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Diabetes Overview for Health Professionals

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Title: 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
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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.

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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

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The End!
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