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DAFNE course, October 2003: a personal view
MANAGEMENT OF DIABETES
The DAFNE tutors also recognize that many of us are set in our ways and that breaking the habits of 20 or 30 years requires a leap of faith. Again, this is handled well, and while throughout the course I heard people say that the old way did this or seemed better than that, no one actually considered going backwards! It becomes clear that, before DAFNE, most of us were ‘winging it’, guessing how much insulin to take, over-compensating for exercise, under-compensating when snacking, or generally oblivious to the reasoning behind key measures of our condition.
DAFNE course, October 2003: a personal view Martin Smith I have had diabetes for more than 20 years. A friend, who also has diabetes, told me about the DAFNE course. During a routine visit to clinic 12 in January 2003, I asked about the course. I was told that there was a long waiting list; in fact, it was about seven months from application and eleven months from first hearing about DAFNE.
Post-DAFNE thoughts: I have attended many courses, some good, some bad. The DAFNE course successfully engaged my complete attention from beginning to end and exceeded my expectations, for the following reasons. • The course is completely relevant and recognizes many aspects of life as a diabetic. • The course is run in a structured way, but in an informal setting. This may sound contradictory, but I am reflecting on the interaction of the group, its tutors and the flow of information. • The group’s attitude to the course throughout was positive. The mix of backgrounds, experiences and age range was just right. Of the eight in my group, no one ‘hid in the corner’ and all were willing to share. • I gained an otherwise unknown perspective on the way my body should work and the way that I had been treating myself previously − sometimes dangerously (never knew about ketones!). • The explanation of the relationship between food intake, insulin needs and metabolic activity was highly valuable and provides me with the basic understanding to view my actions in a measured and informed way. The guesswork is taken out. • The frameworks that I need to independently self-regulate my actions are in place. My attitude to the previously passive experience of going to clinic 12 for a review has radically changed. I now want to know what my test results are, and explain to the professionals what I am up to (at last, meaningful dialogue?). • The prospect of being relatively free of a ‘fixed routine’ is a concept that only a diabetic can fully understand, but it is extremely important. As the course progressed, I gained confidence that this is now possible. • The possibility to interact socially, eat at the same time as my family or friends and not appear restricted or isolated is equally important. • I can reason why, for example, I am overweight (previously too much insulin) and have already adapted to compensate for this ‘side-effect’ on my own. • The word ‘empowerment’ was used a couple of times during the week. This word is somewhat overused in modern life, but I actually finished the course feeling empowered − to take control of a condition that has previously controlled me.
Day 1 kicks off with a round-table introduction of who we are and our expectations. The confidentiality of our discussions is also mentioned, and, possibly for this reason, the group seemed to talk freely and honestly. A summary of group expectations is written and stuck to the wall, where it remains for the duration. This introduction puts everyone at ease, as it becomes obvious that our individual expectations are common, namely: • eat what you want when you want – how? • improve control of the condition • work out a structured framework around which we can lead a near-normal or flexible lifestyle • improve our understanding of the condition and eliminate the guesswork • independently manage our lives in circumstances such as illness • review long-term health issues such as complications. It also becomes clear that there is a diverse range of lifestyles, and in my group a total of 130 years of diabetic management! The remainder of the first day is an intensive review of issues such as carbohydrate counting, how insulin works, metabolic monitoring and general discussion about issues that directly contrast the DAFNE approach to our previously fixed regimen. The way these issues are tackled using props, informal group discussion and structured presentation converts this potentially complex and confusing subject material into a digestible format. Day 1 finishes with a review of individual blood glucose targets by the entire group. In common with the others, I was looking forward to returning for day 2. Days 2−5: the following days have a similar format, starting with reviews of blood sugar levels away from the class, and group input into any adjustments in insulin taken or other observations relating to diet. Each day covers mandatory subjects specific to the DAFNE syllabus. The potentially complex issues in the syllabus are broken down and the group’s full participation ensures that we understand and continue to move along at the same pace.
MEDICINE 34:2
68
© 2006 Elsevier Ltd
The DAFNE tutors also recognize that many of us are set in our ways and that breaking the habits of 20 or 30 years requires a leap of faith. Again, this is handled well, and while throughout the course I heard people say that the old way did this or seemed better than that, no one actually considered going backwards! It becomes clear that, before DAFNE, most of us were ‘winging it’, guessing how much insulin to take, over-compensating for exercise, under-compensating when snacking, or generally oblivious to the reasoning behind key measures of our condition.
DAFNE course, October 2003: a personal view Martin Smith I have had diabetes for more than 20 years. A friend, who also has diabetes, told me about the DAFNE course. During a routine visit to clinic 12 in January 2003, I asked about the course. I was told that there was a long waiting list; in fact, it was about seven months from application and eleven months from first hearing about DAFNE.
Post-DAFNE thoughts: I have attended many courses, some good, some bad. The DAFNE course successfully engaged my complete attention from beginning to end and exceeded my expectations, for the following reasons. • The course is completely relevant and recognizes many aspects of life as a diabetic. • The course is run in a structured way, but in an informal setting. This may sound contradictory, but I am reflecting on the interaction of the group, its tutors and the flow of information. • The group’s attitude to the course throughout was positive. The mix of backgrounds, experiences and age range was just right. Of the eight in my group, no one ‘hid in the corner’ and all were willing to share. • I gained an otherwise unknown perspective on the way my body should work and the way that I had been treating myself previously − sometimes dangerously (never knew about ketones!). • The explanation of the relationship between food intake, insulin needs and metabolic activity was highly valuable and provides me with the basic understanding to view my actions in a measured and informed way. The guesswork is taken out. • The frameworks that I need to independently self-regulate my actions are in place. My attitude to the previously passive experience of going to clinic 12 for a review has radically changed. I now want to know what my test results are, and explain to the professionals what I am up to (at last, meaningful dialogue?). • The prospect of being relatively free of a ‘fixed routine’ is a concept that only a diabetic can fully understand, but it is extremely important. As the course progressed, I gained confidence that this is now possible. • The possibility to interact socially, eat at the same time as my family or friends and not appear restricted or isolated is equally important. • I can reason why, for example, I am overweight (previously too much insulin) and have already adapted to compensate for this ‘side-effect’ on my own. • The word ‘empowerment’ was used a couple of times during the week. This word is somewhat overused in modern life, but I actually finished the course feeling empowered − to take control of a condition that has previously controlled me.
Day 1 kicks off with a round-table introduction of who we are and our expectations. The confidentiality of our discussions is also mentioned, and, possibly for this reason, the group seemed to talk freely and honestly. A summary of group expectations is written and stuck to the wall, where it remains for the duration. This introduction puts everyone at ease, as it becomes obvious that our individual expectations are common, namely: • eat what you want when you want – how? • improve control of the condition • work out a structured framework around which we can lead a near-normal or flexible lifestyle • improve our understanding of the condition and eliminate the guesswork • independently manage our lives in circumstances such as illness • review long-term health issues such as complications. It also becomes clear that there is a diverse range of lifestyles, and in my group a total of 130 years of diabetic management! The remainder of the first day is an intensive review of issues such as carbohydrate counting, how insulin works, metabolic monitoring and general discussion about issues that directly contrast the DAFNE approach to our previously fixed regimen. The way these issues are tackled using props, informal group discussion and structured presentation converts this potentially complex and confusing subject material into a digestible format. Day 1 finishes with a review of individual blood glucose targets by the entire group. In common with the others, I was looking forward to returning for day 2. Days 2−5: the following days have a similar format, starting with reviews of blood sugar levels away from the class, and group input into any adjustments in insulin taken or other observations relating to diet. Each day covers mandatory subjects specific to the DAFNE syllabus. The potentially complex issues in the syllabus are broken down and the group’s full participation ensures that we understand and continue to move along at the same pace.
MEDICINE 34:2
68
© 2006 Elsevier Ltd