Full Course Description

Improving Diabetes Management: Tools for the Nurse

Program Information

Outline

Glycemic Targets for Hospitalized Patients

Clear interpretation of AACE & ADA guidelines
Adjusting limits for the critically ill patient
Non-critical patients: How high is too high

Recognizing Symptoms of Hypoglycemia

Hypoglycemic unawareness: How are we missing this?
Interventions that change outcomes
15/15 Rule
Timing and Dose: The good, the bad, the ugly
- IV dextrose
- Glucagon

Reducing Incidence of Hypoglycemia

Finger sticks & technique – it does matter!
Critical timing for pre-meal & correction insulin
The nurse’s role in ensuring carbohydrate-consistent meals

Symptoms & Critical Interventions for Hyperglycemia

The differences of DKA & HHNK
Diabetic Ketoacidosis
- A complex metabolic process
- Identifying the patient at risk
- Managing fluid replacement to avoid complications
- Insulin drips
- Critical labs & acute management
Nursing Management of HHNK
- Identifying the symptoms
- Don’t forget your ABCs
- Common laboratory pitfalls
- Restoring electrolyte balance

Consequences of Acute Hyperglycemia

Addressing & managing new wound infections
The dangers of:
- Platelet abnormalities
- Inflammatory cytokine response
The patient & the facility at risk:
- Poor patient outcomes
- Readmissions
- Increased length of stay
Insulin resistance

Treating Special Populations Using a Simple Formula

The patient newly prescribed steroids
Adjusting for tube feedings
TPN: Understanding the effects for the diabetic patient
Considerations for patients on R-U-500 insulin

Insulin for Improved Glucose Control

Type 1 vs. Type 2 guidelines
Action times of insulins
Calculating Basal/ Bolus Insulin
Miami 4/12 Rule
Correction scales based on insulin sensitivity

Oral Agents in the Hospital Setting

NPO vs eating status
Precautions for Metformin

Safety Issues with Managing Insulin Pumps

Patient exclusion criteria
Recognizing pump problems
When to remove pumps

System Improvements Positively Impacting Patient Outcomes

Standardized correction scales based on insulin sensitivity
Standard protocols for treating hypoglycemia
Physician order sets for insulin initiation
Carbohydrate labels on meal trays/snacks

Putting It All Together

Case Studies: What went right and what went wrong
Solving problems using the glucose accordion flowsheet report

Objectives

Differentiate glycemic targets for the hospitalized patient
Distinguish symptoms of hypo/hyperglycemia
Assess metabolic consequences of acute hyperglycemia
Utilize a standardized approach to managing glucose in patients on steroids, tube feedings and TPN
Calculate basal/ bolus (prandial) insulin dosing to achieve optimal glucose control
Formulate 2 ways the bedside nurse can reduce the incidence of hypoglycemia in the hospital
Analyze the use of oral agents in the hospital setting
Assess safety issues with using insulin pumps in the acute care setting
Design 2 system improvements that positively impact patient outcomes

Target Audience

Certified Diabetes Educators, Registered Dietitians & Dietetic Technicians, Nurses, Physician Assistants, and other Healthcare Professionals

Copyright : 05/19/2017

Advanced Diabetes Management: Caring for Today's Complex Patient

Program Information

Outline

New Recommendations

American Diabetes Association (ADA)
- All NEW 2015 Standards of Care
  - BMI Classifications
  - E-cigarettes
Immunization Recommendations
American Association of Clinical Endocrinologists (AACE)
- Updates to the Comprehensive
Diabetes Algorithm
Reimbursement Strategies

Cardiometabolic Disease

Dyslipidemia
- New American College of Cardiology Guidelines
- Recommended Treatment Based on Risk Factors
Critical Lab Values
Statin Therapy
Non-statin LDL-C-lowering Therapy
Fibrates
Omega 3
Niacin
Hypertension
- Modifications in Diagnostic Criteria
- Beta-Blockers
- Calcium Channel Blockers
- Diuretics
- Low Dose vs. Aggressive Therapy

Biomechanical Complications

New Guidelines for Assessment
Foot Exam & Treatment Alterations
Skin Assessment
Ulcers
- Strategies for Patient Compliance
- Recurrence Prevention
Neurological Predisposition
- Peripheral & Autonomic
Neuropathies
Vascular Considerations
- Microvascular changes
- Challenges with Retinopathies

Non-Insulin Medications

AACE Profiles & Recommendations
- Sulfonylureas
- Meglitinides
- Thiazolidinediones
- Biaguanides
- Alpha-glucosidase Inhibitors
- DPP-4 Inhibitors
- SGLT-2 Inhibitors

Blood Glucose Pattern Analysis

2015 Glycemic Targets
Adjusting Treatment
Utilizing CGM

Individualized Glycemic Treatment Goals

Monotherapy
Dual Therapy
Benefit of Early, Aggressive Control

When to Transition to Insulin

Progressive B-cell Failure
Insulin Profiles
Basal Therapy
Intensifying Therapy
Benefits of Insulin Pump Therapy
- New Options
- Sensor-augmented
- Closed Loop Therapy

Management Strategies for Acute Complications

Diabetic Ketoacidosis (DKA)
Hyperglycemic Hyperosmolar Non-ketotic Syndrome (HHNK)
Infection
Surgery & Hospitalization

Addressing Special Populations

Type II in Children/Adolescents
- Variations in Targets and Therapies
Elderly
- Impact of Co-Morbidities

Putting it All Together

AADE-7 Behavioral Goals
Strategies for Compliance
Motivating Change

Objectives

Differentiate the various pharmacologic treatment options for diabetes.
Breakdown effective new strategies to improve patient outcomes.
Formulate a plan of care for the patient with complications related to diabetes.
Integrate motivational interviewing strategies to facilitate patient behavioral changes.
Evaluate biomechanical treatment strategies to improve patient outcomes.
Assess the new recommendations for cardiometabolic disease.
Develop management strategies for the patient experiencing a diabetic emergency.

Target Audience

Certified Diabetes Educators, Registered Dietitians & Dietetic Technicians, Nurses, Pharmacists, Physician Assistants, and other Healthcare Professionals