Welcome to DAFNE
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Transcript of 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`
09.15-10.30 AR/RAGroup Discussion:Individual blood
glucose levels
09.15-10.30 AR/RAGroup Discussion:Individual blood
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
16.15-17.00 RA/ARGroup Discussion:Individual blood
glucose levels
16.15-17.00 RA/ARGroup Discussion:Individual blood
glucose levels
16.15-17.00 RA/ARGroup Discussion:Individual blood
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]