REVISED - Shadow Health DC Summary

Diabetes Educate on diet, exercise, medication compliance, blood sugar monitoring, and follow up. Let Tina know that some of the most common complications of diabetes can affect eyes, heart, kidneys, nerves, and feet. Tina will need to know how to detect and manage signs and symptoms of hypoglycemia and hyperglycemia. Tina also needs instructions on the importance of blood sugar monitoring. Write what you would say to instruct Tina about managing her diabetes. Student Response: Hello Tina. Before you are discharged, we need to discuss a few very important things concerning your health. Let's start by talking about diabetes. Diabetes is a disease in which the body is not able to respond or produce the hormone insulin appropriately resulting in elevated levels of glucose in the blood and urine and abnormal metabolism of carbohydrates. There are different types of diabetes including type 1 and 2, prediabetes, and gestational diabetes. Depending on the severity of the diabetes insulin may be needed for tight blood sugar control when oral regimens no longer seem to be effective. Along with medications, a strict diet needs to be followed to help prevent further health complications. It may feel challenging at first to change and adjust to a new diet, but a clean, healthy diabetic diet can help maintain a healthy weight, keep blood sugar levels at bay, and prevent serious complications such as stroke and heart attack. The key elements in a diabetic diet include fruits, vegetables, whole grains and lean protein. Your diet will need to be low in fat and calories. Try to stay away from foods high in cholesterol and saturated and trans fats. You will also want to avoid foods that are high in sodium and sugar. Try to eat foods that are high in fiber. Other foods that you need to avoid include things such as chocolate milk, 2% or whole milk, buttermilk or foods made with these products. Avoid meats that are smoked, cured, koshered, pickled or salted such as chipped beef, sardines, pickled herring and anchovies. Also prime and heavily marbled cuts of beef and fried or fatty meats such as sausage or bacon. Try to avoid quick breads such as muffins, biscuits, cornbread, pancakes, and waffles. I know this may sound overwhelming and this diet will be life-changing, but you will feel better and be working to improve your overall healing ability and health all while being able to better control your sugar levels. Other foods that you need to try and avoid include donuts, sweet rolls, fritters, granola-type cereals, potato mixes, canned beans, fried potatoes and french fries. Things such as butter, lard, shortening, stick margarine, bacon, bacon grease, cream cheese, candy, sweets, tropical oils and coconut and desserts made with sugar should also be avoided. I want to also give you some examples of appropriate servings for a diabetic diet. Try and limit milk servings to no more than 3 cups per day. You may have 2-3 servings or up to 6 oz. of cooked meat or meat substitutes per day. Limit red meat to 3 oz. two times per week. Three ounces of cooked meat is about the same size of a deck of cards. Limit cheese to one ounce per day. Try and keep starches and starchy vegetable servings to 6-11 servings per day. An example of one serving would be one slice of bread, 1/2 cup of pasta, cereal, or starchy vegetable. Try to stay with 3-5 servings per day of fresh, frozen, or canned vegetables without sauces. You may have 2-4 servings of fruit per day. An example of one serving is 1/2 cup of juice or one small piece of fruit. Limit your servings of fat to 3-6 per day and try to eat any desserts in moderation. As for beverages, if you drink soft drinks try and drink sugar-free and diet carbonated beverages. Try to remember to drink sugar-free Kool-aid if you choose to drink Kool-aid. Keep your servings of fruit juice down to one cup if possible. We need to now discuss the importance of exercise. Participating in a moderate amount of exercise also contributes to maintaining a healthy weight, keeping blood sugar levels close to normal and is good for your heart and health. Activities and exercises that are best for people affected by diabetes include things like swimming, jogging/running, playing tennis, stair climbing, low-impact aerobics, brisk walking and bicycling. Swimming is probably the best possible exercise because it is aerobic and does not put pressure on your joints and is easier on your feet. No matter what exercise you choose, it is important to try and get at least 150 minutes per week of moderate-intensity aerobic physical activity or 90 minutes of vigorous exercise. But along with diet and exercise you need to really make sure that you are compliant with taking the medications as the doctor has ordered for you each day. Not taking your diabetic medication properly can lead to serious morbidities, can increase your risk for mortality, increase the number of emergency room visits you have, and cause other complications that may affect your eyes, heart, kidneys, nerves and feet. These complications may include glaucoma, heart attack, kidney failure, neuropathy and diabetic ulcers just to name a few. You must not forget to closely monitor your blood sugar as well to help maintain good blood sugar levels. You will be checking your blood sugar with a portable electronic device called a glucometer, in which I see you already have at home. The home health nurse will be able to also answer any questions and show you how to use your diabetic equipment if needed. Your home health nurse is a good resource with a wealth of information for the care of your diabetes and foot infection. So why do we check our blood sugar? When we test our blood sugar, we are able to then identify if our blood sugar is high or low and how often. We are also able to see the how well our diabetes medications are working and understand how other factors, such as illness and stress affect blood sugar levels. Your primary care physician will also help to monitor your blood sugar levels through blood testing and will adjust how often he or she would like for you to check your blood sugar levels throughout your day. But for now, you will need to check your blood sugar levels before meals and snacks, before and after exercise, before bed and sometimes during the night if you should wake up sweaty, light-headed or sick to your stomach. When you are ill you may find that you will need to check your blood sugar levels more often. When you do follow-up with your primary care physician they may order blood work that may include a HgA1c about every three months or until your result is less than 7% and then maybe only twice per year thereafter. .............................................................................................CONTINUE.