Supporting your patientsSupporting your patients with...
Transcript of Supporting your patientsSupporting your patients with...
Supporting your patientsSupporting your patientsSupporting your patients Supporting your patients with diabetes:with diabetes:
Wh t d t kWhat you need to know…Janice Langley RD, CDE
ll CJames Morrell RN, MN, CDE
Today’s Agenda
What is diabetes?What’s the risk?What s the risk?
You asked about foot care
Why numbers matterWhy numbers matterResourcesTh f l fThe new referral form
What is type 2 Diabetes?What is type 2 Diabetes?
PANCREAS
S
SSS BODY CELLS
RESISTANCE
S
SS
SSS
SS LIVER
Natural History of Type 2 Diabetesy ypUndiagnosed
DiabetesImpaired
Glucose ToleranceKnown
Diabetes
Insulin Resistance
Postmeal GlucoseInsulin Secretion
4-7 YearsMacrovascular complications
Microvascular complications
4-7 Years
Ramlo-Halsted BA, et al. Clinical Diabetes 2000;18:80-85, with permission from The American Diabetes Association
Type 2 Diabetes is NOT a Mild Type 2 Diabetes is NOT a Mild DiseaseDiseaseDiseaseDisease
Stroke2 to 4 fold increase in
Diabetic Retinopathy 2- to 4-fold increase in
cardiovascular mortality and stroke3
p yLeading cause of
blindness in working-age adults1
Cardiovascular Disease8/10 diabetic patients die from CV events4Diabetic die from CV events
Diabetic Neuropathy
NephropathyLeading cause of
end-stage renal disease2 p y
Leading cause of non-traumatic lower extremity amputations5
1. Fong DS et al. Diabetes Care 2003; 26(Suppl 1):S99-S102. 2. Molitch ME et al. Diabetes Care 2003; 26(Suppl 1):S94-S98. 3. Kannel WB et al. Am J Heart 1990; 120:672-6. 4. Gray RP and Yudkin JS. In: Textbook of Diabetes. 1997. 5. Mayfield JA, et al. Diabetes Care 2003; 26(Suppl 1):S78-S79.
Why Do Foot Assessments?Why Do Foot Assessments?
Prevent foot ulcers with associated risk of lower leg amputationg pEarly intervention for foot problems.Improved wound outcomesImproved wound outcomes.Reduce severity of complications.Improve quality of life.
The oneThe one--minute roleminute roleThe oneThe one minute roleminute role
Your role The Doctor’s roleYour roleHave the patient take off shoes and socks
The Doctor s roleFIRST 15 SECONDS:
Ask are your feet ever numb?Look at the feet and shoes, examine
Keeps the Dr’s within the 1-minute assessment
lik lih d f
,the foot for skin condition, color, calluses, toenail condition & structural deformities
NEXT 15 SECONDS:Increases likelihood of having this done
Ask do your feet ever tingle?Palpate the foot for temp and general ROM
FINAL 30 SECONDS: Ask do your feet ever burn?Ask do your feet ever feel like insects are crawling on them?Check for sensory intactness using aCheck for sensory intactness using a 10gm monofilament
A1c (2A1c (2--3 month average)3 month average)A1c (2A1c (2--3 month average)3 month average)A1c (2A1c (2 3 month average)3 month average)Recommended every 3Recommended every 3--4 months4 months
A1c (2A1c (2 3 month average)3 month average)Recommended every 3Recommended every 3--4 months4 months
% A1
Over8 4%
% A1c
7 8 4%
8.4%
7 - 8.4%
Target Range Under7%
Based on a normal A1c range of 4 - 6%
UKPDS: RUKPDS: Reduced Microeduced Micro-- and Macrovascular and Macrovascular Complications for a 1% Decrease in A1CComplications for a 1% Decrease in A1CComplications for a 1% Decrease in A1CComplications for a 1% Decrease in A1C
Any diabetes-related
Diabetes-related All-cause Myocardial
Peripheral vascular
Micro-vascular Cataract
–10
–5
0
sk (%
)ll
in A
1C
endpoint death mortality infarction Stroke disease* disease extraction
19%
12%14%14%
21%21%25
–20
–15
–10
rela
tive
risto
a 1
% fa
37%–35
–30
–25
educ
tion
ines
pond
ing
37%
43%
–50
–45
–40Re
corr
e
Adapted from Stratton IM et al. UKPDS 35. BMJ 2000; 321:405-12.
*Lower extremity amputation or fatal peripheral vascular disease
ResourcesResources
Prediabetes
Just the Basics– For newly diagnosed diabetesy g
Staying Healthy with Diabetes– What patients need to knowWhat patients need to know
Outpatient Adult Diabetes Services REFERRAL FORM
*Patient Name: ____________________________________ Last First
*Physician Name: _________________________________
Physician Phone #: ________________________________
Our New Referral FormOur New Referral Form*PHN: __________________ *Date of Birth:_____________ dd/mm/yy *Patient Phone #s: (H): __________________ (C) or (W):___________________
*Patient Address: _________________________________ (include postal code) _____________________________ Patient Email: _______________________________
Adult Clinic, RJH, Clinic 7 Fax: (250) 370‐8357Phone: (250) 370‐8322
Diabetes in Pregnancy Clinic, VGH Fax: (250) 727‐4168Phone: (250) 727‐4528
Diagnosis: Type 1 Type 2 Pre‐DiabetesNew Diagnosis?: Yes No
Diagnosis: Type 1 Type 2 IGTGDM Other
Important things:•Complete the *’s New Diagnosis?: Yes No
If No, Year of Diagnosis: ________________ GDM Other ___________________ Gravida: ______________ Para:___________________ EDC:_________________ Weeks pregnant: _________ dd/mm/yy
Diagnostic Lab Values: FBG: _______________ mmol/L (recent diagnosis only) RBG: _______________ mmol/L 2 hr GTT:____________ mmol/L
*Please attach all available most recent lab data, as follows:
Comorbidities: CVD Hypertension
Current Data ‐ Please attach pre‐natal recordDiabetes in past pregnancy? Yes NoPrevious LGA? Yes No
•Complete the s•Include diagnostic lab values
•If not diagnostic you’re getting it back
•Attach labs Fasting BG A1C Lipid Profile eGFR Creatinine Albumin/Creatinine Ratio
Renal Disease Neuropathy Retinopathy Depression Sexual Dysfunction
Other:
For Type 1 or 2: A1C: __________ Date: ______________ dd/mm/yy 1 Hr GTT (50 g): Result: __________ Date: ______________ dd/mm/yy 2 Hr GTT (75 g): Results: __________ Date: _____________ __________ dd/mm/yy __________
Services Required – Adult Clinic (See back of page) Services Required – Diabetes in PregnancyInitial teaching/education General education
Really important things:If a new diagnosis, is patient “group
t i l” Initial teaching/education BG monitor training/certification Review regarding: _______________________________
_______________________________
General education General education and Endocrinology consultation (recommended for pre‐pregnancy Type 1, Type 2
Diabetes, and GDM requiring insulin)
Insulin Start (*orders required) Insulin Type Dose Timing _______________ ___________ ________________ _______________ ___________ ________________
Adjust HS insulin by units q days until FBG <
Comments:
material”i.e., elderly (over 75 in
general), hearing or visual deficit, or other, such as alien, or “male”…
Adjust HS insulin by ___units q ___days until FBG <____ Oral antihyperglycemic agents: Unchanged Change to: ______________________ Current Treatment: Diet and exercise only Type / Dose / Timing Oral Antihyperglycemics: ___________________________________________________________________________
___________________________________________________________________________ Insulin(s): ____________________________________________________________________________________
Barriers to Group Learning: Language barrier Hearing impairment Unstable mental illness Cognitive deficit Visual impairment Other (specify):
Physician Signature:
_____________________________________
Office Use Only:Date received (dd/mm/yy): _____________________Date triaged (dd/mm/yy): ________________ Initials:_____ Appointment type: ____________________________