What patient teaching is recommended for a patient with Diabetes Mellitus (DM)?

From the Guidelines

Patient teaching for Diabetes Mellitus (DM) should focus on self-management skills, including how to match mealtime insulin doses to carbohydrate intake and fat and protein intake, as well as modifying insulin doses based on concurrent glycemia, glycemic trends, and anticipated physical activity, as recommended by the most recent guidelines 1. To achieve this, patients should be educated on proper insulin administration, including injection technique, rotation of injection sites, and storage requirements.

• Emphasize the importance of monitoring blood glucose regularly using a glucometer, typically before meals and at bedtime, and understanding target glucose ranges, generally 80-130 mg/dL before meals and below 180 mg/dL after meals.
• Patients should also be taught to recognize hypoglycemia symptoms, such as shakiness, confusion, and sweating, and know how to treat it with 15-20g of fast-acting carbohydrates like glucose tablets or juice.
• A balanced diet with carbohydrate counting and regular physical activity, aiming for 150 minutes weekly, should be encouraged, along with regular foot examinations.
• Regular medical follow-ups are crucial, including HbA1c testing every 3-6 months, with a target generally below 7%, annual eye exams, and kidney function tests, as supported by previous guidelines 1. The goal of patient teaching is to empower individuals with DM to manage their condition effectively, reducing the risk of complications and improving their quality of life, which is in line with the latest recommendations for diabetes care 1.

From the FDA Drug Label

Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use) Never Share a MERILOG SoloStar Prefilled Pen between Patients Advise patients that they must never share MERILOG SoloStar prefilled pen device with another person even if the needle is changed, because doing so carries a risk for transmission of blood-borne pathogens. Advise patients using MERILOG vials not to share needles or syringes with another person. Inform patients that hypoglycemia is the most common adverse reaction with insulin. Instruct patients on self-management procedures including glucose monitoring, proper injection technique, and management of hypoglycemia and hyperglycemia, especially at initiation of MERILOG therapy Instruct patients on handling of special situations such as intercurrent conditions (illness, stress, or emotional disturbances), an inadequate or skipped insulin dose, inadvertent administration of an increased insulin dose, inadequate food intake, and skipped meals. Instruct patients on the management of hypoglycemia Inform patients that their ability to concentrate and react may be impaired as a result of hypoglycemia. Advise patients who have frequent hypoglycemia or reduced or absent warning signs of hypoglycemia to use caution when driving or operating machinery Advise patients that changes in insulin regimen can predispose to hyperglycemia or hypoglycemia and that changes in insulin regimen should be made under close medical supervision Instruct patients to always check the insulin label before each injection to avoid mix-ups between insulin products Advise patients that hypersensitivity reactions have occurred with insulin aspart products. Inform patients of the symptoms of hypersensitivity reactions

Patient Teaching for Diabetes Mellitus (DM):

• Instruct patients on glucose monitoring and proper injection technique.
• Teach patients on management of hypoglycemia and hyperglycemia.
• Advise patients not to share insulin pens or needles to prevent transmission of blood-borne pathogens.
• Instruct patients to check insulin labels before each injection to avoid mix-ups between insulin products.
• Inform patients of the symptoms of hypersensitivity reactions and advise them to use caution when driving or operating machinery if they have frequent hypoglycemia.
• Emphasize the importance of close medical supervision when changing insulin regimens. 2 3

From the Research

Patient Teaching for Diabetes Mellitus (DM)

Patient teaching is a crucial aspect of managing Diabetes Mellitus (DM). The following are recommended patient teaching strategies:

• Empowering patients with knowledge for successful glycemic control 4
• Individualized, targeted instruction to enhance patient and family-centered care and patient safety 4
• Using health promotion and education theories and models, such as the PRECEDE and Health Belief Models, to improve self-care and self-management behaviors 5
• Focusing on the seven self-care behaviors known as the AADE7 Self-Care Behaviors™, developed by the American Association of Diabetes Educators, which include:
  • Assessment
  • Goal setting
  • Planning
  • Implementation
  • Evaluation
  • Documentation
  • Promoting behavior change 6
• Therapeutic patient education (TPE) to empower patients to change lifestyle, maintain an adequate diet and physical activity, manage the disease, and follow a specific program of periodic medical checks and education sessions 7
• Integrating diabetes education with disease management (DM) programs to encourage participation and adherence to recommended care, leading to improved health outcomes and reduced cost 8

Key Components of Patient Teaching

The following are key components of patient teaching for DM:

• Assessment of patient's learning needs and goals
• Individualized education and support
• Ongoing evaluation and documentation of patient progress
• Collaboration with the patient's healthcare team to promote informed, shared decision making 6
• Use of cognitive theories and behavioral change techniques to encourage effective self-management 8