Saint Luke’s Diabetes Webinar Part 1

Diabetes Self-Care: Focus for the Everyday and the Extreme Days

Vicky Taylor, RN, BSN, CDE

Every day focus for diabetes care.

SELF-MANAGEMENT SAFETY SUPPORT

Self-management

Challenges

• Understanding the bigger picture

• Type 1 vs Type 2

Self-management

Symptoms•Often no symptoms• Easily overlooked•Daily action needed

Type 1 or Type 2

What’s the difference?

Pre Diabetes

88 million people –this is time for prevention!

Type 1

Autoimmune, often younger, sick at time of diagnosis

Type 2

Insulin resistance, often no symptoms, extra weight, family history, little exercise, diet influences

33 million combined (most type 2)

Self-management

Reducing Risks

• Looking ahead•Don’t wait to take action• Starting today

Feet – checking daily, doctor check yearly, change in feeling?

Eyes – yearly dilated exam, preventing vision loss

Kidney – blood and urine check at least 1 x year at PCP visit

Heart (blood vessels)

Blood pressure

Blood sugar

Cholesterol

Self-management

Self-management

Need to know and understand:

What are MY?• A1C% target• Daily blood sugar targets• Medications for blood sugar:• How to take• When to take• What to expect

Safety

• Blood sugar, highs, lows and somewhere in between

• Diet and exercise, medications

• Sick day management basics

• Impact of COVID-19, illness/stress

S A I N T L U K E ’ S H E A L T H S Y S T E M 9

SafetyBlood sugar goals (for most)

• Pre meal 70-130

• 2 hr post meal less than 180

• Bedtime goals may need to be identified

o Finger Stick Monitoring

o Continuous Glucose Monitoring (CGM)

o Supplies (and costs!)

Average Blood Sugar

over timeA1C Risk

13% 326 mg/dl

12% 298 mg/dl

11% 269 mg/dl

10% 240 mg/dl

9% 212 mg/dl

8% 183 mg/dl

7% or less

without excessive

hypoglycemia

154 mg/dl

6.5% or less

without excessive

hypoglycemia

140 mg/dl

5.7 % to 6.4 % 112-134 mg/dl If no known diabetes, at

increased risk for diabetes

4.0 % to 5.6% 58 - 109mg/dl Normal for people without

diabetes

ADA target

AACE target

Keeping blood sugar levels near normal can help

reduce the risk of eye disease

nerve disease kidney disease and

heart disease

Schedule A1C testing every 3-6 months

Why does blood sugar go up?

• Learn from choices•Consider drinking

water•How long since last

food/drink•Hands clean?• Time for a walk?•Medication• If Type 1, time to

check ketones?•How am I feeling?

Rule of 15’s • 15 grams rapid acting

sugar• Wait 15 min and re-check

your blood glucose to be sure it’s back to at least 70

Any portion from this list:• ½ cup juice• 4 glucose tablets• 5 oz. regular soda• 6 saltine crackers• 3-4 peppermints • 1 TBSP honey• 2 TBSP raisins

S A I N T L U K E ’ S

H E A L T H S Y S T E M

1 3

If low, do you know why?

“Extreme”Days

Should I keep taking diabetes medications if I’m sick?

• Talk to your health care provider!

• Have plenty of testing supplies

• Insulin

• Urine ketone test strips (type 1)

• Sick day supplies

What if I am sick and taking medication for diabetes?

Talk to your doctor if you take:

• Invokana, Farxiga, Jardiance

These allow your body to make more insulin, CAUTION if not eating:

• Glimepiride, Glipizide, Glyburide

• (or any combo med that includes these)

Never stop taking your insulin without talking to your team

Sick Day Management

• HYDRATION is important!

• Know when to call your diabetes team!

• NEVER stop taking insulin without talking to your health care provider

• You may need to change your usual routine when you are ill

• Test blood sugar frequently

S A I N T L U K E ’ S H E A L T H S Y S T E M 1 6

Support• Teamwork

• Healthy coping/ stress management

• Look for facts

• Ongoing education

You Can Visit: cdc.gov/coronavirus/2019Diabetes.org/coronavirus-covid-19

• Depression is higher risk with diabetes

• Blood sugar response

• Connect with your team or health care provider if needed

S A I N T L U K E ’ S

H E A L T H S Y S T E M

1 8

Healthy Coping

BE MINDFUL BE FLEXIBLE BE WELL

S A I N T L U K E ’ S H E A L T H S Y S T E M

Behavior Matters

Reminders

• Daily self-foot check (including bottom of feet), yearly provider check (with shoes off!)

• Blood Sugar testing – individualized usually at least 1 time daily or as discussed with provider

• Yearly Dilated eye exam

• Yearly urine/blood test to check kidneys

• Yearly cholesterol/lipid test

• Blood pressure check at each provider visit

• A1C every 3 to 6 months

• Consider meeting yearly with Diabetes Education team (Covered benefit for Medicare/replacement and many private insurances)

Reminders

Resources:

Saint Luke’s Diabetes Centers

S A I N T L U K E ’ S

H E A L T H S Y S T E M 2 1

Individualized Diabetes Education on site or virtual visit

Call 816-932-2707 to make an appointment (requires provider referral)

Centers available at Saint Luke's Plaza, North, South and East Clinics

Resources:

Saint Luke’sDiabetesCenters

S A I N T L U K E ’ S

H E A L T H S Y S T E M 2 2

Barry Road

816-880-6100

Blue Springs

816-347-4600

Blue Valley

913-323-8830

Cushing

913-651-6565

East

816-347-5600

Independence 816-251-5200

Lee’s Summit

816-347-5100

Mission Farms 913-317-7990

Parkville

816-569-1506

Platte City

816-858-7050

Plaza

816-932-3100

Shoal Creek

816-437-8161

Smithville 816-532-3999

Southridge913-317-3200

Resources:

Saint Luke’sPrimary Care

Clinics

Resources:

Saint Luke’s Community Resource Hubhttps://saintlukesresources.org/