diabetes self management laura wintersteen-arleth, mn, rn,cde
TRANSCRIPT
Diabetes Self Management
Laura Wintersteen-Arleth, MN, RN,CDE
Learning Objectives
oUnderstand the impact of diabetes oDistinguish the different types of DiabetesoIdentify treatment options for diabetes
managementoIdentify methods of applying the Chronic
Care Model to diabetes self-management oDescribe tools which health care providers
can use to empower patients
Impact of Diabetes
o 220 million worldwide have diabetes
o 80% of deaths from diabetes in low and middle-income countries
o Diabetes deaths will double between 2005 and 2030
o Diabetes has significant financial impact
Diabetes
Diabetes is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. This leads to an increased concentration of glucose in the blood
Diabetes
o Type 1o Type 2o Gestationalo LADA: Latent Autoimmune Diabetes of
Agingo Pre-Diabeteso Impaired Glucose Tolerance (IGT)o Impaired Fasting Glucose (IFG)
Risk Factors for Diabetes
Type 1o Under 30o Geneticso Autoimmuneo Environmento Viral infection
Type 2o Older age o Overweighto Hypertension o Abnormal lipid levels o Geneticso Race/ethnicityo History of gestational diabetes o History of vascular disease o Inactivity
Clinical Manifestations: Comparisons
Type 1o Polyuriao Polyphagiao Polydipsiao Significant weight
losso Fatigue
Type 2o Fatigueo Dry, itchy skino Numbness, tinglingo Polydipsiao Polyuriao Blurred visiono Impaired healingo Yeast infectionso Sexual dysfunction
Acute Complications of Diabetes
o Dawn Phenomenono Somogyi
Phenomenono Hypoglycemiao Diabetic
Ketoacidosiso Hyperglycemia,
Hyperosmolar Syndrome
Chronic Complications of Diabetes
Microvascularo Retinopathyo Nephropathyo Neuropathy
Chronic Complications of Diabetes
Macrovascularo Cardiovascular
Diseaseo Cerebral Vascular
Accidento Peripheral Vascular
Disease
Glucose Tolerance Categories
18 mg/dL = 1 mmol, therefore 18 mg/dL X 7 mmol = 126 mg/dL
Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183-1197.
FPG
126 mg/dL
100 mg/dL
7.0 mmol/L
5.6 mmol/L
Impaired FastingGlucose
Normal
2-Hour PG or OGTT
200 mg/dL
140 mg/dL
11.1 mmol/L
7.8 mmol/L
Diabetes Mellitus
Impaired GlucoseTolerance
Normal
Diabetes Mellitus
1-2
Treatment Options for Diabetes
o Nutritiono Activityo Medications
Importance of Testing Blood Sugars
o Testing blood glucoseo Alternate timeso Develop a patterno Be sure to include 2
hours post prandialo Record the numberso Discuss at visitso Use to revise
treatment plan
Chronic Care Model and Diabetes
Chronic Care Model and Diabetes
o The patient becomes knowledgeable and the expert in diabetes and its complications
o The patient understands the importance of taking control of their diabetes
o The patient has people who are important to them and their management of diabetes and the provider includes them as the patient wants
o The provider will take time to build a relationship with the patient and understands their beliefs, values, culture
Maslow’s Theory
Using the 5 “A’s” With Diabetes
o Assess o Advise o Agree o Assist o Arrange
Empowering Patients: 4 Important Lessons Patient Need to Learn
o Their illness is seriouso Their condition is essentially self-managedo They have optionso They can change their behavior
Helping Patients Set Goals
o Start at the problemo Develop a collaborative goalo Validate their goal and plan
Old Model vs New Model: Being put on Insulin
Old Model
If you don’t start to control your blood glucose, I am going to have to put you on insulin and you will have to take shots. Your diabetes is not getting any better.
New Empowering Model
You have been working to control your blood glucose, but often a patient will need some assistance form insulin. Research shows that starting someone on insulin sooner than later, assists them in getting better control. What about insulin concerns you?
World Health Organization and Diabetes
o The mission of the WHO Diabetes Program is to prevent diabetes
o Core Functionso Diabetes Action Nowo World Diabetes day
Summary
o Diabetes is a chronic condition affecting millions worldwide
o Self-management techniques can delay or prevent complications
o Empowering the and becoming a partner with them, will help provide positive results of control
o Tools were given to assist the provider in understanding diabetes and thus assisting their patients
Questions and Discussion
