Hypopatterns nutrition part 1

Question 1

What is pattern management?

Applying results of home blood glucose monitoring to drug therapy management

Recognizing _______/______ that occur in
patterns.

Recommending appropriate __________ to address the patterns of highs and lows seen.

Follow-up on results for changes made.

Answer 1

highs/lows

drug therapy

Question 2

Advantages of Meter Download Packages

Quickly put data in a format beneficial for pattern management

Provide graphic representation of _______
Gives a “picture” of their blood sugars

Provide other support and tools directly to PWD (people with diabetes)

Provide value added service to establish relationship with PWD (people with diabetes)

Track/_______ data for measuring outcomes Individual patients over time

Can assist you to compile data for _________ to determine impact of clinical service

Answer 2

trends

multiple patients

store data

Question 3

So many numbers… …where to start?

Look for most ___________ FIRST
Patterns – which has most above goal
– Breakfast
– Lunch
– Dinner
– Bedtime
Reflective of previous meal or med dose

Answer 3

dangerous

Question 4

Documentation of BS (Blood Sugars)

State RANGE of BS at specific time
State number of BS that are above
target
State the target – in what part of note? objective
Example:
Before breakfast 104-182, 6/11 <130
Before breakfast 104-182, 5/11 >130

Question 5

Documentation of BS
O: am fasting 63-134, 13/28 <130
after breakfast 154-219, 7/19 >180

A: About half of blood sugars before
breakfast are in range and about half are
in range after breakfast…..

(Objective has numbers

((Assessment cannot have any numbers just words!!)

Question 6

Hypoglycemia – Low Blood Glucose

_________ is defined as a blood glucose that is lower than normal.

Blood glucose less than 70 mg/dL

Answer 6

Hypoglycemia

Question 7

Hypoglycemia

Everyone is unique –two people may have the same low blood glucose level but experience very different symptoms

Every episode is unique
Symptoms vary from episode to episode
Symptoms may begin at different glucose levels on
different occasions

Hypoglycemia unawareness

Question 8

Hypoglycemia - Signs and Symptoms

Shaking/trembling
Weakness
_________/light-headed
Sleepiness
Trouble concentrating
_________
Nervous feeling
__________ speech
Sweaty, clammy skin
Intense __________
Heart “skips a beat”
Blurred vision
Nausea/queasiness
Tingling in hands/feet/lips

Answer 8

shaking

dizziness

Headache

Slurred speech

intense hunger

Question 9

Hypoglycemia - Nocturnal

More than half of all episodes of hypoglycemia
occur during the night – and you may sleep
through it
Common Symptoms
Nightmares
Night sweats
__________/thrashing (observed by a bed partner)
Bed partner cannot ___________ you from sleep
Unexplained _________ upon waking

Answer 9

seizures

cannot arouse

headache

Question 10

Hypoglycemia - Nocturnal

More than half of all episodes of hypoglycemia
occur during the night – and you may sleep
through it
Common Symptoms
____________
Night sweats
__________/thrashing (observed by a bed partner)
Bed partner ___________ you from sleep
Unexplained ____________upon waking

Answer 10

Nightmares

seizures

cannot arouse

headache

Question 11

Risk Factors for Hypoglycemia

Regimen-Related

Intensive insulin regimen (_________ daily doses)

__________ glycemic goal

_________doses of insulins

Insulins with longer __________ and duration

Diabetes medications that cause hypoglycemia (e.g. sulfonylureas-glipizide, glimepride, glybuide; meglitindes-repaglinide, nateglinide

Answer 11

multiple

aggresive

higher doses

longer peaks

Question 12

Risk Factors for Hypoglycemia

Patient-related
Advanced __________
Decreased ____________ intake in comparison to insulin dose

Erratic meal schedule or ________meal(s)

Exercise

History of ___________

______ intake

Renal dysfunction (decreased insulin clearance)

Hepatic dysfunction (decreased gluconeogenesis)

Having type ______

Error in insulin __________ (injecting incorrect dose,
waiting >15 minutes to eat after injecting rapid-acting insulin)

Answer 12

age

carbohydrate intake

missed meals

hypoglycemia

alcohol

type 1 diabetes

administration

Question 13

Hypoglycemia – Rule of 15

Treat with 15 gm of fasting-acting carb,
wait 15 minutes,recheck BS, retreat if
needed.

Seek help if severe or not responding to
treatment

Question 14

Hypoglycemia – Rule of 15

As soon as you suspect hypoglycemia, check your
blood glucose – Do not Delay

If your blood glucose is below target, promptly
eat or drink 15 grams of _____________
carbohydrate.

Wait 15 minutes, and then recheck your glucose
level

Answer 14

fasting acting carbohydrate

Question 15

Examples of 15 grams of Fast Acting Carbohydrate

__________ tablets (4 tablets)
_______ juice (4 oz,______ cup)
Milk (8 oz)
__________soft drink (4 oz, _____can)
Sugar (3 to 4 teaspoons/packet or 1 Tbsp)
Hard Candy (3 or 4 pieces, depending on size)
Lifesavers (5-6 pieces)
Jelly (1 Tbsp)

Answer 15

glucose tablets (4 tablets)

fruit juice (1/2 cup)

Non-diet soft drink (1/2 can)

Question 16

What to Do at Recheck
At recheck, if glucose level still below target, ________ carbohydrate treatment (even if your
symptoms have resolved)

At recheck, if glucose level is within target, do
not eat or drink any more carbohydrates (even
if you still have ________)

After treating hypoglycemia, monitor your
blood glucose periodically over the next ________
to check for a relapse

Answer 16

repeat

symptoms

hour

Question 17

Hypoglycemia – Over Treating

Let your ___________ readings drive your actions, not just your symptoms.

Symptoms may persist for a while, even after the glucose has corrected

Give your body time to readjust to the change in glucose level

If you’re in a situation where checking your glucose level is not possible, go ahead and take the 15 grams of carbohydrate in this case based on symptoms , you must assume that you have hypoglycemia.

Answer 17

glucose readings

Question 18

Hypoglycemia - Prevention

If you experience hypoglycemia, monitor your glucose for the next day or two as one episode can lead to fewer warning symptoms if another episode occurs with the next 24 hours

Eat meals and snacks on time. During waking hours, don’t go more than _____hours without some nutrition

If you take insulin that peaks during your sleeping hours, be sure to eat a bedtime _____

Balanced increased activity with ______ intake

If you drink alcoholic beverages, use in moderation and _______ while drinking

Answer 18

don’t go more than 5 hours

bedtime snack

food intake

eat

Question 19

Brief Counseling Tips

Ask for and review food and physical activity
records

Review goals, problems and solutions

Ask individuals what they need to do

Promote realistic expectations

Write down and set realistic lifestyle goals—not weight loss goals—based on readiness to change

Give positive ___________; never criticize

Look for and recommend ________ systems

Answer 19

encouragement

support systems