DIABETES HEALTH PROMOTION PLAN

Target Group: Diabetics 60 years and older

Student name: Osscennie Gentles

Id #: 1101A0625
Lecturer: Mrs Edith Evans
School: IUC
Course: Gerontology
Due date: October 2014

What is diabetes?

Diabetes is the condition in which the body does not properly process food for use as energy.
Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The
pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose
get into the cells of our bodies. When you have diabetes, your body either doesn't make enough
insulin or can't use its own insulin as well as it should. This causes sugars to build up in your
blood. This is why many people refer to diabetes as sugar. Diabetes can cause serious health
complications including heart disease, blindness, kidney failure, and lower-extremity
amputations.

How prevalent is diabetes among blacks?

Blacks are 1.7 times as likely to develop diabetes as whites
The prevalence of diabetes among blacks has quadrupled during the past 30 years
Among blacks age 20 and older, about 2.3 million have diabetes 10.8 percent of that
age group
Blacks with diabetes are more likely than non-Hispanic whites to develop diabetes and
to experience greater disability from diabetes-related complications such as
amputations, adult blindness, kidney failure, and increased risk of heart disease and
stroke.

 Death rates for blacks with diabetes are 27 percent higher than for whites.

What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for diagnosis. They might
have some or none of the following symptoms:

Frequent urination
Excessive thirst
Unexplained weight loss
Extreme hunger
Sudden vision changes
Tingling or numbness in hands or feet
Feeling very tired much of the time
Very dry skin
Sores that are slow to heal
More infections than usual

Pre-Diabetes:

Pre-diabetes means that the cells in your body are becoming resistant to insulin or your pancreas
is not producing as much insulin as required. Your blood glucose levels are higher than normal,
but not high enough to be called diabetes. This is also known as "impaired fasting glucose" or
"impaired glucose tolerance". A diagnosis of pre-diabetes is a warning sign that diabetes will
develop later. The good news: You can prevent the development of Type 2 diabetes by losing
weight, making changes in your diet and exercising.
Type 1 Diabetes:

A person with Type 1 diabetes can't make any insulin. Type 1 most often occurs before age 30,
but may strike at any age. Type 1 can be caused by a genetic disorder. The origins of Type 1 are
not fully understood, and there are several theories. But all of the possible causes still have the
same end result: The pancreas produces very little or no insulin anymore. Frequent insulin
injections are needed for Type 1.

Type 2 Diabetes:
A person with Type 2 diabetes has adequate insulin, but the cells have become resistant to it.
Type 2 usually occurs in adults over 35 years old, but can affect anyone, including children. The
National Institutes of Health state that 95 percent of all diabetes cases are Type 2. Why? It's a
lifestyle disease, triggered by obesity, a lack of exercise, increased age and to some degree,
genetic predisposition.

Gestational Diabetes:
Gestational diabetes (GD) affects about 4 percent of all pregnant women. It usually appears
during the second trimester and disappears after the birth of the baby.
Like Type 1 and Type 2, your body can't use glucose effectively and blood glucose levels get too
high. When GD is not controlled, complications can affect both you and your baby. Your doctor
will help you work out a diet and exercise plan, and possibly medication. Having GD increases
your risk for developing it again during future pregnancies and also raises your risk of Type 2
diabetes later in life.

Why a health promotion plan??

The purpose of health promotion programs is to provide a positive atmosphere and guide the
patient about the treatment.
The Health Promotion Program fosters an environment which supports positive health as well as

fitness practices to reduce risk factors regarding health, maintain healthy lifestyle and become
more fit.
Following factors increase the chances of getting diabetes:
1) People who are overweight and over 40.
2) People who have family members with the disease.
3) Women who develop diabetes when pregnant are likely to develop it,later in life.
4) People of African-American or Asian heritage.

Target Group

The target group for this health promotion plan is individuals, elderly male and female; 60 years
and older and are already diagnosed with diabetes. This promotion plan will initiate and
highlights ways that these individuals can lead a healthy lifestyle and prevent onset of other
complications. It is very important for diabetics to maintain a normal blood glucose level at all
times and constant care of their bodies.

Assessment of the Geriatric diabetic patients

The key to develop an appropriate treatment plan for geriatric diabetic patients involves the
following:
Comprehensive assessment of the health status.

 Assessment of signs and symptoms related to hyperglycemia and diabetic complications.

Evaluation of hyperlipidemia, hypertension, and other risk factors associated with
atherosclerosis by using medical history and physical examination.
Evaluation of patients medications, dietary and exercise habits, nutritional, functional,
and cognitive status, attitudes towards his or health, and financial and social status.
Similarly for patients with disabilities and multiple chronic diseases, who may also face
problems with financial or social support, assessment by a geriatrician and multidisciplinary
team may be necessary. Subspecialty consultation may also be necessary for ophthalmological,
neurological, podiatric, and other complications. Thus, without a thorough evaluation, a safe and
effective treatment plan cannot be developed.
The various components of the comprehensive assessment of an older diabetic patient are:

History and physical

Function
Cognition and affect
Nutritional status
Medication use and possible inappropriate polypharmacy
Social situation and support

Health Team
Collaborative Care:

Nurse
Physiotherapist
Doctor
Dietician

Promoting Health In Diabetics

Individuals diagnosed with diabetes, whether it may be type 1 or type 2, need to practice certain
habits in order to stay fit and healthy. They should follow a proper diet plan and need to pay
attention to exercise, as exercise helps our body in using insulin in a better way to convert
glucose into energy. Those with type 1 diabetes and some of the people with diabetes type 2,
need to take insulin injections. People with diabetes type 2 are prescribed specific medications
which help their body to produce more insulin and use it. Some people with type 2 diabetes diet
can manage their disease with exercise and weight loss alone and don't need any diabetic
medicines.

Diet
Dietary compliance is often not feasible for elders who exhibit difficulties with instrumental
activities of daily living, because their functional capabilities may limit their ability to prepare
basic meals. Restricting caloric intake in long-term care patients should be done with much
caution. Many already have insufficient caloric intake because of confusion, dysphasia, and
diminished appetite. Often, a consultation with a dietician and home evaluations by social
workers can provide some insight.
Patients suffering from diabetes cannot break down stored fat for energy with ease. They even
find it difficult to break down proteins. Blood sugar level rises as it gets stocked up in the blood
due to the lack of converter hormone insulin. Excess sugar level in your blood can create
complications for you. That is why when diabetes is detected, your doctor tells you to make
changes in eating habits, weight control and have exercise programs, and may even prescribe

drugs to keep it in check. You should also have regular checkups. Dietary control is an integral
part of management of the diabetes patients. The perfect diet would be such that apart from
providing the essentials of good nutrition, it should be open to adjustments from time to time for
changing metabolic needs, for example during growth, pregnancy, lactation or modified activity.
Below are some of the guidelines for diabetic patients regarding their meal planning.

Diabetic patients should always try to reduce overall fat. Use oils or foods that are high in
Omega-3 fatty acid, such as olive oil, rapeseeds oil, flaxseed and flaxseed oil as they
require lower insulin. Avoid fried food.
Refined carbohydrates and sugar should be avoided as they increase the blood sugar
immediately. Fruits should be the major source of sweetness in your diet, as they are low
in calories, high in fibres, and many other minerals and vitamins which are essential for
keeping the body healthy.
Glycemic Index shows how much your blood sugar increases after eating different foods.
With the help of glycemic acid, you can always keep the blood sugar level under control
as higher glycemic acid means higher blood sugar level.
Try to minimize Protein from your diet as much as you can. It is always better to use
meat substitutes or non-animal protein foods such as legumes tofu. Legumes are excellent
as insulin regulators. Red meat should be completely avoided. Instead, the amount of fish
should be increased in your diet.
Some vegetables decrease the severity of diabetes. Some of them are celery, bitter melon,
onion, garlic, asparagus and spinach.
Non-healthy eating habits increase your blood glucose level. Your meal plan should
include healthy foods which are beneficial in checking your diabetes and if not that then
at least which do not increase it. That is why, it is wise to consult with your dietician to

make a meal plan that fits the way you usually eat, that fits with your daily routine and
that does not confront with your diabetes medicines.

Exercise

The Type II diabetes usually occurs during the old age. At this stage, the pancreas does not
produce enough insulin to control the body glucose level. A person diagnosed with type II
diabetes is recommended exercise and weight control. These two ways help the person to
manage their blood sugar level. If the above two ways do not work, then some medications are
prescribed by the doctor. The person suffering from type II diabetes has a risk of suffering from
inactivity, high cholesterol, obesity, and hypertension. Inactivity or lack of exercise is the main
reason that causes diabetes. Exercise has a positive effect on diabetes type II which improves the
insulin sensitivity in the person, while type I cannot be controlled through an exercise program
alone. As many as 90% people suffer from type II diabetes. Since exercise causes the body to
process the glucose faster which helps in lowering the blood sugar level, the intense exercise
helps the body to utilize glucose faster.
Working in collaborative care with a physiotherapist to promote exercise and physical activity
is important. The physiotherapist will assess each individuals level of activity and what he/she
can tolerate.
However, it is highly recommendable that before any exercise program, consult your doctor to
make it more effective. It is also important to understand the dangers of injecting insulin
immediately prior to exercise. A person with type I diabetes injects the normal amount of insulin

for a sedentary situation. Now, this may sometimes pose the risk of hypoglycaemia or insulin
shock during exercise. It is recommended that a person suffering from type I diabetes must take
adequate rest during the exercise. This will further help to prevent high blood pressure. The
person who is exercising must avoid heavy weight lifting, and consume carbohydrates in
between.
In case the blood sugar levels goes down, the individual may feel shaky, disoriented,
hungry, anxious, and irritable or experience trembling. Having a carbohydrate snack or beverage
stops these symptoms in minutes. Check your blood sugar level before exercising and make
sure that it is not below normal range.
The blood level should be checked on regular intervals, It may be tested before, during, after
three to five hours after exercise. During this period it is good to consume carbohydrates to
prevent hypoglycaemia. People with type I diabetes must keep carbohydrate supplements to
prevent rising blood sugar levels. It maintains the energy level by providing strength to the
person. It is best to consult a good doctor to cure both types of diabetics as he can best
recommend the diet and exercise level that you must follow.

Treatment/Medication
The major goal in treating diabetes is to minimize any elevation of blood sugar (glucose) without
causing abnormally low levels of blood sugar. Type 1 diabetes is treated with insulin, exercise,
and a diabetic diet. Type 2 diabetes is treated first with weight reduction, a diabetic diet, and
exercise. When these measures fail to control the elevated blood sugars, oral medications are
used. If oral medications are still insufficient, treatment with insulin is considered.

Adherence to a diabetic diet is an important aspect of controlling elevated blood sugar in patients
with diabetes. The American Diabetes Association (ADA) has provided guidelines for a diabetic
diet. The ADA diet is a balanced, nutritious diet that is low in fat, cholesterol, and simple sugars.
The total daily calories are evenly divided into three meals. In the past two years, the ADA has
lifted the absolute ban on simple sugars. Small amounts of simple sugars are allowed when
consumed with a complex meal.
Weight reduction and exercise are important treatments for diabetes. Weight reduction and
exercise increase the body's sensitivity to insulin, thus helping to control blood sugar elevations.
Based on what is known, medications for type 2 diabetes are designed to:

Increase the insulin output by the pancreas,

Decrease the amount of glucose released from the liver,
Increase the sensitivity (response) of cells to insulin,
Decrease the absorption of carbohydrates from the intestine, and
Slow emptying of the stomach to delay the presentation of carbohydrates for digestion
and absorption in the small intestine.

When selecting therapy for type 2 diabetes, consideration should be given to:

The magnitude of change in blood sugar control that each medication will provide;
Other coexisting medical conditions (high blood pressure, high cholesterol, etc.);
Adverse effects of the therapy;
Contraindications to therapy;
Issues that may affect compliance (timing of medication, frequency of dosing); and
Cost to the patient and the health care system.

It's important to remember that if a drug can provide more than one benefit (lower blood sugar
and have a beneficial effect on cholesterol, for example), it should be preferred. It's also

important to bear in mind that the cost of drug therapy is relatively small compared to the cost of
managing the long-term complications associated with poorly controlled diabetes.

Varying combinations of medications also are used to correct abnormally elevated levels of
blood glucose in diabetes. As the list of medications continues to expand, treatment options for
type 2 diabetes can be better tailored to meet an individuals needs. Not every patient with type 2
diabetes will benefit from every drug, and not every drug is suitable for each patient. Patients
with type 2 diabetes should work closely with their physicians to achieve an approach that
provides the greatest benefits while minimizing risks.

Treatment of diabetes with insulin

Insulin is the mainstay of treatment for patients with type 1 diabetes. Insulin is also important in
type 2 diabetes when blood glucose levels cannot be controlled by diet, weight loss, exercise, and
oral medications.

Ideally, insulin should be administered in a manner that mimics the natural pattern of insulin
secretion by a healthy pancreas; however, the complex pattern of insulin secretion by the
pancreas is difficult to duplicate. Still, adequate blood glucose control can be achieved with
careful attention to diet, regular exercise, home blood glucose monitoring, and multiple insulin
injections throughout the day. Taking care of your diabetes with careful home care and
monitoring assists in controlling blood sugar levels and effective diabetes treatment.

In the past, the insulin was being derived from animal sources, particularly cows and pigs. Not
only was there a problem with enough supply of insulin to meet the demand, but beef and pork

insulin also had specific problems. Originating from animals, these types of insulin caused
immune reactions in some people. Patients would become intolerant or resistant to animal
insulin. With the acceleration of scientific research in the latter half of the twentieth century, beef
and pork insulin were replaced by human insulin. In 1977, the gene for human insulin was
cloned, and through modern technology, manufactured human insulin was made available.
Human insulin is now widely used.

Insulin comes in a variety of preparations that differ in the amount of time following injection
until they begin to work and the duration of their action. Because of these differences,
combinations of insulin are often used to allow for a more tailored regimen of blood sugar
control. The types of insulin currently in use are as follows:

Rapid-acting insulins begin to take effect 5 minutes after administration. Their peak
effect occurs in about 1 hour, and they continue to have an effect for 2 to 4 hours total.
Examples are insulin lispro, insulin aspart, and insulin gliulisine.
Regular insulins takes effect within 30 minutes, peak at 2 to 3 hours after injection, and
is effective for 3 to 6 hours total.
Intermediate-acting insulins typically have an effect about 2 to 4 hours after injection,
peak 4 to 12 hours later, and are effective for about 12 to 18 hours.
Long-acting insulins take effect within 6 to 10 hours. They are usually effective for 20 to
24 hours. The two long-acting insulin analogues glargine and detemir generally lower
glucose levels fairly evenly over a 24-hour period.

Diabetes Foot Care

When you have diabetes, proper foot care is very important. Poor foot care may lead to
amputation of a foot or leg.
As a person with diabetes, you are more vulnerable to foot problems, because diabetes can
damage your nerves and reduce blood flow to your feet. The American Diabetes Association
estimates that one in five people with diabetes who seek hospital care do so for foot problems.
By taking proper care of your feet, most serious health problems associated with diabetes can be
prevented. Your doctor will check your feet each year for any problems.

Wash and Dry Your Feet Daily

Use mild soaps

Use warm water

Pat your skin dry; do not rub. Thoroughly dry your feet.
After washing, use lotion on your feet to prevent cracking. Do not put lotion between
your toes.

Examine Your Feet Each Day

 Check the tops and bottoms of your feet. Have someone else look at your feet if you

cannot see them.

Check for dry, cracked skin.
Look for blisters, cuts, scratches, or other sores.
Check for redness, increased warmth, or tenderness when touching any area of your feet.
Check for ingrown toenails, corns, and calluses.
If you get a blister or sore from your shoes, do not "pop" it. Apply a bandage and wear a
different pair of shoes.

Take Care of Your Toenails

Cut toenails after bathing, when they are soft.

Cut toenails straight across and smooth with a nail file.
Avoid cutting into the corners of toes.
Do not cut cuticles.
You may want a podiatrist (foot doctor) to cut your toenails.

Be Careful When Exercising

Walk and exercise in comfortable shoes.
Do not exercise when you have open sores on your feet.

Protect Your Feet with Shoes and Socks

Never go barefoot. Always protect your feet by wearing shoes or hard-soled slippers or
footwear.
Avoid shoes with high heels and pointed toes.
Avoid shoes that expose your toes or heels (such as open-toed shoes or sandals). These
types of shoes increase your risk for injury and potential infections.
Try on new footwear with the type of socks you usually wear.
Do not wear new shoes for more than an hour at a time.
Change your socks daily.

 Look and feel inside your shoes before putting them on to make sure there are no foreign

objects or rough areas.

Avoid tight socks.
Wear natural-fiber socks (cotton, wool, or a cotton-wool blend).
Wear special shoes if your health care provider recommends them.
Wear shoes/boots that will protect your feet from various weather conditions (cold,

moisture, etc.).
Make sure your shoes fit properly. If you have neuropathy (nerve damage), you may not
notice that your shoes are too tight. Perform the "footwear test" described below.

Simple Healthy living Tips

Eat healthy
Exercise
Regular screening
Proper Foot care
Take medication as prescribed
Try not to get cuts or bruises
Get enough rest and adequate sleep
Enjoy leisure activities
Learn to understand and accept your feelings, and live well.
Wear diabetic bracelet at all times if available

Complications from diabetes fall into two major categories:

Acute
Chronic

Acute Complications
Serious, life-threatening complications can arise quickly. Fortunately, such complications can go
away just as quickly if you and those closest to you know what to do and how to do it.
Acute complications arise from uncontrolled high blood sugars (hyperglycemia) and low blood
sugars (hypoglycemia) caused by a mismatching of available insulin and need. In short, you
either have taken too much diabetes medication or too little.
Some acute complications require immediate medical attention.
These emergencies include:
Hypoglycaemia
Hyperglycaemic Hyperosmolar State (HHS)
Diabetic Ketoacidosis (DKA)

Chronic Complications
Chronic complications tend to arise over years or decades. Often, there is damage before there
are symptoms so routine screening is recommended to catch and treat problems before they
occur or get worse.

Problems include:
Vision loss or blindness
Kidney damage or failure

Nerve pain and damage

Heart and blood vessel disease
High blood pressure
Dental problems
Hand problems
Foot problems

Reference

Complication. (2014). Retrieved from Diabetes Teaching Center at the University of

California, San Francisco: http://dtc.ucsf.edu/living-withdiabetes/complications/
Debra Manzella, R. (2014, June 11). What is Diabetes. Retrieved from AboutHealth:
http://diabetes.about.com/od/whatisdiabetes/p/whatisdiabetes.htm
Melissa Conrad Stppler, M. (2013, April 04). Diabetes treatment. Retrieved from
MedicineNet.com:
http://www.medicinenet.com/diabetes_treatment/page8.htm#treatment_of_di
abetes_with_insulin
WebMD. (2008). Retrieved from Diabetes Foot Care:
http://www.webmd.com/diabetes/caring-feet