This is the first of a number of postings I'm going to write on the topic of improving the control of diabetes.

I've had type one diabetes for thirty-three years.

I've been lucky: nobody has ever considered chopping off my feet because of poor circulations; my kidneys seem to be working fine; I haven't needed laser treatment to prevent me going blind due to retinopathy... and I haven't had a heart attack. (Although, to be honest, I'm not sure whether the tests my doctors do would necessarily disclose macro-vascular problems before I had a heart attack).

Genetic Luck?

I suspect my good health may well be partly due to good luck: some people may be more likely to develop complications than others based on their genes. So I don't want to sound superior when I describe my state of health.

And Good Control

However: anybody who has diabetes (especially those taking insulin) knows that some days they manage get better results than others.

The degree to which you take control of your life can make astonishing differences to how your outcomes. No matter whether you got a good or a bad set of genes, you can do a lot to improve your control.

First Step: Deciding to take control

The first step is to decide to improve your control. At different times in your life you'll be more or less ready to take the effort. I've always paid a fair bit of attention to my control over the 33 years, but there were long periods of time when I was fairly slack. A little over two years ago I decided I was ready to take my control to a better level.

If you're ready to do that, then please read my postings on this topic.

Second Step: Knowing what to do

I've "known" how to look after my diabetes since I was 12. As I sat in hospital for days whilst I was being stabilised, I was old enough to read and (with sufficient time) understand most of the information that was placed in front of me describing diabetes. I was helped by my mother who carefully cut one crust off each slice of bread in my sandwiches (so they were exactly 'one portion' each) and who made sure I did each and every urine test (two per day!) to measure my control. With that knowledge I managed to get control that was "pretty good": HbA1c readings of about 7% or a little lower. My specialist was happy with this and told me that any person with diabetes who got lower levels (eg normal readings of 6%) only did so by having "heaps of hypos". The implication was that I shouldn't try harder.

Over the last couple of years I've disproved that. My HbA1c readings are now down around 5.3-5.4%. And I feel more in control than I have at any time over the last 33 years.

I'm not the only person with diabetes who can do this: there are other people who have achieved results that surprise most medical professionals/diabetes educators. On average, people with diabetes are getting better at control (and complications less frequent). With the correct approach you can get ahead of the curve. Here's how I did it.


This is my acronym. It stands for Dose Adjustment With Modified Eating and Tons of Testing. It's a variation I've come up with that partly incorporates one part of my tighter control: DAFNE plus some other stuff.

There are the three components to my changed control:

  • I attended a five day course following a program called Dose Adjustment for Normal Eating (DAFNE)
    Although I already counted carbohydrates and adjusted my insulin, I did so in a fairly unstructured way. By following this approach (which is taught in Germany, the UK and Australia), I developed a much better approach which revealed serious problems with my previous approach. It was necessary but not sufficient for my tight control.
  • Modified Eating
    The control given to my by the DAFNE principles showed to me that some meals gave me a heavy carbohydrate loadings that sent my blood sugars unacceptably high almost every day of the week. Some people advocate huge reductions in carbohydrates to get good diabetes control. I've only found it necessary to make some minor changes to my eating habits (that I will describe).
  • Tons of Testing
    Even with the DAFNE principles and modified eating, many things can throw your diabetes control out of whack. I've now made measuring my glucose - and keeping scrupulous records - a regular part of my day.

Stay tuned for more information.

Second posting: DAFNE

(By the way: I'm not a doctor. I'm not providing medical advice. I'm describing my own experience. If you are making changes to your diabetes management, do so with care and consult your health professionals if in doubt. I can't take responsibility for any action you might or might not take.)

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Anthony Holmes May 24th, 2009 11:46:12 PM

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