Colbert and Williams Training: Webinar 1- Diabetes and Flu. UIC College of Nursing

Transcription

1 Colbert and Williams Training: Webinar 1- Diabetes and Flu UIC College of Nursing

2 Agenda Introduction Chronic Condition: Diabetes Seasonal Update: Influenza Conclusion References/Resources 2

3 Purpose 1. Provide education on the most common chronic medical conditions. 2. Education on red flags related to these conditions and how to respond. 3. Increase self-confidence for working with member s with these conditions. 4. Locate resources for members. 3

4 Objectives 1. Provide a basic level of knowledge regarding diabetes to Care Coordinators/ Team Members. 2. Identify red flags for diabetes. 3. Discuss possible actions CCs/TCs can take when red flags are identified. 4. Discuss the importance of the flu vaccine for the Colbert and Williams population. 4

5 Colbert-Williams Training Combined training initiative including process and clinical topics Includes Williams and Colbert agencies Supported by IDoA and DMH Presented by UIC CON in a combination of in-person and webinar trainings Website with links to presentations and clinical guides will be available 5

6 Topic Identification Discussion with DMH and IDoA UIC CON reviews and reports Agency feedback 6

7 Ground Rules Please turn phones or computer on mute Participate and ask questions Respect your peers 7

8 Diabetes 8

9 What is Diabetes? A long term (chronic) disorder A hormone (endocrine) disorder Diabetes impacts your body s processing of glucose (sugar) Type 1, Type 2, Gestational Diabetes, Pre-diabetic 9

10 Diabetes by the Numbers More than 29 million American adults are living with diabetes (about 9.3%). More than 86 million American adults are living with prediabetes. 7 th leading cause of death in US. Diabetes is leading cause of kidney failure. 20% of health care spending is for people with diabetes. Approximately 25% of adults with diabetes in the US are unaware they have diabetes. Up to 90% of adults with pre-diabetes in the US are unaware they have pre-diabetes. (CDC, 2016a; CDC, 2014) 10

11 Diabetes in Williams and Colbert Diabetes has been linked with increased risk of incidents and mortality. Diabetes is seen with co-morbid medical, mental health, and/or substance use conditions. TCs/CCs can work with member to improve health behaviors such as Diet Exercise Medication adherence Self-management skills Reviewing glucose logs Improved health behaviors reduces risk for complications. 11

12 Case Study 2- Lotto Leaves 56-year-old Caucasian male Estranged from his wife and son, no social support MCO health plan 10 th grade education, history of odd jobs and homelessness Criminal history assault, trespassing, battery 4 NFs in past 4 years Diagnoses include: diabetes, renal failure, history of wounds, history of MI, below knee amputation, sleep apnea, hyperlipidemia, obesity, hypertension, GERD, schizophrenia, major depressive disorder, history of alcohol misuse, and history of polysubstance misuse 12

13 Lotto s Medication List Dorzolamide/Timolol 2/0.5% solution, one drop in both eyes twice a day for ocular hypertension Potassium chloride 20 meq by mouth daily for hypokalemia prevention Ferrous Sulfate 325 mg by mouth three times a day with food for supplementation Calcium with vitamin D, take one tablet by mouth daily for supplementation Lisinopril/hydrochlorothiazide 20/25, take 1 tablet by mouth daily for hypertension Lipitor 40 mg by mouth daily for hypercholesterolemia zinc oxide 20% ointment apply as needed for wound care ranitidine 150 mg by mouth twice a day for GERD Lantus 10 units subcutaneous twice daily for diabetes Humalog 30 units subcutaneous before meals three times daily for diabetes Metformin 1000 mg by mouth twice a day for diabetes Lexapro 10 mg by mouth daily for depression Trazodone 100 mg by mouth at bedtime as needed for sleep Latuda 160 mg by mouth daily for schizophrenia 13

14 Type 1 and Type 2 Diabetes Insulin Onset Type 1 Type 2 The body does not make enough insulin Typically childhood but anytime Body cannot use insulin properly Typically adulthood but anytime Prevention Not preventable Preventable Cause Immune response Unknown Risk Factors Family history Race/ethnicity Geography Genetic markers Overweight/obesity Inactivity Family history Race/ethnicity Advanced age Gestational diabetes history (CDC, 2016a; CDC, 2014) 14

15 What is Insulin? Insulin is a hormone produced by your pancreas. Insulin helps your body move glucose (sugar) from your blood into cells to be used and stored. If you body does not make insulin or does not use it effectively, the glucose (sugar) stays in your blood. 15

16 Food, Insulin, and Glucose With Insulin Response Without Insulin Response

17 Diabetes Major Complications Coma Death Cardiovascular disease Stroke Eye damage Kidney damage Nerve damage Wounds and amputation 17

18 Lotto Leaves- Diabetes Complications Coma Death Cardiovascular disease Stroke Eye damage Kidney damage Nerve damage Wounds and amputation 18

19 Diabetes Management Treatment plan is unique to that individual Medication Monitoring Diet and exercise plan Communication with managing provider is key Developing goals Scheduling appointments and tests Identifying self-management tasks 19

20 Diabetes Management Medication Nutrition Exercise Care Plan 20

21 Diabetes Management Review Collaborate with providers Medication plan Diabetes supplies Self-management skills Nutrition Lifestyle habits and choices Glucose logs Red flags 21

22 Collaboration Many individuals with diabetes have multiple health conditions. Individuals commonly have multiple providers and need to be seen regularly to monitor Primary Care Provider (every 3 months) Ophthalmologist (once a year) Podiatrist (every 3-6 months) Collaboration Prevents duplicating treatment Facilitates a comprehensive care plan Identifies complications Identifies resources Impact of co-morbid conditions 22

23 Collaboration: Lotto Leaves Primary Care Provider (every 3 months) Endocrinologist (if applicable) Ophthalmologist (once a year) Podiatrist (every 3-6 months) Cardiologist Wound Care Dialysis Center Dietician Diabetes Educator Psychiatrist and CMHC 23

24 Diabetes Medication: Insulin Always needed for Type 1 Can be used with Type 2 Replaces insulin Delivered by injection Syringe Insulin pen Insulin pump Insulin is not universal Rapid, short, long, intermediate Combination Set dose or adjustable dose 24

25 Diabetes Medication: Oral Hypoglycemic Used mostly with type 2 diabetes Does not replace insulin Standard doses 25

26 Medication Management: Lotto Dorzolamide/Timolol 2/0.5% solution, one drop in both eyes twice a day for ocular hypertension Potassium chloride 20 meq by mouth daily for hypokalemia prevention Ferrous Sulfate 325 mg by mouth three times a day with food for supplementation Calcium with vitamin D, take one tablet by mouth daily for supplementation Lisinopril/hydrochlorothiazide 20/25, take 1 tablet by mouth daily for hypertension Lipitor 40 mg by mouth daily for hypercholesterolemia Zinc oxide 20% ointment apply as needed for wound care Ranitidine 150 mg by mouth twice a day for GERD Lantus 10 units subcutaneous twice daily for diabetes Humalog 30 units subcutaneous before meals three times daily for diabetes Metformin 1000 mg by mouth twice a day for diabetes Lexapro 10 mg by mouth daily for depression Trazodone 100 mg by mouth at bedtime as needed for sleep Latuda 160 mg by mouth daily for schizophrenia 26

27 Diabetes Supplies Glucose monitor Test strips Lancets Bandages, cotton balls, first aid supplies Rubbing alcohol Insulin supplies (syringe, pen, pump) Sharps container Simple carbohydrates Diabetic shoes Medical ID 27

28 Self Management What tasks does the member need to do? What is their current knowledge? How do they learn? Who can be involved? 28

29 Self Management Knowledge Resources Abilities Barriers 29

30 Glucose Levels How frequently does this member need to check their blood sugar? How frequently do other tests need to be done? What were the member s recent results? What is this member s normal and what are their target levels? 30

31 Glucose Checks Goal is between 70 and120 fasting (before meals) Goal numbers and frequency of checks vary based on the member s individual plan Typically blood glucose is checked between 1 and 4 times a day in most cases Need for additional action is based on symptoms and what their glucose level Above 70 Below 250 Review with members and communicate with providers 31

32 Glucose Log Name: Date: Time Fasting (check if yes) Result Symptoms/ Comments 32

33 Hemoglobin A1C Repeated regularly At least every 3 months for poorly/ difficult to control diabetes At least every 6 months for well controlled diabetes Provides a snapshot of blood sugar over the past 3 months Goal is individualized Image from: 33

34 Hyperglycemia High blood sugar May result from Not enough insulin Not responding to insulin Skipping medication More food or less exercise then planned Illness Stress Can lead to ketoacidosis which is life threatening Treatment will depend on severity and individual plan (ADA, 2016; Mayo Clinic, 2016) 34

35 Hyperglycemia symptoms Early signs Increased thirst Increased urination Blurry vision Fatigue Headache Late signs Ketones in urine Shortness of breath Nausea/vomiting Dry mouth Fruity smelling breath Weakness Confusion Abdominal pain Coma (ADA, 2016; Mayo Clinic, 2016) 35

36 Hypoglycemia Low blood sugar Could be a result of too much insulin or not enough food Needs to be addressed quickly Usually occurs when glucose is under 70 but symptoms can occur with a rapid drop in blood sugar Individuals may be unaware of blood sugar, especially if they have had diabetes for a long time frequently have low glucose levels have tighter control on their glucose (ADA, 2016) 36

37 Hypoglycemia Symptoms Symptoms include: Shakiness Sweating or chills Confusion Weakness Fatigue Delirium Lack of coordination Fast heart rate Hunger Nausea Sleepiness Blurred or impaired vision Headache Anxiety/nervousness Irritability Anger Seizures Unconsciousness (ADA, 2016) 37

38 Hypoglycemia Treatment Typical treatment includes consuming glucose or simple carbohydrates and rechecking blood sugar after 15 minutes; repeating if needed 15 grams of simple carbohydrates: glucose tab or gel tube, 2 T raisins, 4 oz. juice, 1 T honey or sugar Glucagon may be used if the person is unconscious (ADA, 2016) 38

39 Nutrition Talk to the care team about recommended diet Healthy food choices plays a large role in management Know foods that impact blood sugar 39

40 Lifestyle Choices and Habits Sleep Exercise Hygiene 40

41 Red Flags Change in consciousness Dizziness Weakness Fatigue Heart palpitations Increased hunger Increased thirst Increased urination Blurred vision Dry mouth Seizure Agitation Wounds that won t heal 41

42 What do I do? 1. If there is imminent danger (the person is not responding, having difficulty talking, breathing, not thinking clearly, etc.) stay with the member and call emergency services. 2. If the person has an ongoing problem that is not resolving or getting worse, assist the member in seeking more help A. Use your team B. Call providers to communicate symptoms C. Assist in getting further evaluation D. Follow up 42

43 Common Barriers Education level Income Access to providers Motivation Health literacy Functional status Social support Co-morbid Conditions Others? 43

44 Why does this Matter? TCs/CCs identify risks and coordinate services. Diabetes is linked to increased risk for morbidity and mortality in this population. Effective diabetes management can improve outcomes such as: Decreased complications Higher quality of life Decreased healthcare utilization Decreased cost 44

45 Resources: Diabetes American Diabetes Association CDC. Diabetes prevention. CDC. Prediabetes and Type 2 diabetes. CDC. Diabetes lifestyle change program. CDC 2014 Statistics Report (infographics) t.html My Plate 45

46 Influenza 46

47 Influenza Flu season starts in the fall and peaks over winter months in this area, decreasing in the spring. For most people, the flu does not cause any major symptoms. The flu can cause serious illness or death, especially for those at highest risk (the very young, very old, or the ill) % of deaths are in individuals over 65. Vaccination is needed every year. (CDC, 2016b) 47

48 Prevention Wash your hands Get vaccinated Proper nutrition Stay well rested and well hydrated Limit contact with those you know are ill and reduce exposing others when you are ill Clean common surfaces 48

49 Symptoms Signs and Symptoms Influenza Cold Symptom onset Abrupt Gradual Fever Usual; lasts 3-4 days Rare Aches Usual; often severe Slight Chills Fairly common Uncommon Fatigue, weakness Usual Sometimes Sneezing Sometimes Common Stuffy nose Sometimes Common Sore throat Sometimes Common Chest discomfort, cough Common; can be severe Headache Common Rare Mild to moderate; hacking cough ( from CDC, 2016b) 49

50 Flu Symptoms Encourage the member to seek emergent treatment if they have Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Confusion Sudden dizziness Severe vomiting or vomiting that does not resolve Symptoms that improve then return with fever a more severe cough *Adult symptoms (CDC, 2016b) 50

51 The Flu Shot Vaccinating reduces the chance of contracting the flu Vaccinations reduces the severity of illness if you do get the flu The vaccine also reduced your chance of spreading the flu to others The CDC recommends everyone over the age of 6 months get the flu shot. There is more than one type of shot available, providers should match the vaccine to the individual and screen for contraindications (reasons someone should not get the shot such as an allergy to the vaccine) It takes about 2 weeks for the flu shot to be effective (CDC, 2016b) 51

52 Resources: Influenza Centers for Disease Control and Prevention- Flu IDPH: 52

53 References American Diabetes Association (2016). Living with diabetes. Retrieved from Centers for Disease Control and Prevention (2016a). Diabetes: Working to reverse the US Epidemic at a glance Retrieved from Centers for Disease Control and Prevention (2014). National Diabetes Statistics Report: Estimates of diabetes and Its burden in the United States, Retrieved from Centers for Disease Control and prevention (2016b). Influenza (Flu). Retrieved from Mayo Clinic (2016). Hyperglycemia in diabetes. Retrieved from 53

54 Discussion 54

55 Conclusion This presentation was developed by UIC CON for IDoA and DMH.