Banking or parking questions

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Slide 1 narration:

In order to keep the session on track, it may be necessary to 'park' or 'bank' questions from participants. You may choose to make a note of these yourself, and save them to the ‘Parked questions’ flip chart. Alternatively, your participants may prefer to make a note of their own questions and add these to the flip chart themselves.

End transcript

 

A downloadable version [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]   is also available in a PowerPoint format.

You are aware of banking or parking questions from your experience of facilitating Remote DAFNE. Banking or parking questions is a good way of not going off track in a face-to-face course if the discussion is unrelated to the immediate topic. On the wall have a pre-prepared piece of flipchart paper titled ‘question bank’ or ‘question park’.

Ask the participant to write their question on a sticky note and add it to the question bank. It lets participants know that you won’t forget the question and that you will come back to it at the relevant time. It also reminds you to come back to the question. You may find common themes to some questions or topics and the question bank will allow you to combine them.

Team teaching

Delivery of face-to-face DAFNE course formats is based on a team teaching approach, when two or more teachers cooperate, deliberately and methodically in the teaching process to teach the course, assess the learning and evaluate each other’s performance.

Team teaching draws on the expertise and knowledge of the team to promote effective learning and expose learners to a variety of different teaching styles.

Team teaching is particularly useful in the daily (or weekly) discussions of DAFNE diaries or CGM downloads, and the daily lunchtime CP counting and insulin adjustment sessions, when participants can benefit from the expertise of DAFNE educators from different disciplines.

You may have delivered Remote DAFNE alone or with a colleague. The following videos demonstrate a team teaching approach to the discussion of DAFNE diaries or CGM downloads.

This session in a DAFNE course differs from remote DAFNE or 5x1 DAFNE as the group are reviewing diaries at the beginning and end of each day, focusing on identifying patterns in Glucose as they develop over 48 hours, rather than patterns that can develop over a week.

Participants may or may not see Glucose patterns developing by Wednesday of the DAFNE course. Participants who are not able to identify patterns may become frustrated by a perceived lack of progress if their Glucose is not in their target range.

In this situation, part of the educator role is to encourage participants to ‘wait and see’ rather than jumping in and making insulin dose adjustments when the evidence for making a change is not clear.

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Click 'Start' to begin.

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Slide 1 narration:

The video you’re about to watch demonstrates the Glucose diary discussion within the group; it shows the ways in which both educators work with the group and with each other to support a participant to identify an action plan.

Video transcript:

Sue:

Welcome back from the break everyone, we’re going to be looking at your Glucose diaries in this session; as before, we’ll spend a few minutes looking at each other’s diaries or downloads in turn, you’ll have the opportunity to talk through how things have been going, what changes you’ve made, how they’ve worked and think about your action plan overnight and the next few days - so who’d like to go first?

Paula:

Everyone’s eager this afternoon! This doesn’t normally happen until Wednesday!

Faye:

Can I go first please? I’ve got to pick my daughter up at 5 from the childminder and might have to go early and I really wanted to talk this through?

Sue:

OK, no problem, just remind me, have you got a Glucose diary or a CGM download?

Faye:

I’ve got CGM but I’ve been writing down my sugars in my diary. I find it easier to see patterns than using the lines and graphs.

Sue:

Do you want to pop your diary under the visualiser?

Paula:

Can everyone see that clearly?

Majula:

Yeah, that’s fine now.

Sue:

OK, let’s just take a few minutes to look at Faye’s diary. Right then, Faye, before we start, remind us of your targets, your ratios and your BI doses.

Faye:

My targets are the DAFNE targets and my ratios are 1:1 but my BI’s changed a bit this week.

Sue:

Ok, so hold that thought for a second – who can tell me what the DAFNE targets are?

Gillian:

Is it between 5 and 7 in the morning, and then 4 and 7 at lunch and tea time?

Sue:

Yep, spot on, how about bedtime?

Dave:

Between 5 and 9 I think, but I’d rather be closer to 9 than 5!

Sue:

That’s right, thanks for that. Faye – how do you feel about the bedtime target cos Dave isn’t comfy going to bed on a 5?

Faye:

I’m happier going to bed on a 7 or an 8.

Sue:

Ok, so let’s go back to what you’ve changed this week. Talk us through what’s been happening this week and how you’ve managed things.

Faye:

Well I split my BI on Sunday night to 8 and 8 like we discussed a couple of weeks ago. On Tuesday night we decided we’d ALL check at 3am, just to see what was going on, it wasn’t just Estwar having to wake up at 3!

Estwar:

Well thanks for that Faye! I’m so pleased I wasn’t the only one with a 3am alarm call!

Sue:

And what did you find out by doing that Faye?

Faye:

I saw that my correction at bedtime worked cos I was back on target at 3am. My Glucose also stayed steady till breakfast, so I decided to keep my BI on 8 units at bed.

Sue:

Can everyone see that? If we have a closer look - her Glucose was 12.2 before bedtime, 4 hours after her evening meal, took 2 unit correction, hoping to bring that glucose down into target and it worked. 7.1 glucose before breakfast. So what would anyone else expect a correction of 1 unit to do to your Glucose?

Estwar:

Drop it by 2 – 3?

Pauline:

I’ve gone with dropping mine by 3 so I don’t go too low until I become more certain.

Sue:

Good idea Pauline, so you feel safe doing corrections that way. How about anyone else?

Dave:

I’m the same, assume it’ll drop me by 3 until I know for sure.

Sue:

OK, thanks for that everyone, Faye – what was the next thing you tried?

Faye:

Next I wanted to check my morning BI. I’m higher than I’d like to be and corrections aren’t working very well. My action plan from Wednesday morning was to delay my lunch that day and see what happened!

Spencer:

I did the same, but it was really odd cos I’d always thought I HAD to eat every 4 hours and I HAD to have carbs at every meal AND have insulin at every meal, so it was really weird.

Paula:

Sue can I just jump in here?

Sue:

Yeah please do.

Paula:

Jas, you mentioned this on Tuesday when we talked about assessing your BI, remind us what you shared with us then.

Jas:

If I can remember! Was it when I said about not needing to inject for every meal – that bit?

Paula:

That’s it, what was it you said?

Jas:

Just that it’ll be great to have free choice on a menu when I go out and not always have to order extra sides to make sure I’ve got enough carbs; my mum and dad love to take us to this posh place for our birthdays but you always have to order veg etc as extra and there’s always been this pressure to order chips or potatoes when I don’t always really want to! Now I know I don’t have to but my mother’s still a bit sceptical!

Paula:

I guess it’s a hangover from when she was looking after you as a child so she’s still very protective?

Jas:

Exactly that yeah, but I’m old enough now to do this myself and she’s just going to have to get used to it!

Sue:

Ok guys, let’s get back to Faye’s diary and her action planning; so Faye, you delayed your lunch yesterday, talk us through what happened and what you found out.

Faye:

I’ve never done this before so it’s actually really, really useful! I started the day on 7.1. Then I had 4 ½ CPs for breakfast so I rounded up my insulin to 5 units because I was just over the top of my target. By lunch I was 10.6, I had a black coffee and nothing else and then by 3 o’clock, I was 13.7.

Sue:

And what did you do then?

Faye:

I had a snack and took some QA with a correction.

Sue:

And what did you decide to do as a result of delaying your lunch and assessing your morning BI?

Faye:

Well this morning, I put my BI up from 8 units to 10 units. I’ve just checked my CGM and I’m 6.4 so I’m happy with that!

Paula:

So basically, you’ve sorted out your BI and it’s only Thursday! Well done Faye!

Dave:

Yeah, that’s amazing, makes me realise that even though I haven’t made as much progress as other people, this DAFNE stuff must work!

Sue:

I guess it’s helpful to learn from each other isn’t it?

Majula:

Yes that’s good – so if someone else messes up we know not to do the same thing!

Faye:

Thanks for that Majula! No pressure then!

Sue:

So let’s continue the learning from each other theme, Faye – tell us what your action plan is this evening.

Faye:

I’ve checked my BI so I want to move on to my tea time ratio. If I don’t correct, I go up.

Sue:

So what specifically are you going to do now?

Faye:

I’m going to check my Glucose before tea. Then I’m going to weigh my carbs, I’ll have something easy to work out. I’ll only have a carb free drink after tea. And then I’ll check 4 hours later. Then I’ll be able to see what my QA’s doing.

Sue:

OK thanks for that, and why d’you think Faye’s going to wait 4 hours before checking her Glucose at bed?

Gillian:

Is it because that’s how long her insulin lasts from tea time?

Sue:

Absolutely, yes, Faye’s on a quick acting insulin at meals – remind me which one?

Faye:

Humalog

Sue:

Yep, I remember now – that’s why Faye’s going to wait 4 hours. Faye you said you’d have something easy to work out for tea?

Faye:

I’ve got some individual portions of lasagne in the freezer. It tells you how many carbs per portion on the label.

Paula:

What will you have with it?

Faye:

Just a salad on the side.

Sue:

Ok, so you’ve got a plan for tea, and a plan for your Glucose checking. How will you know if you need to increase your ratio?

Faye:

Well if I go up by more than 1.5 by bedtime. I might just do it tomorrow just to be sure. I’ve only just increased my morning BI today.

Sue:

Ok, you’ve got a plan you’re happy with there, so let us know how you get on when we come back tomorrow! Anything else you’d like to think about this evening?

Faye:

No I don’t think so, I’m happy just to keep it simple.

Sue:

Ok, thanks for that Faye, who’s going to go next?

End transcript