April 21, 2017
Ambulatory Glucose Profile
Diabetes patient education is a crucial part of management of diabetes patients. A diabetic patient himself has to be actively involved in managing his own disease. From diabetic diet to foot care, there are a number of things that a the treating physician or diabetes educator should be educating every patient about. Patient education is an exhaustive subject and all these self help tips can not be taught in one single session. At Diabecity every patient is gradually trained over number of visits during his routine follow up. Important things to be covered under patient education program are –
Diabetic Diet – Diet plays a crucial role in controlling not just blood sugar but controlling weight and other parameters like blood pressure and cholesterol. Though the dietary needs of every patient are different and the advice needs to be individualized, certain basic things must be followed by every diabetic patient. Simple sugar or glucose intake in any form should be completely stopped. This includes desserts made of sugar, beverages and juices with added sugar though artificial sweeteners can be consumed. Fruits with high glycemic index like Mango, Banana, Chiku, Grapes and custard apple are to be avoided. Other fruits like oranges, guava, apple etc. may be consumed in moderation. Rice and Potato are rich in starch and are better to be avoided, though the patients for whom rice is a staple food may be advised to continue it. Patients with hypertension should restrict their salt intake, they should simply avoid taking extra salt. Patients with high cholesterol levels or the ones who are at risk of heart disease should cut down on their fat intake by using less of oil in cooking.
Exercise – Regular exercise not just helps in controlling blood sugars and weight but also reduces the risk of complications. The general advice that can be given to all patients is brisk walk (fast walk at a speed just less than jogging) for 45 minutes a day. Those who can not go for a walk may be advised for Yoga, Pranayam and other ergometric exercises. Any kind of aerobic exercise like running, swimming, cycling etc is good for diabetic patients.
Self Monitoring of Blood Glucose – patients on insulin therapy and those with fluctuating levels of blood sugars need to monitor their blood sugar frequently at home. Self monitoring may also be needed during change in doses or medication. Self monitoring is usually done by glucometer and various meters use different methodology for glucose estimation. Patients should better be educated and hands on training be given with the meter that they are using.
Hypoglycemia – Diabetic patients on glucose lowering drugs are at high risk of hypoglycemia and it can be fatal in some cases. Number of patients land up in hospital simply because they were not aware of hypoglycemia and could not manage it home. A patient should be told about common symptoms of hypoglycemia. The immediate treatment for hypoglycemia is eating. If the episode is severe glucose may be consumed. For patients who are unconscious, glucose paste should be put in their buccal cavity.
Self adjustment of Insulin doses – Doses of insulin often need to be adjusted based on glucose readings obtained on self monitoring. There are variety of insulin preparations and its better if the patient is aware of the mechanism of its action. That helps the patient in titrating doses of insulin between the visits to doctors clinic.
Insulin injection technique – a number of patients fail to achieve their glycemic targets because faulty injection technique. Patients must be aware of the storage conditions for insulin, the proper syringe to be used, the site of injection and technique of injection.
Sick day schedule for type 1 diabetic – patients with type 1 diabetes are at high risk of fluctuations in sugar levels when they are in stress which might be physical stress like fever and trauma or mental stress. They need to consume a lot of fluids during this period to avoid dehydration. They should also monitor their sugar levels more frequently and adjust the doses of insulin if needed.
Foot care – long term diabetic patients often suffer from neuropathy. They fail to feel the pain of trauma to feet. such unnoticed wound may not heal and may land up the patient into severe foot infections. Such patients need to take care of their feet regularly. The shoes should also be customized for such patients.