This is Day 1. You can return to the Start here > DAFNE Course Review
They say at the outset that the five day DAFNE course is only an introduction to the DAFNE programme.
One result of the education this week is that we will need less insulin by the end of it.
To begin, we introduced ourselves and gave a little history about ourselves. Different ages, different histories and different number of years with diabetes. Also a huge variation in insulin dosage. Different circumstances at the time of diagnosis, one person being in a high blood sugar coma for three days when diagnosed.
Normally the group is made up of 6 to 8 people, plus the diabetes nurse and a dietitian. Our group was bigger with at least 150 years experience of Type 1 diabetes between us.
The week comprises sessions on different topics interspersed with routine sessions of estimates and analysis of each individual’s own estimations and blood glucose (BG) measurements.
Topic: What is Diabetes?
We all think we know what diabetes is but it is surprising what we forget. This topic gave a bit of history and modern trends.
For example nowadays there are a significant number of people whose pancreas deteriorates gradually and eventually someone who is originally diagnosed as Type 2 becomes Type 1. There is a tendency to describe the intermediate state as “Type 1 and a half”. Strangely enough in the first year of my diabetes one doctor said my symptoms were confusingly between Type 1 and Type 2 so when I suggested “Type 1 and a half” I was only joking.
This topic introduced things that were new to many of us. For example I hadn’t heard of the diabetes honeymoon period where beginning insulin treatment provides relief for the overstressed beta cells of the pancreas such that it appears for a limited time that there is some recovery of the pancreas. That is a temporary effect and not everyone experiences it.
Topic: Nutrition 1
Reminder of the main components of food: Carbohydrate, Protein and Fat.
The cornerstone of DAFNE is to gain knowledge of the amount of carbohydrate in different foods and their varying portion sizes. Ten grams (10g) of carbohydrate is called a Carbohydrate Portion (CP) and from this point on we talk about CPs.
The speed at which food is absorbed (glycaemic index) is mentioned but we concentrate on total carbohydrate quantities in foods and don’t take into account the sugar content of that carbohydrate as printed on food packets.
CP estimation, insulin dose adjustment and lunch.
On the first day lunch is provided. We are given a choice of food and we estimate the CPs and choose an insulin dose based on the CPs with a possible adjustment up or down depending on the current blood glucose (BG) level and a ratio figure. We are each given our own ratio based on our measurement history and the HbA1c measurement made a few days before the course.
We are told the target BG levels that are ideal before a meal so that we can work out the adjustment of insulin to compensate for our current BG level being different from the ideal. If our estimates are correct then our insulin dose should take us to the target level by the next meal time.
The ratio is the number we use to multiply the CP figure to get the dose. The ratio depends on the individual’s BG history and HbA1c. This can be from 1 to 3 in steps of 0.5 and the figure can be different for each meal time with the breakfast often needing a higher ratio.
This ratio figure is an adjustment for the insulin sensitivity of individual. Repeated tests throughout the week will allow the best ratios for each of us to be established.
The effect of this first estimation and the next one for this evenings meal will be analysed and discussed at the beginning of Day 2.
Topic: Diabetes control targets.
A talk about good control and HbA1c measurements. Monitoring techniques including finger pricking and injections with samples of 4mm needles that avoid injecting muscle areas. Injection sites and insulin storage and lifespan.
A look at the range of blood glucose meters with the opportunity to choose a new one. We were shown an insulin inhaler and an insulin pump.
The first day is pretty intense and covers a lot of ground. For me it is a revelation that it is possible to greatly improve control over Type 1 diabetes. After all these years of guesswork, at last something concrete.
NEXT: DAFNE Course Day 2