Twenty years on, the OzDAFNE program continues to transform the lives of people living with type 1 diabetes. ZOE DELEUIL talks to Ruth Hansen, a recent participant with Diabetes WA. 

Taking five days out of your routine to learn more about managing type 1 diabetes is a significant commitment. But for Ruth Hansen it has been life changing.

“I’ve managed quite well over the years, so I was reluctant to do OzDAFNE, and extremely reluctant to try carb counting. It also meant taking a week off work to fly to Perth from Wickham. But Linda, my diabetes educator, strongly encouraged me as there were some things I couldn’t manage, including my morning highs. So I gave it a go.”

A key tool of the program is a daily worksheet that records each participant’s food intake, insulin dose and glucose level. By analysing results as a group, everyone gains a better individual understanding of hypos and the impact of diet, exercise and other factors. Participants learn more about working out how much insulin they need for what they want to eat and if they need more or less insulin based on their glucose levels.

“We’d start the day by going through everyone’s worksheets. We could see what happened overnight, and as a group we’d work out what changes we could make,” says Ruth. “It’s hard to do that by yourself, but if you do it together you feel more confident adjusting your insulin. It gets you out of a rut.”

In bringing together a small group of people from a diverse range of backgrounds – young and old, newly diagnosed or living with type one diabetes for many years – participants also gain valuable new insights into living well with diabetes.

“It was a lovely bunch of people,” says Ruth. “Everyone was very considerate, and it was so helpful to learn more about how other people manage. We had a couple of family members whose child had a recent diagnosis. It was good for them to meet people with more experience in handling hypos and to get a sense of the longer-term medical impact – but also to see us getting on with our lives.”

“Sometimes you lose confidence in the way that you are managing life, but in fact you’re doing really well. OzDAFNE helped me to realise that.

Brainstorming practicalities as a group is a key part of the program, with participants sharing tips, stories and even recipes.

“One participant was newly diagnosed and wasn’t sure if he’d be able to continue sailing,” says Ruth. “We worked through his situation in an afternoon – all the practical considerations, including what to wear, how to keep his insulin cool, how to think about what his glucose levels are doing – and all that gave him confidence that his new diagnosis didn’t have to inhibit him doing something he loves.”

Along with carb counting and insulin dose adjustment, the program covers physiology, tech for type 1 diabetes and the newer drugs.

“Every day was a bit different, and it was worth spending time on the minutiae and going right back to basics. One thing I was advised was to consider going on an insulin pump, which I’d never wanted to do, but I’m now reconsidering it. It reset my mind frame around the tech that’s available.”

Analysing her results has also enabled Ruth to reduce her insulin. “I was always having insulin that I felt was forcing me to eat, now I eat when I’m hungry. My insulin is down to a third of what I used previously, my time in range is now up to 78% from 50% and I’ve lost weight. It’s about making the tech and medicine and systems work for your life.”

As for counting carbs, Ruth realised that not only is it possible, but she’d been intuitively doing it all along.

“Sometimes you lose confidence in the way that you are managing your life, but in fact you’re doing really well. OzDAFNE helped me to realise that. It’s five days, but it can change your attitude towards diabetes and how you manage it. It can change your whole life.”

What is OzDAFNE?

The DAFNE (dose adjustment for normal eating) program was developed in Germany in the 1980s and then later launched in the UK, where the NHS continues to offer it to everyone diagnosed with type 1 diabetes. The Australian version, OzDAFNE, launched more than 20 years ago and is currently offered for free through Diabetes WA on behalf of the NDSS to West Australian adults living with type 1 diabetes using insulin pens.

Rather than relying on short and intermittent appointments with a health care professional, the face-to-face version of the program runs over five consecutive days. There are two diabetes educators running the program (a dietitian and a registered nurse) supporting up to eight participants. This allows time to learn, talk, reflect and ask more questions with each new topic.

Diabetes WA dietitian CDE Linda Bradbury says she encourages many of her adult type 1 diabetes clients to consider the free program, either face to face or online, because she knows how valuable it can be when people learn from one another.

With every single OzDAFNE program we run there is a real connection

“The course itself requires hours of preparation by the diabetes educators, to systematically explore each participants health history,” she explains. “We provide personalised insulin-to-carbohydrate ratios and targets, which help people adjust their insulin with ideally more confidence and accuracy. Across the week we track participants’ glucose levels to see if any adjustments are necessary. While this is happening, we are introducing and weaving in key type 1 diabetes topics that are built on during the week. This includes teaching carbohydrate counting, how to use insulin/carbohydrate ratios and other relevant topics such as sick day management, exercise and eating out to name just a few.”

Before courses like OzDAFNE, Linda says, many people had no choice but to rely on fixed insulin doses. Even those given ratios could still find it challenging to tease out if these calculations were working well, as there is usually limited time in the health system for instant two-way communication between the patient and health professional. OzDAFNE bridges this gap. Many type 1 clients are looking for a more flexible approach to insulin management, and having clear principles to guide dose adjustment builds confidence and supports safer and often more effective diabetes care.

“It’s a very individualised program,” she says. “It’s also incredibly powerful to be a part of, as often participants are meeting others living with type 1 diabetes for the first time. With every single program we run there is a real connection and bond formed in the group.”

“Anecdotally, after completing the course, many participants are often at a loss why these types of courses are not mandatory for those newly diagnosed with type 1 diabetes in Australia. The value of gaining fundamental knowledge and tools to help manage the condition, along with the added benefit of learning alongside others in the same situation, is priceless.”

Are you living with type 1 diabetes and want to learn more about OzDAFNE?

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