SUGAR BUSTER:

A COMMUNITY-BASED
PROGRAM FOR PATIENTS
WITH DIABETES MELLITUS
ELIZABETH GILBERT
TABLE OF CONTENT

1 2 3 4 5 6 7 8 9

Objectives What is What are the Who is Sugar Session One: Session Two: Session Three: Session Four:
Diabetes? signs and affected by BUSTER Being familiar Understanding Strategies to Techniques to
symptoms of Diabetes Program with the the treatments Improve enhance health
Diabetes Mellitus? Introduction impact of of Diabetes Quality of Life and nutrition
Mellitus? Diabetes Mellitus
TABLE OF CONTENT (CONTINUED)

10 11 12 14 16 17

Session Five: Session Six: Evaluating Secondary Role of DNP: Summary References
Exacerbations and Resources for Outcomes Prevention Plan Leadership and
Complications Support Competencies for
Development and
Implementation of
Sugar BUSTER.
PRESENTATION OBJECTIVES
Define Define Diabetes Mellitus

Examine Examine the effect of Diabetes Mellitus on the health of the nation

Describe Describe health risks for Diabetes Mellitus patients

Propose Propose an interdisciplinary plan, Sugar Buster, to address the needs of

Diabetes Mellitus patients

Outline a method for evaluating the impact of Sugar Buster on participants

Outline quality of life.

Discuss Discuss DNP leadership competencies utilized to develop and implement the
plan, Don’t Sugar Coat It.
WHAT IS DIABETES MELLITUS?
– There are several classifications of Diabetes Mellitus
– Type 1 Diabetes Mellitus
• Pancreas fails to produce insulin
• More commonly appears during childhood or adolescence
– Type 2 Diabetes Mellitus
• Most common
• The cells fail to respond to the insulin properly
• More commonly appears in people older than 40 years
– Gestational Diabetes
• Occurs during pregnancy and resolves after childbirth
– Monogenic Diabetes
• Various causes grouped together under this one heading
• Makes up less than 10% of diabetes cases
WHAT ARE THE SIGNS
AND SYMPTOMS OF
DIABETES MELLITUS?
• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections:
– gums or
– skin infections
– vaginal infections
• Ketones in the urine
WHO IS AFFECTED BY DIABETES MELLITUS?

23.1 Million 7.2 Million People

30.3 Million People Have Have
People of All Diagnosed Undiagnosed
Ages Had Diabetes Diabetes Only 5% of
Diabetes in • 18 – 44 years : 3.0 • 18 – 44years : 1.6 people with
2015 million million Diabetes
• 45 – 64 years: 10.7 • 45 – 64 years: 3.6
(9.4% of the million million have Type 1
U.S. • > 65 years: 9.9 million • > 65 years: 2.1 million
population) • Women: 11.7 million • Women: 3.1 million
• Men: 11.3 million • Men: 4.0 million
WHO IS
AFFECTED BY American Indians / Alaska Natives: 15.1%

DIABETES
Non-Hispanic
Non-Hispanic
Hispanics:
Asians:Blacks:
Whites:
8.0%
12.1%12.7%
7.4%

MELLITUS?
 Leading Causes of Death in the US
1

WHO IS 2

AFFECTED 3

BY 4

DIABETES
5

MELLITUS? 7

10
1995 2000 2005 2010 2015
Diabetes
NATIONAL DIABETES
ACTION PLAN
• Four goals to address the complex issues related to the
disease
– Increase national awareness of diabetes, its impact, and
what various stakeholders can do to prevent or manage the
disease;
– Reduce the prevalence of diabetes and factors that increase
the risk of diabetes;
– Promote improved detection, monitoring, and treatment of
the disease; and
– Identify existing public and private efforts to facilitate
coordination and to leverage existing resources for
detection, prevention, and treatment of diabetes.
 SUGAR BUSTER:
A COMMUNITY-BASED PROGRAM FOR
PATIENTS WITH DIABETES MELLITUS.
 SUGAR BUSTER
A SIX-W EEK INTERDISCIPLINARY P ROGRAM DESIGNED TO IMP ROVE
THE QUALITY OF LIF E OF PATIE NTS WITH DIABE TES MELLITUS

• PROGRAM DESIGN
– B – Being Familiar with the Impact of Diabetes
Mellitus
– U – Understanding the Treatments of Diabetes Mellitus
– S – Strategies to Improve Quality of Life
– T – Techniques to Enhance Health and Nutrition
– E – Exacerbations and Complications
– R – Resources for Support
This Photo by Unknown Author is licensed under CC BY
SUGAR BUSTER
B – B E I N G FA M I L I A R
W I T H T H E I M PA C T O F
DIABETES MELLITUS
• Session One
– Objectives:
• Discuss the purpose of Sugar
BUSTER
• Outline the goals and
objectives of Sugar BUSTER
• Provide an overview of the
disease
• Discuss the incidence and
prevalence of Diabetes
Mellitus
• Measure the effects of
Diabetes Mellitus on
participant’s health using the
programs Diabetes
Management Assessment
Tool (DMAT)
• Introduce the
interdisciplinary team
SUGAR BUSTER
U – UNDERSTANDING THE TREATMENT OF
DIABETES MELLITUS

• Session Two:
– Objectives:
• Provide an overview of commonly used Diabetes
medications
• Explain the indication for use
• Explore the mechanism of action
• Review medication side effects
• Demonstrate how to properly administer and maintain
medication delivery devices
 COMMONLY USED DIABETES MEDICATIONS
• METFORMIN
– First medicine prescribed for Type 2 Diabetes
– Improves sensitivity of body tissue to insulin, so the body uses insulin more effectively
– Lowers glucose production in the liver
– May not lower blood sugar enough on its own, requires lifestyle changes
– Side effects: Nausea and Diarrhea
– Brand names: Glucophage and Glumetza
• SULFONYLUREAS (glyburide, glipizide, glimepiride)
– Help the body secrete more insulin
– Side effects: Low blood sugar and weight gain
– Brand names: DiaBeta, Glynase, Glucotrol, and Amaryl
• MEGLITINIDES (repaglinide and nateglinide)
– Work like Sulfonylureas, however they act faster and have a shorter effect in the body
– Stimulate pancreas to produce more insulin
– Brand names: Prandin and Starlix
• THIAZOLIDINEDIONES (rosiglitazone and pioglitazone)
– Make the body more sensitive to insulin
– Side effects: weight gain and have a potential risk for heart failure and fractures
– Brand names: Avandia and Actos
COMMONLY USED DIABETES MEDICINES (CONTINUED)
• DPP-4 INHIBITORS (sitagliptin, saxagliptin, linagliptin)
– Reduce blood sugar levels, modestly
– Brand names: Januvia, Onglyza, andTradjenta

• GLP-1 RECEPTOR AGONISTS (exenatide, liraglutide)

– Slow digestion and help lower blood sugar levels
– Not recommended for use alone
– Side effects: Nausea and Pancreatitis
– Brand names: Byetta and Victoza

• SGLT2 INHIBITORS (canagliflozin, dapagliflozin)

– Prevent kidneys from reabsorbing sugar
– Sugar is excreted in the urine
– Side effects: Yeast infections, UTI, rare and serious genital infections, increased urination, and hypotension
– Brand names: Invokana and Farxiga

• INSULIN (Insulin lispro, Insulin glulisine, Insulin aspart, Insulin glargine, Insulin detemir, Insulin isophane)
– Must be injected
– Side effects: low blood glucose
– Brand names: Humalog, Apidra, Novolog, Lantua, Levemir, Humalin N, and Novolin N
 SUGAR BUSTER
S – STRATEGIES TO
IMPROVE QUALITY OF LIFE

• Session Three:
– Objectives:
• Smoking Cessation
– Explain the importance of smoking cessation
– Identify strategies to assist the client with smoking cessation
– Develop a plan for smoking cessation
• Immunizations
– Explain the importance of immunizations such as Hepatitis B, Flu,
and Pneumonia vaccines.
• Regular Check-ups
– Recognize the importance of regular primary care visits
– Recognize the importance of regular eye exams
– Recognize the importance of regular dental exams
 SUGAR BUSTER
T – TECHNIQUES TO IMPROVE HEALTH AND
NUTRITION
• Session Four:
– Objectives:
• Nutrition:
– Recognize the impact of nutrition on disease
management
– Select optimal food choices to support caloric
need
– Develop individual nutrition plan based on
client’s needs
• Exercise:
– Recognize the impact of exercise on disease
management
– Develop an individualized exercise plan based on
the clients needs and abilities
SUGAR BUSTER

E – EXACERBATIONS
AND COMPLICATIONS

• Part Five:
– Objectives:
• Define acute exacerbations of
Diabetes Mellitus
• Recognize prevention strategies
that decrease exacerbation risks
• Analyze complications of
Diabetes and risks for
exacerbations
• Develop and individual action
plan to manage exacerbations
Complications of Complications of
Chronic Diabetes Acute Diabetes
Mellitus Mellitus
• Cardiovascular disease • Hypoglycemia

• Nerve damage
• Kidney damage
• Visual disturbances
• Hearing impairment
• Blood vessel damage
• Depression
• Alzheimer’s Disease
• Skin infections
• Diabetic Ketoacidosis
SUGAR BUSTER
S – STRATEGIES TO IMPROVE QUALITY OF
LIFE
• Part Six:
– Objectives:
• Support System
– Identify resources available for medical management
– Provide strategies to assist clients cope with Diabetes
– Evaluate the need for social services support for advanced care
planning
– Assemble a community support group
 Evaluating Outcomes
• Diabetes Management Assessment Test (DMAT)
– A valid, reliable instrument
– 8-item Likert scale
– Patient completed questionnaire
– Measures the effect of Diabetes on the patient’s
health
– Enhances understanding between patients and
providers to optimize management of disease
 SECONDARY
PREVENTION

• Smoking cessation
• Nutrition plans
• Immunizations
• Exercise plans
• Regular physical exams
• Medication education
• Glucose monitoring
 ROLE OF DNP:
LEADERSHIP AND
Vision

Fac
i li t
ato ement COMPETENCIES
nag
FOR
r of a
Ch M
m
ang gra
e Pro

DEVELOPMENT
AND
De
ci
IMPLEMENTATION
OF SUGAR
e sio
a tiv n
ov Ma
Inn ki ng

BUSTER
Communicating
 Diabetes Mellitus places a
chronic burden on the US
healthcare system.

There is an urgent need to

30.3 million people of all
develop and support
ages had Diabetes Mellitus
community based Diabetes
in 2015
Mellitus programs.

SUMMARY
Diabetes Mellitus was the 7th
Untreated Diabetes Mellitus
leading cause of death in
can be fatal
2015

Under treated Diabetes

Mellitus can lead to several Diabetes Mellitus can
other debilitating health severely effect quality of life
conditions.
 Being familiar with
the impact of Diabetes
Mellitus

Resources and Understanding the

Support for Diabetes treatments of Diabetes
Mellitus Mellitus

SUMMARY
Exacerbations and Strategies to Improve
complications of Quality of Life with
Diabetes Mellitus Diabetes Mellitus

Techniques to enhance
health and nutrition
for people with
Diabetes Mellitus
 REFERENCES
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