Transcript Diabetes on Your OWN Terms! A Personal Approach To

Presenter Disclosure Information
In compliance with the accrediting board policies, the
American Diabetes Association requires the following
disclosure to the participants:
NAME OF PRESENTER:
Janis Roszler, RD, CDE, LD/N
Consultant: dLifeTV (LifeMed Media)
Other: Animas Corp
Diabetes on Your
OWN Terms!
A Personal Approach To Diabetes Self-Care
Janis Roszler, RD, CDE, LD/N
Kris Freeman
US Olympic Cross Country Skier
• Diagnosed with type 1
while preparing for
2002 Winter Olympics
• Told he must stop
competing
• Took a personal
approach and
competed in the 2006
Olympics
Douglas Cairns – First to Fly Solo
Around the World
• Flight instructor with
Britain’s Royal Air Force
• Lost license when
diagnosed with type 1
• Told by Air Force, “You
are a diabetic and you
WERE a pilot.”
• Took a personal approach
and flew 159 days around
the world.
Advice from Kris and
Douglas:
“Learn as much as you
can about the
disease…learn as
much as you can
about the
treatments…learn as
much as you can
about [which] diets
will work for you to
help you achieve
whatever dream you
have.”
Why a Personal Approach?
• Patients will carry out self-management tasks
more consistently and over a longer period of
time if they were freely chosen by patients.*
Anderson RM, Funnell MM. (2005) The Art of Empowerment: Stories and Strategies
for Diabetes Educators. 2nd Ed. Alexandria, VA: ADA
Why Encourage a Personal
Approach?
• Makes patient more self-sufficient
• Reduces emergencies
– They can treat more issues before they become
urgent…without calling YOU.
• Relieves us of guilt – we give them
“Roots and Wings.”
How to Encourage Personalized
Care
Guilt
• Options
Remove the Guilt
• “Perfect control isn’t possible, even
when we’re doing everything
perfectly…and no one does, because
we’re humans first and we live with
diabetes second.”
Betty Brackenridge - coauthor Diabetes Myths,
Misconceptions, and Big Fat Lies
How Many Patients Think We See
Them
Asked of 6,500 dLife.com Message
Board Members…
• “Did your health care provider ever say or do
anything that could make patients lose the
desire to care for their diabetes?”
Shelly…
• “When I was a kid my doctor told me that I
was the worst type 1 diabetic that he had ever
seen! That wasn't really too motivating for
me. I just continued down the same path. Why
take care of it?”
Rich…
• “If my endo didn’t think your numbers were
good enough, he chewed you out and said
that HE had given you the right instructions
and if you had followed them you would have
good numbers. He was so condescending. He
treated his patients like they were naughty
children.”
Options
Begin with Comforting Facts
• With good care, you can live a long, healthy
life with diabetes.
• Your diabetes is not your fault.
• Diabetes doesn’t have to run your life.
Ref: behavioraldiabetes.org
Personalizing Blood Glucose
Control
• Laura Menninger, the
“Glucose Goddess”
• “Your meter is like a
compass to a mountain
climber. It tells you
where you’re at so you
can reach your goal.”
Tom…
• “Do not tell your patients they only need to
test their blood once a day. This seems to be
the result of the view that diabetics are noncompliant. Patients can learn to be compliant.
Testing once a day is not enough and should
not be an option.”
Blood Glucose Testing
• Let your patients know:
– When to check their blood
– How to interpret the results
– What to do with the results
– That you care about their results…(PLEASE look at
their testing diaries!)
Chuck…
“I can live with a lot, but a doctor that simply
knows the numbers for the average diabetic
and doesn't adjust them for the individual, will
not see me a second time.”
Treatment for Abnormal BG Levels
• Low blood glucose
• 15/15 rule
– Eat 15 grams rapid-acting carbohydrate
– Wait 15 minutes
– Check again. Repeat if needed
High BG prior to a meal:
– Wait a bit before eating
– Take smaller portion of next meal
– Do light activity – brisk walk
– Break up upcoming meal into small snacks or save
fruit for later
– Take medication, if instructed to do so
High BG following a meal
– Take a gentle walk or do light exercise
– Drink generous serving of water
– Delay next snack
– Take additional medicine as directed or use insulin
correcting technique
Insulin Correcting
• Estimate number of insulin units you take in
typical day
• Divide total into 1,800
• Answer is insulin correction number – the
amount of points a single unit of rapid-acting
insulin should bring blood glucose level down
within ~4 hours
• Extremely empowering!
Set Personal Goals
AADE-7
•
•
•
•
Choose focus and document
Set goal
Follow-up on set date
Maintain communication – keep copy in
patient’s folder, patient receives copy also
A Personal Approach to Behavior
Change
“Jump Start Pledge”
Guilt-free way to add new health behaviors to
your life
•
•
•
Choose a small, measureable goal
Pledge to keep it for a single week
At the end of one week…
1. Renew your pledge
2. Change your pledge to fit you better
3. Add another pledge to your week
Jump Start Pledge
• “I like the Jump Start Pledge. It has given me something to
strive for. It makes me commit to a goal and be accountable.
It has created good habits and made me let go of bad ones. In
my Jump Start pledge, I pledged to exercise 4 days this week. I
have met that goal and now it’s a habit.
-Clarissa
“HURRAY! I kept my JSP from last week. I walked all 7
days. The weather was so good yesterday and today that I
walked outdoors. That was great!”
-Richard
Jump Start Pledge
• Totally guilt-free. If you were unable to
complete your pledge, it wasn’t right for you.
Adjust it to fit you better and try again.
• Post Jump Start Pledges at
www.dearjanis.com
A Personal Approach to Meal Planning
• Meet with an RD/CDE
– Can create a
personalized meal plan
– Will help patient
succeed on current plan
Carb Counting/Carb Factors
•
•
•
•
Great flexibility
Match insulin to carbohydrate intake
Minimum 130g digestible carb/day*
Carb factors for favorite/homecooked foods:
– Food weight (grams) x Carb factor = Carb count
• Pumping Insulin, Walsh & Roberts
*ADA Clinical Practice Recommendations, 2009; Dietary Reference Intakes:
Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids.
Washington, DC, National Academies Press: 2002.
The Plate Method
Glycemic Index – Enhance Personal
Options
• “…use of glycemic index
and glycemic load may
provide a modest
additional benefit for
glycemic control over
that observed when
total carbohydrate is
considered alone.”
-ADA Clinical Practice
Recommendations, 2009
Glycemic Index
• High (gushers):
– White bread, bagel,
English muffin,
microwaved potato
• Medium
– Split pea soup, quick oats
• Low (tricklers):
– 100% Whole grain bread,
tomato juice, old
fashioned oats
Glycemic Load
• Enables patients to enjoy favorite and home
cooked foods
• Glycemic Load = (grams carb in serving x GI of
the food) ÷ 100
• Helps predict how BG level will respond
• A large portion of a low-GI food will cause
glucose spike
• Bottom line: portion size counts!
2-Hour Post-Prandial BG testing
• Confirms food choices and portion sizes
• Enhances confidence
• Allows patient to “cheat”
Target range
options:
<180mg/dl (ADA)
<160mg/dl (Joslin)
<140mg/dl (AACE ; IDF)
Personal Approach to Medication
• Include patient in medication decision
• Explain how they work and what they do
“The last medication my doctor considered, he
picked up his computer and checked the side
effects because he knew I would as soon as I got
home! He has also become more positive over the
years because he knows I take care of my self and
pay attention.”
- Roger
Personal Options - Information
Diabetes.org
Joslin.org
dLife.com
Childrenwithdiabetes
.com
Webmd.com
dLifeTV on CNBC
Calorieking.com
Medlineplus.gov
Quackwatch.com
Books for your patients
• Diabetes on Your OWN Terms, J. Roszler
• Diabetes Burnout, W.H. Polonsky
• Complete Guide to Carb Counting, H. Warshaw
and K. Kulkarni
• Think Like a Pancreas, Gary Scheiner
• Your First Year With Diabetes, Theresa
Garnero
Empower Your Patients
•
•
•
•
Respect their opinion
Be open to the information they bring
Focus on them during appointments
Don’t insult them, especially when they offer
alternative suggestions
• Stay current and offer new information
Missy Foy
• First person with
diabetes to qualify for
Olympic marathon
trials.
• Diagnosed with type 1
10 years ago.
• Ranked 9th in America
for 50 mile ultramarathon
Missy Foy
• “Not succeeding was
not an option.”
Final Word
• “The best things my doctor ever told me is that
it is in my hands as to how much of a negative
impact diabetes is going to have on my health
and life, and that he believes in me.”
– Shire (type 2)