Type 1 diabetes management skills
Education – the gateway to better glucose control
Decades ago, Elliott P Joslin said ‘The diabetic who knows the most lives the longest’.
DAFNE (Dosage Adjustment For Normal Eating) is a well-known structured education programme about how to manage your condition for people with type 1 diabetes, but it’s not the only one, and you don’t have to wait passively to be given a place on a course. Ask your team whether or not your hospital runs a DAFNE or similar programme.
BERTIE Online is a the type 1 diabetes education programme developed by Bournemouth Diabetes and Endocrine Centre. You can register for free at the BERTIE Online website.
If you’ve been managing your diabetes anyway, why bother to do a course?
Undertaking structured education will enable you to personalise your diabetes management to fit your lifestyle and your individual needs and responses to insulin, exercise, food and illness. You will also brush up your carbohydrate counting skills.
Some hospitals insist on DAFNE or a similar course prior to starting on a pump. We believe everyone should begin structured education from diagnosis, whether or not they plan to use a pump.
What does NICE* say about education for people with type 1 diabetes?
NICE Guideline NG17:Type 1 diabetes in adults: diagnosis and management (published in August 2015) makes a key priority of offering structured education 6 – 12 months after diagnosis. If you have already been diagnosed longer than 12 months, there is still a list of recommendations on education which update and replace the NICE technology appraisal guidance on the use of patient-education models for diabetes for adults with type 1 diabetes (TA60).
1.3.1 Offer all adults with type 1 diabetes a structured education programme of proven benefit, for example the DAFNE (dose-adjustment for normal eating) programme.Offer this programme 6–12 months after diagnosis.
1.3.2 If a structured education programme has not been undertaken by an adult with type 1 diabetes by 12 months after diagnosis, offer it at any time that is clinically appropriate and suitable for the person, regardless of duration of type 1 diabetes.
1.3.3 Provide an alternative of equal standard for any adult with type 1 diabetes unable or unwilling to participate in group education.
1.3.4 Ensure that any structured education programme for adults with type 1 diabetes includes the following components:
- It is evidence-based, and suits the needs of the person.
- It has specific aims and learning objectives, and supports the person and their family members and carers in developing attitudes, beliefs, knowledge and skills to self-manage diabetes.
- It has a structured curriculum that is theory-driven, evidence-based and resource-effective, has supporting materials, and is written down.
- It is delivered by trained educators who have an understanding of educational theory appropriate to the age and needs of the person, and who are trained and competent to deliver the principles and content of the programme.
- It is quality assured, and reviewed by trained, competent, independent assessors who measure it against criteria that ensure consistency.
- The outcomes are audited regularly.
1.3.5 Explain to adults with type 1 diabetes that structured education is an integral part of diabetes care.
1.3.6 Provide information about type 1 diabetes and its management to adults with type 1 diabetes at all opportunities from diagnosis onwards. Follow the principles in the NICE guideline on patient experience in adult NHS services.
1.3.7 Consider the Blood Glucose Awareness Training (BGAT) programme for adults with type 1 diabetes who are having recurrent episodes of hypoglycaemia.
1.3.8 Carry out more formal review of self-care and needs annually in all adults with type 1 diabetes. Vary the agenda addressed each year according to the priorities agreed between the healthcare professional and the adult with type 1 diabetes.
Plus, the following recommendations under dietary management:
1.4.2 Consider carbohydrate-counting courses for adults with type 1 diabetes who are waiting for a more detailed structured education programme or are unable to take part in a stand-alone structured education programme.
NICE Guideline NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management (also published in August 2015) makes the following recommendations:
1.2.1 Offer children and young people with type 1 diabetes and their family members
or carers (as appropriate) a continuing programme of education from diagnosis.
Ensure that the programme includes the following core topics:
- insulin therapy, including its aims, how it works, its mode of delivery and dosage adjustment
- blood glucose monitoring, including targets for blood glucose control (blood glucose and HbA1c levels)
- the effects of diet, physical activity and intercurrent illness on blood glucose control managing intercurrent illness (‘sick-day rules’, including monitoring of blood ketones [beta-hydroxybutyrate])
- detecting and managing hypoglycaemia, hyperglycaemia and ketosis.
1.2.2 Tailor the education programme to each child or young person with type 1 diabetes and their family members or carers (as appropriate), taking account of issues such as: personal preferences, emotional wellbeing, age and maturity, cultural considerations, existing knowledge and current and future social circumstances
*The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. NICE was originally set up in 1999 as the National Institute for Clinical Excellence, a special health authority, to reduce variation in the availability and quality of NHS treatments and care.
Note that NICE clinical guidelines are not mandatory, they are recommendations for good service provision.
You can also do a lot to educate yourself.
- t1resources.uk has been put together by people living with diabetes and healthcare professionals to offer a selection of valuable resources that have been reviewed and agreed to be helpful, informative and to offer good support
- Bertie Online – Bertie Type 1 Diabetes Education Program, to help you to understand and manage your diabetes in a way that suits you and your lifestyle.
- DAFNE – Dose Adjustment for Normal Eating
- Roche Accu-Chek Carbohydrating Counting Tool – free online training but you’ll need to register. You don’t have to use an Accu-Chek pump or meter to use this.
- Desang Magazine – Carb Counting – Desang online magazine is free to sign up for and run by a type 1 pumper.
- Diabetes UK free ebook on Carb Counting and insulin dose adjustment
- 10 Steps to improving control on MDI by Edinburgh Centre for Endocrinology & Diabetes
- ExCarbs – a website full of info about managing type 1 diabetes during exercise (for normal people, not athletes!)
- The Power Within – by Stephen Ponder MD, a US endocrinologist who has type 1 diabetes, about his technique called Sugar Surfing
- RunSweet – “helping athletes with diabetes to be winners”
- VoyageMD – practical advice for travelling with diabetes
Are you already using a pump?
Here are some useful links:
Choosing, using and rotating sites – AADE IPT Best practice from the American Association of Diabetes Educators regarding insulin pump infusion set usage. Aimed at healthcare professionals, it still contains good advice for site rotation, choosing sets etc.
Video: How to test and adjust your basal rates by Bournemouth Diabetes & Endocrine Centre & Roche
CGM use and interpretation guide from Edinburgh Centre for Endocrinology & Diabetes
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