Archive for category: Diabetes

Post written by Whitney Venegoni, APRN, FNP-C, Family Nurse Practitioner, Diabetes Clinic

November is Diabetes Awareness month and the perfect time to talk about the comprehensive diabetes care provided at Health Partnership Clinic (HPC).

Unfortunately, diabetes is prevalent among patients seeking care at our clinic. At HPC, 18 percent of our adult patients have diabetes. The risks associated with uncontrolled diabetes are widespread. To help address the need for more comprehensive care, we have a High-Risk Diabetes Clinic (HRDC) that focuses on diabetes and other chronic conditions that contribute to diabetes. One of the goals of the HRDC is to get AICs and blood sugar levels under control.

To learn more about the HRDC at HPC watch our video.

Post written by Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Diabetes Clinic

The diabetes clinic is a specialized clinic at Health Partnership Clinic. Patients are referred to the clinic from their primary care provider if the provider feels like the patient would benefit from more concentrated care for the diabetes. Typically, this is a patient who is having difficulty reaching their goal A1C which is a measure of blood glucose. The goal set out by the American Diabetes Association is less than 7.0. If a patient has an A1C of nine or greater then they may be referred to the diabetes clinic.

How is an appointment with the diabetes clinic different than a regular appointment?

The diabetes clinic focuses on providing comprehensive care for the diabetic patient to help them improve the A1C. The diabetes clinic is made up of a medical assistant, a diabetes coordinator, a behavior health clinician and the nurse practitioner. We all have our roles. As the nurse practitioner, I am responsible for ordering medications which include oral agents and injections that will work best for the patient and to work with the patient to find a routine that works for them. I also do routine labs and conduct a physical exam to watch for any complications of the disorder. Education is very important to controlling diabetes well, and the patient will receive education and tips from both the nurse practitioner and the diabetes coordinator. The diabetes coordinator helps things run smoothly. She makes appointments, monitors the diabetes schedule, and will make follow up calls to the patient, especially when there have been changes to their insulin or medication regimes.

A behavioral health clinician meets with patients as well at the time of their visit. They help identify barriers which affect the patient’s ability to follow through on their treatment plan. These might be mental health issues such as depression, or practical challenges such as finances and access to medications.

How do patient’s receive help to get them the medications they need?

In the diabetes clinic we try to help patients get their medications in several ways. There is a pharmacy discount program that helps those who are uninsured or who have inadequate insurance get access to some of the new diabetes medications. Some patients are eligible for prescription assistance plans and we will help patients apply for their needed medications. Finally, we also have a limited supply of some insulin products for patients who qualify.

Have you seen patients make improvements?

We have had several “success stories” of patients who have met their A1C goal or at least made an improvement. The patients who have made progress list the following things as key to their success:

1. Increased knowledge of a healthy diabetic diet and learning how to count carbohydrates. We have seen incredible improvements in those patients who are heavy soda drinkers when they stop drinking sugar sweetened beverages.
2. Access to medication: Patients often just need help getting the right medications and finding options that are affordable – this can make a big difference in their care.
3. More consistent appointments that focus just on diabetes. That increased accountability has been helpful to some patients in obtaining improved control over their diabetes.

Our goal is to help patients help themselves. We want to provide our patients with the tools, resources and education to enable them to be successful and improve their health. It will benefit them in so many ways in the future if they can improve the control of their diabetes today!

 

Post by: Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Diabetes Clinic

The COVID-19 pandemic has brought new health concerns for all of us but even more for the individual with diabetes.

According to the American Association of Diabetes, approximately just over 10 percent of the American population has diabetes. Nearly 1.6 million people have type I diabetes, a condition in which your pancreas does not make insulin. Approximately 32.6 million Americans have type II diabetes, which is characterized by insulin resistance and/or your body’s inability to make all the insulin that it needs. Insulin is needed to help break down and store glucose.

Having diabetes does not necessarily increase your risk for catching the virus but according to the Centers for Disease Control (CDC), it does increase the risk of having a more serious illness should you contract COVID-19.

These tips have been recommended as measures to take to stay healthy during a pandemic:

1. Continue taking your diabetes pills and insulin as usual.

It is important to keep your blood sugar, blood pressure and cholesterol under control so you can keep healthy. Continue taking your prescribed medications!

Always try to have at least one month’s supply of your medication available to you, including insulin. If you need refills or are having difficulty obtaining your medication, please contact your provider. We do not want you going without your medications! The only exception to this advice is if you have nausea or vomiting that prevents you from eating. In that case, you need to check your blood sugars and follow your health care providers “sick day” instructions.

2. Test your blood sugar and keep track of the results, as directed by your health care provider.

Notify your health care provider if you have unusual lows or high blood sugar results, or you are not keeping your blood sugars well controlled.

Glycemic Goals

Recommended by American Diabetes Association (ADA)

A1C – < 7%
Fasting plasma glucose – 80-130 mg/dL
Post prandial plasma glucose – < 180 mg/dL
(measured 1-2 hours after a meal)

 

3. Stay Active

Regular exercise can help your body use insulin more effectively, help control your blood pressure and improves your mood and sense of well-being. Aim for a minimum of 30 minutes of walking or an exercise you enjoy, five days a week.

4. Protect Your Immunity

You have heard these instructions repeatedly by now but here they are again. Wash your hands frequently, avoid large crowds and wear your face mask when running errands or when indoors with individuals other than your immediate family members. Also, this is a good time to remind you to get your flu shot!

5. Maintain a Healthy Diet

Avoid those high carbohydrate comfort foods!  Include foods that promote health and strengthen the immune system. See the following chart for suggestions from The University of Texas Southwestern Medical Center.

Source: https://utswmed.org/medblog/diabetes-covid-19-risks/

6. Call your health care provider if you have concerns about your condition or feel sick.

In Closing

We cannot control everything about the virus, but we can control how we take care of ourselves. Make your health a priority and do not neglect taking your medications, eating properly, or keeping your regular appointments. If needed, a telehealth appointment can be set for you if you cannot come to the clinic in person. At Health Partnership Clinic we are here to help you keep healthy and manage your diabetes during this difficult season. If you are need an appointment with your regular provider or the diabetes clinic, please call the clinic at 913-648-2266.

Post written by Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Health Partnership Clinic

In response to a challenge from Health Resources and Services Administration (HRSA) to create a quality improvement plan to address the number of patients with uncontrolled diabetes, HPC started a focused High-Risk Diabetes Clinic (HRDC) in August 2018. It takes place on Mondays and is open to any patient with an A1C greater than or equal to nine. An A1C is sometimes referred to as the “three-month blood sugar” as it reflects the average blood sugar the patient has had over the past three months. The goal for a person with diabetes per the American Diabetes Association (ADA) is to have an A1C of seven or lower. At present there are 100 patients participating in the HRDC.

There are three goals of the HRDC:

• To improve patients understanding of effective lifestyle change and to assess and address psycho-social barriers to diabetes care.
• To provide additional education and support for diabetes self-care especially with regards to insulin administration.
• To remove financial barriers to obtaining insulin for self-administration and diabetes treatment.

Helping patients control their diabetes is not as simple as just providing medication or telling someone not to eat sugary foods. Diabetes can be a complex and multifaceted disease and patients need not only medication but education, counseling, support and self-management tools so that they can become experts in controlling their own blood sugars.

At HPC, we recognized the need for more comprehensive care and started the HRDC for those patients with uncontrolled blood sugars.

In the HRDC, we focus on education, counseling, mental and behavioral support along with medication management. This provides patients with comprehensive diabetes care and ultimately helps improve their quality of life. Lifestyle management is a fundamental aspect of diabetes care, and we focus on helping patients address risk factors and implement dietary and physical activity changes.

Diabetes self-management education focuses on providing individuals with the knowledge and tools they need to improve their control of diabetes. Patients are encouraged to check daily blood sugars, learn to recognize the signs of blood sugars that are too high or low and then learn how to manage those situations. They are taught how to take their medications safely, particularly insulin and even how to adjust insulin doses at home. Information about foot care and a variety of other topics are also addressed. Lastly, during clinic time a medical provider will perform necessary physical assessments and provide medication management tailored to the individual’s needs.

Medications for diabetes can be very expensive for those both with and without insurance. However, several medications prescribed are made affordable through an assistance program called the 340 B plan and through our association with AuBurn Pharmacy in Olathe. We also have been able to assist patients to obtain insulin when necessary for blood sugar control.

Results

Since starting the clinic, over half of our patients have A1Cs that have now fallen below nine percent, with an average individual decrease in A1C of approximately two percent. Our overall percentage of patients with diabetes who are considered “uncontrolled” (an A1C greater than nine) has dropped from 43 percent to 33 percent since the clinic began.

We hope to continue to support our patients with diabetes with the tools and resources they need to improve control of their diabetes and as a result, improve the quality of their lives.