diabetes webinar: best care for sick days · diabetes webinar: best care for sick days katie...
TRANSCRIPT
![Page 1: Diabetes Webinar: Best Care for Sick Days · Diabetes Webinar: Best Care for Sick Days Katie Wilson, PharmD, BCACP and Vicky Taylor, RN, BSN, CDE. Testing Blood Glucose (blood sugar)](https://reader034.vdocument.in/reader034/viewer/2022051904/5ff506435bda4a4e8a0ee3aa/html5/thumbnails/1.jpg)
Diabetes Webinar:
Best Care for Sick DaysKatie Wilson, PharmD, BCACP
and
Vicky Taylor, RN, BSN, CDE
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Testing Blood Glucose (blood sugar)
• Primary tool to determine at any point in time if your blood glucose levels are within your target range.
• Blood glucose meter
• Continuous glucose monitor (CGM)
• Log glucose readings to share with your provider
• Fasting blood glucose
• Pre-prandial (before meals)
• Post-prandial (after meals)
• Hemaglobin A1C
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Blood Sugar and A1C Targets
• Individualized
TIME Goal
Fasting 80-130 mg/dL
Pre-prandial (Pre Meal)
80-130 mg/dL
Post-prandial (After meal)
<180 mg/dL
A1C <7%
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Oral Diabetic Medications
• Metformin (Glucophage)
• Sulfonylureas - glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl)
• Meglitinides - repaglinide (Prandin) and nateglinide (Starlix)
• Thiazolidinediones (TZD) - rosiglitazone (Avandia) and pioglitazone (Actos)
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Oral Diabetic Medications
Medication How to take Adverse Effects
Metformin Taken 1 or 2 times daily with food. GI, diarrhea
Glyburide , Glipizide and Glimepiride Taken 1 or 2 times daily with meal(s) Hypoglycemia, weight gain
Prandin, Starlix Taken 3 times daily within 30 min of meal
Hypoglycemia, weight gain
Actos Taken once daily with or without food Edema/fluid retention
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Newer Oral Diabetic Medications
• DPP-4 inhibitors - sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta)
• SGLT2 - canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance)
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Newer Oral Diabetic Medications
Medication How to take Adverse Effects
Januvia, Onglyza and Tradjenta
Taken once daily with or without food
Runny/stuffy nose, headache
Invokana, Farxiga, Jardiance
Taken once daily with or without meals
Increased urination, UTIs
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Insulin
• Rapid acting (Humalog, Novolog)
• Short acting (Regular Insulin)
• Intermediate acting (Humulin N, Insulin NPH)
• Long acting (Lantus, Levemir)
• Ultra-long acting (Tresiba, Toujeo)
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Other injectable diabetic medications
GLP-1 Agonists
• Dulaglutide (Trulicity)
• Exenatide (Byetta)
• Exenatide Ext Rel (Bydureon)
• Liraglutide (Victoza)
• Semaglutide (Ozempic)
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Other injectable diabetic medications
Medication How to take Adverse Effects
Trulicity, Byetta, Bydureon, Victoza, Ozempic
Inject 1-2 times daily, or weekly
GI related (nausea, vomiting, diarrhea), weight loss
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Poll Question
What’s your biggest fear/concern around insulin?
a. Needles
b. The thought of getting daily injection(s)
c. Side effects (weight gain, hypoglycemia)
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Why Take Your Medicine?
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https://pdb101.rcsb.org/global-health/diabetes-mellitus/monitoring/complications
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The Struggle is Real
•75% of patientsstruggle to take medicines as prescribed1
1. Improving prescription medicine adherence is key to better healthcare: taking medicines as prescribed can lower costs and improve health outcomes. PhRMA website. http://phrma.org/sites/default/files/pdf/PhRMA_Improving%20Medication%20Adherence_Issue%20Brief.pdf. Accessed January 6, 2017.
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Barriers
• Starting a New Medication
Starting 31%
• Taking a Medication the way it will work the best for you
Taking 40%
• Stopping a MedicationStopping
33%1. Improving prescription medicine adherence is key to better healthcare: taking medicines as prescribed can lower costs and improve health outcomes. PhRMA website. http://phrma.org/sites/default/files/pdf/PhRMA_Improving%20Medication%20Adherence_Issue%20Brief.pdf. Accessed January 6, 2017. 2. Fischer MA, Stedman MR, Lii J, Vogeli C, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25(4):284-290.
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What can you do?
• Tricks for reducing costStarting
• Make sure you understand instructions
• Use Tools and TipsTaking
• Tell your health care provider before you stopStopping
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Tips on Taking Your Medications
• Know your Medications
• Ask questions, best time to take, with or without food, what if I miss a dose
• Routine
• Consistent time, associate with another daily activity (meal, brushing teeth, bedtime)
• Reminders
• Pill box, phone alarm, make medications visible
• Simplify
• Combinations pills, take medications at the same time if able, ask provider to help simplify regimen
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Medications Wrap-up
• Importance of checking glucose to optimize medications and dose
• Individualized medication regimens based on many factors
• Understand importance of taking medications and overcoming barriers
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SAINT LUKE’S HEALTH SYSTEM 20
Which of the following are true?
1. If I am sick and unable to eat, I do not need to test my blood sugar.
2. If I am sick and unable to eat, I do not need to take my insulin.
3. If I am sick and unable to eat, I need to test blood sugar only if I feel high or low.
4. Being sick or having and infection will likely cause my blood sugar to go up.
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How are you doing?
SAINT LUKE’S HEALTH SYSTEM 21
Impact of illness
Do you have what you need available
Blood sugar high and lows
What is your plan
Self- management on sick days
When should I call the doctor
When do I seek emergency care
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Guidelines for sick days
• Minor illness
• Cold
• Flu
• Off of your “regular routine”
• Upset stomach
• Dental
• Minor same day procedure
SAINT LUKE’S HEALTH SYSTEM 22
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Sick day supplies
• Thermometer
• Sick day guidelines
• Gelatin packets (one regular and one sugar free)
• Tylenol/ibuprofen
• Cough drops (regular/sugar free)
• Regular and sugar free soft drinks
SAINT LUKE’S HEALTH SYSTEM 23
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Sick Day Management
• HYDRATION is important!
• Know when to call your diabetes team!
• NEVER stop taking insulin without talking to your healthcare provider
• You may need to change your usual routine when you are ill
• Test blood sugar frequently
S A I N T L U K E ’ S H E A L T H
S Y S T E M 2 4
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•Blood sugar every 2-4 hours
• Temperature
• Frequency of fluid intake
•Vomiting/diarrhea
•Urine Ketones
Monitoring and tracking
SAINT LUKE’S HEALTH SYSTEM 25
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SAINT LUKE’S HEALTH SYSTEM 26
Sick Day Log
Time Temp Eat/drink Medication Blood glucose
Urine Ketones(test every 4 hr)
Notes:
8 AM 97.8 8 oz hot tea with 2 tsp honey
None 161Feeling nauseated
11:30 183 Feeling worse –really nauseated
1:30 101.2 12 regular 7-UP 6 units Humalog
250 Moderate Tylenol (2-325 mg)
2:45 8 oz Diet 7-UP3 saltine crackers
187
6:00 pm 100.4 Hot tea with honey, 1 pc dry toast
6 units Humalog
143 Trace
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Frequentfeedings/hydration
Sick day meal/carb goals, likely need to include snacks
(listed are grams of carbohydrate)
S A I N T L U K E ’ S
H E A L T H S Y S T E M 2 7
BREAKFAST15-30 SNACK 15-30 LUNCH 30-45
SNACK 15-30 SUPPER 30-45 SNACK 15-30
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SAINT LUKE’S HEALTH SYSTEM 28
Carb count for sick day foods
Food Portion Carb grams
Soft drink (regular) ½ cup 15 grams
Apple or Orange juice ½ cup 15 grams
Cooked cereal ½ cup 15 grams
Gelatin (regular) ½ cup 20 grams
Popsicle 1 24 grams
Soup (thin creamy) 1 cup 15 grams
Pudding (regular) ½ cup 30 grams
Pudding (sugar free) ½ cup 15 grams
Saltine crackers 6 15 grams
Toast 1 piece 15 grams
Fruit ½ cup 15 grams
Sports drink 1 cup 15 grams
Regular soda pop 5 oz 15 grmas
Honey or syrup 1 Tablespoon =3 teaspoons 15 grams
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SAINT LUKE’S HEALTH SYSTEM 29
Meal (carb goal) Food Portion Carb grams Total carb/ feeding
Breakfast (15-30) Hot tea 1 cup 0 grams
Honey 2 tsp 10 grams
Toast 1 pc 15 grams 25
Snack (15-30) Saltine crackers 6 15 grams
SF 7-Up 12 oz can 0 grams 15
Lunch (30-45) Regular jello 1 cup 40 grams 40
Snack (15-30) Popsicle 1 24 grams 24
Supper (30-45) Oatmeal 1 cup 30 grams
Honey 2 tsp 10 grams
Hot tea 1 cup 0 grams 40
Snack (15-30) SF 7 up 6 oz 0 grams
Toast 1 piece 15 grmas 15
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Emergency Attention• Serious complication from VERY HIGH
blood sugars• “Diabetic Coma”
• Type 1
• Type 2
• LOW blood sugar
SAINT LUKE’S HEALTH SYSTEM 30
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Warning Signs
Heart Attack:• May last short time and go away then come back
• Pain in arm(s), jaw, back, neck or stomach
• Cold sweat, nausea, vomiting
• Decreased awareness of pain (silent heart attack)
Stroke:• Sudden numbness or weakness of face, arm, body
(one side)
• Sudden difficulty with speech/understanding
• Sudden visual changes (one or both eyes)
• Sudden loss of balance, dizziness or trouble walking
• Sudden, severe headache (no cause)
SAINT LUKE’S HEALTH SYSTEM 31
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RemindersPrevention is best plan
Plan Ahead for illnessVaccines up to date?
No one size fits all
Blood sugar testing when ill – every 2-4 hours for some
Have your sick day supplies and Sick Day Plan ready
Medications
Emergency plan
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SAINT LUKE’S HEALTH SYSTEM 33
Which of the following are true?
1. If I am sick and unable to eat, I do not need to test my blood sugar.
2. If I am sick and unable to eat, I do not need to take my insulin.
3. If I am sick and unable to eat, I need to test blood sugar only if I feel high or low.
4. Being sick or having and infection will likely cause my blood sugar to go up.
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Resources:
Saint Luke’s Diabetes Centers
S A I N T L U K E ’ S
H E A L T H S Y S T E M 3 4
Individualized Diabetes Education on site or virtual visit
Call 816-932-2707 to make an appointment (requires provider referral)
Centers available at Saint Luke's Plaza, North, South and East Clinics
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Resources:
Saint Luke’s Primary Care
S A I N T L U K E ’ S
H E A L T H S Y S T E M 3 5
Barry Road
816-880-6100
Blue Springs
816-347-4600
Blue Valley
913-323-8830
Cushing
913-651-6565
East
816-347-5600
Independence 816-251-5200
Lee’s Summit
816-347-5100
Mission Farms 913-317-7990
Parkville
816-569-1506
Platte City
816-858-7050
Plaza
816-932-3100
Shoal Creek
816-437-8161
Smithville 816-532-3999
Southridge913-317-3200
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Resources:
Saint Luke’s Community Resource Hubhttps://saintlukesresources.org/