Diabetes Overview for Health Professionals

1
Diabetes Overview for Health Professionals

2
Objectives

• Identify and contrast 2 principle types of
  diabetes
• State the diagnostic criteria for diabetes
• Describe acute and chronic complications of
  diabetes with treatment interventions.
• State appropriate nursing diagnosis/nursing
  interventions for patients with diabetes
• Describe actions and indications of oral
  anti-diabetes medications and insulins.
• Describe benefits of exercise and meal planning
• Describe sick day management
• Discuss techniques for promoting self-care

3
Why Diabetes?

• 18 million diagnosed
• Estimated that 6 million are undiagnosed
• Third leading cause of death in the U.S.
• Leading cause of blindness
• Patient education is the cornerstone of diabetic
  treatment and management
• Complications can be prevented or delayed
  through intensive treatment

4
Definition

• genetically influenced metabolic disorder of
  carbohydrate, fat, and protein metabolism
  characterized by abnormally high blood glucose
  levels due to inadequate or absent insulin
  production and or impaired insulin action
  (Millonig Miller,1999)
• In other wordsdefects in insulin secretion,
  metabolism, or both

5
Quick Review

• PANCREAS
• Produces and secretes insulin, which stimulates
  the transport of glucose across the plasma
  membranes of muscles, fat and liver cells
• Produces and secretes glucagon (stimulates liver
  to release glucose that is stored in adipose
  tissue)

6
Quick Review

• Glucose fuel for your body
• Insulin hormone that body uses to get glucose
  from the blood to all cells in body
• Insulin is like a key that opens the cell
  door
• Normal glucose values between 70-100 mg/dl
• Hemoglobin A1c a lab test done every 3 months
  that measures overall glucose control for past
  60-90 days

7
Principle Types of Diabetes

• Type 1
• Type 2
• Gestational diabetes applies only to women in
  whom glucose intolerance develops or is first
  discovered during pregnancy
• Secondary diabetes - as a result of other
  disorders or treatments

8
Principle Types of Diabetes

• Type 1 and Type 2 are totally different diseases
• Type 1
• Autoimmune disorder
• Generally diagnosed in persons under age 30
• Body does not produce insulin
• 10-15 are of this type
• Primarily Caucasian population

9
Signs and Symptoms Type 1

• Usually sudden and severe in onset
• Polyuria
• Polydipsia
• Polyphagia
• Weight loss/increased appetite
• Blurred vision

• Fatigue/weakness
• Nausea/vomiting
• Vaginal itching/infections
• Skin rashes

10
Principle Types of Diabetes

• Type 2
• Decreased sensitivity to insulin (doesnt work as
  well) or failure of the beta cells to produce
  enough insulin
• Strong genetic familial pattern
• Age gt 45 (now being seen in adolescents)
• African American, Asian-American, Native
  American, or Pacific Islander race, Hispanic

11
Signs Symptoms Type 2

• Onset more insidious
• Early symptoms may go unnoticed
• Polyphagia, polyuria, polydipsia
• Blurred vision
• Fatigue

• Sores that heal slowly
• Sexual dysfunction (erectile dysfunction)
• Infections (vaginal in women)

12
Diagnostic Tests/Findings

• Dx will be made if FBS gt 126mg/dl on 2 occasions
• Random (casual) non-fasting glucose level is gt
  200mg/dl and symptoms are present
• 2-hour plasma glucose (OGTT) gt 200
• Type 2 diabetes may be present, on average, for
  about 6 years prior to its clinical
  identification and treatment

13
Impaired Fasting Glucose

• No Borderline Diabetes!!!! pre diabetes
• Fasting gt100mg/dl, but lt 126mg/dl
• Roughly 60 go on to develop diabetes

14
Know Your ABCs - Goals

• A A1C lt7
• B Blood Pressure lt130/80
• C Cholesterol Profile LDL lt 100
• HDL gt 40
• Triglycerides lt 150

15
Diabetes Complications

• Acute sudden onset, usually reversible
• Chronic gradual onset, irreversible
• - classified microvascular or macrovascular

16
Acute Complications

• Hypoglycemia (glucose lt 70)
• Hyperglycemia (glucose gt200)
• Diabetic Ketoacidosis (DKA, excessive high
  glucose)
• Hyperosmolar Hyperglycemic State (HHS, excessive
  high glucose and dehydration)

17
Acute Complications

• Hypoglycemia (causes)
• Too much insulin
• Skip or delay meals
• Heavy exercise
• Errors in medication administration
• Weight loss
• Alcohol

18
Hypoglycemia

• Symptoms
• Weakness
• Sweating
• Shakiness
• Tremors

• Nervousness
• HA/Dizzyness/Hunger
• Irritability
• Tachycardia, palpitations
• Convulsions, confusion, coma

19
Treatments for Hypoglycemia

• gt50 lt70mg/dl treat with 15 grams of carbohydrate
• 4 ounces of fruit juice (1/2 cup)
• 4 ounces of non-diet soft drink
• 4 teaspoons of granulated sugar
• 2 tablespoons of raisins
• 1 tablespoon of honey or syrup
• 6-7 lifesavers
• 1 cup of skim milk
• 3 or 4 glucose tablets

20
Treatment of Hypoglycemia

• For blood glucose value lt50mg/dl- treat with 30
  grams of carbohydrate
• Double prior list

21
Patients need to know

• They should feel better 10-15 minutes after
  treatment
• Test blood glucose after 15 minutes then 1 hour
  after episode
• Go ahead and treat if having symptoms and no way
  of checking glucose

22
Hypoglycemia Unawareness

• Normally with hypoglycemia, body produces
  hormones that raise blood glucose and produce
  symptoms
• With hypoglycemia unawareness - loss of early
  warning signals of hypoglycemia
• Experience severe hypoglycemia, confusion,
  unconsciousness
• Causes
• Nerve damage (preventing hormone release)
• Too tight control (low A1c level)-dull response
• Recurrent hypoglycemic episodes

23
Hypoglycemia Risk Reduction

• Key to reversing hypoglycemia unawareness is to
  avoid hypoglycemia
• After 2-3 weeks of no hypoglycemia episodes,
  early response mechanism returns
• Alert family to behavior cues
• Glucose source available
• Dont skip meals
• Report hypoglycemic episodes to provider
• Check BGs before exercise, post exercise, before
  driving

24
Hyperglycemia

• Symptoms
• Polyuria
• Polydypsia
• Polyphagia
• Drowsiness
• Nausea
• Hunger
• Dry skin

25
Hyperglycemia Acute Complications

• Diabetic Ketoacidosis (DKA)
• Hyperglycemia with ketonuria and disruption of
  the fluid, electrolyte, and pH balance leading to
  coma and even death
• Often presenting sign in undiagnosed type 1

26
Diabetic Ketoacidosis (DKA)

• Causes
• infection
• trauma
• heart attack
• severe stress
• not enough insulin (either prescribed or taken)
• malfunctioning insulin pump

27
DKA

• Signs and Symptoms
• Dry mouth
• Great thirst
• Fruity breath
• Nausea/vomiting
• Stomach pain
• Dry, flushed skin
• Labored breathing

28
Treatment for DKA

• Emergency fluid replacement
• Insulin therapy
• Close monitoring of blood levels
• Treat underlying cause

29
Hyperosmolar Hyperglycemic State (HHS)

• 4 Primary Features
• Severe high glucose
• Dehydration
• No ketones in urine
• Neurological symptoms
• May lead to coma and death if not treated

30
HHS

• Sometimes overlooked and often confused with
  other illness
• HHS occurs in elderly with Type 2 diabetes, can
  be initial presentation of type 2 diabetes
• Often precipitated by illness, inadequate fluid
  intake, prolonged osmotic diuresis secondary to
  hyperglycemia, diarrhea, diuretics
• Mortality rate greater than in DKA due to severe
  metabolic changes, delay in diagnosis, or medical
  complications in the elderly

31
HHS

• Symptoms
• Blood glucose level over 600mg/dl
• No ketones in urine
• Dry, parched mouth, Extreme thirst
• Warm, dry skin without sweating
• High fever
• Sleepiness or confusion
• Loss of vision
• Symptoms can mimic a stroke

32
HHS

• Treatment
• Similar to ketoacidosis, but need less insulin
  and more fluid replacement
• Treat underlying cause

33
Metabolic Syndrome

• Cluster of disorders which includes
• hypertension
• abnormal lipid profile
• HDL lt 40 mg/dl
• triglycerides gt 150 mg/dl
• abdominal obesity
• insulin resistance (high fasting glucose)

34
Metabolic Syndrome

• Diagnosed when person has 3 or more of previously
  listed conditions
• - obesity increases likelihood
• Higher risk for developing Type 2 diabetes and
  dying from cardiovascular disease
• Cells resist the action of insulin and glucose
  cannot pass through cell membrane even when
  normal amounts of insulin are present.
• Pancreas must produce more insulin to maintain
  normal levels

35
Metabolic Syndrome

• Treatment and Prevention
• - Reduce body weight as little as 10
• - Increase physical activity

36
Chronic Complications of Diabetes

• Eye disease (retinopathy, cataracts, glaucoma)
• Neuropathy
• Nephropathy
• Cardiovascular Disease/PVD
• Lower Extremity complications
• High Risk for infections

37
Sexual Dysfunction

• Affects both men and women
• Physical as well as psychological causes
• Too tired
• Loss of sensation
• Lack of bladder control
• Damaged limbs or joints (body image)

38
Sexual Dysfunction

• Women
• Vaginal infections, dryness, tightness
• UTIs
• Men
• Impotence ½ all men with diabetes
• Damage to the blood vessels in the penis
• Poor control over blood glucose levels

39
Complications of the Skin

• Bacterial infections, fungal infections,
• diabetic dermopathy red/brown scaly patches
• Digital sclerosis- cause the skin on hands,
  fingers, and toes to become thick and tight and
  look waxy or shiny

40
What patients need to know!

• Written Treatment Plan
• When to call provider
• Self Management of Blood Glucose
• How to treat hypoglycemia
• Sick day management
• Identifying diabetic status
• Preventative Care
• Nutrition Therapy/Exercise
• Medications

41
Self-Monitoring Blood Glucose (SMBG)

• How often to test
• Operating glucometer
• Keeping a blood glucose diary and bringing it to
  every appt. (even if glucometer has memory)
• Enough supplies until next appt. and how to
  obtain more
• The most common SMBG user error is failure to get
  an adequate blood sample

42
Sick Day Management

• Keep taking their diabetes medicines
• Test blood sugar 4x days
• Check ketones if type 1
• Check temperature 2x day
• Drink plenty of fluids
• Eat small frequent meals or snacks
• Keep in contact with provider
• Over-the-counter medications should be
  sugar-free, needs to check with provider on types
  to take

43
Preventing Eye Disease

• See ophthalmologist once a year for a dilated
  eye exam
• Report blurred or double vision
• Seeing dark spots
• Narrowed field of vision
• Have blood pressure checked often- increase in
  systolic blood pressure can aggregate underlying
  eye pathology with a concomitant increase in
  intraocular pressure

44
Skin Care Guidelines

• Remind to bathe daily
• -Keep dry parts of skin moist
• -Mild soap and lukewarm water
• Protect Skin
• -Avoid scratches, cuts and other injuries
• -DO NOT GO BAREFOOT!
• -Protect skin from the sun, sunscreen
• Treat injuries promptly
• -Wash cuts with soap and water
• -Notify doctor if cuts dont heal or signs of
  infection.

45
Skin Care Guidelines

• Dont soak feet
• No OTC remedies for corn/calluses, they may cause
  burns or ulcers
• Wear comfortable leather shoes. Buy shoes that
  fit. Buy shoes in the afternoon when feet are
  more swollen
• Keep blood glucose in ideal range

46
Skin Care Guidelines

• Quit smoking
• Have foot check once a year by a health care
  provider
• Clip toenails straight across
• Keep feet out of water that is too hot or too
  cold. No heating pads

47
Dental Health

• Control blood glucose
• Keep teeth clean
• Dont brush too hard
• Replace toothbrush every 2 months
• Go to the dentist every 6 months for cleaning,
  full mouth x- rays every 2 years to check for
  bone loss

48
Call Provider

• Know what glucose level to report
• Having more than one episode of hypoglycemia in a
  week
• Developing complications

49
Daily to do list

• Daily to do list
• Check BG level
• Take medications as prescribed
• Follow meal plan
• Exercise and stress reduction
• Inspect feet
• Dental care

50
Quarterly to do list

• Make appointment with health care provider
• Take BG log, take record of questions
• Have Hemoglobin A1c checked

51
Annual to do list

• Annual eye exam by ophthalmologist
• Annual Dental exam
• Annual Flu vaccine
• Pneumococcal vaccine (once)
• Tetanus vaccine every 10 years
• Primary care manager appointment to
• - review cholesterol profile and metabolic
  profile (checks kidney, liver, proteins,
  electrolytes, and minerals)
• Complete foot exam

52
Travel Tips

• Carry and wear diabetes identification
• Have diabetes medical information available
• Follow usual meal, exercise, medications
• Insulin storage
• Easy to carry, easy to eat carb snacks
• Wear comfortable shoes
• Take sunblock
• Call airlines for traveling with syringe and
  lancet information

53
Medication Update Diabetes
54
Diabetes Type 2

• Insulin resistance and impaired insulin secretion
• Diet and exercise are cornerstones of therapy
• Medications target different tissues and have
  different mechanisms of action
• Medication divided into several classes

55
Med Classification

• Sulfonylureas (SUL-fah-nil-YOO-ree-ahs)
• Biguanides (by-GWAN-ides)
• Alpha-glucosidase inhibitors (AL-fa
  gloo-KOS-ih-dayss in-HIB-it-ers)
• Thiazolidinediones (THIGH-ah-ZO-li-deen-DYE-owns)
• Meglitinides (meh-GLIT-in-ides).
• D-phenylalanine (dee-fen-nel-AL-ah-neen)
  derivatives

56
Sulfonylureas Brand Names

• AmarylDiaBetaDiabinaseDymelorGlucotrol

• Glucotrol XLGlynase PresTabMicronaseOrinaseTo
  linase

57
Sulfonylureas - Actions

• Increase insulin release from your pancreas
• Help improve muscle sensitivity to insulin
• Pancreas must be actively making insulin to work

58
Sulfonylureas side effects

• Hypoglycemia
• Upset stomach
• Skin rash or itching
• Weight gain

59
Sulfonylureas directions for use

• Once daily 30 minutes before breakfast
• Twice daily 30 minutes before breakfast and
  supper
• Be aware of hypoglycemia
• Contraindication Hypersensitivity to
  sulfonamides and other sulfonylreas

60
Biguanides

• Metformin (Glucophage, Glucophage XR)
• Decrease glucose production in the liver
• Increase muscle sensitivity to insulin
• Decrease insulin need
• May help with weight loss
• Less risk of hypoglycemia
• Improve cholesterol values

61
Biguanides side effects

• Nausea, vomiting, and diarrhea
• Lactic acidosis
• Taste disturbance
• Hypoglycemia

62
Biguanides contraindications

• Liver disease
• Alcohol abuse
• Kidney failure/insufficiency
• Severe heart failure
• Severe respiratory disease
• Hypersensitivity to metformin

63
Biguanides monitoring

• Liver enzymes
• Kidney function
• Blood glucose

64
Biguanides directions for use

• Metformin dose should be titrated from lowest
  dose (500mg/day) to most effective dose (up to
  2550mg/day)
• Metformin usually dosed twice or three times
  daily with meals
• Metformin XR are dosed once daily with evening
  meal

65
Biguanides miscellaneous

• Surgery Metformin should be held during period
  of surgery or any procedure that may compromise
  the kidney such as medical tests that use dyes
• Communicate with provider

66
Thiazolidinediones

• Pioglitazone (Actos)
• Rosiglitazone (Avandia)
• Help make cells more sensitive to insulin

67
Thiazolidinediones side effects

• Liver toxicity
• Weight gain
• Edema
• May increase risk for anemia
• May increase risk for heart failure
• Hypoglycemia

68
Thiazolidinediones monitoring

• Liver enzymes every other month for the first
  year then periodically thereafter
• Signs and symptoms of liver toxicity
• Signs and symptoms of heart failure
• Blood sugar

69
Thiazolidinediones directions for use

• Pioglitazone (Actos) once daily with or without
  meals
• Rosiglitazone (Avandia) once or twice daily with
  or without meals
• Do not start or stop medication without doctors
  consent

70
Alpha Glucosidase Inhibitors

• Miglitol (Glyset)
• Acarbose (Precose)
• Blocks enzymes that digest starches in the
  stomach and intestines
• Reduces post-meal sugars

71
Alpha Glucosidase Inhibitors

• Take with the first bite of meal
• Usually are dosed three times a day with meals
• Titration is recommended (start low go slow) to
  decrease side effects
• Only major side effects are gas, bloating, and
  diarrhea
• Virtually no hypoglycemia

72
Meglitinides

• Repaglanide (Prandin)
• Helps pancreas secrete more insulin right after
  meals thus reducing post meal blood sugar
• Works fast and short duration of action

73
Meglitinides

• Take before meals
• Do not take if skip meal
• Most effect will be seen within one hour of dose
• Eliminated from body within 3-4 hours
• Side effects include weight gain and hypoglycemia

74
D-phenylalanine Derivatives

• Nagletinide (Starlix)
• Increase insulin release from pancreas
• Short acting
• Take with each meal
• Dont take if skip meal
• Side effects include hypoglycemia

75
Insulin Rapid-acting

• Rapid-acting, insulin lispro (Humalog)Starts
  working in 5 to 15 minutes.Lowers blood glucose
  most in 45 to 90 minutes.Finishes working in 3
  to 4 hours.
• Rapid-acting, insulin aspart (Novolog)Starts
  working in 10 to 20 minutes.Lowers blood glucose
  most in 1 to 3 hours.Finishes working in 3 to 5
  hours.

76
Insulin short-acting

• Short-acting, Regular (R) insulinStarts working
  in 30 minutes.Lowers blood glucose most in 2 to
  5 hours. Finishes working in 5 to 8 hours.

77
Insulin intermediate-acting

• Intermediate-acting, NPH (N) or Lente (L)
  insulinStarts working in 1 to 3 hours. Lowers
  blood glucose most in 6 to 12 hours.Finishes
  working in 16 to 24 hours

78
Insulin long-acting

• Long-acting, Ultralente (U) insulinStarts
  working in 4 to 6 hours. Lowers blood glucose
  most in 8 to 20 hours.Finishes working in 24 to
  28 hours

79
Insulin very long-acting

• Very long-acting, insulin glargine
  (Lantus)Starts working in 1 hour.Lowers blood
  glucose evenly for 24 hours.Finishes working in
  24 hours and is taken once a day at bedtime.
  Lantus should not be mixed together in a
  syringe with any other form of insulin before use

80
Insulin premixed

• NPH and Regular insulin mixtureTwo types of
  insulins mixed together in one bottle.Starts
  working in 30 minutes.Lowers blood sugar most in
  7 to 12 hours. Finishes working in 16 to 24 hours

81
Insulin use considerations

• You can inject insulin into several places on
  your body. Insulin injected near the stomach
  works fastest. Insulin injected into the thigh
  works slowest. Insulin injected into the arm
  works at medium speed.

82
(No Transcript)
83
Insulin storage

• Insulin should be stored in the refrigerator if
  not in use
• Insulin can be stored at room temperature if used
  within 28 days

84
Exercise
85
Effects of Exercise

• Improvement in blood glucose control
• Improved insulin sensitivity
• Reduction in body fat
• Cardiovascular benefits
• Stress reduction
• Prevention of Type 2 diabetes

86
Effects of Exercise on InsulinRequirement
Single Exercise Bout

• One hour of exercise requires an additional 15
  grams of CHO either before or after activity.
• Metabolic response to exercise differs according
  to
• Individuals fitness level
• Intensity and duration of the exercise
• Timing of exercise in relationship to meal and
  medication
• Blood glucose level prior to activity
• Use of other medication

87
Contraindications to Exercise

• Active retinopathy, retinal hemorrhage
  retinopathy therapy
• Presence of illness or infection
• Blood glucose level gt 250 to 300 mg dl with
  presence of ketones, or
• Blood glucose level 80 to 100 mg dl

88
Exercise Precautions

• Keep sources of rapidly acting CHO available
  during exercise
• Consume plenty of fluids before, during and after
  exercise
• Practice good foot care and wear proper exercise
  shoes and cotton or moisture-wicking socks
• Carry medical identification

89
Exercise Programming

• Aerobic Large muscle group activities
• 50-80 HR Max (220-Age x .5-.8)
• Monitor Rate of Perceived Exertion (RPE)
• 4-7 days a week
• 20-60 minutes/session

90
Exercise Programming

• Strength/Anaerobic
• Free weights, weight machines
• 1-3 times a week
• Flexibility Stretching/Yoga
• Maintain/increase range of motion
• Improve gait/balance and coordination

91
Diabetes Carbohydrate Counting
92
Rememberall foods fit!
93
Individual Meal Planning

• Tips for success
• Refer to a dietitian
• Major groups are represented grains and breads,
  fruits, vegetables, meats and dairy products
• No more than 4-5 hours between meals
• Meals should be at consistent times
• Incorporate what you like to eat
• Dont skip meals
• All foods fit

94
Nutrition Guidelines for DM

• Eat a variety of healthy, nutritious foods
• Reduce fat and protein to reasonable amounts
• Balance carbohydrates (CHO) with medication
  (insulin) and exercise

95
Nutrition Guidelines for DM

• Foods contain carbohydrates, fats, and proteins
  as sources of energy, plus many other important
  ingredients like vitamins and minerals
• Carbohydrates in food have the most impact on the
  blood sugar

96
Nutrition Guidelines for DM

• Although high fat foods can contribute to
  obesity, heart disease, and higher blood sugars
  in the long run, they play only a minor role in
  daily blood sugar control
• Protein is also a minor player in short-term
  control - half the protein we eat is converted to
  CHO over a period of several hours but should
  only make up 10-20 of our total calories

97
What are Carbohydrates?

• Grains (bread, cereal, rice, pasta)
• Fruits
• Vegetables
• Most milk products (not cheeses)
• Desserts and candies
• -ose foods sucrose, fructose, maltose

98
Counting Carbohydrates - WHY?

• Offers more variety in choices
• Information on food labels makes meal planning
  easier
• You can swap an occasional high sugar food (even
  though it may contain fewer nutrients) for other
  CHO-containing foods
• Better sense of control and better glycemic
  control

99
Simple CHO Counting

• Work with a dietitian to plan how many grams of
  CHO to eat at each meal and snack
• Choose foods from the CHO containing food groups
  to meet allowance
• One serving from the Bread/Starch group is
  equivalent to 15 grams of CHO
• One serving form the Fruit group is equivalent to
  15 grams of CHO

100
Simple CHO Counting

• One serving from the Milk group is equivalent to
  12 grams of CHO
• One serving from the Vegetable group is
  equivalent to 5 grams of CHO (3 svgs15g)
• Meat and Fats do not contain CHO
• Because Starch/Bread, Fruit and Milk all have
  approx the same amount of CHO they can be
  exchanged for one another

101
Simple CHO Counting

• Therefore, if your meal plan calls for 1 Starch,
  and you would prefer a piece of fruit, thats
  fine

102
PORTION SIZES

• VERY IMPORTANT
• Many people make good food choices but eat WAY
  too much!
• Use Meal Planning Guide to look up proper
  portions sizes and use measuring cups/spoons to
  ensure accuracy

103
Meats Very lean, Lean, Medium-fat, High-fat

• 1 oz meat, poultry, fish
• ¼ cup canned fish (packed in water)
• 1 oz cheese
• 1 egg or 3 egg whites
• 1 tablespoon peanut butter

104
Fats Monounsaturated, Polyunsaturated and
Saturated

• 1 teaspoon oil, margarine or mayonnaise
• 1 Tbsp cream cheese
• 1/8 avocado
• 1 slice bacon
• 1 tablespoon regular salad dressing

105
SweetsUSE SPARINGLY

• 1/8 of a 9 pie or cake
• 2 small cookies

106
Other Carbohydrates15 grams carbohydrates

• ¼ cup cranberry sauce
• 3 gingersnaps
• ½ cup sugar-free pudding
• ½ cup fat-free, sugar-free frozen yogurt
• 1 Tbsp regular jam

107
FREE FOODSfewer than 20 calories

• Celery, cucumber, onions, radishes, salad greens
• Salsa, hot sauce, garlic, herbs
• Sugar free gelatin, jam or jelly
• Catsup, mustard
• Sugar-free drinks, coffee, tea

108
About Protein and Fat

• When a CHO is eaten with protein and fat, blood
  sugar may not rise as quickly
• Remember to eat only MODERATE amounts of both
  protein and fat
• Very-lean and lean protein sources
• Monounsaturated and polyunsaturated fats

109
Emotional Aspects of Diabetes
110
Coping with Diabetes

• Living with diabetes is challenging
• Depression and anger is normal
• Identify what they need to help cope
• Seek help from provider, family, friends
• Stress reduction
• Seek help for depression
• Diabetes is a life-long learning process

111
Facilitate Diabetes Self-Care

• Patient centered
• Assist patient with self-management skills
• Shift from leader image to consultant/advisor/advo
  cate/ally
• Determine patients needs/wants
• Help patient develop effective coping skills
• Share goals for diabetic control
• Motivation

112
Facilitate Diabetes Self-Care

• Research has shown that when people with diabetes
  practice appropriate self-care, their blood
  glucose levels improve, they have less
  hospitalizations and experience fewer
  complications.
• Nursing Care is most effective when it enables
  the patient to reach an optimal level of
  independence. Patient good health is our goal.

113
Principles of Adult Learning

• Ask the patient what is the most important issue
• Focus on the perceived problem
• Find out what the patient already knows
• Keep the patient active in the learning process
• Allow for interaction, questions and sharing
• Give the patient a reason to learn
• Focus on the benefits that can result from
  learning

114
The End!