through visits with our certified diabetes educators MidMichigan’s diabetes education programs have been awarded recognition by the …
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Issue 7
Diabetes Center 4005 Orchard Drive Midland MI 48670 Phone: 989839-3123 Fax: 989 839-1388 diabetes@midmichiganorg
Diabetes Dialogue
Winter, 2004
Insulin Pump Therapy
Insulin Pumps are now used by 162,000 patients with diabetes The following are medical indications for pump therapy: Need to improve overall glycemic control o Bolus options may help the patient with gastroparesis avoid postprandial high and low blood glucose readings Reduce the incidence of hypoglycemia o Exercise-induced hypoglycemia is easier to prevent because the basal rate can be reduced, eliminated, or suspended Nocturnal hypoglycemia can be controlled and the naturally occurring reduction in the need for insulin can be anticipated Control the dawn phenomenon Insulin sensitivity can be managed more easily basal rates as low as 005 unit per hour are possible Benefits appropriate women with Type 1 diabetes during pregnancy Variable lifestyle and changing work and activity schedules are handled more smoothly Those who travel frequently may find they have better control Motivation is the most important ingredient for success for a pump candidate Also the individual must be able to handle a
variety of tasks and responsibilities The most successful pumpers exhibit the following: Emotional maturity for effective problem solving and acceptance of the disease Ability to troubleshoot problems, keep records, adjust insulin Master carbohydrate counting and use of insulin-to-carbohydrate ratios Dexterity to operate the pump Financial resources initial pump cost of 5000 and ongoing expenses of 1500/year Willingness to check blood glucose levels frequently at least 4 times daily, always before each meal Ability to respond quickly when blood glucose levels show hyperglycemia and/or if ketones in urine
Regularly monitor pump and the insertion site for any problems The Diabetes Center teaches patients the skills necessary for successful insulin pump therapy through visits with our certified diabetes educators who are also certified Insulin pump trainers
Staged Diabetes Management
Staged Diabetes Management SDM provides the Diabetes Center staff with clinical pathways for diabetes detection and treatment SDM uses evidence-based medicine to address the key issues of diabetes management The practice guidelines outline diagnosis, treatment options, blood glucose targets, self
blood glucose monitoring regimes and adjustment of insulin based on blood glucose patterns Physician orders are required for the Diabetes Center staff to adjust patients insulin regimes based on blood glucose patterns Please indicate on the referral form if you want us to initiate and adjust the insulin on your patient Below is an example from SDM of starting insulin for a patient, with a two-dose regime:
Start Insulin Stage 2 RA/N–0–RA/N–0 R/N–0–R/N–0
Calculate total dose at 03 U/kg based on current weight AM Midday PM BT Distribution 2/3 0 1/3 0 RA/N or R/N ratio 1:2 1:1 Pre-mixed insulin may be used for patients unable to draw insulin correctly R regular NNPH RARapid-acting insulin analog-Lispro or Aspart
Pattern adjustments would be made based on the following:
Insulin Stage 2 Pattern Adjustments
AM or 3 AM MIDDAY MID PM 80 mg/dL PM N 1-2 U AM RA or R 1-2 U AM N 1-2 U 100 mg/dL PM RA or R 1-2 U 140-250 mg/dL PM N 1-2 U AM RA or R 1-2 U AM N 1-2 U 160-250 mg/dL PM RA or R 1-2 U 250 mg/dL PM N 2-4 U AM RA or R 2-4 U AM N 2-4 U 250 mg/dL PM RA or R 2-4 U
BEDTIME BT
While SDM is being used patients are asked to fax or call their blood glucoses to the Diabetes Center
every few days Patients are seen every 1 2 weeks to ensure correct techniques for blood glucose monitoring/insulin administration as well as continued education on Carbohydrate Counting, pattern management and other issues
Insulin Pump Support Group
Wednesday, February 11, Exercise and Your Pump, 6:30 pm in the Private Dining Room
Steps to Healthy Living: Reduce Your Diabetes Risk
Diabetes affects 18 million Americans Risk factors include a family history of the disease, overweight and inactivity Steps to Healthy Living is a four-week weight-management and exercise group program for individuals who are at increased risk of developing Type 2 diabetes Participants will use a pedometer to monitor their exercise progress during class and the last class includes a Grocery Store Tour Dont wait for symptoms to strike; with the help of a certified diabetes educator you can make healthy living changes to last a lifetime Space is limited, call for your reservation Thursdays, February 5, 12, 19, 26 7:00 pm MidMichigan Medical Center-Midland Private Dining Room Cost: 25 per person or 40 per couple
Continuous Glucose Monitoring Overview
Continuous Glucose Monitoring offers new insight into
patient blood glucose control The system, produced by Medtronic Minimed, offers continuous blood glucose readings for up to 3 days Residing inside a permeable membrane, the flexible electrode is inserted just under the skin on the abdomen, sending an interstitial glucose measurement to the monitor every 10 seconds Monitor insertion is done by the Diabetes Center nurses Patients are taught how to calibrate the monitor, enter meals, exercise, medication and other events that are incorporated into reports Average blood glucose values are recorded every five minutes for a total possible 288 readings reported/day After 3 days the monitor is returned to the Diabetes Center where reports are downloaded and sent to the referring physician Reports help identify the interactions between meals, exercise, medication and insulin on blood glucose values With these dynamics revealed, informed decisions can be made about adjustments to medication or insulin Patients can be scheduled for Continuous Glucose Monitoring System by checking the box on our referral form If you would like to see examples of reports, please call 839-1813
Adult Support Group
January 27: Peripheral Vascular Disease and
Angioplasty: What Individuals with Diabetes Should Know February 24: Metabolic Syndrome: What Is It and How Does it Affect My Diabetes? Kelli Crawford, RN, BSN, CDE, East Central Diabetes Outreach Network March 23: Walking 10,000 Steps a Day: How to Get Started and Stay Motivated Janet Dominowski, RD, CDE All meet at 7:00 pm, Private Dining Room MidMichigan Medical Center
CMS Changes Diabetes Training Eligibility
Effective January 1, 2004, all Medicare beneficiaries with diabetes qualify for both initial and follow-up Diabetes training without having to meet further criteria such as being newly diagnosed This change means that all Medicare beneficiaries, can access diabetes training, with a physician referral, on an on-going basis The initial benefit is for 10 hours of education and 2 hours update yearly thereafter
Water Exercise Class
This three-week program is offered to provide individuals with diabetes a water exercise experience in a small group setting Participants learn an exercise routine under the direction of a certified therapeutic recreation specialist, while monitoring their diabetes This program encourages participants to pursue a more active exercise program
Classes are available in Midland, Clare Gladwin Call the following for dates and to register: Midland: Diabetes Center, 1-800-727-3123 Clare: MidMichigan Health Line, 1-800-999-3199 Mt Pleasant: MidMichigan Health Line, 1-800-9993199
Community Programming
Free Blood Sugar Screening for those not yet diagnosed with diabetes Sunday, February 8, 2004 Midland Mall 12 pm 6 pm
MidMichigans diabetes education programs have been awarded recognition by the American Diabetes Association and Michigan Department of Community Health The Diabetes Dialogue was produced to communicate diabetes information to MidMichigan Physicians, please call Mary Greeley, MS, RD, CDE, with any questions, 839-1813
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