Carbohydrate counting is an effective skill and tool used to optimise the management of blood glucose in type 1 diabetes. The Paediatric Diabetes Team at Southport and Ormskirk NHS Trust developed a 360 degree approach to education for health care professionals, carers, children and young people with the condition. Joint drop-in specialist nurse and diabetes dietitian clinics were set up weekly, dietitian home visits and school visits were initiated, and large group carbohydrate counting education workshops were implemented. After the 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.
Understanding about MDI regimen and how to match insulin dose to the amount of carbohydrate eaten is an important aspect to ensure optimal diabetes management. Carbohydrate counting is a dietary management in diabetes that is currently a source of concern with many diabetes units relying 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 their confidence in implementation carbohydrate counting in the wards were demonstrated to be very poor. To date, many units do not establish carbohydrate counting in the wards due to lack of knowledge, and education is only implemented by the dietitian weeks after diagnosis.
It was important that all healthcare staff, patients and carers had access to teaching materials and understood basic carbohydrate portion guides, practical estimation of foods, interpretation of carbohydrate values on food packets and calculation of carbohydrate in recipes. The team ensured that the following objectives were fulfilled at the end of the carbohydrate counting programme for all healthcare professionals, patients and their carers:
- Understanding of target blood glucose levels
- Ability to apply all aspects of basic carbohydrate counting
- Understanding of the action of insulin and the basal-bolus insulin concept
- Ability to carry out pattern management
- Understanding good nutrition and how diabetes can affect health, and what they can do to stay healthy
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