Related pages

Insulin dose adjustment in detail new insulin regimes Lantus/glargine & Levemir/detemir carbohydrate counting carbohydrate counting website hypos testing your sugar http://www.insulin-pumpers.org.uk/ pumps this site type 2 diabetes testing glucose hypo unawareness basic insulin rules multiple insulin injections prevent retinopathy twice daily insulin AIDA computer simulation SEE our simulations SEE

Diabetes education

• What is diabetes education
• DAFNE in brief
• DAFNE in detail
• DESMOND
• XPERT none-insulin users
• XPERT insulin users 
• A patients story...link
• a buddy

For professionals

• the 5 A's
• A primary care plan
  
• Take account of cultural differences

 

What is diabetes education?

Diabetes is a big challenge if you want to achieve good control. The NHS and experts around the world recommend that everyone in diabetes understands their condition, and understands how to prevent complications. They need to know what to do is something goes wrong, and how to adjust their insulin is they use it.

Diabetes education courses

type 1 DAFNE BERTIE new type 2 DESMOND type 2 XPERT type 2 support Birmingham Own Health

For insulin users, the DAFNE or BERTIE or insulin pump courses are highly recommended. It teaches people how to achieve food control and how to adjust insulin in their everyday life, see.

For newly diagnosed non-insulin users, the DESMOND course is recommended. For long-standing type 2 patients, the XPERT program is very helpful.

These are very very important programs that should be made available by GPs. Very few general practices provide such training. The NHS diabetes framework strongly advises such a course is made available to patients, and I believe patients should insist they attend one. Eventually they should be available to all people with diabetes near home. Ophthalmologists should be involved. Only 1/100 patients have attended a structured education program such as DAFNE or DESMOND, despite this being an NSF target from about 2005 (Liverpool 2007). UK diabetic paediatric clinics generally have much worse blood results than those such as Yale.  Good communiciation is important BMJ 2012ed.

 

What is DAFNE?

DAFNE stands for Dose Adjustment For Normal Eating. It is described in detail DAFNE. Here is advice about adjusting insulin dose.

DAFNE is a way of managing Type 1 diabetes and provides people with the skills necessary to estimate the carbohydrate in each meal and to inject the right dose of insulin.

DAFNE is based on:

• 2 injections of long-acting (Background) insulin each day
• Injecting quick-acting insulin each time you eat
• Testing your blood sugar level before each injection
• details on this site

DAFNE involves attending a 5-day training course (9am to 5pm Monday to Friday) plus a follow-up session around 8 weeks after the course and yearly half-day top-up sessions. The structured teaching program is delivered to groups of 6-8 participants and covers topics including carbohydrate estimation, blood glucose monitoring, insulin regimens, hypos, illness and exercise.

The DAFNE course is about learning from experience. During the week you practice the skills of carbohydrate estimation and insulin adjustment under the supervision of DAFNE-trained nurses and dietitians.

Most of the training is built around group work, sharing and comparing experiences with other people with Type 1 diabetes. However, there are opportunities for each person to speak to a doctor, nurse or dietitian individually.

DAFNE allows people to fit diabetes into their lifestyle, rather than changing their lifestyle to fit in with their diabetes.
The aim of DAFNE is to help you lead as normal a life as possible, while controlling your blood glucose levels, hence reducing the risk of long-term complications related to diabetes.  

It is described in detail DAFNE. If you use insulin and want good diabetic control, insist you can attend such a course. This site teaches you to count your carbohydrates, so you can work out your insulin dose (you need to register and log in).

Many people have benefitied tremendously, see "The DAFNE course absolutely blew me away".

 

XPERT none-insulin users

• see www.xperthealth.org.uk
• Available in nearly all parts of the UK
• for type 2 diabetes patients who have been diabetic some time
• See
• With other people, you learn about diabetes, weight management, and glucose control. You learn from others, they learn from you, and you learn to take control of your diabetes.

XPERT for insulin users

• as expert above, but suitable for inslulin users

 

What is DESMOND?

• DESMOND is aimed at newly diagnosed type 2 patients
• detail    also see diabetes     BMJ 2010   BMJ 2012 BMJ 2012ed
• it provides 6 hours of nurse lead group education
• there is a formal curriculum
• groups consist of 6-10 people newly diagnosed with Type 2 diabetes
• each person a can choose to be accompanied by a partner, family member or friend

 

If you are diabetic and want good diabetic control, insist you can attend one of these four courses. Find a course and ask if your GP if you can attend.

 

Birmingham OwnHealth

"If you enrol with Birmingham OwnHealth®, our innovative telephone-based approach ensures that you play a much bigger role in the delivery of your care and that you are never more than a phone call away from all the information, support and encouragement needed to improve your health and well being in the way which is best suited to you." See.

Essentially patients are advised about their diabetic control over the phone once a month. Such patients should have attended the relevant diabetes education program as above beforehand. They are advised what to do if the sugars are high etc over the phone.
This program has just started. At present it does not address the weight issues of diabetes, and may not tackle changes in insulin regimes (eg from twice daily to more intensive control). The program is developing, and will hopefully address these issues.

 

A buddy

This is available in parts of the UK. "The Buddy Service is a group of trained volunteers in Lothian who have personal experience of the life changes required to live with diabetes successfully. They all have diabetes or are looking after partners, parents or children with diabetes and come from different backgrounds.

A buddy's job is to listen to and talk with others in the same situation and to give help whenever possible. Buddies don’t give any medical advice, that is provided by experienced doctors and nurses. Buddies can share the practical problems of living with diabetes, day in, day out." See.

 

 

For professionals

the '5 A's

From here  the 5 As in diabetes education

Advice has to list to patients problems, and tailor the goals accordingly. There are many strategies, (p115) , including the Care Ambassador program  & here.  Such strategies should be used. (P126) as below, describes an office based intervention.

 

A Primary care plan (p126)

prior to visit mailed reminder goals, self-monitoring records, blood tests

waiting room patient completes self management form surrounded by diabetes information.. pamphlets, leaflets, posters

examination room nurse gives feedback on changes nurse checks self management form and finds areas of most concern

doctor examination check self-management form and discuss areas of most concern TO PATIENT reinforce willingness to change behaviour, refer to nurse for specific plan

nurse follow-up review and clarify goals in one area of self-care develop a realistic specific & measurable plan have patient identify barriers & assist problem solving plan continues support...diabetes support group, education, community, phone call between  visits record goal and plan for follow-up at next visits

 

Diabetes and Culture

See BMJ 2008. The central role of a healthy diet and lifestyle is recognised by many religions and religious leaders. There is no cultural 'fatalism', that is leaving everything to God. The individual should adopt a healthy diet and should exercise.