Although the nursing has traditionally led the fundamental weight of diabetological education other professionals such as dietitians, pharmacists, podians or physical education teachers are incorporated.
The nurse is the main figure in diabetological education, although the great heterogeneity of her role in our country has contributed to the coordination of educational programs and the improvement of knowledge and skills of diabetological education professionals are shared withEndocrinologists or internist and family doctors especially sensitized who work in diabetes and assume that responsibility.
In this context, the function of the primary care doctor is to guarantee therapeutic education, especially at the time of diagnosis of type 2 diabetes;Know the educational program and participate in its periodic update, participate with the center's staff in therapeutic education, taking into account the particular situation of each center, transmit the treatment and objectives to be achieved in each patient, to participate in the disease, promote a healthy lifestyle, evaluate the effectiveness of interventions with educating nurses and the rest of the team and inform the patient and their family in the natural history of diabetes and their complications.
Continuing Education
Education can be carried out at different times of the disease, although in these cases the nursing staff continues to be a reference in diabetological education.Even so, the educator must possess knowledge and skills to guarantee therapeutic education in the appropriate framework.With all this, you must have basic scientific and technical knowledge about pathology, knowledge about the material for education and training plan, about lifestyle modifications such as eating habits and physical activity and security and efficiency in medicines among others.
The role of the pediatric endocrinologist who serves children with diabetes does not differ in general from the adult endocrinologist, with the proviso that in more than 95% of the situations it is a type 1 diabetes.It refers to the participation in the patient's therapeutic education, logically it must be adapted to the characteristics of the child and, according to their age, education focuses on parents or guardians.
Diabetes has a high prevalence in elderly patients and with important metabolic disorders both in their diet and in the practice of exercise and lifestyle changes towards a healthier profile.
Multidisciplinary talks
Sometimes nursing personnel carry talks with small groups of patients to activate and reaffirm better compliance with the comprehensive treatment of diabetes.At the same time, the participation of community pharmacists could also be important to reinforce the actions cited, taking into account the dispersion of the population we have in our territory
The programs that are being carried out to increase the patient's participation, explaining their disease in a clear and affordable way, trying that both the patient and his caregiver become aware of the disease, their chronicity and their effects, are paying off.
The efforts are aimed at performing primary prevention of the disease and trying to diagnose as soon as possible people.Within the possibilities offered by our health system, it is insisted on physical activity programs and monitoring of healthy diets.Many times it is observed that the patient is not aware of the dangers and damage that diabetes will cause in his body if hygienic-dietary measures are not followed and theContinuous and regular treatment.
A complication that often arises in the diabetic patient is the lack of adhesion to treatment.Sometimes it is a consequence of involuntary acts such as oblivion or confusion, but the patient also stops taking the medication for believing it unnecessary, for economic aspects or for the perception of improvement that makes them consider unnecessary to continue with the treatment.
Information for compliance
There is evidence that patients make decisions about their medication based on their own knowledge of diabetes, so the cultural level of the patient greatly influences adherence to treatment.The patient's perception of the need to take medication will influence his right decision.
Currently, electronic recipe helps greatly discover when a patient shows symptoms of non -adhesion to treatment.
The Diabetes specialized nurse is the main figure in the care of the patient with diabetes participates in the advice on the medication and treatment of special situations and must coordinate the continuity of education and self -care outside the own environment.The fundamental function will be to favor independence and encourage the freedom of the person with diabetes developing a program that identifies obstacles to modifying behaviors and combines education strategies.It must include the relatives of people with diabetes by giving them the prominence they require.The periodic evaluation of the development of the program and its results, through the generally qualitative evaluation, must be quantitative, triangulate to use both methods.A regulated assessment must be carried out, in search of the real or risk problems of the person.
The program includes information about what diabetes, chronic and acute complications of diabetes, comorbidities, vascular risk factors, interpretation of treatments, such as food, exercise, drugs and different insulinization schemes;Insulin and glucose automation injection techniques.In addition, the update of information, incorporation of new technologies such as telemedicine and implementation of participation in educational programs.The Diabetes specialized nurse is the main figure in the task of therapeutic education and advice, and participates in the advice on medication and the treatment of special situations, so it must coordinate the continuity of education and self -care outside the fieldown.
Diet and exercise
The diet is the main pillar and in some cases, together with the exercise, the only treatment.It must be healthy and balanced and must be shared with the whole family.It is convenient to perform 4 to 6 meals a day and respect the schedules especially if you take medication.The objective is to achieve a correct nutritional value, maintain adequate weight and regulate blood glucose avoiding oscillations.The food to avoid are fast sugars: sugar, chocolate, candies, honey, ice cream, jams.Eating in adequate and well distributed quantities in the day: bread, potatoes, flours, rice, fruits and legumes.Consume meat, eggs and sausages.It is recommended to consume salad, vegetables, drinkless drinks, milk and skimmed yogurt.You must also take care of fat consumption to avoid vascular problems.
With respect to sweeteners, they should know that it can be used to replace sugar, saccharin, aspartame and cyclamate and you have to be careful with diabetic foods because they can contain sorbitol or fructose, which are natural sweeteners and therefore up glucose.In packaged foods, it is convenient to consult tags to know thequantity and type of carbohydrates they contain.While light and white soda drinks are indicated by not providing sugars.
When talking about physical exercise, it must be programmed and progressive.Drink liquid during exercise, wear proper footwear and take carbohydrate supplements to avoid exercise at maximum temperature.
Treatment
In case of insulin treatment, insulin must be injected away from the exercise zone and perform self -analysis before and after exercise.Be careful with asymptomatic hypoglycemia and glycemia greater than 250 mg/dl.
When implanting oral antidiabetics, you have to know that to do so correctly they are classified into sulfonylureas, thiazolindione, DPP-4 inhibitors, biguanidas, alfaglucosidase inhibitors, while among the injectables are the SGLT-2 inhibitors and agonist of theLPI receiver.
Oral antidiabetics are taken to reduce blood glucose levels and are only effective when the pancreas still produces insulin;that is, in type 2 diabetes. Among the tips for the use of oral antidiabetics are that no diabetes pills of another person are taken, they must know the name of their pills, as well as the dose and time of the shots.Almost all pills have an effect of 6-24 hours.It is advisable to take the pill every day at the same time and you must look for some trick to remember the time.If you forget to take the morning and remember later, you can take it, but if you take one every day and forget you should not take two the next day.Check the expiration of the pills and keep stored at room temperature, do not take them if they have changed color in the same boat.
The patient must be remembered to wear the pills always on top when he goes on a trip and not in the suitcase and carry some more container.If you are sick and cannot eat, you should take the pill since in these cases the glucose usually rises.Any diabetes pill must be accompanied by some exercise and an adequate diet.
Insulin should be administered to all people with type 1 diabetes and many with type 2 diabetes. It is necessary to distinguish between various types of insulin.According to action time they can be quick action, regular insulin;of ultra -grape action, Lispro;of intermediate action, insulin NPH, and prolonged action, glargina/detection.The duration of the insulin effect depends on what is used.
As for the preparation, it is usually presented in what we call pen or pen, although each pen is different according to the mark.The needle with which insulin is injected is of disposable material and must be removed once the insulin is placed to prevent air into the pen.
Insulin application
Thus, insulin must be injected into the subcutaneous tissue, taking a pinch of the chosen zone (belly, thighs, arms, buttocks) with an inclination of the needle to prevent it from entering the muscle and producing bruises.Do not forget about self -analysis, where you have to measure glycemia of capillary blood and blood or urine ketone bodies.
In the management of diabetes 2, a very important element must be taken into account, which is the aging of the welfare population and the large number of patients that are attended to consultations every day.
The implementation of the electronic recipe, the digital medical history and the spontaneous visit to the nursing staff by the patient are assuming an improvement in the decrease of our care load and an improvement in the control of chronic diseases and, especially, ofCardiomethabolic.
However, it can be improved in the early detection of the diabetic patient and the interventions that helpto a good monitoring and compliance with the prescribed treatment.For that, the simplification in the dosage and adaptation of dietary measures to each patient would be convenient, together with the participation of nursing personnel in the approach and monitoring of the disease.Nursing consultation is an ideal environment to obtain information about fears.Therefore, integral diabetological education, both for the patient, and for their closest and closest family environment is of great importance for disease management.
For the elaboration of this article, the collaboration of the doctors specializing in Family Medicine Isabel Ramírez Polo, Juan A. Gutiérrez Espinosa de los Monteros, José Ramón Aragón Baliña, Nicomedes Carvajal Trujillo, Ignacio Giménez Vélez and the care doctor and the doctor of carePrimary Federico Bonilla Toyo, from the Cayetano Roldán Health Center, from San Fernando, Cádiz;Alfonso Delgado Torralbo, Antonio Zambrano Barea, Enrique Silva García, Fernando Zambrano Barea and Juan Jesús Sánchez-Pardo García, from the Jerez Hospital, María José Mulero García, Carmen Tabero Ortiz, José Montaño Montaño, Juan Luis Lemus Gallego, Antonio Cabanillas Valenzuela andPedro Vélez Morgado, from the Llerena Health Center, and the Family Doctors Antonio Silvelo Rodríguez, Manuel López Lens, María José Martínez Fiallega, Lourdes Linares Regueira, Ana Flora Guerra España España and Alfonso Rodríguez Rodríguez, of the Ribadeo Health Center.