Electronic Charting – Keeping it HUMAN

As diabetes educators, having eye contact and listening carefully without distraction, is a critical part of our assessment.  This initial meeting helps us sort out what is working with the person’s diabetes and what barriers might be getting in the way. The words we use, our body language, and how we engage in this encounter sets the stage for our ongoing working relationship. Plus, it can influence the self-perception of the person sitting across from us. 

However, many providers and educators may rely on computers to review notes and labs and to document the visit. This means there may be moments spent looking at the screen instead of the person sitting across from us.

Unfortunately, people with diabetes may feel that the computer is a distraction and a barrier to effective two-way communication.

Good news! There are strategies to compassionately engage with people with diabetes during the visit, while using the computer.

At the American College of Physicians Internal Medicine Meeting, speaker Wei Wei Lee MD, assistant professor of medicine at the University of Chicago, said utilizing the mnemonic HUMAN LEVEL provide guidance on how to succeed with electronic charting

The mnemonic HUMAN LEVEL stands for:

H stands for honoring the golden minute. “The first minute of the visit with the patient should be completely technology free. Greet the patient, start with what’s on their mind, what their agenda is and then transition into using the computer,” she said.

U – Use the triangle of trust by placing the computer so that you and the patient can see the screen at the same time.

M – Maximize interaction by engaging the patients as much as possible, as you work on the computer.

A – Acquaint yourself with the patient’s chart before entering the examination room.

N – Not focusing exclusively on the screen during the visit, especially when the patient is talking about sensitive subjects.

 

For the complete mnemonic and more info on establishing a collaborative relationship, here is the article by Healio – “Doctors, patients benefit when the ‘eyes’ have it”

We have also created a resource page called the ABCs of Language Use in Diabetes, which provides insights on using strength-bases language in the clinical setting.

 

A series of studies performed at the Mayo Clinic in Minnesota, Rochester and Johns Hopkins Medical Center have encouraged a 510 (k) clearance of the StatStrip, ” a finger-stick capillary testing meter for critically ill patients with or without diabetes.” The subjects utilized for these studies were between the ages of 1 month and 106 years old and all received medical care in intensive care such as the burn unit, cardiac, orthopedic, surgical or neurological. A total of 16,778 individuals participated in this study.

Results concluded that the capillary testing meter showed the same glucose results as arterial or venous plasma results. The FDA has cleared the capillary meter to be a safe method to use on critically ill patients.

Currently, StatStrip is the only approved glucose meter that can now be used with arterial, venous or capillary specimens from all patients, including those who are critically ill.

The FDA clearance indicates that StatStrip is safe, effective and reliable for use by CLIA-waived operator for point-of-care testing that measures and corrects for abnormal hematocrit and has no clinically significant interferences, which can lead to the mismanagement of critically ill patients, the release stated.

A hematocrit study was performed to verify that, “varying hematocrit levels do not affect the glucose results.” 

The StatStrip was initially cleared in 2006 to monitor diabetes but was not available for use on critically ill patients. It did not become available to critically ill patients until 2014. However, it only had clearance for arterial and venous specimens. It is now the, “only glucose meter to earn this clearance and can now be used with arterial, venous, or capillary specimens from all patients.”

To learn more about the StatStrip glucose hospital meter system, visit FDA clears first glucose meter for critically ill patients.

To view the full decision summary, visit Review Memorandum for a list of intended uses as well as all studies included in the decision making process.

Contributed by: Sofia Sepulveda

The FreeStyle Libre is a continuous glucose monitor (CGM), which automatically measures glucose readings day and night. This technology helps track glucose levels and in turn, manage diabetes. A new study suggest that CGM helps decrease health costs as it improves treatment adherence. Although people are still advised to perform standard glucose tests to confirm the accuracy, the monitor is reading and reporting glucose levels automatically through out the day. 

The study suggest that from a cost perspective, the CGM saves money due to the lessened frequency of testing and materials necessary. The study also found that people with Type 1 and 2 experienced a reduction in hypoglycemia when using the CGM. 

“For people with T1DM or T2DM who use MDI therapy, flash CGM has demonstrated improved adherence to the ADA recommendation as well as reduced acquisition cost when compared with routine SMBG.” 

Learn more with – FreeStyle Libre boosts testing adherence and lowers costs during MDI treatment, US study reports by Diabetes.co.uk


View our July Newsletter

For this issue, we discuss the differences and similarities of human and analog insulin. Topics covered include:

  • Insulin, Analogs or Human Insulin?
  • The ADA Petition to keep insulin affordable
  • Human Insulin for Medicare Beneficiaries
  • and more!

Click here to read our newsletter! 

Test your knowledge by clicking here.

This weeks question reflects the new ADA Guidelines for Cardiovascular Disease and Diabetes. 

And we invite you to join our newly updated webinar on this important and critical topic.

Cardiovascular Disease and Diabetes  – 1.5 CE, individual price $29.00  Recorded July 2018. Ready for OnDemand Viewing.
Want to learn more about the current standards for Diabetes and CV Disease? This course takes a close look at insulin resistance syndrome and vascular complications. We discuss the impact of vessel disease from the heart to the toes. Included is a discussion of identifying and preventing vascular disease and the goals of care.

 

Cardiovascular Disease Management- American Diabetes Association Standard of Care – Jan 2018

AACE 2018 Diabetes Managment Algorithms Slide Summary

AACE Diabetes Algorithm Executive Summary 2018

We are exited about our growing Diabetes Education Blog

Anne Carter, is not only in charge of operations and customer happiness at Diabetes Education Services, she is expanding her role to include reporting on the latest information and trends in the rapidly changing diabetes landscape.

Some of my favorite blog posts by Anne include:

Diabetes Alert Day Resource Page – March 27th is our opportunity to find people with undetected prediabetes and diabetes.

Question of the Week – Anne gently nudges Coach Beverly to write up a timely question to challenge and engage our community.

New Glucose Monitoring Contact Lens – Imagine a contact lens that you could wear that would light up if your glucose levels were high?

Interested in keeping up with our Blog Posts? We are working on a subscription format, but in the meantime, j


 

“There could be greater health benefits for women from breastfeeding than previously recognized,” said lead study author Erica Gunderson of the Kaiser Permanente Division of Research in Oakland, California.

Compared to women who didn’t breastfeed at all, mothers who nursed babies for at least six months were 48 percent less likely to develop diabetes.

Rates of breastfeeding are on the rise.  More than 75% of women initiate breastfeeding and by one year 25% are still breastfeeding. There are many wonderful benefits linked to breastfeeding, lowering the risk of allergies, obesity, respiratory infections and now diabetes! 

In spite of the benefits of breastfeeding, some women may face barriers to success, including lack of social support, lack of paid leave and lack of onsite childcare. Since breastfeeding provides a tremendous benefit for the child, mom and society, we want to keep encouraging women to breastfeed and create environments that support success.

“Longer breastfeeding tied to lower diabetes risk for mothers” – Lisa Rapaport for Reuters Health

Check out this fantastic resource by “Mom loves best” – The 111 Benefits of Breastfeeding – For Babies, Moms & Everyone Else


Want to learn more about Women and Diabetes, enroll in our Level 2 – Women and Diabetes online course:

Level 2 – Women and Diabetes 1.0 CEs – $ 19.00

Women with diabetes are confronted with a variety of issues that require special attention, education and understanding. This course reviews those special needs while focusing on Gestational Diabetes and Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals and prevention of complications during pregnancy. A helpful review for the CDE® Exam and for those who want more information on Women with Diabetes.

We will be providing a Live Webinar Update on May 18, 2018.

 


 

Main Message from ADA – Individualize approach and focus on eating nutrient dense foods

The ADA Standards of Care, states that there is no ideal percentage of calories from carbs, protein and fat. The key is to individualize nutrition recommendations using a patient centered approach.  Emphasis is on healthy eating patterns which include nutrient dense foods and consumption of less added sugar and processed foods.

The ADA recommends a variety of eating plans based on available research.

Examples of Healthful Choices include:

  • Mediterranean Diet
  • DASH Diet
  • Plant-based Diets
  • Diabetes Plate Method

Common theme for the best diets includes more whole grains, fruits, vegetables, beans, nuts, fish and less processed foods and added sugars.

Resources

Best Diets for 2018 – Great NPR article that ranks diets from best to worse.

Joy of Six – Sugar Pledge Resource Page – Great tools and information to support eating less foods with added sugar.

Mediterranean Diet Info – from Oldways Website

Plant based eating resource page – Full of recipes, getting started resources and articles supporting the benefits of plant based eating.

DASH (Dietary Approaches to Stopping Hypertension). Here the NIH DASH Website which provides research and links to patient and professional resources.

DASH Diet Info from US News

Oldways Website “inspiring good health through cultural food traditions”.  Oldways is a nonpro?t food and nutrition education organization, with a mission to inspire healthy eating through cultural food traditions and lifestyles.  Includes cultural food info on plant based diets, Mediterranean Diet, Asian Diets and more. Lots of handouts and resources for patients and professionals.

Diabetes Plate Method – a nice summary of using this method from Diabetes Forecast


Want more info?

Visit our Diabetes Education Online University

Download our FREE CDE Coach App

The 2018 American Diabetes Association Standards of Care is here.

Interestingly, the ADA will update the Standards of Care even more frequently online, if new evidence or regulatory changes merit a critical update or addition.

In addition to some exciting new charts and verbiage, the Standards include an updated treatment algorithm for Type 2 diabetes and clarification around CV Risk and B/P management.

This version delves deeper into individualizing care, taking a patient centered approach and using language and phrases that put people first.

How to learn more:

2018 ADA Standards of Care Updated

This 90-minute course is an essential review for anyone in the field of diabetes. We summarize the 2018 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provide critical teaching points and content for health care professionals involved in diabetes care and education.

The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.

Topics Include:

  • A review of changes and updates to the 2018 ADA Standards of Medical Care
  • Identification of key elements of the position statement
  • Discussion of how diabetes educators can
  • Apply this information in their clinical setting


Pre-Order 2018 ADA Standards of Care Booklet – $20

The book includes:

  • ADA’s standards for diagnosing and treating diabetes
  • Nutrition recommendations and principles
  • Position statements on managing diabetes and its complications in various settings

 

 

Pre-Order 2018 ADA Standards of Care PocketChart – $4.99 

This small laminated folding chart includes the latest from the 2018 Standards of Medical Care in Diabetes.

The 2018 ADA Standards of Medical Care Pocket Chart is available in early January! Pre-order today and the chat will ship in early January.

 

 


Download our FREE CDE Coach App 

  • ADA 2018 Standards of Care at your fingertips 

  • Diabetes Medication and Insulin PocketCards™ 

  • New interactive Question of the Week and CDE® Practice Tests

  • Study Tools and Resources you need to prepare for the CDE® Exam

  • Diabetes Online University—Earn CEs on your mobile device

“Sugary Drinks Could Break Your Heart”

Just 2 sugary drinks a week is linked to weight gain, diabetes, metabolic syndrome, heart disease and stroke. Let’s get the word out and improve the health of our communities.

To learn more, click here to read the entire article.

Make sure you sign up for Coach Beverly’s Monthly Newsletter, next issue – how to survive the holiday season! 

Newsletter Sign Up Here


The Joy of Six – Sugar Pledge 

To enjoy up to six teaspoons of added sugar and increase sugar awareness in our communities.

We have created this pledge campaign to raise awareness on the health risks of added sugar and more so, the benefits of enjoying less.

By eating less added sugar starting today, we will not suffer from any nutritional deficiency. On the contrary, we will get healthier.

Learn more about The Joy of Six – Sugar Campaign

October 29th – World Stroke Day

“I never thought I could have a stroke, but I did! Let’s share these signs with our community. Early recognition and treatment saves lives. It saved mine.

Read my story here” -Coach Beverly