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Urge diabetics to quit smoking, exercise more
Monitor weight loss carefully
(Editor’s note: This is the second of a two-part series that takes a look at diabetes management for home health patients. Last month, we looked at proper diagnosis and clinical management of diabetes for home health patients. This month we examine how lifestyle changes can be addressed in home health.)
For both Type 1 and Type 2 diabetes, weight control, exercise, and elimination of tobacco use are essential for controlling blood sugar levels and minimizing complications, says Faith Thibodeau, MS, RD, LD, CDE, a diabetes educator for Visiting Nurse Service in Saco, ME.
Because many Type 2 diabetics are overweight, diet and exercise are very important, she says. "Typically, an overweight diabetic patient can lose 10 pounds and gain greater control of their diabetes, but more than 20 pounds weight loss is not helpful," she says.
The most important part of planning a diet plan for a diabetic patient is to keep the recommendations realistic, Thibodeau says.
"Nurses need to understand that the [Alex-andria, VA-based] American Diabetes Association’s exchange plan is not suited for the way most people eat," she says. Because most Americans get too much fat in their diet, she suggests that a diet plan for diabetics focus on reducing fat.
Linda C. Pearce RN, C, BSN, a consultant with Diabetes Education Consulting in Blacksburg, VA, suggests that nurses evaluate patients carefully before recommending weight loss. It is risky to put many elderly patients on a weight-loss diet because they need carbohydrates, she says.
"It is important that these patients receive careful meal-planning advice because many elderly patients are undernourished and may not be getting the combination of carbohydrates and other food groups they need," she adds.
Although you might not think your home health patient can exercise, there are activities that can help, Pearce says. "Something as simple as walking around a dining room table and setting a timer to gradually increase walking time can help a patient who can walk," she says. If your patient can’t walk, simply rocking in a rocking chair will add some activity to their daily routine, she adds.
Getting your patient to stop smoking also is important, says Pearce. Not only does smoking damage and constrict blood vessels that worsens foot ulcers and leads to other leg and foot diseases, but smokers with diabetes are more likely to suffer from nerve damage, kidney disease, and cardiovascular problems. She also points out that smoking raises blood sugar levels, which makes it harder to control diabetes.
[For more information on diabetes control, contact:
• Faith Thibodeau, MS, RD, LD, Diabetes Educator, Visiting Nurse Services, 15 Industrial Park Road, Saco, ME. Telephone: (207) 284-4566. Fax: (207) 282-4148. E-mail: email@example.com.
• Linda C. Pearce, RN, C, BSM, Consultant, Diabetes Education Consulting, 2523 Black Cherry Lane, Blacksburg, VA 24060. Telephone: (540) 969-0246. E-mail: firstname.lastname@example.org.]