Diabetic care

Introduction:
Diabetes  is  one  of  the  leading causes  of  death  and  disability  in  India. India and  China  together  hold  the  largest  number  of  diabetes  with  India  being  known  as  the  diabetes  capital   of the  world. There  are  now  an  estimate  of  more  than  62  million  patients  with   diabetes  in  India.   It  is  the  leading  cause  of  adult   blindness, kidney  failure  and  amputations  of  the  foot  or  leg. It also puts people at increased risk of heart disease and stroke.  Diabetes  is not  like  a  disease,  it’s  just a  metabolic  disorder  which  is  preventable  and  manageable,  yet  public  awareness  about  the  diabetes  is  very  low  and  many  people  do not  understand how  to  control their  disease  and  prevent  complications. Therefore, in  order to manage  diabetes  properly,  diabetic  patient  need  to  attend  diabetic  clinic  where diabetic  education   and  diabetic care  is  available.

Importance of Diabetes Education:
Diabetes education  is  the cornerstone  of  diabetes  management, because  diabetes  requires  day  to day  knowledge  of  nutrition, exercise , monitoring  and  medication. Diabetic  education, increases your knowledge, attitude and perception of the disease and its future consequences, and  allows you  to  better  incorporate education  into  your  life  and  make  the  necessary  changes  to  improve  your  lifestyle for a healthy living.

Who are the people that are involve in Diabetic   Clinic:
1. Physician
2. Diabetes educator
3. Dietician  
4. Physiotherapist /Podiatrist
5. Opthalmologist

Benefits/advantages of    diabetes education classes:
Diabetes  is  a  chronic   condition  that  requires  you  to  make  multiple  decisions  throughout  the  day  to  successfully  manage  blood  sugars  and  prevent  diabetes  related  health  problems. These problems include:
*What   to eat?
*When   to eat?
*When to take medicine?
*How to check blood sugar?
*What to do for high or low sugar?
*How to take care of your feet?
Diabetes  education  classes   are  the  best  way  for  you  to  learn   the  answers  to  these  questions. It  is  an  ongoing  process  that  should  be  repeated    either  with  a  diabetes nurse  educator  or  dietician. This allows the patients to keep up to date with their diabetes control. Diabetes  education  gives  you  the  power  to  control  your  diabetes,  so  it  doesn’t  end  up  controlling  you. Proper  education  can  lower  a  person’s  average blood  sugar     and   prevent  emergencies  like  hypoglycemia (low  blood  sugar )  and  hyperglycemia (high  blood  sugar ).

How are the classes structured?
*Classes  are  made  up  of  small  groups  and  also  individual  education  is  provided        according  to  requirement.
*20 to 30 minutes time is required for the first meet.
*From second visit onward, diabetic educator will assess and re-enforce education and, if needed provide as per the requirement.

Main areas covered   during diabetes education:
*Pathphysiology(cause) of diabetes and types of diabetes:
 Those  who  attend  the  class  are  taught  about  pathophysiology, types  and  management  of  diabetes  according  to  their  needs  and  understanding  level.
*Diet: Nutritional assessment  is  used  to  determine what  the   individual  with  diabetes  is  able  and  willing  to  do. Nurse educator  identify  the  area  for  dietary  intervention and explain  the meal pattern, meal  plan, food  exchanges  and  lifestyle  modification  according  to  the individual’s living  standard, diet pattern and  sugar  level.
*Exercise: Exercise  is  being  increasingly  recognized  as  a part of  the  treatment  of  diabetes  mellitus. The  benefit of  exercise, its  importance, types  of  exercise, duration and  precautions to be  taken   are  taught in  the  process  of  diabetic  education.
*Medications: There are different types of medicine to control diabetes mellitus and it is individualized according to the type of diabetes. Medicine dosage, timing and regularity of treatment and complications which can arise due to diabetes are taught by the   diabetic educator.
*Insulin  therapy: The  practical  aspect  of  insulin  therapy  becomes  very  important and  are discuss and demonstrated well  in  detail. Insulin storage, insulin  syringes, reuse  and  disposal  of  syringes, syringe  alternatives  such  as pen like  devices and  insulin-containing cartridges, sites  for  insulin  administration, factors  that  affect  rate  of  insulin  absorption and  complications  of  insulin  therapy  are  taught  to  those  who are  dependent  on  insulin.
*Self  Blood  Glucose  Monitoring (SBGM):  Since  regular  monitoring  of  blood  glucose  is  necessary, use  of   glucometer (a machine use to check sugar)  is    demonstrated and  frequency  of  its use  are  taught  to the patient so that they can manage such things  at  home  confidently.
*Self  care: The  education  class  also cover  the  importance  of  eye care  and  dental care  since  diabetes  is  a  chronic  and  progressive  condition.
*Diabetic  complications: The possible  short  term  complications  such  as  Hypoglycaemia (low  blood  sugar)   and  Hyperglycaemia (high  blood  sugar )   awareness, its remedy  and  management  are  taught  as  well  as  long  term  complications  such  as  retinopathy (eye  problem), nephropathy (Kidney  problem ) and  neuropathy (nerve  problem).
*Diabetic  foot  care: High  blood  glucose  in  diabetes  causes  nerve  damage  and  poor  blood  flow which can result in  foot  problems that  can lead  to  amputation of  leg  and  foot. For  early  diagnosis  and  prevention of such complications, foot  examination  and  nerve  function  test  is  done   from  the  first  visit .
*Documentation: Detail  assessment and   documentations  are  maintain  for  every  individual, so that  the  disease  progress  is well recorded  and the  education  team has a clear  knowledge  about  their  diabetes  patient’s  progress and  give  care  as  per  needed.
*Education Booklet: A small leaflet which contents information   regarding diabetes and its management, diet and foot care are provided to the patient. Also  diabetic diary  is  provided  to record  blood  sugar  for  those  who  have  glucometer (a  small  handy  machine which  is  use  to  check  blood  sugar).

Do  I  need  diabetes  education  if  I  see  my  doctor  regularly?
It’s  a  good  idea  to  see  a  diabetic  educator  atleast   every  3 months  even  if  it  is  in  good  control  to  be  sure  you  are  on  track  with  your  diabetes  care. The  educator  works together  with  your  physician  to  ensure  you  have the  skills   and  knowledge  required   to  manage  diabetes. As  a  result of  research  and  technology  innovations,  you  may  benefit  from  seeing  an  educator  to  learn  the  latest  about   nutrition  guidelines, new  glucometers, new  medications,  or  improved  insulin  delivery  devices.

I’ve   had   diabetes   for 15 years. Can I still benefit from diabetes education classes?
Since  diabetes  is  a  chronic  and  progressive  condition, it’s  very  likely  that  the  strategies  used  to  manage  it  will need  to be  adapted  overtime. Likewise, other  health  conditions  of  lifestyle  changes  may  impact  how  you  care  for  your  diabetes. Attending  diabetes  education  classes  will  help   you  to  stay  current  on  the  best  treatments  and  guidelines  available  now .

How    can I get   Diabetic   Education?
*Make   an   appointment   where   there   is diabetic clinic and walk in.
Conclusion:
Diabetes  is  unlike  other  diseases   such  as  TB , Malaria, Typhoid etc, where  medication  along  can  often  times  successfully  treat it.  There  are  a  lot  of   other  components  to  diabetes  such  as  : The diabetes  disease  process, nutritional  management,  physical    activity,  medications , glucose  monitoring  and  psychosocial  adjustment. Thus, diabetes  education  and  self  management  training  should  be  done  with  the  team.