diabetes 101: are you ready?. objectives identify education as an essential treatment mode of...
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Diabetes 101: Are You ReadyDiabetes 101: Are You Ready??
ObjectivesObjectives
Identify education as an essential treatment Identify education as an essential treatment mode of diabetesmode of diabetesDescribe practical tips in preparing patients Describe practical tips in preparing patients awaiting consultation with a health care awaiting consultation with a health care professional (GP, Nurses, Dieticians, etc)professional (GP, Nurses, Dieticians, etc)Identify common problems affecting reliability of Identify common problems affecting reliability of capillary testingcapillary testingDemonstrate how an individualized self-Demonstrate how an individualized self-management plan of diabetes can foster management plan of diabetes can foster empowerment and positive outcomes empowerment and positive outcomes
Carmela D’Avella, BSc N, CDE
Role of Diabetes Nurse EducatorRole of Diabetes Nurse Educator
Certified Diabetes EducatorCertified Diabetes Educator
Empower self management skills and Empower self management skills and knowledge knowledge
Diabetes Health TeamDiabetes Health Team
Carmela D’Avella, BSc N, CDE
53 year old presents at ER53 year old presents at ER
Administrator and Union presidentAdministrator and Union president
Married, no children Married, no children
Caring for 2 family members terminally illCaring for 2 family members terminally ill
30 lbs weight loss X 5 months30 lbs weight loss X 5 months
Polyuria, polydipsia, fatigue, can’t sleepPolyuria, polydipsia, fatigue, can’t sleep
Under investigation anginaUnder investigation angina
Refuses to stay in ER, non-negotiableRefuses to stay in ER, non-negotiable
Carmela D’Avella, BSc N, CDE
Lab Values in ERLab Values in ER
Glucose 18.0 mmol/lGlucose 18.0 mmol/lCreatinine 66 umol/LCreatinine 66 umol/LHbA 12.4 %HbA 12.4 %Cholesterol 4.99 mmol/lCholesterol 4.99 mmol/lHDL 1.32 mmol/lHDL 1.32 mmol/lLDL 2.65 mmol/lLDL 2.65 mmol/lTriglycerides 2.22 mmolTriglycerides 2.22 mmol/l/lC/HDL 3.8C/HDL 3.8ACR 48.0 mg mmol/lACR 48.0 mg mmol/l
Carmela D’Avella, BSc N, CDE
1c
On discharge in EROn discharge in ER
New diagnosis type 2 diabetesNew diagnosis type 2 diabetes
Metformin 250 mg bidMetformin 250 mg bid
Glyburide 5 mg bidGlyburide 5 mg bid
Referral to a GP because no diabetes Referral to a GP because no diabetes clinic in vicinity clinic in vicinity
Cardiology consultCardiology consult
Carmela D’Avella BSc N, CDE
3 days later at GP’s office3 days later at GP’s office
Diabetes diagnosed 5 years agoDiabetes diagnosed 5 years ago
Family history of diabetesFamily history of diabetes
Family history of CVDFamily history of CVD
SedentarySedentary
Smokes Smokes
135/ 90 P 74135/ 90 P 74
5’3, 217 lbs BMI 385’3, 217 lbs BMI 38
Carmela D’Avella, BSc N, CDE
At the OfficeAt the Office
Sleeps at night, ‘feels better’Sleeps at night, ‘feels better’Skips meals, big supperSkips meals, big supperTakes pills pc mealsTakes pills pc mealsAt diagnosis 5 years ago, At diagnosis 5 years ago,
-lost weight-lost weight --”No DM, felt fine” – stopped pills ”No DM, felt fine” – stopped pills -Never monitored- “no need if on-Never monitored- “no need if on pills and diet” pills and diet”
Carmela D’Avella BSc N, CDE
Where do I start Where do I start ??
What does she need to knowWhat does she need to knowvsvs
nice to know ?nice to know ?
Carmela D’Avella BSc N, CDE
What Can I Eat ?What Can I Eat ?
Improve and maintain quality of life and Improve and maintain quality of life and nutritional statusnutritional status
Consistency in meal timesConsistency in meal times
Just the Basics - CDAJust the Basics - CDA
Carmela D’Avella, BSc N, CDE
Zim Ba Wee Hand Jive
CARBOHYDRATES PROTEIN
VEGETABLES FAT
Carmela D’Avella, BSc N, CDESource: Canadian Diabetes Association
To help you plan for healthy eating
Carmela D’Avella, BSc N, CDESource: Canadian Diabetes Association
Pills, Pills and MORE PillsPills, Pills and MORE Pills
ComplianceCompliance
Do I really need itDo I really need it
When is the best time to take itWhen is the best time to take it
What about side effectsWhat about side effects
Carmela D’Avella, BSc N, CDE
What about HYPOGLYCEMIAWhat about HYPOGLYCEMIA
Prevention = EducationPrevention = Education
Find the CauseFind the Cause
How do I treat How do I treat ??
Carmela D’Avella, BSc N, CDE
TREATMENT
Examples of 15 g of CHO for the treatment of mild to
moderate hypoglycemia:
15 g of glucose in the form of glucose tablets
15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water
175 mL (3/4 cup) of juice or regular soft drink
6 Life Savers
15 mL (1 tablespoon) of honey
WHAT’S IN IT FOR ME ?WHAT’S IN IT FOR ME ?
remember self testing will provideremember self testing will provide
-RIGHT information to make-RIGHT information to make
-RIGHT choice at-RIGHT choice at
-RIGHT time with-RIGHT time with
-RIGHT dose for-RIGHT dose for
-RIGHT quality of life-RIGHT quality of life
Carmela D’Avella, BSc N, CDE
WHAT’S MY TARGET ?WHAT’S MY TARGET ?
Carmela D’Avella, BSc N, CDE
A1C Fasting / preprandial
glucose (mmol/L)
2-hourpostprandial
glucose (mmol/L)
Target for most patients
7 % 4.0 – 7.0 5.0 – 10.0
Normal range
6 % 4.0 – 6.0 5.0 – 8.0
Consider targets in normal range for patients in whom it can be achieved safely.
TARGETS
Getting The Most Out of Getting The Most Out of MonitoringMonitoring
Which is the best meter?
The best meter is ...
Carmela D’Avella, BSc N, CDE
Should Should
ACCURACY ACCURACY
be an issue ? be an issue ?
Carmela D’Avella BSc N, CDE
Should accuracy be an Issue ?Should accuracy be an Issue ?
Drop sizeDrop size
CalibrationCalibration
Expired /exposed stripsExpired /exposed strips
Meter memory vs log bookMeter memory vs log book
Is it mg/dl or mmol/l ?Is it mg/dl or mmol/l ?
HbAHbA
Carmela D’Avella BSc N, CDE
1c
When is the best time to test?When is the best time to test?
-type 1 - 3 X day-type 1 - 3 X day
-type 2 – at least qd -type 2 – at least qd
Carmela D’Avella, BSc N, CDE
What to recordWhat to record
DateDate
TimeTime
ResultsResults
Time of medicationsTime of medications
DoseDose
Anything that is differentAnything that is different
“ “ My meter has a memory, I don’t need My meter has a memory, I don’t need to write my results”to write my results”
Carmela D’Avella, BSc N, CDE
Fear of PAINFear of PAIN
Myths Myths / Failure/ Failure
BargainingBargaining
Carmela D’Avella, BSc N, CDESource: Novo Nordisk Inc.
Initiation of Insulin
2 months later2 months later
Glucose 5.1 mmol/lGlucose 5.1 mmol/lCreatinine 62 umol/lCreatinine 62 umol/lHbA 6.4 %HbA 6.4 %Cholesterol 3.28mmol/lCholesterol 3.28mmol/lHDL 1.33 mmol/lHDL 1.33 mmol/lLDL 1.39 mmol/lLDL 1.39 mmol/lTriglycerides 1.21 mmol/lTriglycerides 1.21 mmol/lC/HDL 2.5C/HDL 2.5ACR 28.4 mg/mmolACR 28.4 mg/mmol
Carmela D’Avella BSc N, CDE
1c
2 months later2 months later
Wishes to improve self esteemWishes to improve self esteem
Family eating healthy Family eating healthy
Delegates at work, reassessing valuesDelegates at work, reassessing values
Control within targetControl within target
Smokes less, most difficult goalSmokes less, most difficult goal
Thinking starting exercise programThinking starting exercise program
Weight 206 lbs BMI 36.6Weight 206 lbs BMI 36.6
Carmela D’Avella BSc N, CDE
2 Months later2 Months later
Glyburide 5 mg bidGlyburide 5 mg bid
Metformin 500 mg bidMetformin 500 mg bid
Coversyl 2 mg qdCoversyl 2 mg qd
Zocor 20 mg qdZocor 20 mg qd
Asaphen 80 mg qdAsaphen 80 mg qd
Opthamology consultOpthamology consult
One year and half laterOne year and half later
Feels great, family eating healthy mealsFeels great, family eating healthy meals20 minute aerobics twice a week20 minute aerobics twice a weekStill smoking, tried the patchStill smoking, tried the patchCapillary results within target rangeCapillary results within target rangeFrequent hypoglycemiaFrequent hypoglycemia178.7 lbs BMI 31.7178.7 lbs BMI 31.7BP 120/80BP 120/80
One year and half laterOne year and half later
Glucose 5.0 mmol/lGlucose 5.0 mmol/lCreatinine 64Creatinine 64HbA 5.8 %HbA 5.8 %Chol 3.47Chol 3.47HDL 1.64HDL 1.64LDL 1.53LDL 1.53Triglyceride 0.65Triglyceride 0.65C/HDL 2.1C/HDL 2.1ACR 10.5ACR 10.5
1c
One year and half laterOne year and half later
Glyburide 2.5 mg bidGlyburide 2.5 mg bid
Metformin 850 mg tidMetformin 850 mg tid
Asaphen 80 mg qdAsaphen 80 mg qd
Zocor 20 mg qdZocor 20 mg qd
Coversyl 4 mg qdCoversyl 4 mg qd
SummarySummary
DiagnosisDiagnosis 2 months2 months 1 ½1 ½ years years
GlucoseGlucose 18.0 mmol/l18.0 mmol/l 5.1 mmol/l5.1 mmol/l 5.0 mmol/l5.0 mmol/l
CreatinineCreatinine 66 umol/l66 umol/l 62 umol/l62 umol/l 64 umol/l64 umol/l
HbAHbA 12.4 %12.4 % 6.4 %6.4 % 5.8 %5.8 %
LDLLDL 2.65 mmol/l2.65 mmol/l 1.39 mmol/l1.39 mmol/l 1.53 mmol/l1.53 mmol/l
C/HDLC/HDL 3.83.8 2.52.5 2.12.1
ACRACR 48.048.0
mg/mmol mg/mmol
28.428.4
mg/mmol mg/mmol
10.510.5
mg/mmol mg/mmol
1c
SummarySummary
DiagnosisDiagnosis 2 months2 months 1 ½ years1 ½ years
WeightWeight 217 lbs217 lbs 206 lbs206 lbs 178.7 lbs178.7 lbs
BMIBMI 3838 36.536.5 31.731.7
BPBP 135/90135/90 120/80120/80
The Bottom LineThe Bottom Line
IndividualizeIndividualize
Avoid OverloadAvoid Overload
Communicate ExpectationsCommunicate Expectations
Positive ApproachPositive Approach
Tools & Community ResourcesTools & Community Resources
Follow up / repetitionFollow up / repetition
K.I.S.S.K.I.S.S.
Carmela D’Avella, BSc N, CDE
EDUCATION IS THE KEYEDUCATION IS THE KEY
Carmela D’Avella, BSc N, CDESource: Lifescan Canada Inc.