Have "amber" colour for just-over BG

19 posts, 6 contributors

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thebatoutofhull DAFNE Graduate
Sheffield Teaching Hospitals
60 posts

I ran a similar idea by the team, l think it was last year and got a +ve reply. However nothing has changed yet. This would help me when I see my G.P. I take my ipad with me and show the graphs. She seams somewhat alarmed at the amount of bad/high results. In fact a lot are in the 7.6 to 10 range. I get ten minutes with her. Most of which is used explaining. This is wasted time / money!!

Podarcis You have my full support.

Diabetes is not red and green, Life is not red and green, DAFNE online is!

Any one on the development, team this is an idea worth pursuing. It still allows the official DAFNE bands to be displayed (which you can change yourself anyway) but also gives greater depth of information to doctors.

This idea is not going away.

thebatoutofhull DAFNE Graduate
Sheffield Teaching Hospitals
60 posts

'the DAFNE programme or course which is generally what people on this site are looking to follow' marke site admin.

This site is excellent and truly has made a huge difference to my diabetic control. However users willingly follow the DAFNE programme. There has to be scope for change and innovation! You talk of evidence over opinion. I agree but where is your evidence that users of this site would not want to follow the 'DAFNE programme' with alteration? From 2000 the DAFNE approach HAS changed. New terminology and tweeks have been implimented, I have had to re learn recently, changes put into practice.

The DAFNE ethos is about choice and adaptability. ADJUSTMENT for normal eating.

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

Just out of curiosity, what recent changes had you to re learn?

I would be interested to hear them...... Very Happy

marke Site Administrator
South East Kent PCT
659 posts

There IS scope for change and innovation, the DAFNE programme is constantly evolving. I am on the DAFNE User Action Group committee that tries to do this. However as I said change needs to be backed up by evidence not opinion, opinion drives the change by getting research to provide evidence. Yes the majority of people on this site would probably support change however this is NOT the majority of the people who have done the DAFNE course its the minority. I am happy to discuss the idea of banding with the DAFNE Programme team but I'm sure their position would be the same as me, it would only be done after research to understand the effect it hasa on peoples control. Thats not to say Simon won't add it to the site, it merely would not be supported by DAFNE until they have gathered evidence of its benefit. It may well benefit some people on this site but may just confuse others and the DAFNE Programme is for all.

thebatoutofhull DAFNE Graduate
Sheffield Teaching Hospitals
60 posts

Thank you for your reply. So how can we argue the case for change? I clearly see benefits for me, but understand my opinion may not be shared by others.

marke said:
There IS scope for change and innovation, the DAFNE programme is constantly evolving. I am on the DAFNE User Action Group committee that tries to do this. However as I said change needs to be backed up by evidence not opinion, opinion drives the change by getting research to provide evidence. Yes the majority of people on this site would probably support change however this is NOT the majority of the people who have done the DAFNE course its the minority. I am happy to discuss the idea of banding with the DAFNE Programme team but I'm sure their position would be the same as me, it would only be done after research to understand the effect it hasa on peoples control. Thats not to say Simon won't add it to the site, it merely would not be supported by DAFNE until they have gathered evidence of its benefit. It may well benefit some people on this site but may just confuse others and the DAFNE Programme is for all.

marke Site Administrator
South East Kent PCT
659 posts

Well I can raise the issue at a DAFNE User Action Group meeting with regards to the DAFNE Course but that is NOT the same as this site which is not part of the DAFNE Programme and is run outside of it. That said we have to abide by the rules set down by the DAFNE Programme to a degree. I think I am guilty of confusing people here, apologies for that. People seem to be approaching this from a different angle to me. I will try to explain again what I mean.

Currently the graphs in the Diary pages shown anything outside the 'standard' DAFNE range as red. This is because years of research into Diabetes and DAFNE have shown that if you keep your BG within that range you substantially reduce the chances of you having complications. This research is what I refer to as 'evidence'. There has been no research, as far as I am aware, on the risk of complications in a range above this say 7.5 - 11, this is the range people are suggesting should be shown in yellow. If we as a site show this range in yellow we are suggesting to people that there is less danger being in this range than the red range, however there is no evidence to back this up. A number of posts seem to be looking at this from a 'one off' point of view i.e if I have one reading above 7.5 then its not a problem since I can correct to bring it back in range. I agree for a one off that is ok however at what point do the number of readings in the yellow range constitute a 'red' situation i.e an increased risk of complications. This is the root of my concern, NOT one off readings but the average being outside the range. In addition everyone is different so an average of 8.0 for some people could be a 'red' situation where as for others it could be fine. This is why I am not convinced that this is a good idea and would not be comfortable with it being implemented without consultation with Medical experts rather than just graduates which is what we all are.
If people can come up with a good reasoned arguement to justify this I am happy to take it to the DUAG and DAFNE Programme even if I don't personnally agree with it. However I think it needs more discussion with a wider range of people on the site to produce a good concensus.

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

marke makes good points there............

there would be no point changing things and opening up a can of worms just so folk using the online diary can have something more appealing to look at and make them feel better about their control.......it would be easier to remove the colour coding would it not.........the main concern is the 7, 14, 30 and 90 day averages........ Wink ............[obviously minimal spiking is good too......]

I initially thought it would be a good idea, but I can see the points made by marke make sense........

Podarcis DAFNE Graduate
Darent Valley Hospital, Dartford
14 posts

Mark - I understand what you are saying about medical evidence. But, you must accept, there is also no medical evidence that contradicts the common-sense view that a BG that often goes into the 7.5-10.5 zone but rarely above 10.5 is less likely to lead to complications than one that often goes above 10.5. What is more, I very much doubt that any evidence will be found if it were investigated, because the common-sense view is almost certainly right. And that is why most of us feel it would be a useful addition to the DAFNE Online web site records and the phone apps. Good for you that you're prepared to support us even if you have reservations, and I hope you find support when you do take it forward.

We should consider this fact, that IS recognised by medical authorities, that there is a danger, as my Diabetes Nurse tells me, that keeping BG too low leads to hypo unawareness (something I have suffered from and am trying to overcome with the aid of DAFNE). She is quite happy for me to have a significant number of BG readings slightly above the target range (but not way above), and it is that fact that prompted me to make this "yellow" suggestion. It would support me in trying to achieve what my nurse is advising me to do.

thebatoutofhull DAFNE Graduate
Sheffield Teaching Hospitals
60 posts

A graph is easier and quicker to understand than a list of numbers.

It is instant. My GP follows a graph quickly. It is her I want to get my information across to.

I want to show her I am improving or not improving my control by comparing two or more graphs.
Even if my control improves significantly the target charts can still look the same.

So maybe we leave it as it is.

I have 2 ideas. 1) Can some one tell me how I should use the current graphs/charts to effect change with a view to improve my diabetes management? I normally use the tables but there must be a reason for the graphs.

2) Lets have a new chart. A pie chart like the target chart but with no fixed section markers to adhere to. A Blood Glucose pertentage chart. Simply 1m/mol through to 40m/mol. Done over a fixed period of time. It would not under mine the DAFNE charting system but it would state the FACTS as a percentage. It could be a rainbow of colours graduating dependant on BG results. It could work beautifully in tandem with the target chart.

The BG% chart would be a great motivational tool balanced by the structured target chart.
Let me know what you think. Is there any mileage in this?