Diabetes and You – Diabetes Education for Newly Diagnosed Patients

a patient who is diagnosed with type 1 diabetes would be expected to:
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Im Megan Im a diabetes educator at unitypoint health a diabetes diagnosis requires education so that you have a longer healthier life with fewer complications the goal of this video is to give you the information you need to live well with diabetes it is also meant to complement the booklet given to you by your nurse diabetes in you your nurses and dietitians are available to give you the information and tools you need to live well with diabetes learning to take care of your diabetes will take time and may affect how you learn new things but remember we look forward to being part of your healthcare team and are available to review information with you as often as you would like please feel free to ask questions during the learning process taking care of your diabetes at discharge your health care provider may refer you to a diabetes specialist if you are experiencing difficulties controlling your blood sugar such as readings that are too high or too low or for any other special needs related to your diabetes we are here to help you manage your condition and offer services at several locations what is diabetes diabetes happens when your body is not able to use and store blood sugar like it should sugar builds up in your blood which increases your blood sugar you may also hear blood sugar referred to by the clinical term of blood glucose as you learn to care for your diabetes you will gain more experience in how to keep your blood sugar at a healthy level the role of sugar glucose most of the food we eat is turned into glucose or sugar for our bodies to use as energy glucose is carried to the cells through the blood insulin is a hormone produced by the pancreas insulin is the assistant that helps move glucose from the blood into the tissues and use it for fuel and energy type 1 diabetes formerly called juvenile diabetes or insulin dependent diabetes type one diabetes is an autoimmune disorder most often seen in children and young adults with type 1 diabetes very little or no insulin is made in the pancreas because of this the condition must be treated with insulin injections several times a day its important to check and record your blood Sugars eating healthy meals and being active are important in managing type 1 diabetes type-2 diabetes formerly called adult-onset or non insulin-dependent diabetes type 2 diabetes can be caused by insulin deficiency or insulin resistance insulin deficiency is when your body does not make enough insulin insulin resistance is when the insulin your body makes does not work very well risk factors for type 2 diabetes include a family history of the condition inactivity forty years or older overweight gestational diabetes in addition you may be at an increased risk if you have elevated blood pressure high LDL cholesterol or low HDL cholesterol living well with type 2 diabetes type 2 diabetes develops over time and is caused by the bodys inability to control glucose in the blood it may begin with insulin resistance where the insulin your body makes does not work well the condition can also cause insulin deficiency where your body cannot make enough insulin living well with type 2 diabetes involves checking and recording your blood sugar planning and eating healthy meals and being active its also important to take any diabetes medications as directed by your provider some people with type 2 diabetes may need to take insulin a healthy lifestyle exercise and diabetes medication may not be enough to alone treat your diabetes checking your blood sugar goals and supplies your healthcare team will provide information about checking blood sugar including what blood sugar goal is safe for you and how many times to check your blood sugar each day checking your blood sugar will tell you if you need to change your food choices and amounts activity or diabeetus medications blood sugar goals and supplies the American Diabetes Association a da provides guidelines for healthy blood sugar you should always check your blood sugar as instructed by your healthcare team using your blood sugar meter blood sugar before eating or drinking should be 90 to 130 milligrams per deciliter blood sugar two hours after the start of a meal should be less than 180 milligrams per deciliter the supplies you need include blood sugar test strips lancets and a blood sugar meter all of these items may be purchased at most drugstores your insurance will cover all or part of these costs if you have a prescription a 1c lab test the a1c blood test provides an approximate average of your blood sugar during the past three months it actually measures the sugar coating your red blood cells this lab test is used to identify complications associated with diabetes a low a1c result has a low risk of complications while a high a1c result has a high risk of complications its important to have an a1c blood test every three months a 1c is measured in percent and a normal a1c is about four to six percent the higher your blood sugar has been in the past few months the higher your a1c will be your a 1c goal is to be less than 7% or what your doctor recommends hyperglycemia or high blood sugar hyperglycemia is high blood sugar causes can include not enough diabetes medication not enough exercise eating too much food stress or illness signs and symptoms may include feeling thirsty urinating a lot feeling tired sores that dont heal unplanned weight loss or vision changes if you experience hyperglycemia check your blood sugar more often and drink more carbohydrate free fluids such as water or tea be sure to follow your meal plan and work with your health care team to adjust medicine as necessary people with type 1 diabetes should check their ketones if told to do so and then drink 8 to 10 ounces of water and recheck your blood sugar in 30 minutes hypoglycemia or low blood sugar the opposite of hyperglycemia is low blood sugar or hypoglycemia this condition develops if your blood sugar is less than 70 milligrams per deciliter if you experience symptoms such as blurred vision or dizziness sit down and check your blood sugar each one carbohydrate choice 15 grams and wait 15 minutes and check your blood sugar again carbohydrate choices include 4 glucose tablets 1/2 cup of fruit juice or half a cup of regular soda or 1 cup of milk if your blood

sugar is less than 70 milligrams per deciliter eat another carbohydrate and wait another 15 minutes check your blood sugar again if its still less than 70 milligrams per deciliter call your doctor or go to the emergency room you should not drive sick days sick days can happen it helps to have a plan ready before you get sick so you know what to do a cold the flu or other infection may raise your blood sugar talk to your health care team about getting the flu and pneumonia shots if you do get sick heres what you need to remember to help keep your diabetes under control check your blood sugar before meals and at bedtime drink four to eight ounces of sugar free caffeine free fluids like broth tea coffee water and diet soda every hour get plenty of rest follow your meal plan if you cannot eat drink fluids that will give carbohydrates such as juice regular soda or regular jello always take your long-acting insulin even if you cannot eat check your ketones if you have type 1 diabetes call your doctor if you do not get better if any of the following conditions persist its time for you to call your doctor have a blood sugar of 240 milligrams per deciliter or higher for 24 hours throw up or have loose stools for 6 hours have a fever that stays over 101 degrees have trouble breathing confusion have stomach or chest pain notice a change in your eyesight or you cant see very well are not getting better after two days meal planning and healthy eating with a diabetes diagnosis its important to eat a balanced diet with healthy foods from all food groups myplate.gov is a guide to help you know how much to eat from each food group you can start being healthier by eating three meals a day you should space meals four to six hours apart be sure to include a small snack if meals are more than six hours apart do not drink – juices try to drink sugar-free Crystal Light diet soda and water youll need to limit milk to no more than eight ounces or one cup at a meal you may sweetened foods like coffee tea or cereal with Splenda or equal eating right is important a dietitian will visit with you during your hospitalization to review meal planning and answer any questions you may have during follow-up care for your diabetes you will also learn more about healthy eating diabetes affects many parts of your body its important to have regular check-ups with your health care team refer to your diabetes and you handbook for recommendations exercise and activity exercise helps your body use insulin better lower blood sugar cholesterol blood pressure and reduce stress be prepared to treat low blood sugar if you are active carry a fast-acting carbohydrates such as glucose tablets take four if you are at risk for low blood sugar medications there are many different diabetes medications at work in different ways your doctor will help determine your treatment use a reminder system to help you remember to take your medication at the correct times some examples include using a pill organizer calendar or checklist you should always take your medication as prescribed do not change your dose or skip medication without talking to your doctor you may or may not need medicine if you have type-2 diabetes blood sugar checks will help your doctor decide the best medicines for you insulin is a key medication in controlling diabetes long-acting insulin such as lantus or Lev Amir works up to 24 hours to prevent high blood sugars between meals short-acting insulin such as humalog or novalog is taken at meal time works quickly and lasts for a few hours hi Marie Im Megan Im gonna die very nice to meet you Im a diabetes nurse and were going to talk about taking insulin shots today okay the first step to take an slit shots and making sure you have clean hands so were going to go ahead and wash our hands yes its perfect there are two ways that you can give your insulin shot one is using an insulin vial and the other is using an insulin pen so Im going to show you how to do both with an insulin vial or a pen either one if the insulin inside is a cloudy insulin you want to make sure to mix it before you use it so you can roll the vial or the pen between the palms of your hands okay and thatll mix that insulin up before you take it so lets start with using the insulin vial you want to clean off the top of the vial if its a new vial itll come with a little cap on top that youll pop off so youll clean the top with an alcohol swab okay and then youll go ahead and prepare your needle so theres going to be a couple cap so youre going to pull off the bottom cap in the top cap and then what we do is we put in air into your syringe so for this example your doctor prescribes you 10 units of insulin so were going to pull back the syringe and the plunger on that syringe until there is 10 units of air in the syringe once you have the air in your syringe youre going to stick the needle in the top of the vial and push in that air okay before you take out your needle youre going to flip that vial over and youre going to make sure that theres insulin covering the top of your needle and vile and now were going to go ahead and pull back insulin into your syringe so we usually say pull back push up and then pull back a second time and that kind of gets any air bubbles out of that syringe so you want to make you sure that you pull back to the 10 units which is your dose everybodys dose is different but pull back to the dose that your doctor prescribes you and always double-check because sometimes those little lines are very hard to see double-check that you have the 10 units so how do you double-check and make sure that thats what we have okay and then you can pull out your needle at this point if you re losing the insulin vial and syringe youll be ready to give your shot now well talk about preparing an

insulin shot first wash your hands with soap and water or an antiseptic if the insulin is cloudy mix by rolling the vial between the palms of your hands if it is a new vial pull off the flat colored cap do not remove the rubber stopper or metal ring at the top of the insulin vial clean the rubber stopper with an alcohol swab take the cap off the top of your syringe and needle pull the plunger back to fill the syringe with air pull back to the tip of the plunger and tell the tip of the plunger is that the line for the number of units of insulin needed for this example well pull the plunger back to 10 units push the needle through the rubber stopper of insulin at the top of the insulin vial push in your air without removing your needle turn your vial upside down and pull back on your plunger your syringe will fill with insulin push that insulin back up and pull down to the dose that you have been prescribed to by your physician for this example were pulling back to 10 units its always a good idea to double-check your dose and double-check the amount of insulin that you have pull back in your syringe double-check that there are no air bubbles between the top of the plunger and the top of your syringe if you see air bubbles push your insulin back into the vial and again pull back down to the dose when you have the right amount of insulin without air bubbles go ahead and pull out your needle at this point youre ready to give your insulin shot but lets go over the pen so the same kind of thought process with a pen youre going to take the cap off and youre going to clean the rubber stopper at the top of the pen this is your pen needle youre gonna take this tab off and your needles in there youre gonna stick it into the rubber stopper and youre gonna roll it righty-tighty once you have that take your caps off of your needle and youre gonna what youre going to prime your pin so what we do is we look in this dosing window and we roll this tutu and were going to push and hold the bottom of your pin button and youre going to be looking at the top of your pen and that needle to make sure theres insulin bubbles coming out if you dont see any bubbles coming out then you need to dry it again so it automatically rolls back to zero when youre pushing and holding that button youre going to roll it up to to push and hold and look for insulin coming out at the top of your needle okay thats just to make sure that theres no air between the top of your vial and that the top of your pen and the top of your needle so that you get your full dose once youve done that double-check that youre back to zero and then roll it up to the dose that your doctor prescribed you so for this example it would be ten units and then youd be ready to give your shot insulin pens are another great medication option for insulin to use an insulin pin wash your hands first with soap and water or an antiseptic remove the pin cap wipe the rubber stopper with an alcohol swab remove the paper tab from the needle and screw on to the pen again if you are using a cloudy insulin you need to mix the insulin before you use it you can roll the pin between your palms of your hands or rotate it back and forth about ten times once you have your pin needle on you can remove the caps pen needles need to be primed before each use to prime your pin needle look in your dosing window and roll your dose up – – you should hear clicks when you turn your dial once you have your dose rolled up – to push and hold the bottom of the insulin pen and look at the top of the needle for insulin bubbles if you do not see any insulin bubbles coming out at the top of your needle try it again look in your dosing window roll – – and push and hold the button at the bottom this is to make sure all the air is out of your needle and that your needle is working fine your dosing window should automatically roll back to zero at that point you would roll up your dosing window – the amount of insulin prescribed to you by your doctor so for this example our doctor prescribed 10 units at that point it would be ready to give your insulin shot okay so lets talk about where you can give your shots and how to give an insulin shot so you can use any part of your belly as long as you stay two inches away from your belly button or any scars you can also use the thighs so the top of the outer part of your thighs or the back of your arms most people choose their belly the biggest thing is to rotate around and not give the shot in the same exact spot every time so if you take a shot over here then you want to move it down at least an inch or two inches away from the last spot you gave your shot to give your next one so the first thing youd want to do with your skin is to prepare your skin with an alcohol swab okay so where do you think youll give your shot today probably my belly okay perfect and then its important to let that alcohol dry because itll sting if you go ahead and give you a shot without letting it dry if youre giving an injection with the pen or with the syringe either one youre going to do the exact same thing so youre going to go ahead and youre going to take that needle and youre going to go straight in at a 90 degree angle perfect and go ahead and press down on your plunger make sure that needles all the way in there press down on your plunger perfect and then you want to hold that needle in there and count to ten and then you can go ahead and pull out your needle

that gives you some time for that insulin to absorb before you pull out your needle okay okay the same thing with an insulin pen you would go ahead and clean the set your sight or its a part of your skin stick it in a straight 90 degree angle push and hold down on your pen itll automatically roll to zero at that point you would count to ten and then pull out your pen now I saw that you were pinching and thats perfect with the longer needles you would need to pinch your skin up they say pinch an inch so pinch up that skin if its a shorter needle like this one so anything below an inch and a half or eight millimeters you dont have to pinch any more so you can go ahead and just clean your skin inject the air insert the needle inject the insulin count to ten and then pull out okay okay see how many questions okay its important after you prepare your insulin shot to either cover the needle or lay your needle and syringe on a flat surface so that way that needle doesnt come into contact with anything before you give your shot it is important to get rid of your needles or your sharps in a designated container you can either purchase a sharps container at your pharmacy or use a liquid larger a detergent container a bleach container or a fabric softener container thats a thick hard plastic and has a screw on lid after using your pen needle make sure to unscrew the cap and place it in one of those containers you can also do that with your insulin syringes diabetic ketoacidosis or DKA when there is little or no insulin to help your body use sugar your body will use fat as fuel when the body uses fat for fuel it produces ketones ketones build up in your blood and urine and make you very sick this is called diabetic ketoacidosis DKA DKA is an emerge agency and you will be hospitalized it is most commonly caused by illness infection or skipping insulin checking for ketones if you have type 1 diabetes you were told to check for ketones ketones can make you very ill you should check for ketones in your urine when your blood sugar is above 240 milligrams per deciliter first thing in the morning your blood sugar is above 300 milligrams per deciliter at other times of the day anytime you throw up even once you feel sick the key to preventing DKA is finding ketones in small amounts if this happens give extra fast acting insulin according to your doctors instructions and drink lots of calorie-free liquids signs of DKA include trouble breathing confusion stomach pain changes in vision sweet fruity smelling breath or extreme drowsiness now well demonstrate how to check for ketones if you have type 1 diabetes summary I want to show you how to check for ketones there are two different ways that you can buy keto strips or strips to cut test for ketones at the store they either come in a canister or in a foil-lined package if you buy the ones in the foil-lined package theyre good until the expiration date on that package if you get keto sticks that are in a canister like this once you open that canister its good for six months unopened its good until the expiration date okay so you can do it two ways you can either urinate into a cup and put the keto strip stick into the cup or you can urinate on this on the keto stick itself wait 15 seconds and then look at the compare the colors on your strip do the colors on the side of the container and that will tell you how many ketones that you have in your urine how do care for your feet diabetes can cause high blood sugar levels which can lead to foot problems its important to check your feet every day look for cuts sores red spots swelling and infected toenails you may have foot problems but feel no pain in your feet if you have trouble bending over to see your feet use a mirror to help you you can also ask a family member or caregiver to help you have your health care provider look at your feet every office visit to care for your feet make sure to wash your feet every day and warm not hot water dont soak your feet as this can dry out your skin and cause too much moisture between your toes before bathing or showering test the water to make sure it is not too hot you can use a thermometer 90 to 95 degrees Fahrenheit as a safe temperature or your elbow to test the water keep the skin soft and smooth rub a thin coat of moisturizing lotion and cream on the tops and bottoms of your feet do not put moisturizing lotion or cream between your toes because this might cause too much moisture and/or infection smooth corns and calluses thick patches of skin called corns or calluses can grow on your feet if you have corns or calluses check with your foot doctor about the best way to care for them do not cut corn or calluses do not use razor blades corn plasters or liquid corn and callus removers they can damage your skin and cause an infection trimming your toenails use nail clippers after you wash and dry your feet trim straight across and smooth corners with an emery board do not cut into the corners of the toenail see a doctor when you cant see your feet cant reach your feet have toenails that are thicker yellowed have nails that curved and grow into the skin while there is no cure for diabetes you can control the symptoms and take charge of your health your healthcare team is here with you to give you the skills and tools you need to live well with diabetes we encourage you to seek education after you leave the hospital for Dera diabetes care your nurse will help make this referral knowing how to keep your blood Sugars in the healthy range is called diabetes self-management that means most of the work in keeping your blood sugars and your diabetes in control is done by you this can be overwhelming your nurses doctors dieticians and other health care team members are available in the hospitals in the clinics in at home to help you

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