DAFNE Study Notes

What are the DAFNE target glucose levels before breakfast?

5.0–7.0 mmol/L

What are the target glucose levels before other meals?

4.0–7.0 mmol/L

What is the bedtime glucose target?

5.0–9.0 mmol/L

What is the recommended overall glucose target range?

3.9–10.0 mmol/L

What does “time in range” mean?

Glucose levels within the defined target range

What does QA insulin stand for?

Quick-acting insulin

What is QA insulin used for?

Cover carbohydrates and correct glucose levels

QA insulin onset, peak, and duration?

Onset: 5–15 min; Peak: 50–90 min; Duration: 2–5 hrs

How long does QA insulin stay active in the body?

~4 hours

What does BI insulin stand for?

Basal insulin

What is the role of basal insulin?

Maintain glucose levels when not eating

How often should basal insulin doses be spaced?

At least 7 hours apart

Which basal insulin lasts the longest?

Tresiba (~42 hours)

How much does 1 unit of QA insulin lower glucose?

2–3 mmol/L

How much does 1 carb portion (10 g CHO) raise glucose?

2–3 mmol/L

What value is usually assumed for calculations?

3 mmol/L

What is the maximum correction dose allowed?

4 units QA

Why should you avoid correcting between meals?

Risk of insulin stacking

Why should you avoid correcting before bed?

Risk of nocturnal hypoglycaemia

When should you NOT correct high glucose after hypoglycaemia?

• Mild hypo → wait until next meal

• Severe hypo → wait 24 hours

When CAN you correct between meals?

• Illness

13 mmol/L 3 hrs post-meal with rising CGM

Name 2 factors that increase insulin requirements

Puberty, illness, weight gain, high CHO diet

Name 2 factors that decrease insulin requirements

Exercise, weight loss, honeymoon period, low CHO diet

What is the dawn phenomenon?

Early morning rise in glucose (≈3am–wake)

What is the first step in DAFNE adjustment?

Identify the problem

How long should you observe patterns before adjusting?

≥48 hours

How much should basal insulin be adjusted initially?

Reduce by 10–20%

Key rule when adjusting insulin?

Only change ONE dose at a time

Why does alcohol increase hypoglycaemia risk?

Inhibits liver glucose release

How long does it take to process 1 unit of alcohol?

~1 hour

Should you give correction insulin after alcohol?

No

Why might glucagon not work after alcohol?

Liver cannot release glucose

What is the insulin rule for alcohol with carbs?

1 unit QA per 2 CP (½:1 ratio)

When should insulin for alcoholic drinks be given?

After finishing the drink

What is the target glucose before exercise?

7–15 mmol/L

What glucose level suggests risk of hypoglycaemia before exercise?

<5.5 mmol/L

What happens to glucose in aerobic exercise?

Decreases

What happens to glucose in anaerobic/high-intensity exercise?

Increases

How long can hypo risk persist after exercise?

Up to 48 hours

Why avoid exercise if glucose >15 mmol/L?

Risk of DKA

If exercising within 2 hours of a meal, what should you do?

Reduce QA dose

Why is insulin stacking dangerous?

Causes delayed hypoglycaemia

Why are CGM readings less accurate during exercise?

Time lag between blood and interstitial glucose

What is the “drizzle effect”?

Small amounts of carbs consumed during exercise

What should you avoid after a severe hypo?

Exercise (glycogen depleted)