Diabetes 101: Are You Ready?. Objectives Identify education as an essential treatment mode of...

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.