survival skills for diabetes

Transcription

SURVIVAL SKILLS
FOR
DIABETES
H1035_NR486 FYI (03/03/2015)
TABLE OF CONTENTS:
Definition of Diabetes Treatment Plan
What is Diabetes?
Types of Diabetes
Hyperglycemia (High Blood Glucose)
Risk Factors for Diabetes
Treatment of Diabetes
Glucose Self Monitoring
Procedures for Glucose Monitoring
Hypoglycemia (Low Blood Sugar)
Warning Signs of Hypoglycemia
Treating Hypoglycemia
Tips for Preventing Hypoglycemia
Increased Activity
Safety Guidelines for Exercise
Exercise Precautions
Foot Care
Diabetes Medications
Diabetes Medications (Chart)
Diabetes Medications (continued)
Eating Healthy
Serving Sizes
Plate Method
Insulin
Injecting Insulin
Mixing Insulin in One Syringe
Giving the Injection
Storage of Insulin
Nutrition Guidelines in Order for Insulin to Work Effectively
Sharp’s Disposal Program
Questions for Class
2
H1035_NR486 FYI (03/03/2015)
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Basic diabetes education (survival skills) includes information and skills
needed to cope successfully with diabetes.
Definition of Diabetes (Hyperglycemia)
Treatment Plan
G………… Glucose Monitoring
(Demo with equipment & Return Demo, Target Goals)
I………… Increased Activity
M…………Medications
(Name, Dosage, Timing, and Side Effects)
E………… Eating Healthy
(Basic Guidelines)
3
WHAT IS DIABETES
Diabetes affects millions of people. It is a serious lifelong health problem
that can be managed. The pancreas (the organ that makes the hormone
insulin) may have been damaged or does not work right anymore.
Insulin is required by the body to move glucose (a form of sugar from food)
into the cells to produce energy. Your body needs the right amount of
insulin and glucose all the time to work properly.
A treatment plan is needed to keep your insulin and glucose in balance.
Most of the daily care of diabetes (95-99%) is self-care. Caring for diabetes
is different than caring for other conditions. You must take an active part in
the self-management process.
Keeping your blood glucose as close to normal as possible lowers your risk
for serious health problems and complications associated with diabetes.
4
TYPES OF DIABETES
Type 1 Diabetes is caused by beta cell destruction of the pancreas. It is an
autoimmune disorder that has shut down the pancreas’s ability to produce
insulin. Therefore, insulin must be provided to help the body process
glucose from the food we eat.
Type 2 Diabetes is associated with multiple disorders. It can be caused by
an insulin resistance, insulin deficiency, or increased glucose production by
the liver. Treatment varies according to the body’s need.
Gestational Diabetes is another form of diabetes that may occur to women
during pregnancy. Due to an increase in placental hormones, the pancreas
may not be able to utilize insulin effectively and maintain normal blood
glucose levels. Some women with gestational diabetes may need insulin
injections during the pregnancy, 80-90% of women in mild GDM can be
managed with lifestyle therapy alone.
5
High blood sugar (Hyperglycemia)
Causes
High blood sugar (also called hyperglycemia) is when
there is too much sugar in your blood. Over time, it can
cause serious health problems. High blood sugar can
happen if you:
n Skip a dose of insulin or diabetes pills
n Eat more than usual
n Are less active than usual
n Are under stress or sick
What to do about high
blood sugar
The best way to avoid high blood sugar is to follow
your diabetes care plan. Call your diabetes care team
if your blood sugar has been higher than your goal for
3 days and you don’t know why.
Of course, the best way to know if you have high
blood sugar is to check your blood sugar regularly, as
directed by your doctor.
Signs & Symptoms
Here’s what may happen when your blood sugar is high:
Very thirsty
Needing to pass urine
more than usual
Very hungry
Sleepy
Blurry vision
Infections or injuries
heal more slowly
than usual
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December 2013
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HYPERGLYCEMIA (High Blood Glucose)
Signs and Symptoms of Elevated Glucose (Blood Sugar) include:
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• Frequent Yeast
Infections
• Wounds that heal more
slowly
• Male Erectile
Dysfunction
• Sudden Weight Loss
Always Tired
Constant Thirst
Frequent Urination
Blurred Vision
Dry, itchy skin
Numbness and tingling
of the feet
• Increased Hunger
The symptoms of hyperglycemia can result from too much
food consumption, illness, lack of physical activity, stress,
and either over-treating low blood sugar (hypoglycemia)
or not treating it at all.
RISK FACTORS FOR DIABETES:
Anyone can get diabetes. However, certain factors put you at
higher risk, such as:
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• Ethnicity (Native American,
Hispanic, African American,
Pacific Islander)
• Women with PCOS
• Heart disease such as
hypertension or decreased
LDL or increased
triglycerides
Overweight or obesity
Family History
Increasing Age
Lack of Physical Activity
Autoimmune Disorders
Stress or Trauma
Gestational Diabetes
• Certain Medications
(Prednisone, etc.)
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TREATMENT OF DIABETES
Treatment plans for controlling diabetes are individualized. The plan should
be developed to emphasize self-management. Your physician will help you
decide which type of treatment is best for you. Make sure you follow the
guidelines given by your diabetes team and follow-up with your physician on
a regular basis.
The following are important methods of treatment:
• Glucose Self Monitoring
• Increased Activity
• Medications (if prescribed by physician)
• Eating Healthy
GLUCOSE SELF MONITORING
Glucose monitoring at home will tell you what your blood sugar is at that
moment in time. By self-monitoring and recording your blood sugars on a
regular basis, you will see how foods, activity, medications, stress, and
illness affects your blood sugars. You need a prescription from your doctor
to get strips and lancets from a Florida Health Care Plans pharmacy for a
co-pay.
(Fee for Service – use participating pharmacies in your policy.)
By managing your diabetes, YOU can prevent or delay long-term
complications, such as eye, kidney, and nerve damage, as well as heart
disease.
TARGET BLOOD GLUCOSE RANGES
TIME
Fasting (waking)
Before Meals
2 hours after food
•
GOAL
80* - 130 mg/dl
80* - 130 mg/dl
Less than 180mg/dl
Goals are individualized by your physician based on your age, other medical conditions, and
medications that you are taking.
8
Procedures for Glucose Monitoring:
The best area to collect a blood sample is from your finger. Use warm water
and soap, if available, to wash your hands first. To increase the blood flow,
you may rub your hands together or milk your finger. Use the sides of the
fingers, not the tips.
To Maintain Meters:
• Use control solutions monthly
• Change batteries yearly or indicated by your meter
• Store properly (not in extreme heat or cold)
• Clean outside only with a damp cloth
• Dispose of needles in red sharps containers
(See Sharp’s disposal program on page 32)
Call Bayer at 1-800-348-8100 for additional assistance or meter
replacement.
If you have a different meter through Fee for Service, please
contact the company for assistance.
9
Low blood sugar (Hypoglycemia)
Causes
You might get low blood sugar (also called hypoglycemia) if you:
n Take certain medicines and eat too few carbohydrates, or skip or delay a meal
n Take too much insulin or diabetes pills (ask your diabetes care team if this applies to you)
re more active than usual
nA
Signs and Symptoms
Here’s what may happen when your blood sugar is low:
Sweaty
Shaky
Hungry
Sudden behavior
change
Weak or tired
Dizzy
Headache
Nervous or upset
If low blood sugar is not treated, it can become severe and cause you to pass out.
If low blood sugar is a problem for you, talk to your doctor or diabetes care team.
Low blood sugar (Hypoglycemia)
What to do if you think you have
low blood sugar
Check your blood sugar right away if you have
any symptoms of low blood sugar. If you think your
blood sugar is low but cannot check it at that time,
treat anyway.
Treat by eating or drinking 15 grams of
something high in sugar, such as:
n 4 ounces (½ cup) of regular fruit juice (like
orange, apple, or grape juice)
ounces (½ cup) of regular soda pop (not diet)
n4
or 4 glucose tablets
n3
to 6 hard candies that you can chew quickly
n5
(such as mints)
Wait 15 minutes and then check your blood
sugar again. If it is still low, eat or drink something
high in sugar again. Once your blood sugar returns
to normal, eat a meal or snack. This can help keep
low blood sugar from coming back.
For more information, visit
1213-00019325-1 December 2013
HYPOGLYCEMIA (Low Blood
HYPOGLYCEMIA (Low Blood Sugar)
Our body also reacts when blood sugars fall below 70 mg/dl (less than 80 for
those with heart disease). Most people can tell if they have low blood sugar
by the way they feel because it occurs rapidly. Low blood sugar is called
hypoglycemia. While stress and illness can result in either high blood sugar
OR low blood sugar, other facts listed below can cause blood sugars to
drop….. sometimes TOO LOW.
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Going too long without eating
Not eating enough food (or carbohydrates)
Exercising harder or longer than usual
Taking too much insulin
Drinking alcohol, especially on an empty stomach
Taking too much diabetes medication
WARNING SIGNS OF HYPOGLYCEMIA
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Dizzy
Light-headed
Sweaty
Weak
Pale
Nervous
Irritable
Headache
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Shaky
Confused
Dry Mouth
Tired
Tense
Hungry
Rapid Heartbeat
Blurred Vision
TREATING HYPOGLYCEMIA
When you start feeling that your blood sugar has dropped too low, treat it
right away, or you may pass out. AT WORSE, it may cause seizures, coma,
and even death. Follow these important steps:
1.
2.
3.
4.
Stop what you are doing and sit down
If you are able, check your blood glucose level
Start treatment plan immediately
Treat with 15 grams of carbohydrate every 15 minutes until glucose is
over 100 mg/dl.
5. Wait 15 minutes after treating, and then recheck blood glucose level.
Once blood glucose is at 100 mg/dl, eat an extra snack containing both
protein and carbohydrate if your next meal is more than 30 minutes away.
Record in a log what your readings were and how you treated them. Figure
out why your blood sugar fell so low in order to prevent it from happening
again. If it happens more than once a week, report it to your doctor. Keep
something with you at all times to treat low blood sugar.
TREAT HYPOGLYCEMIA with 15 grams of carbohydrates:
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3-4 glucose tablets ** (best choice)
4 ounces (1/2 cup) fruit juice
4 ounces regular soda (NOT diet)
8 ounces low fat or skim milk
4-7 small pieces of candy (such as lifesavers, peppermints, or jelly
beans….. not chocolate!)
• 1 Tablespoon honey or syrup
• 3 sugar cubes or packets of sugar (1 Tbsp)
• 1 tube of gel frosting or glucose gel
∗ If you take Precose, treat hypoglycemia ONLY with milk, glucose tablets, or gel.
Other more common types of carbohydrates will not work.
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A Word about GLUCAGON
Glucagon is the hormone given when a person becomes unconscious (or unable to swallow) due to low
blood glucose. It is available only by prescription. The hormone causes the liver to release glucose,
but it only lasts for about 30 minutes.
Before use, The Glucagon kit should be stored at controlled room temperature and should ONLY be
mixed immediately prior to use. Follow the instructions given with your glucagon kit carefully.
The person should regain consciousness within 15 minutes. 911 should be called. Glucagon can
cause a person to vomit; therefore, make sure the person is turned on their side to prevent aspiration
once the hormone has been administered. Notify your doctor after treatment.
TIPS FOR PREVENTING HYPOGLYCEMIA
(LOW Blood Sugar)
• Eat meals no longer than 4-5 hours apart, and include foods from all
food groups, especially starches, fruit, and milk
• Take the correct dose of your medication at the correct times
• Inform all physicians of your diabetes when medication is prescribed
• Read warning labels on all over the counter medicines you purchase
• Check your blood glucose often when you are traveling, or are sick
• Remember your bedtime snack if you take diabetes medicine
• Exercise 1-2 hours after eating. Do NOT exercise when your medicine
is working at its peak (see chart on page 14)
• Add a snack before exercising if glucose is below 100 mg/dl
• If you are going to drink alcohol, check your blood sugar at bedtime
and adjust your snack if needed.
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INCREASED ACTIVITY
Exercise is a very important part of your treatment plan. The benefits of
exercise include:
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Lowers your blood glucose levels
Helps your insulin work better
Helps you lose weight
Helps lower blood pressure
Reduces stress
Gives you more energy
Helps lower your cholesterol and triglycerides
Helps you sleep better
Promotes bone health
Improves strength and muscle tone
Improves digestion and elimination, and more…….
The U.S. Surgeon General recommends that everyone get 30 minutes of
physical activity most days, whether all at once, or accumulated throughout
the day. It is recommended that at least 2 days a week for 20 minutes or
more of anaerobic activity (resistance training, weights, or toning. Try not to
sit for more than 30 minutes at a time (watching TV, knitting, working on the
computer, playing cards, etc.). Get up and move, walk, clean, stretch for 10
minutes or more.
Some exercise is better than no exercise!
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SAFETY GUIDELINES FOR EXERCISE
• Check with your physician before you begin an exercise program if
you have other serious health conditions (e.g., heart/lung disease, foot
problems)
• Exercise 1-2 hours after a meal to prevent low blood sugar
• Stretch before you begin and cool down after you finish to prevent
injury
• Increase activity level and time gradually
• Wear comfortable clothing and supportive shoes
• Drink lots of fluids to prevent dehydration
• Stay in well-lit populated areas
• Carry a quick sugar source (ex: glucose tablets) to treat low blood sugar
• Wear a medical identification bracelet or neck chain
• Carry your cell phone with you
Exercise Precautions
• Do NOT exercise if blood glucose is too low (under 100 mg/dl) before
beginning.
• Always carry a source of quick sugar (glucose tablets) when exercising
away from home, to treat possible low blood sugar
• Check your blood sugar level before and after exercise
• STOP exercising if you experience chest pain or shortness of breath
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Foot care for people with diabetes
People with diabetes have to take special care of their feet. You should have
a comprehensive foot exam by your doctor every year. This page shows
some more things you can do on your own to keep your feet healthy.
Wash your feet in warm water
every day.
Dry your feet well, especially between
the toes.
Keep the skin soft with a
moisturizing lotion, but do not
apply it between the toes.
Inspect your feet every day for cuts, sores, blisters,
redness, calluses, or other problems. If you cannot see
well, ask someone else to check your feet for you.
Ask your diabetes care team
how you should care for your
toenails.
Foot care for people with diabetes
To avoid blisters, always wear clean, soft socks
that fit you. Do not wear socks or knee-high stockings
that are too tight below your knee.
Always wear shoes that fit well.
Break them in slowly.
Never walk barefoot indoors or outdoors.
Before putting your shoes on,
feel the insides for sharp edges,
cracks, pebbles, nails, or anything
that could hurt your feet.
For more information, visit
1213-00019347-1
December 2013
DIABETES MEDICATIONS
PRESCRIPTION MEDICATIONS:
People with Type 1 diabetes will always need to take insulin. The insulin
has to be injected because there is no pill form that exists. Acids in the
stomach destroy insulin if taken by mouth. Pharmaceutical companies are
working to find other possible ways to take insulin.
Those with Type 2 diabetes may be able to control their blood sugar with
healthy eating and exercise. For those unable to do so, different kinds of
medications (pills) may be needed. Some people with Type 2 diabetes may
also need to take insulin injections.
As with ANY medications, you should know the following:
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NAME of pill _____________________________________________
DOSE of pill______________________________________________
TIME of day taken_________________________________________
Does it need to be taken BEFORE OR AFTER MEALS? ________
POTENTIAL SIDE EFFECTS______________________________
What to do if I MISS a dose? ________________________________
Can it be COMBINED with other prescribed or over-the-counter
medications, vitamins or herbal supplements? _________________
NAME
MY DIABETES MEDICATIONS
AMOUNT
TIME OF DAY
17
DIABETES PRESCRIPTION MEDICATIONS (ORAL):
MEDICATION
CLASS/NAME
Biguanides
Metformin
Glucophage
Glucophage XR
Combinations
(e.g., Glucovance)
Sulfonylureas
Glipizide
(Glucatrol &
Glucatrol XL)
Glyburide
(Micronase, Glynase,
Diabeta)
Glimepiride
(Amaryl)
Meglitinides
Repaglinide
(Prandin)
Nateglinide
(Starlix)
MODE OF
ACTION
Decrease the rate
the liver releases
stored sugar, and
make muscle
tissue more
sensitive to
insulin
FREQUENCY
Glucophage
2 or 3 times/day
Glucophage XR
1 or 2 times/day
Glucovance
1 or 2 times/day
POSSIBLE SIDE
EFFECTS/COMMENTS
Take with meals (to minimize
possible gastrointestinal side
effects).
Doesn’t cause hypoglycemia when
used alone (Glucovance or other
combinations that include a
sulfonylurea may).
Not recommended for those with
kidney disease, severe respiratory
problems, age 80 or older, heart
failure (acute or unstable), history
of liver disease, drink excessively
(binge drinking) or while
hospitalized.
Tell your doctor you are taking
Metformin if he/she is ordering
tests that use injected dye.
Stimulate the
pancreas to
produce and
release more
insulin to move
glucose into the
body cells
Amaryl or
Glucatrol XL
-once daily
All others
1 or 2 times/day
Should be taken with meals (can
cause hypoglycemia!). Glucatrol
should be taken ½ hour before
meals on an empty stomach
Those with kidney or liver
impairment may require a lower
dose
Stimulate the
pancreas to
produce and
release more
insulin to move
glucose into the
body cells
3 times a day
Should be taken before each meal
(can cause hypoglycemia!)
Duration of action is 2-3 hours
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DIABETES PRESCRIPTION MEDICATIONS (Continued):
MEDICATION
CLASS/NAME
Alpha-Glucosidase
Inhibitors
Acarbose
(Precose)
Miglitol
(Glyset)
MODE OF
FREQUENCY
ACTION
POSSIBLE SIDE
EFFECTS/COMMENTS
Block the 3 times a day
enzymes
that digest
the
starches
eaten
Take with the first bite of each
meal
Doesn’t cause hypoglycemia
when used alone
Must use pure glucose (glucose
tablets or gels) if hypoglycemia
occurs
Should not be taken by those with
inflammatory bowel disease or
other intestinal diseases
Dose should be increased slowly
to decrease GI side effects (gas,
bloating and diarrhea)
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MEDICATION
CLASS/NAME
Thiazolidinediones
Rosiglitazone
(Avandia)
Pioglitazone
(Actos)
Dipeptidyl Peptidase
IV
(DPP-IV) Inhibitors
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
MODE OF
ACTION
Enhance
insulin
sensitivity
FREQUEN
CY
POSSIBLE SIDE
EFFECTS/COMMENTS
Avandia
1 or 2
times/day
Actos
-once
daily
Typically takes 4-6 weeks to see an
affect on blood glucose
Liver function tests should be done
before starting and periodically
thereafter.
Can cause weight gain/fluid retention
Contraindicated for those with NYHA
class III or IV heart failure (Class III:
patients with marked limitation of
activity; they are comfortable only at
rest. Class IV: patients who should be at
complete rest, confined to bed or chair;
any physical activity brings on
discomfort and symptoms occur at rest)
The doctor should be called right away
if any signs of heart failure are seen
(e.g., rapid weight gain, shortness of
breath, edema)
Avandia carries a potential for increased
heart attack risk
May cause ovulation in premenopausal
women who do not ovulate, enabling
them to conceive
Stimulate
-once
insulin
daily
release during
a meal
Decrease
liver’s release
of sugar
20
Doesn’t cause hypoglycemia when used
alone.
Can be taken with or without food, but
should be taken at the same time each
day. Those with kidney impairment may
require a lower dose. (Januvia, Onglyza
and Nesina). Can cause nasal
congestion. See pharmacy handouts for
additional possible side effects to report.
MEDICATION
CLASS/NAME
SGLT-2 Inhibitors
Canagliflozin
(Invokana)
Dapagliflozin
(Farxiga)
Empagliflozin
(Jardiance)
MODE OF
FREQUENCY
ACTION
Decrease the
1 time a day
reabsorption of
glucose (sugar)
in the kidneys
(causing more
to be excreted in
the urine)
POSSIBLE SIDE
EFFECTS/COMMENTS
Invokana is best taken before the
first meal of the day.
Should not be taken by those
with severe kidney problems or
are on dialysis, those with Type
I Diabetes, or women who plan
to become or are pregnant or
breastfeeding. Should not be
used to treat diabetic
ketoacidosis. Before taking
Invokana, tell your doctor if you
take water pills or medications
to treat heart problems or HIV
infection, to control seizures or
to treat or prevent TB. Tell your
doctor if you have or have had
bladder cancer.
Dehydration, vaginal yeast
infection, yeast infection of the
penis, urinary tract infection,
high amount of potassium in the
blood, changes in urination,
including urgent need to urinate
more often, in larger amounts, or
at night. Drugs in this class may
also cause an increase in LDL
(“Bad”) Cholesterol and
increased risk of bladder cancer.
May cause low blood sugar if
taken with a sulfonylurea or
insulin.
Call your doctor for dosing
instructions if you have a fever,
infection, surgery or other
trauma (e.g., car accident).
21
MEDICATION
CLASS/NAME
Incretin Mimetic
Exenatide (Byetta)
MODE OF
ACTION
Stimulates
insulin release
during a meal.
Decreases
Liraglutide (Victoza) liver’s release
of sugar.
Bydureon (Exenatide Slows down
how quickly
Extended-Release)
food leaves the
stomach,
Albiglutide
helping to
(Tanzeum)
prevent high
sugar after
Dulaglutide
eating. May
(Trulicity)
reduce appetite
and amount of
food eaten.
FREQUENCY
1-2 times a day
injection
Once weekly
22
POSSIBLE SIDE
EFFECTS/COMMENTS
Tell your doctor if you have
kidney problems, such as
delayed emptying
(gastroparesis) or problems with
digesting food. Before taking
any medications in this class, tell
your doctor if you have had
pancreatitis, stones in your
gallbladder (gallstones), a
history of alcoholism, or high
blood triglyceride levels. Call
your healthcare provider right
away if you have pain in your
stomach area (abdomen) that is
severe, and will not go away.
The pain may happen with or
without vomiting and may be
felt going from your abdomen
through to your back. Nausea is
most common side effect when
first starting this class of
medication, but decreases over
time in most people as their
body gets used to it. The risk
for hypoglycemia is higher if
you take this type of medicine
with another medicine that can
cause low blood sugar, (e.g.,
sulfonylurea). The dose of your
sulfonylurea medicine may need
to be lowered while you take
medications in this class.
MEDICATION
CLASS/NAME
Amylin Analog
Pramlintide
(Symlin)
MODE OF
ACTION
Slow down
how quickly
food leaves the
stomach,
helping to
prevent high
sugar after
eating.
Decrease
appetite.
Decrease
liver’s release
of sugar.
FREQUENCY
3 times a day
23
POSSIBLE SIDE
EFFECTS/COMMENTS
THIS MEDICATION IS NOT
INSULIN (but is used in
conjunction with insulin in those
who already take insulin as
prescribed, but still need better
blood sugar control). Not to be
used in those with hypoglycemia
unawareness, gastroparesis, or
women who are pregnant or
breastfeeding. Take along with
mealtime insulin (do not mix in
the same syringe!), injection
sites must be at least 2 inches
apart. Take only before a major
meal (contains at least 250
calories or 30 grams of
carbohydrate). Hypoglycemia
can occur when added to
mealtime insulin (especially
with Type 1 diabetes), so premeal insulin dose is usually
adjusted. Nausea is most
common side effect, but
decreases over time in most
people as their body gets used to
it. Tell your doctor about all the
medicines you take including
prescription and nonprescription medicines,
vitamins, and herbal
supplements. SYMLIN can
slow down how other medicines
pass through your stomach and
may affect how much of them
get into your body. You may
have to change the times you
take certain medicines.
EATING HEALTHY
Healthy Eating is the first step in taking care of your diabetes. You can
make a difference in your blood glucose control through your food choices.
To keep your blood glucose levels near normal, you need to balance the food
you eat with the insulin your body makes or gets by injection and with your
physical activities.
BASIC GUIDELINES:
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Do NOT skip meals
Eat about the same amount of food at the same time every day
Eat a wide variety of foods
Choose a diet with plenty of fiber, fruits, and vegetables
Eat meals no more than 4-5 hours apart
If you are on diabetes medications or insulin, exercise within 2 hours after eating
If you are on most medications for diabetes (especially insulin), you need a
bedtime snack
Examples of good bedtime snacks include:
• 1 slice toast with peanut butter
• 1 cup (8 oz.) low-fat or fat-free milk
• 3 graham cracker squares
• 6 crackers with 1 ounce low-fat cheese
• ¼ cup cottage cheese with ½ cup light fruit
• 1 cup light yogurt
(Choose 2 servings if you take insulin)
A healthy daily intake includes a minimum of:
•
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3 servings of vegetables
2 servings of fruits
5 servings of grains, beans, or starchy vegetables
3 servings of low-fat or fat-free milk
about 5 ounces of meat or meat substitutes
small amounts of heart healthy fat
24
A serving is:
½ cup for the vegetable, fruit, and grains group
1 cup for the milk group
3 ounces of meat is the size of 1 deck of cards
The actual amounts will depend on the number of calories you need, which
in turn depends on your size, age, and activity level. To get specific nutrition
recommendations, an individual appointment with the registered dietitian is
needed after completing the diabetes self-management classes. This
appointment is called “Medical Nutrition Therapy”.
Source: "Eating Well with Diabetes" A Guide to Meal Planning. 2003 The StayWell Company
25
The Plate Method
Healthy eating includes having a variety of foods. Try to plan meals around
whole grains, vegetables, and whole fresh fruits. Limit meat and other fatty
foods. As a guide, you can use the plate model to make your meals. When
you put food on your plate, aim to:
• Make half of your plate fruits and vegetables.
• Cover ¼ (25%) of your plate with meat, poultry, fish, or other sources
of protein and ¼ (25%) of your plate with whole grains.
Some Immediate Changes You Can Make Now:
• Limit sweets and desserts. Per the American Heart Association limit added sugar
to less than 25g (6 tsp.) for women and less than 37.5g (9 tsp.) for men.
• Use sugar-free beverages
• Use no-calorie sweeteners
• Choose foods from all of the food groups daily
• SIGN UP FOR DIABETES CLASS TODAY! You do NOT need a referral.
To make an appointment, call:
FHCP Daytona Beach (386) 226-4518 or toll free 1-877-229-4518
26
INSULIN
Everyone needs insulin to live. If your body doesn’t produce enough on its
own, and oral medications do not keep your blood glucose levels controlled,
you will need to inject insulin. In the past, insulin was made from beef
and/or pork. These were not the purer forms that are now available as
synthetic human insulin. Animal source insulin action was less predictable
than human insulin. The improvement to the synthetic human form now
helps prevent allergic reactions, and insulin resistance problems. Insulin
affects different people in different ways, depending on factors such as
activity level, stress, injection site, and food or beverage intake.
SYNTHETIC HUMAN INSULIN
Insulin
Lispro (HumalogTM)
Aspart (NovoLog TM)
Onset
<15 min
Glulisine (Apidra TM)
Peak
1-2 hr
1-3 hr
Duration
3-4 hr
1½-3 hr
Regular (Novolin R TM,
Humulin R TM)
½-1 hr
2-4 hr
6-8 hr
NPH (Novolin N TM,
Humulin N TM)
1-2 hr
3-8 hr
12-15 hr
Glargine (Lantus TM)
1-2 hr
None
24 hr
50% in 3-4 hr,
Doselasting up to
dependent (up
14 hr (low
to 24 hr)
peak)
Detemir (Levemir TM)
1-2 hr
Humalog TM 75/25
NovoLog Mix TM 70/30
<15 min
½ -8 hr
12-15 hr
HumulinTM 70/30
Novolin TM 70/30
½-1 hr
3-8 hr
12-15 hr
Humulin R TM U-500
½ hr
Varies
Varies
27
Comments
Take 0-15 minutes before a meal.
This insulin is clear in appearance.
Best if taken 30 minutes before a
meal. This insulin is clear in
appearance.
Does not need to be given with a
meal. This insulin is cloudy in
appearance.
DO NOT MIX IN SAME SYRINGE
WITH OTHER INSULINS. Does not
need to be given with a meal. This
insulin is clear in appearance.
WITH OTHER INSULINS. Does not
need to be given with a meal. This
insulin is clear in appearance.
Take 0-15 minutes before a meal.
This insulin is cloudy in appearance.
Best if taken 30 minutes before a
meal. This insulin is cloudy in
appearance.
WITH OTHER INSULINS. Given
with a meal. This insulin is clear in
appearance.
INJECTING INSULIN
Insulin injections are no longer as scary as they once were. Unlike tetanus
and penicillin injections, the micro-fine, ultra-sharp, short disposable needles
do not hurt much.
Below are a few simple reminders when it comes to injecting yourself:
1. Wash your hands and swab top of Insulin bottle with alcohol.
2. If the insulin is a suspension, gently roll the bottle between your hands. DON’T
SHAKE IT. Mix it thoroughly but avoid any bubbles or foam.
3. If using insulin that is clear, inspect before each use to ensure it is clear and
doesn’t have particles.
4. Leave bottle upright and inject the amount of air equal to the amount of insulin to
be withdrawn into the bottle. Leave needle in bottle and turn whole bottle upside
down.
5. While holding bottle upside down, withdraw insulin.
6. Air bubbles will make your dose of insulin wrong. If you see a bubble, DON’T
flick the syringe. Push the insulin back into the bottle and pull it out again.
7. Double-check your dose.
MIXING INSULINS IN ONE SYRINGE:
1. Start with the cloudy insulin first. Leaving bottle on flat surface, inject air equal
to the amount of NPH to be used into the bottle. Remove needle from bottle (you
are not going to draw out any cloudy insulin yet).
2. Inject air equal to amount of clear insulin into the clear insulin bottle. Turn clear
bottle upside down before withdrawing the ordered dose of clear insulin. Pull
slowly to avoid getting air bubbles in the syringe. Pull the needle out of the clear
insulin bottle.
3. Now take the cloudy insulin bottle, insert needle, being careful not to push in the
plunger, and turn bottle upside down. Slowly withdraw cloudy insulin until the
total of both clear and cloudy insulin doses is reached.
4. If an error occurs, dispose of the current mix and start all over again.
28
GIVING THE INJECTION
1. Changing sites increases the effect of the insulin. Find a new site for each
injection. (Common sites are the abdomen, flank, thigh, upper arm, shoulder fat
pad and buttocks). Check that the skin is clean and dry.
2. Pinch the skin.
3. Insert needle at 90-degree angle, straight down and all the way in.
4. Push plunger gently all the way down to inject the insulin.
5. Release the skin.
6. Pull needle straight out and avoid rubbing the area.
The law requires proper disposal of needles. Refer to the “Sharps Disposal
Program” on page 32
29
STORAGE OF INSULIN
Those who live in Florida should keep their insulin in the refrigerator. Keep it out of
direct sunlight. You should date your bottle when you start using it, and use the opened
vial of your type of insulin for the number of days noted below (all are stable until the
expiration date on the label when unopened and stored in the refrigerator).
Insulin
Stability after
opened and at room
or refrigerator
temperature (days)
Insulin
Rapid-acting insulin
NovoLog
Humalog
Apidra
Stability after
opened and at room
or refrigerator
temperature (days)
Pre-mixed insulin
28
Short-acting insulin
Humulin 70/30
Humalog 75/25
Humalog 50/50
28
Novolin 70/30
42
28
Humulin R
28
NovoLog 70/30
Novolin R
42
Long-acting insulin
Intermediate-acting insulin (NPH)
Humulin N
28
Novolin N
42
30
Lantus
28
Levemir
42
Nutrition Guidelines
In Order for Insulin to Work Effectively
•
•
•
Eat meals no more than 4-5 hours apart during the day
•
Include ALL food groups in your meals, especially starches,
fruit, and milk
Eat at the same time every day
A bedtime snack should be eaten every night. It should
include 1-2 servings from the starch, fruit, or milk group
An Individualized meal plan will be given to you after the Florida
Health Care Plans diabetes education classes when you schedule
an individual appointment with the registered dietitian.
For an appointment, call:
FHCP Daytona Beach (386) 226-4518
or toll free 1-877-229-4518
31
All Walgreen’s sells the Complete Needle Collection & Disposal System. In addition anyone
can purchase and dispose of Sharp’s containers at the following locations:
D AYTON A B EACH
N EW S M Y R N A B EAC H
Volusia County Health Dept.
Environmental Health
1845 Holsonback Dr.
386-274-0694
Monday thru Friday 8:00am–5:00pm
Cost: $5 for large container (8 qt.)
$3 for small container (lancets only)
No cost to dispose of full Sharps containers
717 W. Canal St.
386-424-2061 ext. 5197
D ELAN D
D EL TON A
121 W. Rich Ave.
386-822-6250 ext. 5198
Deltona Health Center
3151 Howland Blvd.
386/789-7507
B U N NEL L
Flagler County Health Dept.
208 Dr. Carter Blvd.
386-437-7358
TOM OK A LAN DFI LL – D R OP OFF ON LY
1990 Tomoka Farms Rd.
386-947-2952
Monday thru Saturday 7:00am–5:30pm
No Cost to dispose of but must be in an
approved Sharp’s container. Take the
container to the landfill scale house
for disposal instructions.
02-207/5-12rx
Remember to dispose of your
syringes & lancets properly. It is
IMPORTANT to protect the health
& safety of yourself and others.
32
Questions for Class
Diabetes Education Survival Skills Booklet Developed 9/2004 By:
Myra Juhasz, RN, CDE, Catherine Robinson, RD, LD, CDE, April Engel, MSH, RD, CDE, Chris
Willman, RN, CDE, with supplemental information from Novo Nordisk’s Cornerstones4Care.com
Revised 1/2015 by:
David Fox, PharmD
Clinical Pharmacy Manager
Cara Karner, MS, RDN, LD, CDE
Catherine Robinson, MS, RDN, LD, CDE
Melissa Baumann, MS, RDN, LD, CDE
Patricia Teuton, RN, CDE, CPT
Patricia Weiss, RN, CDE, CPT
1
H1035_NR486 FYI (03/03/2015)

survival skills for diabetes

Transcription

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