Lecture Flashcards
4 things to remember with diabetes
- Diabetes care team: members and roles
- Diabetes basics
- Components of diabetes care plan
- Helping patients cope with diabetes
A good diabetes care takes a team…
Patient Physician : Primary Care Physician , Endocrinologist Nurse (RN, NP, LPN) Physician assistant Medical assistant Other office staff members Family and friends Certified diabetes educator Registered dietitian Ophthalmologist Foot doctor Pharmacist
beta cells of pancreas produce no insulin
Type 1:
beta cells produce insufficient insulin and body does not use insulin effectively
Type 2:
diabetes diagnosed during pregnancy
Gestational
general category that includes diabetic related to other causes (eg. genetic disorder or pancreatic disease)
other forms of diabetes
Carbohydrates are metabolized into glucose during digestion
Glucose enters bloodstream
Rising blood glucose level causes beta cells in the pancreas to release insulin
Insulin moves glucose from blood into the cells, where it is used for engery
Carbohydrates increase blood glucose levels; insulin decreases blood glucose levels
How Food Turns into Energy:
________ makes little or no insulin or the body cannot use the insulin that is in the body
Pancreas
____ can’t get in the cell so it stays in the blood causing hypoglycemia
glucose
Glucose can’t get into cells, so it stays in the
_______
blood
Blood glucose levels increase, resulting in_________
hyperglycemia
Family history of diabetes High-risk ethnic population Excessive body weight High blood pressure Physical inactivity
Risk Factors.. Type 2 Diabetes
A1C 6.5% or higher: A1C: over a 3 month span
Fasting blood sugar 126 mg/dL or higher
2-hour blood glucose 200mg.dL or higher during oral glucose tolerance test
Classic: symptoms of high blood sugar or hyperglycemia crisis and blood sugar over 200 or higher on a random blood glucose test
Criteria for Diagnosis of Diabetes…
A1C 5.1
prediabetes
Urinating often Being thirsty or hungry more often than usual Unusual weight loss Tired more often than usual Numb or tingling hands or feet Cuts or bruises slow to heal Blurry vision Irritability
Signs and Symptoms:
of diabetes
Patients need to understand:
The basics of diabetes
How to incorporate a meal plan into their lifestyle
How to incorporate physical activity into their lifestyle
How to take medicines
How to check their blood sugar
How to prevent, detect and manage diabetes-related problems
What strategies they can use to make health-related changes
How to deal with psychosocial issues (depression can cause diabetes or diabetes can cause depression
Developing a Diabetes Care Plan:
Help patients to understand that they need to …
want a variety of healthy foods
eat meals and snacks at regular times
check food labels for calories, CHO, fat, sodium, cholesterol, protein, and fiber
watch portion sizes, especially of CHO foods.
The Basics of a Meal Plan…
Motivate patient by informing them about the benefits
- -> Improved blood glucose control
- ->Reduced risk of CV disease
- -> Weight loss
- -> Improved well being
Provide a physical activity prescription
- -> At least 150 minutes (2.5 hours) per week of moderate-intensity aerobic activity
- -> In absence of contraindications, 2 session per week of resistance exercise
The basics of physical activity plan…
Check blood sugar before and at regular intervals during activity Wear or carry medical ID Carry food or meals Check you feet A1C Home monitoring of blood sugar Checking both A1C and blood sugar helps assess diabetes control Higher the A1C more related to fasting Over 9% is more post meal
Checkinging Both A1C and Blood Sugar is Important…
Reflects average blood sugar for the past few months
If at goal they would check it 2 a year
AIC
Provides instant feedback or current blood sugar level
home glucose monitoring
when do we check blood sugars
At bedtime and after
waking up
Before meals
1 to 2 hours after meals
In the middle of the night
Advise patient to track readings in a blood sugar diary
What Are the Goals for Blood Sugar and A1C?
Blood glucose parameters
- ->A1C
- ->Preprandial glucose
What Are the ABC’s?
A: A1C
B: Blood glucose
C:Cholesterol
A Sample Diabetes Care Schedule
Every 3 months:
Regular office visit
A1 C test ( if blood sugar is not stable)
Check: Blood pressure, Weight, Feet
A Sample Diabetes Care Schedule
Every 6 months:
A1C blood sugar is stable
Dental exam
A Sample Diabetes Care Schedule
Every year:
Physical Exam
Comprehensive foot exam
Check: Lipid profile, Kidneys, Eyes
Flu shot/ pneumonia shots
Teaching Patient to Recognize Signs and Symptoms of High Blood Sugar
(3)
- Thirst or hunger
- Passing more urine than usual
- Feeling tired
Check blood sugar
Following meal, physical activity and medicine plans
Call doctor or nurse if blood sugar is high and they don’t know why
Note high blood sugar readings in diary along with factors that may have contributed so that the can discuss
missed the rest of this slide
causes of Hypoglycemia
Too little food or CHO
Skipping or delaying meals
Being more active than usual
Taking too much insulin
signs and symptoms of hypoglycemia
Hunger Anger/irritable Nausea Lightheadedness Shakiness Tiredness Clammy/sweaty pale skin
Rule of 15
Eat or drink something with 15 grams of carbohydrates, such as:
- -> 0.5 cup of regular juice (4 ounces)
- -> 0.5 cup of regular soda
- -> Candy like pack of skittles: 5 to 6 hard candies
- -> 3 or 4 glucose tabs
Check blood sugar again 15 min
If blood sugar is still low, eat or drink another 15 grams of CHO
tell you patient when they should be checking their
blood sugars and urine ketones
Advice patient to stay motivated they do not need to be perfect
help them to identify obstacles that may be preventing them from taking the best possible care of themselves
Advise them to make sure that they have support
Encourage them to stay in close touch with the diabetes care team.
Helping Patients Cope with Diabetes Burnout
Hoffman said: Know what lab values and test values for diabetes: go with ADA recommendation
so i will add this once i find it
Why meals matter in diabetes
Be a part of diabetes care plan Blood sugar is affected by What we eat How much we eat When we eat
Your meal plan should consider
Culture
Lifestyle
Food likes and dislikes
Budget
80/20 rule
eat healthy 80% of the time; other 20% they can eat what they want
Carbohydrate counting
more flexible meal plan
It’s important to…
Eat at regular times
Match amount eaten with activity level
Count carbohydrates (carbs)
Planning Healthy Meals
Lots of vegetables and fruits Whole-grain foods Fish 2 to 3 times a week Lean cuts of beef and pork Non fat dairy products More liquid fats than solid fats (Limit grantinitie)
healthy food choices
One of the main components of meals
The main kind of food that raises blood sugar levels
Simple (sugar) or complex (starchy foods)
Carbohydrates
The 3 Main Types of Carbohydrates
Starches (or complex carbs): fructose, fruit, lactose, milk
Sugars (simple carbohydrates) : honey, agave nectar,
Fiber
*****All 3 types raise blood sugar, but they do so at different rates
Foods that contain the most carbs
Starches (for example, bread) Starchy vegetables Fruits and fruit juices Milk and yogurt Sweets and other sugary foods
Foods that don’t contain cards
Meats and eggs
Fats and oils
Lack enzymes to break down fiber → should eat 25 to 30 a day
Adding fiber to the diet should be gradual
sugars
Check serving size, information on the label is based on the serving size
See how many grams of carb are in each serving
Decide whether the food fits in the plan.
Don’t forget to count the carbs in your dinks
find something that works for you
reading the label
Calorie counting:
what are you looking at on the label (6)
Harmful fats: Saturated fat Trans fat Healthier fats Monosaccharides Polyunsaturated fat
Eating out: Tips that can help
Split dinner in half
If you don’t know what’s in a dish, ask…..
The 10 diabetes superfoods
some reason only have 5 written.. so five me 5
Beans Dark green leafy veges Citrus fruits Sweet potatoes Berries
Cornerstones 4 care:
Patient support program
60-65g per day of carbs
Males
45-60g per day of carbs
Women
