DIABETES: SHARE TO RAISE AWARENESS

1. Introduction: (DM) Diabetes Mellitus is not just an abnormality of blood glucose levels but it is a multisystem disease that is associated with significant acute (short term) and chronic (long term) complications. The goal of care will be to improve the quality of life of patents with DM. Evidence has shown that life of patients with DM. Evidence has shown that education and comprehensible care can make the course of diabetes smoother and maximize the quality of life of the patient. It is important to have early diagnosis and aggressive glucose control. Continual screening is important to prevent or control complications, as diabetes can affect your heart, kidney, eyes and cause numbers and decreased sensation in your extremities. About 25 Million people in the U.S are affected by diabetes, with about (6 million people) unaware of their diagnosis. 2. Types of Diabetes Type 1 diabetes: Type II diabetes: NB/ 90% of patients with diabetes have Type II. Gestational Diabetes 3. Chart Comparison of Type I and II Risk of Development of Type II Type 1 diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes. Overweight and Inactive Too much glucose (sugar) in your blood. Gestational Diabetes high blood sugar during pregnancy.

4. Ways to Monitor Blood Glucose A. Hb A/C (Glycosylated Hemoglobin) done every 3 months Can be thought of as providing the big picture of a patients glycemic control. A/C is calculated by assessing the amount of glucose that adheres to hemoglobin molecules through a farceuse known as glaciation.

It is the most accurate predictor of future complications due to blood glucose control. It gives a patient average blood glucose control over a 2-3 month period.

ADA recommend a A/C (%) of <7.0

B. SMBG (Self-Monitoring of Blood glucose) is a way to monitor if the patient is either (Hypoglycemic or Hyperglycemic) It is a useful way in what changes to make in the treatment regimen of a patient on insulin. It improves diabetes control in these patients. It provides feedback in effectiveness of changes in food intake and activity level. Blood Glucose Target Chart (ADA)

Types of SMBG 1. 2. 3. 4. Sporadic Checking (< or = 1 times per day) Systematic Checking (1-2 times per day) Block Checking (a minimum of 3-4 cheks, and up to 7-8 daily checks. Over 3-4 days) Intensive Daily Monitoring (> or = 4 times a day, every day) for Type I and gestational diabetes)

5. Steps for Blood Glucose Self-Monitoring 1. The patient should wash and dry his/her hands. The skin area selected for checking does not need to be wiped with alcohol, as alcohol can cause dryness and discomfort. 2. A blood sample should be obtained by pricking the side of the fingertip, because it is less painful or, if appropriate, an alternative site. Most patients prick

themselves using a skin-piercing (lancing) device that holds and releases a lancet via a spring mechanism. Many lancing devices are equipped with dial settings that can control the depth to which the lancet enters the finger. 3. Dispose of the used lancet in a sharps container. 4. The patient should obtain a blood drop from the site by gently kneading the skin. 5. Insert the test strip into meter and check for calibration. 6. Apply blood sample per manufacturers instructions. 7. Wait for a result, and record in log book.

6. Barriers to Self-Monitoring Education: Patients do not understand the diabetes disease process or do not know their target BG or A1C goals, and consequently do not understand the role of SMBG in achieving their goals. Language: Patients have difficulty communicating in English or prefer languages other than English. Financial: Insurance does not cover and/or patients cannot afford out-of-pocket expenditures for strips. Convenience/lifestyle interference: Patients schedules do not provide flexibility for regular monitoring: alternatively, environmental barriers (such as working in an environment that limits a patients ability to self-monitor) may impede access. Emotional: Patients may fear the anticipated pain of SMBG and/or may not want to be perceived as different from others; they may also be in denial about their diabetes or lack support from family or caregivers. Physical: Patients may have visual or dexterity impairments or other disabilities that limit their ability to operate a glucose monitor or read results. Cognitive: Young people and some elderly patients may be unable to conduct glucose monitoring without assistance.