A description of two patients with Type 1 diabetes living in a high secure psychiatric hospital: Their journey moving from fixed dose to self-directed variable dose insulin using an individualised adaptation of the Bournemouth Type 1 Intensive Education (BERTIE) Programme and a unique calculation tool
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The High Secure Pychiatric Hospital treats mentally unwell people who are a 'grave and immediate danger to themselves and/or others' .It is one of only three high secure hospitals in the country and has its own health centre with associated staff. This project aimed to educate two patients with Type 1 diabetes in carbohydrate counting and insulin dose adjustment. Historically patients have been prescribed fixed dose insulin to avoid errors and potential self-harm. Allowing them to calculate their own fast acting insulin doses was initially met with resistance from care teams at this hospital; however, changes in working relationships has produced a collaboration of care providing improved outcomes for health. Empowering patients with learning difficulties and low numeracy skills to calculate and adjust their fast acting insulin has been shown, in two cases, to improve glycaemic control. The principle of calculating a correction dose, estimating the carbohydrate in any food or drink and administering a dose of fast acting insulin was taken from training done by educators on the BERTIE Programme. The programme was adapted in timescale (to allow for extra education) and delivery. Individual sessions allowed for the complex needs of the patients and a unique calculation tool or 'slide rule' was developed to aid the process. Working with healthcare professionals across all specialities these patients now show improved biochemistry and health outcomes.