1. Diabetes 101: Are You Ready?

2. Objectives Identify education as an essential treatment mode of diabetes Describe practical tips in preparing patients awaiting consultation with a health care professional (GP, Nurses, Dieticians, etc) Identify common problems affecting reliability of capillary testing Demonstrate how an individualized self- management plan of diabetes can foster empowerment and positive outcomes Carmela D’Avella, BSc N, CDE

3. Role of Diabetes Nurse Educator Certified Diabetes Educator Empower self management skills and knowledge Diabetes Health Team Carmela D’Avella, BSc N, CDE

4. 53 year old presents at ER Administrator and Union president Married, no children Caring for 2 family members terminally ill 30 lbs weight loss X 5 months Polyuria, polydipsia, fatigue, can’t sleep Under investigation angina Refuses to stay in ER, non-negotiable Carmela D’Avella, BSc N, CDE

5. Lab Values in ER Glucose 18.0 mmol/l Creatinine 66 umol/L HbA 12.4 % Cholesterol 4.99 mmol/l HDL 1.32 mmol/l LDL 2.65 mmol/l Triglycerides 2.22 mmol/l C/HDL 3.8 ACR 48.0 mg mmol/l Carmela D’Avella, BSc N, CDE 1c

6. On discharge in ER New diagnosis type 2 diabetes Metformin 250 mg bid Glyburide 5 mg bid Referral to a GP because no diabetes clinic in vicinity Cardiology consult Carmela D’Avella BSc N, CDE

7. 3 days later at GP’s office Diabetes diagnosed 5 years ago Family history of diabetes Family history of CVD SedentarySmokes 135/ 90 P 74 5’3, 217 lbs BMI 38 Carmela D’Avella, BSc N, CDE

8. At the Office Sleeps at night, ‘feels better’ Skips meals, big supper Takes pills pc meals At diagnosis 5 years ago, -lost weight -lost weight -”No DM, felt fine” – stopped pills -”No DM, felt fine” – stopped pills -Never monitored- “no need if on -Never monitored- “no need if on pills and diet” pills and diet” Carmela D’Avella BSc N, CDE

9. Where do I start ? What does she need to know vs nice to know ? Carmela D’Avella BSc N, CDE

10. What Can I Eat ? Improve and maintain quality of life and nutritional status Consistency in meal times Just the Basics - CDA Carmela D’Avella, BSc N, CDE

11. Zim Ba Wee Hand Jive CARBOHYDRATES PROTEIN VEGETABLESFAT Carmela D’Avella, BSc N, CDE Source: Canadian Diabetes Association

12. To help you plan for healthy eating Carmela D’Avella, BSc N, CDE Source: Canadian Diabetes Association

13. Pills, Pills and MORE Pills Compliance Do I really need it When is the best time to take it What about side effects Carmela D’Avella, BSc N, CDE

14. What about HYPOGLYCEMIA Prevention = Education Find the Cause How do I treat ? Carmela D’Avella, BSc N, CDE

15. TREATMENT Examples of 15 g of CHO for the treatment of mild to moderate hypoglycemia: 15 g of glucose in the form of glucose tablets 15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water 175 mL (3/4 cup) of juice or regular soft drink 6 Life Savers 15 mL (1 tablespoon) of honey

16. WHAT’S IN IT FOR ME ? remember self testing will provide -RIGHT information to make -RIGHT choice at -RIGHT time with -RIGHT dose for -RIGHT quality of life Carmela D’Avella, BSc N, CDE

17. WHAT’S MY TARGET ?

18. A1CFasting / preprandial glucose (mmol/L) 2-hour postprandial glucose (mmol/L) Target for most patients  7 % 4.0 – 7.05.0 – 10.0 Normal range  6 % 4.0 – 6.05.0 – 8.0 Consider targets in normal range for patients in whom it can be achieved safely. TARGETS

19. Getting The Most Out of Monitoring Which is the best meter? The best meter is... Carmela D’Avella, BSc N, CDE

20. Should ACCURACY be an issue ? Carmela D’Avella BSc N, CDE

21. Should accuracy be an Issue ? Drop size Calibration Expired /exposed strips Meter memory vs log book Is it mg/dl or mmol/l ? HbA Carmela D’Avella BSc N, CDE 1c

22. When is the best time to test? -type 1 - 3 X day -type 2 – at least qd Carmela D’Avella, BSc N, CDE

23. What to record DateTimeResults Time of medications Dose Anything that is different “ My meter has a memory, I don’t need to write my results” Carmela D’Avella, BSc N, CDE

24. Fear of PAIN Myths / Failure Bargaining Source: Novo Nordisk Inc. Initiation of Insulin

25. 2 months later Glucose 5.1 mmol/l Creatinine 62 umol/l HbA 6.4 % Cholesterol 3.28mmol/l HDL 1.33 mmol/l LDL 1.39 mmol/l Triglycerides 1.21 mmol/l C/HDL 2.5 ACR 28.4 mg/mmol Carmela D’Avella BSc N, CDE 1c

26. 2 months later Wishes to improve self esteem Family eating healthy Delegates at work, reassessing values Control within target Smokes less, most difficult goal Thinking starting exercise program Weight 206 lbs BMI 36.6 Carmela D’Avella BSc N, CDE

27. 2 Months later Glyburide 5 mg bid Metformin 500 mg bid Coversyl 2 mg qd Zocor 20 mg qd Asaphen 80 mg qd Opthamology consult

28. One year and half later Feels great, family eating healthy meals 20 minute aerobics twice a week Still smoking, tried the patch Capillary results within target range Frequent hypoglycemia 178.7 lbs BMI 31.7 BP 120/80

29. One year and half later Glucose 5.0 mmol/l Creatinine 64 HbA 5.8 % Chol 3.47 HDL 1.64 LDL 1.53 Triglyceride 0.65 C/HDL 2.1 ACR 10.5 1c

30. One year and half later Glyburide 2.5 mg bid Metformin 850 mg tid Asaphen 80 mg qd Zocor 20 mg qd Coversyl 4 mg qd

31. Summary Summary Diagnosis 2 months 1 ½ years Glucose 18.0 mmol/l 5.1 mmol/l 5.0 mmol/l Creatinine 66 umol/l 62 umol/l 64 umol/l HbA 12.4 % 6.4 % 5.8 % LDL 2.65 mmol/l 1.39 mmol/l 1.53 mmol/l C/HDL3.82.52.1 ACR48.0mg/mmol28.4mg/mmol10.5mg/mmol 1c

32. Summary Diagnosis 2 months 1 ½ years Weight 217 lbs 206 lbs 178.7 lbs BMI3836.531.7 BP135/90120/80

33. The Bottom Line Individualize Avoid Overload Communicate Expectations Positive Approach Tools & Community Resources Follow up / repetition K.I.S.S. Carmela D’Avella, BSc N, CDE

34. EDUCATION IS THE KEY Carmela D’Avella, BSc N, CDE Source: Lifescan Canada Inc.