Patient Education
All education efforts should be patient-centered. The patient should be an active participant in managing their diabetes. Nearly all patients with diabetes are the daily managers of their disease.
Explaining The Diagnosis
Education efforts should begin the moment the patient is found to have elevated blood or urine glucose. The significance should be reviewed with the patient and examination and confirmatory tests discussed. Once hyperglycemia is confirmed, then a concise and clear explanation of the diagnosis should occur. Complications of the disease should be discussed along with the importance of available therapies. Adherence studies have found that exploring the patient’s health beliefs are more important than inadequate knowledge of the disease. Providers should make time to ask patients open ended questions about how they think diabetes works. Culturally-responsive reading materials that are appropriately tailored to the patient’s health literacy level can help reinforce discussion points. Referral to a specialized diabetes education center may be appropriate if office or hospital teaching resources do not meet the patient’s needs. Group education classes, if amenable to the patient, can be cost effective and are reimbursed by many insurance plans. Some select excellent education resources are listed below:
Self-Monitoring of Blood Glucose
All diabetic patients should be taught to check their own blood glucose. Blood glucose levels can decide if immediate therapeutic interventions must be made. Patterns of blood glucose levels over time can be used by the patient and doctor to make long term adjustments to therapy.
Patients should be provided glucometers that are small, accurate, fast, and have memory capacity. Most modern glucometers are less dependent on user technique than their predecessors. Some glucometers can connect to computers. Accuracy and effectiveness of less invasive glucometers is still being studied. Patients should consider models that are inexpensive or have rebate coupons from the manufacturer or their health insurance. Self monitoring blood glucose skills should be reassessed periodically.
Medication Counseling
Patients taking oral medications should be counseled on dosage and frequency instructions, potential side effects, and the treatment goals. Patients receiving insulin should be counseled on instructions on self-administration, avoiding exercise induced hypoglycemia, and the use of glucagon in hypoglycemia.
All diabetic patients should receive instruction on managing brief illnesses (ex. viral syndromes, etc,). Recommendations during a brief illness include: (Choose the one best answer.)
The answer is B. These patients should continue taking their medications, check their sugars more frequently (q 2 – 4 hours), check ketones (q 4 hours), and drink lots of non-caffeinated fluids. They should call their doctor if they:
- can not hold down fluids or carbohydrate intake for over 6 hours
- can not eat regular food for one day
- develop intractable heavy vomiting or diarrhea, tachypnea, drowsiness or recurrent hypoglycemia
Counseling on Acute and Chronic Complications
Diabetic patients should all be advised to wear medic alert bracelets. They should be taught about acute complications including infections, hyperosmolar coma, ketoacidosis, hyperglycemia, and hypoglycemia.
| Hypoglycemia | Hyperglycemia |
|---|---|
| Causes: Taking too much diabetes medicine, missing a meal or snack, exercising too much, drinking alcohol may cause hypoglycemia. | Causes: Forgetting to take medicines on time, eating too much and getting too little exercise may cause hyperglycemia. Being ill also can raise blood glucose levels. |
The signs of hypoglycemia:
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The signs of hyperglycemia:
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Plan: If you experience these symptoms, test your blood glucose. If it is 70 or less, eat one of the following right away:
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| Source: National Institute of Diabetes and Digestive and Kidney Diseases | |
Diabetes patient education also includes counseling on chronic complications. Patients should be taught to monitor the signs of long term damage of the eye, cardiovascular, skin, renal, nervous, gastrointestinal, and vascular systems, and psychological issues. Foot care including self-inspection and hygiene should be encouraged. The ADA provides an excellent overview of chronic complications of diabetes for patients at:
Family Education
Successful lifestyle modifications for a diabetic patient usually require support, cooperation, and understanding by their social support system. It will be challenging for diabetic patients to eat well if the rest of their family is not eating healthy on a daily basis. Counseling about diabetes of patient’s significant others, parents, and children will not only increase support, but may educate family members about their own risk of developing diabetes.
Psychosocial Issues
Exploring how a patient understands their disease is a vital listening skill for a physician (ex. What is diabetes? What made it happen? What makes it better? What makes it worse? How does treatment work?). Making the time to listen to a patient with diabetes can provide important information on how to tailor your counseling, the likelihood of adherence to treatment, and how the patient is experiencing the “illness” of diabetes rather than the “disease”. Many people living with diabetes can benefit from support groups that can provide suggestions for coping with stress and daily living challenges.
One third of diabetic patients suffer from depression at some point in their lives. The ADA recommends screening for depression during a new diabetes diagnosis, during regular visits, or if adherence issues arise. Integrating psychosocial care into routine care is better rather than waiting for deterioration of psychological status.
Some risk factors for depression in diabetic patients include:
- Age <65
- Previous history of depression
- Unmarried status
- Female
- Poor physical health
- Poor mental health
Diabetes Self-Management Education Programs (DSME)
Diabetes self-management education programs (DSME) are important elements of diabetes care. There has been a progressive shift over the past decades from didactic approaches of DSME to skill-based, patient centered, and longitudinal approaches in DSME. Research has found that DSME is associated with better knowledge of diabetes, better self-management decisions, and better clinical outcomes. DSME programs are reimbursed by Medicare and Medicaid programs. The ADA has national standards for DSME programs. In order to receive an ADA certification, a DSME program must include registered nurses and nutritionist staff; must cover all areas of diabetes management in the curriculum; and have continuous quality improvement projects as part of their assessment of effectiveness. More information on DSME programs can be found in the library of this module.