Patient Education - Ethiopian Diabetes Association

Ethiopian Diabetes
Association
Diabetes Education
Program for People with
Diabetes
Authors and contributors:
Prof. Jemal Abdulkadir, Health First Higher Clinic
Dr. Ahmed Reja, Ethiopian Diabetes Association
Jutta Schroth, Roche Diagnostics GmbH, Germany
Roland Schindler, Roche Diagnostics GmbH, Germany
Misrak Tarekegn, Ethiopian Diabetes Association
Sr. Felege Berhane, Health First Higher Clinic
Ethiopian Diabetes Association
Patient Education Program
Diabetes Mellitus
 Diabetes mellitus is a
worldwide chronic disease.
 The cost of diabetes therapy is very
high for patients and their families
as well as for the national
economies.
 One way to lower costs is to
educate persons with diabetes
and their families. This will help
them to learn to take better care
of their diabetes and live a
normal and productive life.
 This program helps to achieve this.
Ethiopian Diabetes Association
Patient Education Program
What is Diabetes?
 Diabetes mellitus is a lifelong disease
caused by too much sugar in your blood.
 This happens because your body
produces little or no insulin or the insulin
produced is no longer working.
 Insulin is a hormone that is produced in
the pancreas.
 Insulin is necessary to bring sugar from
the blood to the different parts of your
body, where it is needed to produce
energy.
 Blood sugar comes mainly from the food
we eat.
 You can learn to manage your diabetes
and live a normal and productive life.
Ethiopian Diabetes Association
Patient Education Program
Why does the body need
insulin?
Our body burns sugar to make energy!
Insulin
Sugar
House = Bodycell
Pancreas
Blood
Intestine
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Patient Education Program
Type 1 Diabetes
All keys need to come from the outside
= Insulin must be injected
Insulin
Sugar
House = Bodycelll
Pancreas
Blood
Intestine
Ethiopian Diabetes Association
Patient Education Program
Type 2 Diabetes
Some insulin keys are not working
= the pancreas has to work very hard
Insulin
Sugar
House = Bodycell
Pancreas
Blood
Intestine
Ethiopian Diabetes Association
Patient Education Program
With these symptoms you are
at risk of having diabetes
 Frequent urinating
(especially at night)
 Constantly feeling thirsty
 Sleepy or no energy
 Losing weight inspite of
being hungry all the time
Symptoms which are often not noticed:
 Wounds are not healing
 Problems with seeing
 Many infections
 Itchy skin
 Tingling sensations or no feeling in hands or feet
 A woman gave birth to a very large baby
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High blood sugar causes no
pain, but damages the body
over time
brain
eyes
heart
kidneys
feet
Ethiopian Diabetes Association
Patient Education Program
What should a person
with diabetes do?
Eat healthy
 Eat small meals at regular times
 Include one starchy food with each meal
 Have more vegetables and some fruit
 Eat less fatty, sugary and salty foods
Be active
 Do a 30 minute walk every day
Take good care of your feet
 Check every day for injuries,
if possible with a mirror
 Do not walk without shoes
 Dry your feet after washing
and use cream or lotion
Ethiopian Diabetes Association
Patient Education Program
What should a person
with diabetes do?
Check your weight
 Keep a record of your body weight.
If you constantly loose weight
see your doctor.
Keep your teeth and mouth healthy
 Rinse your mouth after meals and clean your
teeth 2 times a day. For bleeding gums or other
non-healing wounds in mouth see your doctor.
Know your blood sugar
 Check your blood sugar regularly,
or have it checked at a lab.
Have a lab check also HbA1c.
Take your medication or insulin as
explained by your nurse
See your doctor or nurse regularily
 Keep contact with your doctor at least 2 times a
year
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Patient Education Program
Taking your diabetes
medication
Why diabetes medication?
 If you have type 2 diabetes, you
can lower your blood sugar with
diabetes medication.
 If you forget to take your
medication, your blood sugar level
will rise and you risk diabetes
complications like eye damage and
foot ulcers.
Diabetes medication will not help
people with type 1 diabetes!
They must be treated with
insulin!
Ethiopian Diabetes Association
Patient Education Program
Why you need to take
good care of
your feet
People with diabetes very often
develop foot problems.This can
result in amputation!
Do you know somebody who lost his legs
due to diabetes?
This happens because of

Nerve damage – you do no longer feel
pain or heat in your feet

Foot deformities – you do not feel that
your shoes are too tight or hurt you

Poor circulation in the legs and feet –
this gets worse if you smoke

Infection in badly healing wounds
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How to take good care
of your feet (1)
Pay attention to the
warning symptoms!
 Redness or swelling of the foot or ankle
 The foot gets bigger or smaller
 Very cold feet or legs
 Pain in the legs at rest or while walking
 Open sores
 Non-healing wounds
 Ingrown toenails
Do not self-treat small even small
wounds. See you doctor or nurse!
Ethiopian Diabetes Association
Patient Education Program
How to take good care
of your feet
Wear good shoes!
Ethiopian Diabetes Association
Patient Education Program
Things you need to know
before Insulin therapy
 Know how to store your insulin
 Know about the technique of insulin
injection
 Know about the effect of insulin
 Know about the effect of food upon the
blood sugar
 Know about the effect of exercise upon
the blood sugar
 If possible: self-control of glucose in blood
and/or urine
Ethiopian Diabetes Association
Patient Education Program
What you need to know about
handling Insulin
 If possible, store your supply of insulin in
a fridge (2–8 degrees celsius), but never
freeze the insulin!
 Other ways to keep insulin cool are
 Store the insulin in a waterproof container
(like a plastic bag) and put it into a clay pot
filled halfway with water.
 Dig a hole into the sand in your house and put
the insulin container into it. Keep the sand
moist.
 Store the insulin in a container wrapped with
rope and keep the rope moist.
 Make sure children in your household
cannot get to your insulin.
 Always keep needle and syringe in a very
clean place like a small box. Store the
syringe with the caps on both ends.
 When you use the syringe, keep the caps
in your clean box
 Never share syringes or needles with
another person. Risk of infection!
Ethiopian Diabetes Association
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Injecting Insulin
Control your syringe and the needle.
Never share syringe or needle with another
person! Danger of infections!
Mix (or roll) the insulin inside the
ampoule slowly, about 20 times for
about 2 minutes. Don‘t shake it!
Clean the place of injection with some
alcohol. Let it dry before you inject.
Never wipe the needle with alcohol!
Make a skinfold, hold it while you inject
the insulin and then let it go. Count to
10, before you remove the needle.
More body fat: inject at 90° angle.
Less body fat: inject at 45° angle.
faster
effect
slower
effect
Important to know:
change the place of
injection each time.
Stay away from the area around
the belly button (2 fingers wide)
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Patient Education Program
Handling your Insulin syringe
1. Mix your insulin
how you have learnt it
2. Draw up the same quantity of air
in the syringe you need in insulin
3. Push the air which
is inside the syringe in
the bottle with insulin
4. Draw up
the insulin
5. Check the
insulin-dose
6. Inject
the insulin
Ethiopian Diabetes Association
Patient Education Program
Effect of eating and
exercise on Insulin levels
Release of insulin if you do NOT
have diabetes
sugar
7
12
19
24
7
12
19
24
7
insulin
7
Your body automatically regulates the amount of
insulin according to the sugar in the blood (from the
food)
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Patient Education Program
Using an Intermediate
Acting Insulin
6 am
9
12
breakfast
lunch
3
6 pm
9
12
3
6 am
bed time snack
dinner
 Inject it regularly and always at the same time of
the day.
 Inject it two times a day (morning time, evening
time). One injection is effective for about 12 hours.
 Have regular meals (look at the arrows!).
 Have a small meal (e.g. a banana) between
breakfast and lunch and between lunch and
dinner.
 Do not wait too long (no longer than 30-45
minutes) with the next meal after injecting insulin
 Save a little food from dinner and eat before you
go to bed.
 If you exercise more than usual, reduce the
quantity of the next dose you inject.
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Patient Education Program
Blood sugar
(normal – high)
Is your blood sugar too
high?
Insulin and time
Some common causes of high blood
sugar:
 Eating too much food
 Injected too little insulin or
injecting insulin incorrectly
 Excitement/anxiety
 Not taking your medication
 Illness
See poster 9 for symptoms of high blood sugar
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Warning signs and treatment
of low blood sugar
Early symptoms:
• Hunger
mild
What to do?
• Irritability
Eat a starchy food and
some fruit
• Tiredness and
poor concentration
Later symptoms:
Immediately eat or drink
sugar based foods
• Sweating
• Shaking
• Rapid heartbeat
• Confusion,
difficulties to speak
Severe symptoms:
• COMA
severe
• Nausia, headache
Some candies
One glass of fruit juice ot
cola (not sugar free!)
Tea with 4 teaspoons of
sugar
A tablespoon of honey or
heavy syrup
You need to be treated in
the hospital
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Patient Education Program
Causes of low blood sugar
We speak of low blood sugar
(Hypoglycaemia) when the value is lower
than 60 mg/dl.
Causes of low blood sugar are
 Skipping or delaying a meal
 Eating too little (especially a meal low in
carbohydrates)
 Alcohol intake (especially without eating)
 Excessive exercise
 Medication (too much insulin or diabetes
pills)
To prevent low blood sugar especially during the
night, keep to an evening ritual
 Wash and carefully dry your feet
 Check your feet with a mirror for injuries
 Tab your whole body with your hands to
detect feelings of numbness
 Pay attention to your tongue and mouth
Ethiopian Diabetes Association
Patient Education Program
Diabetes and food
If you have diabetes, you do not have to keep a „diet“ or eat
different food than the rest of your family. It is important to
keep to a healthy eating plan. This will also be good for
the health of your family.
To eat healthy meals
 Do not eat more food than your body needs (if you
keep gaining weight you are probably eating too much)
 Eat one starchy food with each meal. Try to eat starchy
foods which raise your blood sugar slowly, like injera,
potatoes, pasta, darker breads, rice and high fibre
unsweetened cerials
 Know the amount of starchy food you eat with each
meal, like 2 pieces of injera, or 3 potatoes. You can do
this best, if you use your own plate during family
meals
 Eat more vegetables. Vegetables and fruit are
protecting your body. Try to eat 2 times more
vegetables than starchy foods and meat.
 Reduce the amount of fat you eat. Use more
unsaturated fats, like sunflower and olive oils and avoid
saturated fat like butter and cream
 Reduce sugary foods like candy, cookies, sweetened
ready made cerials, pastries and all kinds of softdrinks
(Cola, Fanta, etc.)
 Drink very little alcohol (less than 1 drink per day)
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The plate method
is a way to eat healthier meals without measuring.
You fill your plate (20 centimeters in diameter) to match the
amount of vegetables, starches and meat and then add a
piece of fruit and/or a glass of low fat milk
Breakfast
lowfat
milk
starch
Protein/meat
optional
vegetable
Lunch/dinner
fruit
Protein/meat
vegetable
starch
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Starchy and energy giving foods
injera
corn
bread
potatoes
pasta
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Starchy foods raising blood
sugar very quickly
Eat those only in
small amounts.
crackers
sugar
cookies
Fruit juice
mix juice with water
cake
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Vegetables protect your
health
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Fruits protect your health
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Meat, fish and other protein
foods
¼ of your meal
should be protein
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Reduce oily and fatty foods, but
some fats are better than others
Good fats from
vegetables and fish
Bad fats from meat
and industrially
baked products
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Foods to avoid are softdrinks, candy and
saturated fats like margarine, butter and
very fatty meat like Kitfo
Ethiopian Diabetes Association
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