East Clinical Team,
I hope everyone enjoyed the long holiday weekend! As we settle into the new normal where your days are filled with patient trainings and follow-up “cheerleading” sessions, I thought I would share a perspective with you. If you have not yet come across the exceptional Type A+ personality with diabetes, you soon will. I’ve heard from a number of you as these folks test your patience and cause you to question your own logical thinking. These patients strive for perfection and settle for nothing less. As you try to tie their impressive outcomes back to the pivotal trial findings and remind them that the average time in range was 72% and that resulted in an average A1c of 6.9%, they tell you their goal is near 100%.
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Then point out their estimated A1c and compare that to their baseline OR compare it the recommendations set forth by ADA and AACE
Provide education about time in range o Share the results of the pivotal trial to level-set expectations. The average time in range was 72% and the average A1c was 6.9%. This concept of time in range takes time to process, so remember that you are using new language that doesn’t have strong a context for them yet, so continue to reiterate it often. Let me say it again, the average time in range for individuals in the pivotal trial was 72%. Not 80%, not 85%, and certainly not 100%! :)
Get in front of the HCP before the patient does o Share Carelink reports with the HCP early on
This allows HCP to have perspective when they listen to the patient’s perceptions of their glucose levels in auto mode.
Share with the HCP what you’re doing to re-level set expectations with the patient. Remember, this is new for the HCP and they need your coaching and guidance on how to message effectively. If you don’t help them through this, they may inclined to appease the patient and tell the shut it off. That is not doing what’s best for
This made me nervous as to how I was going to communicate with her. My mentor stood back in order to allow me to administer the medications and I felt unable to ask the question, “How do I communicate with this patient?”
I feel that the communicating between Patient A and myself worked well during this event. I noticed that she was uncomfortable by her body language and I picked up quickly which method was best to
HbA1C is elevated at 8.8% and the goal for diabetics is to keep that value below 7%
Transition: Lastly, we will be taking a look at the 3 most common types of diabetes.
The first thing I will do in this situation is take the visitor aside and explain to him that this is not the right time to be talking about this subject. I will obviously stop the treatment and give time to my patient to process the incident and express his/her feelings if he/she wants to
The American Diabetes Association (2004) defines diabetes as a subset of metabolic diseases associated with hyperglycemia secondary to insulin failing to release, act, or both. Complications related to chronic diabetes can be detrimental to one’s health including but not limited to: heart disease, stroke, kidney disease, amputations, blindness, and other optical diseases. Furthermore, the prevalence of diabetes is rising at an astronomical rate within the United States as well as internationally. According to the Center for Disease Control and Prevention (CDC) (2016) an estimated 29 million people suffer with diabetes and 86 million are prediabetic within the United States (US). Without major interventions from the healthcare community,
The study had an overall total of 1150 participants. Although there were many participants to begin with, they did not provide all of the feedback the researchers had requested. This resulted in the expulsion of their participation, so their results were not included in the final reports of the study. The number of patients that did provide the essential information added up to a total of 901. The profile for a participant was a patients diagnosed with Type 2 diabetes in the last 6 months, but has been diagnosed no more than 10 years ago. They had to be between 35-70 years of age. Their BMI had to be more or less than 24 kg/m2 and have an HbA1c more or less than 6.5%. They also had to have treatment with a diet or oral glucose lowering medication. Those needing insulin shots, had been diagnosed with chronic diseases, or had a change in diet or lifestyle 3 months prior to the study were not included in the overall
Diabetes is a chronic illness that requires continuous medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications[ ].
During one of my rotations, I was assigned a young adult patient who had run out of insulin and had been admitted to the hospital following a Diabetes Ketoacidosis (DKA) episode. I realized that my patient was probably torn between buying insulin and buying healthy food because her chart showed several admissions in the
The metric that is underperforming to the most significant degree for the federal benchmarks is the percentage of patients receiving eye exams (Integris Health, 2017). However, the most widespread under improving benchmark that affects the most patients and healthcare professionals of the SRDC is the percentage of patients having a HbA1C higher than 9%. This affects all areas of the SRDC due to abnormal patient glucose levels affects all aspects of the diabetic patient’s health and healthcare (Chrvala, Sherr, & Lipman, 2016). Subsequently, the most significant opportunity to improve the health of the SRDC patients, the community’s health, the SRDC, and improve patient outcomes is to improve the HbA1C levels of the patients.
He has seen improvement in his numbers, both fasting as well as postprandial. He got a lot out of for diabetes education he received through York Hospital and has been really trying to incorporate those. Again, he has lost weight. His last A1C was done in July at 7.4%. He does have a lab slip to check labs again in one month and he has an appointment to follow up at that
Learning objective #2: (Affective) patient will be able to verbalize the benefits of maintaining acceptable blood glucose levels and the importance of taking insulin exactly as prescribed.
Diabetes is associated with wide range of complications such as chronic renal failure, blindness, amputations, heart disease, high blood pressure, stroke, and neuropathy (Alotabi, A., et al., 2016). There is no known cure for diabetes, but the disease can be controlled through health management that includes multiple perspectives of care such as medications, blood glucose monitoring, diet, nutrition, screening for long-term complications and regular physical activity (Alotabi, A., et al., 2016). Managing diabetes may be complicated and requires the knowledge and skills of both healthcare providers and the clients. Studies have shown that to prevent or delay diabetic complications due to diabetes, counseling and other lifestyle interventions are the effective therapy. Even with many policies set up for diabetes, 8.1 million Americans are undiagnosed with diabetes mellitus, and approximately 86 million Americans ages 20 and older have blood glucose levels that considerably increase their risk of developing Diabetes Mellitus in the next several years (CDC, 2015). For diabetes care to be successful there needs to be a good understanding of the disease and management by both patients and healthcare providers,
I addressed the situation by telling the patient we just switched over to a new program, that everyone makes mistakes and we would do our best to make sure that it did not happen again. After that I quickly changed the subject, so the patient would not be agitated for the rest of the treatment
On November 15, 2017, I attended a professional meeting called “Think Like A Pancreas: A Practical Guide to Managing Diabetes with Insulin.” The sponsors for this meeting were SNDA and CVD. The speaker who presented at the meeting was Gary Scheiner Ms, CDE. He is an author of the book “Think Like A Pancreas: A Practical Guide to Managing Diabetes with Insulin.” The general objective for this meeting helped people gain more knowledge about diabetes, and learned more from author personal experiences with type I diabetes. After I attended this meeting, I become more knowledgeable about diabetes. I have a chance to learn more about diabetes nutrition, different type of medications, and many tools that are available for diabetes patients to keep track on the blood glucose.