DICEDiabetes, Insulin & Carbohydrate Education

Denise Morrison PDSN

Stephanie Howe DSD

Luton & Dunstable Hospital

Background 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

To improve self-management skills

To improve glycaemic control

To improve nutritional/Diabetes knowledge

To audit the project

Our Education Programmes

DICE (Diabetes, Insulin & Carbohydrate Education) aged 12-16 years 5 hours delivered over one day

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 (12-16y) & 10/24 foods (9-11y) wrongly categorised by >40

TimeD I C E

Diabetes Insulin & Carbohydrate Education Resources/Activity

10.00-10.15 Introduction Housekeeping: fire/breaks/toilets/mobiles Content of session Names & key questions

D&S FlipChart & pensCourse PacksHypo trayName labelsPens & Clipboards

10.15-10.45 Insulin Types of insulin Hba1c Need for insulin to cover food intake Is your background insulin right? Blood glucose testing & meters

D Hba1c demonstrationHbA1C resultsOwn BG readings on OHP &

discussion

10.45-11.05 Introduction to Carbohydrate Counting Why count carbohydrates? What is carbohydrate? Basic carb portions & CP values Basic food labels

S Slides& discussion: benefits of checking blood glucose Basic carb foods & simple

food labelsCarb quizIntroduce CP booklet

11.05-11.15 Break Estimate carbs in your snack

All Own snacks Flip chart

11.15-11.30 Snacks 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 PortionsWeighing typical portions of key carbohydrates: using scales household measures calculationEstimating carbs from plated meals picturesPreparing to estimate the carbs in your lunch

S Sample foodsServing equipment

ScalesOwn portion record

CalculatorsLunch carbs sheet

BG meters & record

12.30-1pm Lunch All Individual help with estimating

1.00-1.30 Hypos

Exercise

D display items Discuss examples

1.30-2.00 Eating Out

Keeping Healthy

S Slides/discussionFlip chartWebsites

2.00-2.30 Correction dosesHow to calculate your own correction dose

D Cards with own CD onCalculation sheet

2.30-3.00 ReviewReturn to key questionsWhat next….

D&S “What next” handoutRecord sheets to send in

Evaluation form

TimeMini- DICE

Diabetes Insulin Carbohydrate Education

Resources/Activity

10.30-10.45 Introduction Housekeeping: fire/breaks/toilets/mobiles Content of session Introductions & key questions

D&S FlipChart & pensCourse PacksHypo trayName labelsPens & Clipboards

10.45-11.00 Insulin Need for insulin to cover food intake Is your background insulin right? Blood glucose testing & meters HBA1C

D Own BG readings on OHP

11.00-11.50 Carbohydrate Counting 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

S Flip chart Food models/packetsCarb quiz Basic carb foods & CP bookletPlated meals picturesScalesCereals & staplesCP portion record Calculators

11.50-12.20 lunch All Lunch record sheetIndividual help with estimating

12.20-12.35

SnacksIdentify CP content (in pairs)Sort into groupsDiscuss best choices

S

CP booklet/food labelsSample snacks

Large laminates (“small effect on blood glucose”, “bigger effect on BG”)

12.35-1.05 Hypos

Exercise

D handouts

1.05-1.20 Correction dosesHow they work

D Handout

1.20-1.30 Review Review key questionsWhat next….

D&S

“What next” handoutRecord sheets to send in

Evaluation form

Evaluation

Self reflection: parent /child dynamics variable (DICE) so aim to increase time for children to work separately

Self reflection: aim to improve attendance, particularly boys

Self reflection: aim to improve follow up & on going education

Participants: 86% (DICE) and 100% (mini-DICE) rated course as whole very useful, although 36% found DICE too long

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 ResultsPre group >2/12 post

groupChange in Hba1c

DICE 9.46% 8.7%* Down 0.76%

Matched group(12-16y)

9.32% 9.75%* Up 0.42%

Mini-DICE 9.61% 9.05%* Down 0.56%

What Next?

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!