This is Day 2. 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. We have each marked up our own transparent acetate with our diary details so that we can discuss what we ate, what activities we did, and how we reacted to our measurements.
You might think it could be embarrassing to discuss your own blood sugar levels in front of others but it didn’t seem to be a problem to anybody. The range of levels and insulin dosage was surprising with some establishing excellent figures on the second day and others struggling with high blood glucose levels and high insulin dosage as well. Those with the worst figures stand to benefit hugely from improved control.
The course leaders advise on ratios of insulin to Carbohydrate Portion (CP) and on background (slow acting) insulin. This is the start of the valuable feedback we get on our ability to count carbohydrate (carbs) in our food and judge the required amount of insulin.
As well as the insulin ratio we also look at the background insulin which most of us take before bed. This shows us the huge range of individual situations with some on levels of say 9 units and others on 50 units. Surprisingly some on 50 units of night time insulin had been advised to drop from levels of 90 units in order to work out the DAFNE regimen.
Topic: Insulin Regimen.
We look in some detail at different types of insulin available and how they are used.
For example a lot of us take Novorapid for our quick acting insulin and that usually lasts for about 4.5 hours before tailing off rather quickly but bigger doses can last longer.
Knowing that, we can be pretty certain that any insulin influence more than 5 hours after injecting Novorapid is likely to be from the background insulin dose. Before the DANFE course I had no idea about that and it wasn’t part of my thinking. I began to realise that before the DAFNE course my good control was comparatively haphazard.
A lot of us take Lantus for our slow acting background insulin and that lasts for about 23 hours. Some take this at night, some in the morning and some twice a day.
Getting your background insulin dose right means you should be able to go throughout the day without eating because the dose should equate to the normal level of insulin in a fasting healthy person. There is of course no recommendation that you to stop eating. That’s simply a way of telling you that there is a right dose level for each of us.
We discussed the dawn phenomenon in which hormones kick in when we wake and the liver releases stored glucose to help us start the day. This means blood glucose readings can be expected to to be higher in the morning.
The insulin honeymoon period is where the pancreas appears to recover when insulin is taken for the first time. It is as if the injected insulin allows the pancreas to relax to the point where it for a short time is able to become more productive.
Some of us need a higher insulin / carb ratio at breakfast whereas others don’t. We will decide on this throughout the week as we gather measurement data.
The DAFNE Step-Wise Approach is the technique of recognising a problem over a 48 hour period and if known possible causes can be excluded then either the ratio of insulin dose to carbohydrate can be changed or the background insulin dose can be changed to see if that alters the pattern. If you think that is complicated, it isn’t. Just do the DAFNE course to find out!
Topic: Nutrition 2
CPs (carbohydrate portions) of foods.
We are shown a range of food items and we are given the exercise of working out the CPs using the CP book which in many cases tells us the CP values for particular portion sizes and also for particular weights.
This is a matter of working out which foods contain carbohydrates that you need to count, foods which contain virtually none and those which contain some but for the DAFNE technique you don’t count them. The CP book is useful for many foods but for other foods it is worth looking at the carbohydrate figure in the packet to work out then number of CPs you are going to eat.
For example, for baked beans the beans are treated as zero carb but the tomato sauce is counted. The ingredients section on the package tells you the total carb but the beans have such a low glycaemic index you need to disregard the beans but count the sauce. The DAFNE course makes you aware of that and how to deal with it.
Can you snack between meals without insulin? If so how big a snack? When would you add the snack CPs to the next meal’s figures? Snacks for control when exercising or doing a physical activity.
Snacks before driving or travelling to ensure hypo’s don’t occur.
NEXT: DAFNE Course Day 3