From: UVA Diabetes Resource Group UVA Diabetes Education & Management Program

Transcription

1 From: UVA Diabetes Resource Group UVA Diabetes Education & Management Program

2 Diabetes Tool Kit Table of Contents: Page Introduction... 1 Diabetes Self-Care Check List... 2 Home Glucose Monitoring Hypo/Hyperglycemia Diabetes Medications... 7 Insulin Sick Day Guidelines What to Eat? Foot Care Guidelines Diabetes Report Card Diabetes Resources Forms located in the back of each booklet: Patient Education Plan (PEP) Order for Diabetes Services

3 Diabetes Tool Kit Introduction: This diabetes tool kit has been assembled for your information while you are here in the hospital and after you go home. We hope that this will be of help to you as you learn more about how to manage your diabetes successfully. You may have just been told you have diabetes, or you may have had it for a long time. Either way, your healthcare team is here to help you with the questions and concerns that you may have. Ask your doctor or nurse if you have questions. In addition, we have a fulltime diabetes resource nurse who can help you get the information that you need while you are here or after you go home. The last page in this booklet contains a full list of UVA diabetes resources that you might find helpful. Successful diabetes management is possible using the right tools. Your role during your hospital stay: If you need a glucose meter to check your blood sugars at home, let your nurse know. If you already have a meter, have someone bring it to the hospital so that we can make sure it is working correctly. Let your nurse know if you need to see the dietitian or diabetes educator while you are here. Complete the Diabetes Self-Care Checklist so that we can help you with your diabetes self-management needs. 1

4 Please complete this Diabetes Self-Care Checklist: Place a check by the self-care activities that you already do: Exercise type how often Check blood sugar times a day. Eat healthy Monitor blood pressure Attend a diabetes education class See the eye doctor Date of last visit See the dentist Date of last exam See the foot doctor Date of last visit Other Please check below the topics that you need more information on: How to monitor blood sugar How to recognize and treat low blood sugar How to recognize and treat high blood sugar Diabetes and food Diabetes medications Understanding insulin Sick day management Foot care Diabetes resources Other 2

5 What you need to know about home blood glucose monitoring A very important part of managing your diabetes is knowing what your blood sugar levels are. You will be asked to monitor your blood sugar based on your individual needs and the type of diabetes that you have. Your doctor and diabetes educator will be able to know how to make adjustments in your medications and diet based on the blood sugar log that you keep. It is important that you bring that with you when you see your doctor or the diabetes educator. Get yourself ready: Wash your hands vigorously with soap and warm water, alcohol wipes are not necessary. Allow your hand to hang at your side for 30 seconds so the blood can pool in your hand. Be sure to alternate sites. Use a lancing devise that is adjustable for deeper puncture. Stick the sides of your finger, not the tip. Make the finger stick then gently milk the blood from the bottom to the tip of your finger until you get a well-rounded drop of blood on your finger. Follow the procedure for your individual meter. Record the blood sugar in your daily log including date and time. When to check your blood sugar: **Your doctor and your diabetes educator will help you plan a monitoring schedule that meets your individual needs. Fasting is before your first meal of the day. A fasting blood sugar tells us whether the insulin you have or insulin you take is controlling your blood sugars overnight. Pre-meal blood sugars help us to guide your decisions about food choices and medication needs for the upcoming meal. After-meal blood sugar tells us whether your body had the right amount of medication to cover the food you ate. It also tells us the effects of the meal on your blood sugar. Bedtime blood sugar checks indicate your need for additional food or medication to cover you for the hours of sleep. 3

6 Best times to check your blood sugar: First thing in the morning before breakfast. Whenever you feel bad or are not sure if sugar is causing the symptoms Before driving your car. Do not drive if your blood sugar is below 100mg/dl. Have a snack, recheck it before driving. Before and after exercise. Before bedtime. Test more often if and when: Illness Surgery Travel Stress Change in level of activity or exercise Pregnancy Target goals: American Diabetes Association (ADA) recommendations: Home blood glucose monitoring guidelines when using your glucose meter: Whole Blood: Plasma: Fasting mg./dl mg/dl. Before Meals mg./dl mg/dl. After Meals Less than 180mg/dl Less than 180mg/dl. Bedtime mg./dl mg./dl. Remember: Always check test strips for expiration date. Keep a logbook of your blood sugar and take to the doctor and diabetes educator each visit. Keep test strips in original container with lid on and protect from extreme temperatures. Take your meter to your nurse educator to be checked for accuracy. 4

7 Low blood sugar: (Hypoglycemia) One of the complications of diabetes is hypoglycemia or low blood sugar. Typically this occurs at 70mg/dl or less; however, the number and symptoms can vary with individual. Causes: To little food To much insulin or diabetes medication Extra activity Symptoms: Weak, nervous, shaky Anxious Hungry Headache Fast heart rate Dizziness Treatment: (The Rule of 15) 15 grams carbohydrates in one of the following choices. ½ cup (4oz) juice ½ cup (4oz) regular soda (not diet!) 5-6 pieces of hard candy 1cup milk 4 glucose tablets ****Wait 15 minutes and recheck blood sugar, if still low repeat with 15 grams carbohydrates, if still low have a light snack (½ meat sandwich and ½ cup milk), recheck blood sugar. Goal: Blood sugar 100mg/dl. High blood sugar: (Hyperglycemia) Causes: Too much food Too little insulin or medication Illness or stress Symptoms: Extreme thirst Frequent urination Blurred vision Drowsiness Treatments: Drink water unless otherwise restricted. Take your insulin or diabetes medication as prescribed If blood sugar greater than 200mg/dl/ two checks in a row call your doctor. Type 1 diabetics check for ketones. 5

8 Check your blood sugar: before breakfast before lunch before dinner before exercise after exercise before bed other: And anytime you feel unusual or sick! Blood sugar goals: Between & before meals Between & before bed If your blood sugar is below Treat for low blood sugar with 15 grams of carbohydrate, such as: ½ cup (4oz) fruit juice ½ cup (4oz) regular soft drink (not diet!) 1 cup (8oz) milk 5-6 pieces of hard candy or 4 glucose tablets If your blood sugar is higher than for 24 hours, Call your doctor at Or your diabetes educator at Date Meds ( ) Your blood sugar test results AVG AM PM Before Breakfast b/lunch b/dinner b/bed other or Notes AVG 6

9 What you need to know about diabetes medications Diabetes pills: Diabetes pills can be used to help decrease your blood sugar levels. If you have type 2 or non-insulin dependent diabetes, your pancreas is still making insulin. However, it is either not making enough insulin or the cells in your body are not able to use the insulin properly. Different types of diabetes pills: There are different types of diabetes pills that work differently in your body to control your blood sugar. Some of the pills help your pancreas release more insulin and slow down the release of sugar by the liver. Others help your body use the insulin you have release better. Your doctor will prescribe the diabetes pill that is right for you. Ask your nurse for specific information related to the diabetes pill (s) that your doctor prescribes. Important things to remember as you take diabetes pills: Call your doctor if you experience any of the following symptoms when taking these medications: nausea, stomach pain, vomiting, hives, skin rash, dizziness, unusual bruising/bleeding, chest pain, or shortness of breath. It is important to watch for symptoms of low blood sugar. Low blood sugar can last for many hours with diabetes pills. If you have symptoms of low blood sugar you need to eat something containing sugar right away (½ cup (4oz) fruit juice, ½ cup (4oz) regular soft drink (not diet!), 1 cup (8oz) milk, 5-6 pieces of hard candy or 4 glucose tablets. Certain medications may increase or decrease the effects of diabetes pills, including aspirin and alcohol. Inform all of your doctors that you are taking medication for your diabetes. Avoid drinking alcoholic beverages. Diabetes pills may cause your skin to be more sensitive to sunlight than it is normally. Exposure to the sun may cause skin rash or severe sunburn. You should avoid exposure to the sun and cover your skin or use a sunscreen with SPF 15 or higher. You should not take diabetes pills if you become pregnant or are breastfeeding. Inform your doctor if you become pregnant or are breastfeeding. You should wear a medical identification bracelet or chain at all times. Check the label on the bottle for expiration date and instructions. 7

10 What you need to know about insulin If your doctor prescribes insulin this is to replace the insulin that your body needs but is unable to release. Insulin is given by injection only and is used to treat patients with type 1 (insulin dependent diabetes) or patients with type 2 that need more than diabetes pills to control their blood sugar. Insulin is a hormone released by the pancreas to control blood sugar levels. Insulin is needed to get the sugar in the food that you eat or drink from the blood to the muscles for energy. Any change in your insulin dose or type should be made with your doctors supervision. Important tips if you are taking insulin: Keep an extra supply of insulin and syringes on hand. Wear a medical identification bracelet, or carry a diabetes card in case of an emergency. Check the label on the insulin bottle for expiration date. Do not use if it is past the expiration date. Do not use your insulin if it appears cloudy, thickened, colored or has solid particles in it. Insulin should be stored in the refrigerator, or a cool place away from heat and light. When you travel across time zones, your insulin dose may need to be adjusted. Things that may change your insulin needs: Illness: Especially nausea, vomiting, fever or infection may change your insulin needs. Continue to take your usual insulin dose when you are sick, and monitor your blood sugar level more frequently. If you are not eating and your blood sugar is below 100 mg/dl, take sips of juice or sweetened liquid every hour. If you are not eating and your blood sugar is greater than 200mg/dl, sip on sugar free liquids each hour. Call your doctor if you have recurrent vomiting. Pregnancy: Good control of diabetes is especially important for you and your unborn baby. Pregnancy may make managing your diabetes more challenging. Exercise: Insulin needs change during and after your exercise session. Exercise can speed up the action times of insulin. Talk with your doctor and diabetes educator about the types of exercise you do and how this may affect your diabetes and insulin needs. 8

11 Types of insulin: Become a partner with your diabetes doctor and diabetes educator. Your dose of insulin may need to be adjusted based on your changing needs. Keeping a daily record of your blood sugar levels will help you and your health care team to choose the right amount of insulin you need. All insulin has the same action but the time of action, peak and duration is different. It is important to know the action time of the insulin you are taking. Name Onset Peak Duration Humulin Regular Humulin NPH Humulin Humalog Humulin 70/30 Glargine (Lantus) ½ hour 2 ½ - 5 hours 8 hours 1-2 hours 6-12 hours hours Less than ½ ½ hour 1 ½ Less than 6 hours hour hours ½ hour 4-8 hours 24 hours 3-4 hours No peak > 24 hours My diabetes medications are: 9

12 What you need to know about sick days From time to time, all of us become sick from cold, flu or other illness that may disrupt our regular daily routine. Your illness may cause an adjustment of your normal meal plan. Feeling out of sorts, vomiting, diarrhea, or running a fever may cause you to lose your appetite. Appropriate adjustments will help prevent minor illnesses from becoming major complications for persons like you with diabetes. Work out a sick day plan with your doctor or diabetes educator BEFORE you become ill. This written plan should tell you when to call your doctor, how often to check your blood glucose and urine ketones, and what and how often to eat. Keep this plan convenient, perhaps on the inside of your medicine cabinet, or in your desk or locker at work. Share this information with a family member, friend or co-worker in case you are too ill to care for yourself. Someone other than you should be able to check your blood glucose and urine ketones. Seek out support from others you do not have to manage your diabetes by yourself. If you are not able to manage your illness at home, call your healthcare provider, or if unavailable, call 911. Sick day management tips: Never omit insulin or your diabetes pills even if you can t eat. You may need additional insulin, but do not take additional diabetes pills. Call your doctor if you are taking metformin (Glucophage) and are vomiting or have diarrhea. Test your blood sugar every 3-4 hours. Call your doctor if your blood sugar stays below 70mg/dl or above 200mg/dl two checks in a row. If you have type 1 diabetes, test your urine for ketones every 4 hours. Drink clear liquids (at least ½ cup every hour) and eat light foods if you can. Rest; do not exercise during an illness. 10

13 Suggestions on food choices for low blood sugar: ½ cup fruit juice, ½ cup regular soda (caffeine free), 1 slice toast? cup frozen yogurt, 6 saltine crackers, ½ cup ice cream ¼ cup regular pudding, 1 cup sugar free yogurt, 1 cup Gatorade ½ cup cooked cereal, ¼ cup sherbet, ½ cup regular jello Examples of sugar-free liquids would include water, caffeine free tea, sugar free sodas, or broth. When to call your doctor: You have vomiting more than once. You are unable to eat or drink fluids. You are ill for more than 24 hours. You have a fever greater than 101 degrees. You have diarrhea more than 5 times or longer than 24 hours. You have shortness of breath, chest pain or discomfort. You have blood sugars higher than 200mg/dl two checks in a row. You have blood sugars lower than 70mg/dl two checks in a row. You have moderate or large ketones in your urine. You have any signs of infection. You have increased or painful urination. You have a cough with yellow or green sputum. You have questions regarding adjusting your insulin or diabetes pills. Seek immediate medical help: Call 911: You are having trouble breathing, rapid or labored breathing. Persistent vomiting, diarrhea or weakness. If you are having difficulty thinking clearly. Feel sleepier than usual or have difficulty staying awake. Are unsure that you can take care of yourself. Call your health care provider if you have questions or concerns! 11

14 What you need to know about what to eat Good health begins with good nutrition. This is true for everyone. However, when you have diabetes it is especially important to pay attention to what you eat, when you eat and how much you eat. Basic food guidelines: Eat a variety of foods. Eat three meals and planned snacks at the same time every day. Avoid skipping meals. Eat the same amount of food at each meal and snack. Know carbohydrate foods and how they affect your blood glucose. Maintain a healthy weight. Become more physically active. Food groups: Carbohydrate is the main component of food that affects blood sugar (glucose) levels. Foods in the starch, fruit and milk group contains carbohydrate. Choose foods from each of these groups every day. There are two main types of carbohydrates: starches (complex carbohydrate), such as pasta, bread or rice and sugars (simple carbohydrate), such as desserts and candy. Sugars are also found naturally in foods like fruit and milk. Sugars and starches both make blood glucose go up. The amount of carbohydrate matters more than the type. Sugars have the same amount of carbohydrate as starches but starches have vitamins, minerals and fiber. Therefore; A CARBOHYDRATE = A CARBOHYDRATE = A CARBOHYDRATE Complex carbohydrate Simple carbohydrate 1/3 cup rice 1 T maple syrup 3 cups popcorn 1/4 cup sherbet 1/2 cup dried beans 1/24 angel food cake In a healthy diet, at least half of your calories should come from carbohydrates. Most people should eat 4-5 servings of carbohydrates with each meal. However, this may not work for everyone. It is best to work with your dietitian to develop a meal plan that is right for your lifestyle. 12

15 It is important to try to eat meals at regular times everyday. Avoid skipping meals. Generally snacks are encouraged as a part of the meal plan in order to maintain blood sugar levels. Diabetics must space carbohydrates throughout the day with meals and snacks. Serving size is important. One serving of carbohydrate is equal to 15 grams of total carbohydrate. Examples: One serving of carbohydrate is: One small fruit ½ cup fruit juice ½ cup cereal, rice or pasta 1 slice bread, ½ hamburger bun, ½ small bagel 1 small potato ½ cup cooked starchy vegetable (corn, peas, beans, etc.) Protein and Fat does not raise your blood sugar as much as carbohydrates do. It is important that you eat a balance of all nutrients. Protein and Fat do contain calories and must be eaten in moderation. Fat contains more calories and in excess increases your risk of heart disease, cancer and obesity. Exercise and diabetes: Weight control Feel better Better blood sugar control Heart healthy Keep active 13

16 What you need to know about foot care and diabetes *People with diabetes have to take extra special care of their feet. General foot care guidelines: Do s Wash your feet daily with warm water and soap. Never soak your feet without first checking the temperature of the water by hand. Dry your feet well, especially between the toes. Keep the skin supple with a moisturizing lotion. Check your feet daily for blisters, cuts, sores, redness or swelling. Use a mirror to check the bottom of your feet. Notify your doctor right away if you find something wrong. Use an emery board gently to shape toenails even with the ends of the toes. Wear socks or stockings without seams or bumps that are clean and soft and well fitting. Keep your feet warm and dry. Wear shoes that fit well and do not rub toes or heels. Examine your shoes daily for cracks, pebbles, nails or anything that could hurt your feet. See your podiatrist (foot doctor) if you have a wound that is not healing. Don ts Never walk barefoot indoors or outdoors. Never use a hot water bottle or heating pad on your feet. Don t put lotion between your toes. Never use a knife or razor blade to cut your toenails or feet. Don t use chemicals or corn and callous removers yourself. Never rip off a hangnail. Never wear garters or other clothing, which cuts off circulation to your feet. Don t smoke! 14

17 Diabetes report card In order to achieve the goal of diabetes self-management, the person with diabetes is advised to monitor their blood sugar everyday. However, in order to manage diabetes completely, the individual needs to take an active role in monitoring more than just blood sugar levels. A diabetes report card can be used to track the lab reports and other tests that need to be monitored in order to prevent the complications of this disease. Name Physician Eye doctor Diabetes educator Podiatrist (foot doctor) HOW OFTEN NORMAL VALUE DATE - VALUE DATE - VALUE DATE - VALUE DATE - VALUE DATE - VALUE Blood pressure Each visit Less than 130/80 Weight Glycated Hemoglobin Urine Micro- Albumin Each visit Discuss your target with MD Every 3 to 6 mos. Yearly Target is 7% or below Less than 30 mg Cholesterol Yearly Less than 200 LDL Yearly Less than 100 HDL Yearly Over 45 Triglycerides Yearly Less than 150 Dilated Eye Exam Foot Exam Yearly At least yearly No sign of retinopathy No sign of decreased sensation Flu Shot Date: (annual) PneumoniaVaccine Date: (ask your educator for frequency) 15

18 Local: Diabetes Resources: Diabetes Community Network at UVA... (434) Education classes, workshops and individual education JABA (Jefferson Area Board for Aging)... (434) Free Charlottesville Clinic... (434) Consumer Network and Social Support Program... (434) Nursing Foot Care Clinic at UVA... (434) Salvation Army... (434) Medfit... (434) Northridge Cardiac Rehabilitation... (434) Smoking Cessation UVA... (434) Martha Jefferson Hospital... (434) Nicotine Anonymous... (434) National and Internet Web Sites: American Diabetes Association American Association of Diabetes Educators National Diabetes Education Program ***Resources available in Virginia and West Virginia are available upon request or are available on the American Diabetes Association Web site. 16