Intensive Diabetes
Management Training 1

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Welcome to the training module
“Intensive Diabetes
Management Training 1”
Version 1.0

The following presentation is for educational purposes only. It is not a replacement for medical advice from your HCP. You should contact your HCP before making any changes in your diabetes management treatment plan.

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Introduction: Intensive Diabetes
Management Training 1

This course is designed to give you a basic overview of diabetes as well as the basics needed to transition to intensive diabetes management using insulin injections or an insulin pump.

Introduction: Intensive Diabetes
Management Training 1

Intensive diabetes management involves using multiple injections or an insulin pump to provide basal and bolus insulin similar to that of someone without diabetes.

Goal: Keep blood glucose as close to normal as possible without experiencing repeated episodes of low blood glucose in order to prevent and delay diabetes complications.1

Potential Benefits:

What is involved:

Introduction: Intensive Diabetes
Management Training 1

The Diabetes Control and Complications Trial (DCCT) shows intensive glucose control in type 1 diabetes:1

What did DCCT patients do?1

Section 1:
Overview of diabetes and
good nutrition

Theory of basal/bolus insulin therapy.1,2

Basal/bolus insulin therapy.1

Types of basal insulin:

Bolus insulin: rapid acting insulin given when you eat food or drink with carbohydrate or if your blood glucose is above your target.

Types of bolus insulin (rapid acting):

Or insulin pump therapy:

The insulin pump only uses rapid acting insulin. The Animas® insulin pump automatically releases small amounts of insulin every few minutes. This is called a basal rate. Unlike long-acting insulin, the basal rate can be adjusted based on your blood glucose trends to keep the blood glucose level steady between meals, during sleep and if needed when hormones fluctuate.

Bolus dose details.1,2,3

Two common types of bolus:

Please click on each of the terms below to learn more about them:

Knowledge check.

Click on the term that best completes the statement:

  1. Rapid acting insulin taken to cover carbohydrate in food or drink is  .

Knowledge check.

Click on the term that best completes the statement:

  1. If your blood glucose is above your target range, you may need to take a  .

Knowledge check.

Click on the term that best completes the statement:

  1. If you know how many mg/dL 1 unit of insulin will lower your blood glucose, you know your  .

Knowledge check.

Click on the term that best completes the statement:

  1. If you know 1 unit of insulin covers 10 grams of carbohydrate, then you know your  .

Section 2:
Carbohydrate gram counting

Carbohydrate gram counting.1,2

The basics.

The carbohydrate in food raises your blood glucose the quickest. Almost all of the carbohydrate you eat will turn to glucose in the blood within a few hours. Many foods, such as bread, cereals, fruits, fruit juice, (even with “no sugar added”), rice, pasta, milk, yogurt, starchy vegetables, and sweets contain carbohydrate.

Counting carbohydrate.

Counting your carbohydrate grams will help you determine your carbohydrate bolus amount. This approach gives you greater flexibility in food choices since you can match your insulin to your food and portion size.

Balancing your carbohydrate intake with the appropriate dose of bolus insulin will help keep your blood glucose closer to your target range.

Let’s start by identifying some foods that contain carbohydrate.

Carbohydrate counting methods.1,2

Two basic methods of carbohydrate counting.

Carbohydrate counting is more precise and works easily when using an insulin to carbohydrate ratio (I:C).

Most packaged food items are labeled which makes carb counting even easier. It is important to pay attention to the serving size and your portion sizes.

The table to the right represents some common tools to help with carbohydrate counting as well.

Estimating portion sizes.1

It is best to weigh and measure your food to get the most accuracy in carbohydrate counting.

Use estimates when you cannot measure based on familiar items.

a tennis ball Tennis Ball 1 medium piece of fruit
a CD CD or DVD 1 slice of bread
a baseball Baseball 1 cup of fruit
a woman's fist Most women's fist 1 cup cooked rice, pasta or vegetables
a man's fist Most men's fist 1.5 cups cooked rice, pasta or vegetables
a lightbulb Light Bulb 1/2 cup of fruit or vegetables

How to read a
nutrition label.1

How to read a nutrition label:

General rules for fiber and sugar alcohol.

Fiber: If there are more than 5 grams of fiber listed, then half of the fiber grams should be subtracted from the total carb count.

Sugar alcohol: If there are more than 5 grams of sugar alcohols listed, then half of the sugar alcohol grams should be subtracted from the total carb amount.

Knowledge check:
label reading

Try answering the questions below by referring to the nutrition label on the right, then click on each question to reveal the correct answer.

  1. What is 1 serving size?
  2. How many grams of carbohydrate are in each serving?
  3. If you are eating 1 cup, how many grams of carbohydrate are you eating?
  4. If you are eating 1/4 cup, how many grams of carbohydrate are you eating?

Section 3:
Carbohydrate counting

Carbohydrate counting.

Make a lunch no more than 60 grams of carbohydrate by choosing from food choices.

Simply click or tap to to add or remove a food item from the plate.




Knowledge check:
let’s put it all together.1,2

Calculate the following insulin bolus doses using the example on this page and fill in the table. For this practice exercise do not round.

  1. What would be your carb bolus?
  2. What would be your BG bolus?
  3. What would be your total bolus?

Section 4:
Blood glucose management
and record keeping

Blood glucose management.1–5

Monitoring your blood glucose provides you with a quick snapshot of your blood glucose so that you can make informed decisions regarding your food choices, insulin doses and exercise.

A few benefits of frequent blood glucose monitoring and self-management compared to A1c testing:

Detailed record keeping.1,2

Identify Patterns

Low blood glucose
(hypoglycemia).1,2

Common causes:

Treatment of hypoglycemia
using the “Rule of 15.”1,2

The rule of 15:

Examples of food/drink with 15 grams of carbohydrate:

Severe hypoglycemia
(low blood glucose).1

Low blood glucose is severe any time you have a low blood glucose and are unable to tolerate or cooperate to take glucose by mouth safely. You may be unconscious or having a seizure.

Treatment.

Do not give anything by mouth. Treatment for severe hypoglycemia includes giving an injection of glucagon.

What is glucagon?

Glucagon is a hormone that raises blood glucose quickly. It is a powder that must be mixed with diluting solution in a syringe immediately before being injected into the arm, leg, or buttocks.

Prepare.

  1. Check with your healthcare professional if you take insulin and do not have a glucagon kit.
  2. Make sure family members, coworkers, and close friends are familiar with and trained on how to give glucagon.

The picture above gives you an idea of what a glucagon kit looks like. Become familiar with your healthcare professional's instructions and those on the package insert.

Tip:
Check your glucagon expiration date and put it on your calendar a few weeks ahead to remind you to refill.

Causes and symptoms
of hyperglycemia.1,2

High blood glucose is a result of not having enough insulin. Everyone with diabetes will experience high blood glucose at one time or another. The goal is to minimize high blood glucose in order to prevent complications.

Causes

Symptoms

Understanding ketones and symptoms
of diabetic ketoacidosis (DKA).1,2

What are ketones?

Ketones occur when your body burns fat for energy instead of glucose due to lack of insulin. Ketones are acids resulting from the burning fat. If not treated, ketones can increase to toxic levels. This is called ketoacidosis. Ketoacidosis is dangerous and must be treated immediately.

You can test for ketones in your urine or blood at home. Check with your healthcare provider for guidelines on when you should check for ketones.

Ketones can happen quickly to someone on a pump since the pump only uses rapid acting insulin. If the pump site becomes dislodged then your blood glucose rises very quickly.

Some causes of DKA.

Sick day management.1–3

Sick day management.

Infections and illness can make controlling your blood glucose more difficult. Below are a few guidelines to help manage blood glucose. If you have guidelines from your healthcare professional follow them instead.

General guidelines.

Below are some general guidelines, but please check with your healthcare professional for specific directions.

Insulin Blood glucose/ketone monitoring Nutrition/fluid
Never skip your insulin! Your dose may need to be adjusted. Check your BG every 2–4 hours. Consume 150–200 grams of carbohydrate containing food or liquids daily.
Speak to your HCP for directions on insulin dosing if you are unsure of what to do. Monitor ketones if BG is greater than 250 mg/dL. If you have direction from your HCP, follow those instructions. Try to drink 8 oz of fluid every hour. Sipping small amounts during the hour may be better tolerated.
Insulin pumpers may need to increase or decrease basal rates. If ketones are present, follow your plan. If moderate to large ketones, limit activity. If you are not on a sodium restricted diet and you have vomiting diarrhea, you may try some Gatorade or broth.

Sick day management.1,2

General guidelines—when your healthcare provider may want you to call.

Always follow your healthcare provider’s recommendations. If you are uncertain about what to do call your healthcare professional.

Congratulations!

You have completed this course, Intensive Diabetes Management Training 1.

Here is a review of what was covered:

  • Theory of basal/bolus insulin therapy
  • Bolus dose details
  • Carbohydrate gram counting
  • Carbohydrate counting methods
  • Estimating portion sizes
  • How to read a nutrition label
  • Carbohydrate counting
  • Blood glucose management
  • Detailed record keeping
  • Low blood glucose (hypoglycemia)
  • Treatment of hypoglycemia using the “Rule of 15”
  • Severe hypoglycemia (low blood glucose)
  • Causes and symptoms of hyperglycemia (high blood glucose)
  • Understading ketones and symptoms of diabetic ketoacidosis (DKA)
  • Sick day management

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name below and click
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completion certificate.

Certificate of completion.


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Intensive Diabetes Management Training 1