Diabetes Teaching Plan

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Diabetes Teaching Plan

Diabetic Teaching Plan

FOOT CARE: Daily foot care is essential. Avoid exteme water temps, toe nail care (avoid cutting them yourself), get well-fitting shoes, never go barefoot, moisturize, and direct observation daily. If you see any fungus or have any pain notify your doctor immedietly. EMPLOYMENT CONSIDERATIONS: Lack of scheduled or sporadic meal could cause problems, plan ahead. 45 minute driver without adequate meal intake could be a problem as well.EXERCISE: Purpose/Benefits: Regardless of the type of diabetes you have, regular physical activity is important for your overall health and wellness. With type 1, it’s very important to balance your insulin doses with the food you eat and the activity that you do – even if you are just doing house or yard work. Planning ahead and knowing your body’s typical blood glucose response to exercise can help you keep your blood glucose from going too low or too high.Ways to increase exercise: Park further away, use stairs, desk exercises.Snacks if prolonged exercise: Always carry a carbohydrate food or drink (like juice or glucose tabs) that will quickly raise your blood glucose. Type: Aerobic exercise, strength training, flexibility exercises/stretching, balance exercises, and activity throughout the day are the types of activities we recommend for people with diabetes. Timing//Length/Frequency: 30 min per day.WEIGHT MANAGEMENT: Maintaining a healthy weight or wight loss; Losing 10-15 pounds can make a difference and can decrease amount of exogenous insulin needed or eliminate the need which is a great motivator.STRESS MANAGEMENT: Ideas to decrease or managing stress levels: Prayer, yoga, aroma therapy, plan ahead.RECORD KEEPING: Any form of record keeping to help patient stay organized and manage trends will help keep you regulated. Keep a diary of your eating/exercise habits. Keep track of all doctors appointment notes.

Environmental Health Issues

FINGER STICK BLOOD SUGAR CHECKS AND RESULTS: Purpose: Blood glucose (blood sugar) is an essential measure of your health. If you're struggling to manage your blood glucose levels, we can help! With the latest tools and strategies, you can take steps today to monitor your condition, prevent serious complications and feel better while living with diabetes.How of needed: At least daily or more if neccessary.How performed: After washing your hands, insert a test strip into your meter. Use your lancing device on the side of your fingertip to get a drop of blood. Touch and hold the edge of the test strip to the drop of blood, and wait for the result. Your blood glucose level will appear on the meter's display.Address concerns fo noncompliance: Your blood sugar may get out of control if you do not check it frequently. (Still having strips from former visit)When do you notify doctor of abnormal readings; sick day rules (what to do if results are not within specified limits, set by physician): notify the physician.HYPOGLYCERMIA:Treatment: Get the right kind of food into your body or some glucose/insulin.Signs & Symptoms: Not enough food, like a meal or snack with fewer carbohydrates than usual, missing a meal or snack. Alcohol, especially on an empty stomach. Too much insulin or oral diabetes medications. Side effects from other medicationsMore physical activity or exercise than usual – physical activity makes your body more sensitive to insulin and can lower blood glucose.HYPERGLYCERMIA:Treatment: Exercise, insulin, dieting per diabetic diet.Signs & Symptoms: Too much food, like a meal or snack with more carbohydrates than usual. Not being active. Not enough insulin or oral diabetes medications. Side effects from other medications, such as steroids, anti-psychotic medicationsIllness – your body releases hormones to fight the illness, and those hormones raise blood glucose levels. Stress, which can produce hormones that raise blood glucose levels. Short- or long-term pain, like pain from a sunburn – your body releases hormones that raise glucose levels. Menstrual periods, which cause changes in hormone levels. DehydrationBLOOD PRESSURE:Importance of maintaining blood pressure within acceptable range <140/90: Take all blood pressure medications and keep exercising because a high blood pressure can lead to other diseases and problesm. Affects overall health and blood sugars.MEDIC ALERT BRACELET:ALL Diabetics should wear a medic alert bracelet: If you are out in the public or have an attack people around you will have a better idea of how to help you if they know that you are diabetic.VACCINATIONS: Get yearly influenza and pneumococcal vaccinations.

Treatments

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METFORMIN:What it is: Oral Hypoglycemic AgentHow it works: Metformin is an antihyperglycemic agent which improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Its pharmacologic mechanisms of action are different from other classes of oral antihyperglycemic agents. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Unlike sulfonylureas, Metformin does not produce hypoglycemia in either patients with type 2 diabetes or normal subjects (except in special circumstances, see PRECAUTIONS) and does not cause hyperinsulinemia. With Metformin therapy, insulin secretion remains unchanged while fasting insulin levels and day-long plasma insulin response may actually decrease.When it is to be taken; dosage: 500 mg orally twice a day (with the morning and evening meal)Address concerns of noncompliance: If you skip a dose, take the missed dose as soon as you remember (be sure to take the medicine with food). Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. If you stop taking your medication then your diabetic symptoms will come right back.Side effects of medication: Get emergency medical help if you have any of these signs of an allergic reaction to metformin: hives; difficult breathing; swelling of your face, lips, tongue, or throat. This medication may cause lactic acidosis (a build-up of lactic acid in the body, which can be fatal). Lactic acidosis can start slowly and get worse over time. Get emergency medical help if you have even mild symptoms of lactic acidosis, such as: muscle pain or weakness; numb or cold feeling in your arms and legs; trouble breathing; feeling dizzy, light-headed, tired, or very weak; stomach pain, nausea with vomiting; or slow or uneven heart rate.Call your doctor at once if you have any other serious side effect such as: feeling short of breath, even with mild exertion; swelling or rapid weight gain; or fever, chills, body aches, flu symptoms.Less serious metformin side effects may include: headache or muscle pain; weakness; or mild nausea, vomiting, diarrhea, gas, stomach pain.Patient considerations: Disease interatctions; Applies to: Renal Dysfunction, Liver Disease, Congestive Heart Failure, Dehydration, Sepsis, Shock, Myocardial Infarction, Asphyxia, Acidosis, Diarrhea, Vomiting, Anemia, Alcoholism HUMULIN REGULAR INSULIN:What it is: Exogenous Subcutaneous Injectable Hypoglycemic AgentHow it works/Function/Purpose (Peak, onset, and duration): It works by lowering levels of glucose (sugar) in the blood. Insulin isophane is a long-acting form of insulin that is slightly different from other forms of insulin that are not man-made. Humulin is used to treat diabetes. Humulin is a crystalline suspension of human insulin with protamine and zinc providing an intermediate-acting insulin with a slower onset of action and a longer duration of activity (up to 24 hours) than that of Regular human insulin. The time course of action of any insulin may vary considerably in different individuals or at different times in the same individual.When it is to be taken/Dosage amounts: 20 units in the morning & 5 units at supperInsulin injection sites: Humulin is injected under the skin. You will be shown how to use injections at home. Use a different place on your stomach, thigh, or upper arm each time you give the injection. Do not inject Humulin into the same place two times in a row.Importance of rotation/absorption: It is very important to rotate injection sites so that you don't build up a lot of scar tissue and then you won't be able to absorp all of the needed insulin.Side effects of medication/Patient considerations: Check with your doctor if any of these most COMMON side effects persist or become bothersome: Redness, swelling, itching, or mild pain at the injection site. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; wheezing; muscle pain); change in skin to thick or thin where the injection was given; changes in vision; chills; confusion; dizziness; drowsiness; fainting; fast or irregular heartbeat; headache; loss of consciousness; mood changes; seizures; shortness of breath; slurred speech; swelling of the hands, ankles, or feet; tremor; trouble breathing; trouble concentrating; unusual hunger; unusual sweating; weakness. Seek emergency medical attention if you think you have used too much of this medicine. An insulin overdose can cause life-threatening hypoglycemia.Do not change the brand of insulin or syringe you are using without first talking to your doctor or pharmacist. Some brands of insulin isophane and syringes are interchangeable, while others are not. Your doctor and/or pharmacist know which brands can be substituted for one another. Avoid drinking alcohol. Your blood sugar may become dangerously low if you drink alcohol while using Humulin.ADMINISTRATION:Needle type/different delivery methods (pump/pen): The insulin comes in different ways of getting it adminitered. There are insulin pens that are already preloaded and you just add the needle to the tip of it, or you can get syringes and a bottle of insulin and administer it that way as well.Labeling after opening with outdate: Always check the expiration date before administering your insult. After you open you vial you need to write the date that you opened it on the outside of the bottle or pen.Checking for patency: You need to roll the vial in between your hand to make sure that the insulin isn't clumping. Do not administer if you see clumping in the bottle.Check the expiration date: Always check the expiration date before administering insulin.Storage of insulin: Storage requirements: Protect from heat and light; do not freeze (do not use if frozen)-Unopened vials and pens: Store in refrigerator 36F to 46F (2C to 8C)-Open (in-use) vials: Humulin N: Store below 77F (25C) and use within 31 days; alternatively, may refrigerate, discard unused portion after 31 days-Open (in-use) vials: Novolin N: Store below 86F (30C) and use within 42 days; alternatively, may refrigerate, discard unused portion after 42 days-Open (in-use) Humulin N pens: Do not refrigerate after opening; use within 14 days; discard unused portionWhere to dispose of used needles: No needle recap. Do not reuse needles ever once they have been used. Always dispose of your needles in a sharps container.Acquiring/Disposal of sharps container. Where and when to dispose: You may use a liquid laundry container, taped shut if you do not want to buy a sharps container. You can buy a sharps container from your local pharmacy. (ask your pharmacist where you can get one and how to dispose of it).Protocol for missed doses: Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.Concerns addressed over fear of self-administering insulin: Practice/return demo with patient; use active listening skills.Diovan HCT: 80/12.5 dail for blood pressureSimvastatin: Get prescription filled and use as prescribed.St. John's wort extract: 300 mg, three times daily

Medications &Medication Teachings

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MICROVASCULAR COMPLICATIONS AND PREVENTION:Nephropathy: End End Stage Renal Diesease (ESRD): Renal failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function. Neuropathy: Amputaions, nerve damage; Peripheral Vascular Disease (PVD):It is caused by build-up of fatty material within the vessels, called atherosclerosis. This is gradual process in which the artery gradually becomes blocked, narrowed, or weakened.Retinopathy: Blindness; Blurred vision: is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).MACROVASCULAR COMPLICATIONS AND PREVENTION:Coronary Artery Disease (CAD): is a result of plaque buildup in your coronary arteries -- a condition called atherosclerosis -- that leads to blockages. The arteries, which start out smooth and elastic, become narrow and rigid, restricting blood flow to the heart. The heart becomes starved of oxygen and the vital nutrients it needs to pump properly.Cerebral Vascular Accident (CVA): A cerebrovascular accident is the medical term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by a blockage or a rupture of a blood vessel. MONITORING LAB:Glycosylated hemoglobin test HbA1c: The hemoglobin A1c test, also called HbA1c, glycated hemoglobin test, or glycohemoglobin, is an important blood test that shows how well your diabetes is being controlled. Hemoglobin A1c provides an average of your blood sugar control over the past 2 to 3 months and is used along with home blood sugar monitoring to make adjustments in your diabetes medicines.Fasting Blood Sugar (FBS): A fasting blood sugar (FBS) level is one of the tests used to diagnose diabetes mellitus. In a person with symptoms of osmotic diuresis and an elevated fasting blood sugar level, the diagnosis of diabetes mellitus is usually made. The fasting blood sugar is determined by taking a sample of venous blood after at least eight hours of fasting. The sugar level is then evaluated in the blood sample.Lipids diagnosed with high cholesterol: Diagnostic testing includes a blood test that measures cholesterol levels. Cholesterol testing primarily measures the total amount of cholesterol and the three components of cholesterol, HDL, LDL and triglycerides.OTHER COMPLICATIONS AND CONCERNS:Hyperglycemic Hyperosmolar nonketotic Syndrome (HHNS): what it is: In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine. You make lots of urine at first, and you have to go to the bathroom more often. Later you may not have to go to the bathroom as often, and your urine becomes very dark. Also, you may be very thirsty. Even if you are not thirsty, you need to drink liquids. If you don't drink enough liquids at this point, you can get dehydrated. How to treat it and avoid it: HHNS only occurs when diabetes is uncontrolled. The best way to avoid HHNS is to check your blood sugar regularly. Many people check their blood sugar several times a day, such as before or after meals. Talk with your health care team about when to check and what the numbers mean. You should also talk with your health care team about your target blood sugar range and when to call if your blood sugars are too high, or too low and not in your target range. When you are sick, you will check your blood sugar more often, and drink a glass of liquid (alcohol-free and caffeine-free) every hour. Work with your team to develop your own sick day plan.Take along kit for exercise and travel: Bring your doctor's name and phone number and keep it with you at all times.Bring a list of the medicines you take and keep it with you at all times.Always carry and wear medical identification that tells others that you have diabetes.Keep medicines, syringes, and blood sugar testing supplies in your carry-on luggage. Don’t put them in checked luggage in case the airline loses your bag. Also, the cargo hold isn’t heated or insulated well, which could damage your medicine and supplies.Take enough medicines and supplies to last an extra week in case you get stranded or stay longer than you planned. If you’re traveling with someone, ask if he can carry some of them for you.Always carry hard candy, a small snack, or glucose gel or tablets in case your blood sugar dips too low.Support smoking cessation: Smoking is bad for everyone, and it's especially risky if you have diabetes. The nicotine in cigarettes makes your blood vessels harden and narrow, curbing blood flow around your body. And since diabetes makes you more likely to get heart disease, you definitely don't want the extra risk that comes from smoking.No matter how much or how long you have smoked, quitting helps your health. You'll feel better, look better (since smoking gives you wrinkles before you're old), and you'll save money, too.DM TYPE II:What it is: is a metabolic disorder that is characterized by hyperglycemia (high blood sugar) in the context of insulin resistance and relative lack of insulin.Risk Factors: The development of type 2 diabetes is caused by a combination of lifestyle and genetic factors. While some of these factors are under personal control, such as diet and obesity, other factors are not, such as increasing age, female gender, and genetics. A lack of sleep has been linked to type 2 diabetes. This is believed to act through its effect on metabolism. The nutritional status of a mother during fetal development may also play a role, with one proposed mechanism being that of altered DNA methylation.Signs and Symptoms of Diabetes: The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss. Other symptoms that are commonly present at diagnosis include a history of blurred vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and fatigue. Many people, however, have no symptoms during the first few years and are diagnosed on routine testing. People with type 2 diabetes mellitus may rarely present with hyperosmolar hyperglycemic state (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).Acceptable Blood sugar range: maintain as close to 100 as able.

Health & Knowledge

INTERDISCIPLINARY TEAMWORK:Diabetic Educator: A key member of the diabetes management team, a diabetes educator will help you learn how to take care of yourself -- guide you through your treatment and help you with any fears, issues and problems you encounter along the way. Doctor visits for monitoring (usually every 6 months, every 3 months for lab work): Regular diabetes testing is an important part of your diabetes care. Speak up when you visit your doctor: Your health care team is there to support you.Podiatrist foot/nail care as needed: Today's podiatrist is an integral part of the treatment team and has documented success in preventing amputations: More than 65,000 lower limbs are amputated annually due to complications from diabetes. After an amputation, the chance of another amputation within three to five years is as high as 50 percent. Including a podiatrist in your diabetes care can reduce the risk of lower limb amputation up to 85 percent and lowers the risk of hospitalization by 24 percent. The keys to amputation prevention are early recognition and regular foot screenings performed by a podiatrist, the foot and ankle expert.Optometrist or Opthalmologist {At least an annual visit (possibly every 6 months)}: As essential health care providers for patients with diabetes, optometrists have both the capacity and responsibility to increase patient awareness about the condition, facilitate early detection, and assist in disease management and treatment. This article provides insight on how optometrists can better educate their patients about diabetes management.Dental Health (annual appointments): Tell your dentist that you have diabetes and what medicines you take. Let her know if your blood sugar level is off-track, and if you take insulin, tell her when you took your most recent dose. Get your teeth and gums cleaned and checked by your dentist twice a year. Your dentist may recommend that you do it more often, depending upon your condition.REFERRALS, AGENCIES, OR ASSISTANCE:Diabetes education program (almost all area hospitals provide this service): The National Diabetes Education Program (NDEP) provides tools and resources to empower organizations and individuals to effectively deal with diabetes.Websites/Handouts (if provided) for patient use: What is Pre-Diabetes Exercise and Type 2 Diabetes, by SCAN & DCE DPG Ready, Set, Start Counting! Carbohydrate Counting-A Tool to Help Manage Your Blood Glucose Advanced Insulin Management: Using Insulin-to-Carb Ratios and Correction FactorsHealthy Eating on a Lean Budget (On The Cutting Edge article, Spring 2010)Mealtime Insulin ManagementManaging and Preventing HypoglycemiaLocal resources: support groups, diabetes organizaitons, hospital, doctor's office, health department.Community assistance available for cost coverage for supplies and medication: For diabetic patients who need financial assistance with supplies and related health care items and services, the following programs may be of help. Categories: Free Glucose Meters Test Strips Insulin Syringes Medical Testing Multiple Diabetes Supplies Available Service Animals Pharmaceutical Company ProgramsSources, ways the patient would access this information or agencies: On the internet, from referrals from doctors or friends.

Nursing Care Plan

MEAL MANAGEMENT:Fast food meals: make healthier choices, such as salads, fruits, vegetables, protein, avoid fried foods and a lot of sugars.Making meals, freezing them and packing a lunch for work/school: Healthy alternative to fast food. Diabetes meal planning starts with eating a well-balanced diet that includes carbohydrates (carbs), protein, and fat. Carbs (found in starches, fruit, vegetables, milk/yogurt and sweets) turn into sugar (glucose) in the body. The body needs carbs for energy. Eating too many carbs can raise blood glucose levels too much, but it is important not cut out these foods. Eating too few carbs may cause your blood glucose to go too low. Eating a moderate amount of carbs at each meal, with a balanced intake of protein and fat, will help your blood glucose stay in a healthy range. Here are some tips to get you started. Your dietitian will give you more specific information when you meet with him or her. Plate method or discussion of calorie count/carb count/portion size: Meal Planning- Plate Method Eat 3 meals and 0-2 snacks daily. Choose at least 3-4 food groups at meals and up to 1-2 food groups at snacks. Yellow groups are carbohydrate. Carbohydrate gives energy. Include both carb and non-carb food groups each meal.Fruit (15 g carb) Fat 2 tsp butter 2 tsp tub margarine 2 tsp olive oil 1 Tbsp salad dressing Starch/ Grain (15 g carb) Meat/Protein1-2 eggs 2 Tbsp peanut butter ounce low fat cheesee cheese 1-2 oz low fat turkey sausage 2-3 ounces chicken or turkey 2-3 ounces tuna or salmon 2-3 ounces lean beef or pork ADA Compliance: American Dietetic Association – Nutrition Care Manual® Diabetes Mellitus In Nutrition Care, click on “Diabetes Mellitus” in the main navigation to access the following information: Carbohydrate Counting Choose Your Foods: Exchange Lists for Diabetes Glucose Tolerance Test Glycemic Index Nutrition labels: always check the labels and count your caloriesFood pyramid or overall picture of what daily intake should look like: Meal Planning- Plate Method Eat 3 meals and 0-2 snacks daily. Choose at least 3-4 food groups at meals and up to 1-2 food groups at snacks. Yellow groups are carbohydrate. Carbohydrate gives energy. Include both carb and non-carb food groups each meal.Fruit (15 g carb) Fat 2 tsp butter 2 tsp tub margarine 2 tsp olive oil 1 Tbsp salad dressing Starch/ Grain (15 g carb) Meat/Protein1-2 eggs 2 Tbsp peanut butter ounce low fat cheesee cheese 1-2 oz low fat turkey sausage 2-3 ounces chicken or turkey 2-3 ounces tuna or salmon 2-3 ounces lean beef or pork Limiting Alcohol and noncaloric fluid intake: Check with your doctor to make sure alcohol doesn’t interfere with your medications or complicate any of your medical conditions. Drinking alcohol can lead to serious low blood sugar reactions, especially if you take insulin or types of diabetes pills that stimulate the release of insulin from the pancreas. Alcohol can also affect other medical conditions you may have, like diabetic nerve damage, diabetic eye disease, and high blood triglycerides. Get guidelines for alcohol use from your medical provider.Portable Healthy snacks: Caramelized Pumpkin Seeds, Dark Chocolate Coconut Protein Balls, Homemade Turkey Jerky, Annie Chun's Seaweed Snacks, Trail Mix, Veggies, Canned FishCultural choices or challenges for the African-American descent: Based on the 1993 National Health Interview Survey(NHIS), the prevalence of known, physician-diagnosed diabetes among African Americans is 3.7%, rising from 1.3% at age 0-45 years to 17.4% at age 65-74 years. The rate of diabetes in blacks has tripled during the past 30 years. Prevalence of diagnosed diabetes in adults is now 1.4 times as frequent in blacks as inwhites. This excess occurs for both black men andblack women. Approximately 1.3 million African Americans have been diagnosed as having diabetes.PERSONALIZED DIET PLANS:Fast food menu breakdowns: McDonald’s:Rescued! If you hold the mayo, the Premium Grilled Chicken Classic Sandwich is a nutritious pick; it’ll set you back 350 calories, 9 grams of fat, and 2 grams of saturated fat. Another good option: The Big ’N Tasty. Men’s Health, the best restaurant detective in the business, calls it the best fast-food burger in America: “This generous patty edges out the iconic BK burger by a full 210 calories and brings a nice balance of protein, fat, and carbs to the table.” Comes with lettuce, tomatoes, onion, and pickles. Or order the grilled-chicken salad.Taco Bell:Rescued! Hold the cheese and sauces and order items “fresco style,” a healthy, flavorful mix of tomatoes, onions, and cilantro. Good picks: The Fresco Chicken Soft Taco (150 calories, 3.5 grams of fat, 1 gram of saturated fat, and 2 grams of fiber) and Fresco Crunchy Taco (150 calories, 8 grams of fat, 2 grams of saturated fat, and 3 grams of fiber). This chain has a couple of healthy salads on its menu, too—just forgo the crispy salad “bowl” and order them fresco style.Meal tips: Stock your refrigerator with protein, Eat seafood three times a week, Keep packaged snack foods to a minimum, and shop for them only in the natural foods section of your store, Buy good-quality spices and fresh herbs, and Go big with a fruit bowl.

Dietary Teaching


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