the management of blood glucose in Type 1 diabetes.Understanding about multiple-daily insulin (MDI) regimen and how to match insulin dose to the amount of carbohydrate eaten is an important aspect to ensure optimal diabetes management. However, carbohydrate counting education often relies solely on the local diabetes dietitian in providing patients and carers with adequate knowledge and education. This has resulted in delays in appropriate MDI management.
In 2010, a survey showed that baseline knowledge and confidence of healthcare professionals in carbohydrate counting education and implementation was demonstrated to be very poor. All newly diagnosed type 1 diabetes patients were not started on MDI regimen until after carbohydrate counting education was initiated by the paediatric diabetes team at least 2 weeks later.
The Paediatric Diabetes Team at Southport and Ormskirk Hospital NHS Trust developed a 360 degree approach of specific carbohydrate counting education schemes for ward nurses, junior doctors, carers and patients from the point of diagnosis. Joint drop-in specialist nurse and diabetes dietitian clinics were also set up weekly, dietitian home visits and school visits were initiated, and large group carbohydrate counting education workshops were implemented.
The 360 approach towards dietary management ensured that education was consistent at all points of the patient’s diabetes journey by providing key education to all healthcare professionals and developing a structured education of carbohydrate counting and good nutritional advice to patients and families.
Post-initiatives, it was demonstrated that MDI regimen with carbohydrate counting education can be initiated at the point of diagnosis by competent ward staff.
Surveys showed that patient/carer and staff knowledge and their confidence were significantly improved. The key to success in carbohydrate counting education was that healthcare professionals, children and their families receive consistent messages from staff at all points of the patient’s diabetes journey.
This initiative showed improved quality of care, satisfaction, knowledge and confidence of healthcare professionals, patients and their families.