# How do I get on DAFNE?



## tracey w (Nov 24, 2008)

Hi,

How do you get to go on DAFNE course. Ive been type 1 for nearly a year and feel it would benefit me greatly. With all the good things I have heard about it.

However my doctor, consultant and diabetes nurse have never mentioned it. I have a hospital appointment in a couple of weeks, is this when I should mention it? And what sort of things would make a good case? How do they decide who gets on? Any advice appreciated.


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## aymes (Nov 24, 2008)

Hi Tracey

Unfortunately access to DAFNE can be quite patchy dependant on where you live. If you go to the DAFNE website (just google dafne and it should be the first one) they have a list of where the course is run. If it is run by the health Trust where you are a patient the next thing is dependant on funding, how many people they can put on it depends on how much money they have so  the rules for how they decide will vary according to area. For where I live the rules were that you had to have been diagnosed for at least 2 years (to make sure you're not honeymooning) and have an a1c under 12. They also wanted to see that you were willing to work at your control so I guess a willingness to learn, keeping a diary up to date, testing when you should etc!

Definately worth asking at your appointment, I'd highly recommend it and everyone I've spoken to about it though it was great.

Good luck, let us know how you get on!

A


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## Lizzie (Nov 24, 2008)

Hi Tracey

Aymes has really good advice. Also, some hospitals run courses but do not call them DAFNE. For example, in DAFNE you have to get a whole week off work (5 consecutive weekdays) which is hard for some people. So some centres choose to run their courses on 5 consecutive weekends, for example. So ask your diabetic team about any course they run, not just DAFNE. Also someone posted a link to an online education course in an early discussion, I can find it if you want. It includes all the DAFNE skills. But you miss out on meeting other diabetics which some people find very helpful. These skills like carb counting can be learned from your diabetic team but a lot of teams just do not teach them, plus the intensive educational setting of DAFNE is helpful (you have 5 days to only think about diabetes, whereas for appointments you have about 15 minutes).


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## jax (Nov 24, 2008)

I'm desperate to get on a DAFNE course too. I asked at my hospital, where I have my diabetes clinic; they don't run one, and they can't refer you to other hospitals for it.

Apparently you can only go on a course if its at a place where you receive 'routine treatment', however the only hospital in Glasgow that offers it, doesnt have a diabetes clinic, and only provides diabetic services for those being admitted and diagnosed.. which doesn't sound like routine treatment to me.

I'm going to asking about it again with my GP on Wednesday to see if they can refer me to a hospital for it (which I'm a little doubtful of, but no harm in asking), or if there are any other courses around here.

If anyone has any luck getting on a DAFNE if there hospital/centre doesnt offer it, I'd love to know how


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## tracey w (Nov 24, 2008)

Thanks guys!

I will do some more research on it, and will be asking at my next appointment. But really it should be offered to everyone who wants it. Usual story y the sound of it, postcode lottery. Good luck to all trying to get on it. Will keep you posted.


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## tracey w (Nov 24, 2008)

Just checked the website and my hospital is one of the sites that do it, its a start.

think its a shame if I have to wait another year before being considered though. Just to get educated on my own disorder.


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## Daisy (Nov 24, 2008)

*Good luck!*

I really hope you get on the course - It's ridiculous - we are told to take responsibility and when you try to - the doors are slammed in your face!
Argggghhhhhh! 
I have never been offered a DAFNE course - in 35 years! But it is the method I use by common sense and what they first taught to my Mom all those years ago!


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## AlanJardine (Nov 24, 2008)

When I asked one of my DSNs about DAFNE, I was told they don't run it, but they can make arrangements to see their dieticians. Never did get a referal though.

Last clinic at the hospital was useless. Wanted to speak about increasing the concentratin of insulin I use or maybe even going on a pump. The doctor (not even a specialist) was impressed by my knowledge of DM, but then just went into a spiel about daily exercise. No consideration about any other health issues such as back problems, or how to actually fit in any exercise into an already busy schedule.


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## Northerner (Nov 25, 2008)

Lizzie said:


> Hi Tracey
> 
> Aymes has really good advice. Also, some hospitals run courses but do not call them DAFNE. For example, in DAFNE you have to get a whole week off work (5 consecutive weekdays) which is hard for some people. So some centres choose to run their courses on 5 consecutive weekends, for example. So ask your diabetic team about any course they run, not just DAFNE.



My clinic did a course which took place one day a week, over 4 weeks. We had talks from a podiatrist and eye specialist, plus a carb-counting introduction. It was very good, and good to meet fellow diabetics. Most were newly diagnosed, but one person had been Type 1 for several years and came away learning a lot from what had changed since his diagnosis - for example, his meter was out of date and not working properly, plus he only took account of sugar content in foods, not total carb content.


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## isabeau (Nov 27, 2008)

As far as I could gather, there are not that many DAFNE courses running in the UK at the moment.  Far too few for the number of diabetics anyway!  I only now realize how lucky I was to go on a course!  Also, as far as I know, there is just one DAFNE trained diabetic consultant in Thanet, the area where I got my training.    Maybe if more diabetics put pressure on government, their own GP's, hospitals, dieticians etc, they will train more people to run courses.  I have an appointment with my consultant tomorrow, and will make it clear that I think it is a fantastic course, and could save the NHS/government millions by empowering diabetics to have better control.  Leading to fewer complications...  Prevention is better than cure, and since there is no cure for diabetes, surely prevention of complications makes sense...


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## Lizzie (Nov 28, 2008)

"Also, as far as I know, there is just one DAFNE trained diabetic consultant in Thanet, the area where I got my training."

I think this is a problem. The nurses and dietitians seem to run the courses and they are great. But on my DAFNE course the consultant just dropped in for a few minutes to answer questions and seemed to be treated like a minor deity - throughout the week, if we did not know something, the nurses always told us to ask the doctor as if they would know better than us and better than the nurses just because they read a book many years ago. I thought it was supposed to be an exchange of knowledge, not the same old same old 'doctor-knows-everything' approach. The doctors should be learning from us as well as us learning from them.

"Maybe if more diabetics put pressure on government, their own GP's, hospitals, dieticians etc, they will train more people to run courses."

I agree 100%. There is information on the DAFNE site here http://www.dafne.uk.com/scripts/typeonediabetes/gettinginvolved.html and a leaflet here http://www.diabetes.nhs.uk/downloads/structured_patient_education_diabetes_leaflet.pdf to print and show your doctor what they should be providing in terms of structured education.


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## stute (Nov 29, 2008)

I have now got inject my self at mealtimes using the carb counting method, this to me is similar to dafne method , juat my opion.


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## xbethanyx (Nov 29, 2008)

edinburgh infirmary runs a one day course which i cant remember what they called it... would glasgow refer a patient through to edinburgh for it maybe?


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## sofaraway (Dec 1, 2008)

I wanted to go on the course that my clinic runs, which is very similar to DAFNE but called something else. But told that i can't go because I ahve MODY. I've taught myself to carb count but it would have been nice to go on the course


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## VBH (Dec 1, 2008)

While you're nagging your PCT to provide DAFNE, in the meantime you might want to check out BDEC and in particular their online courses:
http://213.105.192.75/bdec2/index.shtml


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## Viki (Dec 1, 2008)

*DAFNE Advocate*

Sorry to here you are having probs getting on DAFNE. My advice is dont give up. 

Id been diagnosed almost a year to the day when i did a 5 day DAFNE course. It completely changed my control and attitude towards having diabetes.

The staff that ran mine were fab but the opportunity to meet people with the same condition and experiences was empowering. Ive been following DAFNE a year now and Im in no way a perfect diabetic but i am far more knowledgable and confident about dealing with the hiccups!

Ive spoken to people that havent done it who say that theyve been carb counting forever so dont need to do it, but you learn so much more that just how much insulin to have with a certain meal. It covers adjustments to make for illness, alcohol consumption, excercise and anything else you might want to do!

Sadly i have found with other aspects of my care that in some places the people who shout the loudest tend to get what they want/need. So keep going, ask everyone and dont be afraid of being a bit demanding. Its your condition and you deserve access to the knowledge that can imrpove your short and long term control.

(PS. My proven use of DAFNE theory also helped my consultant make a case for a pump for me, and that was because i asked him for one!) although im still waiting to find out if ill get funding.

Good Luck x


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## tracey w (Dec 1, 2008)

Vicki good luck with funding for your pump! Thanks to everyone for all your advice, see consultant on 18th and will be asking questions then. let you know what happens

tracey


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## tracey w (Dec 18, 2008)

Hi guys,

Just thought Id let you all know how I got on at clinic today.

Am going on to basal/bolus regime, which I am quite happy about, AND

am on the list for the DAFNE course!!!

My diabetic nurse was so impressed with my motivation and knowledge about foing onto basal/bolus (which I must say have learned everything from reading the posts on this forum!!), she asked me If id heard of DAFNE, before I even mentioned it.

looking forward to changing regime and doing the course in the new year. 

Thanks for all your advice


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## aymes (Dec 18, 2008)

fantastic news, you really will get so much out of it. I've always found that going to appointments armed with a bit if knowledge always means I get so much more out of it so good for you!!


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## sofaraway (Dec 19, 2008)

thats great news Tracy, It'll be alot of work but I persoanlly think it's definatly worth it.
which insulins will you be using?


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## tracey w (Dec 19, 2008)

I will be on humalog and humulin i.

will start new years day, as very busy at work right now (retail) and the nurse wants to make sure people around for me to talk to regularly.  Cant wait, and really looking forward to the course. 

I take humalog 25 at present so hopefully wont get any problems as Im not changing type of insulin.


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## sofaraway (Dec 19, 2008)

Hope it works out for you. Sounds a good idea to wait until the new year so your nurse will be around to help you out with dosing. Mine was resulctant to start me on a friday afternoon, so she gave me her mobile number for the weekend. 

Are you having to 'feed' your current insulin by having snacks between meals?


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## tracey w (Dec 19, 2008)

sofaraway said:


> Hope it works out for you. Sounds a good idea to wait until the new year so your nurse will be around to help you out with dosing. Mine was resulctant to start me on a friday afternoon, so she gave me her mobile number for the weekend.
> 
> Are you having to 'feed' your current insulin by having snacks between meals?



not really. I was doing ok on twice daily until I started working shifts a couple of months ago. Cant seem to get it right now, always really high in the afternoon so much so often dont eat lunch! But if i try to compensate with my morning insulin I get really  low 1 -2 hours after and then end up having 2 breakfasts. My days off are fine but not when working! Working in the evenings can be problematic to. If I take too much then I have really low night hypos and too little again sugars high in the morning, very frustating


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## sofaraway (Dec 19, 2008)

think you will do much better on basal bolus as you should be able to overcome those problems, by adjusting each dose to need. as you ahve founf on a mix adjusting for one meal will affects all other readings.
 Just have a look at the action profile of humulin I, it's not a particulary flat basal insulin, but it does suit some people better.


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## tracey w (Dec 21, 2008)

sofaraway said:


> think you will do much better on basal bolus as you should be able to overcome those problems, by adjusting each dose to need. as you ahve founf on a mix adjusting for one meal will affects all other readings.
> Just have a look at the action profile of humulin I, it's not a particulary flat basal insulin, but it does suit some people better.



thanks,

when you say not a flat insulin, do you mean that it has a peak? The dns told me that if i take at bedtime it should peak around breakfast as most peoples readings go up naturally then due to hormones.


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## sofaraway (Dec 22, 2008)

tracey w said:


> thanks,
> 
> when you say not a flat insulin, do you mean that it has a peak? The dns told me that if i take at bedtime it should peak around breakfast as most peoples readings go up naturally then due to hormones.



yes it does have quite a peak, in comparision with lantus/levemir. 
yeah thats true and a reason why people use it at night to combat dawn phenomenon (where the blood sugar rises in the morning).

Really it should be given twice a day to provide full basal coverage as it only lasts around 12 hours.


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## tracey w (Dec 23, 2008)

sofaraway said:


> yes it does have quite a peak, in comparision with lantus/levemir.
> yeah thats true and a reason why people use it at night to combat dawn phenomenon (where the blood sugar rises in the morning).
> 
> Really it should be given twice a day to provide full basal coverage as it only lasts around 12 hours.



Hmm, wonder why they are putting me on this as my bs are usually good on waking 4-5? 

She did say there were other insulins she could put me on but asked me a few personal questions and decided to go with this one. But now i am worried i may hypo after breakfast. you are very knowledgeable about insulins, do you mind if i ask you if you are in the medical profession? It is good to get such great advice on here though, thank you.


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## sofaraway (Dec 24, 2008)

http://www.rajeun.net/images/Lantus.gif

Should take you to a picture of the action profile so you can see when it peaks. 

You said in a previous post if I remember right that you are often high at lunchtime, it might be that the peak will help you be in range at lunchtime coupled with an accurate humalog dose will prevent you having hypo's after breakfast.

by increasing your humalog mix dose to try and control the lunchtime reading you were going hypo after breakfats because you were having to increase both short and long acting insulin at the same time. having the long and short insulins seperate means you can adjust each dose seperately. 

and don't forget that you were already on both these insulins (just mixed together) and these worked well on the days you weren't working. 
I'm sorry if I have worried you in any way, not my intention at all.

I've been around forums for a while so have absorbed alot of information (i know a fair bit about pumps for example having never used one)


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## tracey w (Dec 29, 2008)

sofaraway said:


> http://www.rajeun.net/images/Lantus.gif
> 
> Should take you to a picture of the action profile so you can see when it peaks.
> 
> ...



thanks, things becoming a bit clearer, does make sense what you have said. sure it will work out well once I have got the doses right, fingers crosssed.

just a little confused at graph? Is lantus same as humulin I? When i go on the dafne course will they tell me how to compensate for the peak of the insulin and carb count? I think my brain is gonna hurt real bad, but cant wait to get to grips with it all!!


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## sofaraway (Dec 30, 2008)

well I reckon when you go on DAFNE you'll know loads more now than compared to when you first joined this site. they should go everything with you and work out ratios for you to start with, i've heard good reports, however not been myself.

on that graph, sorry should have explained better, the solid flatter line is lantus, humalinI is like the NPH the dotted line with the pronounced peak. 
there is a member here copepod who using humalin I maybe they could chip in and give some personal advice.


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## tracey w (Dec 30, 2008)

sofaraway said:


> well I reckon when you go on DAFNE you'll know loads more now than compared to when you first joined this site. they should go everything with you and work out ratios for you to start with, i've heard good reports, however not been myself.
> 
> on that graph, sorry should have explained better, the solid flatter line is lantus, humalinI is like the NPH the dotted line with the pronounced peak.
> there is a member here copepod who using humalin I maybe they could chip in and give some personal advice.



thank you, still worrying me that big peak though!


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## piggie 101 (Dec 30, 2008)

hi my name is hannah im 19. i have done the DAFNE corse it is well worth doing. i would say that u need to talk to your diabeties nurse. i have found with the DAFNE corse it give you the freedom to feel semi mormal with what you eat as you can eat what you like as long as you stick to your ratios. hope this helps


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## tracey w (Dec 30, 2008)

piggie 101 said:


> hi my name is hannah im 19. i have done the DAFNE corse it is well worth doing. i would say that u need to talk to your diabeties nurse. i have found with the DAFNE corse it give you the freedom to feel semi mormal with what you eat as you can eat what you like as long as you stick to your ratios. hope this helps



thank you, im sure it will help me loads, wont be for quite a few months yet though. the course that is, start my basal/bolus in couple of days and sure things will be better after that. Started new job today and was soo hard to concentrate as was between 11 an 16 all afternoon until tea time. and you cant explain to people how you feel can you?! At other times I can drop loads in 30 minutes. rambling now, anyway thanks again for all help on this forum, much appreciated.


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## Copepod (Dec 30, 2008)

*Humalin I - splitting doses AFTER ADVICE*

When I mentioned occasionally waking up with low blood sugar in the wee small hours or at normal waking hours, and reporting not liking eating late at night and a sometimes irregular lifestyle my DSN suggested splitting my Humalin I dose, into 2 equal doses. Note it's important to give information like that to obtain appropriate advice -otherwise I think he might had suggested a late night snack. This worked well for me, but I wouldn't have even thought of it without his suggestion. The regime suits me particularly well as I sometimes work some very odd hours eg manning checkpoints through the night, sometimes several nights in a row, during expedition adventure races, with unpredictable periods of exercise eg moving 10s of large boxes, bikes, kayaks etc, so having 2 chances in each 24 hours to adjust basal dose is helpful. Not that you have to do odd things like me to find it worth considering discussing this with your DNS or other professional advisor who knows you.

But I still haven't managed to fit in a DAFNE course, although speakign with some who had done it and a dietician who runs it helped. I'm on the waiting list and a reserve in case of cancellation.


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## tracey w (Jan 1, 2009)

Copepod said:


> When I mentioned occasionally waking up with low blood sugar in the wee small hours or at normal waking hours, and reporting not liking eating late at night and a sometimes irregular lifestyle my DSN suggested splitting my Humalin I dose, into 2 equal doses. Note it's important to give information like that to obtain appropriate advice -otherwise I think he might had suggested a late night snack. This worked well for me, but I wouldn't have even thought of it without his suggestion. The regime suits me particularly well as I sometimes work some very odd hours eg manning checkpoints through the night, sometimes several nights in a row, during expedition adventure races, with unpredictable periods of exercise eg moving 10s of large boxes, bikes, kayaks etc, so having 2 chances in each 24 hours to adjust basal dose is helpful. Not that you have to do odd things like me to find it worth considering discussing this with your DNS or other professional advisor who knows you.
> 
> But I still haven't managed to fit in a DAFNE course, although speakign with some who had done it and a dietician who runs it helped. I'm on the waiting list and a reserve in case of cancellation.



thanks for advice, have started regime today so first humulin I tonight. will have to see how I go, but what you said about splitting does make sense. I work shifts and do exersise. but dont have a particular physically demanding job such as yours sounds! I think they probably start you on one dose initially to see how you go maybe? Its difficult to get out all info on hospital visit about your lifestyle as it changes doesnt it. Most of us dont have a regular pattern of work, especially shift work and I like variety in my diet, not same old same ole every single mealtime. Challenging, will of course be speaking to dns over next couple of days. thanks again


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## piggie 101 (Jan 2, 2009)

i realy hope you get on the DAFNE corse soon its changed my life and i hope it will do the same for you. please keep us posted and let us no how you get on with it good look!


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