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

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

3. 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;
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.

4. 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

5. Patient ‘Costs’ Baseline clinic visit (individual appt) 5 day course
Follow up weeks post DAFNE
Follow up 12 – 18 months post DAFNE

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

7. DAFNE Timetable PUB!! Monday Tuesday Wednesday Thursday FridayAR
Introduction
AR/RA
Group Discussion:
Individual blood glucose levels `
AR/RA
AR/RA AR
What is diabetes?
Coffee
Coffee AR
Nutrition 1
Identify carbohydrates AR
Nutrition 2
Putting carbohydrate estimation into practice AR
Nutrition 3
Food Packaging
Recipes
Nutrition 4
Alcohol
Eating out
Healthy eating/ weight control SC
Annual review and screening SC
Questions For The Doctor
Lunch
PUB!! RA
Self monitoring RA
DAFNE insulin adjustment
HYPOGLYCAEMIA
(Relatives/partners welcome)
Sick Day Rules
RA + AR
Quiz
RA + AR
Evaluation and follow up arrangements
Coffee
15.00 – Coffee
Close RA
All about insulin RA
Insulin injection technique
Managing physical activity
Social aspects
(Pregnancy, travelling, driving and insurance)
RA/AR

8. 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%

9. “…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.”

10. “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.”

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

12. Questions ??

13. www.dafne.uk.com Aileen Robertson Senior Dietitian Diabetic Clinic
Woolmanhill
Aberdeen
Tel: (01224)
Razia Amin
DSN
Diabetic Clinic
Woolmanhill
Aberdeen
Tel: (01224)