Welcome to DAFNE

Aileen Robertson and Razia Amin DAFNE EducatorsDiabetes CentreNHS Grampian

Grampian Diabetes Professional Conference24th May 2006

Welcome to DAFNE

Mike – 35 years old

Poor glycaemic controlNocturnal hypoglycaemiaComplications

To switch to a basal bolus regimen

Case Study

Background

Dose Adjustment For Normal Eating

5 day structured education for type 1 diabetesSelf management, confidence and competencyStarted in UK in 2000 (Scotland in 2005)

BMJ 2002; 325; 746-751

Inclusion Criteria

• Type 1 diabetes - post ‘honeymoon’ period• Over age 17 years• HbA1c < 12%• Motivated to improve control• Able to read and converse English• Able to attend a full 5 day course • Willing to test and inject at least 4 times a day

8 participants per group

Patient ‘Costs’

• Baseline clinic visit (individual appt)

• 5 day course

• Follow up 6 - 8 weeks post DAFNE

• Follow up 12 – 18 months post DAFNE

• 0.5 % reduction in HbA1c

• Improvements in QoL• No increase in hypoglycaemia• No weight gainBMJ 2002; 325; 746-751

NICE Guideline 60, Diabetes UK report

Evidence

DAFNE TimetableMonday Tuesday Wednesday Thursday Friday

09.15-09.45 ARIntroduction

09.15-10.30 AR/RAGroup Discussion:Individual blood

glucose levels`


glucose levels


glucose levels

09.15-10.30 AR/RA Group Discussion:Individual blood

glucose levels09.45-10.45 ARWhat is diabetes?

10.45-11.00 Coffee 10.30-10.45 Coffee 10.30-10.45 Coffee 10.30-10.45 Coffee 10.30-10.45 Coffee

11.00-12.30 ARNutrition 1 Identify

carbohydrates

10.45-12.30 ARNutrition 2 Putting

carbohydrate estimation into practice

10.45-12.30 AR Nutrition 3 Food Packaging Recipes

10.45-12.30 ARNutrition 4 Alcohol Eating out Healthy eating/

weight control

10.45-12.00 SCAnnual review and

screening

12.00-13.00 SCQuestions For The

Doctor

12.30-13.30 Lunch 12.30-13.30 Lunch 12.30-13.30 Lunch 12.30-13.30 Lunch PUB!!13.30-15.00 RASelf monitoring

13.30-15.00 RADAFNE insulin

adjustment

13.30-15.00 RA HYPOGLYCAEMIA(Relatives/partners

welcome)

13.30-15.00 RA Sick Day Rules

14.00-15.00 RA + AR

Quiz

15.00-15.30 RA + AR

Evaluation and follow up arrangements

15.00-15.15 Coffee 15.00-15.15 Coffee 15.00-15.15 Coffee 15.00 – 15.15 Coffee

Close

15.15-16.15 RAAll about insulin

15.15-16.15 RAInsulin injection

technique

15.15-16.15 RAManaging physical

activity

15.15-16.15 RASocial aspects(Pregnancy, travelling,

driving and insurance)

16.15-17.00 RA/ARGroup Discussion:Individual blood

glucose levels


glucose levels


glucose levels


glucose levels

DAFNE Targets

Target Blood Glucose Levels (mmol/l)

Before Breakfast

5.5 – 7.5

Before Other Meals

4.5 – 7.5

Before Bed 6.5 – 8.0

HbA1C = 6.0 – 7.0%

• “…This is a must for all diabetics.”

• “Fantastic – it is like a light bulb being switched on after being in the dark for the past 25 years.”

• “Fantastic. This week has gifted me with the tools I have been missing over the years.”

• “To be in control of me for the first time ..”

• “I understand more about diabetes now than I managed to pick up in twenty years.”

• “Looking forward to life now, not dreading it.”

• “This course is essential. The value of the course and it’s content cannot be underestimated.”

• “An amazing week, not only can I now eat what I want but I can live a normal life. Suddenly diabetes is no challenge.”

• “Instead of being ruled by my diabetes I will control it.”

• “This week has taught be how to live with diabetes rather than fighting it on a daily basis. Everyone with type 1 diabetes should have the opportunity to live a normal life.”

Case StudyMike – 35 years old

Poor glycaemic controlNocturnal hypoglycaemiaComplications

To switch to a basal bolus regimen

Questions ??

www.dafne.uk.com

Aileen RobertsonSenior DietitianDiabetic ClinicWoolmanhillAberdeenTel: (01224) 555221aileen.robertson@nhs

.net

Razia Amin

DSN

Diabetic Clinic

Woolmanhill

Aberdeen

Tel: (01224) [email protected]

Documents

Welcome to DAFNE