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DICEDiabetes, Insulin & Carbohydrate Education
Denise Morrison PDSN
Stephanie Howe DSD
Luton & Dunstable Hospital
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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
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Key Objectives
To improve self-management skills
To improve glycaemic control
To improve nutritional/Diabetes knowledge
To audit the project
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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
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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
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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)
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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
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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
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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
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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
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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%
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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!