1. UNIT FOUR LESSON 12 Working with Your Health Care Team

2. Objectives At the end of the lesson, participants should be able to: 1. State the importance of the team approach to managing diabetes 2. Identify members of the health care team 3. Set a goal that relates to working with the health care team 4. Describe feelings and experiences of living with diabetes 5. Identify ways to modify everyday snacks to fit into the diabetes meal plan

3. L-esson

4. Team Approach to Diabetes Management Diabetes affect the eyes, kidneys, blood vessels, heart, legs, and feet A team approach is needed to manage the disease, identify problems, and reduce or prevent diabetes complications

5. Members of the Health Care Team

6. Core Team Members You Primary care provider (doctor) Family members Certified diabetes educator (CDE) Registered dietitian Nurse educator

7. You Are the Most Important Member of the Team

8. Family Members and Friends

9. Primary Care Provider - Doctor

10. Questions to Ask Your Doctor What target range should I have for my blood glucose? Am I controlling my blood glucose? How is my blood pressure? How is my blood cholesterol?

11. Questions to Ask Your Doctor Do I have symptoms of nerve damage? Are my feet healthy? Do I have signs of kidney disease? Should I get a flu or pneumonia vaccine? When next should I see you?

12. Certified Diabetes Educator (CDE) CDEs are health professionals who have special training in teaching people with diabetes how to manage the disease

13. Questions to Ask Your CDE What is type 2 diabetes and what are the symptoms? How do I cope with diabetes? How do I manage my diabetes? How does diabetes affect my eyes, kidneys, heart and nerves?

14. Questions to Ask Your CDE How do I use a glucose meter to monitor my blood glucose? What should I do if my blood glucose numbers are too low or too high? How do I give myself insulin injections?

15. Registered Dietitian (RD) A dietitian is trained in nutrition and has passed a national exam Some dietitians have special training in working with individuals with diabetes Your doctor refers you to a dietitian

16. Questions to Ask Your RD How do I make good food choices? What foods cause my blood glucose to rise quickly? What foods should I choose when I am eating out?

17. Questions to Ask Your RD How do I find diabetes recipes? How do I include cultural foods into my meal plan? How do I eat when I am sick? What is the best diet to follow if I want to lose weight?

18. Nurse Educator A nurse educator is a registered nurse (RN) with special training in caring for and teaching people how to live with and manage diabetes

19. Questions to Ask your Nurse Educator How can I make changes in my daily habits so that I can cope with diabetes? How can I manage my diabetes? How can I reduce my risk for diabetes complications?

20. Other Team Members Pharmacist, CDE if available Eye doctor (ophthalmologist) Podiatrist (foot doctor) Dentist Counselor Exercise Physiologist

21. Pharmacist The pharmacist is trained in the science and use of prescription and over-the- counter medications They can be found in neighborhood drugstores and large food chains They help with the selection of blood glucose meters and over-the- counter diabetes supplies

22. Pharmacist Let the pharmacist know all the medications you are taking, including herbal supplements, because they can interact with the medications your doctor prescribed

23. Questions to Ask Your Pharmacist How does the medicine work? How should I take the medicine? What should I do if I miss a dose? How do I know if the medicine is working? What are some of the side effects of taking this medication?

24. Questions to Ask Your Pharmacist What should I avoid when taking this medication? How should I store the medicine? Do I need a refill? Are there generic brands of this medication?

25. Ophthalmologist: Eye Doctor An ophthalmologist is a doctor who specializes in diseases of the eye.

26. Questions to Ask Your Eye Doctor Do I have eye problems? Do I need glasses or new glasses? Do I need special treatment? Am I eligible to drive? What can I do to take care of my eyes? What should I do if I notice changes in my vision?

27. Podiatrist or Foot Doctor A podiatrist is a doctor trained to prevent, diagnose, and treat problems of the lower legs

28. Questions to Ask Your Podiatrist How can diabetes affect my feet? How well are the nerves in my feet sensing feeling? How is the blood flow to my legs and feet? Are there changes in my feet? What is the best way to trim my toenails?

29. Questions to Ask Your Podiatrist What type of lotion or cream should I use on my legs and feet? What are the best types of shoes to purchase? Can special shoes help my feet? How can I care for my feet?

30. Dentist People with diabetes are more likely to have gum disease especially if their blood sugar is not well controlled They are also more likely to get infections and that is another reason they tend to have teeth, mouth, and gum problems

31. Questions to Ask Your Dentist Do I have early signs of tooth, mouth, or gum problems? How should I protect my teeth? What is the correct way to brush and floss my teeth? What should I do to keep my teeth, mouth, and gums healthy?

32. Mental Health Professionals

33. A mental health professional may be a social worker, psychologist, psychiatrist, or counselor These members of your team help with the social and emotional side of living with diabetes

34. Depression People with diabetes are more likely to be depressed The daily tasks needed to manage diabetes can become overwhelming, especially if a person is experiencing diabetes complications such as nerve damage, kidney problems, and/or poor blood glucose control

35. Questions to Ask Your Mental Health Professional Is depression normal for persons with diabetes? How do I deal with my feelings and emotions? Can my emotions raise my blood glucose?

36. Questions to Ask Your Mental Health Professional Social Worker What kind of costs does Medicare cover? How can I find resources to help with medical and financial needs?

37. Questions to Ask Your Mental Health Professional Counselor Where can I find support for depression and emotional stress? How can I deal with depression as a result of diabetes?

38. Questions to Ask Your Mental Health Professionals Psychiatrist If I have to take medication, what are the side effects of medication? Are there other treatment? How will medication affect my blood glucose levels?

39. Exercise Physiologist An exercise physiologist is a licensed health professional who can plan an exercise program that is safe and appropriate for you Benefits of Exercise: Lowers blood glucose level Helps the body use insulin more effectively Improves heart functions Controls your weight Helps you feel better

40. Questions to Ask Your Exercise Physiologist What type of exercise is best for me? How can I exercise safely? How long should I exercise?

41. Putting it All Together Share what you learned about diabetes and the health care team

42. E-mpowerment Diabetes Education Series: Working with Your Health Care Team

43. Diabetes Education Series Describe your experiences and feelings working with your health care team. What worked well for you? What was most difficult? What are ways that you could overcome some of these difficulties?

44. A-ction Did you accomplish the goal you set last week? Your goal is to develop your health care team.

45. R-eal-Life Problem Solving Phyllis’ Story

47. Questions about Phyllis’ Story What information would you give Phyllis concerning individuals who should be on her diabetes care team? Explain the role of these individuals to Phyllis and how often she should see them. What other information can you pass on to Phyllis? How can Phyllis keep track of what health care specialist she needs to see and how often?

48. Questions about Phyllis’ Story Please find the Real-Life Problem Solving handout for this lesson in your folder These questions will help with your understanding of Phyllis’ story

49. N-utrition Menu Fruit Yogurt Dip Mini Bran Muffin

50. We have come to the end! Continue on the path of success! Keep reaching for your goals!

51. Date: References: Margaret E. Cook-Newell, Ph.D., R.D., L.D., CDE Irene Hong-McAtee, MD, MCR Adrienne Glodt, B.S., Graduate Student Laura Hieronymus, MSEd, APRN, BC-ADM, CDE Cheryl Case, M.S., Harrison County Ann Hollon, M.A., Wolfe County Hazel Forsythe, Ph.D., R.D., L.D., CFCS Stephen D. Perry, M.S., R.D., L.D. Pam Sigler, M.S. Lynn Blankenship, M.S., Metcalfe County Theresa Scott, M.A., Floyd County Tamara Thomas, M.S., Franklin County Rusty Manseau, B.A., Graphic Artist Author: Ingrid Adams, Ph.D., Assistant Professor, Nutrition and Food Science, University of Kentucky Other Contributors