Category: Family

Implementing self-care plans for diabetes

Implementing self-care plans for diabetes

Google Scholar Iplementing LD: The impact of low health selff-care on diabetes Implenenting. Educating the patient about these variations Fueling your run them understand the potential differences in insulin action and adjust their self-management strategies accordingly. Ramachandran A, Ramachandran S, Snehalatha C, Augustine C, Murugesan N, Viswanathan V: Increasing expenditure on health care incurred by diabetic subjects in a developing country: A study from India.

Implementing self-care plans for diabetes -

Using locations with a suitable structure and holding classes on the ground floor, especially for the elderly, must be taken into consideration. Besides, in-person education at home or on the phone and distance education through mass media and cyberspace are among the reliable methods to communicate information to patients and their family members and to solve spatial problems.

Individual, social and familial factors are other obstacles on the way to participating in the self-care training schemes. In line with the current study, previous studies have suggested hectic work and business and difficulty in getting time off work as social obstacles to the training and self-care of diabetic patients [ 23 , 24 ].

Previous studies showed that patients who are unemployed or retired are more likely to attend in self-management programs than those who work full or part-time [ 10 , 25 ]. Therefore, having flexible timing and holding classes in the afternoon, and making use of alternative methods of educational classes help to alleviate these obstacles.

It is reported that support from fellows and family members as the facilitating factor in enabling individuals in self-care behavior in their study [ 26 ]. Thus, awareness of family members about the importance of self-care behavior and the necessity for participation in educational programs to support the patients in their participation in educational classes is crucial.

Another effective factor in the reduction in exploiting self-care educational programs among diabetic patients is related to the physical abilities of the patients. Old age and suffering from chronic diseases result in physical disabilities and problems leading to impediments to participation in educational classes.

Mogre et al. have also identified old age and pain as obstacles to the implementation of self-care behavior [ 27 ]. Making use of mobile phone applications leads to an increase in self-care behavior in patients with chronic diseases [ 28 ].

Understanding diabetes on the part of patients in terms of preserving self-care behavior is vital. have also identified the false image of contracting diabetes as one of the obstacles to self-care in their study [ 27 ]. The findings of the present study identify the negative attitude toward the effectiveness of self-care behavior in controlling diabetes as one of the obstacles to the implementation of self-care behavior in patients.

This result is consistent with the results of study conducted by Gucciardi et al. Part of these attitudes is the result of cultural beliefs identified in the study done by Whittermore et al.

as one of the obstacles to the creation of self-care behavior [ 29 ]. It seems that unless individuals acquire a proper insight into diabetes, the possibility of participation in in-person classes will not increase.

This, in turn, needs a clear explication of the importance of the disease and its dangerous side-effects on the part of healthcare providers, instructors, health media, and diabetes associations. Studies show that in developed countries patients have higher expectations and more information should be provided for patient participation.

These studies found that centers that provide patients with information on when and where to go, where to park, what to bring, whom they will see, and what to expect, in addition to providing a reminder call prior to the appointment, dramatically reduce initial non-attendance rate [ 31 ].

One study showed that the absence of heartening instruments by healthcare providers as motivational obstacles effective on participation in educational programs [ 30 ].

Monitoring and following up with patients after participating in educational classes via telephone or in-person contribute to their more success in controlling their ailment and more participation in educational classes.

Providing awards and prizes for those who attend the classes regularly as offered by patients. The findings of various studies showed that the relationship between the doctor and the patient affected the implementation and following up self-care behavior [ 17 , 32 ].

Therefore, teaching and enhancing the communicative skills of service providers and instructors are of the exigencies of holding educational courses.

Although training is one of the most effective ways to enhance self-care conduct, weakness in contents and unsuitable teaching techniques can hinder the use of the educational programs, which are also mentioned by the patients in the present study. In another study, unsuitable teaching content is said to be one reason for the disinterest in such schemes [ 24 ].

Using supplementary books and reflecting the experience of cured patients by themselves were suggested by the interviewees. Schafer et al. have recommended using the private than group education and adopting a multidimensional rather than presentational method because they are more effective on self-care behavior [ 17 ].

Therefore, enjoying such various teaching methods as educational technology, multimedia resources, and sending educational short messages in designing self-care educational schemes are suggested. A feeling of not needing educational programs is an effective factor in non-participation in self-care programs.

The present findings introduce ignorance of the danger of diabetes on the part of patients as another obstacle to the implementation of self-care behavior, which confirms the results of previous studies [ 10 , 33 ]. Thus, building awareness about the dangers of diabetes and its side effects in patients by healthcare providers, mass media, and affiliated associations seems all-important.

Inaccessibility of educational information through other resources such as the media, the Internet and tutorial booklets is another obstacle to participation in educational programs. Various studies have shown that using suitable educational apparatus laptop, DVD, and PowerPoint , phone tracking, mobile virtual system, and email is effective in teaching self-care to cardiac patients [ 34 , 35 ].

Despite the advantages of these educational methods, unknown and adverse information given by the media will result in distrust of therapeutic programs [ 36 ]. As a result, surveillance and giving, the necessary instructions to implement these educational methods should be considered by healthcare planners and decision-makers.

In the present study, the patients did not continue taking part in the educational classes after they had acquired the ability to handle their disease and created a feeling of self-efficacy. Therefore, regarding the fact that patients do not attend the educational classes following the creation of self-efficacy, phone tracking by providers to monitor self-care behavior in such patients can contribute to the better implementation of this salubrious behavior.

One of the limitations of this study was a lack of collaboration on the part of the health center officials and those who participated in the study as well, who were briefed to cooperate by offering explanations about the advantages and importance of the study.

Recommendations for further research include economic evaluation studies of training programs for diabetic patient, longitudinal studies that examine the impact of training programs on quality of life and costs of diabetic patients. This study concludes that there are many barriers against the participation of diabetic patients in self-care programs that should be facilitated.

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Preferences of persons with type 2 diabetes for diabetes self-management education interventions: an exploration. Adams KF, Sperl-Hillen JM, Davis H, Spain CV, Hanson AM, Fernandes OD, et al.

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The effect of different training programs on antioxidant status, oxidative stress, and metabolic control in type 2 diabetes. Appl Physiol Nutr Metab. Park S-Y, Lee I-H. Effects on training and detraining on physical function, control of diabetes and anthropometrics in type 2 diabetes; a randomized controlled trial.

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In a previous study, we developed an approach to address many of these limitations of existing web-based interventions [ 15 ]. In the current study, we tested the impact of this approach on self-efficacy, quality of life, self-care, blood pressure, cholesterol, glycemic control, and exercise promotion amongst people with type 2 diabetes.

This study consisted of five phases: 1 development of the intervention, 2 feasibility testing, 3 usability testing; 4 refinement of the intervention, and 5 evaluation of the intervention using a cohort study and individual interviews. The study protocol and results of the first four phases are reported elsewhere [ 15 ],[ 16 ].

We report here the results of Phase 5. The Diabetes Online Companion is a self-contained diabetes self-management website that was systematically developed according to self-efficacy theory.

Randomized controlled trials have shown that diabetes self-management education programs incorporating principles of self-efficacy are associated with improvements in knowledge [ 18 ], health behaviours [ 18 ],[ 19 ], self-efficacy [ 18 ]-[ 20 ], HbA1c [ 18 ]-[ 21 ], weight [ 18 ], and microvascular complications [ 19 ].

Our intervention incorporated evidence-based content and behaviour-change strategies and followed the principles of user-centred design [ 15 ]. The website had four main components: 1 general information static , 2 tailored information interactive , 3 self-monitoring logs interactive , and 4 a blog interactive see Additional file 1 for sample screenshots.

We posted a total of 53 blog posts over the intervention period, initially at a frequency of one per week. After four weeks of limited user activity, we increased the frequency of blog posts to two per week and added email prompts with each new posting. The topics, which covered medical content, diabetes-related news items, and practical issues, were selected on the basis of our feasibility and usability testing [ 15 ].

In addition, participants received weekly email reminders to visit the site or complete their self-management trackers, as well as notices of any new content [ 15 ]. We conducted a single-arm pre-post cohort study.

Consecutive series of individuals with diabetes were recruited from two family practice units and two endocrinology clinics in Toronto one each from two academic health science centres. We excluded those who had Canadian Cardiovascular Society class 3 or 4 angina, did not speak English, were not available for follow-up, or had no regular access to the telephone and internet.

Website usage: We analyzed logs for the web server to assess the frequency and duration of specific components of the intervention [ 16 ]. Specifically, we collected data for the following variables: duration of use by individual users, frequency of use, site penetration, most frequently accessed tools and pages, and patterns of use over time.

We selected self-efficacy because not only has it been validated in predicting and promoting patient behaviour change, but it also has been demonstrated to improve clinical outcomes [ 18 ],[ 20 ],[ 24 ],[ 25 ]. We assessed self-care behaviour with the Summary of Diabetes Self-Care Activities Measure — Revised [ 26 ] and diabetes-specific quality of life with the Diabetes Distress Scale [ 27 ].

These patient-based outcomes were selected because they are relevant measures of knowledge use by patients. Clinical outcomes: We collected data on HbA1c, systolic and diastolic blood pressure, LDL-C, and weight every three months. These outcomes were chosen to inform the sample size calculations in future trials.

We obtained data for age, sex, ethnicity, education, self-reported health literacy, employment, duration of diabetes, complications, smoking status, medications, HbA1c, systolic blood pressure, LDL-C, weight, current use of and comfort with a computer and the internet, self-care score, self-efficacy score, and quality-of-life score at baseline.

Outcome data were collected by means of patient-completed questionnaires. For the pre- and post-implementation phases, aggregates of patient-completed questionnaires were obtained every three weeks for nine months through web-based surveys, resulting in 12 data points for each phase.

Health literacy was measured by a three-item validated questionnaire completed by the patients [ 28 ],[ 29 ]. HbA1c and LDL-C were collected from medical records via chart audit.

Systolic and diastolic blood pressures were measured by the research coordinator and were recorded as the average of three readings. Weight was also measured by the research coordinator. At the end of the study, each participant was asked to disclose whether he or she had used other web-based interventions and if so, whether those interventions employed text- or image-based didactic materials, interactive technology, or behavioural strategies.

To assess for threats to validity from historical effects, we recorded secular events that might have affected our outcomes such as diabetes-related news reports. Using a range of correlations from 0. Differences of 0. A formula for paired mean comparisons was applied [ 30 ], and the longitudinal nature of the study increased its power [ 31 ].

Linear mixed models were used to examine the effect of the intervention and time intervention × time interaction on self-efficacy, self-care, and diabetes distress. We selected these models to accommodate the complexities of typical longitudinal data sets for continuous outcomes; specifically, they allowed us to account properly for both within- and between-participant variability [ 33 ],[ 34 ] and have been used in previous studies for similar analyses [ 35 ]-[ 37 ].

The model examining the self-care outcome was also adjusted for interaction terms of the aforementioned variables with time. No additional interaction terms with time were included for other outcome models, because all additional interaction terms examined were non-significant.

To avoid inflation of R 2 , all variables were specified a priori, and all interactions were tested simultaneously using a cut-off value of 0. Models were assessed by means of residual plots.

To assess the potential effect of missing income data for three of the participants, a sensitivity analysis imputing income as both high and low was performed. Linear mixed models were also used to examine the effect of the intervention and time intervention × time interaction on secondary outcomes.

These models were adjusted for age, self-efficacy score, income, ethnicity, and insulin use for HbA1c and weight only. We also compared the effect of the intervention between users and non-users of the website.

Finally, we used descriptive statistics to analyze website usage. R software version 2. Individual interviews were conducted 2 to 21 weeks after completion of quantitative data collection. We used a purposive sampling strategy to recruit participants with a range of experiences and characteristics [ 42 ] sex, age, ethnicity, duration of diabetes, educational attainment, income from the broader pool of cohort study participants.

We made the website available during each interview, in case the interviewee wanted to show the interviewer something on the website. All interviews were audiotaped and transcribed verbatim [ 43 ]. Transcripts were inductively analyzed to identify emergent categories and themes using a constant comparative approach [ 44 ].

Coding was conducted independently by three team members with expertise in qualitative research methods CHY, JAP, SH [ 44 ]. After coding an initial subset of interviews, a preliminary coding framework was developed on the basis of the emerging analysis, with discussion and consensus amongst the analysts [ 45 ]; the framework was then iteratively tested and refined with subsequent interviews [ 44 ].

Thematic saturation was attained with 21 interviews [ 42 ]. NVivo software version 9 was used to assist with data management and retrieval. Techniques to ensure analytic rigour included use of multiple analysts, negative case analysis, and triangulation of the qualitative findings with the quantitative results [ 42 ],[ 44 ],[ 46 ].

The study was approved by the Research Ethics Boards of St. All participants gave written and verbal informed consent. Of the 98 participants recruited, 81 had complete data collection for at least two time points one before and one after the intervention was implemented and were included in the analysis.

The mean number of days on which users logged in during the study period was 8. The average frequency of use was 0. Increased use of the website during those weeks appeared to be driven by the blog. In general, website use appeared to parallel blog use, with users visiting the blog repeatedly during the same login or visit Figure 1.

Website login and blog use by week. Black bar: Number of logins per week. Grey bar: Number of blog views per week. Regarding site penetration, users viewed 6.

Within the blog section of the website, there were a total of page views by 35 participants over the study period, with peaks at week 10 54 views , week 27 43 views , and week 30 53 views , corresponding to blog entries about the medication log, supplements and insulin, and foot and kidney care, respectively.

A total of 13 comments responding to the blog postings were submitted by five participants. These comments took the following forms: 1 responding to the blog agreement or disagreement ; 2 requesting help with or providing feedback on the website; 3 requesting help with self-management; 4 offering assistance, empowerment, and their own solutions including food recipes ; 5 self-reporting behaviour change; 6 sharing responses to medication; and 7 warning others about interactions with health care providers.

These users had a mean of 3. Self-efficacy: Despite a significant short-term increase in self-efficacy score immediately after implementation of the intervention 0. Self-efficacy, self-care, and diabetes distress nine months before and nine months after intervention implementation. Reference categories used in the plot were as follows: female, mean age Self-care: The self-care score improved by 0.

Self-care scores were positively correlated with age 0. Diabetes distress varied with age and sex: younger female participants had greater diabetes distress. Seventy-three of the participants were included in the analysis of clinical outcomes.

The other eight participants were excluded because of missing data for HbA1c, blood pressure, LDL-C, or weight within 90 days of the self-efficacy data or because no data were obtained after implementation of the intervention.

The intervention had no effect on HbA1c, blood pressure, LDL-C, or weight in either the unadjusted or the adjusted models Table 2.

At the nine-month follow-up after implementation of the intervention, there was no difference between users and non-users in terms of self-efficacy 0. Twenty-one individuals Table 1 participated in an interview.

The sample consisted of White and Asian men and women of various ages, duration of diabetes, educational attainment, and employment status, who used computers frequently and were comfortable with using the internet. Additional themes will be the focus of future publications.

The following four themes are considered here: 1 barriers and facilitators of website use; 2 patterns of website use, including the role of the blog in driving site traffic; 3 general feedback on website characteristics; and 4 potential mechanisms for the effect of the website on self-efficacy, behaviour change, and diabetes distress.

Representative quotes for each theme appear in Table 3. In particular, participants reported feeling frustrated with the uncontrolled nature of their disease, and the collection of self-monitoring information that showed a lack of metabolic control exacerbated this frustration Table 3 ; 1d.

Similarly, some participants said that they were sometimes overcome with a sense of futility. They perceived that regardless of their actions, some outcomes such as dialysis were inevitable Table 3 ; 1e ; hence, they saw no value in learning about the disease or in trying to self-manage the disease or use the website.

Others were limited by poor computer or internet access and said they would prefer a mobile solution Table 3 ; 1g. Finally, some participants noted that the onerous process for correcting error in log entries discouraged them from using the self-management tools Table 3 ; 1h.

In contrast, other website characteristics appeared to encourage users to visit and return. Similarly, routinization of the online experience appeared to routinize use of the internet for certain aspects of health care.

Rather than browsing at random, users said they were goal-directed: when they had a specific concern, they focused on that area of the website Table 3 ; 2a. For example, one participant was initially motivated to visit and subsequently continued to visit the foot care section of the website because of her foot symptoms Table 3 ; 2b.

Participants also commented that they used the website to gauge the urgency of their concerns and to try to obtain immediate answers to their questions Table 3 ; 2b. We explored potential reasons for the unexpected finding that the blog was the most frequently accessed tool and appeared to drive website usage.

participating in a discussion thread. However, this was not a universal sentiment, and some participants felt uncomfortable with and disconnected from the blog Table 3 ; 2c,ii. Participants perceived that the website was accurate, comprehensive Table 3 ; 3a , and easy to navigate Table 3 ; 3b.

Deeper exploration of the data regarding patterns of use and website features uncovered factors that might account for these quantitative findings. For example, rather than returning to the site to revisit and review items, some participants reported that they printed items of interest from the website and subsequently referred to these paper copies Table 3 ; 4a.

The use of reminder emails also had an effect. Participants reported that these emails not only prompted them to return to and log into the website, but also encouraged them in their own self-management Table 3 ; 4b.

Although she did not subsequently login to the website to record these behaviours, she did continue to record them on paper. We found that a self-management website for patients with type 2 diabetes led to no improvement in self-efficacy, diabetes distress, or clinical outcomes over the study period.

However, there was an improvement in self-care a secondary outcome , and the group that used the website experienced significantly lower diabetes distress than those who did not use it.

Despite a user-centred design process and an increase in the frequency of blog posting from weekly to twice weekly, use of the website as ascertained by login records was limited.

Our interviews revealed that both patient-related factors e. competing health and life concerns, a sense of futility and website-related factors e. requirement for login, limited computer or internet access limited use of the website.

These qualitative findings have confirmed the importance of website features such as the reliability and authoritativeness of information [ 47 ], as well as the use of blogs [ 15 ] and reminders [ 48 ] for continued engagement of users.

Our data also suggest that mobile devices are a potential avenue through which to improve accessibility and use of a self-management site. However, as with web-based technology, a systematic approach to development, testing, implementation, and evaluation of mobile health technology is warranted.

Although such technologies are proliferating, with over applications related to diabetes alone, their usability and clinical effectiveness are variable [ 53 ], and concerns exist regarding their effectiveness and safety, as well as the security of personal health information [ 54 ].

Our findings regarding user engagement with web-based technology echo those for mobile technology: an evaluation of 10 mobile diabetes applications emphasized the importance of user-centred design, an engaging interface, and context-driven use [ 55 ].

Competing health concerns were identified as a barrier to web-based self-management. depression , which in turn directly affects self-management ability and competes for time and attention [ 56 ].

For example, patients with a greater number of comorbidities placed a lower priority on diabetes and had worse diabetes self-management ability [ 57 ]. Future interventions should consider strategies, such as shared decision-making and priority-setting, to empower patients with multiple comorbidities to optimize their self-care [ 58 ].

For example, a patient may identify mood management as a priority, which is key to subsequent self-care. Finally, our results may be extrapolated to other chronic diseases.

In particular, our finding of the need for tailored content and peer support, balanced with concerns regarding information reliability and confidentiality, is applicable to other strategies for managing chronic disease.

For example, a systematic review of the benefits and limitations of social media in the context of chronic disease identified benefits increased interaction and social support, tailored and accessible information and limitations quality concerns and lack of reliability, confidentiality, and privacy [ 59 ] to those we identified.

Similarly, our finding of a reduction in diabetes distress in conjunction with no improvements in clinical outcomes echoes findings from intervention strategies targeting other chronic diseases.

For example, another systematic review examining the effect of social media on psychological and physical outcomes in chronic disease found a relatively large body of evidence demonstrating psychological benefit 19 identified studies but limited evidence for physical outcomes 4 identified studies [ 60 ].

This study was limited by its non-randomized design. However, we employed a repeated-measures design that permitted reliable assessment of baseline self-efficacy.

Although our primary outcome self-efficacy was a non-clinical outcome, it is a validated predictor of patient behaviour change and clinical outcomes [ 18 ],[ 20 ],[ 24 ],[ 25 ]. The infrequency of website use likely limited the effect of this intervention, but we obtained valuable insights regarding mediators of website use through our individual interviews.

This pre-exercise snack helps prevent unexpected hypoglycemia by providing the necessary fuel for physical activity and counteracting the potential decrease in circulating insulin during exercise.

Provide instructions on managing post-exercise hypoglycemia for patients taking insulin. Hypoglycemia can occur hours after exercise in patients taking insulin. To prevent post-exercise hypoglycemia, patients may need to consume a snack at the end of the exercise session and at bedtime, as well as monitor their blood glucose levels more frequently.

Patients who are capable, knowledgeable, and responsible can learn to adjust their insulin doses in collaboration with a diabetes educator. Others require specific instructions on managing their blood glucose levels during and after exercise.

Educate patients on regular blood glucose monitoring during extended periods of exercise. Patients taking insulin and engaging in extended periods of exercise should monitor their blood glucose levels before, during, and after the exercise period.

This monitoring helps them adjust their carbohydrate intake to maintain blood glucose levels within the target range. It is important for others involved in exercise activities to be aware that the person exercising has diabetes.

By informing exercise participants and observers, they can provide appropriate assistance in case of severe hypoglycemia. This promotes a safe exercise environment and ensures that prompt action can be taken if a diabetes-related emergency occurs. Provide education on exercise considerations for patients with diabetic complications.

Patients with diabetic complications, such as retinopathy, autonomic neuropathy, sensorimotor neuropathy, and cardiovascular disease, may require modifications in their exercise regimen.

Educate patient with diabetes on the importance of proper footwear and protective equipment. Wearing appropriate footwear and protective equipment reduces the risk of injuries during exercise. This is particularly important for individuals with diabetes, as they may have reduced sensation in their lower extremities due to peripheral neuropathy.

By emphasizing the use of proper footwear and protective equipment, nurses help prevent foot injuries and promote safety during exercise. Advise patients to meticulously inspect their feet daily after exercise. Patients with diabetes are at a higher risk of foot complications. By instructing patients to inspect their feet daily after exercise, nurses promote early detection of any foot abnormalities, such as blisters or wounds.

Timely identification and appropriate management of foot issues can prevent the development of serious complications, such as foot ulcers. Provide recommendations for avoiding exercise in extreme weather conditions and periods of poor metabolic control.

Extreme heat or cold can pose risks to individuals with diabetes during exercise. Additionally, exercising during periods of poor metabolic control may lead to unstable blood glucose levels.

By advising patients to avoid exercise in extreme weather conditions and during periods of poor metabolic control, nurses promote patient safety and help maintain stable blood glucose levels. Assess the physical capacity and functional limitations of older adults with diabetes before initiating an exercise program.

Older adults may have specific physical limitations, chronic conditions, or age-related changes that need to be considered when planning an exercise program.

Assessing their physical capacity and functional abilities helps determine appropriate exercises and adaptations to ensure safety and optimize the benefits of physical activity.

Develop an individualized exercise plan that includes low-impact activities, balance exercises, and flexibility training. Older adults may have reduced joint mobility , balance issues, and age-related musculoskeletal changes that require modifications in exercise programming.

Including low-impact activities e. Emphasize the importance of gradual progression and frequent rest breaks during exercise sessions. Older adults may need more time to adapt and recover from exercise due to decreased stamina and reduced exercise tolerance.

Encouraging gradual progression, such as increasing exercise duration or intensity in small increments, and incorporating frequent rest breaks during exercise sessions helps prevent overexertion, fatigue, and injury.

This approach supports older adults in safely building endurance and strength while minimizing the risk of adverse events. Provide education on the use of assistive devices and safe exercise techniques. Older adults may benefit from the use of assistive devices e. Teaching proper use of assistive devices and demonstrating safe exercise techniques help minimize the risk of falls, strains, and other injuries.

Incorporate social support and group activities for motivation and enjoyment. Older adults often thrive in supportive and socially engaging environments. Encouraging participation in group exercise classes, walking groups, or community-based programs fosters social interaction, motivation, and enjoyment.

The positive social aspect of exercise can enhance adherence and long-term commitment to regular physical activity among older adults with diabetes. Hyperglycemia is a common occurrence in hospitalized patients, particularly those admitted for the illness that led to hospitalization.

Several factors contribute to hyperglycemia, including changes in treatment regimen, medications such as corticosteroids, inadequate insulin therapy with IV dextrose, inappropriate insulin management, and mismatched timing of meals and insulin.

Nursing interventions play a crucial role in correcting these factors to prevent hyperglycemia. Monitor blood glucose levels regularly.

Blood glucose monitoring is a vital sign and provides essential information for assessing glycemic control. It helps identify hyperglycemia and informs the need for additional insulin doses. Obtain orders for extra doses of insulin when blood glucose levels are elevated.

Blood glucose monitoring results inform nurses of the need for additional doses of insulin. Administering additional doses of insulin at appropriate times helps manage hyperglycemia and promote glycemic control.

Do not withhold insulin when blood glucose levels are within the normal range. Withholding insulin when blood glucose levels are normal can lead to hyperglycemia. It is important to administer insulin consistently to maintain glycemic control.

Test blood glucose levels before meals and administer insulin at that time. Administering insulin before meals, based on premeal blood glucose levels, helps prevent postprandial hyperglycemia and promotes a physiologic response to glucose intake. Administer short-acting insulin to avoid postprandial hyperglycemia.

Short-acting insulin is necessary to control blood glucose levels after meals, even in patients with normal pre-meal glucose levels. Administering it at the appropriate time ensures effective glycemic control.

Be cautious with the use of corticosteroids e. Corticosteroids can induce hyperglycemia, so close monitoring of blood glucose levels is essential. Adjustments to insulin therapy may be necessary to maintain glycemic control. Use normal saline NS as the preferred solution for IV antibiotics , if possible, to minimize dextrose infusion.

Excessive infusion of dextrose through IV fluids can contribute to hyperglycemia. Using NS as the diluent for IV antibiotics helps avoid this potential cause of elevated blood glucose levels.

Avoid overly aggressive treatment of hypoglycemia. Aggressive treatment of hypoglycemia can lead to rebound hyperglycemia. Managing hypoglycemia with appropriate measures prevents subsequent hyperglycemia.

Hypoglycemia in hospitalized patients is often attributed to excessive insulin administration or delays in eating. Follow the established hospital protocol for treating hypoglycemia. Assess the pattern of glucose values and avoid repeated doses of insulin leading to hypoglycemia.

Adjustments in insulin therapy may be necessary to prevent recurrent hypoglycemia. Administer repeat treatments for hypoglycemia if the initial treatment does not sufficiently increase glucose levels, following the specified time interval e.

Repeat treatments allow for further correction of hypoglycemia if the initial intervention was insufficient. Limit successive doses of subcutaneous regular insulin to no more than every 3 to 4 hours. Administering multiple doses of regular insulin in quick succession increases the risk of hypoglycemia.

Adhering to appropriate dosing intervals helps maintain glycemic stability. Exercise caution when administering supplemental doses of regular insulin in patients receiving intermediate insulin before breakfast and dinner. Careful consideration is needed when providing additional regular insulin doses in patients who are already receiving intermediate-acting insulin.

Timing and dosage adjustments should be made to prevent overlapping peaks and subsequent hypoglycemia. Arrange for snacks to be given if meals are delayed due to procedures, physical therapy, or other activities. Delayed food intake can contribute to hypoglycemia.

Providing snacks as needed helps maintain glucose levels and prevent hypoglycemic reactions in patients whose meals are delayed. Monitor the patient for signs and symptoms of hypoglycemia, such as sweating, tremor, tachycardia, confusion , and changes in behavior.

Regular monitoring allows the nurse to detect early signs of hypoglycemia and intervene promptly to prevent complications. Immediate administration of carbohydrates helps restore blood glucose levels and alleviate hypoglycemic symptoms.

Prepare and administer glucagon, as prescribed, in emergency situations when the patient is unconscious or unable to swallow. Glucagon stimulates the liver to release stored glucose, rapidly increasing blood glucose levels. Administration of glucagon can be life-saving in severe hypoglycemia.

Provide emotional support and reassurance to the patient during episodes of hypoglycemia, addressing any fears or concerns they may have. Emotional support helps alleviate anxiety and encourages the patient to actively participate in their diabetes management.

Educate the patient and their family or caregivers on recognizing and managing hypoglycemic episodes, including the use of fast-acting carbohydrates and glucagon.

Patient and caregiver education promotes awareness and empowers them to respond effectively to hypoglycemia, ensuring timely treatment. Educate the patient on the signs and symptoms of hypoglycemia and the importance of early recognition and prompt treatment.

Early recognition of hypoglycemia allows for timely intervention and prevents the condition from worsening. Prompt treatment helps restore blood glucose levels to a safe range, preventing complications and promoting patient well-being.

Instruct the patient on the appropriate management of hypoglycemia with fast-acting sources of carbohydrate, such as fruit juice or glucose tablets. Fast-acting carbohydrates quickly raise blood glucose levels, providing immediate relief from hypoglycemic symptoms.

Patients need to be aware of the recommended sources of carbohydrates and the appropriate quantities to consume for effective management. Teach patients and their families or caregivers about the use of glucagon in emergency situations when the patient is unconscious or unable to swallow.

Glucagon is a life-saving hormone that stimulates the liver to release stored glucose, raising blood glucose levels rapidly.

It is crucial for family members and caregivers to understand how to administer glucagon in emergency situations to ensure timely treatment.

Emphasize the importance of regular blood glucose monitoring, especially before driving or engaging in potentially dangerous activities.

Regular blood glucose monitoring helps patients with diabetes assess their glycemic status and anticipate changes in insulin requirements. It enables them to take appropriate actions to prevent hypoglycemia and maintain safe blood glucose levels. Provide education on lifestyle factors that can contribute to hypoglycemia, such as meal timing, physical activity, and medication adherence.

Proper meal planning, adherence to medication schedules, and awareness of the impact of physical activity help patients prevent hypoglycemia. Education empowers patients to make informed decisions and take proactive steps to manage their condition effectively. Encourage patients to carry a source of simple sugar e.

Carrying a source of fast-acting carbohydrates ensures that patients can quickly treat hypoglycemia, even in situations where other food options may not be readily available. It promotes patient autonomy and preparedness for managing hypoglycemic episodes. Monitor the patient for signs and symptoms of DKA, including hyperglycemia, dehydration , electrolyte imbalances, and acidosis.

Regular monitoring allows for early detection of DKA and prompt intervention to prevent complications. Administer intravenous fluids , such as normal saline NS or half-strength NS, as indicated and at the prescribed rate, to rehydrate the patient and restore tissue perfusion.

Rehydration is crucial in managing DKA to maintain fluid balance , improve tissue perfusion, and facilitate the excretion of excess glucose and ketones.

Monitoring vital signs helps identify signs of dehydration or fluid overload and guides appropriate fluid management. Monitor electrolyte levels, particularly potassium , and replace electrolytes as indicated to maintain balance and prevent dysrhythmias.

DKA can cause electrolyte imbalances, including hyperkalemia or hypokalemia, which require careful monitoring and timely replacement to prevent complications. Cautious administration of potassium supplements helps prevent rapid potassium fluctuations and the risk of hyperkalemia.

It ensures a gradual and controlled increase in serum potassium levels. Administer insulin therapy as prescribed, usually through continuous intravenous infusion, to reverse acidosis and promote glucose utilization.

Insulin administration inhibits fat breakdown, stops ketone production, and helps correct acidosis in DKA. Continuous infusion ensures a steady supply of insulin until subcutaneous insulin therapy can be resumed. Proper management during illness helps prevent DKA episodes and promotes early intervention to maintain glycemic control.

For more information, please visit: 4 Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome Nursing Care Plans. Monitor the patient for signs and symptoms of HHS, including hypotension , profound dehydration, tachycardia, and neurologic changes.

Regular monitoring allows for early detection of HHS and prompt intervention to prevent complications. Administer intravenous fluids, such as 0. Rehydration is essential in managing HHS to improve tissue perfusion, correct dehydration, and restore fluid balance.

Monitoring vital signs, fluid balance, and electrolyte levels helps identify dehydration, electrolyte imbalances, and prevents complications such as fluid overload or cardiac dysrhythmias. Close monitoring of fluid balance and urine output is crucial due to the high risk of kidney failure resulting from severe dehydration.

As HHS commonly affects older patients, the nurse should take into account the physiological changes associated with aging. It is important for the nurse to carefully assess cardiovascular, pulmonary, and kidney function throughout the acute and recovery phases of HHS to ensure appropriate management and prevent complications.

Administer potassium supplements as indicated and monitor potassium levels closely to maintain electrolyte balance and prevent cardiac dysrhythmias. Potassium replacement is necessary to correct electrolyte imbalances and prevent complications related to hypokalemia or hyperkalemia.

Administer insulin therapy as prescribed to treat hyperglycemia and promote glucose utilization. Although insulin plays a lesser role in HHS compared to DKA, it is still administered to manage hyperglycemia.

Continuous low-rate insulin infusion is usually given to achieve glycemic control. Monitor neurologic status closely, including mental status changes and focal neurologic deficits, to assess the response to treatment and identify any complications related to cerebral dehydration.

Monitoring neurological status helps determine the effectiveness of treatment and allows for early intervention if neurologic complications arise. Provide patient education on self-management strategies, including medication adherence, lifestyle modifications, and regular self-monitoring of blood glucose levels.

Patient education empowers the individual to manage their condition effectively, prevent recurrence of HHS, and maintain optimal glycemic control.

ASCVD atherosclerotic cardiovascular disease is a significant cause of morbidity and mortality in individuals with diabetes.

It primarily affects the medium to large blood vessels, leading to thickening, sclerosis, and plaque formation, which eventually obstruct blood flow. The three main types of macrovascular complications seen frequently in diabetes are coronary artery disease , cerebrovascular disease, and peripheral arterial disease.

Assess cardiovascular risk factors. Individuals with diabetes have a higher risk of myocardial infarction MI , which is more common and carries an increased likelihood of complications and recurrent events compared to those without diabetes.

Identifying and assessing these risk factors helps in developing an individualized care plan and determining the appropriate management strategies. Educate the patient on the importance of risk factor control.

Provide education on the significance of managing risk factors such as obesity, hypertension , dyslipidemia, and smoking cessation. Patient education empowers individuals to take an active role in managing their risk factors, promoting better control and reducing the likelihood of macrovascular complications.

Monitor blood pressure regularly. Measure blood pressure at each routine clinical visit and encourage patients to monitor their blood pressure at home. Hypertension control is essential in individuals with diabetes, and regular blood pressure monitoring, both at clinical visits and at home, is recommended.

Regular blood pressure monitoring helps in identifying and managing hypertension, a significant risk factor for ASCVD, and allows for timely intervention and treatment adjustments. Treatment targets should be individualized based on cardiovascular risk factors and patient preferences.

Lifestyle interventions, such as weight loss, adopting a Dietary Approaches to Stop Hypertension DASH eating pattern, reducing sodium intake, and increasing physical activity, are recommended. Pharmacologic interventions, including antihypertensive drug therapy, are initiated when blood pressure is persistently elevated, and combination therapy may be necessary to achieve targets.

Encourage lifestyle modifications. Promote adherence to lifestyle interventions, including medical nutrition therapy MNT , weight loss when indicated, adoption of a Dietary Approaches to Stop Hypertension DASH eating pattern, reduction of sodium intake, moderation of alcohol consumption, and increased physical activity.

Lifestyle modifications play a crucial role in managing obesity, hypertension, and hyperlipidemia, reducing the risk of ASCVD and macrovascular complications. Administer medications as prescribed. Ensure the patient receives prescribed medications for managing hypertension, hyperlipidemia, and diabetes.

Lipid management plays a crucial role in preventing ASCVD in diabetes. Lifestyle modifications, such as weight loss, adopting a Mediterranean or DASH eating pattern, reducing saturated and trans fats, and increasing physical activity, are recommended.

Lipid profiles should be obtained regularly, and statin therapy is recommended for primary and secondary prevention based on age, ASCVD risk factors, and baseline LDL cholesterol levels. Additional lipid-lowering agents, such as ezetimibe or icosapent ethyl, may be considered in certain cases.

Pharmacologic interventions are necessary to achieve optimal control of blood pressure, lipid levels, and glucose management, reducing the risk of macrovascular complications. Antiplatelet therapy with aspirin is recommended for secondary prevention in individuals with diabetes and a history of ASCVD.

Dual antiplatelet therapy may be considered after an acute coronary syndrome. Screening for coronary artery disease is not recommended in asymptomatic individuals if ASCVD risk factors are adequately treated.

However, investigations for CAD are indicated in the presence of atypical cardiac symptoms, signs of associated vascular disease, or ECG abnormalities. Monitor blood glucose levels.

Regularly assess and monitor blood glucose levels in patients with symptoms suggestive of acute diabetic complications or stroke. Elevated blood glucose levels can worsen the outcome of a stroke and may mimic symptoms of acute diabetic complications, making it crucial to assess and treat abnormal glucose levels promptly.

Cerebrovascular disease is also more prevalent in individuals with diabetes, increasing the risk of transient ischemic attacks and strokes. Prompt assessment of blood glucose levels is crucial in differentiating stroke symptoms from acute diabetic complications.

Diabetes-related atherosclerosis affects the large blood vessels in the lower extremities, leading to occlusive peripheral arterial disease and an increased risk of gangrene and amputation. Diabetic foot disease is also influenced by neuropathy and impaired wound healing.

Promote adherence to statin therapy. Educate patients about the importance of adhering to statin therapy for lipid management, especially for individuals with ASCVD or high cardiovascular risk.

Statin therapy has proven benefits in reducing LDL cholesterol and preventing cardiovascular events in individuals with diabetes and ASCVD.

Nursing management plays a vital role in implementing individual care plans and educating patients. Patient education emphasizes the importance of regular eye examinations, glycemic and blood pressure control, and self-care for eye health.

Conduct frequent visual examinations using appropriate tools and techniques to monitor changes in visual acuity and identify potential signs of retinopathy progression. Regular visual assessments by nurses help in detecting early signs of retinal changes and allow for timely intervention and referral to ophthalmology specialists.

Screening recommendations include initial and subsequent dilated eye examinations by ophthalmologists or optometrists, with increased frequency if retinopathy is present or progressing. Provide comprehensive education to patients regarding the significance of regular eye examinations, adherence to prescribed medications, and self-care practices to maintain optimal eye health.

Education empowers patients with knowledge and promotes proactive engagement in eye care, facilitating early intervention and better management of diabetic retinopathy. Retinal photography programs can be alternative screening strategies.

Treatment recommendations emphasize prompt referral for management of macular edema and any level of nonproliferative or proliferative retinopathy. Emphasize to patients the role of consistent blood glucose management through medication adherence, lifestyle modifications, and regular monitoring.

Maintaining normal or near-normal blood glucose levels through intensive insulin therapy and patient education significantly reduces the risk and progression of retinopathy in both type 1 and type 2 diabetes.

Nurses play a crucial role in reinforcing the importance of glycemic control, as it directly impacts the progression of retinopathy and reduces the risk of vision loss.

Assist patients in making transportation arrangements to ensure they can attend regular ophthalmology appointments and follow-up visits for retinopathy management. Many patients with visual impairments may face challenges in accessing transportation. By helping them secure transportation options, nurses promote continuity of care and timely interventions.

Provide detailed instructions on the correct administration techniques, dosage schedules, and potential side effects of prescribed eye medications used for retinopathy management. Proper medication administration is crucial for the effectiveness of treatment. Nurse education empowers patients to self-administer eye medications correctly, promoting treatment adherence and better outcomes.

Regularly assess and monitor for complications associated with retinopathy, such as macular edema or vitreous hemorrhage , and promptly communicate any changes to the healthcare team for appropriate intervention. Early detection and management of complications can prevent further visual impairment and improve the chances of preserving vision in patients with diabetic retinopathy.

Teach patients self-care techniques for maintaining eye health, including proper eye hygiene, protection from UV light, and recognition of warning signs requiring immediate medical attention. Empowering patients with self-management skills enhances their ability to actively participate in the prevention and early detection of complications related to diabetic retinopathy.

Nephropathy is a common complication of diabetes, characterized by kidney disease resulting from microvascular changes. Regular monitoring of blood glucose levels helps assess glycemic control and identify any fluctuations that may contribute to kidney dysfunction.

It allows for timely adjustments in medication dosages or treatment plans. Intensive blood glucose control has been shown to reduce early signs of nephropathy in type 1 diabetes, while managing blood glucose levels effectively in type 2 diabetes can lower the incidence of overt nephropathy.

Assess urinary albumin levels annually and check for the presence of microalbumin in the urine. Urinary albumin is an early indicator of kidney damage. Detecting microalbuminuria allows for early intervention and treatment to prevent the progression of nephropathy.

People with established diabetic kidney disease DKD should have monitoring of urinary albumin and eGFR times per year depending on the stage of the disease. Monitor serum creatinine and BUN levels. Conduct regular assessments of serum creatinine and blood urea nitrogen BUN levels. Serum creatinine and BUN levels help evaluate kidney function.

Monitoring these levels annually aids in detecting any decline in kidney function and guides treatment decisions. Administer angiotensin-converting enzyme ACE inhibitors or angiotensin receptor blockers ARBs , as indicated, to manage hypertension in patients with diabetes and kidney disease.

Hypertension is a common complication in patients with diabetes and can contribute to kidney damage. ACE inhibitors and ARBs help control blood pressure and reduce proteinuria , thus protecting the kidneys. ACE inhibitors or ARBs are not recommended for the primary prevention of CKD in people with diabetes who have normal blood pressure, normal urinary albumin, and normal eGFR.

Encourage a low-sodium and low-protein diet. Educate the patient about the importance of following a diet low in sodium and protein. A low-sodium diet helps manage hypertension, while a low-protein diet reduces the workload on the kidneys.

These dietary modifications can slow the progression of kidney disease and minimize complications. Monitor for signs of worsening kidney function. Assess the patient regularly for signs and symptoms of declining kidney function, such as increased proteinuria, decreased urine output, fluid retention, and changes in electrolyte levels.

Early identification of worsening kidney function enables timely interventions and prevents further damage.

Close monitoring helps in adjusting treatment plans and preventing complications. Infectious diseases are more frequent and more serious in patients with diabetes mellitus due to the hyperglycemic environment that favors immune dysfunction e.

Monitor for the signs of infection and inflammation: fever , flushed appearance, wound drainage, purulent sputum, cloudy urine. Early diagnosis and treatment of infections can control their severity and decreases complications.

Patients with diabetes may be admitted with infection, which could have precipitated the ketoacidosis state. They may also develop a nosocomial infection. Teach and promote good hand hygiene. Hand hygiene is the single most effective way to prevent the transmission of diseases.

Maintain asepsis during IV insertion, administration of medications, and providing wound or site care. Rotate IV sites as indicated. Increased glucose in the blood creates an excellent medium for immune dysfunction and for pathogens to thrive. Provide catheter or perineal care.

Teach female patients to clean from front to back after elimination. Urinary tract infections are more prevalent in individuals with diabetes.

Diabetes is a predisposing factor for vaginitis. Poor perineal hygiene increases the risk of vaginitis and can spread through the urinary tract causing infection.

Provide meticulous skincare by gently massaging bony areas, keeping skin dry. Keep linens dry and wrinkle-free. An impairment or ineffective peripheral circulation can place the patient at risk for increased skin breakdown and the development of infection.

Recommend obtaining vaccines, as indicated. Streptococcus pneumonia and influenza virus are the most frequent respiratory infections associated with persons with diabetes.

They are six times more likely to need hospitalizations during influenza epidemics than non-diabetic patients. Anti-pneumococcal and influenza vaccines are recommended. Diabetic neuropathy encompasses various nerve disorders affecting peripheral, autonomic, and spinal nerves.

Elevated blood glucose levels over time contribute to the development of neuropathy, and controlling blood glucose levels can reduce its incidence. The underlying causes involve vascular and metabolic factors, including capillary basement membrane thickening, capillary closure, demyelination of nerves, and disruptions in nerve conduction.

Peripheral neuropathy primarily impacts the distal areas of the nerves, particularly those in the lower extremities. It tends to affect both sides of the body equally and can potentially extend in a proximal direction. Diabetic neuropathy can be asymptomatic in some patients, but it may manifest as paresthesias, burning sensations, and numbness in the feet.

This can lead to decreased proprioception, light touch sensation, and an unsteady gait. Reduced pain and temperature sensations increase the risk of unnoticed foot injuries and infections. Charcot joints, foot deformities, can also occur. Physical examination reveals decreased reflexes and vibratory sensation, providing important indicators of neuropathic changes.

Other potential causes should be ruled out in patients with neuropathy symptoms. Educate the patient about the importance of maintaining optimal blood glucose control through intensive insulin therapy, emphasizing the correlation between glycemic control and the delay in the onset and progression of neuropathy.

Proper blood glucose control helps in minimizing nerve damage and reducing the severity of symptoms associated with diabetic neuropathy. Provide education on foot care and hygiene, including daily foot inspections, proper cleaning, moisturizing, and protection of the feet to prevent injuries, infections, and foot deformities.

Teaching patients about foot care promotes early detection of foot problems, reduces the risk of complications, and improves overall foot health in individuals with neuropathy. Administer prescribed analgesic agents, such as non opioid medications, as part of a comprehensive pain management plan to alleviate neuropathic pain in the lower extremities.

Initial pharmacologic treatments for neuropathic pain in diabetes include gabapentinoids, serotonin- norepinephrine reuptake inhibitors SNRIs , tricyclic antidepressants TCAs , and sodium channel blockers. Assess for paresthesias, burning sensations, and numbness.

Perform regular neurologic assessments including deep tendon reflexes, vibratory sensation, and evaluation of proprioception to monitor for changes in neuropathy status.

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Be mindful of portion sizes. Learn what portion size is right for each type of food. Everyday objects can help you remember. For example, one serving of self-fare or poultry is about the size pkans a deck of cards.

A serving of cheese is about the size of six grapes. And a serving of cooked pasta or rice is about the size of a fist. You also can use measuring cups or a scale to help make sure you get the right portion sizes.

Balance your meals and medicines. If you take diabetes medicine, it's important to balance what you eat and drink with your medicine. Too little food in proportion to your diabetes medicine — especially insulin — can lead to dangerously low blood sugar.

This is called hypoglycemia. Too much food may cause your blood sugar level to climb too high. This is called hyperglycemia.

Talk to your diabetes health care team about how to best coordinate meal and medicine schedules. Limit sugary drinks. Sugar-sweetened drinks tend to be high in calories and low in nutrition. They also cause blood sugar to rise quickly. So it's best to limit these types of drinks if you have diabetes.

The exception is if you have a low blood sugar level. Sugary drinks can be used to quickly raise blood sugar that is too low. These drinks include regular soda, juice and sports drinks. Exercise is another important part of managing diabetes. When you move and get active, your muscles use blood sugar for energy.

Regular physical activity also helps your body use insulin better. These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts.

But even light activities can improve your blood sugar level. Light activities include housework, gardening and walking. Talk to your healthcare professional about an exercise plan. Ask your healthcare professional what type of exercise is right for you.

In general, most adults should get at least minutes a week of moderate aerobic activity. That includes activities that get the heart pumping, such as walking, biking and swimming. Aim for about 30 minutes of moderate aerobic activity a day on most days of the week.

Most adults also should aim to do strength-building exercise 2 to 3 times a week. If you haven't been active for a long time, your healthcare professional may want to check your overall health first. Then the right balance of aerobic and muscle-strengthening exercise can be recommended.

Keep an exercise schedule. Ask your healthcare professional about the self-carf time of day for you to exercise. That way, your workout routine is aligned with your meal and medicine schedules.

Know your numbers. Talk with your healthcare professional about what blood sugar levels are right for you before you start exercise. Check your blood sugar level. Also talk with your healthcare professional about your blood sugar testing needs. If you don't take insulin or other diabetes medicines, you likely won't need to check your blood sugar before or during exercise.

But if you take insulin or other diabetes medicines, testing is important. Check your blood sugar before, during and after exercise. Many diabetes medicines lower blood sugar. So does exercise, and its effects can last up to a day later. The risk of low blood sugar is greater if the activity is new to you.

The risk also is greater if you start to exercise at a more intense level. Be aware of symptoms of low blood sugar.

These include feeling shaky, weak, tired, hungry, lightheaded, irritable, anxious or confused. See if you need a snack. Have a small snack before you exercise if you use insulin and your blood sugar level is low. The snack you have before exercise should contain about 15 to 30 grams of carbs.

Or you could take 10 to 20 grams of glucose products. This helps prevent a low blood sugar level. Stay hydrated. Drink plenty of water or other fluids while exercising. Dehydration can affect blood sugar levels. Be prepared. Always have a small snack, glucose tablets or glucose gel with you during exercise.

: Implementing self-care plans for diabetes

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Management and self-care - Diabetes Canada

People with diabetes can learn self-management skills through diabetes self-management education and support DSMES programs. DSMES programs provide both education and ongoing support to control and manage diabetes.

These programs help people learn self-management skills and provide support to sustain self-management behaviors. DSMES programs have helped people with diabetes lower blood sugar glucose levels, prevent complications, improve quality of life, and reduce healthcare costs.

The Stanford Diabetes Self-Management program is an evidence-based approach designed to improve diabetes self-management practices, and delivered by certified educators.

While it is important for people with diabetes to develop and engage in self-management practices, self-management can also involve family members, friends, or other caregivers.

These individuals can offer emotional support, model healthy behaviors, participate in exercise activities, help monitor blood sugar glucose levels, administer insulin or other medications, and open communication around effective self-management practices.

Enhanced social support from family and friends can help build self-efficacy for diabetes self-management. Self-efficacy, related to diabetes self-management, is an individual's belief in their ability to successfully manage their own health needs. Self-efficacy is important for effective diabetes self-management.

It is important that patients understand the benefit of diabetes self-management activities. Programs can encourage healthcare providers to speak openly with patients about self-management and refer patients to self-management programs.

Patients with diabetes should be encouraged to ask questions and be reminded that these activities can help them to achieve successful disease management. Diabetes Self-Management Education and Support in Rural America Website An overview of the benefits of diabetes self-management programs.

Describes different types of diabetes self-management education and support programs available to communities. Organization s : Centers for Disease Control and Prevention CDC. Diabetes Self-Management Education and Support Website Provides links to resources and tools to help communities develop, promote, implement and sustain diabetes self-management education and support DSMES programs.

Includes a DSMES toolkit, technical assistance guide, policies, reports, and several case studies. Diabetes Self-Management Program DSMP Website Describes the Stanford self-management model, an evidence-based program delivered by certified trainers, designed to improve diabetes self-management practices.

The trainers are non-health professionals who may have diabetes themselves and have completed the master training program. Includes educational resources that supplement the program curriculum. Organization s : Self-Management Resource Center. Realizing the multi-faceted nature of the problem, a systematic, multi-pronged and an integrated approach is required for promoting self-care practices among diabetic patients to avert any long-term complications.

Astrid N. van Smoorenburg, Dorijn F. Hertroijs, … Marijke Melles. Diabetes mellitus DM is a chronic progressive metabolic disorder characterized by hyperglycemia mainly due to absolute Type 1 DM or relative Type 2 DM deficiency of insulin hormone[ 1 ].

DM virtually affects every system of the body mainly due to metabolic disturbances caused by hyperglycemia, especially if diabetes control over a period of time proves to be suboptimal[ 1 ].

Until recently it was believed to be a disease occurring mainly in developed countries, but recent findings reveal a rise in number of new cases of type 2 DM with an earlier onset and associated complications in developing countries[ 2 — 4 ].

Diabetes is associated with complications such as cardiovascular diseases, nephropathy, retinopathy and neuropathy, which can lead to chronic morbidities and mortality[ 5 , 6 ].

World Health Organization WHO estimates that more than million people worldwide have DM. According to WHO report, India today heads the world with over 32 million diabetic patients and this number is projected to increase to One of the biggest challenges for health care providers today is addressing the continued needs and demands of individuals with chronic illnesses like diabetes[ 12 ].

The importance of regular follow-up of diabetic patients with the health care provider is of great significance in averting any long term complications. Studies have reported that strict metabolic control can delay or prevent the progression of complications associated with diabetes[ 13 , 14 ].

Some of the Indian studies revealed very poor adherence to treatment regimens due to poor attitude towards the disease and poor health literacy among the general public[ 15 , 16 ]. The introduction of home blood glucose monitors and widespread use of glycosylated hemoglobin as an indicator of metabolic control has contributed to self-care in diabetes and thus has shifted more responsibility to the patient[ 17 , 18 ].

Self-care in diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of the diabetes in a social context[ 20 , 21 ].

There are seven essential self-care behaviors in people with diabetes which predict good outcomes. These are healthy eating, being physically active, monitoring of blood sugar, compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviors[ 26 ].

These proposed measures can be useful for both clinicians and educators treating individual patients and for researchers evaluating new approaches to care.

Self-report is by far the most practical and cost-effective approach to self-care assessment and yet is often seen as undependable. Diabetes self-care activities are behaviors undertaken by people with or at risk of diabetes in order to successfully manage the disease on their own[ 26 ].

All these seven behaviors have been found to be positively correlated with good glycemic control, reduction of complications and improvement in quality of life[ 27 — 31 ]. In addition, it was observed that self-care encompasses not only performing these activities but also the interrelationships between them[ 32 ].

Diabetes self-care requires the patient to make many dietary and lifestyle modifications supplemented with the supportive role of healthcare staff for maintaining a higher level of self-confidence leading to a successful behavior change[ 33 ].

Though genetics play an important role in the development of diabetes, monozygotic twin studies have certainly shown the importance of environmental influences[ 34 ]. Individuals with diabetes have been shown to make a dramatic impact on the progression and development of their disease by participating in their own care[ 13 ].

This participation can succeed only if those with diabetes and their health care providers are informed about taking effective care for the disease.

It is expected that those with the greatest knowledge will have a better understanding of the disease and have a better impact on the progression of the disease and complications. The American Association of Clinical Endocrinologists emphasizes the importance of patients becoming active and knowledgeable participants in their care[ 35 ].

Likewise, WHO has also recognized the importance of patients learning to manage their diabetes[ 36 ]. The American Diabetes Association had reviewed the standards of diabetes self management education and found that there was a four-fold increase in diabetic complications for those individuals with diabetes who had not received formal education concerning self-care practices[ 37 ].

A meta-analysis of self-management education for adults with type-2 diabetes revealed improvement in glycemic control at immediate follow-up. However, the observed benefit declined one to three months after the intervention ceased, suggesting that continuing education is necessary[ 38 ].

A review of diabetes self-management education revealed that education is successful in lowering glycosylated hemoglobin levels[ 39 ]. Diabetes education is important but it must be transferred to action or self-care activities to fully benefit the patient. Self-care activities refer to behaviors such as following a diet plan, avoiding high fat foods, increased exercise, self-glucose monitoring, and foot care[ 40 ].

Changes in self-care activities should also be evaluated for progress toward behavioral change[ 41 ]. Self-monitoring of glycemic control is a cornerstone of diabetes care that can ensure patient participation in achieving and maintaining specific glycemic targets.

The most important objective of monitoring is the assessment of overall glycemic control and initiation of appropriate steps in a timely manner to achieve optimum control. Self-monitoring provides information about current glycemic status, allowing for assessment of therapy and guiding adjustments in diet, exercise and medication in order to achieve optimal glycemic control.

Irrespective of weight loss, engaging in regular physical activity has been found to be associated with improved health outcomes among diabetics[ 42 — 45 ]. The National Institutes of Health[ 46 ] and the American College of Sports Medicine[ 47 ] recommend that all adults, including those with diabetes, should engage in regular physical activity.

Treatment adherence in diabetes is an area of interest and concern to health professionals and clinical researchers even though a great deal of prior research has been done in the area.

In diabetes, patients are expected to follow a complex set of behavioral actions to care for their diabetes on a daily basis. These actions involve engaging in positive lifestyle behaviors, including following a meal plan and engaging in appropriate physical activity; taking medications insulin or an oral hypoglycemic agent when indicated; monitoring blood glucose levels; responding to and self-treating diabetes- related symptoms; following foot-care guidelines; and seeking individually appropriate medical care for diabetes or other health-related problems[ 48 ].

The majority of patients with diabetes can significantly reduce the chances of developing long-term complications by improving self-care activities. In the process of delivering adequate support healthcare providers should not blame the patients even when their compliance is poor[ 49 ].

One of the realities about type-2 diabetes is that only being compliant to self-care activities will not lead to good metabolic control. Research work across the globe has documented that metabolic control is a combination of many variables, not just patient compliance[ 51 , 52 ]. In an American trial, it was found that participants were more likely to make changes when each change was implemented individually.

Success, therefore, may vary depending on how the changes are implemented, simultaneously or individually[ 53 ]. Some of the researchers have even suggested that health professionals should tailor their patient self-care support based on the degree of personal responsibility the patient is willing to assume towards their diabetes self-care management[ 54 ].

The role of healthcare providers in care of diabetic patients has been well recognized. Socio-demographic and cultural barriers such as poor access to drugs, high cost, patient satisfaction with their medical care, patient provider relationship, degree of symptoms, unequal distribution of health providers between urban and rural areas have restricted self-care activities in developing countries[ 39 , 55 — 58 ].

Another study stressed on both patient factors adherence, attitude, beliefs, knowledge about diabetes, culture and language capabilities, health literacy, financial resources, co-morbidities and social support and clinician related factors attitude, beliefs and knowledge about diabetes, effective communication [ 60 ].

Because diabetes self-care activities can have a dramatic impact on lowering glycosylated hemoglobin levels, healthcare providers and educators should evaluate perceived patient barriers to self-care behaviors and make recommendations with these in mind. Unfortunately, though patients often look to healthcare providers for guidance, many healthcare providers are not discussing self-care activities with patients[ 61 ].

Some patients may experience difficulty in understanding and following the basics of diabetes self-care activities. When adhering to self-care activities patients are sometimes expected to make what would in many cases be a medical decision and many patients are not comfortable or able to make such complex assessments.

It is critical that health care providers actively involve their patients in developing self-care regimens for each individual patient. This regimen should be the best possible combination for every individual patient plus it should sound realistic to the patient so that he or she can follow it[ 62 ].

Also, the need of regular follow-up can never be underestimated in a chronic illness like diabetes and therefore be looked upon as an integral component of its long term management. A clinician should be able to recognize patients who are prone for non-compliance and thus give special attention to them.

On a grass-root level, countries need good diabetes self-management education programs at the primary care level with emphasis on motivating good self-care behaviors especially lifestyle modification. Furthermore, these programs should not happen just once, but periodic reinforcement is necessary to achieve change in behavior and sustain the same for long-term.

While organizing these education programs adequate social support systems such as support groups, should be arranged. As most of the reported studies are from developed countries so there is an immense need for extensive research in rural areas of developing nations. Concurrently, field research should be promoted in developing countries about perceptions of patients on the effectiveness of their self-care management so that resources for diabetes mellitus can be used efficiently.

To prevent diabetes related morbidity and mortality, there is an immense need of dedicated self-care behaviors in multiple domains, including food choices, physical activity, proper medications intake and blood glucose monitoring from the patients.

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Introduction The health system may be limited in changing some of these conditions but needs to help each person navigate their situation to maximize their choices that affect their health. BMC Medical Informatics and Decision Making volume 14 , Article number: Cite this article. Emphasize the need to keep the feet clean, dry, and moisturized. There are seven essential self-care behaviors in people with diabetes which predict good outcomes namely healthy eating, being physically active, monitoring of blood sugar, compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviors. J Gen Intern Med. Emphasize the importance of not injecting cloudy insulin into a vial of clear insulin to prevent contamination and alteration of insulin action. Effective insulin management is vital for optimal diabetes control.
Type 2 Diabetes Self-Care: Blood Sugar, Mental Health, Medications, and Meals Provide guidance on proper meter cleaning and maintenance. Describes different types of diabetes self-management education and support programs available to communities. The other eight participants were excluded because of missing data for HbA1c, blood pressure, LDL-C, or weight within 90 days of the self-efficacy data or because no data were obtained after implementation of the intervention. For patients For patients. What does self-care mean for individuals with diabetes? Additional support from the entire care team and referral to DSMES are appropriate responses to any of these needs.
Role of self-care in management of diabetes mellitus Nutritional support for digestion PubMed Google Scholar Ruppert K, Uhler A, Siminerio L: Examining patient risk factors, comorbid conditions, participation, Implementing self-care plans for diabetes plasn referrals Implementing self-care plans for diabetes a rural pland self-management education program. Some people may need Implementinf check a couple of times a day, while others may choose to check their blood sugars more frequently. How to manage diabetes. Research Faculty. How does diabetes develop? Frequent DSMES visits may be needed when the individual is starting a new diabetes medication such as insulin 64is experiencing unexplained hypoglycemia or hyperglycemia, has worsening clinical indicators, or has unmet goals. PDF 1 MB.
Chronic Disease Anti-arthritic effects Rural Sdlf-care This topic guide Implementing self-care plans for diabetes the latest diavetes, events, Mediterranean diet and culinary traditions, and funding related to diabetes, as well as a comprehensive overview of related issues. Diabetes self-management refers to the activities and behaviors an individual undertakes to control and treat their condition. People with diabetes must monitor their health regularly. Diabetes self-management typically occurs in the home and includes:. People with diabetes can learn self-management skills through diabetes self-management education and support DSMES programs.

Author: Vudolar

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