Structured Education Courses for people living with Diabetes

Mike announced our forthcoming events and introduced Jane Young, who is the lead specialist Diabetes nurse at Broomfield Hospital, to the members.

Jane’s presentation was on structured education courses for people living with diabetes. Structured education is important as it empowers the person with diabetes to manage their condition.

Type 1 Diabetes

The original name of the course that was delivered to those with type 1 diabetes was called ‘DAFNE’. ‘DAFNE’ stands for (Dose Adjustment for Normal Eating). The idea of the course was to teach those with diabetes how to adjust their insulin doses to match the amount of carbohydrate ingested. The ‘BERTIE’ course, which was designed by a hospital in Bournemouth and is similar the ‘DAFNE’, is run at Broomfield Hospital. The ‘DAFNE’ course is a residential course and is delivered over 5 days, whereas the ‘BERTIE’ course is delivered over 31/2 days (usually one day a week for 3 weeks followed by 1/2 day on the fourth week). It was felt this type of regime would best suit most people. The ‘BERTIE’ course attracts 8 people at a time. The whole course is based on carb counting and insulin delivery. Each attendee is expected to share their data (carbs eaten, insulin delivery and blood sugar results). This helps the understanding of carbohydrate to insulin ratio’s. Other items discussed are injection sites, the importance of keeping a food diary, eating out, rules for sickness, and travel. The aim is to keep HbA1c results within range 6.5 to 7.5 mmol/l or 48 -58 mmol/mol. All blood testing equipment gives slightly different results. The ‘BERTIE’ course prerequisite of being able to have an insulin pump.

Type 2 Diabetes

Type 2 diabetes is a complex condition that is managed by a number of different treatments. The type 2 course that is delivered locally is called ‘CREDIT’. The ‘CREDIT’ course was adopted from the Xpert programme. The Xpert programme is a six week course and only had an attendance rate of 50%. The ‘CREDIT’ course is run over two 1/2 days. The ‘DESMOND’ course was not accepted locally as an affiliation fee had to be paid. The Type 2 courses are usually held in Church halls. Items covered in the ‘CREDIT’ course are ‘What is Diabetes?’, medications, what are hypos, what are hypers, driving regulations, diet, complications of diabetes, exercise, illness, travel, and routine surveillance. Diet is covered extensively on the course. The eat well plate shows the portion sizes of each food group. The plate has recently changed and now shows carbohydrate and protein foods taking up a quarter of the plate each and vegetables taking up half of the plate. The aim is to keep HbA1c results within range 6.5 to 7.5 mmol/l or 48 -58 mmol/mol.

Other notes

The Diabetes UK website has a couple of YouTube clips that provide an insight into what is taught on an educational course. There are more and more diabetes educational tools going on- line. The hospital hope to launch a digital application from the 1 April 2019. The application consists of short videos followed by questions.

Jane advised the members that the Diabetes Centre at Broomfield Hospital have brought food models and fat belts with the funds from the Bellringers donation. These items are being used on the structured education courses.

Jane answered a number of questions that were posed by the members, one of which was the glycemic index. Jane explained the glycemic index which rates how quickly carbohydrates are absorbed into the body. The higher the glycemic number the quicker the carbohydrate is absorbed; which in turn causes a spiking in blood sugar levels. Conversely a carbohydrate food with a low glycemic number will take much longer to absorb into the blood stream and therefore will not cause blood sugar levels to spike.

Jane went onto explain the new rules relating to obtaining the Freestyle Libre on prescription have not yet been released by the Mid Essex CCG.