Advanced Diabetes Case Management

#1 - Medication Options for Type 2 Diabetes (Part 1)

I. Blood glucose goals

A. Pre/post meal

B. A1c goals

II. Causes of hyperglycemia

A. Insulin resistance

B. Hepatic glucose production

C. Insulin deficiency

D. Loss of first phase insulin release

E. GLP – 1 deficiency

III. Meds to delay glucose absorption

IV. Insulin sensitizers

V. Insulin secretagogues

Behavioral/Learning Objectives:

1. List 2 causes of hyperglycemia in those with type 2 diabetes.
2. State the mechanisms of action for 2 of the classes of medications for managing type 2 diabetes.
3. Identify 2 areas of education necessary for medication use in type 2 diabetes.
   

#2 - Medication Options for Type 2 Diabetes (Part 2)

I. Incretins

A. Mechanism of action
B. Dosing and administration
C. Potential side effects

II. Symlin

A. Mechanism of action
B. Dosing
C. Potential side effects

III. Insulin

A. When to use in type 2 diabetes
B. Initiation regimes

VI. Case Studies

VII. Summary

Behavioral/Learning Objectives:

1. Discuss the common insulin regimes used in type 2 diabetes.
2. Demonstrate pattern management.
3. Identify an appropriate candidate for using incretin.
   

#3 - Insulin (Part 1)

I. BG goals for diabetes

A. Pre/Post meal
B. A1c goals

II. Function of insulin

III. Types of insulin

A. Long acting
B. Intermediate acting
C. Short and fast acting
D. Mixed insulins

IV. Insulin Initiation

A. Calculating doses
B. Adjusting doses

V. Insulin/carbohydrate ratio’s

A. 500 Rule
B. Testing carb ratio’s

VI. Correcting insulin for hyperglycemia

A. 1800 rule
B. Testing correction doses

VII. Survival skills education

Behavioral/Learning Objectives:

1. Identify 3 different kinds of insulin.
2. Demonstrate how to initiate an insulin/carbohydrate ratio.
3. Identify how to adjust an insulin regime for hyperglycemia.
   

#4 - Insulin & Symlin (Part 2)

I. Insulin pumps

A. Candidates
B. Considerations
C. Calculating initiation doses
D. Evaluating BG patterns

II. Symlin

A. Using in type 1 diabetes
B. Dosing

III. Case Studies

IV. Summary

Behavioral/Learning Objectives:

1. Identify an appropriate insulin pump candidate.
2. State the mechanism of action for symlin.
3. Demonstrate pattern management using insulin regimes.
   

#5 - Advanced Carb Counting

I. Nutrition Assessment

A. Medical History/concurrent illness
B. Lab Values
C. Medicaitons (for diabetes and other conditions)
D. Usual intake/diet recall
E. Individualized meal planning

1. What changes need to be made?
2. What changes is the client willing to make?

II. Discuss nutrients function, role in blood glucose control and source of:

A. Carbohydrates including fiber
B. Protein
C. Fat: saturated, unsaturated, trans fatty acids

III. Diabetes meal planning principles

A. Tips for type 1 diabetes
B. Tips for type 2 diabetes
C. Carbohydrate counting

1. Definition
2. What foods contain carbs?
3. Determining what is a carb serving/portion control
4. Determining carbs per meal and snack
5. Factors that influence glycemic response
6. Demonstrate basic carb counting

Behavioral/Learning Objectives:

1. State 3 components of a nutrition assessment.
2. Describe how the 3 caloric nutrients impact blood glucose levels.
3. Define carbohydrate counting.

#6 - Advanced Carb Counting (Part 2)

I. Using Nutrition Facts Label in diabetes meal planning

II. Serving sizes and recommendations for

A. Carbohydrates
B. Fat (saturated, trans, unsaturated, cholesterol)
C. Sodium

III. Exercises using nutrition facts information.

IV. Advanced Carb Counting

A. Definiton of a carb to insulin ratio

1. 500 rule for calculating carb to insulin ratios

B. Determining accuracy of carb to insulin ratios

1. Pre-Post meal blood glucose testing

V. Carb Counting technique

A. Pattern management: adjustments based on SMBG results
B. Reasons for high and low blood glucose levels
C. Factors for adjusting for physical activity

Behavioral/Learning Objectives:

1. Demonstrate carb counting using the nutrition facts label.
2. Calculate a carb to insulin ratio.
3. List 3 factors to consider when adjusting carbs for physical activity.
   

Accreditation Information

Nurses – Academy Medical Systems is an approved provider of continuing nursing education by the Illinois Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Academy medical Systems is also a provider approved by the California Board of Registered Nursing, provider #CEP14413, for 9.0 hours. And we are also a provider approved by the Florida Board of Nursing, provider #50-19, for 9.0 hours.

Iowa Nurses - The Iowa Board of Nurses will recognize the recorded webinars as a home study program. They recognize our ANCC approved provider status as well as our CA and Fl Board of Nursing provider approval for home study products for nurses in Iowa.

All other states recognize our approved provider status listed in the above text for continuing education credit for nurses.

Dietitians - Academy Medical Systems is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 9.0 continuing professional education units (CPEUs) for completion of this program/material.

Occupational Therapist - Occupational Therapist will receive 9, continuing education hours for completion this program and a test score of 70% or better. AMS is an approved provider for the AOTA , provider # 5470.  This course is an intermediate education level.

Exercise Physiologist – ACSM recognizes AMS’s approved provider status with the ANCC and will honor our continuing education for Certified Exercise Physiologist recertification purposes.

Certified Athletic Trainers – Academy Medical Systems is recognized by the Board of Certification (BOC) to offer continuing education for certified athletic trainers. 9 hours will be awarded at the completion of this program.

Physical Therapists - PTs in the following states will receive 9 contact hours for completion of all 6 webinars: AK, CA, CO, CT, HI, IA, ID, IN, KS (Cat 2), MA, ME, MI, MN (Cat 2), MT, NE, NM, ND, OR, PA, RI, SC, SD, UT, VA (Type 2), VT, VI, WA, WY.

Because each state’s continuing education requirements for physical therapists is subject to change, please verify this information with your state board. Thank you.

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