The Cleveland County Health Department has provided quality diabetes education to Janet is also the nurse manager for our Diabetes …
Sweet Nothings
Spotlight on Cleveland County
Submitted by Dana McNeilly, RN, BSN, Diabetes Program Supervisor Cleveland County Health Department The Cleveland County Health Department has provided quality diabetes education to diabetic individuals in Cleveland County for over a decade In keeping with the mission of providing quality diabetes education, the Health Department is pleased to enhance our diabetes education to meet the American Diabetes Associations National Standards for Diabetes Self-Management Education through participation in Cohort II of the NC Diabetes Education Recognition Program Currently, Beth Silvers, RD, CDE, LDN provides individual and group education sessions, medical nutrition therapy, and Beth Silvers, RD, CDE, LDN assistance with insulin pump therapy Janet Sanders, RN has attended the ECU Diabetes Fellowship and is providing the initial and 3 month follow-up visits with patients enrolled in our program Janet is also the nurse manager for our Diabetes Clinic where we provide primary diabetes care to eligible individuals in Cleveland County As of September, clients participating in our diabetes education program are receiving education based on the NC
Diabetes Self-Management Curriculum Our education class is made up of two 4-hour sessions Session A is held on the 2nd Thursday morning and Session B is held on the 4th Thursday morning of each month All modules of the curriculum are covered during these sessions Diabetes is the 5th leading cause of death in Cleveland County, Janet Sanders, RN just as in North Carolina Diabetes presents major issues for many families in Cleveland County Through our participation in Cohort II, we feel we are moving one step closer to meeting our objective to provide these families with the knowledge, tools, and services needed to successfully manage diabetes and prevent its debilitating complications
October 2008
Volume II, Issue 10
Inside this issue:
Melindas Medication Moment Crockpot White Chicken Chilli So Many Pumpkins, So Few Carbs
2
3
3
Heart Disease Soars to 4 90 With Obesity, Diabetes Carbohydrate Counting and Fast Food 4
Tell Your Clients to Get 5 Their Flu and Pneumonia Vaccines Soon Resources 6
Remember
Data reports are due the 5th of each month
THE MEDICATION THAT MATTERS: MOTION
Submitted by Melinda Rummage, RN, CDE For improved glucose control, exercise needs to be done at
least every other day and preferably no less than 5 days per week Regular exercise may reduce insulin and other medication requirements Exercise improves the blood sugar for up to 12 - 72 hours after exercising Lets take a walk today
Did You Know?
When high fructose corn syrup is metabolized, it is immediately stored as fat?
Sweet Nothings–October 2008
Sweet Nothings Melindas Medication Moment
Page 2
Submitted by Melinda Rummage, RN, CDE Insulin has gotten a bad rap But Im here to set the score straight Insulin is a wonderful drug that gives us fast control of our blood sugars with very little side effects compared to oral medications prescribed to achieve the same goal Oral agents used to treat diabetes are not insulin pills Remember the purpose of insulin? Insulin is normally produced by our bodies in the beta cells of the pancreas which sits behind our stomachs Its job is to go to the receptor sites on each cell and open them so the sugar in our blood can move into our cells to be used for energy When our insulin isnt working insulin resistance or our beta cells arent producing enough insulin or none at all, then we need insulin to manage this problem Today there are many
insulins on the market to help people achieve good control of their blood glucose Heres a list of insulins being used in the USA today Rapid Acting : onset is 15 minutes Humalog Lispro Novalog Aspart Apidra Glulisine Short Acting : onset is 30 - 60 minutes Regular Humulin R, Novolin R Intermediate-acting : onset 1-4 hours NPH Humulin N, Novolin N Lente Novolin, Humulin L Long Acting : onset varies between 3, 4 to 6 hours–never mix these insulins with other insulins Glargine Lantus Detemire Levemir Ultralente Pre-mixed Human : 1 - 2 hours Humalog 75/25 : Novolog Mix 70/30 : Humalin 70/30 : Novolin 70/30 x x x x x x type of insulin amount prescribed site rotation how the patient is injecting the insulin vial or pen if the patient knows how to treat a low blood glucose how much the patient is actually taking 75 NPL, 25 Lispro 70 NPH, 30 Aspart 70 NPH, 30 regular 70 NPH, 30 regular
When talking with your patients, it is important for you to know:
x Whether the patient has had insulin instructions Ask your patient questions about their medications and how they are taking their medications This information will help guide you to better meet your patients needs A great resource is
Diabetes Medications Supplement at wwwndepnihgov/diabetes/pubs/Drug_tables_supplementpdf This publication has all the medications related to diabetes that your patient may be on including insulin, oral agents, insulin, incretins and amylins, blood pressure medications, and medications used to treat dyslipidemia Source: NDEP, 2007 wwwndepnihgov
Sweet Nothings–October 2008 Diabetes Prevention and Control Branch–NC Division of Public Health
Sweet Nothings Crockpot White Chicken Chili
Page 3
Ingredients x x x x x x x x x x x x
2 lbs boneless skinless icken ch 2 51 ounce ans c 1 51 ounce an southwestern orn c c 1 1 4/1 ounce enveope taco seasoning mild or ot l h 1 4 2/1 ounce an of opped c hc 1 14 ounce can low-sodium 2/1 up at-ree c ff chopped sour ream c 4/1 up Instant brown rice c green onionoptional optional is, and soups in the rockpot on ow et ook 01-8 ours c l Lc h Serve with onion and eese ae with a salad and hc Hv Monterey ak eese j c hc irections: D green iies hc l iken broth hc c 1 01 4/3 ounce an reduced-at ream of iken soup c fc hc c boiled and cubed great northern beans or navy beans
Plae ooked ubed iken, beans, orn, taco seasoning, il cc c hc c c hc
x 03 minutes
prior to eating, add rice et ook Tih s will ep thiken the ihc il Lc hl c some trans-at free tortilla ips f ch
Makes 8 servings: 1 up: 541 aories, g arbs, g protein, g at, g iber c cl 51 c 6 2f 8f
So Many Pumpkins, So Few Carbs
Submitted by Joanne Rinker, MS, RD, CDE
What are you going to do with all of those pumpkins after Halloween? Believe it or not, they make a great side dish They are low in carbs and very simple to prepare You can roast the seeds, too, for a great snack Just take your pumpkin, slice it in half Take out all of the seeds and leave the flesh Just rinse the pumpkin seeds under cold water and pick out the pulp and strings this is easiest just after youve removed the seeds from the pumpkin, before the pulp has dried Place the pumpkin seeds in a single layer on an oiled baking sheet, stirring to coat Sprinkle with salt and bake at 325 degrees F until toasted, about 25 minutes, checking and stirring after 10 minutes Let cool and store in an air-tight container While these are baking, place the halved pumpkin into the oven as well Bake for about 2 hours on 325 degrees You can then spoon it off the pumpkin peel and place it all in a blender Blend until smooth You can
use this as a side dish with some spray butter and salt You can also use it to make pumpkin bread or pumpkin muffins, pumpkin pie or pumpkin soup The greatest part of this wonderful treat is that you can eat a whole cup and it is only 12 grams of carbohydrates ENJOY
Sweet Nothings–October 2008
Sweet Nothings Heart Disease Soars to 90 with Obesity, Diabetes
Summary by Laura Edwards, RN
Page 4
People who are both obese and have diabetes are highly likely to develop heart disease during their lifetime, a new study shows Research has found that of more than 3,400 adults in a long-running US heart study, women who were obese and diabetic had a nearly 80 chance of developing heart disease at some point For their male counterparts, that figure was nearly 90 Lifetime risk was based on the likelihood that a 50-year-old would develop heart disease in the next 30 years Obesity and diabetes commonly go hand-in-hand The new findings, published in Diabetes Care, show that diabetes on its own significantly raises the lifetime risk of heart disease, and that obesity worsens the situation Per Dr Caroline S Fox of the National Heart, Lung and Blood Institute in Bethesda, Maryland, and her
colleagues, the lifetime heart disease risk of normal-weight women who did not have diabetes was 34 The risk for norm 
al-weight women with diabetes was 55 Among obese women, those who did not have diabetes had a 47 chance of developing heart disease, while the risk for those with diabetes was 79 The pattern was similar for men, with a lifetime heart disease risk of 49 among normal-weight, non-diabetic men, and a 77 risk for normal-weight men with diabetes Obese men without diabetes had a 67 lifetime heart disease risk, while the risk for obese diabetic men was 87 The number of Americans with diabetes is expected to rise to 483 million by 2050, and heart disease due to diabetes appears to already be on the rise The full article can be found in Diabetes Care, August 2008
Carbohydrate Counting and Fast Food
Submitted by Joanne Rinker, MS, RD, CDE
Did you know that the average person eats out for one out of every 4 meals? That is a lot of high-fat, high-carb, drive-through and made-to-order mealsnot to mention, its expensive When you go to a fast-food restaurant, ask for the nutrition facts guide The restaurant may not have this pamphlet sitting out, but they usually have one
available on request Some common carb counts of fast food include: 1 burrito: 3 servings of carbohydrates; 6 chicken nuggets: 1 carbohydrate; 1 slice pepperoni pizza: 3 carbohydrates; 1 grilled chicken sandwich: 3 carbohydrates; 1 crispy chicken sandwich: 35 carbohydrates; 1 regular hamburger: 2 carbohydrates; 6 sub: 3 carbohydrates; small order fries: 3 carbohydrates; medium order fries: 4 carbohydrates; large fries: 5 carbohydrates; 12-oz milkshake: 6 carbohydrates Source: ADA Exchange List for Diabetes Obviously, there are some good choices and some very unhealthy choices when eating in fast-food restaurants What is important is that you and your patients are armed with the knowledge to make a great choice Remember to order salads with low-fat dressings, skip the fries, and have water or diet sodas with your meals These small changes will cut carbohydrate counts and help control blood sugar
Carb Counting Quiz
If Eva had a regular hamburger, small order of fries and a 12-oz milkshake, how many carbs would she have eaten? Answers: 6, 9, 11, or 13? Answer is on page 5
Sweet Nothings–October 2008
Sweet Nothings Tell Your Clients to Get Their Flu and Pneumonia Vaccines
Soon
Submitted by Melinda Rummage, RN, CDE
Page 5
Yes, people with diabetes especially need to get their annual flu and pneumonia vaccine as soon as it is available Why? People with diabetes are almost 3 times more likely than others to die with influenza flu and pneumonia Yet only half of people with diabetes get a flu shot, and only one-third are immunized against peumococcal disease Influenza: The flu is contagious and is spread from person to person by coughing, sneezing and nasal secretions Anyone can get the flu, but rates are highest among children For most people, it lasts a few days with symptoms such as fever, chills, sore throat, headache, fatigue, muscle aches and cough The flu can lead to pneumonia and can be dangerous for people with heart and breathing conditions On average, 226,000 people are hospitalized every year because of flu and 36,000 die, most of them elderly The flu shot is an inactivated vaccine containing killed virus that is given with a needle in the arm The shot is approved for use in people 6 months old and older About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body This shot is
good for one year Flu vaccine is recommended for people 50 years of age and older and people of any age with certain chronic medical conditions There are some people who should not be vaccinated without first consulting a physician These include: x x x x x People who have a severe allergy to chicken eggs People who have had a severe reaction to an influenza vaccination People who developed Guillain-Barré syndrome GBS within 6 weeks of getting an influenza vaccine Children under 6 months of age influenza vaccine is not approved for this age group, and People who have a moderate-to-severe illness with a fever they should wait until they recover to get vaccinated
Pneumonia: Pneumonia is inflammation in the lungs Symptoms of pneumonia are shortness of breath, fever, cough, malaise, chest pain and headache It can be passed person-to-person by secretions It is one of the leading causes of death among the elderly There are several different kinds of pneumonia; bacterial pneumonia is treated with antibiotics Pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined, and people with diabetes are at greater risk A pneumonia
shot can also protect against other infections caused by the same bacteria About 10,000 people die each year because of these bacterial infections A pneumonia shot, however, can help protect you against getting these illnesses For most people, one shot is enough protection for a lifetime People under 65 who have a chronic illness or a weakened immune system should ask their doctor about getting another shot 5 to 10 years after their first one As diabetes educators, you may want to provide your clients with brochures available through the CDC web site informing clients of their need for flu and pneumonia vaccines Also promote good handwashing techniques to prevent the spread of germs Source: CDCorg 2007, 2008, 2009 wwwcdcgov
Answer to Carb Counting Quiz on page 4
Answer: 11
Sweet Nothings–October 2008
Sweet Nothings
Division of Public Health Chronic Disease and Injury Section Diabetes Prevention and Control Program Diabetes Education Recognition Program 1915 Mail Service Center Raleigh, NC 27699-1915 Laura Edwards, RN, Program Coordinator Phone: 919-707-5376 Fax: 919-870-4801 E-mail: LauraEdwards@ncmailnet Joanne Rinker, MS, RD, CDE, Education Specialist Phone: 919-707-5349
Cell: 919-218-8219 Fax: 919-870-4801 Email: JoanneRinker@ncmailnet Melinda Rummage, RN, CDE, Education Specialist Cell: 919-218-3648 Fax: 919-870-4801 Email: MelindaRummage@ncmailnet Brenda Brogden, Administrative Assistant Phone: 919-707-5346 Fax: 919-870-4801 Email: BrendaBrogden@ncmailnet
Page 6
RESOURCES
Lower Extremity Amputation Prevention and Treatment of the Neuropathic Foot Online Course - Understand the characteristics of lower extremity diabetic neuropathy - Identify the etiology and mechanical process of ulceration - List the five elements of the LEAP program - Assign a patient into a risk category based on evaluation results - Formulate an appropriate management plan according to risk category - Describe orthotic and footwear appliances used to reduce foot pressure COURSE FEE: 60 CREDIT: 6 Contact Hours Course Registration: Contact Josie Major at 800-642-2477, 225-756-3761 or email her at jmajor@hrsagov System Requirements: PC Windows2000, XP, VISTA Mac102, 103, 104, 105128 MB of RAM 2GB of free disk space Ethernet or Wireless network card for high-speed Internet connection or 56K modem for dial-up Internet connection T1, DSL, Cable, or Satellite high-speed
connection 56K dial-up will work, but the online course system will run slowly Participants will be provided an online username and password and have 24hour access to the course materials The site contains PowerPoint presentations, notes, a discussion area and post-tests All modules and post-tests must be completed within 2 weeks of enrollment After you have satisfactory completed the course, a Certificate of Completion will be mailed to you within 2 working days Heres a link to continuing education opportunities for nurses: http://nursingceuncedu This is a great website for our PAs and Pharmacists for free CEU Opportunities from the National Diabetes Education Initiative for Educators wwwndeiorg/ Below is the link to find a Core Concepts Class that will be offered near you This course is perfect for anyone interested in becoming a CDE https://wwwdiabeteseducatororg/ProfessionalResources/products/viewhtml ?target35sub1F2Fsub2Educational20Conferences View this presentation by Dr John Buse titled: Targets and Techniques for Treating Type II Diabetes Get 15 free hours from South East AHEC wwwseahecnet/Departments/ContinuingEducation/Conti
nuingMedicalEducation/TreatingDiabetes/tabid/334/Def aultaspx
Providing Quality Comprehensive Diabetes Self-Management Education to Empower Persons With Diabetes
wwwncdiabetesorg
wwwdiabeteshealthcom
Sweet Nothings–October 2008
Source:ncdiabetes.org
