The goal of education is to aid the patient and his family in understanding the nature of the disease, the control of the disease, and the prevention of complications.
a. The patient must understand that diabetes is a life-long disease that is controlled, not cured.
(1) Explain normal and abnormal physiology of glucose metabolism in a manner that is understandable to the patient.
(2) Explain the signs and symptoms that occur, and why they occur.
b. The patient must understand and comply with diet therapy and weight control.
(1) Explain the relation between obesity and diabetes.
(2) Explain the effects of a controlled and uncontrolled diet on blood sugar level.
(3) Explain the purpose of a regulated diet in relation to blood sugar.
(4) Teach the patient how to utilize the food exchange lists within his prescribed diet.
(5) Caution the patient about the consequences of deviation from the prescribed diet.
c. The patient must understand the importance of exercise and activity in relation to blood sugar level.
(1) Explain that activity/exercise requires fuel (glucose) and will lower the blood sugar level.
(2) Activity or exercise that is more strenuous than the patient’s normal routine may cause blood sugar to drop dangerously low.
(3) Extra activity or exercise should be planned for in advance. Insulin dosage may need to be decreased, or food intake increased.
(4) Explain that regular exercise improves circulation and general health.
d. The patient must understand the purpose, actions, and side effects of prescribed medication (insulin or oral hypoglycemic agents).
(1) Explain the type, action, dosage, route and times of administration, and side effects of the medication prescribed.
(2) Demonstrate and discuss the proper procedures for storage and administration of medications.
e. The patient must understand the importance of regular urine testing.
(1) Explain that the purpose of regular urine testing is to detect the presence of glucose and/or ketones “spilled over” into the urine.
(2) Demonstrate and discuss the correct procedure for collecting and testing a urine specimen.
(3) Explain how to interpret the test results, along with actions to be taken for the different results.
(4) Stress the importance of documentation of the results and actions taken. Encourage good record keeping.
f. The patient must be made aware of the complication of diabetic neuropathy.
(1) Neuropathy is a common complication of diabetes that causes impaired sensation in the extremities, especially the feet.
(2) Damaged nerves lose their ability to adequately conduct impulses. Because of this, the diabetic may not feel an injury.
(3) Instruct the patient to be cautious due to the decreased sensation. Emphasize the following:
(a) Wear only well fitted shoes.
(b) Never walk bare-footed.
(c) Do not use heating pads or hot-water bottles. The patient could sustain a heat injury due to decreased sensation.
g. The patient must be made aware of the complication of peripheral vascular disease (PVD).
(1) Another common complication of diabetes, PVD causes impaired circulation, which results in decreased oxygen perfusion to body tissues.
(2) Teach the patient to recognize the signs and symptoms of PVD.
(a) Decreased skin temperature.
(b) Decreased venous and capillary filling.
(c) Diminished or absent pulses.
(d) Skin that appears thin and shiny.
(e) Loss of hair on the back of the hand or dorsum of the foot.
(f) Thick and ridged toenails.
(3) Discuss methods of promoting good circulation.
(a) Daily exercise to improve circulation. Walking is the best exercise.
(b) Keep feet warm. Use socks, blankets, etc.
(c) Do not sit or lie with legs crossed.
(d) Do not use stockings or garters with tight elastic bands.
(4) Instruct patient to thoroughly inspect and properly care for his feet.
(a) Soak feet for about five to ten minutes each day to keep the skin and nails soft.
(b) Dry feet thoroughly and apply lotion.
(c) Inspect the feet for cuts, scrapes, sores, blisters, or other skin changes.
(d) Emphasize that no foot problem should be self-treated. The patient must always seek the care of a physician.
h. The patient must be made aware of the complication of infection.
(1) Impaired circulation and decreased oxygen to body tissue results in slow and lengthy healing times as well as an increase in the likelihood of serious infection.
(2) Teach the patient to observe for signs of infection.
(3) Teach the patient to prevent infection.
(a) Never self-treat open sores.
(b) Use extreme care and proper technique when performing nail care. Use only a proper nail clipper and cut straight across the nail.
(c) Never pick at sores, scabs, cracked skin, or ingrown nails.
(4) Explain that the fever of an infection will cause an increase in the metabolic rate, which will cause a change in caloric requirements. The patient with fever should always consult with his physician.
i. The patient and his family must be aware of the signs and symptoms as well as emergency treatment for the diabetic emergencies of ketoacidosis and insulin shock. As discussed in paragraphs 1-73 and 1-74, reinforce the following:
(1) Causes.
(2) Signs and symptoms.
(3) Emergency treatment.
(4) Prevention.