Patients admitted to Health Care Partners with a primary or secondary diagnosis of diabetes mellitus, will automatically be referred for consult to one of our many qualified diabetes nurse instructors.  We have RN instructors for every region. Once a referral has been initiated, the instructor will then see the patient for a comprehensive assessment of needs for diabetes education.  The patient/caregiver and the instructor jointly determine the educational plan.  The RN instructor will then provide education with 1-2 visits the first week and approximately one visit per week thereafter until education is completed.  Upon completion of education the instructor will help the patient select behavior change goals.

All program patients who have not seen a dietitian within six months, or who are having problems with their meal plans need an automatic referral to the RD program instructors.  The RD instructors will assess nutritional status and provide appropriate recommendations
and education for medical nutrition therapy. The case manager will reinforce education provided by the RN and RD instructors.

  • Minimize diabetic emergencies and hospital admissions.
  • Develop a partnership with the patient and family, involving the patient and family in decision making about the management of the disease.
  • Prevent and / or manage chronic and troublesome symptoms such as hypo / hyperglycemic attacks.
  • Involving the patient and family in decision making
    about the management of the disease.
  • Minimize recurrent complications of the disease
  • Meet state and national standards.
(*All program instructors must minimally meet professional and educational requirements set by Michigan Department of Community Health & American Diabetes Association  for both basic and continuing education in diabetes, diabetes related topics, educational principles and behavioral change strategies.  Supervision and ongoing educational opportunities
are provided through our CDE Coordinator).
 
Advisory Committee
  • Guides program coordinator and program policies
  • Consists of physicians CDE (Certified Diabetic Educator) coordinator, RN program instructors, RD program instructors, MSW, community representative / consumer

Coordinator

  • RN / CDE with MSA degree
  • Over 25 years experience in care and treatment of diabetes
  • Over 20 years experience in program development and management

Qualified Instructors

  • Registered Dietician
  • Registered Nurse Instructor - at least one instructor for each agency regions.

 
 
Our teaching plan is based on a curriculum approved by the American Diabetes Association. A comprehensive
assessment of the patient/caregiver’s current knowledge
and skills is performed. An educational plan is then set up according to patient/caregiver’s needs.  This includes, but is
 not limited to, the following:
 
Disease Process
Methods of Management
Monitoring
Foot Care
Skin Care
Long Term Complications: recognition, treatment and prevention
Short term complications: recognition, treatment and prevention
Referrals to other appropriate health    professionals or programs, such as...
  • Smoking cessation programs
  • Support groups
  • Outpatient diabetes program
  • Self-management program when patient is no longer homebound
 
Effective outcomes are the desired results for both the Diabetes Self Management Program and the program participants. Our goal is so that you will be able to...
 
  • Compare the hospitalization rate/emergency room visits pre program and post-program for each patient
  • Measure glycemic control pre- program and post program using
    glycohemoglobin tests
  • Upon completion of the program, each patient will select a behavioral change goal to improve health or quality of life. Some of these behavioral changes may include:
  1. "I will eat pretzels instead of chips for my snack"
  2. “I will test my blood sugar two
    times per day and call my doctor with the results monthly”.
  3. “I will park farther away from the
    store to get more exercise”

 
   
  • Being very thirsty
  • Urinating often
  • Feeling very hungry or tired
  • Losing weight without trying
  • Having sores that heal slowly
  • Having dry, itchy skin
  • Losing the feeling in your feet or having tingling in your feet
  • Having blurry eyesight
Diabetes means that your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health.

Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical (a hormone) made in a part of the body called the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body doesn't make enough insulin or if the insulin doesn't work the way it should, glucose can't get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing you to have diabetes.

People can get diabetes at any age. There are three main kinds.

Type 1 Diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. In this form of diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. Treatment for Type 1 Diabetes includes taking insulin shots or using an insulin pump, making wise food choices, exercising regularly, taking aspirin daily and controlling blood pressure and cholesterol.

Type 2 Diabetes, formerly called adult-onset diabetes or non-insulin-dependent diabetes, is the most common form of diabetes. People can develop Type 2 Diabetes at any age -- even during childhood. In type 2 diabetes, the pancreas does not make enough insulin, and the fat, muscle, or liver cells do not use it properly.  Being overweight can increase the chances of developing type 2 diabetes. Treatment includes using diabetes medicines, making wise food choices, exercising regularly, taking aspirin daily and controlling blood pressure and cholesterol.

Gestational Diabetes

Some women develop Gestational Diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop Type 2 Diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.

  
  • The CDE (Certified Diabetic Educator) Program Coordinator will work with all diabetes instructors in developing their educational plans for the program patients. The CDE will provide ongoing education, guidance and supervision for the  diabetes program instructors.
  • Upon completion of the program, the CDE coordinator will send a summary of diabetes education and a copy of patient’s behavior change goals to the referring
    physician.
  • One to three months after the completion of the program, the instructor or CDE will call the patient and ask questions on the follow up assessment form regarding the patient’s current health status, diabetes control, achievement of behavior change goals and brief assessment of further educational needs.
For more information on our Diabetic Program please call (248) 358-1186

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