Management Program at Community ... - Diabetes...
Transcript of Management Program at Community ... - Diabetes...
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This product was developed by the RWJ Diabetes Self Management Program at Community Health Center, Inc. in Middleton, CT. Support for this product was provided by a grant from the Robert Wood Johnson Foundation® in Princeton, New Jersey.
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RWJ Advancing Self Management Diabetes Program
Daren Anderson, MD Joan ChristisonLagay, MAT, MPH
Hilda Cardona, RN, CDE Paula Kellogg Leibovitz, RD, MS, CDE
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Diabetes An Epidemic Feared
CDC estimates that there are currently 17 million diabetics in the US
The number of diabetics tripled from the mid l960’s
to the mid l990’s
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American adults and kids
Not to be impolite or hurt feelings but many Americans, young and old, are
Overweight
Inactive
And it’s killing us!
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Diabetes and More
Americans are putting themselves at risk for
v Diabetes
v Heart Disease
v Stroke
v Cancer
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We are putting our children at risk
1 in 3 of all children & 1 in 2 of Black and Hispanic
children born in 2003 are predicted to develop diabetes
If you have 2 or 3 small children or grandchildren, one of them is predicted
to develop diabetes
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What Can You Do?
Get Moving and get your
children moving
even a little exercise helps
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What Else Can You Do?
Eat Smart and make sure your children eat smart
losing just 10 pounds can make a big difference
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If Someone Already Has Diabetes
These are essential
v Exercising
v Eating smart
v Taking medication
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For Diabetics at CHC
v CHC has a new program for diabetics
v It’s a Robert Wood Johnson (RWJ) Advancing Self Management Project
v New Britain, Meriden and Middletown are part of the project and we need your help!
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The RWJ Diabetes Self Management Program
Diabetics should be referred to one of our certified diabetes educators
Hilda Cardona, RN, CDE Paula Kellogg Leibovitz, RD, CDE
Any one at CHC can make a referral using our referral cards
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Diabetes Self Management
People have to help themselves!
Hilda or Paula work with people to help them set their own goals. Examples: v Taking medication everyday v Eating 2 doughnuts instead of 6 v Walking in the mall regularly v Talking to a friend or a group about feelings
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Individual or Group Session
v Participants can see Hilda or Paula 1 on 1 or in groups sessions
v Many diabetics are depressed. Paula or Hilda will refer them to counseling or back to their PCP
v In the spring, we will offer walking groups
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Sessions
v Try to be fun
v Are easy to understand
v Let participants know that they can help themselves
v Give participants lots of choices
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Group Sessions
Food served
Samples such as glucose tablets or sugarfree jello are distributed
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Annual CookaThons
The Diabetes team creates delicious, diabeticfriendly meals for diabetic patients. After the tasting, patients vote for the best cook and receive a bilingual cookbook of the food creations.
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Examples of Teaching Overheads
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Why Me?
Did I eat too much sugar?
You did not eat too much sugar and give yourself diabetes!
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What do the numbers mean?
v Normal glucose level before meals is 80 120
v After meals, up to 180 is ok
180+ too high
below 70, too low
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What does A1C Mean?
vYour A1C is like a report card
v It tells how much sugar has been sticking to your blood cells for the past 3 months
vThis number is very important. 7.0 or lower is great.
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Lifetime Risks of 20 people with different A1C levels
Kidney Failure
Amputation
Blindness
A1C of 7.2 A1C of 10.0 Problem
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Keep in control with the ABC’s of Diabetes
A: A1C of 7.0 or lower
B: Blood pressure 130/80 or lower
C: Cholesterol level below 200:
this little guy lost control
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Self Management Help Yourself!
v Make a goal related to something we talked about today
v Bring the sheet to the next session
v If you forget one day, don’t worry. Just don’t give up!
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I’ll Never Enjoy Eating Again! Oh yes, you will!
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Cooking & Eating Tips
Smaller portions Grill or bake, don’t fry
White meats more than red
Olive or canola oil Not butter, lard or Crisco
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Your mother was right! Eat Your Vegetables
Would you like some homemade vegetable soup?
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Portion Control
Healthy blood glucose is helped by moderate portion sizes. You may think the portions seem small.
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Make a Dinner Carbohydrates
Women pick 3 Men pick 4
from the list below 1/2 cup mashed potato 1/2 cup corn, peas 1 cup winter squash 1/3 cup cooked stuffing, pasta or rice 1 small baked potato 1/3 cup baked beans 1 slice whole wheat bread 1 small apple, orange, pear, or peach 1 1/4 cup whole strawberries 1 small banana 17 grapes 1/2 cup canned fruit in own juice 4 oz. fruit juice 8 oz. skim milk 6 oz. sugar free yogurt 1/2 cup sugar free pudding 3 small gingersnaps or 5 vanilla wafers 1/2 cup frozen yogurt
Meats and Proteins Women pick 1 Men pick 12
3 oz. chicken, no skin 3 oz. turkey, no skin 3 oz. fish 3 oz. seafood 3 oz. lean beef 3 oz. lean pork 3 oz. lean lamb 3 oz. veal 3 oz. lean hamburger 3/4 cup low fat cottage cheese
FREE FOODS Vegetables, spices, Coffee, tea, diet soda Clear broth, sugar free jello
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Snack Choices
Free snacks v Sugar free jello v Tea, coffee, sugar free soda v Celery and carrot sticks
Carb snacks (must count) v Small piece of fruit v Sugar free, low fat yogurt v Gingersnaps or vanilla wafers v Nuts Did somebody say nuts?
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Fast Foods Buyers Beware
Super sizing produces super sizes and other problems
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Fast Food Restaurants v They are easy v They are fast v They are cheap v Kids love them
BUT v They help set kids up for diabetes v They may increase the risk of heart attack, stroke and diabetes complications.
WHAT CAN YOU DO?
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Fast Food Restaurants How to be Smart!
vDiet soda or water vNo special sauces vHold the cheese vNo supersizing vBe really good, pull off the top bun
vLet’s discuss your favorites
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Diabetes: A Progressive Disease Over time, most patients will need insulin to reach their targets. This is NOT a failure.
Many new devices greatly reduce the discomfort.
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Foot Care
Check your feet everyday
Always wear shoes and socks
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Dental Care
v Brush v Floss v See a dentist every year v Call if you have: Ø loose/sore teeth or dentures Ø red, swollen or bleeding gums Ø problems chewing Ø a bad taste in your mouth.
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Exercise: don’t be a v Take your kids or grandkids to a park
v Walk
v Garden
v Dance
v Other ideas?
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Self Management Goals Help yourself!
v Using your self management goal sheet, make a goal related to something discussed today.
v It may be as simple as always wearing shoes, or flossing your teeth everyday, or parking further from the door of the store.
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Session 6 Grocery Store Tour Meat and seafood area Margarine and oil areas Dietetic Food Section Dairy Section Deli Fresh, frozen & canned fruit/vegetable areas
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Grocery Store Shopping
Hilda Cardona, RN, Certified Diabetes Educator Extraordinaire .
.
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Examples of Printed Materials Used in the Diabetes Program
v Self management goal sheets
v Referral Cards
v Make a meal sheets
All CHC staff are part of patient care! Start making referrals today to the diabetes
program