Desang Test by james elliott

ISSUE 11

DESANG magazine

Meet DAFNE

… and her friends Desmond, Sadie and Bertie

Courses for skills and tools for the diabetic life

THIS ISSUE IS SPONSORED BY

PLUS

• New Products • Groovy giveaways • News (for T1 and T2)

Making your own insulin Accurate results you can dosing decisions?

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Suitable for patients on insulin who test several times a day and regularly make their own treatment decisions

NEW

Using meters that do not have as many interferences may help you feel safer. Close–to-lab accuracy**

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Accuracy where it counts - at low glucose, at high glucose and everywhere in between. The NEW Glycaemic ® ® self-management system with: OneTouch GlucoFilter technology Filters common substances that interfere with test accuracy. Unsurpassed accuracy*

Our new glycaemic self-management system provides you with:

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Tools for optimising your insulin: High and Low Pattern OneTouch® GlucoFilter® technology

See when to adjust your insulin! Your meter can tell you when it detects Filters substances that interfere with test accuracy, in just 5 seconds blood glucose patterns, so you can consider insulin therapy adjustments.

Tools for optimizing insulin therapy: High and Low Pattern Tool Automatically informs your patients of low patterns in their blood glucose results so they can consider insulin therapy adjustments

On insulin and regularly making your own insulin dosing decisions? OneTouch® Verio®Pro may be suitable for your needs.

Do your patients need better glycaemic control To order meter trial call 0800 279 4142 (UK) 1800 930 120 (ROI) with less your fearFREE* of hypoglycaemia? quoting code AE108.

To find out how OneTouch® Verio®Pro can help your patients, Lines open 8.30am-6pm Mon-Fri, 9am-1pm Sat call: 1-800-123-4567 or visit: www.lifescan.com *TERMS AND CONDITIONS ® ® ® ® Offer open on to insulin users comparisons resident in theusing UK aged 16 or blood. over only, excluding existing users of a OneTouch UltraEasy , OneTouch 2, * Based laboratory venous When compared with: Accu-Chek® Active, Accu-Chek® Mobile,Ultra AccuOneTouch® Vita® or OneTouch® UltraSmart® Blood Glucose meter. Offer closing date 30th September 2011. Those eligible to participate in Chek® Aviva, Accu-Chek® Compact Plus, Bayer Contour®, Bayer Contour® USB, Elta Satellite, FreeStyle Lite® (with ZipWik™), ® ® the free meter trial will be offered a OneTouch Verio Pro Blood Glucose meter and a questionnaire about their experience of using the Glucocard™ G and WaveSense™ Jazz, no other system was more accurate than OneTouch® Verio®Pro. Results on file. OneTouch® Verio®Pro to complete and return in the reply paid envelope provided. Only one free OneTouch® Verio®Pro Blood Glucose meter ** +/at or above 4.4 mmol/L and +/- 0.7 mmol/L trial per 15% person. Meters are subject to availability. This offer is below limited 4.4 to ammol/L. maximum of 4,000 free OneTouch® Verio®Pro meters. Allow 28 days for delivery.LifeScan Logo, OneTouch®, OneTouch® GlucoFilter® and OneTouch® Verio®Pro are trademarks of LifeScan Inc. LifeScan,

LifeScan, LifeScan Logo, OneTouch® and OneTouch® Verio®Pro are trademarks of LifeScan Inc. © UK and Ireland 2011 11-076 AW 097-500 www.LifeScan.co.uk

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NEW

Editor’s comment... CONTENTS 4

our understanding of food changes significantly when you’re diagnosed with diabetes. From that point on, everything you eat and drink could affect your blood glucose level. You think twice about almost everything you want to put in your belly. It takes some getting used to and for years there was nothing much to help us on our way, but things have changed. We talk to one of the instigators of the original DAFNE course (Dose Adjustment For Normal Eating), Dr. Simon Heller about the opportunity it presents to ‘set diabetics free’ just by giving them information and skills to live a life with diabetes..

Sue Marshall

Help count carbs with Salter’s Nutri-Weigh scales. Give your tootsies a boost with Footkiss. Get helmet ID for safer cycling and other sports.

NEWS...

LIVING...

DIABETES KIT...

Medtronic’s new Enlite CGM sensor. A charter of diabetes rights. JDRF ‘discovery day’ in Bethnal Green. Join a picnic in the park for children with diabetes. Saucy fish recipes. Chocolate munchy seeds giveaway.

Who or What are DAFNE, DESMOND and their associates, Sadie, Bertie and others.

SPECIAL OFFERS

HERE’S SADIE!

Courses that can teach you skills for a life with diabetes.

See the all-new OneTouch Verio from Lifescan (see contact details on opposite page for free meter samples).

Published by Desang Ltd the aim of this newsletter is to bring news and information to people living with diabetes. Please check all matters concerning how you handle your health with your healthcare team. We welcome any feedback on the magazine or ideas for future articles. Editor: Sue Marshall sue.marshall@desang.net Design: rehabdesign

Get £5 off the USB meter by clicking through the advert and using code USBDSE115!

With thanks to Charlotte Axworthy for the lovely artwork used in this issue to illustrate our DAFNE (and friends) feature www.charlotteaxworthy.com

KIT

Carb count calculator Salter’s Nutri-Weigh Slim Electronic Scale can be used to keep your eye on what’s in your food, what’s a good portion-size of the food as well as give its nutritional content. But for diabetics the biggest boon is the assessment the scales can also give of the carbohydrate content of that food. In days of old, all diabetics were encouraged to count carbs, but then the system went out of fashion. It’s certainly making a come-back with the advent of courses such as DAFNE and DESMOND. With all the nutritional values of your food – including the carbs -- in hand then you should be on-track for keeping your diabetes under control too. These scales can help you keep tabs on making the most informed food choices possible.

The scales calculate the nutritional value of 999 foods from a national food database based on British eating habits, simultaneously displaying their nutritional results (carbohydrates, calories, fat, protein, salt and cholesterol values). The scales memory function enables you to total up the nutritional values for all the components of a meal. This can then be assed by day or week so if you want to stick to a 200-carbs-a-day regime then it should be possible to do so. The scales double up as kitchen scale as well as a being a dietary computer (including measuring liquids). Around £44.99 www.salterhousewares.com/ salter_uk

Fab feet with FootKiss It may only be spring time, but we know summer’s round the corner. Is it time to get your feet ready for some exposure? Thick, hard skin naturally builds up on the heels during the winter. The Footkiss Callus Removal Kit works in minutes to remove dead skin leaving your feet smooth and healthy, crack-free and soft. Finish off the treatment with the moisturising foot balm. The Footkiss Callus Removal Kit contains enough for two treatments per foot and the kit contains pads, Heel Softener, Heel Balm and scraper tool.

The Footkiss Callus Removal Kit is available from www.peak-nutrition. co.uk for £19.95.

Hats off to…

…this fabby little idea, perfect for all activities which mean wearing a helmet. The neat Helmet ID Tag contains vital info that first responders and paramedics can easily see and open in order to access your lifesaving medical, allergy and contact information. Using bright 3M Scotchlite yellow reflective material, it sticks to your hard hat using “Helmet Safe” adhesive. The pack also supplied with 2 x 3M reflective sticker sheets to attach to your helmet or bike. It’s waterproof, durable and you’ll never forget it as it’s always attached to your helmet. The ID card fits inside an inner pocket - out of sight in normal use – but easily updated if necessary. From the ID Band company for £8.95 www.theidbandco.com

For Diabetes

TEST TEST

Introducing Bayer’s CONTOUR® USB meter. The first blood glucose meter with plug & play diabetes management software. ® management experience. Plug into a whole new diabetes Introducing Bayer’s CONTOUR USB meter. The first blood glucose meter with plug Gain thediabetes knowledge that can software. help youPlug lower your HbA1c. & play management into a whole new diabetes management experience. the win. knowledge that can help you lower your HbA1c. Now that’s a Now that’s a Gain simple

simple win.

Over 97% of patients rated ™ DELUXE software can help you discover valuable insight Bayer’s new GLUCOFACTS ™ Bayer’s CONTOUR® + + Bayer’s GLUCOFACTS DELUXE software can help + Knowledge you can share with your healthcare professional USB as ‘good’, you discover valuable insight + Utilises Bayer’s CONTOUR® test strips, available on prescription ‘very good’, or + Knowledge you can share with your healthcare professional ‘excellent’1

+ + Plug & play playtechnology technologyforfor instant access to patterns and trends Plug & instant access to patterns and trends

® + Bayer's Utilises Bayer’s USB CONTOUR testatstrips, ononline prescription CONTOUR is available £24.99available RRP. Buy at www.bayercontourusb.co.uk and,

as an introductory offer, if you do so before 30 June 2010 you can claim £5 off by typing USBMH5 in the promotional code box.

Bayer’s CONTOUR® USB is available at £24.99 RRP plus P&P. Buy online at www.bayercontourusb.co.uk and, if you do so before 30 June 2011 you can claim £5 off by typing USBDS135 in the promotional code box.*

Bayer (reg’d), the Bayer Cross (reg’d), CONTOUR, GLUCOFACTS and simplewins are trademarks of Bayer.

*Not available in conjunction with any other offer. 1. Data on File, Bayer HealthCare. Bayer (reg’d), the Bayer Cross (reg’d), CONTOUR, GLUCOFACTS and simplewins are trademarks of Bayer.

USB MH 06/10

USB DS 05/11

SPONSORED BY

NEWS

Charter of diabetes rights The International Diabetes Federation (IDF) has launched the first ever Charter setting out the fundamental rights of the more than 300 million people living with diabetes. Raising awareness about the rights of people with diabetes is a key element of IDF’s demand for coordinated and concerted international action to tackle the diabetes epidemic before, during and after the UN Summit on noncommunicable diseases (NCDs) to be held this September in New York. You can read more about the charter here: www.idf.org/idf-charterpromotesrights-people-diabetes

Picnic in the park British charity IDDT is hosting a picnic in order to help raise awareness of the fact that there are 23,000 children aged 15 or under in the UK who have Type 1 diabetes. On the day you can meet other families as well as enjoying live music, games for the whole family, face painting, clowns, stilt walkers, Kids Vs Parents Sports Day, visit the Famous Faces Tombola where kids can win signed photo of there favourite celebrities and of course, meet Wilbert who will be taking part in a giant game of human chequers on a giant picnic blanket. Wilbert’s Picnic in the Park takes place on 26 June at Wicksteed Park, Kettering, www.wicksteedpark. co.uk Tickets are £4.50 each, under 2s go free of charge. To book email bev@iddtinternational.org

ENTS S E R P T R E B IL W

Rich pickings Munch bunch Discovery Days are a family friendly events run by the Juvenile Diabetes Research Foundation (JDRF) and cater for both parents and children of people with Type 1 diabetes. On Saturday 4th of June, a ‘discover day’ is being held at the Culture and Arts Centre, The Rich Mix, in Bethnal Green http://www.richmix.org.uk/ The event will begin at 2pm and finish around 4pm. Speaking at he event is Katrina Raymond, a psychologist who specialises in diabetes. There will also be insights into JDRF’s Youth Ambassador program. As well as education and information, there are also arts and crafts sessions for children to attend. Places are limited so do register. A £5 donation per adult is suggested. www.jdrf.org.uk/events. asp?section=355&itemid=1933

Choccy Munchy Seeds are a nutritious and delicious chocolate treat, a mix of sunflower and pumpkin seeds with pieces of dried apricot, enrobed in luxurious quality Belgian milk and dark chocolate. Seeds are sources of Vitamin E, Iron and minerals, which help to strengthen the body’s defences, as well as protein and fibre, so this snack gives you a chocolate fix with other good goodies too. Made in Suffolk by a family company with a passion for ‘mindful munching’, Choccy Seeds are available in 50g snack bags (rrp £1.50). Suitable for vegetarians and coeliacs. Stockists include Tescos, Waitrose and Lakeland.

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DIABETES

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No more test strips 50 tests in one cassette

CLICK HERE FOR FURTHER INFORMATION

www.accu-chek.co.uk/mymobile ACCU-CHEK, ACCU-CHEK MOBILE and FASTCLIX are trademarks of Roche. ÂŠ 2010 Roche Diagnostics Limited.

Roche Diagnostics Limited, Charles Avenue, Burgess Hill, RH15 9RY. Company registration number: 571546

LIVING

Meet DAFNE and her friends

Desmond, Bertie, Sadie, Delia and othersâ&#x20AC;Ś

LIVING

Living with diabetes is a marathon, not a sprint, it affects all your eating choices and the more you know about that you are eating and how it can affect your blood sugar control then the better equipped you are to make a good job of it.

ou may not have heard of DAFNE (Dose Adjustment for Normal Eating) or the associated educational programmes for diabetes such as DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) and BERTIE (Beta cell Education Resources for Training in Insulin and Eating). The list goes on, with others in the ‘gang’ including BRUCIE in Ayr, DAFYDD in Abergavenney, ALFFI in Carshalton, DELIA in Dudley and DAISY in South Tyneside. Each is a variant of the original DAFNE course that is based on a programme of education first undertaken in Germany for enhanced T1 diabetes control. And it’s not just a fad. NICE has

recommended that structured education be offered to all people with diabetes at the time of diagnosis and then, as required, based on a formal, regular assessment of need. Meanwhile the Diabetes National Service Framework (NSF) highlights the crucial part that patient education has to play in enabling people with diabetes to effectively take control of their condition, by including referral for structured education as a dimension of systematic care. Put simply, to live a long happy life with diabetes, you need the “know-how”. It needn’t all be total guesswork.There are tools and skills that can help but you might not have them yet, such as carbcounting. DAFNE, the original diabetes education course, was introduced in the UK a decade ago. We look at its history and achivements overleaf.

THOUGHT FOR FOOD: Check with your local healthcare provider for access to one of these courses. DAFNE and DESMOND are most widely known. They can teach such key skills as carb-counting and dose adjustment.

LIVING

BACK TO BASICS We spoke to Dr Simon Heller, Professor Of Clinical Diabetes at Sheffield Teaching Hospitals Foundation Trust who looks back on the inception of DAFNE in the UK. “It was 1996 when Sue Roberts and I attended a meeting in Helsinki and ended up discussing a talk we had heard by Michael Berger a diabetes specialist from Dusseldorf. Sue and I already knew of their claims that Germany were taking better care of type 1 diabetes than those of us in the rest of Europe, and especially Britain. A multi-disciplinary team led by Sue, from our two units and that of Professor Stephanie Amiel’s group at Kings College Hospital went to Dusseldorf and met with Berger’s

team, all of which were very generous with their time. We met various staff, looked at their courses and spoke to patients who confirmed that they loved the course -- they felt that they were being taught skills that could ‘set them free’ through information. We all agreed that the course should be looked at within the context of the UK healthcare system.” Heller continues, “In order to start getting the necessary funding we designed a research study and applied to Diabetes UK for funding. We have also received generous funding from Novo Nordisk, which has been extremely supportive. There were nay-sayers then, as there continues to be, but we think that the results speak for themselves. The point of the study was to establish whether or not we can change the outcome of HbA1c results as well as the quality of life of the patients. As it happens, what we have been able to prove time and time again is the improved quality of life, although it may not impact an individual’s HbA1c level. In 2002 we printed our results in the British Medical Journal. We had done the study across three sites -- Kings College Hospital London, North Tyneside Hospital and Sheffield Teaching Hospital. It was then, and remains, a very exciting project. Although improvements in HbA1c levels may have been modest, the quality of life showed massive improvements; patients just loved it.”

Dr Simon Heller SKILLS FOR LIFE Skills for diabetes self-management is recognised across the healthcare industry, but what is actually available are various alternative courses, which is why there are so many other names involved – Bertie, Sadie, Delia and so on. The fact is that many centres can’t fund the appropriate training – to do it right DAFNE is a significant investment in terms of staff time. Each DAFNE course is usually two teachers with 6 to 8 participants, and the full course

“QUALITY OF LIFE SHOWED MASSIVE IMPROVEMENT; PATIENTS JUST LOVED IT” is five full days, so it is quite demanding in terms of staff time. Heller explains the validity of the commitment saying, “The point is that we are equipping people with tools that will last them a lifetime, improving their quality of life, and hopefully their length of life as well. So whilst it is intensive it is worth every moment, and every penny. It is very important to have face-to-face contact between the educator and the patients themselves.” The DAFNE courses are peer-reviewed in order to check the skills set of the educators and the course delivery. This ensures there is a consistency on what

LIVING “WE ARE EQUIPPING PEOPLE WITH TOOLS THAT WILL LAST THEM A LIFETIME” information is being taught and how it is being taught. The original results from the first courses were published in 2002 in the British Medical Journal and many patients since have said that it has changed their lives. Says Heller, “It is widely understood that people with diabetes need to control their blood sugar levels and often they are told they need to get better control by their consultants. When they come back into hospitals for a subsequent appointment they are then told off for not achieving better control and yet they are given no specific skills to help them to achieve this. DAFNE addresses this by equipping people with Type 1 diabetes with new skills, or even brush up on forgotten ones. Thousands of patients have gone through DAFNE down but we are not resting on our laurels. We now have the courses being taught in about 70 centres, which is somewhere between a quarter and a third of all hospitals with dedicated clinics for diabetes care, but we would like to think that anyone who wanted to improve their skill set would be able to access a DAFNE course in their area.”

CHANGE MANAGEMENT As with any new skill set, it can take time to understand, adapt to and made part of your daily life. The DAFNE course is not preserved unchanged and can be improved upon to deliver around specific needs. Says Heller, “The tools currently offered to self manage diabetes and replace the failing pancreas gland are very limited, just taking more insulin to

bring blood glucose down will end up in hypos. To keep going with DAFNE guidelines every day is really very hard and some healthcare professionals don’t stay the course either, moving away from core DAFNE principles and cherrypicking parts of the course they prefer or find easier to teach. More support is still required for people with diabetes to live within the DAFNE criteria, and it needs to go on beyond the course itself. Patients if they are in a DAFNE area are lucky and that’s great, but if you are in a local area and it is not available then that is a tragedy. Nor is it all about the technology, it is about the education behind using it. I would defend the right for the choice to a pump if it is the right thing for your care and control, likewise with appropriate blood glucose monitoring tools. If you can self-manage well on multiple daily injections then there might be no need for a pump. It really is about education, education, education.”

For any of these courses you will need to talk to your healthcare provider and see if they can get you on a course in your area.

RESOURCES DAFNE, Dose Adjustment for Normal Eating: http://www.DAFNE.uk.com/ 293.html DESMOND, Diabetes Education and Self-Management for Ongoing and Newly Diagnosed: http://www.desmond-project.org.uk/locationmap.html BERTIE, Beta cell Education Resources for Training in Insulin and Eating): There is a free online learning facility based on the part of the BERTIE programme which covers carbohydrate counting and insulin dose adjustment at www.bdec-e-learning.com Detailed NICE guidance can be found at: www.nice.org.uk/Docref.asp?d=68383 With many thanks to Charlotte Axworthy for the yummy illustrations www.charlotteaxworthy.com

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