DICE Diabetes, Insulin & Carbohydrate Education Denise Morrison PDSN Stephanie Howe DSD Luton & Dunstable Hospital

Background 150 children on PDSN caseload Very limited paediatric dietetic service for diabetes 74 children on Basal bolus (increased from 50 over past 6/12) Mean Hba1cs 10.15%(12-16years) 9.06%(9-11years) 9.14%(<9years) Education Programmes developed as part of project funded by Novo Nordisk to offer enhanced dietetic service to children on basal bolus & their parents

Key Objectives To improve self-management skills To improve glycaemic control To improve nutritional/Diabetes knowledge To audit the project

Our Education Programmes DICE (Diabetes, Insulin & Carbohydrate Education) aged years 5 hours delivered over one day Mini-DICE for those aged 9-11 years 3 hours delivered as one session

Baseline Knowledge & Behaviour Questionnaires 60% (12-16y) & 86%(9-11y) only adjusted background insulin dose when advised to do so by DSN/Doctor 40%(12-16y) & 28%(9-11y) only adjusted short acting insulin dose infrequently/when advised by DSN/Dr Food knowledge was poor: 12/24 foods (12- 16y) & 10/24 foods (9-11y) wrongly categorised by >40

Time D I C E Diabetes Insulin & Carbohydrate Education Resources/Activity Introduction Housekeeping: fire/breaks/toilets/mobiles Content of session Names & key questions D&SFlipChart & pens Course Packs Hypo tray Name labels Pens & Clipboards Insulin Types of insulin Hba1c Need for insulin to cover food intake Is your background insulin right? Blood glucose testing & meters DHba1c demonstration HbA1C results Own BG readings on OHP & discussion Introduction to Carbohydrate Counting Why count carbohydrates? What is carbohydrate? Basic carb portions & CP values Basic food labels SSlides& discussion: benefits of checking blood glucose Basic carb foods & simple food labels Carb quiz Introduce CP booklet Break Estimate carbs in your snack AllOwn snacks Flip chart Snacks Discuss snack size Types of snacks & different effects on blood glucose Reasons for snacks S Sample snacks Laminates (big effect, small effect)

Estimating Carbohydrate Portions Weighing typical portions of key carbohydrates: using scales household measures calculation Estimating carbs from plated meals pictures Preparing to estimate the carbs in your lunch SSample foods Serving equipment Scales Own portion record Calculators Lunch carbs sheet BG meters & record pm Lunch AllIndividual help with estimating Hypos Exercise Ddisplay items Discuss examples Eating Out Keeping Healthy SSlides/discussion Flip chart Websites Correction doses How to calculate your own correction dose DCards with own CD on Calculation sheet Review Return to key questions What next…. D&SWhat next handout Record sheets to send in Evaluation form

Time Mini- DICE Diabetes Insulin Carbohydrate Education Resources/Activity Introduction Housekeeping: fire/breaks/toilets/mobiles Content of session Introductions & key questions D&SFlipChart & pens Course Packs Hypo tray Name labels Pens & Clipboards Insulin Need for insulin to cover food intake Is your background insulin right? Blood glucose testing & meters HBA1C DOwn BG readings on OHP Carbohydrate Counting What are carbohydrates? Food sorting What is a CP? Basic carb portions & CP values Quiz (kids)/ Weighing foods (parents) Review quiz (everyone) Plated meal pictures (everyone) Prepare to estimate the carbs in your lunch S Flip chart Food models/packets Carb quiz Basic carb foods & CP booklet Plated meals pictures Scales Cereals & staples CP portion record Calculators lunch AllLunch record sheet Individual help with estimating

Snacks Identify CP content (in pairs) Sort into groups Discuss best choices S CP booklet/food labels Sample snacks Large laminates (small effect on blood glucose, bigger effect on BG) Hypos Exercise D handouts Correction doses How they work D Handout Review Review key questions What next…. D& S What next handout Record sheets to send in Evaluation form

Evaluation Self reflection: parent /child dynamics variable (DICE) so aim to increase time for children to work separately Self reflection: aim to improve attendance, particularly boys Self reflection: aim to improve follow up & on going education Participants: 86% (DICE) and 100% (mini-DICE) rated course as whole very useful, although 36% found DICE too long Participants: sections on basic carbohydrate portions, weighing own portions, estimating carbs in meals, snacks, hypos and correction doses all rated very highly

Pre & Post Group Hba1c Results Pre group>2/12 post group Change in Hba1c DICE9.46%8.7%*Down 0.76% Matched group(12- 16y) 9.32%9.75%*Up 0.42% Mini-DICE9.61%9.05%*Down 0.56%

What Next? Assess post group knowledge & self management skills/behaviour (awaiting results) Trial a group follow up session Trial reviewed format of DICE to reduce potential for parent/child tensions Long term: Funding!