Transcript Diabetes

Caring for Individuals At Risk or Diagnosed with
Diabetes and Schizophrenia or Bipolar Disorder
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Learning Points:
• Know the difference between Type 1 and Type 2 diabetes
• Know symptoms that members you are working with may
be experiencing due to having diabetes
• Know what kind of tests members need
• Know how often members should be tested
• Understand the importance of good coordination of care
and integrated treatment planning
Types of Diabetes Conditions
• Type 1 Diabetes
• The person does not produce insulin
• In the majority of cases, this type of diabetes appears before
the patient is 40 years old. That is why this type of diabetes is
also known as Juvenile Diabetes or Childhood Diabetes.
• Diabetes Type 1 onset can appear after the age of 40, but it is
extremely rare.
• About 15 percent of all diabetes patients have Type 1.
• Type 2 Diabetes
– Persons with Diabetes Type 2 has one of two problems, and
sometimes both:
• Not enough insulin is being produced.
• The insulin is not working properly - this is known as
insulin resistance.
– The vast majority of patients who develop Type 2 do so
because they are overweight and unfit, and have been
overweight and unfit for some time.
– Certain types of medications can increase risk (i.e. newer
antipsychotics)
– This type of diabetes tends to appear later on in life.
Signs of High and Low Blood Sugar
• High Blood Sugar Symptoms:
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Extreme thirst
Frequent urination
Dry skin
Hunger
Blurred vision
Drowsiness
Decreased healing
• Low Blood Sugar Symptoms:
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Shaking
Hunger
Fast heartbeat
Impaired vision
Sweating
Weakness/fatigue
Dizziness
Headache
Anxiety
Irritability
Tests for Monitoring Individuals At Risk
or Diagnosed with Diabetes
• Hb A1c – Hemoglobin
• LCL-C (Low Density Lipoprotein)
Hemoglobin A1c Test (HbA1c)
• HbA1c is the blood sugar test that tells you your average
blood sugar for the past 2 to 3 months and how well your
blood sugar is being controlled over time.
• An HbA1c of 5.6% or less is normal.
• The following are the results when the HbA1c is being
used to diagnose diabetes:
• Normal: Less than 5.7%
• Pre-diabetes: 5.7% to 6.4%
• Diabetes: 6.5% or higher
• HbA1c is a measure of long-term diabetes control.
• Members with diabetes should have an HbA1c test every
3-6 months.
• The doctor may need to check more often if blood sugars
are above goal (7% or less), the HbA1c was high or there
was symptoms of low blood sugar.
Low Density Lipoprotein (LDL- C) Test
• The test for LDL cholesterol is one of several tests that
are used to predict risk of developing heart disease.
• Cholesterol is affected by blood pressure and blood
glucose. If blood glucose and blood pressure are high,
cholesterol numbers may be off as well.
• If a patient with diabetes has a high Low Density
Lipoprotein (LDL), or "bad" cholesterol level, the
physician can help the patient make the changes they
need to lower their LDL cholesterol levels (often
involving medications and/or lifestyle changes such as
dietary modifications and increased exercise).
• LDL or “bad” cholesterol is not strictly due to diabetes.
A patient has a higher risk when having diabetes, but it
can occur alone or in conjunction with other diseases
unrelated to diabetes as well.
Coordination of Care
• Individuals taking atypical antipsychotic medications
have increased levels of blood lipids that can raise the
risk of cardiac disease, weight gain, increased
abdominal girth obesity, prediabetes, and type 2
diabetes.
• Assisting these individuals in coordinating care between
their Primary Care Physician (PCP) and Behavioral
Health provider is crucial to ensure these individuals
are receiving appropriate screening and monitoring of
their conditions.
How to help coordinate physical and
behavioral health care for these individuals
1. Discuss member’s physical healthcare needs and
incorporate goals to address them into member’s
treatment/service plan.
2. Communicate with the member’s support systems.
Encourage family members and friends to support
member in their journey to stay healthy.
3. Facilitate cohesive relationships between member’s
behavioral health and physical healthcare providers.
4. Encourage member to follow the agreed upon
treatment/service plan.
5. Assist member in coordinating transportation to
scheduled appointments.
6. Encourage member to take personal responsibility for
their healthcare.
Physical Healthcare Goals for Members
Diagnosed with Diabetes
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Have an HbA1c test, twice yearly.
Have an LDL-C, at least once yearly.
See an eye doctor for a retinal eye exam, yearly.
See a PCP, a minimum of 4 times per year.
Check blood sugars, as directed.
Have blood pressure checked at each healthcare
appointment.
• Check feet daily for cuts and sores.
Why are these interventions needed?
• Diabetes can, over time, cause damage to many
organs in the body including:
– Retinal changes
– Kidney changes that can cause decreased renal
functioning
– Neurological changes called neuropathy (include
nerve changes in the hands of feet)
– Changes in the peripheral circulation ( neuropathy
and circulation changes may lead to foot ulcers or
skin breakdown in the feet)
– Increased risks of cardiac disease
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Treatment Plan Example:
Helpful Tips
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UHCCP does not require members to have a PCP
referral to see a specialist; however, most specialists
prefer a PCP referral when accepting new members.
Yearly retinal eye exams must be completed by a
credentialed ophthalmologist. Go to the following
website and conduct a provider directory search:
www.uhcrivervalley.com.
Foot exams can be administered by the member’s
PCP.
Referrals to a podiatrist should be made by the PCP
when something unusual is found.
UHCCP does have in network endocrinologists. To
find a network endocrinologist, you can go to the
following website and conduct a provider directory
search: www.uhcrivervalley.com.
PCP referrals are required to see an endocrinologist
only when the provider is out of network within a 30-40
mile radius.
The out of network endocrinologist must contact
UHCCP customer service at 1-800-690-1606 to get
approval.
Questions?
Behavioral Health
Quality Contacts
• Hayley Clothier, Quality Director
• Phone: 615-493-9559
• Email: [email protected]
• Charles Nails, Quality Analyst
• Phone: 615-493-9514
• Email: [email protected]
References
• http://www.diabetes.org/diabetes-basics/?loc=GlobalNavDB
• http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm