DIY DAFNE

I was reading up a little about dafne (Dose Adjustment for Normal Eating) yesterday, including an account of one person's experience of the introductory course which gave a pretty good overview of the approach. It surprised me in two ways. Firstly it made me feel pretty fortunate to have had the care teams I did when I was first diagnosed and in the early years. It was more than 20 years ago and at that time 'exchanges' were the thing (an exchange was a unit of 10g of carbohydrate - if you've come across dafne this will already be sounding pretty familiar). To keep things relatively simple to start with, the advice was to keep a standard set of doses each day, keep your mealtimes regular and of a measured amount of carbs. I never got on very well with premixed insulin as the requirement to have meals and snacks at precisely predetermined times each single day does not fit with any kind of life I know.

When I moved back to Bristol they quickly suggested I went on to basal-bolus 4 injection a day pen system. Much more flexible, they said. You could eat at different times if you needed to, or even miss a meal entirely in exceptional circumstances - suddenly getting caught in a motorway traffic jam was not a life or death crisis. If you wanted to eat slightly more, or less carbohydrate at a meal you could adjust the short-acting insulin dose accordingly. You were being your own pancreas. I suddenly felt much more in control of diabetes. At this stage the team were also telling me that people didn't really 'do' exchanges any more. People weren't being taught to be able to guess how many grams of carbohydrate are in that jacket spud. That some vague sense of relative proportions of food groups on the plate were the New Way. I remember thinking at the time that this made no sense at all. How hugely varied two rougly equal looking plates can be. How glad I was that I had been taught how to guestimate carbs from the beginning.

And that's the thing I think that really surprised me yesterday. Reading the account of the introductory course made me realise that I've been doing a sort of 'diy dafne' for years, long before it was developed as a course and hailed as the Next Big Thing. It appears, however, this is not a universal experience. The whole concept of basal-bolus was introduced to me in a dafne-type way. Why wouldn't it be? How else does it make any sense? I'd be interested to hear if anyone has been put on a basal-bolus system and not had that kind of introduction - matching the amount of carbohydrate you eat with your short-acting insulin doses, keeping a close eye on your blood glucose results, correction doses when you underestimate; something sugary when you overdo it. And if not... then just how they were advised to make it work.