DAFNE: dose adjustment for normal eating

Structured education for people with type 1 diabetes

This leaflet provides information to those with Type 1 Diabetes who are interested in participating in a structured education course called DAFNE – this stands for Dose Adjustment for Normal Eating. DAFNE. The course aims to help adults with type 1 diabetes lead as normal a life as possible, whilst also maintaining blood glucose levels within healthy targets. This reduces the risk of long-term diabetes complications. Family, friends and carers may also find the leaflet helpful to be able to give support.

What is DAFNE?

The DAFNE course is for adults (over 17 years old) who have type 1 diabetes for at least six months. The course is a comprehensive and often life-changing experience. It is far more than a carbohydrate counting programme, although learning and refining the skills necessary to count the carbohydrate in each meal and to inject the right dose of insulin are an important part of the course.

You may also be appropriate for DAFNE if you do not have type 1 diabetes; if so this will be assessed by your diabetes doctor / educator.

Why do DAFNE?

DAFNE enables you to:

• Exercise and manage your insulin so you don’t have hypos (hypoglycaemia).
• Feel confident to eat out or enjoy celebrations in any social or work environment and still maintain optimal blood glucose levels.
• Not to worry about high or low blood glucose levels every time you drink alcohol.
• Choose to eat snacks because you want to, not because you have to.
• Maintain more predictable blood glucose levels.

DAFNE audit data (national) has shown the following benefits:

• 40% achieving target HbA1c of 58mmol / mol
• Improved quality of life
• Improved treatment satisfaction
• Mean HbA1c decrease of 4 - 6mmol / mol
• Severe hypos reduced by 75%
• DKA reduced by 80%
• Reduction in diabetes related anxiety and depression

DKA = Diabetic Keto Acidosis

HbA1c = a measure of average blood glucose (sugar) levels for the last two to three months.

Severe hypos = low blood glucose levels that requires assistance from another person to treat.

Course Formats

There are different ways in which you can complete a DAFNE course, either on a face-to-face DAFNE course or a Remote DAFNE course – a blend of self-directed online learning with virtual group sessions.

Every course will have a pre-assessment appointment that takes place approximately three weeks before the course starts and takes about 30 minutes. . We will go through what the course entails, the timetable, expectations and ensure you have up to date blood / urine tests etc. You will also have the opportunity to ask questions or seek clarification.

Face-to-face, one week DAFNE courses: Monday to Friday, 9am - 5pm

Face-to-face, one day a week over five weeks DAFNE course: 9am – 5pm (varying days of the week)

Remote DAFNE course for insulin pen users: Video calls (3 - 3.5hrs long) one day a week over 6 weeks . Alongside weekly self-directed online learning (3 - 6hrs).

Remote DAFNE courses for insulin pump users: Video calls (3 - 3.5hrs long) one day a week over 6 weeks . Alongside weekly self-directed online learning (3 - 6hrs).

Face-to-face courses take place in the Wolfson diabetes and endocrinology clinic (clinic 32) on-site at Addenbrooke’s hospital.

• Face-to-face courses are also offered in Ely – the specific venue may vary
• A face-to-face version of pump DAFNE is coming soon

Face-to-face course

If you choose a face-to-face course, you will attend a 5-day training course (either Monday to Friday, 9am - 5pm, or one day per week for 5 weeks), with a follow-up session around 6 - 8 weeks after the course. There are sessions on managing insulin around exercise, illness, and social activities including drinking alcohol. This is why the course might be longer than other ‘self-management’ training you might have heard about.

The face-to-face course is delivered to groups of up to eight participants under the supervision of DAFNE-trained educators (specialist nurses and dietitians).

Remote DAFNE course (for those on insulin pens and insulin pumps)

Remote DAFNE courses enable you to learn at home; fitting around your work and home commitments. The remote DAFNE course will takesix weeks to complete. It includes online learning from home each week. This is three to six hours per week, however this reduces as the weeks go on. You will also join a weekly group video support calls with up to five other participants three to three and a half hours long) and a trained Remote DAFNE educator. Video calls are on Microsoft Teams and are compulsory. A virtual follow-up group session takes place approximately six to eight weeks after the course.

Support will be provided to access Microsoft Teams should this be required.

The DAFNE course, in whichever format, is about learning from experience, trying new things under supervision and benefiting from the support and personal experiences of the other people on your course. During the course you practice the skills of carbohydrate counting and insulin adjustment around lifestyle activities.

DAFNE for those on insulin pens: what will you learn?

• Getting the basics right and learning more about diabetes
• Targets and optimisation using the step-wise approach
• Carbohydrate counting; managing snacks; sweeteners and eating out
• Goal setting
• Exercise
• Alcohol
• Managing hypoglycaemia
• Illness and diabetes
• Complications of diabetes
• Healthy eating and diabetes
• Managing work, pregnancy and travel
• Opportunity to ask doctors questions (face to face course only)
• … and more

Pump DAFNE: what will you learn?

Sensitivity / correction factor testing standard pump therapy and those on hybrid closed loop pumps.

• Getting the basics right
• Continuous glucose monitoring
• Targets and optimisation
• Practicalities of pump therapy
• Basal testing
• Carbohydrate ratio testing and carbohydrate counting / managing snacks and eating out
• Sensitivity / correction factor testing
• Advanced bolusing
• Fat and protein counting
• Exercise
• Alcohol
• Managing hypoglycaemia
• Illness and diabetes
• … and more!

What you will need

• To be motivated and committed to the course
• To be willing to share your personal diabetes data (blood glucose levels, carb intake, sensor downloads, pump downloads, insulin doses etc)
• To participate in carbohydrate counting at lunch time (for face to face courses)
• To complete glucose diaries and food diaries where required
• To respect your peers and educators

In addition, for remote courses:

• Access to a laptop / PC and stable internet connection
• Be able to use Microsoft Teams and email
• Commit to the online learning (set aside three to six hours each week) and weekly video support calls – in a quiet, private place

Time off work

We can provide you with a letter for your employer explaining why you should be given paid time off work (as a health-related absence) because attending DAFNE could be one of the most beneficial things you ever get the chance to participate in from the point of view of your diabetes management and long term health. Your successful attendance could be a benefit to your ability to do your job.

DAFNE refresher

If you have completed a DAFNE course before and it has been more than 5 years, you can request to repeat a DAFNE course, or opt to do a DAFNE refresher.

A DAFNE refresher is self directed online learning, without the video calls. We can offer a clinic appointment or a group video call to help facilitate your learning after you have completed the online learning.

Testimonials

The following testimonials are from DAFNE graduates who have completed a variety of different DAFNE courses at CUH.

"I came somewhat reluctantly but learnt a great deal both theory and practical. This was totally opposite to what I expected."

"A fantastic course that I believe has changed my life for the better forever."

"My confidence, knowledge and general understanding of this disease is a total game changer due to DAFNE."

"It has taken me 10 years to agree to do DAFNE. Now I know I have been doing some things wrong all this time."

"The course is essential education for all people with type 1 diabetes."

"The course teachers are fantastic, very knowledgeable and above all approachable."

"I will look back on this week in years to come and realise how much it changed my life. This week has been life-extending."

"I was concerned that as an older person I would not fit into the group, my worries were unfounded – the wonderful educators were supportive and helpful."

"To be informed and actually take the time to study and understandyour own condition enables yout the tools and confidence to control and be in command of your condtition."

"Thought I knew a lot about diabetes and control was/is quite good. But DAFNE hs helped me understand the whys and answered all the questions I have."

"You have inspired me to take control of my life again and plan for the future I want!"

"Doing DAFNE has made me realise that diabetes isn’t and doesn’t have to be as onerous as you first think."

"I feel so much happier and more confident. I highly recommend the course and it was very enjoyable to be part of a very supportive and helpful group of people."

My Chart

If you have not already done so, we would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals which allows patients to securely access parts of their health record held within the hospitals’ electronic patient record system (Epic). It is available via your home computer or smart phone.

If you are interested in this please let us know and we can provide information, or look on our website: My Chart.

Contacts

Lead DAFNE educators:

• Caroline Byrne (Diabetes Specialist Nurse): 01223 348790
• Tak-Wai Ho (Diabetes Specialist Dietitian): 01223 348769

DAFNE administrator:

• Allison Housden / Nicola Croxon: 01223 348781

Resources

• DAFNE NHS website (opens in a new tab)

Videos

• Diabetes UK - Follow Bob, Sarah and Ross on their DAFNE course (opens in a new tab)
• Diabetes UK - What is a DAFNE course really like? Ross finds out (opens in a new tab)
• Diabetes UK - What is a DAFNE course really like? Sarah finds out (opens in a new tab)

If you don’t think DAFNE is for you, take a look at the below alternatives:

• Bertie Online (opens in a new tab)
• My type 1 diabetes (opens in a new tab)