Scenario 1: Anger

Download this video clip.Video player: nc3612_dafne_2018_vid034.mp4

Show transcript|Hide transcript

Transcript

DEAN

This is my DAFNE session. I'm late. I had a terrible night. Sometimes I wonder about these sessions. I'm not sure the approach is working.

EDUCATOR

Morning, everyone. Come on in. Don't be shy. Have a seat. It's great to see you all again.

FRED

You too.

EDUCATOR

Yeah, guys. Just sit there where you were yesterday is fine. OK. And you've remembered to bring your diaries back in as well. That's great. That's what I like to see. OK, so how is everyone this morning?

[INTERPOSING VOICES]

Good. And you're finding the course good, or--

FRED

Challenging, yeah.

EDUCATOR

Yeah?

STEVE

Getting there.

EDUCATOR

Great. So let's get started, shall we? Hi, Dean. You're happy to go first this morning. Thank you very much. And so you let me know earlier that you didn't have a very good night last night. I think it would be useful for you to go first, so we can have a little talk about what's happening. And is that still OK?

DEAN

Fine.

EDUCATOR

OK. I mean, if you'd rather not talk through your diary today, that's fine, too.

DEAN

Go ahead.

EDUCATOR

OK. So talk us through what happened between leaving the session yesterday and arriving back here this morning. Which part would you like to talk about first?

DEAN

Well, to be honest, I nearly didn't come back. The way it messed me up, I think I was better off before.

EDUCATOR

OK. So you think you were better off before. Well, let's have a little look at your diary and see if we can figure out what's been happening, OK? So I can see that you had a hypo last night. Is that what you'd like to talk about first? So what was your BG like before the course?

DEAN

Well, nobody's ever been able to get it right, but I wasn't having two hypos a day, like I am now.

EDUCATOR

OK. So you mentioned on Monday that you wanted to join the course so that you could get a more predictable BG and a better HbA1c. That's your goal. Well, we aren't quite there yet, but it has only been two days.

If we have a little work through the stepwise approach, perhaps we can have a little look and see why the hypos are happening and how we can prevent them from happening in the future. OK. So let's start with the evening meal last night, Dean. What were the CPs for that?

DEAN

Well, I had fish and chips on the way home.

EDUCATOR

OK. So you had a takeaway.

DEAN

Yes.

EDUCATOR

And how did you work out the CPs?

DEAN

Well, there was CPs in the chips and in the fish batter. It wasn't a huge portion, so I guessed at maybe eight. I've been counting carbs for years, so I went off the picture that we had in class. I didn't think I was far out.

EDUCATOR

OK. So you used a visual estimate based on the picture that we saw yesterday because that's all you had to go on. OK. So thinking about the stepwise approach, how can we rule out that CP counting is what's knocking the BG out of sync at the moment?

FRED

Not at the moment, but it could be something else.

EDUCATOR

Dean, are there any other factors in the other causes section that might have affected your BG?

DEAN

No. I didn't exercise. No snacks. I didn't have anything to drink.

OLGA

And what about the corrections you've taken every night after you've eaten?

DEAN

Well, it's never been a problem before. I always correct before bed. It was never a problem before the change made it twice a day basal. I was fine on once.

EDUCATOR

OK. So it sounds like you think it could be the basal. Let's think about insulin. So Dean, thinking about the stepwise approach, what does it say about the action on your QA insulin?

DEAN

It's about up to 15 minutes. Peaks at about 60 and then lasts for two hours.

EDUCATOR

OK. So when you took your QA at half past nine last night, when do you think it might run out?

DEAN

Well, it takes two hours, so about half eleven.

EDUCATOR

And what does everyone else think?

FRED

Well, I thought it lasted for four hours. I mean, it does for me.

DEAN

Well, everybody is different. Mine last for two.

EDUCATOR

Now, the manufacturers say that it lasts between two and five hours, but for most people it lasts around four. Let's think about corrections. Dean, can you talk us through your correction last night?

DEAN

Well, I took an extra two units of QA because my BG was high, and I thought I'd take a little less than the night before so I wouldn't have a hypo, but I had one anyway.

EDUCATOR

OK. So you are following the DAFNE guidance and not having any more than four units of correction for now, until you figure out what works for you.

DEAN

Yes.

EDUCATOR

What else did we say on Monday about corrections?

DEAN

I don't remember.

FRED

We said not to correct between meals. You have to leave it three or four hours after an injection. So just correct at the next meal. Four hours works for me.

EDUCATOR

OK, Dean. So based on previous experience, you think that QA lasts for two hours. What do you think might happen if you were to correct after two?

STEVE

Is that what you're calling insulin stacking? Where you get two doses working at the same time, which would cause a hypo?

OLGA

Looking at your diary, Dean, do you think it might last four hours? Your hypos are both one or two hours afterwards. Maybe you don't need it.

DEAN

I don't think that's right. That might be right for you, but it's not right for me. I think it's the basal.

EDUCATOR

What could you do to check that? What other information do we need?

DEAN

So you want me to get up at 3 o'clock in the morning? Priceless.

STEVE

How about having an earlier meal tonight, then that way you definitely have four hours between the meal and your bed checks. So if you left it, then you'd be able to see how long your QA lasts.

DEAN

What about fitting diabetes around my life and not my life around diabetes? You want me to get up at 3 o'clock in the morning and then change all my meals? Listen, if this is the way DAFNE is going to be, then stuff it!

STEVE

Look, I'm not saying that you do that. I'm just saying just do it for tonight. Like a bit of an experiment.

EDUCATOR

OK, Dean. You seem angry. Can I ask why that is?

DEAN

I am angry. You're making me angry. All this stuff, it's like you're blaming me.

EDUCATOR

Well, I'm sorry you feel that way. I'm not here to make you do anything or make you feel like you're doing anything wrong. This is just another way of doing it. It's another tool for you to have. And sometimes I get enthusiastic because I really have seen this work for so many people before. If I've said or done anything to make you feel bad, then I really am sorry.

Dean, I'm really impressed that you've come on this course and tried new things, even though you haven't had a very positive experience with your diabetes team in the past. Looking at your diary, I can already see that you were in target from midday yesterday up until 9:30. That's a third of the day cracked already, and it's only been two days. To me, that seems like a real positive. So what do you all think of Dean's diary so far?

OLGA

Oh, I understand how it makes you feel crazy angry. We've all felt like that at some point.

FRED

Yours is better than mine at the moment. I've been having hypos every night for years. I just figured out yesterday that I just must have too much insulin somewhere. You're probably the same.

DEAN

Maybe.

EDUCATOR

OK. So I don't think looking at your diary is helpful right now, so I'm going to stop, if that's OK with you.

DEAN

Fine.

EDUCATOR

OK. How is everybody feeling? We can either carry on and go straight onto Olga's diary or, if you prefer, we can have a short coffee break and come back and do the diaries afterwards. We'll still have a break at the usual time, but maybe just a bit of a shorter one. What would you all like to do?

[ALL AGREEING]

EDUCATOR

Dean, I'd really like to understand what just happened. I'd appreciate it if we could have a chat on our own at lunch time. Would that be all right with you?

DEAN

Yes.

EDUCATOR

Great. Thank you.

DEAN

OK. No problem.

End transcript

Download

 

As you watch the video, think about:

Which educator behaviours can you observe being used to manage the challenging behaviour, diffuse the situation and protect the group?

If you need to refresh your memory about educator behaviours refer to Educator behaviours that demonstrate the DAFNE philosophy [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] , which is available in the resources area.

Record your observations in your workshop pack.

Reflect on what you have observed. What will be different for you when you are in the room delivering face-to-face DAFNE courses? What might you have done differently? Record your reflections in your workshop pack.

Bring your observations and reflections to the workshop. You will have an opportunity to discuss them there.