St.

Paul University Philippines

Tuguegarao City, Cagayan 3500

ADVANCED ADULT NURSING III: DIABETES NURSING

From Theory to Praxis

A Narrative Report on New Trends/Issues in

Diabetes Care Management
Presented to
Professor Andr N. Canaria, MSN, RN
Course Professor of the Graduate School

Presented by
Arianne M. Rodriguez, RN
Chezca P. Bilog, RN
Cristina S. Dela Cruz, RN
Joshua H. Tubungbanua, RN

March 11, 2017

New Trends/Issues in Diabetes Care
Management
Diet
Insulin Therapy
A Statin Therapy
Bioactive Elements in Plants
Exercise Program for Diabetes
The Hgt/Blood Glucose Monitoring
Evaluation of Self Care Management
Support Group
New Trends/Issues in Diabetes Care Management
DIET
The objectives of nutritional therapy in diabetes is
to regulate optimal level of lipids in blood, ideal
body weight, and blood glucose level in normal
range
Protein- 10-20% of the total daily energy
Carbohydrate- 10-20% of the total daily
energy
Fat- 20% of the total energy intake
Fiber- 30- 40g per day
Alcohol- be limited
to 5% of total
energy intake
Sodium- 1000mg/
1000 kcal
Sweeteners-
in moderation
New Trends/Issues in Diabetes Care Management

INSULIN THERAPY
The therapeutics for type 1
diabetes includes the
following:
stimulation of insulin secretion through
GLP analogues like Exenatide and
Liraglutide
insulin injections to compensate for cell
defects, dipeptidyl peptidase-4 (DPP-4)
inhibition by Sitagliptin
increased islet survival and islet cell
regeneration through islet neogenesis
associated protein (INGAP) peptide
therapy aiming at islet cell regeneration
among others.
New Trends/Issues in Diabetes Care Management

INSULIN THERAPY
The treatment approach for type 2 diabetes includes several conventional
therapeutics:
sulfonylureas and repaglinide enhance insulin secretion
troglitazone increases insulin action in fat and muscle
metformin promotes insulin mechanism in liver tissue,
miglitol and acarbose enact delayed carbohydrate absorption from food
intake, respectively.
The other major medications strategies constitutes
combinational therapy of insulin with sulfonylureas which reduced the daily
requirement of insulin
insulin and metformin combination therapy (approved by FDA); minimizing
weight gain due to insulin therapy
troglitazone-insulin in combination efficiently reduced insulin requirement and
improved glycemic control.
New Trends/Issues in Diabetes Care Management

A STATIN THERAPY
Statins are defined as inhibitors of 3-hydroxy-3-
methylglutaryl coenzyme A and inhibit the
crucial process of LDL cholesterol in liver,
thereby decreasing its level in the blood besides
increasing healthy blood vessel lining.
Since the long term effect of diabetes include
the high risk of cardiovascular diseases, statins
(HMG-CoA reductase inhibitor) are a main line
of therapy in reducing cardiovascular risk in the
patients suffering from type 2 diabetes.
Statin therapy reduces low density lipoprotein
(LDL) cholesterol to a significant level thereby
greatly decreasing the chances of developing
a coronary artery disease
New Trends/Issues in Diabetes Care Management

BIOACTIVE ELEMENTS IN PLANTS

The bioactive constituents found in many
plant species are isolated for direct use as
drugs lead compounds, or pharmacological
agents.
Plants possessing antidiabetic properties may
be suitable as aide to the existing therapies or
as a prospective source of new
hypoglycemic compounds.
Many new bioactive drugs isolated from
plants having hypoglycemic effects
demonstrate antidiabetic activity equal to
and sometimes even more potent than
known oral hypoglycemic agents such as
daonil, tolbutamide, and chlorpropamide.
New Trends/Issues in Diabetes Care Management
BIOACTIVE ELEMENTS IN PLANTS
Several plant species being a major source of terpenoids, flavonoids,
phenolics, coumarins, and other bioactive constituents have shown
reduction in blood glucose levels
Several plants like Allium sativum Linn. (Liliaceae), Gymnema sylvestre
(Retz.) Schult (Asclepiadaceae), Murraya koenigii (L.) Spreng. (Rutaceae),
Allium cepa (Liliaceae), Withania somnifera Dunal (Solanaceae), and
Ferula foetida Linn. (Umbelliferae) have been found to possess antidiabetic
properties when assessed in experimental models of diabetes.

(LiliLiliaceae Gymnema sylvestre (Retz) Schult (Asclepiadaceae)

New Trends/Issues in Diabetes Care Management

EXERCISE
Lifestyle Approaches to Managing Diabetes
The Diabetes Prevention Program and similar
trials showed that attention to lifestyle with
nutrition and exercise, and a weight loss of 7%
to 10% of body weight, can reverse pre-
diabetes.
Weight training can build extra muscle and
therefore increase the storage capacity for
glucose. Glucose is stored with water as
glycogen.
New Trends/Issues in Diabetes Care Management
EXERCISE
A Comprehensive Training Program for Diabetes and Pre-Diabetes
Below is a weekly training program, with progression advice, that
combines both aerobics and weight training.
Day 1. Aerobic exercise. Walk, jog, treadmill or outdoors for 30 minutes at
moderate intensity
Day 2. Weight training. Use the Basic Strength and Muscle program as a
guide. You can do this at a gym or you can do most of the exercises at
home with a home gym or even a set of dumbbells.
Day 3. and Day 4 Aerobic training as for day 1.
Day 5. Weight training as for day 2.
Day 6. Aerobic training as for day 1.
Day 7. Rest.

Exercise Progression
With increasing fitness, you can gradually increase the intensity and
volume of your exercise program. This is best done under the supervision of
a qualified trainer. Here are some tips on how to do that.
New Trends/Issues in Diabetes Care Management
THE HGT/BLOOD GLUCOSE MONITORING
New Non-invasive Blood Glucose monitoring devices.

DIA-VIT is a non-invasive glucose self-monitoring device. It

measures the glucose level in the blood. The smartphone
app keeps a diary of daily data, so the patient can track
patterns in fluctuation glucose level.
SugarBeat is a non-invasive
patch. It contains an
electronic sensor that detects
real time measurements. The
patch is disposable and is
about 1mm thick. The glucose
level is measured through the skin every
5 minutes. SugarBeat is connected
to an app where also all the readings are forwarded.
 New Trends/Issues in Diabetes Care Management

THE HGT/BLOOD GLUCOSE MONITORING

GlucoTrack clippes to your earlobe in
order to test your blood sugar level.
The device contains 2 parts:
Main Unit (MU) and ear clip. The
glucose level appears on the MU.
GlucoTrack uses three independent
technologies, simultaneously:
ultrasonic, electromagnetic and thermal. All
measurements are combined by a unique proprietary
algorithm, which calculates the weighted average
and returns the users glucose level.
New Trends/Issues in Diabetes Care Management

EVALUATION OF SELF-CARE
MANAGEMENT
The Ultimate goal of Self-Care Management is
to Decrease the glycosylated hemoglobin
level of the patient, to prevent progression of
complications and improvement of quality of
life.
Compliance to Medications
Foot Care
Self-Monitoring of Glycemia
Lifestyle Modifications
Compliance with Diet-Plan
Evaluation should include Identification of
perceived patient barriers to self care and to
make specific and realistic care plans.
New Trends/Issues in Diabetes Care Management

SUPPORT GROUP
Support Group is a key to a successful
diabetes care and self-management.
Provision of social support by patients
with DM to other patients with the
same illness may experience less
anxiety, heightened self-esteem and
self-efficacy and a general
improvement of quality of life.
Face-to-Face Self Management
program Discussion of key self-
management issues participants face.
Peer Coaching Peer Coaches or
Mentors meet patients one on one to
listen discuss concerns and provide
support.
New Trends/Issues in Diabetes Care Management

SUPPORT GROUP
Community Health Workers Community members who act as bridges
between ethnic, cultural and geographical communities and health care
providers to promote health usually among groups that have traditionally
lacked access to adequate health care.
Telephone-Based Peer Group Telephone-Based Peer group is an
effective and cost-efficient extension of clinic-based diabetes service
training and support. It provides frequent patient contacts at a low-cost.
Web and E-mail Based Peer Support
Web and E-mail based support are low
cost and dissemination of content is
fairly easy