Care Guide - Diabetes
Patient Education
Curriculum by Correctional HealthCare Consultants
Based on The National Diabetes Education Program of the National Institute of Health
Diabetes in Corrections
In correctional settings, keeping Diabetes in control may be an even greater challenge than in the free world, since people who have the ability to choose the timing of their blood glucose checks, medication administration, exercise regimen and the foods that they eat still have difficulty maintaining medication and diet compliance and overall disease control. Inmates have little flexibility within their day, and many have no motivation to make the lifestyle changes necessary to maintain good control of their Diabetes. It is therefore up the to Provider and the Nursing staff to encourage the inmate to become part of their health care team. Collaboration by all is needed regarding medication adherence, patient education, and blood sugar monitoring. Lifestyle modifications such weight loss, smoking cessation, and exercise, and dietary modifications, including the adherence to a diabetic dietary plan, are key components in the management of Diabetes. With a little thought, these lifestyle modifications can be maintained in the correctional setting.
Components of a good Diabetes Patient Education Program include instruction regarding the nature of the disease, the importance of monitoring blood glucose levels and medication regimen adherence, the signs and symptoms of abnormal blood glucose levels, the potential long-term effects of diabetes and the importance of maintaining a healthy, low fat, low salt diet based upon the recommendations of the American Diabetes Association (ADA). Patient education should be ongoing, and all encounters with a patient are opportunities to reinforce the principles of your Diabetes Patient Education Program. Finally, continuity of care is enhanced when patient education is documented in the health record, including the patient's comprehension of the principles discussed.
Patient Education Program - Diabetes
Objectives:
The patient will
- Describe the type of Diabetes they have and its etiology
- Describe the health problems caused by Diabetes
- List the A-B-C numbers and what their parameters should be
- Verbalize how to manage their Diabetes with a Self-Care Plan
- State the time frames within which they should see their Healthcare Provider for routine care, and what that care should include
- Verbalize the signs and symptoms of Hypoglycemia
Introduction:
Diabetes means having too much sugar (glucose) in the blood. In people who have diabetes, sugar builds up in the blood instead of going into the cells. You may have heard people say they have a “touch” of diabetes, or that their sugar is “a little high”. These words suggest that diabetes in not a serious disease, but this is not true. Diabetes is a chronic disease for which there is no cure. It can be controlled by a combination of diet, exercise, and medical care. Left uncontrolled, it can lead to heart attack, stroke, kidney damage, eyesight problems, gum disease and nerve damage. There are three different types of Diabetes.
The body does not make insulin. Insulin helps the body use glucose from food for energy. People with Type 1 need to take insulin every day.
This type of diabetes may occur when a woman is pregnant. It raises her risk of getting one of the other types of diabetes in the future. It also raises her child’s risk of being overweight and getting diabetes in the future.
The body does not make or use insulin well. People with Type 2 often need to take pills or insulin. Type 2 is the most common form of diabetes.
Which type do you have?
Health Problems caused by Diabetes:
All people with diabetes need to make healthy food choices, maintain a healthy weight, and be physically active every day. Taking care of yourself and your diabetes can help you feel better. It may help you avoid health problems that are caused by diabetes, such as:
Eye problems that can lead to trouble seeing and blindness
Nerve damage that can cause your hands and feet to hurt, tingle or
feel numb. Sometimes people may lose a foot or leg.
Kidney problems that can cause your kidneys to stop working
Gum disease and loss of teeth
Be less thirsty and urinate less often
Heal better and have fewer skin and bladder infections
Have fewer problems with your eyesight, feet and gums
The ABCs of Diabetes:
The A1C blood test shows what your blood glucose has been over the past three months. The A1C goal for most people is below 7. High glucose levels in your blood can damage your heart and blood vessels, kidneys, feet and eyes.
LDL or “bad” cholesterol can build up and clog your blood vessels. It can cause heart attack or stroke. The LDL goal for most people is below 100. HDL or “good” cholesterol helps remove cholesterol from your blood vessels. The HDL goal for most people is 40.
High blood pressure makes your heart work too hard. This can cause heart attack, stroke and kidney disease. The blood pressure goal for most people is below 130/80.
Patient Instructions: Managing your Diabetes
Use your Diabetes meal plan.
Eat healthy foods such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains and low-fat or skim milk and cheese.
Keep fish and lean meat and poultry portions to about 3 ounces (the size of a deck of cards). Prepare it by baking, broiling or grilling it.
Eat foods that have less fat and salt.
Eat foods high in fiber, like whole-grain cereals, breads, crackers, rice or pasta.
Get 30 - 60 minutes of physical activity daily. Brisk walking is a great way to move more.
Stay at a healthy weight by using the meal plan and getting the recommended daily physical activity.
Ask for help if you feel sad.
A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better.
Learn to cope with stress, as it can raise your blood glucose.
We all know how difficult it may be to remove stress from your life, but there are ways you can learn to handle it.
Stop smoking.
There are many smoking cessation aides available, as well as many programs that include counseling and group support.
Always take your medications, even when you feel good.
Ask your Provider if you need a daily aspirin to help prevent a heart attack or stroke. Tell your Provider if you are having any side effects to the medication.
Check your feet every day for cuts, blisters, red spots and swelling.
Let your Provider know right away if you have sores that do not go away.
Brush your teeth and floss every day to help avoid problems with your mouth, teeth or gums.
Check your blood glucose as often as recommended by your Provider and record the readings.
Alter your medications only as directed by your Provider. The nurse will notify the Provider if your blood glucose levels are consistently higher or lower than what is normal for you while incarcerated.
Report any changes in your eyesight to your Provider.
Get Routine Care
While you are incarcerated, you should see the Provider at least quarterly for a diabetes check. In the free world, the recommendation is a Physician visit at least twice per year.
blood pressure check
foot check
weight check
review of your self-care plan
an A1C test (this may be checked more often if over 7)
cholesterol test
triglyceride test
complete foot exam
dental exam to check teeth and gums
dilated eye exam
flu shot
urine and blood test to check for kidney problems
a pneumonia shot
Patient Instructions: Signs and Symptoms of Hypoglycemia
Shakiness
Sweating and clammy feeling
Extreme fatigue
Hunger
Irritation or confusion
Rapid heart rate
Blurred vision
Get help immediately if any of the above occur.
Additional Resources for the Instructor:
Many of these groups offer information in both English and Spanish.
National Diabetes Education Program
1-800-438-5383 www.ndep.nih.gov
American Association of Diabetes Educators
1-800-TEAM-UP4 (800-832-6874) www.diabeteseducator.org
American Diabetes Association
1-800-DIABETES (800-342-2383) www.diabetes.org
American Dietetic Association
1-800-366-1655 www.eatright.org
American Heart Association
800-AHA-USA1 (800-242-8721) www.americanheart.org
Centers for Disease Control and Prevention
1-877-232-3422 www.cdc.gov/diabetes
National Institute of Diabetes and Digestive and Kidney Diseases
National Diabetes Information Clearinghouse
1-800-860-8747 www.niddk.nih.gov