diabetes: Patient education
|Self-Monitoring of Blood Glucose (SMBG)|| Assess the effectiveness of management plan.|
Results of SMBG are useful for:
Preventing s/s of hypoglycemia and hyperglycemia
Adjusting diabetic medications
Evaluation of other drug therapies (e.g. steroids)
Assessing physical activity (before and after exercise)
Assessing nutrition therapy
|Patient Education: Self-Monitoring of Blood Glucose (SMBG)|| Infection control measures|
Interpretation of results
Frequency of testing
Blood glucose therapy goals
Accuracy of blood glucose monitors
Alternate site testing
|Nutritional Therapy|| Cornerstone of care for person with diabetes |
Most challenging for many people
Recommended that diabetes nurse educator, nutritionist or registered dietitian with diabetes experience be members of team
|American Diabetes Association (ADA) outcomes of nutrition therapy:|| Maintaining blood glucose levels in the normal range or close to the normal.|
Maintaining a blood lipid profile that reduces the risk for vascular disease
BP in the normal range or close to normal
Preventing the development of complications by modifications
|ADA outcomes of nutrition therapy:cont|| Nutritional needs based on cultural preference and willingness to change.|
Maintaining the pleasure of eating by limiting food choices only when indicated.
Meeting nutritional needs during certain periods of the life span.
Providing self-management training.
|Nutritional Therapy||Meal plan based on pt's usual food intake, weight-management goals, lipids, and blood glucose patterns. Pts receiving insulin need to eat at times that are coordinated with the timed action of insulin.|
|Principles of nutrition in diabetes: Protein:||intake of 15% to 20% of total daily calories with normal kidney function. Reduce to 10% for pts with microalbuminuria.|
|Principles of nutrition in diabetes: Carbohydrates:|| diet containing of 45% to 65% of calories from CHO, with a minimum intake of 130 g CHO/day. The diet should include CHO from fruits, vegetables, whole grains, legumes, and low-fat milk.|
Place emphasis on total amount of CHO consumed each day.
|Principles of nutrition in diabetes: Dietary fats & cholesterol:|| Limit saturated fats to < 7% of total calories.|
Minimize intake of trans fat. Trans fatty acids raise LDL and lowers the HDL which increases the risk for CV disease. Teach the pt to limit the amt of commercially fried food & bakery foods.
Limit dietary cholesterol to < 200mg/day
|Principles of nutrition in diabetes: Fiber||improves CHO metabolism & lowers cholesterol levels. Assist the pt to reach the goal of 14 g per 1000 calories. The AHA recommends a fiber intake of 25 g each day. Teach the pt to select foods such as legumes, fiber-rich cereals (more than 5 g fiber/serving), fruit, vegetables, & whole grain products.|
|Principles of nutrition in diabetes:||Dietary sucrose does not increase blood glucose more than equal amounts of other starches. Intake of sucrose & sucrose containing foods by pts with diabetes do not have to be restricted out of concern for causing hyperglycemia.|
The FDA has approved these non nutritive sweeteners: saccharin, aspartame, acesulfame potassium, neotame, & sucralose.
|Meal Planning Strategies: Exchange Lists:||The exchange lists include: bread/starch, vegetable, milk, meat, fruit, and fat. Foods within one group (in the portion amt specified) contain equal number of calories and are approximately equal in grams of protein, fat, & CHO. Foods on one list may be interchanged with one another, allowing for a variety while maintaining the nutrient content of the food.|
|Nutritional Therapy: Alcohol||inhibits gluconeogenesis by the liver. This can cause severe hypoglycemia in pts on insulin or oral hypoglycemic medications. Encourage pts to discuss the use of alcohol with their health care provider because its use can make blood glucose more difficult to control.|
|Meal Planning Strategies:CHO counting:||When CHO counting is used, reading labels on food items, knowing what the "CHO budget" for the meal is, & knowing how many grams of CHO are in a serving of a food is the key to success.|
|Meal Planning Strategies:||Pts using intensive insulin or pump therapies can use CHO counting. After the amt of insulin needed to cover the usual meal is determined, insulin may be added or subtracted for changes in CHO intake. An initial formula of 1 unit of rapid acting insulin for each 15g of CHO provides flexibility to meal plans.|
|Special Considerations for type 1 Diabetes||Pts using rapid acting insulin by injection or insulin pump should adjust insulin based on the CHO content of the meals and snacks. Blood glucose monitoring before and 2 hrs after meals determines whether the insulin-to-CHO ratio is correct.|
|Special Considerations for type Diabetes cont||For pts on fixed insulin regimens, consistency of timing of meals and the amt of CHO eaten at each meal is important to prevent hypoglycemia.|
|Special Considerations for type Diabetes cont||Physical exercise can cause hypoglycemia if insulin is not decreased before activity. For planned exercise, reduction in insulin dosage is the preferred method for hypoglycemia prevention. For unplanned exercise, intake of additional CHO is usually needed.|
|Special Considerations for type Diabetes cont||Hyperinsulinemia (chronic high blood insulin levels) can occur with intensive treatment schedules and may result in weight gain. These pts may need to manage hyperglycemia by restricting calories rather than increasing insulin.|
|Special Considerations for type 2 Diabetes||A moderate caloric restriction and an increase in physical activity improve diabetic control and weight control. Decrease of more than 10% of body weight can result in significant improvement in HbA1c.|
|Exercise Therapy|| Based on blood glucose levels.|
Monitor blood glucose levels before, during , and after exercise.
Pts with type 1 should perform vigorous exercise only if blood glucose levels are 80 to 250 mg/dL.
|Exercise Therapy cont|| When urine ketones are present, the pt should not exercise.|
Teach pt not to exercise within 1 hr of insulin injection or at the peak time of insulin action. Exercise increase absorption, increasing blood insulin levels.
Pt. education is individualized according to moderate or vigorous exercise.