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Empowerment CoursePresenters:Melba Mensch Course FacilitatorDr Mary Ho CMO and Course FacilitatorDr. Tuan Quach Diabetes Specialist Rosalie Arnold Diabetes Educator andGuest Speaker

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The beginning

In 1992 conducted a survey of first 100 patients who attended the Diabetes Education and Stabilization Centre which started in September 1975.

Survey question: What knowledge and skills do you want to develop to assist you to better manage your diabetes?

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Results of Survey

• To become actively engaged in diabetes management- learn how to adjust own insulin

• To develop skills in making healthy food choices

• To develop skills in cooking

• To feel better about having diabetes

• Activities versus lectures

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1993 A new model

• Diabetes self management/empowerment• Based on

– -work of Dr. Bob Anderson, U. of Michigan, Michigan, US

»-adult learning theory»- stages of change»-DCCT – basal/bolus

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Evidence for intensive insulin therapy

• USA - Diabetes Control and Complication Trial (DCCT) 10 year study of 14,400 type 1 patients age18- 39Designed to answer two questions

1. if people treated their diabetes intensively would their blood glucose control improve2. if their control improved would they lower their risk of developing diabetes-related complications

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DCCT

• Divided into two groups1. Conventional therapy 1 or 2 injections per day

2. Intensive insulin therapy (IIT) 3 injections per day or pumps and testing at least 4 x/day

1. Insulin- learned to adjust their own doses

2. Diet- carbohydrate counting in grams or exchanges, or counted calories, or used observation to identify the amount of insulin for a set meal.

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DCCT results

• Intensive Insulin Therapy Group• Eye disease reduction by 76%• Decreasing the development of

-early kidney problems by 35%

-more advanced kidney disease by 56%• Nerve damage was reduced by 60%• Medical nutrition therapy reduced HbA1c by 1%• Adverse effects

– more severe hypos 3 x increase– average 10 pound weight gain during 10 years

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Around the world

• UK DAFNE type 1Flexible eating and insulin dose adjustments

HbA1c decrease pre 9.4% to 8.4% at 6 months

DAFNE Study Group Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ,325 Oct. 25, 2002.

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What is the best management? Mimicking nature: basal–bolus insulin concept

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Best Practice for individuals with type 1 diabetes

• Intensive Insulin Therapy• Multi injections or pump therapy• Flexible eating plan with carbohydrate/insulin

dose adjustment

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Empowerment Course

• Goals:To become an active partner in self management of

diabetesTo develop a proactive approach to

carbohydrate/insulin dose managementTo develop confidence in adjustment of insulin

doses to achieve diabetes self management goalsTo set short and long term diabetes self

management goalsTo seek medical services and support as needed

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The course

• Who is it for? Individuals with type 1 diabetes and their support persons

• How often? once a month

• How many days? Four days 9am to 4 pm

• Where? Newcastle Community Health Centre

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The staff

• Endocrinology- Dr. Quach

• Co Facilitators-– Dr. Mary Ho Career Medical Officer– Melba Mensch Dietitian/Diabetes Educator

– Guest Speaker-– Rosalie Arnold, Cred. Diabetes Educator

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Who should attend the Empowerment Course ?

• Referral criteria

Individuals with Type 1 Diabetes

To commence or already on intensive insulin therapy- multiple daily injections or insulin pump

Individuals with problems eg. Hypoglycemia unawareness, poor control

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Requirements for attending

need to be able to read and write basic numeracy normal cognition willing to participate in a group environment

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Type 1 Empowerment Course

What knowledge and skills do the patients need for successful intensive insulin therapy?

Learning about Insulin actionday to day management

About home glucose monitoring

New equipmentWhen to testInterpreting results

Calculating insulin doses

Identifying carbohydrate foods and carbohydrate exchanges

Counting carbohydrates at lunch time

Super market tour

Label reading

Calculating carbohydrate content of recipe

Eating out and alcohol

Managing exerciseReducing insulin?Increasing food?

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About daily living with diabetes

• Hypoglycaemia management

• Over coming fear of hypo

• Managing hypo unawareness

• Driving safely

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The “15” Rule for Treating a “HYPO”

• For prompt and effective “hypo” treatment pack your “hypo kit” and keep it with you at all times and consider keeping one in your car.• Test blood glucose • If level is 4 mmol/L or less-• Treat with 15 grams of high GI food/drink (ie rapidly absorbed)

a) Five Jellybeans

b) 1/3 bottle Lucozade

c) Glucose tablets (take number according to package)

• Wait 15 minutes and retest BGL• If still 4 mmol/L or less-treat again with 15 grams high GI carbohydrate  • If greater than 4 mmol/L have 15 grams ie 1 exchange of Low GI food• If unconscious do not give liquids or solids, call the ambulance or give Glucagon (Glucagen Hypo Kittm) 

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About managing stress

• Hyperglycemia

• DKA

• Illness

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About problem solving & learning about support services

Active learning activities Australian Diabetes CouncilNDSS

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then …. Putting it all together

Diabetes Self-management

Setting Targets and Goals

Developing self confidence

Taking action to reduce complications

LEADS to the Road to Empowerment