diabetic food products which although they can have quite substantial amounts of carbohydrate we can decide whether to discount them. Some diabetic foods have carbs you don’t count in the DAFNE regime.
NEXT: DAFNE Course Day 4