diabetes management (presentation slides - ms word) · web viewslide 2: learning objectives...

Welcome to CNIB’s InFocus Webinar Series Webinar 3: Diabetes Management with

Vision LossPresented by: Lynn Baughan RN, MN, CDEKathryn MacDonald, RD, CDE

CNIB In Focus Webinar 3: Diabetes Management with Vision Loss

Participants will be to:

Identify the key components for diabetes management.

Describe techniques for teaching clients with vision loss, blood glucose monitoring, medication and insulin administration, meal preparation and foot examination.

Identify resources for ongoing education and support for managing diabetes.

Slide 3: Diabetes in Canada…

2.7 million Canadians have diabetes

Estimated number of people diagnosed with diabetes will increase to 4.4 million by 2020 if trends continue

Estimated cost for treatment of diabetes in 2010 is 11.7 billion dollars

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Slide 4: Management of Diabetes

A balance of…

Healthy Eating

Regular Physical Activity

Monitoring

Taking Prescribed Medications

Self-Management and Coping Skills

Manage blood glucose, lipids and blood pressure

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Slide 5:

Management of Diabetes

Working as a team with the client at the centre Instead of “No” and “Can’t” it is “How” Connect with a Diabetes Care Team and other available

resources Provide self management support

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Slide 6:

General Teaching Tips• Use large print materials

• High contrast black on white, at least a 16 point bold serif type (arial) and with lots of white space

• Prefer to use 20 point arial font

• Use a fine tip black felt marker (CNIB or Sharpie)

• Use models (food, foot, meters)

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Slide 7:

Webinar 2 – Supporting your patients

Practical tips and strategies on how to work with clients in a clinical setting:

• Basic etiquette

• How to navigate the patient

• Communication and education

Refer to: www.cnib.ca/infocuswebinarseries

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Slide 8:

Adaptive Diabetes Education• Must be individualized• Matches techniques and equipment for the person• Provides choices• Must ensure safe, accurate performance of skills• Evaluates skills on a regular basis

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Slide 9:

Healthy Eating and Diabetes Individualized approach to meal planning

Balanced, regularly spaced meals, consistent

Emphasis on high fibre- Plenty of raw vegetables- Moderate amounts of whole fruits and whole grains

Low fat and low sodium

Sugar is OK in moderation as part of a balanced intake

Weight management

Portion Moderation

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Slide 10:

CDA Nutrition Guide - Just The Basics

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Slide 11:

Meal Planning Tips• Strive to maintain enjoyment in food preparation,

eating and independence

• Use specific sized serving spoons and dishes to estimate portions

• Rehabilitation specialist:• Does an in-home assessment• Teaches skills for safe meal preparation• Teaches how to label items • Puts tactile labels on the stove or microwave

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Slide 12:

Meal Planning Tips

• Use modified visual aids• Special products are available for meal preparation and

cooking (i.e. extra long oven mitts, fluid level indicators, audible weigh scales etc.)

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Slide 13:

Working Safely In The Kitchen Large print, braille, tactile and audible cues

Bright colours and colour contrasts on cooking utensils

Techniques for spreading, measuring, pouring, and chopping

Safe food storage

Shopping for groceries

Organizing the kitchen

• www.balancefba.org

• www.lowvisionchef.com

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Slide 14:

Physical Activity - Getting Started Safely

Medical check-up first

Eyes, heart and feet checked

Proper fitting foot wear

Check blood glucose before and after

Plan activity 1 to 11/2 hours after meals

Carry a fast acting glucose and identification

Work up to goal of 150 minutes per week total

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Slide 15:

Side Effects of Increased Activity• Risk of Hypoglycemia: for people taking insulin and/or some

oral agents

• Potential Aggravation of Complications: such as cardiac, neuropathy in the feet and retinopathy

• Potential Deterioration of Glycemic Control in Type 1: through counter regulatory hormone response when blood glucose is above 14 mmol/L and ketones are present

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Slide 16:

Hypoglycemia = Low Blood Glucose

• Blood glucose less than 4 mmol/L

• Signs and Symptoms:• Tremors• Palpitations• Sweaty• Headache• Mood changes• Irritable• Difficult thinking

• Test blood glucose if able to

• Treat first if unable to test

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Slide 17:

Treatment of Hypoglycemia

Rule of 15

• Treat with 15 gm glucose

• 3 BD glucose tabs OR 4 dextrose tabs OR 175 ml orange juice

• Wait 15 minutes, recheck blood glucose

• Repeat treatment until blood glucose is > 4 mmol./L

• More than 1 hour to next usual meal or snack?

• Give a 15 gm carbohydrate snack (e.g. 4-6 crackers with cheese, ½ sandwich)

• Assess possible causes for the low blood glucose to prevent recurrence.

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Slide 18:

Blood Glucose Monitoring

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• Education focuses on maximizing use of all available senses

• Conduct assessment under conditions that maximize client’s vision

• Demonstrate various meters to determine best choice for client

• Options for those who cannot read display screen


Slide 19:

Options for Blood Glucose Monitoring

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Slide 20:

Products For Testing Blood Glucose

• Meters with large, bold numbers include:

• Oracle

• Accu-Chek Compact

• One Touch Ultra

• Ascenia Contour

• Ascensia Breeze

• Precision Xtra

• BG Star

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• Blood glucose monitors are available at pharmacies and medical supply companies

• Prescription required for coverage under most health care plans


Slide 21:

Teaching Tips

• Break skill down into small components

• Keep all supplies in consistent location

• Use divided container to store supplies

• Encourage use of all available senses

• Reinforce over time, until independent in skill

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Slide 22:

Obtain Sample

• Land mark by placing thumb on 1st joint below finger tip

• Poke finger• Gently pump 4 times

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Slide 23: Apply the Sample

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Slowly move strip back and forth across the fingertip

Record results in large print log book or on recording device

Upload results to audio log book


Slide 24: Targets for Glycemic Control

Test TargetFasting Blood Glucose andBefore Meals

4.0 to 7.0 mmol/L

2 hours After Meals 5 to10 mmol/L (if A1C in target)5 to 8 mmol/L (if A1C not at target and can be achieved safely)

A1C Glycated Hemoglobin Less than or equal to 7%

Targets are individualized to the client’s risk factors (age, co-morbidities, duration of diabetes, risk of hypoglycemia etc.)

Reference: Adapted from Canadian Diabetes Association. (2008). Clinical Practice Guidelines for Prevention and Management of Diabetes 1n Canada.

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Slide 25: Oral Medication

• Assess current ability in safe administration of oral medications• If difficulties encountered, consider:

• Personal markings on container lids• Different shaped container for each type of pill• Blister pack prepared by pharmacy• Individual dosettes

• Memory aids

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Slide 26: Options for Preparation of Insulin• Ensure safe accurate measurement• Maximize vision with magnifiers:

• Syringe (i.e. BD, Truhand, Insuleze etc.)• Pen dosage dial (i.e. Novolin)• Hand held with or without light source

• Preloaded syringes• Filled by community pharmacist

• Disposable prefilled insulin pens

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Slide 27: Devices For Insulin Measurement

• Re-useable Insulin Pens• HumaPen® Luxura, HD, Memoir• Novolin ® Pen 4, Echo

• Disposable Insulin Pens• HumaMix ® 25 prefilled• Lantus ® Solostar

• Syringe Magnifiers• Count-a-dose

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Slide 28: Tips For Teaching Insulin Pens• Clearly label pens

• Store supplies in a consistent area

• Record instructions on a recorder

• Confirm priming of needle by flushing on tactile area of hand or arm

• Carefully count audible clicks for dosage

• Teach how to reset pen to zero

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Slide 29: Tips For Teaching Insulin Pens• Frequent return demonstrations of skills

• Method for recording amount remaining in insulin cartridge, when to change cartridge and injection sites used

• Extra pen available

• Follow-ups to check equipment

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Slide 30: Adaptive Foot Care• If touch is reliable, teach the client how to check the feet

• Use the fingertips and thumb to check the feet each day

• Feel for changes such as breaks in the skin, blisters, corns, calluses, swollen areas

• Examine the top and bottom of both feet including the surface of each toe

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Slide 31: Foot Care• Use the back of the hand to feel for temperature changes

• Advise client to see doctor immediately if: • A warm or unusually cold area is felt • Other changes such as skin breakdown are felt

• A foul odour may indicate infection

• Arrange for a sighted person to do regular foot checks

• Suggest a foot care specialist to cut or file the nails

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Slide 32: Complication Prevention

A Hemaglobin A1C B Blood Pressure C Cholesterol D Dental Check E Eye F Foot Care

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Slide 33: Successful Behavior Change

Gradual small steps Match strategies to stage of readiness to change Move from story telling to problem solving Use diabetes friendly approaches ie healthy eating not diet

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Slide 34: Helping Clients Change Behavior Determine client’s key concerns and address them first

Gather information and use it

Review the data with the client

Ask questions – shift the responsibility/decision making to the client

Support skills training and knowledge building

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Slide 35: Diabetes and Self Management Services

Inter-professional Team of Health Care Professionals

• Diabetes Education Program• Centers for Complex Diabetes Care• Community Care Access Centres• Community Pharmacist• Eye Care Specialists• Foot Care Specialists

Peer Support

• Support Groups• Self Management Programs

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Slide 36: Eye Connect: Diabetic Retinopathy

www.cnib.ca/dr

- Diabetic retinopathy basics- Prevention- Diagnosis and treatment- Living with diabetic retinopathy- For Health Care Professionals- “Your Guide to Diabetic Retinopathy” Patient Guide

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Slide 37:

CNIB Contacts & Resources

• CNIB Website: www.cnib.ca

• Toll-free CNIB Helpline: 1-800-563-2642

• Email: [email protected]

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Production of materials has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.


Slide 38: Helpful Links for Resources

• Canadian Diabetes Association www.diabetes.ca

• Stand Up To Diabetes www.ontario.ca/diabetes

• The Diabetes Care Community www.diabetescarecommunity.ca

• Eat Right Ontariowww.eatrightontario.ca

• Dietitians of Canada www.dietitians.ca

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Slide 39: Presenters• Lynn Baughan RN, MN, CDE

Central West Diabetes Regional Coordination [email protected]: 905-494-6752

• Kathryn MacDonald RD, CDE

Central West Diabetes Regional Coordination [email protected]

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Final - Slide 40: References1. Bernbaum, M. et. Al. (1985). “A model clinical program for

patients with diabetes and vision impairment” .(1989). The Diabetes Educator, 15: 325-30.

2. Cleary, M. (1985). “Aiding the person who is visually impaired from diabetes”.The Diabetes Educator, Winter Ed.

3. CNIB website, retrieved July 26, 2012. http://www.cnib.ca/en/your-eyes/eye-conditions/eye-connect/DR/Pages/default.aspx

4. Haire-Joshu, D., (Ed.), Herman, W., & Greene, D. (1996). Management of diabetes mellitus perspectives of care across the life span. “Microvascualar complications of diabetes ”. P-239-46. Chapter 7.

5. Jones, H., (Ed.) & Opsteen, C. (2010) 2nd Ed. Building Competencies in Diabetes Education; Advancing Practice. Chapter 7. Management of Chronic Complications, p. 7-56-64.

6. Wagner, H., Pizzimenti, J., Daniel, K., Naushira, P., & Hardigan, P. (2008). “Eye on diabetes a multicultural patient education intervention ”. The Diabetes Educator, Vol. 34., (1), p. 84-89.

39Web: cnib.caEmail: [email protected] Helpline: 1-800-563-2642

diabetes management (presentation slides - ms word) · web viewslide 2: learning objectives...

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