Diabetes Self Management

Mili SarkarDiabetes Educator

DieticianAssociates Clinical Research & Trail

Learning Objectives

•Understand the impact of diabetes •Distinguish the different types of Diabetes•Identify treatment options for diabetes management

•Identify methods of applying the Chronic Care Model to diabetes self-management

•Describe tools which health care providers can use to empower patients

DiabetesDiabetes 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

• Type 1• Type 2• Gestational• LADA: Latent Autoimmune Diabetes

of Aging• Pre-Diabetes• Impaired Glucose Tolerance (IGT)• Impaired Fasting Glucose (IFG)

Risk Factors for DiabetesType 1• Under 30• Genetics• Autoimmune• Environment• Viral infection

Type 2• Older age • Overweight• Hypertension • Abnormal lipid levels • Genetics• Race/ethnicity• History of gestational

diabetes • History of vascular disease

• Inactivity

Clinical Manifestations: Comparisons

Type 1• Polyuria• Polyphagia• Polydipsia• Significant weight loss• Fatigue

Type 2• Fatigue• Dry, itchy skin• Numbness, tingling• Polydipsia• Polyuria• Blurred vision• Impaired healing• Yeast infections• Sexual dysfunction

Acute Complications of Diabetes

• Dawn Phenomenon

• Somogyi Phenomenon

• Hypoglycemia• Diabetic

Ketoacidosis• Hyperglycemia,

Hyperosmolar Syndrome

Chronic Complications of Diabetes

Microvascular

• Retinopathy• Nephropathy• Neuropathy

Chronic Complications of Diabetes

Macrovascular

• Cardiovascular Disease

• Cerebral Vascular Accident

• Peripheral Vascular Disease

Glucose Tolerance Categories

FPG

126 mg/dL

100 mg/dL

7.0 mmol/L

5.6 mmol/L

Impaired Fasting

Glucose

Normal

2-Hour PG or OGTT

200 mg/dL

140 mg/dL

11.1 mmol/L

7.8 mmol/L

Diabetes Mellitus

Impaired Glucose

Tolerance

Normal

Diabetes Mellitus

Treatment Options for Diabetes

• Nutrition• Activity• Medications

Importance of Testing Blood Sugars

• Testing blood glucose

• Alternate times• Develop a pattern• Be sure to include

2 hours post prandial

• Record the numbers

• Discuss at visits• Use to revise

treatment plan

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

• Assess • Advise • Agree • Assist • Arrange

4 Important Lessons Patient Need to Learn

• Their illness is serious• Their condition is essentially self-

managed• They have options• They can change their behavior

Helping Patients Set Goals

• Start at the problem• Develop a collaborative goal• 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 ModelYou 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

• The mission of the WHO Diabetes Program is to prevent diabetes

• Core Functions• Diabetes Action Now• World Diabetes day

Summary• Diabetes is a chronic condition

affecting millions worldwide• Self-management techniques can

delay or prevent complications• Empowering the and becoming a

partner with them, will help provide positive results of control

• Tools were given to assist the provider in understanding diabetes and thus assisting their patients

Questions and Discussion

Resources

Books: Diabetes Burnout

Caring for the Diabetic Soul

Organizations:American Diabetes Association (1-800-DIABETES)

North Carolina Diabetes Association (1-877-362-2678)