Diabetes Mellitus                                 Return to the Beginning

The prevalence of diabetes in our nation is unbelievable, as is the rate at which it will continue to increase over the next few years due to obesity. Diabetes affects adults and children alike. Hospital admissions for diabetes are also growing along with the debate over how much education to provide the patient prior to discharge. 

Nurses are left with the duty of answering questions and providing some educational survival skills on the day of discharge. Patients are easily overwhelmed while in the hospital, especially if they have just been diagnosed with a disease they know nothing about. Healthcare professionals need to be able to provide the patients with just the information they need to take home with them and survive. Once the patient is home and feeling better, full diabetic education can begin as an outpatient.

 

 

Diabetes Information: CADRE Handbook of Diabetes Management “When glucose metabolism is normal, ingested carbohydrate is broken down into glucose in the gastrointestinal tract, enters the bloodstream, and is transported into the body’s cells to be stored or used as energy immediately. Insulin is vital to this transport process. Normally, beta-cells respond to rising plasma glucose levels with an increase in insulin secretion. This secretion tapers off as blood glucose levels return to normal” (8). “All forms of diabetes result from an imbalance between the body’s need for insulin and its ability to secrete insulin. When insulin secretion cannot meet the body’s demand, there is overproduction of glucose and decreased clearance of glucose from the bloodstream, which leads to increased levels of plasma glucose (hyperglycemia)” (8). “Newly diagnosed patients with diabetes need to understand how food intake and physical activity affect their condition. Careful balance of insulin, food, and physical activity contributes to metabolic stability in patients with type 1 diabetes. Weight loss is important for most patients with type 2 diabetes” (8).

 

When a person is diagnosed with diabetes and is in the hospital, he will have lots of questions. The goal of the healthcare professional is to teach the patient that diabetes is a self-managed disease and there are not any foods that he cannot have. This is difficult for the patient to understand when he has just been told that he has a problem with his blood glucose. “It must be from something I ate...” is often the patient’s thought. This is not the case. One must understand that the food is not the problem with diabetes. The food did not cause the problem – however, the body just is not using the food the way it is supposed to and therefore the glucose from the digested food builds up in the blood instead of going into the cells where it is used for energy. The brain, whether you have diabetes or not, needs a certain amount of carbohydrate each minute just to function. So, to eliminate a certain food from the diet is detrimental. Carbohydrates are the foods that, once digested, turn into sugar in our bodies. Carbohydrate foods are starchy foods, fruit, milk, and sweets like cake, cookies, soda, etc. The body does not distinguish between a bowl of cereal, a piece of fruit or a piece of chocolate cake with icing.  It just knows that you gave it some carbohydrate. The amount of glucose in the body will differ depending on the serving of cereal, the size of the fruit or the size of the piece of cake. However, once digested it is all glucose. This is the fuel that our body uses every minute of the day. 

Weight management and blood glucose management work hand-in-hand. Extra weight, especially around the abdomen, makes it difficult for the body to use the energy provided to it after a meal. Portion control and consistency with carbohydrate foods at each meal is the key to managing blood glucose. One’s body quickly adapts to the consistency of the food and will expect a certain amount of carbohydrate at each meal and bedtime snack. 

Always reinforce to the patient that diabetes is a self-managed disease and by taking small steps to an attainable goal the fear of being overwhelmed can be eliminated. Each patient is different and will use a different method of meal planning. There is no such thing as a diabetes diet to prescribe to patients. Meal plans will be individualized once the patient is home and feeling better. Only then will the patient be able to focus on changes that need to be made in order to manage his blood glucose and his weight for the long-term.

Once the patient knows he has diabetes or accepts that his blood glucose management has been substandard, there are a few things that he needs to know before he goes home. Quite often, this responsibility is placed on the nurse taking care of him and getting him ready for discharge. All he really needs to know are the “survival skills,” a few guidelines for the patient to start thinking about once he goes home and starts evaluating his diet and lifestyle. Let him know that the best thing he can do for himself is to go home and practice eating regular meals about every 4-5 hours and have a small snack before bedtime. Foods to limit would be sweet foods: cake, ice cream, soda, etc. These are not off limits forever – once the blood glucose is under control, a plan can be set to incorporate these foods in the diet again. Once the patient is home and well, it is crucial for him to keep food records for the dietitian to review during outpatient counseling. It is very easy for healthcare professionals to control the patient’s diet while in the hospital, so it is important to see some food records to see how the patient is really eating at home. There is no one way to teach diabetes management. Each person is an individual and needs to be treated as such.

 

Diabetes Mellitus Survival Skills

• Do not meals.
• Practice eating three meals daily and space them out about 4-5 hours in between.
• Have a small bedtime snack daily.
• Start to use things like artificial sweeteners, diet soda and diet gelatin...
• Limit the sweets until you return to see the dietitian as an outpatient. She will help you to understand how to include them in your meal planning.
• Start exercising to promote weight management if this is an area of concern.
• Keep four or five days worth of food records and call the dietitian at the hospital to schedule an outpatient to complete diabetes diet education.