Diabetes Project

Rehabilitation Systems

Diabetes Rehabilitation Program Implementation Manual

Healthcare Professional Training Manual

Contents

Rehabilitation, Medication, & Weight Loss Manage Diabetes ................... 3 Diabetes Rehabilitation Patient Assessment Form .................................... 4 Diabetes Rehabilitation Goals during therapy: .......................................... 4 Comments:(MET) to Functional Task Conversions .................................... 9 (MET) to Functional Task Conversions..................................................... 10 SF-36 Health Survey ................................................................................ 11 FORM HCFA-700 (11-91) ......................................................................... 12 6 - MINUTE WALK TEST (6MWT) ............................................................. 13 R P E / FT ................................................................................................. 14 DYSPNEA .................................................................................................. 15 Quick Conversion Chart (MET) ................................................................. 16 Diabetes Patient Education ...................................................................... 19 4 Steps to Control Your Diabetes for Life ................................................ 19 Individual Therapeutic Session ............................................................... 20 SOAP NOTES ............................................................................................ 23 6 - MINUTE WALK TEST (6MWT) ............................................................. 59 SF-36 Health Survey ................................................................................ 60 FORM HCFA-701 (11-91) ......................................................................... 62 Diabetes Rehabilitation Discharge Summary .......................................... 64 Contact information: ................................................................................ 66 Course Evaluation .................................................................................... 67

Rehabilitation Systems 2015 Copying or distributing without written consent is prohibited.

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Rehabilitation, Medication, & Weight Loss Manage Diabetes


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Diabetes Rehabilitation Patient Assessment Form

Patient Information

Name:__________________________________________________ Date: ________________ Address:________________________________________________ Phone: _______________ Emergency Contact:_______________________________________ Phone: _______________ Age: ________ Sex: ________ Weight: ________ Height:__________ Marital status: _________ Occupation:______________________________ Retired?_________ Disabled?_____________ Insurance provider: ________________________________________ Sessions allowed: ______ Diagnosis: _______________________________________________ Date of Dx: ___________ Primary Care Provider: _____________________ Referring Physician: _____________________

Diabetes Rehabilitation Goals during therapy: Help patients with diabetes decrease their risk for cardiovascular disease and diabetes by adopting a healthy lifestyle which includes:

• Increased physical activity • Moderate weight loss

Help patients with diabetes achieve the following:

• Blood glucose levels as close to normal range as safely possible • Calorie levels to attain and maintain reasonable weight • Blood pressure levels that reduce the risk for vascular disease • Optimal health through healthy food choices and physical activity

Goals for nutrition therapy for individual patients will vary with age, type of diabetes, treatment regimen, co-morbidities and personal and cultural preferences and willingness to change behavior. Source: Nutrition principles and recommendations in diabetes: Diabetes Care 2007;30, Supl 1:S48-S65


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http://care.diabetesjournals.org/cgi/content/full/30/suppl_1/S48

http://care.diabetesjournals.org/cgi/content/full/30/suppl_1/S48

BMI is used to determine obesity BMI=Weight divided by height squared (Wt kg/Ht m2) Standards are the same for both adult men and adult women Correlates with body fat Determines degree of obesity and health risk Can be used to track treatment results for obesity May overestimate body fat in athletes and others who have a muscular build May underestimate body fat in older persons and others who have lost muscle mass may be inaccurate for patients with edema The US Preventive Services Task Force recommends including BMI as a vital sign. BMI tables http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm BMI calculator http://www.nhlbisupport.com/bmi/bmicalc.htm BMI calculator to download to PDA http://hin.nhlbi.nih.gov/bmi_palm.htm

BMI Classification Underweight <18.5 Normal weight 18.5-24.9 Overweight 25-29.9 Obesity =>30 Extreme obesity =>40 Classification of Overweight and Obesity http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/txgd/414.htm


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Body Composition: This is a more specific, individualized measurement of body composition. The 7 site method is the most widely used body composition testing method for assessing percent body fat and percent body fat change from beginning to end of program. Equipment used for this assessment includes a skinfold caliper. Take three measurements at the specified sites, then average measurements and total the averages for a score. 7 Site Skinfold: Chest_________________________________________________________________

Triceps________________________________________________________________

Subscapular____________________________________________________________

Axilla__________________________________________________________________

Supra iliac______________________________________________________________

Abdomen______________________________________________________________

Thigh_________________________________________________________________

TOTAL AVERAGES: PRE:____________________________POST:_____________________________


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Medical History: Check ALL spaces below that apply to the patient. Explain and Date: _____Rheumatic fever / heart murmur_______________________________________ _____High blood pressure_________________________________________________ _____Chest discomfort____________________________________________________ _____Heart abnormalities (racing, skipping beats)______________________________ _____Abnormal ECG______________________________________________________ _____Heart Problems_____________________________________________________ _____Coughing up blood__________________________________________________ _____Stomach or intestinal problems________________________________________ _____Anemia____________________________________________________________ _____Stroke_____________________________________________________________ _____Sleeping problems__________________________________________________ _____Migraine or recurrent headaches_______________________________________ _____Dizziness or fainting spells____________________________________________ _____Leg pain after walking short distances__________________________________ _____Back/neck pain/injury_______________________________________________ _____Foot/ankle problems_________________________________________________ _____Knee/hip problems__________________________________________________ _____Lymphedema_______________________________________________________ _____High cholesterol____________________________________________________ _____Diabetes__________________________________________________________ _____Thyroid problems____________________________________________________ _____Lung disease_______________________________________________________ _____Respiratory problems/asthma__________________________________________ _____Chronic or recurrent cough____________________________________________ _____Disease of arteries___________________________________________________ _____Increased anxiety / depression_________________________________________ _____Recurrent fatigue____________________________________________________ _____Arthritis____________________________________________________________ _____Swollen/stiff/painful joints_____________________________________________ _____Epilepsy___________________________________________________________ _____Vision/hearing problems________________________________________


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Risk for Metabolic Syndrome Assess patient’s risk for Metabolic Syndrome. Check all that apply.

Criteria for Metabolic Syndrome Three or More of the Following Risk Factors

Risk Factor Defining Level Abdominal obesity* Men Women Waist circumference+ >102 cm (>40

in) >88 cm (>35 in)

Triglycerides >150 mg/dL or drug treatment for elevated triglycerides

HDL cholesterol Men Women <40 mg/dl <50 mg/dl or drug treatment for reduced HDL-C

Blood pressure >130/85 mmHg or drug treatment for hypertension

Fasting glucose > 100 mg/dL or drug treatment for elevated glucose

*Abdominal obesity is more highly correlated with metabolic risk factors than is an elevated BMI. +Guidelines for measuring waist circumference are available at http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/txgd/4142.htm Source: Diagnosis & Management of the Metabolic Syndrome: AHA/NHLBI Scientific Statement. Circulation. 2005;112:2735-52. http://circ.ahajournals.org/cgi/content/full/112/17/2735

History Food allergies: ______________________ Medication allergies:_______________________ # of hospitalizations in past year:________________ # of days in hospital: ______________ # of ER visits in last year: ______________________________________________________ # of exacerbations in past year: _________________________________________________ Physical Limitation (sensory, stroke, surgeries): _____________________________________

Activities of Daily Living Are you able to care for yourself? _________ Are you able to care for your home?________ Do you exercise? Y/N Type of exercise & how often: _____________________________ Do you have exercise equipment? Y/N Type: _____________________________________ Special interests & hobbies: _____________________________________________________ Do you have transportation? ______ Do you need assistive devices? ____________ If so, which devices? ___________________________________________________________


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Goals for patient ready to increase physical activity Collaboratively agree on one or two specific goals to increase physical activity: Go to Diabetes Rehabilitation 3 times/week at Mountain Land Rehabilitation. Walk on treadmill for 30 minutes Walk dog Monday, Wednesday, Friday after work with my spouse for 20 minutes Physical Assessment: 1. Range Of Motion: ______________________________________________________________________________________________________________________________________________ 2. Strength: 1RM / 3RM, ______________________________________________________________________________________________________________________________________________

List three measurable goals to accomplish in rehabilitation: 1.___________________________________________________________________________ 2.___________________________________________________________________________ 3.___________________________________________________________________________

Physical Assessment Functional Capacity & MET Level: (6:00 Min Walk Test):_______________________________

_______________________________________/_____________ Therapist: Date:

Comments:


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(MET) to Functional Task Conversions 3.0; home activities; cleaning, wash car, wash windows, clean garage 3.5; home activities; mopping 3.0; home activities; cleaning, house or cabin, genera 3.5; home activities; vacuuming 3.8; home activities; scrubbing floors, on hands and knees, bathtub 3.5; home activities; standing - packing/unpacking boxes 3.0; home activities; implied walking - putting away household items 3.0; home activities; walking - light, non-cleaning shut/lock doors 3.5; home activities; standing - bathing dog, and cat –small animals 3.0; home repair; automobile repair, general 3.0; home repair; carpentry, general, workshop 3.0; home repair; painting, papering, plastering, scraping 3.0; home repair; put on and or removal of tarp 3.0; lawn and garden; riding snow blower 2.0; self care; standing - getting ready for bed, in general 2.0; self care; dressing, undressing (standing or sitting) 2.0; self care; talking and eating (standing) 2.0; self care; grooming, shaving, brushing teeth, washing hands 2.5; self care; hairstyling 2.0; self care; showering, toweling off (standing) 2.5; music playing; conducting 2.5; music playing; piano or organ 2.5; music playing; violin 2.5; home activities; multiple household tasks in general, light effort 2.5; home activities; cleaning, dusting, changing linen 2.3; home activities; wash dishes - standing 2.5; home activities; wash dishes; clearing dishes from table – walking 2.0; home activities; cooking or food preparation - general 2.5; home activities; serving food, setting table - walking or standing 2.5; home activities; cooking or food preparation – walking 2.5; home activities; feeding family pet, cat, dog, small animals 2.5; home activities; putting away groceries, carrying groceries 2.3; home activities; food shopping, standing or walking 2.3; home activities; ironing 2.0; home activities; implied standing - laundry, fold or hang clothes 2.0; home activities; making bed 2.5; home activities; watering plants 2.5; home activities; building a fire inside 2.0; home activities; standing-light (pump gas, change light bulb, etc.)


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SF-36 Health Survey

Physical Functioning Score (PFS)

A Physical Functioning raw score of (21) is converted as follows: (21 – 10) ---------------- X 100 = 55 20 PRE PROGRAM: SF 36 PFScore:_________ POST PROGRAM: SF 36 PFScore:_________

The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Please circle one number on each line.)

Activities Yes, limited a lot

Yes, limited a little

Not limited at all

1. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports.

1 2 3

2. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf.

1 2 3

3. Lifting or carrying groceries. 1 2 3 4. Climbing several flights of

stairs. 1 2 3

5. Climbing one flight of stairs. 1 2 3 6. Bending, kneeling, or stooping. 1 2 3 7. Walking more than a mile. 1 2 3 8. Walking several blocks. 1 2 3 9. Walking one block. 1 2 3 10. Bathing or dressing yourself. 1 2 3


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Department of Health and Human Services Healthcare Financing Administration Part A _______ Part B________ Other________

PLAN OF PROGRESS FOR OUTPATIENT REHABILITATION (Complete for INITIAL CLAIMS ONLY)

1. Patient’s LAST NAME

FIRST NAME M.I. 2. PROVIDER NUMBER 3. HICN

4. PROVIDER NAME 5. MEDICAL REC NUMBER (OPTIONAL)

6. ONSET DATE 7. SOC DATE

8. TYPE □ Physical Therapy

9. PRIMARY DIAGNOSIS Pertinent Medical DX)

10. TREATMENT DIAGNOSIS 11. Visits From SOC

12. PLAN of TREATMENT/FUNCTIONAL GOALS 13. Freq/Duration (3/wk X 4 wk) GOALS (Short term) OUTCOME (Long term) PLAN Skilled services required: 1)

1) __Bed Mobility __Transfer training __Gait training __Balance re-ed __Therapeutic ex. Specify OTHER:

__ROM Contracture mgmt. __W/C training __Muscle re-ed __Energy cons. Modalities

__Pt/caregiver training __Home program __Equipment needs __Safety skills __Other (specify)

2)

3)

2)

4)

5)

14. SIGNATURE (professional establishing POC, including professional designation)

15. CERTIFICATION FROM ______________ THROUGH_______________N/A ___________

16. I CERTIFY THE NEED FOR THESE SERVICES FURNISHED UNDER THIS PLAN OF TREATMENT AND WHILE UNDER MY CARE Physician signature: ______________________________________

Date: 17. ON FILE (print/type physician name)

18. INITIAL ASSESSMENT age_____ M/F Rehab potential_______________

19. PRIOR HOSPITALIZATION ____________ to___________ N/A_____

20. HX and level of function at start of care:

21. 6-MINUTE WALK TEST ASSESSMENT Min tolerated Distance Heart Rate % spO2 RPE Dyspnea FiO2 22. Tx Justification:

23. Signature (Or name of professional, including professional designation.) 24. Date

FORM HCFA-700 (11-91) 23. Service Dates FROM _ ________ THROUGH _________


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6 - MINUTE WALK TEST (6MWT)

Name: ___________________________ Date: _________ Resting Data:

HR RPE SOBr % spO2

FiO2/ LPM

6MWT HR RPE SOBr %spO2 FiO2/ LPM Distance Walked

1 MIN Checkmark

2 MIN Checkmark

3 MIN Checkmark

4 MIN Checkmark

5 MIN Checkmark

6 MIN Checkmark Feet:

TOTALS

Checkmarks = 100ft, 100ft = one length. Total feet:

Comments: i.e., signs and symptoms, angina, dizziness, stopped/paused before 6 minutes, reason why, etc.


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R P E / FT Ratings of Perceived Exertion / Ratings of Fatigue Threshold

How much are you (working / fatigued?)

MODIFIED 10 POINT BORG SCALE

0 Nothing at all 0.5 Very, very slight (just noticeable) 1 Very slight 2 Slight (light) 3 Moderate 4 Somewhat severe 5 Severe (heavy) 6 7 Very severe 8 9 10 Very, very severe (maximal)


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DYSPNEA SHORTNESS OF BREATH (SOBr)

How much are you breathing?

MODIFIED 10 POINT BORG SCALE

0 Nothing at all 0.5 Very, very slight (just noticeable)

1 Very slight 2 Slight (light) 3 Moderate 4 Somewhat severe 5 Severe (heavy) 6 7 Very severe 8 9 10 Very, very severe (maximal)


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Quick Conversion Chart (MET)

Speed, Distance, Energy Conversion Chart. MPH Ft Per Min 6MWT / Ft (MET) kcal / min Notes:

0.1 8.8 52.8 1.07 5.35

0.2 17.6 105.6 1.15 5.75

0.3 26.4 158.4 1.22 6.1

0.4 35.2 211.2 1.3 6.5

0.5 44 264 1.38 6.9

0.6 52.8 316.8 1.45 7.25

0.7 61.6 369.6 1.53 7.65

0.8 70.4 422.4 1.61 8.05

0.9 79.2 475.2 1.68 8.4

1 88 528 1.76 8.8

1.1 96.8 580.8 1.84 9.2

1.2 105.6 633.6 1.91 9.55

1.3 114.4 686.4 1.99 9.95

1.4 123.2 739.2 2.07 10.35

1.5 132 792 2.14 10.7

1.6 140.8 844.8 2.22 11.1

1.7 149.6 897.6 2.3 11.5

1.8 158.4 950.4 2.37 11.85

1.9 167.2 1003.2 2.45 12.25

2 176 1056 2.52 12.6

2.1 184.8 1108.8 2.6 13

2.2 193.6 1161.6 2.68 13.4

2.3 202.4 1214.4 2.76 13.8

2.4 211.2 1267.2 2.83 14.15

2.5 220 1320 2.91 14.55

2.6 228.8 1372.8 2.99 14.95

2.7 237.6 1425.6 3.06 15.3

2.8 246.4 1478.4 3.14 15.7

2.9 255.2 1531.2 3.22 16.1

3 264 1584 3.29 16.45

MPH Ft Per Min 6MWT / Ft (MET) kcal / min References:

Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O'Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS. Compendium of Physical Activities: An update of activity codes and MET intensities. Medicine and Science in Sports and Exercise, 2000;32 (Suppl):S498-S516. http://prevention.sph.sc.edu/tools/docs/documents_compendium.pdf


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Gathering information from the 6MWT The amount of time completed on the 6 Minute Walk Test (6MWT) sets the starting point for exercise duration for the first session and to progress through interval training onto continuous exercise with multiple types of exercise equipment as an exercise progression methodology. The patient completed 3 minutes on the (6MWT), this patient starts with an exercise duration of 3 minutes the first session, then as soon as the patient can tolerate it, work to perform 3 minutes of low intensity work, with a 3 minute rest period followed by 3 more minutes of exercise, this is “interval training” and is a standard starting method for patients with low functional levels. Below is an example of incremental exercise progression. Each patient will progress differently depending on type, stage and grade of disease or exacerbation; therefore, therapist must individualize prescriptive exercise based on the individual’s adaptability, resiliency, tolerance, knowledge, skills, abilities, and eagerness to perform therapeutic exercise.

Example of Incremental Increase in Aerobic Exercise & Strength Training Session WORK REST INTERVAL WORK 50-70% - 1RM

Session 1 3 MIN Tread Mill 1 x 8 Session 2 3 MIN 3:00 3 MIN 1 x 8 Session 3 3 MIN 2:30 3 MIN 1 x 8 Session 4 3 MIN 2:00 3 MIN 1 x 10 Session 5 3 MIN 1:30 3 MIN 1 x 10 Session 6 3 MIN 1:00 3 MIN 1 x 10 Session 7 3 MIN 0:30 3 MIN 1 X 12 Session 8 6 MIN End of interval 0:00 0 MIN 1 X 12 Session 9 7 MIN Tread Mill 1 X 12 Session 10 8 MIN Tread Mill 2 x 8 Session 11 6 MIN ADD: CE, NS, UBE 3 MIN 2 x 8 Session 12 6 MIN CE or NS or UBE 4 MIN 2 x 8 Session 13 7 MIN CE or NS or UBE 4 MIN 2 x 10 Session 14 7 MIN CE or NS or UBE 5 MIN 2 x 10 Session 15 7 MIN CE or NS or UBE 6 MIN 2 x 10 Session 16 7 MIN CE or NS or UBE 7 MIN 2 X 12 Session 17 8 MIN CE or NS or UBE 7 MIN 2 X 12 Session 18 8 MIN CE or NS or UBE 8 MIN 2 X 12 Session 19 9 MIN CE or NS or UBE 8 MIN 3 X 8 Session 20 9 MIN CE or NS or UBE 9 MIN 3 X 8 Session 21 10 MIN CE or NS or UBE 9 MIN 3 X 10 Session 22 10 MIN CE or NS or UBE 10 MIN 3 X 10 Session 23 11 MIN CE or NS or UBE 10 MIN 3 X 12 Session 24 11 MIN CE or NS or UBE 11 MIN 3 X 12 Legend:

CE: Cycle Ergometer , NS: NuStep,

UBE: Upper Body Ergometer


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Work-Rest Ratio The Work-Rest-Ratio (WRR) as a method of interval training serves best at the beginning of the low level patients program and should follow the One-to-One (1:1) (WRR) rule, i.e., Work 3 minutes: Rest 3 minutes: Work 3 minutes. The Work-Rest-Ratio-Interval (WRRI) should decrease in 30 second increments from threptic session to therapeutic session or as the patient tolerates without fatigue hangovers. Once the (WRRI) has been closed, the therapist may add one (1) minute of exercise duration per exercise session or as the patient tolerates without fatigue hangovers. (Causing a “Fatigue Hangover” is a cardinal sin) The optimal aerobic activity segment should seek to reach the following “Best Case Scenario”.

GOAL: Best Case Scenario; 15 minutes walking/treadmill, 15 minutes cycling, with 20 minutes of upper and lower extremity strength training exercises. Prescribing exercise in the chronic diseased population requires a significant amount of planning and encouragement. The exercise prescription should proceed gradually since most individuals are extremely limited in the amount of exercise tolerated secondary to deconditioning, exertional distress or hypersensitivity to exertion. References United States Army Center for Health Promotion and Preventive Medicine 5158 Blackhawk Road. Aberdeen Proving Ground, Maryland 21010-5403 F. Edward Hébert School of Medicine Uniformed Services University of the Health Sciences Department of Family, Sports and Preventative Medicine 4301 Jones Bridge Road Bethesda, Maryland 20814 MAJ Robert L. Gauer, MD, FACSM LTC Francis G. O.Connor, MD, FACSM COL Willis B. Campbell, MD, Ph.D., MPH, FACSM Larry W. Laughlin, M.D., Ph.D. FCCP


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Diabetes Patient Education

4 Steps to Control Your Diabetes for Life These four steps help people with diabetes understand, monitor, and manage their diabetes to help them stay healthy. This publication is excellent for people newly diagnosed with diabetes or who just want to learn more about controlling the disease.


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Individual Therapeutic Session Principle Each therapeutic session is an opportunity to provide exercise in a controlled and monitored environment, and education that not only enhances exercise, but also improves all aspects of function. Each session will build on the previous session in both fitness and knowledge. Purpose Exercise sessions should focus on individual needs and aim to progress the patient to a higher level of functioning. Patient goals should be discussed and reviewed at various points throughout the sessions to assist in measuring progress. Documentation during each session also helps both therapists and patients measure success.

Procedure

Subjective Record subjective information that the patient reports, such as, how they are feeling, are you

having any of the following symptoms?; frequent urination, blurry vision, irritability, extreme

hunger, excessive thirst or increased fatigue

Objective

Record a blood glucose levels before exercise rehabilitation.

Measurements • Blood Glucose Levels • HR (Heart Rate) • BP (Blood Pressure) • % spO2 • RPE/SOBr/Fatigue


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Physiological Changes during Exercise

What do these measurements mean? You expect the heart rate to increase with exertion. You should also see an increase in blood pressure with exercise. Any sudden change in any of the baseline measurements or subjective reporting indicates a need to decrease or even stop exercise. Monitoring changes will allow you to determine whether to increase or decrease the intensity of the therapeutic session or seek medical attention from the patient’s physician.

Aerobic Exercise

There are various modes that can be used for aerobic exercise. Ideally two modes of aerobic exercise will provide variety if the patient can tolerate the exercise duration. The treadmill is the most important mode of aerobic training as it easily translates into ADL's and functional independence.

• All aerobic exercise must begin with a 3 min warm up and conclude with a 3 min cool down at minimal loads.

• Aerobic training requires only one warm up and one cool down. Transitioning between equipment is exempt from WU & CD workloads.

• COPD patients often have balance and falls-risk issues so they must be monitored for safety while on exercise equipment. As a rule, most COPD patients will require balance and gait training to counter the lean tissue waisting that occurs from chronic corticoid steroid use.

Resistance Exercise

Resistance exercise is patient dependent; therefore, adjusting intensity, and volume should be considered based on patient needs, ability, and history.

• Resistance exercise is very important for LE & UE as it translates into ADL's.

• Resistance exercise is an emerging research focus for Diabetes patients as it’s revealing functional outcomes equivalent to aerobic exercise training.

• Resistance exercise progression is outlined in the following guidelines: o Sets & Reps:

1x8, 1x10, 1x12, 2x8, 2x10, 2x12, 3x8, 3x10, 3x12.

• ROM exercise may be “medically necessary”, thus, ROM therapy should be carefully attended to.

Patient Education

Exercise sessions will include education associated with your condition. Successive education will build on previous education. You will be asked to read about the benefits of exercise and proper exercise, and you will be given tips for making everyday tasks easier.

• Lessens will be taught and documented. • Patient education is a partnership, ask the patient to pre-read, and then

cover the section & answer questions once a week in a 15-minute lesson session.


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Follow-up

Complete SOAP notes and documentation.

Assessment Document how the patient tolerated the exercise session using intensity, duration, frequency, and mode (IDFM).

Plan Document goals and/or changes for the next session using IDFM.

Measurements

Allow the patient to cool down, and then collect final measurements and compare to baseline measurements. The resting heart rate should be within 8 beats of the baseline.


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SOAP NOTES

Diabetes Rehabilitation

Session # Patient Name: Date:

Subjective: Patient feels (check one) О Good О Fair О Poor

Objective: Current Glucose _______

Resting Measurements Aerobic Exercise

Start Tx End Tx Requirement Type Duration Int HR BP %

spO2 FiO2

HR HR <100 to DC Warm up (3 Min)

BP BP <200/110

%spO2 %spO2 >88%

FiO2 FiO2 Keep % spO2 >88

Education: Notes:

Cool Down (3 Min) RPE/DYSP/Fatigue (1-10)

Strength Training Sets (1-3) Reps (8-12) Load (lbs)

Leg Press Chest Press Overhead Press Pull Downs Rowing

Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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spO2 FiO2


BP BP <200/110

%spO2 %spO2 >88%


Education: Notes:




Assessment:

Planning:

Therapist


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6 - MINUTE WALK TEST (6MWT)

Name: ___________________________ Date: _________ Resting Data:

HR RPE SOBr % spO2

FiO2/ LPM

6MWT HR RPE SOBr %spO2 FiO2/ LPM Distance Walked

1 MIN Checkmark

2 MIN Checkmark

3 MIN Checkmark

4 MIN Checkmark

5 MIN Checkmark

6 MIN Checkmark Feet:

TOTALS

Checkmarks = 100ft, 100ft = one length. Total feet:

Comments: i.e., signs and symptoms, angina, dizziness, stopped/paused before 6 minutes, reason why, etc.


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SF-36 Health Survey

Physical Functioning Score (PFS)

Example of processing a score of 21 from the question above: A Physical Functioning raw score of (21) is converted as follows: (21 – 10) ---------------- X 100 = 55 20 PRE PROGRAM: SF 36 PFScore:_________ POST PROGRAM: SF 36 PFScore:_________

The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Please circle one number on each line.)

Activities Yes, limited a lot

Yes, limited a little

Not limited at all

1. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports.

1 2 3

2. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf.

1 2 3

3. Lifting or carrying groceries. 1 2 3 4. Climbing several flights of

stairs. 1 2 3

5. Climbing one flight of stairs. 1 2 3 6. Bending, kneeling, or stooping. 1 2 3 7. Walking more than a mile. 1 2 3 8. Walking several blocks. 1 2 3 9. Walking one block. 1 2 3 10. Bathing or dressing yourself. 1 2 3


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Department of Health and Human Services Healthcare Financing Administration Part A _______ Part B________ Other________

UPDATED PLAN OF PROGRESS FOR OUTPATIENT REHABILITATION (Complete for Interim to Discharge Claims. Photocopy of HCFA-700 or 701 is required)

2. Patient’s LAST NAME

FIRST NAME M.I. 2. PROVIDER NUMBER 3. HICN

4. PROVIDER NAME 5. MEDICAL REC NUMBER (OPTIONAL)

6. ONSET DATE 7. SOC DATE

8. TYPE □ Physical Therapy

9. PRIMARY DIAGNOSIS Pertinent Medical DX)

10. TREATMENT DIAGNOSIS 11. Visits From SOC

12. FREQ/ DURATION (3/Wk X 4 Wk) 13. CURRENT PLAN UPDATE, FUNCTIONAL GOALS (Specify changes to goal and plan) GOALS (Short term) OUTCOME (Long term) PLAN Skilled services required: 1)

1) __Bed Mobility __Transfer training __Gait training __Balance re-ed __Therapeutic ex. Specify OTHER:

__ROM Contracture mgmt. __W/C training __Muscle re-ed __Energy cons. Modalities

__Pt/caregiver training __Home program __Equipment needs __Safety skills __Other (specify)

2)

3)

2)

4)

5)

14. I HAVE REVIEWED THIS PLAN OF TREATMENT AND RECERTIFY A CONTINUING NEED FOR SERVICES.

N/A ____ DC ____

15. RECERTIFICATION FROM ______________ THROUGH_______________N/A ___________

Physician signature: ______________________________________

16. Date: 17. ON FILE (print/type physician name)

18. REASON(S) FOR CONTINUING TREATMENT THIS BILLING PERIOD (Clarify goals and necessity for continued skilled care) 6 MINUTE WALK TEST ASSESSMENT Min tolerated Distance Heart Rate % spO2 RPE Dyspnea FiO2 Tx Justification:

19. Signature (Or name of professional, including professional designation.) 20. Date

21. ___ Continue Services or ___ Discontinue services

22. FUNCTIONAL LEVEL (At end of billing period relate your documentation to functional outcomes and list problems still present.) 6 MINUTE WALK TEST ASSESSMENT Min tolerated Distance Heart Rate % spO2 RPE Dyspnea FiO2

FORM HCFA-701 (11-91) 23. Service Dates FROM _________ THROUGH _________


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DATE: October 14, 2011 TO: John Doe M.D. (Referring physician) RE: John Doe ( Patient name) Diabetes Rehabilitation Discharge Summary This page is provided as a sample discharge summary. Complete the following page, and then fax, mail, or deliver to the referring physician. OVERALL PROGRESS: POOR FAIR GOOD EXCELLENT Compliance: Good. Mr. Doe was in attendance three times a week and we committed to improving his health. Six minute walk test: Pt able to make improvements with 6 min walk test improving from 350 ft and terminating test at 2 min 37 sec to 740 ft and completing test. Pt required no supplemental oxygen and was able to maintain %SPO2 at 97 and above. Patient Education: Pt received education on medications and equipment for self-care, physical fitness, blood glucose safety levels for exercise, stress management, relaxation, and nutrition for diabetic patients, and disorders of the metabolic system. SF 36 PF Score: Pt reported a 36 on the SF 36 Health related Quality of Life scale before DR. Pt reported a 61 on the SF 36 Health related Quality of Life scale after DR. Home Exercise Program: Pt needs further instructions and pictures to understand his home exercise program (HEP). Pt received a comprehensive HEP designed specifically for their use. Additional Comments: Pt took encouragement during treatment to push himself. Pt motivation was at first poor, but really took off after session 9 which resulted in good overall progress. Thank you for this referral, John Doe (Therapist name), PT (Professional title)


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DATE: TO: RE:

Diabetes Rehabilitation Discharge Summary OVERALL PROGRESS: POOR FAIR GOOD EXCELLENT Compliance: Six minute walk test: Patient Education: SF 36 PF Score: Home Exercise Program: Additional Comments: Thank you for this referral, _________________________, ____________________ Rehabilitation Systems 2015 Copying or distributing without written consent is prohibited.

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Meet Your Presenter:

Roger Campbell, M.S., CET, MFT-c Patient Care Coordinator

Applegate HomeCare & Hospice [email protected]

www.rehabsys.com/diabetes-rehabilitation

Mr. Campbell started his exercise science career in 1985 as

an Army Master Fitness Trainer, where he physically prepared troops for combat readiness. With the GI

Bill, Campbell obtained a Bachelor of Science Degree in Exercise Science from Utah State University,

followed by a Master of Science Degree from the University of Utah, in Clinical Exercise Physiology.

Campbell's greatest passion however, is working for the functional restoration and independence of

medically complex patients, or should it come to it, palliative home care. While serving the University of

Utah's Lung Transplant program, Campbell realized that greater restorative measures could, and

should, be implemented to improve functional abilities of patients, and set his focus on their

rehabilitation pathway.

Campbell spends his best energies devoted to promoting home healthcare services, and creating

specialized home rehabilitation programs. For example, Campbell is the creator of

www.rehabsys.com/gocancerrehab/about.php, a growing cancer rehabilitation network of care

designed to increase access to restorative services, delivered by nurses, physical and occupational

therapists. Additionally, Campbell is committed to the educational development of health care

professionals as a serving panel member of the industries-first, accredited Cancer Specialist certification

prepared by the American College of Sports Medicine (ACSM) and the American Cancer Society (ACS).


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mailto:[email protected]

http://www.rehabsys.com/diabetes-rehabilitation

http://www.rehabsys.com/gocancerrehab/about.php

Contact information:

• Roger Campbell, M.S., CET, MFT-c

• Patient Care Coordinator

• [email protected]

• www.rehabsys.com

• (435) 632 - 7817 mobile

• (435) 628 - 1569 office

• (435) 634 - 9480 fax


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http://www.rehabsys.com/

Course Evaluation Roger Campbell, M.S., CET, MFT-c. The purpose of this evaluation is to gather input so that we may improve this course and how it is taught to improve your learning. We will report back to you on the feedback received if you desire, you may email us at: [email protected] 1. What are the strongest features of this course? In other words, what contributed most to your learning experience? 2. What specific suggestions do you have for changes that we can make to improve the course or how it is taught? 3. Is the pace of the course: (Too Fast) (Just Right) (Too Slow)


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Glossary of Diabetes Terms Acesulfame-k: An artificial sweetener used in place of sugar. It is not metabolized by the body and therefore does not contribute to calories and has contains no carbohydrates. Therefore, it has no effect on blood sugar levels. Acetone: A chemical formed in the blood when the body breaks down fat instead of sugar for energy. If acetone forms, it usually means the cells are starved. Commonly, the body's production of acetone is known as "ketosis." It occurs when there is an absolute or relative deficiency in insulin so sugars cannot get into cells for energy. The body then tries to use other energy sources like proteins from muscle and fat from fat cells. Acetone passes through the body into the urine. Acidosis: Too much acid in the body, usually from the production of ketones like acetone, when cells are starved. For a person with diabetes, the most common type of acidosis is called "ketoacidosis." Acute: Abrupt onset that is usually severe; happens for a limited period of time. Adrenal glands: Two endocrine glands that sit on top of the kidneys and make and release stress hormones, such as: epinephrine (adrenaline), which stimulates carbohydrate metabolism; norepinephrine, which raises heart rate and blood pressure; corticosteroid hormones, which control how the body utilizes fat, protein, carbohydrates, and minerals and help reduce inflammation. They also produce sex hormones like testosterone and can produce DHEA and progesterone. Adult-onset diabetes: A term no longer used. Considered the same as type 2 diabetes, yet the increased epidemic in obesity has lead to an increase in type 2 diabetes in children. Therefore the term is no longer considered valid. "Non insulin dependant diabetes" is also considered an incorrect phrase in describing type 2 diabetes, as patients with this type of diabetes may at some point require insulin. Adverse effect: Harmful effect. Albuminuria: More than normal amounts of a protein called "albumin" in the urine. Albuminuria may be a sign of kidney disease, a problem that can occur in about 30%-45% of people who have had type 1 diabetes for at least 10 years. In patients with type 2 diabetes, the kidneys may already show signs of small amounts of protein spillage when they are diagnosed -- called "microalbumin." This may be from the result of diabetes or from other diseases seen in conjunction with diabetes like high blood pressure. Protein in the urine increases the risk that a person with diabetes can have end stage kidney disease. It also means that the person is at a particularly high risk for the development of cardiovascular disease.


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Alpha cell: A type of cell in an area of the pancreas called the islets of Langerhans. Alpha cells make and release a hormone called "glucagon." Glucagon functions in direct opposition to insulin. In other words, it increases the amount of glucose in the blood by releasing stored sugar from the liver. Anomaly: Birth defects; deviation from the norm or average. Antibodies: Proteins that the body produces to protect itself from foreign substances, such as bacteria or viruses. Antidiabetic agent: A substance that helps a person with diabetes control the level of sugar in their blood so their body functions properly. (See also insulin, oral diabetes medication). Antigens: Substances that cause an immune response in the body; identifying substances or markers on cells. The body produces antibodies to fight antigens, or harmful substances, and tries to eliminate them. Artery: A blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker than veins and have stronger, more elastic walls. Arteries sometimes develop plaque within their walls in a process known as "atherosclerosis." These plaques can become fragile and rupture leading to the complications associated with diabetes such as heart attacks and strokes. Artificial pancreas: A glucose sensor attached to an insulin delivery device. Both are connected together by what is known as a "closed loop system." In other words, it is a system that not only can determine the body glucose level, but takes that information and releases the appropriate amounts of insulin for the particular sugar it just measured. The artificial pancreas can regulate the amount of insulin released, so low sugars would cause the device to decrease insulin delivery. Studies are being conducted to develop a version of this system that can be implanted. Aspartame: An artificial sweetener used in place of sugar because it has few calories. Also known as "Equal" and "NutraSweet." Asymptomatic: No symptoms; no clear sign that disease is present. Atherosclerosis: A disease of the arteries. It is caused by deposits of cholesterol in the walls of arteries. These plaques can build up and cause narrowing of the arteries or they can become fragile and break off, forming blood clots that cause heart attacks and stroke. The arteries that supply blood to the heart can become severely narrowed, decreasing the supply of oxygen-rich blood to the heart, especially during times of increased activity. Autoimmune disease: A disorder of the body's immune system in which the immune system mistakenly attacks itself. Examples of these diseases include type 1 diabetes, hyperthyroidism caused by Graves' disease, hypothyroidism caused by Hashimoto's disease.


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Autonomic neuropathy: Nerve damage to organs of the body that we cannot consciously control. These nerves control our digestive system, blood vessels, urinary system, skin, and sex organs. Autonomic nerves are not under a person's control and function on their own. Background retinopathy: This is the mildest form of eye disease damage from diabetes. It can be associated with normal vision and often progresses to other forms of eye disease. Basal rate: The amount of insulin required to manage normal daily blood glucose fluctuations. Most people constantly produce insulin to manage the glucose fluctuations that occur during the day. In a person with diabetes, giving a constant low level amount of insulin via insulin pump mimics this normal phenomenon. Beta cell: A type of cell in an area of the pancreas called the islets of Langerhans. Beta cells make and release insulin, which helps control the glucose level in the blood. Biosynthetic insulin: Genetically engineered human insulin. This insulin has a much lower risk of inducing an allergic reaction in people who use it, unlike cow (bovine) or pork (porcine) insulins. The manufacturers of synthetic insulin make it in a short-acting form which works to cover meal time increases in sugars, they also produce longer-acting insulins which cover sugars between meals and when fasting, such as during the night. Blood glucose: See glucose. Blood glucose monitoring or testing: A method of testing how much sugar is in your blood. Home blood glucose monitoring involves pricking your finger with a lancing device, putting a drop of blood on a test strip and inserting the test strip into a blood glucose-testing meter that displays your blood glucose level. Blood sugar testing can also be done in the laboratory. Most large recognized organizations recommend blood glucose monitoring numerous times during the day if you have diabetes. Most recommend a glucose check first thing in the morning before eating and a sugar check two hours after meals. Blood pressure: The measurement of the pressure or force of blood against the blood vessels (arteries). Blood pressure is written as two numbers. The first number or top number is called the systolic pressure and is the pressure in the arteries when the heart beats and pushes more blood into the arteries. The second number, called the diastolic pressure, is the pressure in the arteries when the heart rests between beats. The ideal blood pressure for non-pregnant people with diabetes is 130/80 or less. Brittle diabetes: When a person's blood sugar level often shifts very quickly from high to low and from low to high. Blood urea nitrogen (BUN): A product of metabolism that is excreted in the urine. It is measured in the blood as an indirect measure of how well the kidney is functioning. Increased BUN levels in the blood may indicate early kidney damage, meaning the kidneys aren't effectively excreting BUN.


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Bunion: Bump or bulge on the first joint of the big toe caused by the swelling of a sac of fluid under the skin and abnormalities in the joint. Women are usually affected because of tight fitting or pointed shoes or high heels that put pressure on the toes, forcing the outward movement of the joint. People with flat feet or low arches are also prone to bunions. Shoes that fit well and are padded can prevent bunions from forming. Bunions may lead to other problems, such as serious infection from the big toe putting pressure on other toes. Callus: A small area of skin, usually on the foot, that has become thick and hard from rubbing or pressure. Calluses may lead to other problems, such as serious infection. Shoes that fit well can prevent calluses from forming. Calorie: Energy that comes from food. Some foods have more calories than others. Fats have more calories than proteins and carbohydrate. Most vegetables have few. Carbohydrate: One of the three main classes of foods and a source of energy. Carbohydrates are mainly sugars and starches that the body breaks down into glucose (a simple sugar that the body can use to feed its cells). Cardiologist: A doctor who takes care of people with heart disease; a heart specialist. Cardiovascular: Relating to the heart and blood vessels (arteries, veins, and capillaries). Certified Diabetes Educator (CDE): A health care professional that is certified by the American Association of Diabetes Educators (AADE) to teach people with diabetes how to manage their condition. Cholesterol: A waxy, odorless substance made by the liver that is an essential part of cell walls and nerves. Cholesterol plays an important role in body functions such as digestion and hormone production. In addition to being produced by the body, cholesterol comes from animal foods that we eat. Too much cholesterol in the blood causes an increase in particles called LDL (known as bad cholesterol) which increases the build-up of plaque in the artery walls and leads to atherosclerosis. Claudication: See intermittent claudication. Coma: An emergency in which a person is not conscious; may occur in people with diabetes because his or her blood sugar is too high or too low. Dawn phenomenon: A rise in blood sugar levels in the early morning hours. Dehydration: Large loss of body water. If a person with diabetes has a very high blood sugar level, it causes increased water loss through increased urination and the person becomes very thirsty. Diabetes: See type 1 diabetes and type 2 diabetes.


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Diabetic ketoacidosis (DKA): A severe, life-threatening condition that results from hyperglycemia (high blood sugar), dehydration, and acid build up that needs emergency treatment. DKA happens when there is not enough insulin and cells become starved for sugars. An alternative source of energy called ketones becomes activated. The system creates a build up of acids. Ketoacidosis can lead to coma and even death. Dietitian: An expert in nutrition who helps people plan the type and amount of foods to eat for special health needs. A registered dietitian (RD) has special qualifications. Emergency medical identification: Cards, bracelets, or necklaces with a written message, used by people with diabetes or other medical problems to alert others in case of a medical emergency, such as coma. Endocrinologist: A doctor who treats people with hormone problems. Exchange lists: A way of grouping foods together to help people on special diets stay on the diet. Each group lists food in a serving size. A person can exchange, trade, or substitute a food serving in one group for another food serving in the same group. The lists put foods into six groups: starch/bread, meat, vegetables, fruit, milk, and fats. Within a food group, one serving of each food item in that group has about the same amount of carbohydrate, protein, fat, and calories. Fasting plasma glucose test (FPG): The preferred method of screening for diabetes. The FPG measures a person's blood sugar level after fasting or not eating anything for at least 8 hours. Normal fasting blood glucose is less than 100 milligrams per deciliter or mg/dL. A fasting plasma glucose greater than 100 mg/dL and less than126 mg/dL implies that the person has an impaired fasting glucose level, but may not have diabetes. A diagnosis of diabetes is made when the fasting blood glucose is greater than 126 mg/dL and when blood tests confirm abnormal results. These tests can be repeated on a subsequent day or by measuring glucose 2 hours after a meal. The results should show an elevated blood glucose of more than 200 mg/dL. Fats: Substances that help the body use some vitamins and keep the skin healthy. They are also the main way the body stores energy. In food, there are many types of fats; saturated, unsaturated, polyunsaturated, monounsaturated, and trans fats. To maintain your blood cholesterol and triglyceride (lipid) levels as near the normal ranges as possible, the American Diabetes Association recommends limiting the amount of saturated fats and cholesterol in our diets. Saturated fats contribute to blood levels of bad LDL cholesterol. The amount of saturated fats should be limited to less than 10% of total caloric intake and the amount of dietary cholesterol should be limited to 300 mg/day. Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods, but this type of sweetener is typically not recommended to diabetics because it could have a negative effect on blood sugar.


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Gangrene: The death of body tissues, usually due to a lack of blood supply, especially in the legs and feet. Gastroparesis: A form of nerve damage that affects the stomach and intestines. With this condition, food is not digested properly and does not move through the stomach and intestinal tract normally. It can result in bouts of diarrhea or chronic constipation because the transit time of food can be altered by nerve damage. This type of nerve damage can also cause a significant problem with smooth control of blood sugars. Gestational diabetes: A high blood sugar level that starts or is first recognized during pregnancy. As pregnancy progresses, there is an increased need for nutrients for the developing baby. Additionally, hormone changes during pregnancy affect the action of insulin, resulting in high blood sugar levels. Usually, blood sugar levels return to normal after childbirth. However, women who have had gestational diabetes are at increased risk of developing type 2 diabetes later in life. Gestational diabetes can increase complications during labor and delivery and increase the rates of fetal complications related to the increased size of the baby. Glaucoma: An eye disease associated with increased pressure within the eye. Glaucoma can damage the optic nerve and cause impaired vision and blindness. Glucagon: A hormone that raises the level of glucose in the blood by releasing stored glucose from the liver. Glucagon is sometimes injected when a person has lost consciousness (passed out) from a low blood sugar reaction. The injected glucagon helps raise the level of glucose in the blood. Glucose: A simple sugar found in the blood. It is the body's main source of energy; also known as "dextrose." Glucose tolerance test: A test to determine if a person has diabetes. The test is done in a lab or doctor's office in the morning before the person has eaten. A period of at least 8 hours without any food is recommended prior to doing the test. First, a sample of blood is taken. Then the person drinks a liquid that has sugar in it. Two hours later, a second blood test is done. If the results of the fasting or first blood test are abnormal yet still not high enough to be considered in the diabetes range, then the person is said to have glucose intolerance. A fasting blood sugar greater than 126 mg/dl is considered diabetes. If the 2 hour blood test is abnormal but still not high enough to be considered in the diabetic range, this too, is considered an abnormal glucose tolerance. If the two hour test result shows a blood sugar greater than 200 mg/dl, the person is consider to have diabetes. Glycated hemoglobin test (HbA1c): This is an important blood test to determine how well you are managing your diabetes. Hemoglobin is a substance in red blood cells that carries oxygen to tissues. It can also attach to sugar in the blood forming a substance called glycated hemoglobin or a Hemoglobin A1C. The test provides an average blood sugar measurement over a six to 12 week period and is used in conjunction with home glucose monitoring to make treatment adjustments. The ideal range for people with diabetes is generally less than 7%.


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High blood pressure: A condition when the blood flows through the blood vessels at a force greater than normal. High blood pressure strains the heart, harms the arteries, and increases the risk of heart attack, stroke, and kidney problems. Also called "hypertension." The goal for blood pressure in people with diabetes is less than 130/80. High blood sugar: See hyperglycemia. Home blood glucose monitoring: A way in which a person can test how much sugar is in the blood. Also called "self-monitoring of blood glucose." Home glucose monitoring tests whole blood (plasma and blood cell components), thus the results can be different from lab values which test plasma values of glucose. Typically the lab plasma values can be higher than the glucose checks done at home with a glucose monitor. Hormone: A chemical released in one organ or part of the body that travels through the blood to another area where it helps to control certain bodily functions. For instance, insulin is a hormone made by the beta cells in the pancreas and when released, it triggers other cells to use glucose for energy. Human insulin: Bio-engineered insulin very similar to insulin made by the body. The DNA code for making human insulin is put into bacteria or yeast cells and the insulin made is purified and sold as human insulin. Hyperglycemia: High blood sugar. This condition is fairly common in people with diabetes. Many things can cause hyperglycemia. It occurs when the body does not have enough insulin or cannot use the insulin it does have. Hypertension: See high blood pressure. Hypoglycemia: Low blood sugar. The condition often occurs in people with diabetes. Most cases occur when there is too much insulin and not enough glucose in your body. Impotence: Also called "erectile dysfunction." Persistent inability of the penis to become erect or stay erect. Some men may become impotent after having diabetes for a long time because nerves and blood vessels in the penis become damaged. It is estimated that 50% of men diagnosed with type 2 diabetes experience impotence. Injection site rotation: Changing the areas on the body where a person injects insulin. By changing the area of injection, the injections will be easier, safer, and more comfortable. If the same injection site is used over and over again, hardened areas, lumps, or indentations can develop under the skin, which keep the insulin from being used properly. These lumps or indentations are called "lipodystrophies." Injection sites: Places on the body where people can inject insulin most easily.


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Insulin: A hormone produced by the pancreas that helps the body use sugar for energy. The beta cells of the pancreas make insulin. Insulin dependent diabetes: Former term used for type 1 diabetes. Insulin mixture: A mixture of insulin that contains short as well as intermediate- or long-acting insulin. You can buy premixed insulin to eliminate the need for mixing insulin from two bottles. Insulin pump: A small, computerized device -- about the size of a small cell phone -- that is worn on a belt or put in a pocket. Insulin pumps have a small flexible tube with a fine needle on the end. The needle is inserted under the skin of the abdomen and taped in place. A carefully measured, steady flow of insulin is released into the body. Insulin reaction: Another term for hypoglycemia in a person with diabetes. This occurs when a person with diabetes has injected too much insulin, eaten too little food, or has exercised without eating extra food. Insulin receptors: Areas on the outer part of a cell that allow insulin in the blood to join or bind with the cell. When the cell and insulin bind together, the cell can take glucose from the blood and use it for energy. Insulin resistance: When a person's body will not allow insulin to work properly in the body, even if the person takes very high daily doses of insulin. This condition can occur when a person is overweight and it often improves when the person loses weight. Insulin shock: A severe condition that occurs when the level of blood sugar drops quickly. Intermittent claudication: Pain in the muscles of the legs that occurs off and on, usually while walking or exercising. The pain results from atherosclerosis of the blood vessels feeding the muscles of the lower extremities. Claudication usually increases with age and is most common in people in their sixth or seventh decade of life. Risk factors for developing narrowing of the arteries that can cause claudication include smoking cigarettes, high blood pressure, and diabetes. Drugs are available to treat this condition. Jet injector: A device that uses high pressure to push insulin through the skin and into the tissue. Juvenile-onset diabetes: Former term used for type 1 diabetes. Ketoacidosis: See diabetic ketoacidosis (DKA).


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Ketone bodies: Often simply called ketones, one of the products of fat burning in the body. When there is not enough insulin to use blood sugars, your body breaks down its own fat and protein for energy instead of glucose. When fat is used, ketone bodies, an acid, appear in your urine and blood. A large amount of ketones in your system can lead to a serious condition where acids build up in the body called ketoacidosis. Ketones can be detected and monitored in your urine at home using products such as Ketostix, Chemstrips, and Acetest. When your blood sugar is consistently greater than 250 mg/dl, if you are ill or if you are pregnant and have diabetes, ketones should be checked regularly. Kidney disease (nephropathy): In a person with diabetes, nephropathy is any one of several conditions caused by changes in the very small blood vessels in the kidneys. These changes cause scarring of the kidneys which can eventually lead to kidney failure. People who have had diabetes for a long time may develop nephropathy. An early sign of nephropathy is when proteins can be detected in the urine. Kidney threshold: See renal threshold. Lancet: A fine, sharp pointed needle for pricking the skin. Used in blood sugar monitoring. Laser treatment: The use of a strong beam of light (laser) to heal a damaged area. A person with diabetes might receive laser treatments to heal blood vessels in the eye. Late-onset diabetes: Former term used for type 2 diabetes. Lipid: Another term for a fat or fat-like substance in the blood. The body stores fat as energy for future use just like a car that has a reserve fuel tank. When the body needs energy, it can break down lipids into fatty acids and burn them like glucose. Excess amounts of fats in the diet can cause fat build up in the walls of the arteries -- called "atherosclerosis." Excess amounts of calories from fats or other nutrients can lead to an increase in weight gain. Low blood sugar, low blood glucose: See hypoglycemia. Metabolism: All of the physical and chemical processes in the body that occur when food is broken down, energy is created and wastes are produced. Mg/dL (milligrams per deciliter): Measurement that indicates the amount of a particular substance such as glucose in a specific amount of blood. Mixed dose: A prescribed dose of insulin in which two types of insulin are combined and injected at once. A mixed dose commonly combines regular insulin, which is fast-acting, with a longer-acting insulin. A mixed dose may be prescribed to provide better blood sugar control. Nephropathy: Disease of the kidneys caused by damage to the small blood vessels or to the units in the kidneys that clean the blood. People who have had diabetes for a long time may develop nephropathy.


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Neurologist: A doctor who treats people who have problems of the nervous system (brain, spinal cord, and nerves). Neuropathy: Nerve damage. People who have had diabetes that is not well controlled may develop nerve damage. Non-insulin dependent diabetes: Former term for type 2 diabetes. Nutritionist: See dietitian. Obesity: A term uses to describe excess body fat. It is defined in terms of a person's weight and height, or the body mass index (BMI). A BMI over 30 is classified as being obese. Obesity makes your body less sensitive to insulin's action. Extra body fat is thought to be a risk factor for diabetes. Ophthalmologist: A doctor who treats people with eye diseases. Optometrist: A person professionally trained to test the eyes and to detect and treat eye problems, as well as some diseases, by prescribing and adapting corrective lenses. Oral diabetes medications: Medications that people take to lower the level of sugar in the blood. Oral diabetes medications are prescribed for people whose pancreas still produces some insulin. These medications are not used in diabetes during pregnancy. Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so the body can use sugar for energy. Peak action: The time when the effect of something is as strong as it can be, such as when insulin is having the most effect on blood sugar. Periodontal disease: Damage to the gums and tissues around the teeth. People who have diabetes are more likely to have periodontal disease than people who do not have diabetes. Peripheral neuropathy: A type of nerve damage most commonly affecting the feet and legs. Peripheral vascular disease (PVD): An abnormal condition that affects the blood vessels outside the heart. Often occurs as a result of decreased blood flow and narrowing of the arteries from atherosclerosis, to the hands and feet. People who have had diabetes for a long time may develop PVD. Podiatrist: A health professional who diagnoses and treats foot problems. Polydipsia: Excessive thirst that lasts for long periods of time; may be a sign of diabetes.


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Polyphagia: Excessive hunger and eating; may be a sign of diabetes. People with polyphagia often lose weight even though they are eating more than normal. Polyunsaturated fat: A type of fat that can be substituted for saturated fats in the diet and can reduce 'bad' LDL cholesterol. It can have a small effect in lowering 'good' HDL cholesterol as well, but not to the degree that saturated fats do. Polyuria: Increased need to urinate often; a common sign of diabetes. Protein: One of three main classes of food. Proteins are made of amino acids, which are called the "building blocks of the cells." Cells need protein to grow and to mend themselves. Protein is found in many foods, like meat, fish, poultry, eggs, legumes, and dairy products. Rebound effect: See somogyi effect. Regular insulin: A type of insulin that is rapid-acting. Renal: Relating to the kidneys. Retina: The center part of the back lining of the eye that senses light. It has many small blood vessels that are sometimes harmed when a person has had diabetes for a long time. Retinopathy: A disease of the small blood vessels in the retina of the eye. Risk factor: Anything that increases the chance of a person developing a disease or condition. Saccharin: An artificial sweetener that is used in place of sugar because it has no calories and does not increase blood sugar. Self-blood glucose monitoring: See home blood glucose monitoring. Somogyi effect: Also called "rebound effect," it occurs when there is a upward swing in blood sugar from an extremely low level of glucose in the blood to a very high level. It usually happens during the night and early morning hours. People who experience high levels of blood sugar in the morning may need to test their blood sugar levels in the middle of the night. If blood sugar levels are repeatedly low, addition of an evening snack or a lowering of the insulin doses may be recommended. Sorbitol: A sugar -- produced from fruits -- that the body uses slowly. It is a sweetener used in diet foods and is called a "nutritive sweetener" because it has four calories in every gram, just like table sugar and starch. These compounds are used in many foods labeled as 'sugar free' and 'no sugar added' and can raise your blood glucose. Because a food is labeled 'sugar free,' it doesn't necessarily mean carbohydrate free.


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Sucrose: Table sugar; a form of sugar that the body must break down into a more simple form before the blood can absorb it and take it to the cells. Sugar: A class of carbohydrates that tastes sweet. Sugar is a quick and easy fuel for the body to use. Some types of sugar are lactose, glucose, fructose, and sucrose. Sulfonylureas: Pills or capsules that people take to lower the level of sugar in the blood. These oral diabetic medications work to lower your blood sugar by making your pancreas produce more insulin. Triglyceride: Fats carried in the blood from the food we eat. Most of the fats we eat, including butter, margarines, and oils, are in triglyceride form. Excess triglycerides are stored in fat cells throughout the body. The body needs insulin to remove this type of fat from the blood. Type 1 diabetes: A type of diabetes in which the insulin-producing cells (called beta cells) of the pancreas are damaged. People with type 1 diabetes produce little or no insulin, so glucose cannot get into the body's cells for use as energy. This causes blood sugar to rise. People with type 1 diabetes must use insulin injections to control their blood sugar. Type 2 diabetes: A type of diabetes in which the insulin produced is either not enough or the person's body does not respond normally to the amount present. When there is not enough insulin or the insulin is not used as it should be, glucose cannot get into the body's cells for use as energy. This causes blood sugar to rise. U-100: See unit of insulin. Ulcer: A break in the skin; a deep sore. People with diabetes may develop ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that don't fit well. Ulcers can become infected and should be treated promptly. Ultralente insulin: A type of insulin that is long acting, usually the action of this type of insulin works for 25-36 hours after injection. This type of insulin has an onset of action four to five hours after injecting and works most powerfully at eight to 14 hours after injection. Unit of insulin: The basic measure of insulin. U-100 is the most common concentration of insulin. U-100 means that there are 100 units of insulin per milliliter (ml) of liquid. For the occasional patient that has severe insulin resistance insulin is available as a U-500 form. Unstable diabetes: See brittle diabetes. Urine testing: Checking urine to see if it contains ketones. If you have type 1 diabetes, are pregnant and have diabetes, or have gestational diabetes, your doctor may ask you to check your urine for ketones. This is an easy test done at home with a dipstick measure.


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Urologist: A doctor who specializes in treatment of the urinary tract for men and women, as well as treatment of the genital organs for males. Vaginitis: An inflammation or infection of the vaginal tissues. A woman with this condition may have itching or burning or vaginal discharge. Women who have diabetes may develop vaginitis more often than women who do not have diabetes. Vascular: Relating to the body's blood vessels (arteries, veins, and capillaries). Vein: A blood vessel that carries blood to the heart. Vitrectomy: A procedure in which the gel from the center of the eyeball is removed because it has blood and scar tissue in it that blocks vision. An eye surgeon replaces the clouded gel with a clear fluid. Xylitol: A nutritive sweetener used in dietary foods. It is a sugar alcohol that the body uses slowly and contains fewer calories than table sugar.


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Diabetes Project

Documents

diabetes rehabilitation

contents rehabilitation

diabetes patient education

form hcfa

weight loss

functional task conversions

minute walk test

written consent