Diabetic Teaching Plan

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by dml1011
Last updated 4 years ago

Discipline:
Health & Fitness
Subject:
Nutrition

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Diabetic Teaching Plan

Diabetic Education

Foot care:1. Wash your feet daily with lukewarm soap and water2. Dry feet well (especially between toes).3. Moisturize feet with lotion but not between toes.4. Check your feet for blisters, sores, and cuts. You may have to use a small mirror. Notify your doctor if you see any of these, have ingrown toenails or other concerns.5. Use an emery board to shape toenails even with the ends of toes.6. Wear clean, soft stockings or socks daily.7. Keep feet warm and dry8. NEVER walk barefoot indoors or outdoors (bathing is okay).9. Examine shoes daily for rips, cracks, pebbles or other debris.10. Keep legs elevatedEmployment considerations/Meal managment:Living a busy life can make it difficult to make the right choices when it comes to food.*pack meals ahead of time to take with your on your commute*Eat foods high in protein such as cheese, peanut butter & crackers or boiled eggs at least every 4 hours to keep BS stable.*DO NOT skip meals. If you don't have time to eat a full meal, eat a high protein snack. Driving 45 mins to work without proper meal intake puts you and other drivers at risk. Low BS can cause you to have dizziness, shakiness, or fainting episodes which is not safe.If you must eat out - avoid high carbohydrate foods. These will cause your BS to spike high and lower you dramatically. *Choose non starchy vegetables, whole grains, and avoid the bun on burgers. A grilled chicken salad would be a great option. *I have also included an African heritage diet pyramid*Read food labels. "One carb" serving = 15 grams of total carbs. *A "one carb" serving would be: 1 slice of bread, 1/2 c. oatmeal, 1/3 c. cooked pasta or rice, 1/2 bagel or bun, 1/2 c starchy veg such as peas or corn, 1/2 baked potato, 1 c skim milk or yogurt, 1 small piece fruit ect.A plate should consist of:about 40-45 g of carbs per meal - 1/4 plate brown rice or pasta, 1/2 plate non starchy veg, 1/4 plate lean protein plus 2 tbsp fruit, 1 c skim milk or yogurt.*Use "My plate" as an example of what your plate should look like.*Limit alcohol & noncaloric fluid intake which will raise BS and drop you low.*Meet with a dietician for further assistance with meal/snack planning.Exercise:*Exercise will help control your BS by allowing your body to use glucose more efficiently. *Exercise will help lower your BP, maintain good cholesterol, control weight, and increase energy levels.*Eat a high protein snack before prolonged exercise such as peanut butter and crackers.Here are a list of low impact exercises:walking, biking, swimming, and yoga. Parking further away, taking the stairs, and desk exercises are also encouraged.*Gradually build up time while exercising. Starting with a 10 min walk 3x/week and then slowly building up to 30 mins a day is a good start.*Exercise will also help reduce stress and promote weight loss. Losing 10-15 lbs may decrease the amount insulin needed or eliminate the need altogether.A diary or journal of your exercise habits and any weight loss or other achievements can be a great motivator! Find hobbies & activities you enjoy to reduce stress. Exercise, watch a funny movie, talked to a loved one, or anything else that boosts your spirits in a healthy manor.

TreatmentsYou will need to keep track of your blood sugars. A journal is a great method. You will track them to make sure your sugar isn't too high or too low. BS should be range 70 to 120 or limits your doctor sets. To check BS:1. Wash & dry your hands2. Insert a test strip into meter3. Use your lancing device on the side of your fingertip to get a drop of blood. 4. Touch the end of the test strip to blood drop & wait for results.5. Blood glucose level will automatically appear on meter.Generally BS is checked in the AM before anything is eaten. This is a fasting check. Finger sticks should also be checked 2 hours after meals & anytime you are not feeling right. *You will need to know signs & symptoms of high and low blood sugar.It is very important not to reuse test strips. Take your insulin as prescribed even when sick unless told so by your doctor. Your doctor will also give you parameters that are either too high or low & to call the office immediately.Hypoglycemia is low blood sugar. Signs & symptoms include: hunger, shakiness, weakness, confusion, sweating, dizziness, sleepiness & difficulty speaking. If BS is below 70 consume a protein snack like peanut butter & crackers.Hyperglycemia is high blood sugar. Signs & symptoms include: frequent urination, increased thirst, high levels of sugar in urine, nausea & vomiting, & fruity odor on breath.Exercise may lower BS, but do not if it is over 240. Contact doctor if it is out of parameters.*It is recommended that you should obtain yearly flu & pneumococcal vaccines to avoid illness which may affect your bs and your health.*All diabetics should wear a medic alert bracelet to alert people if you may have a diabetic crisis.*Overall health maintanence is import & your blood pressure should be less than 140/90. Watching your diet & exercise should help lower this to acceptable levels.------------------------Diseases & LabsChanges in BS levels put you at greater risk for infection. *You should keep your BS levels in normal range to prevent End stage renal disease (ESRD). *Chronic complications from neurological damage include nerve damage, loss of cutaneous sensation, loss of fine motor skills, peripheral vascular disease (PVD) & may lead to amputations.* Sensory damage may lead to retinopathy which may cause blurred vision, & lead to blindness.* Coronary artery disease - the major blood vessels that supply your heart with blood, oxygen and nutrients become damaged or diseased may occur.*Cerebral Vascular Accident (CVA) or stroke may also occur.*Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS occurs when BS are extremely high & uncontrolled. - it is extremely important to monitor your gluclose levels & alert your doctor if sugars are continually high. You see your doctor every 3-6 mos.A glycosylated hemoglobin test (HbA1c) test consists of lab work (blood draw) that checks your average blood sugar levels over a period of time. It is usually done every 3 months.A fasting blood sugar is drawn first thing in the morning before meals.Lipid levels should also be checked by your doctor to monitor cholesterol.It is important to take a long a kit for travel & exercise. It should include your diabetic supplies (glucose meter, lancets, test strips ect) and snacks for low blood sugar episodes.It is especially important for people who have diabetes to quit smoking.

Additional ResourcesThere are many other people who are additional support & have additonal resources for you in dealing with your diabetes. *You should see a diabetic educator, dietician, podiatrist (foot doctor) who will provide foot & nail care as needed, visit your doctor every 3-6 mos for lab work, an optomotrist or ophthalmologist every 6 mos to a year & a dentist for an annual exam.*It is important to keep all of your appointmentsYou may also contact:American Diabetes Associationfor additonal support & resources. You may also contact your local area hospital for diabetes education.

Medication Education

Foot care/Employment considerations/Exercise/stress:

Metformin: oral hypoglycemic agentTx: Type 2 diabetes*Used to control amount of sugar in blood. *Decreases amount of glucose you absorb from food & amount of gluclose made by the liver. *Itincreases body's response to insulin.Dosage: 500 mg tablet PO BIDCompliance: Important to comply with medication d/t increased risk of morbitiy, higher health care cost as a result of noncompliance & reduced quality of life. S/E: diarrhea, bloating, stomach pain, gas, indigestion, constipation, unpleasant metallic taste in mouth, heartburn, headache, flushing of the skin, nail changes, muscle pain.IMPORTANT WARNING:In rare cases may cause lactic acidosis. *This medication may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms.Humulin Regular Insulin: Exogenous Subcutaneous Injectable Hypoglycemic agent. How does it work?:Diabetes occurs when your pancreas doesn't produce enough insulin to meet body's needs.Used to keep blood glucose levels at a near-normal level. Onset: How quickly insulin will start to lower glucose once you take it.30-60 minsPeak: The time insulin is working the hardest to lower glucose levels.2-4 hoursDuration: length of time the insulin lasts. 5-8 hoursDosage: 20 units at breakfast & 5 units at supper.Injection sites: Choose where to give injection - keep a chart - rotate sites. abdomen- best place to inject - most easily absorbed, upper outer areas of arms, the buttocks, top outer area of thigh.*It is important to rotate injection sites to avoid pits, bumps and fibrosis of tissues which can result in poor absorption and scarring.S/E: low BS - as body gets used to affects of medication it may go away. Rash and/or itching over the whole body, shortness of breath, wheezing, dizziness, blurred vision, fast heartbeat, sweating difficulty breathing or swallowing, weakness muscle cramps, abnormal heartbeat, large weight gain in a short period of time, swelling of the arms, hands, feet, ankles, or lower legs. Patient should be able to recognize s/s of low or high sugars and monitor via glucose checks.Administration:Depending on insurance - pens are often not covered. Syringe & vial is what I will demonstrate use.6mm barrel, 3/10mL syringe, 32G needle, 1/2 inch should be used.*check insulin to make sure no clumping or discoloration has occured. Insulin should be as clear as water. If it is not - discard.*Label after opening - name, and expiration date. Should be discarded 28 days after opening.unopened: Humulin bottles unopened should be stored in a refrigerator.Once opened: can be kept unrefrigerated as long as it is kept as cool as possible [below 86°F (30°C)] away from heat and light.Disposal: Never throw away loose needles and other sharps in trash cans or recycling bins, and never flush them down the toilet. Use a sturdy, non-see-through plastic container, such as a detergent bottle, to dispose of your sharps. When its ¾ full, tape it shut and throw it away in the regular trash; do not recycle. You could also add bleach and water (one part bleach, nine parts water solution). DO NOT RECAP OR REUSE NEEDLES. - risk of injury to self & risk of infection.Missed doses: *If missed dose is within 1 hour - take normal dose as scheduled.*If 2 hours late - 75% of normal dose*If 3 hrs - 50% of normal dose*BS should be checked 2 hrs after mealI understand you have a fear of giving yourself injections Mrs. Smith. If your insurance will cover it a better option may be an insulin pen or pump. Although giving injections may be scary, it is a very important part of your treatment & is necessary. May talk to HCP to see if may be prescribed something for anxiety. Please watch video below on insulin injection. Advil: NSAID - OTC pain relieverTx: Fever reducer, headaches, muscle aches, arthritis pain ect.S/E: Stomach bleeding, uclers, hives, facial swelling & rash. Should avoid more than 3 alcoholic beverages daily.Diovan HCT 80/12.5Tx: Lowers blood pressureDosage: 1 tablet dailyS/E: Cold or flu like symptoms, low BP, dizziness, headache and blurred vision.St. John's WortTx: Depression, anxiety, tiredness, and trouble sleeping.Dosage: 300mgS/E: Weight gain, heart palpations, moodiness and stomach upset. St John's wort interacts with many medications and should be approved by Dr. before continuing to take.Simvastatin Tx: Lowers bad cholesterolS/E: heartburn, gas, bloating, stomach pain, indigestion, nausea, constipation, diarrhea, headache, joint pain, muscle pain, skin rash, sleep problemsMrs. Smith, It is very important that you take your meds as prescriped by your doctor. It is also important to not resuse your BS test strips. You will not get accurate readings. If the test strips are too expensive for your glucometor, you may purchase one from a local drug store that may save you money. Here is a website with various resources which may be able to help you with costs of Tx r/t you diabetes care. http://tinyurl.com/htbzqvy

Type II Diabetes:Metabolic disease in which the body either doesn't produce insulin or produce enough which causes elevated blood glucose levels.Signs & Symptoms:Tiredness, hunger, thirst, may lose weight withouttrying, frequent urination, blurred vision, infectionsthat heal slowly from cuts or bruises.Blood gluclose levels should range from 70-120. You should try to remain as close to 100 as possible.

*I will be explaining this to Mrs. Smith &answering any questions she may have.


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