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Българска Асоциация Диабет
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Initiation of insulin therapy
The objective of this letter a study is to provide guidance to physicians, starting insulin therapy for their patients. We concentrate our efforts on the first three days of insulin treatment. The patient should be able to be mentored ie condition should not be critical. If it was such, must now overcome. The curriculum must be adapted to the specificities of the individual patient. Who should be informed? Information should be given to the patient when he chooses. If the patient is a child - both parents must attend. Training courses should not last more than half an hour. Remember that these patients require continuous emotional support and this program should be seen as the beginning of self-care!
This is the day when deciding to inject insulin by the patient himself. It can happen when you first discuss it with insulin therapy.
- First you need to listen to the patient, helping him to express his attitude to this new situation. This will create an atmosphere conducive to learning and will help the patient to take a decision independently of insulin.
- It's nice to be interested what the patient knows about diabetes and if he knew another person who is insulin injections.
- To explain the patient in simple terms, why he needs insulin, and to emphasize that most likely he will need throughout his life. It is necessary only to be told the whole truth, but it is important to give hope for the future. Enable the patient to ask him all the exciting questions about insulin therapy, some of which you raise. If, despite all your arguments convincing the patient refuses to start insulin therapy, try to understand its refusal and help him overcome his fears and emotions. Compare the small needle for insulin application with other syringe needles. Furthermore, it is absolutely necessary to do a demonstration on himself.
- Initial denial is a normal reaction, but if the patient continues to refuse treatment, to give him time to reflect on things. The physician should discuss the refusal and family, maybe it will help its proper persuasion.
- First self-injection. The first insulin application that will make the patient must be small enough not to cause in any case hipogikemiya. Most should be emphasized that the new injection is not terrible. Physicians must Awards patient with a standing ovation after his first solo insulin injection. Depending on the age, a child with diabetes can only wish only begin to inject insulin. His desire to be encouraged, while having to remind parents that the child will still continue to need their ongoing support and care. Both parents must be trained to inject insulin and to be involved in caring for the sick child.
- Immediately after being placed first solo insulin injection give the patient food, so that from the outset, he starts to draw his habit of eating after each insulin injection.
- Start learning. Vepreki that this letter is divided into three school days, the duration of each will depend on the individual abilities of the patient.
A. Injection: The teacher should show the patient how to fill the syringe with the required amount of insulin. With its help, the patient should do self injection. Then you should continue to exercise to draw different amounts of insulin. Later that day, the patient should be given the opportunity to discuss their eating habits with a member of the team. The next day should be prepared according to the menu according to the oppinion of the sick. Should emphasize the importance of breakfast and that patients should fast, even if they are not hungry.
2. Hipogikemic reactions: Although it is unusual to hypoglycemic reactions occur very first day, the patient must be advised of their possible occurrence. You should describe the main symptoms. You should instruct the patient always carries some sugar and consuming it, when these symptoms occur, even when it is sure that the changes occurring in it are actually hypoglycemic.
3. Remember: There must be continuous assessment of the patient's ability to absorb offered his knowledge of every step of the learning process. This can be done by demonstration or observation. Achievements should be encouraged with a prize and following efforts to assist with printed educational materials
Consolidation. This day should begin with an examination of the acquired present knowledge and skills. If you are not sure that previous information is not fully utilized, do not enter anything new.
A. Injection: The second day should introduce two new ideas. The first is clearly to show injection sites and their sequence and the second required to explain the action of insulin, the duration and the risk of hypoglycemia is greatest. By increasing the dose of insulin should be explained to the patient that does not mean that his diabetes is more severe.
2. Food and Drink: Now that the patient has had the opportunity to try the menu for a day or two it comes time to discuss with him and informed him of the permissible sugar.
3. Hypoglycaemia and physical activity: relationship between carbohydrate intake and the rise and fall of blood glucose should also be discussed. You must clarify the effect of physical activity on blood glucose. For example, an extra amount of food should be taken before, during and after exercise, depending on its duration.
4. Self-determination of some paraclinical indices (self-monitoring): Whatever it means, tell the patient that they will help to control diabetes and maintain it. The patient must be taught how to conduct research and how to report results. The significance of the results must be explained and discussed.
5. Remember: In this period it is important to give the patient time to share their feelings, fears and anxiety for the future. This can be achieved by guiding questions in this direction, and the answers can be discussed in a friendly conversation. Do not try to underestimate the difficulties and solve them together.
At the end of this third period, hospitalized and dispensary patients should have learned to fend for themselves at home and return to normal life. At this point you need to use a questionnaire that will help you evaluate the skills of the patient. Also he should provide printed materials to keep his knowledge and will serve as a reference. You should explain how to store insulin. If the patient is afraid of powerful hypoglycemia, let us determine the blood glucose just before bedtime and eating before bedtime. Before the patient leaves the clinic, make sure that all your shared concerns, including those created in the last minute. You are encouraged to contact their physician or nurse whenever something is unclear. Appoint a meeting with him next week after his discharge.
Prepodavatelyu Be tolerant of mistakes and lack of skills. Mistakes are to be repaired. Izasnete reason, which is due and try to use them for future training.
Future training:
Some lessons must be reserved for a later period. This includes for example "honeymoon" of diabetes, maintenance of diabetes during intercurrent illness, period of leave driving.
This three-day period is designed for newly diagnosed patients, but can be used to refresh the knowledge and skills and dispensary older diabetics.