THE TEAM APPROACH TO CARE IN DIABETES

THE TEAM APPROACH TO CARE IN DIABETES   Susan Streitz, LRD, CDE Marilyn Chandler, RN, CDE  Spring Bakke, Exercise Specialist OBJECTIVES  To describe the importance of exercise therapy in diabetes management. To describe how lifestyle modification, including exercise therapy, may prevent or delay the onset of diabetes. To discuss why dietary management is critical to the success of any diabetes treatment plan. To discuss the place of “fad diets” in diabetes care. To discuss the role of the Certified Diabetes Educator in diabetes management. To describe how the CDE assesses glycemic control and recommends changes in management.      ELEMENTS OF SUCCESSFUL DIABETES MANAGEMENT        Healthy Eating Being Active Monitoring Taking Medication Problem Solving Reducing Risks Healthy Coping Goal of Medical Nutrition Therapy  …To assist persons with diabetes in making self-directed behavior changes that will improve their overall diabetes management and/or nutrition status. ELEMENT #1: HEALTHY EATING  Goal: Achieving desirable A1C – How:  Learning how food affects diabetes management and overall health  Ideally learn carb counting –Essential to work with insulin: carb ratios. HEALTHY EATING (CONTINUED)  Goal: Achieve optimal lipid levels  Goal: Maintain “reasonable body weight” – How:  Focus on small changes consistently.  Appropriate meal planning  Portion control – How:  Focus on being healthy, not blood sugar exclusively.  Know sources of fat Carbs have gotten the reputation of being evil DEALING WITH “FAD DIETS”    Focus on the positive Inform of the negative Give choices ELEMENT #2: PROBLEM SOLVING/HEALTH COPING  Address barriers to healthy eating: knowledge does not mean behavior change. Chronic Barriers….  After starting a new diet, I changed the way I drove to work so I would avoid passing my favorite bakery. This morning, I accidentally drove by the bakery, and as I approached, there in the window was a host of goodies. I felt this was no accident, so I prayed, ... "Lord, it's up to you. If you want me to have any of those delicious goodies, create a parking place for me directly in front of the bakery." And sure enough, ... on the eighth time around the block, there it was! God is so good!" ENVIRONMENTAL TRIGGERS Weekends  Treats at work  Evening television  Socializing  EMOTIONAL TRIGGERS First step is awareness  Strategies to overcome  FINANCIAL FACTORS Not a matter of “compliance”  CULTURAL FACTORS  What are their values  Factors cannot be ignored: Too involved to be addressed in one to two sessions. READINESS FOR CHANGE/MOTIVATIONAL INTERVIEWING   Encourage patient to ID and verbally express their reasons for change Express how current behaviors affect their ability to achieve their goals and live out their values Medical Nutrition Therapy has Changed! from one of restrictions to one of flexibility and patient empowerment.* *The philosophy has changed DIABETES ISN’T EASY DIABETES EDUCATION GOALS      Provide knowledge and skills training Facilitate problem-solving Help individuals identify barriers Motivate for lifestyle changes Develop coping skills to achieve goals DIABETES SELFMANAGEMENT EDUCATION   Begins with an assessment Development of an instructional plan *based on patient goals, interests, abilities and needs BARRIERS TO OVERCOME     Physical limitations Financial Logistical Environmental triggers  Cultural factors Psychological Fear of needles Cognitive    Emotional triggers  MEDICATIONS  Knowledge about each medication – Oral medications – Insulin options – Pumps MONITORING  Assessment of how food, physical activity and medications affect their BG levels  Connects the individual to the outcome  Establish – individual glycemic goals, – timing – frequency PLAN FOR SUCCESSFUL OUTCOMES   Listen to concerns Help patient – set realistic goals – understand the importance of preventative services  Good communication with the team Exercise Therapy & Diabetes Spring Bakke Clinical Exercise Specialist Altru’s Health & Fitness Center Exercise Therapy Goals  Prevention of Diabetes – Reduce Risk Factors      Overweight Physically Inactive Hypertensive High Cholesterol Cardiovascular disease Exercise Therapy Goals  Management of Diabetes – Improves:      Glucose Control & Insulin Sensitivity Cholesterol & Blood Pressure Levels Weight/Body Composition Cardiovascular Fitness, Strength & Flexibility Quality of Life/Self Esteem Complications from Diabetes Stress – Reduces:   Exercise Therapy  All levels of physical activity are possible for those without complications and who have good blood sugar control Starting an Exercise Program  Physician Assessment Referral to an exercise professional, exercise specialist, personal trainer – Individual Fitness Assessment – Individual Exercise Prescription – Ongoing support and education  Special Considerations      Cardiovascular concerns Complications Self Blood Glucose Monitoring Proper Foot Care Safe Environment Barriers to Exercise Therapy   Time Motivation   Pain Access Time Motivation Pain Access Exercise Therapy Components    Cardiovascular Fitness Strength Training Flexibility