Welcome to DAFNE Aileen Robertson and Razia Amin DAFNE Educators Diabetes Centre NHS Grampian Grampian Diabetes Professional Conference 24th May 2006

Case Study Mike – 35 years old Poor glycaemic control Nocturnal hypoglycaemia Complications To switch to a basal bolus regimen

Dose Adjustment For Normal Eating Background Dose Adjustment For Normal Eating 5 day structured education for type 1 diabetes Self management, confidence and competency Started in UK in 2000 (Scotland in 2005) BMJ 2002; 325; 746-751 DAFNE stands for Dose Adjustment For Normal Eating. The DAFNE programme provides structured therapeutic education for people with type 1 diabetes and it provides a problem solving environment that teaches knowledge and skills in the management of diabetes. The principle aim is to facilitate autonomy, competency and confidence in the self management of diabetes by providing skills based training in CHO counting and insulin dose adjustment in a comprehensive range of situations. It includes the development of problem solving skills that ultimately leads to improvement in biomedical and QoL outcomes in people with type1 diabetes and eventual improvements in long term health outcomes. DAFNE enables individuals with type 1 diabetes to have a flexible lifestyle as it encourages insulin doses to be adapted to lifestyle choices using algorithms which can ensure more predictable BGL and subsequently the experience of a greater sense of control.

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

Evidence 0.5 % reduction in HbA1c Improvements in QoL No increase in hypoglycaemia No weight gain BMJ 2002; 325; 746-751 NICE Guideline 60, Diabetes UK report

DAFNE Timetable PUB!! Monday Tuesday Wednesday Thursday Friday 09.15-09.45 AR Introduction 09.15-10.30 AR/RA Group Discussion: Individual blood glucose levels ` 09.15-10.30 AR/RA 09.15-10.30 AR/RA 09.45-10.45 AR What is diabetes? 10.45-11.00 Coffee 10.30-10.45 Coffee 11.00-12.30 AR Nutrition 1 Identify carbohydrates 10.45-12.30 AR Nutrition 2 Putting carbohydrate estimation into practice 10.45-12.30 AR Nutrition 3 Food Packaging Recipes Nutrition 4 Alcohol Eating out Healthy eating/ weight control 10.45-12.00 SC Annual review and screening 12.00-13.00 SC Questions For The Doctor 12.30-13.30 Lunch PUB!! 13.30-15.00 RA Self monitoring 13.30-15.00 RA DAFNE insulin adjustment HYPOGLYCAEMIA (Relatives/partners welcome) 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 Close 15.15-16.15 RA All about insulin 15.15-16.15 RA Insulin injection technique Managing physical activity Social aspects (Pregnancy, travelling, driving and insurance) 16.15-17.00 RA/AR

Target Blood Glucose Levels (mmol/l) 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 “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 Study Mike – 35 years old Poor glycaemic control Nocturnal hypoglycaemia Complications To switch to a basal bolus regimen

Questions ??

www.dafne.uk.com Aileen Robertson Senior Dietitian Diabetic Clinic Woolmanhill Aberdeen Tel: (01224) 555221 aileen.robertson@nhs.net Razia Amin DSN Diabetic Clinic Woolmanhill Aberdeen Tel: (01224) 555471 razia.amin@nhs.net