Transcript Diabetes Self Management

Diabetes Self Management
Laura Wintersteen-Arleth, MN, RN,CDE
Learning Objectives
oUnderstand the impact of diabetes
oDistinguish the different types of Diabetes
oIdentify treatment options for diabetes
management
oIdentify methods of applying the Chronic Care
Model to diabetes self-management
oDescribe tools which health care providers can
use to empower patients
Impact of Diabetes
o 220 million worldwide
have diabetes
o 80% of deaths from
diabetes in low and
middle-income countries
o Diabetes deaths will
double between 2005
and 2030
o Diabetes has significant
financial impact
Diabetes
Diabetes is a chronic
disease, which occurs
when the pancreas does
not produce enough
insulin, or when the
body cannot effectively
use the insulin it
produces. This leads to
an increased
concentration of
glucose in the blood
Diabetes
o
o
o
o
o
o
o
Type 1
Type 2
Gestational
LADA: Latent Autoimmune Diabetes of Aging
Pre-Diabetes
Impaired Glucose Tolerance (IGT)
Impaired Fasting Glucose (IFG)
Risk Factors for Diabetes
Type 1
Type 2
o Under 30
o Genetics
o Autoimmune
o Environment
o Viral infection
o
o
o
o
o
o
o
o
o
Older age
Overweight
Hypertension
Abnormal lipid levels
Genetics
Race/ethnicity
History of gestational diabetes
History of vascular disease
Inactivity
Clinical Manifestations: Comparisons
Type 2
Type 1
o
o
o
o
o
Polyuria
Polyphagia
Polydipsia
Significant weight loss
Fatigue
o
o
o
o
o
o
o
o
o
Fatigue
Dry, itchy skin
Numbness, tingling
Polydipsia
Polyuria
Blurred vision
Impaired healing
Yeast infections
Sexual dysfunction
Acute Complications of Diabetes
o
o
o
o
o
Dawn Phenomenon
Somogyi Phenomenon
Hypoglycemia
Diabetic Ketoacidosis
Hyperglycemia,
Hyperosmolar
Syndrome
Chronic Complications of Diabetes
Microvascular
o Retinopathy
o Nephropathy
o Neuropathy
Chronic Complications of Diabetes
Macrovascular
o Cardiovascular
Disease
o Cerebral Vascular
Accident
o Peripheral Vascular
Disease
Glucose Tolerance Categories
126 mg/dL
100 mg/dL
FPG
2-Hour PG or OGTT
Diabetes Mellitus
Diabetes Mellitus
Impaired Fasting
Glucose
Normal
7.0 mmol/L
200 mg/dL
5.6 mmol/L
140 mg/dL
Impaired Glucose
Tolerance
11.1 mmol/L
7.8 mmol/L
Normal
18 mg/dL = 1 mmol, therefore 18 mg/dL X 7 mmol = 126 mg/dL
Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes
Mellitus. Diabetes Care. 1997;20:1183-1197.
1-2
Treatment Options for Diabetes
o Nutrition
o Activity
o Medications
Importance of Testing Blood Sugars
Testing blood glucose
Alternate times
Develop a pattern
Be sure to include 2
hours post prandial
o Record the numbers
o Discuss at visits
o Use to revise treatment
plan
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o
o
o
Chronic Care Model and Diabetes
Chronic Care Model and Diabetes
o The patient becomes knowledgeable and the expert in
diabetes and its complications
o The patient understands the importance of taking
control of their diabetes
o The patient has people who are important to them and
their management of diabetes and the provider
includes them as the patient wants
o The provider will take time to build a relationship with
the patient and understands their beliefs, values,
culture
Maslow’s Theory
Using the 5 “A’s” With Diabetes
o
o
o
o
o
Assess
Advise
Agree
Assist
Arrange
Empowering Patients: 4 Important
Lessons Patient Need to Learn
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Their illness is serious
Their condition is essentially self-managed
They have options
They can change their behavior
Helping Patients Set Goals
o Start at the problem
o Develop a collaborative goal
o Validate their goal and plan
Old Model vs New Model:
Being put on Insulin
Old Model
If you don’t start to control
your blood glucose, I am
going to have to put you on
insulin and you will have to
take shots. Your diabetes is
not getting any better.
New Empowering Model
You have been working to
control your blood glucose,
but often a patient will
need some assistance form
insulin. Research shows
that starting someone on
insulin sooner than later,
assists them in getting
better control. What about
insulin concerns you?
World Health Organization and Diabetes
o The mission of the WHO Diabetes
Program is to prevent diabetes
o Core Functions
o Diabetes Action Now
o World Diabetes day
Summary
o Diabetes is a chronic condition affecting
millions worldwide
o Self-management techniques can delay or
prevent complications
o Empowering the and becoming a partner with
them, will help provide positive results of
control
o Tools were given to assist the provider in
understanding diabetes and thus assisting their
patients
Questions and Discussion
Contact Information
Laura Wintersteen-Arleth, MN, RN,CDE
[email protected]