Transcript DICE Diabetes, Insulin & Carbohydrate Education

DICE
Diabetes, Insulin &
Carbohydrate Education
Denise Morrison PDSN
Stephanie Howe DSD
Luton & Dunstable Hospital
Background
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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
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To improve self-management skills
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To improve glycaemic control
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To improve nutritional/Diabetes knowledge
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To audit the project
Our Education Programmes
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DICE (Diabetes, Insulin & Carbohydrate
Education) aged 12-16 years
5 hours delivered over one day
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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 (1216y) & 10/24 foods (9-11y) wrongly
categorised by >40
D I C E
Diabetes Insulin & Carbohydrate Education
Time
10.00-10.15
Introduction
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10.15-10.45
D&S
FlipChart & pens
Course Packs
Hypo tray
Name labels
Pens & Clipboards
D
Hba1c demonstration
HbA1C results
Own BG readings on OHP &
discussion
Housekeeping: fire/breaks/toilets/mobiles
Content of session
Names & key questions
Insulin
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Resources/Activity
Types of insulin
Hba1c
Need for insulin to cover food intake
Is your background insulin right?
Blood glucose testing & meters
10.45-11.05
S
Slides& discussion: benefits of
checking blood glucose
Basic carb foods & simple
food labels
Carb quiz
Introduce CP booklet
All
Own snacks
Flip chart
Introduction to Carbohydrate Counting
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11.05-11.15
Why count carbohydrates?
What is carbohydrate?
Basic carb portions & CP values
Basic food labels
Break
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11.15-11.30
Estimate carbs in your snack
Snacks
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Discuss snack size
Types of snacks & different effects on blood glucose
Reasons for snacks
S
Sample snacks
Laminates (big effect, small
effect)
11.30-12.30
Estimating Carbohydrate Portions
S
Sample foods
Serving equipment
Scales
Own portion record
Calculators
Lunch carbs sheet
BG meters & record
All
Individual help with estimating
D
display items
Discuss examples
S
Slides/discussion
Flip chart
Websites
D
Cards with own CD on
Calculation sheet
D&S
“What next” handout
Record sheets to send in
Evaluation form
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
12.30-1pm
1.00-1.30
Lunch
Hypos
Exercise
1.30-2.00
Eating Out
Keeping Healthy
2.00-2.30
Correction doses
How
to calculate your own correction dose
2.30-3.00
Review
Return
to key questions
What next….
Mini- DICE
Time
10.30-10.45
Diabetes Insulin Carbohydrate
Education
Introduction
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10.45-11.00
Resources/Activity
FlipChart & pens
Course Packs
Hypo tray
Name labels
Pens & Clipboards
D
Own BG readings on OHP
Housekeeping: fire/breaks/toilets/mobiles
Content of session
Introductions & key questions
Insulin
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D&S
Need for insulin to cover food intake
Is your background insulin right?
Blood glucose testing & meters
HBA1C
S
11.00-11.50
Carbohydrate Counting
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11.50-12.20
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
lunch
All
Flip chart
Food models/packets
Carb quiz
Basic carb foods &
CP booklet
Plated meals pictures
Scales
Cereals & staples
CP portion record
Calculators
Lunch record sheet
Individual help with estimating
12.2012.35
12.35-1.05
Snacks
Identify CP content (in pairs)
Sort into groups
Discuss best choices
Hypos
S
CP booklet/food labels
Sample snacks
Large laminates (“small effect on blood
glucose”, “bigger effect on BG”)
D
handouts
D
Handout
Exercise
1.05-1.20
Correction doses
How they work
1.20-1.30
Review
 Review key questions
What next….
D&
S
“What next” handout
Record sheets to send in
Evaluation form
Evaluation
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Self reflection: parent /child dynamics variable (DICE) so aim
to increase time for children to work separately
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Self reflection: aim to improve attendance, particularly boys
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Self reflection: aim to improve follow up & on going education
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Participants: 86% (DICE) and 100% (mini-DICE) rated course
as whole very useful, although 36% found DICE too long
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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
DICE
Pre group
>2/12 post
group
Change in
Hba1c
9.46%
8.7%*
Down 0.76%
9.75%*
Up 0.42%
9.05%*
Down 0.56%
Matched
9.32%
group(1216y)
Mini-DICE 9.61%
What Next?
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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!