Title: Individual Dose Adjustment Practise

Title: Individual dose adjustment practise

Flow / timing

These sessions should be delivered at the start and end of each day and be allocated the following minimum times on the timetable:

Monday afternoon 45 minutes
Tuesday-Friday mornings 75 minutes
Tuesday-Thursday afternoons 30 minutes

Purpose of the session

To demonstrate understanding and application of DAFNE skills and principles and to set and review personal daily action plans.

Learning outcomes

By the end of the session(s) participants should be able to:

Recognise that accurate carbohydrate estimation is key to flexible insulin dosing.
Demonstrate an understanding of insulin dose adjustment theory via the DAFNE stepwise approach.
Interpret their own blood glucose results and patterns.
Evaluate their decisions and actions and how they impact on their blood glucose results and control.

DAFNE ©T01.034-6, version 1 - February 2017 1 of 3

Resources

Lesson plan

Participants' DAFNE diaries

Overhead projector/ blank diary acetates/acetate pens

OR visualizer/blank A4 diary sheets/diaries

Insulin action posters

Insulin dose adjustment (correction) example acetates if required:

CP list
Course workbook
Scales and food labels as required

Flipcharts:

 “Target blood glucose levels”

 “Treating a hypo”

 “Guidelines for corrections”

Time / Content / Educator strategies/method / Resources
Essential content – the “need to know”
 The benefits of sharing their blood glucose results with the other group members.
 Before adjusting insulin doses, they should check the accuracy of their carbohydrate estimation.
 Reflect on insulin dose adjustment theory using the systematic step-wise approach.
 Hypoglycaemia (blood glucose below 3.5 mmol/L) should be treated with 1½-2 CPs of rapid-acting carbohydrate.
 A blood glucose reading below target range at a mealtime can be corrected by injecting less quick-acting insulin than required for carbohydrate eaten.
 A blood glucose reading below target range at bedtime can be corrected by eating additional CPs (guideline 1 CP can raise blood glucose by 2-3 mmol/L). / Introduction
Open questioning
Practical activities
Clarification, explanations, information
Reflection and feedback (in group and pairs)
Summary

Time / Content / Educator strategies/method / Resources
Essential content – the “need to know”
 A blood glucose reading above target range at a mealtime or bedtime can be corrected with extra quick-acting insulin, but should be used cautiously until their own insulin sensitivity is established (guideline 1 unit quick-acting insulin can reduce blood glucose by 2-3 mmol/L).
 Apart from during illness, high BG should not be ‘corrected’ in between meals.
 If blood glucose reading is more than 13 mmol/L on more than 1 occasion, or a 1-off reading above 17 mmol/L with no clear cause, they should test for ketones.
 Be clear about their actions and begin to consider how they might relate to their long-term goals.
 Identify and record their daily action plan
Expected content - the "need to be aware"

Benefits of keeping records in DAFNE diary.