Dose Adjustment for Normal Eating (DAFNE) helps prevent hypoglycaemia (low blood glucose) in type 1 diabetes patients. The Department of Endocrinology at Singapore General Hospital explains how.
Learning to lead a normal life with diabetes
Mr Ashley Su, a paralegal, was diagnosed with type 1 diabetes nine years ago when he was 15. Some of his worst hypoglycaemic episodes, when he fell into a faint or a coma, occurred while he was asleep. For instance, one day after class, he felt really tired and took a nap at home unaware that he was in a state of hypoglycaemia.
“I was actually in a state of hypo. I was foaming at the mouth. My mum tried to wake me up but couldn’t. She was pretty scared. I had vague memories of her feeding me something sweet. I seemed to have been able to swallow, although I wasn’t conscious. I was fine when I woke up,” the 23-year-old recalled.
For people with diabetes, hypoglycaemia can occur when their sugar level suddenly drops. They may fall into a faint if the body’s glucose is used up too quickly, or when too much insulin – a hormone that is needed to convert sugar, starches and other foods into energy – is released into the bloodstream. In type 1 diabetes, sometimes referred to as juvenile diabetes because it is usually identified in children and young adults, the body does not produce insulin, and patients need several insulin injections daily to manage the chronic condition.
Regimented meal schedule
With regular insulin injections, diabetes patients follow a regimented meal schedule, eating at about the same time every day, and sticking to the same types of food to prevent their blood sugar or glucose levels from suddenly becoming too high or too low. For instance, if a type 1 diabetes patient does not eat as planned or eats too little after his insulin shot, he effectively suffers from an overdose of insulin, leading to the danger of hypoglycaemia.
Mr Su’s diabetes physician,
Dr Daphne Gardner, Consultant at the
Department of Endocrinology,
Singapore General Hospital (SGH), a member of the
SingHealth group, recommended the "Teach the Dose Adjustment for Normal Eating (DAFNE)" programme to him. Since joining the programme in April 2011, Mr Su has been able to manage his condition much better than before. He said his hypoglycaemic episodes – when his blood glucose level falls below normal – occur two to three times a month, much less frequently than the 10 or more occasions previously.
“DAFNE helps a lot. I can enjoy life now compared to the past. I can have anything I want and, with a bit of care, I just need to adjust the (insulin) dosage according to the food I eat,” he said.
The DAFNE programme imparts skills that type 1 diabetics need to match their insulin dosage to whatever they eat, whenever they want to eat it. Each class, which teaches a set curriculum over five full days (spread out over weekends and public holidays) allows for up to eight participants. It is free for SGH patients.
For more information on DAFNE,
Type 1 When there is too much glucose in the blood due to the inability of the pancreas to produce enough insulin.
Type 2 When the insulin that is produced by the pancreas is ineffective in controlling the glucose levels in the blood.
Genetics vs lifestyle
| ||Type 1 Diabetes||Type 2 Diabetes|
|Age of onset||Mainly under 40 years||Mainly over 40 years|
|Body weight||Usually not associated with being overweight||Commonly associated with being overweight|
|Causes||Genetic predisposition||Genetic predisposition, insulin resistance, insulin depletion, lifestyle factors|
|Triggers||Possibly viruses and infections||Obesity, insufficient exercise, drugs (like steroids), surgery|
|Treatment||Insulin||Lifestyle changes, tablets, insulin|