Diabetes Education and Prevention: Instructional Module for Children

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Based on their preference you can create a more effective presentation of the needed material. There are so many topics that need to be taught regarding diabetes management that it can feel overwhelming to both the clinician and the patient. Before teaching a patient with diabetes, clarify the goal of the learning session. People need to be able to come away from a teaching or training session with the ability to do something that will make a positive impact on their health, and not to just learn academic concepts.

Behavior change is the focus of learning sessions in healthcare. Many times the objective of the learning session is given by the prescribing clinician, it may be learning about insulin devices or counting carbs. Adult learners are generally task-oriented and already know what they want to learn.

The methods of teaching include auditory, visual, one-on-one, group classes, and so on. If a person with diabetes seems interested in a group class, find out your local resources and where you can refer them. If a person says that they prefer private teaching, then schedule that if possible. The following list shows many different methods that could be used for teaching about diabetes:. In addition to selecting appropriate teaching methods, using effective instructional materials is important to creating an effective teaching experience for the patient.

If you found, for example, that your learner prefers to learn by watching videos, then a pamphlet may be useless unless it summarizes information from the video.

Account Options

Written instructional methods can be extremely helpful but they must be written at a fifth-grade reading level and without medical jargon. Using pictures can be helpful for those with limited English proficiency. Pharmaceutical representatives often offer diabetes education materials, generally free of cost. The following list identifies some of the many instructional materials available for diabetes:. Notice that, within this course, each module identifies a learning objective. Knowledge becomes powerful when it prepares you to improve action toward a desired goal.

The four domains of learning depicted earlier include affective emotional , behavioral ability to adopt new behaviors , cognitive knowledge , and psychomotor physical ability. As a diabetes educator you will choose some combination of these to achieve the goal of improved patient outcomes. Insurance companies who pay for diabetes education want to know that their teaching impacts physical health for the better.

Choosing an action item for each teaching session is likely to produce a concrete result from the training. Evaluating the learning experience is important to ascertain whether your explanation was effective. Many people will say yes just to save face for both their sake and yours. Asking them to state back what you said, or requiring them to do a repeat demonstration after your instruction, will give you a better assessment of their learning. You may see holes in their understanding, which you can then fill. Asking patients to teach you is a good way to assess their understanding.

Generally if someone can teach correctly, then they know. Asking open-ended questions after your instruction is also helpful: What questions should you ask yourself about using this instructional material? Can the person read? Is the timing right for this patient to learn about diabetes?

Does the patient wear glasses? Is there someone else in the family who needs to attend the training session? Is there a language barrier? Is there some other material that this patient will find interesting and informative? If patients with diabetes are not moved to take action after being taught how to care for themselves they will not thrive. Educators have developed a number of theories about how adults learn and we will look at these in this section. Essential to effective teaching is an understanding of why and how people learn. The field of psychology helps us understand what drives human behavior.

Russian physiologist Ivan Pavlov demonstrated that behavior may be based on a conditioned response of reward or punishment. If a dog is always rewarded with a bone after a bell rings, the dog will begin to salivate upon hearing the bell. For a person with diabetes, being rewarded with a good blood glucose level after daily exercise can be encouraging and can help encourage repetition of the desired behavior.

A teenage girl with type 1 diabetes may fear weight gain caused by insulin more than developing diabetic ketoacidosis and choose to go without her needed insulin after a meal. Identifying the predominant drive can help us understand the choices people make. Cognitive learning theory states that people can learn logically and by social example; however, in eating we humans tend to be more emotional than rational. For example, a person may know cognitive that pasta elevates blood glucose more rapidly than a lean protein meal but still consume large amounts of pasta because it tastes so good emotional.

Abraham Maslow who developed humanistic learning theory , believes that what drives people to action, including learning and behavior change, is based on trying to fill the most urgent need at the time. His classic pyramid model demonstrates that the most primary human needs are survival, and only after having food, shelter, air, elimination of pain and waste, can we then focus on higher-level needs such as safety and security, social belonging, love and affection, and ultimately self-actualization.

The person with diabetes who is suffering from painful neuropathy, erratic blood sugars, and retinopathy may not be interested in sitting in a class. He may be more focused on learning about behaviors that promise elimination of pain. Adult learning theory identifies how adults learn and helps anyone who teaches adults to understand what motivates them. The following list identifies basic preferences of adult learners. Teaching people of different ages requires different approaches.

Adults generally prefer information that will help solve an immediate problem or need. Adults seek prompt feedback when learning a new skill and prefer a relationship where they are not threatened. Research shows that the patient-provider relationship is crucial to adherence to a prescribed medical regimen Ciechanowski et al.

Creating a collaborative relationship that includes the patient in diagnostic results and creating the health plan is beneficial in creating positive outcomes. The approach of teaching patients self- management that empowers them to take control of their own life produces powerful improvements in health outcomes ADA, You are teaching a man who has type 2 diabetes about his blood glucose meter and his wife continually interrupts to ask questions about food and meals.

What is the best course of action for you as the diabetes educator? According to adult learning theory, you need to address her pressing need for information. Allow her to ask the questions and answer them. Continue with your demonstration when she feels her questions have been answered. It is still polite to remind her your time is limited and the goal of this session is to teach them how to use the meter. Using the meter can help them both identify the effects of the meals on blood sugar. Sometimes we look at educational models and assume they are meant for academics but are not relevant to our daily teaching.

Consider the models that follow and what they may contribute as you teach your patients about diabetes self-care. In addition to the learning theories, the Health Belief Model is a psychological model that can help you understand and predict health behaviors J Pharm Prac, It can also help you to understand resistance to changing positive self-care behaviors. The model identifies factors that can either help or prevent someone from likely engaging in health-promoting behavior.

The way patients perceive self-care actions as benefits or barriers determines what they do. The gap between theory and practice closes as you understand the theories that explain human behavior and begin to adjust the way you teach your patients about diabetes. Thalia Smith, a year-old female with type 1 diabetes, continues to have repeated admissions to the emergency department in DKA due to inconsistency with her insulin injections. What are questions you could ask to identify the cause of her behavior?

What does she understand about diabetes and insulin? What are her barriers to taking insulin? Is there a cost barrier? Is she afraid of weight gain? Does she have insurance? Is she living on her own now that she is 21? Does she see a benefit to taking insulin? What is her understanding of complications from chronic hyperglycemia?

Does she just have diabetes burnout? Assuming the patient has been taught effectively, there are different levels of behavior change that need to be understood and acknowledged. Change is difficult, and most people are inherently resistant to change. Studies show that when people try to change their behavior they move through a series of stages.

The time within the stages is variable; however, progress to action and maintenance of a behavior change must follow stage by stage in a systematic manner. The process is also cyclical, in that people can slip back into earlier stages with relapse and hopeful renewal. Did you achieve it and stay in the ideal state of change or did your progress vary, relapse, and continue at various stages? Knowing about the various stages can help you assess and support the stage of change your patient may be in.

Research states that it takes on average ten times for a healthcare professional to discuss a new behavior, such as smoking cessation, before the person begins to truly think about it. The next stage of contemplation is when the person begins to think seriously about changing a behavior.

The next stage is action, when the person begins to make changes throwing out cigarettes, joining a smoking cessation class, making an appointment to see his provider for a nicotine replacement product. According to research on behavior change, the action stage needs to occur more than 21 consecutive days to become habit. Once the new behavior has been continued for over a month, the new habit moves to the maintenance stage, which can take months or years. Acknowledging that change is hard and requires support, you can shore up continued efforts.

Sometimes, the relapse may be so severe that the person has to begin the entire cycle anew, starting with precontemplation to decide if the effort was worth it. A tool to help guide your patient change is called the ruler method. After patients identify a desired area of improvement, such as ideal weight, ask them:.

The burden is no longer on the diabetes educator but on the patient to explore their own readiness to change and improve health behaviors.

Diabetes Education Modules - English

The educator is there to answer any questions the patient may have and to guide the discussion. The following table demonstrates what you can do to support your patients as they develop new healthy behaviors. Another model pertinent to people with diabetes is the grieving model , as identified by Dr. Each person diagnosed with diabetes experiences the loss of their former good health and goes through stages of grief similar to those of death and dying. Essentially, their old healthy self is now seen as lost.

The stages vary in timing and duration and often follow the sequence of denial, anger, bargaining, depression, and acceptance. Patients may be in the anger or depression stage and not come to an acceptance of the reality of their disease, which delays improvement and glucose control. Recognizing the stages of valid grief can help you become a more compassionate diabetes educator. What questions could you ask him to help him move to the next stage of action? Tell me your concerns about testing your blood sugar.

What gets in the way when you think of testing your blood sugar? What do you think may happen if you continue to have high blood sugar every day? What are some benefits of testing your blood sugar daily? How many times do you think you need to test your blood sugar? What would you do if you tested and had a high or low blood sugar? Armed with an understanding of diabetes and what motivates people to change, it is necessary to know how to teach effectively in order to help patients achieve favorable outcomes.

The determinants of learning can be addressed by answering the who, what, when, where, and how of teaching people with diabetes Redman, The who includes who you are teaching and, hopefully, family members. Parents of children with type 1 diabetes especially need education and support. Although there is no actual type 3 classification of diabetes, family members who care for a patient with diabetes have coined the term for themselves.

There is a very real phenomenon of diabetes burnout, and caregivers also experience this and need support. Deciding what needs to be taught may be easy if it is prescribed—such education for insulin injection or blood glucose monitoring—however, most topics are up to the diabetes educator. You must decide between the nice-to-know and the need-to-know. Because formal diabetes education may be limited by insurance companies to a maximum of ten hours in the first year, teach first survival skills such as basic physiology and medication administration. Long-term goals and special topics such as eating during the holidays, travel, and cooking ideas should be chosen after essentials such as weight loss and blood glucose monitoring.

Topics such as the use of alternative therapies should be limited if there is no position statement from the ADA. For example, patients will want to know if they should be taking cinnamon pills or chromium or cactus pear because they read about it on the Internet or heard it from a friend.

Unless the ADA has endorsed such products, you need to tell the patient that they are not approved. Patients will highly value your opinion as a healthcare professional so you must be careful what you say about vitamins, complementary therapies, and practices not validated by evidence-based medicine.

The use of mnemonics and acrostics help some people remember action items. How to teach is grounded in understanding basic principles of teaching.

Course Modules

Where diabetes education takes place includes both healthcare settings and non-healthcare settings such as the home. Because time and insurance coverage may limit the formal teaching, referring patients to public libraries, community support groups, the Internet, and diabetes organizations can expand their learning resources. When diabetes education can begin depends on the physical and emotional readiness of the learner.

Acute settings such as an emergency department may not be ideal for diabetes education, especially when the patient is in pain or discomfort; however, initial seeds may be planted as patients become newly motivated to avoid acute diabetic emergencies. Telling an obese patient to lose 20 pounds may be unrealistic and overwhelming to the patient and close the patient off to any future discussions.

Discovering what is of most interest to the patient is key. Discussing erectile dysfunction may actually become the right motivator to get a man interested in testing his blood sugar. Again, being able to explain the pathophysiology to them in a manner they understand can help them make connections with the prescribed regimen. The overall goal of diabetes self-management education is to help patients live as full and healthy a life as possible within their limitations. One overarching strategy to achieve this is through controlling chronic hyperglycemia. Once patients understand the overall goal, monitoring their blood sugar levels throughout the day can give them feedback on the effects of exercise and food on their body.

The goal is self-management, and information is key to being able to make adjustments. Blood glucose monitoring or insulin is no longer the enemy, but rather the tool to help them achieve better health. How to teach effectively has been the overall question this continuing education course attempts to answer. Strategies discussed have included:.

Continuing Education for Health Professionals

General principles of effective teaching include being prepared with the material you may need. Give positive feedback and reinforcement rather than chastisement. Always demonstrate an attitude of respect and compassion. After teaching a concept, allow patients to rephrase it in their own words to evaluate understanding.

Be flexible when the patient asks questions about a topic you may not have planned for. Sometimes a patient may ask general questions until gaining confidence in you and then the deeper questions of sexual dysfunction or eating disorders may surface. The diabetic patient refuses to test his blood sugar and states he can just guess his blood sugar by how he feels.

What questions could you ask the patient to better help him? Tell me how you feel when your blood sugar is high? When it is low? How do you know? What benefits are there in testing your blood sugar? What barriers do you have to testing your blood sugar? Do you have a meter? Would you like me to show you how to use it? Let me tell you about hypoglycemic unawareness. Creating a plan for effective teaching begins with identifying the overall purpose of the teaching session.

Writing your plan down helps focus on the overall goal and the topic for learning. What are the learning objectives you want your patient to achieve? Outline the related content to identify the topics you will need to cover, including the realistic time it will take to cover the material. Choose the materials and instructional resources you will use and how you will evaluate the learning. The following table shows how you may outline a simple lesson plan to teach about blood glucose monitoring.

Even though your lesson plan was perfectly organized and delivered, the patient may have a less than impressive retention or understanding of the information you presented. There are many factors that influence learning. Environmental elements may affect the learning experience eg, temperature, noise. Emotional elements impact learning eg, depression, readiness for change, fear. A patient who is anxious while waiting for a test result may not be ready for a lecture on weight loss. Social issues such as family dynamics can impact learning.

Diabetes Education and Prevention : Instructional Module for Children

Support or lack of support from family members or loved ones can change the learning experience. Even cultural values impact the learning experience. When confronted with a wall of resistance, endeavor to identify the barriers you are facing.

Other special considerations are patients with low literacy, attention deficit disorder, or mental illness. For more effective teaching with these persons consider the following strategies:. Teaching all there is to know about diabetes is a daunting task—and unrealistic. Self-management education means you do not have to be the sole person to educate about diabetes, which is a relief. Look at the Resources at the end of this course for many options for you and your patient.

She is 5'3" and weighs pounds, with her pre-pregnancy BMI She is scheduled to complete her g glucose challenge. Her mother has diabetes. It is a screening test for diabetes and identifies how much sugar the body can metabolize after two hours of a glucose load. The patient needs to fast for at least 8 hours. The patient drinks a bottle of 50 grams of pure glucose.

Blood glucose values are measured before the beverage is consumed, at the half-hour, 1-hour, and 2-hour mark. Maria was then scheduled for a g glucose load. The lab tests are shown in the following table. List at least three risk factors that predispose Maria for gestational diabetes mellitus GDM. You now give Maria nutrition guidelines for her GDM. She gives a diet history mainly of rice and beans, fried meats, and tortillas. She tells you her grandmother in Mexico had diabetes and cured it with nopales prickly pear and cinnamon.

She says she gets nauseated with dairy products. What are your dietary goals for Maria? Support her nutritional needs during the pregnancy. This is not a time for weight loss. Provide her a realistic diet plan based on her dietary and cultural preferences and provide calcium in forms other than dairy.

She needs to learn how to measure her blood glucose and how to create a realistic diet plan she can follow during the pregnancy. Maria returns in 4 weeks and has gained 10 pounds. Her FBG today in the clinic is You now instruct her to measure her FBG and 2 hours after eating twice daily. What type of monitor would you suggest for Maria?

What is your approach for education at this visit? What resources do you have for her? She needs a simple monitor. She also needs education in Spanish.

Refer to the ADA for Spanish videos and pamphlets. She could continue to gain excess weight and create complications for herself and the baby. She is at greater risk of developing diabetes mellitus. When she comes 1 week later you will teach her insulin injections TID. What are your teaching approaches and considerations? She needs to understand why she will be taking insulin and that it will help her baby grow normally. During the next months, she will return to the clinic every 4 weeks. What are other topics you will assess and teach her? She needs to learn about fetal kick counts and plan for a safe delivery.

She also needs to begin to think about weight loss after the delivery to avoid fully getting diabetes type 2 after her gestational diabetes. In preparation for her labor, she wants to know if she will be on insulin for the rest of her life like her mother. What pre- and postpartum counsel do you have for her? Explain to her how the pathophysiology of gestational diabetes compares to type 1 and type 2. Assess what kind of diabetes her mother had. Explain that she will have her blood sugar tested after delivery and may not need to be on insulin anymore. Frank comes to the clinic where you are employed.

He has been complaining of chronic fatigue, increased thirst, constant hunger, and frequent urination. He denies any pain or burning on urination. He admits to smoking since losing his job but has recently found a new job at a loan company. He also complains of having difficulty reading numbers and reports and making more mistakes in his paperwork.

He reports that his feet hurt as he stands at a bank teller station for many hours and so he sits and watches TV when he gets off work at night, not having enough energy to do anything else. His labs reveal the following: Frank was started on lispro Humalog and glargine Lantus insulin with carb counting. Lispro is fast-acting and glargine is long-acting. They cannot be mixed together even though they are both clear in the vials.

He has a friend who does. What are your options for teaching him meal planning? He can use the plate method, portion control, food guide pyramid, or other food management systems. What other complications does Frank have with his diabetes? What questions would you ask to assess other complications? It appears he is already developing retinopathy, neuropathy, lipodystrophies, and possible cardiovascular complications. What are some changes Frank can make to reduce the risk or slow the progression of both microvascular and macrovascular disease?

Interpret the following blood glucose log book. What are your recommendations?

Brown is a year-old African American male. He and his wife have grown children and he works as a manager of a mechanic shop, which he states is very stressful. He was put on insulin three years ago: He is afraid of hypoglycemia because at work he had one episode when he felt sweaty and shaky and had to lie down. His last eye examination revealed a few microaneuysms and he was diagnosed with mild nonproliferative retinopathy in both eyes.

All health professionals need access to proven, effective, professional education about diabetes. IDF diabetes education resources are designed to improve the profile of education and the expertise of diabetes educators and other health professionals. For more diabetes education resources, please visit the D-NET library. This guide is an awareness and information tool created to inform teachers, parents of children with diabetes as well as all parents and children of the important role of nutrition in the management and prevention of diabetes.

The number of health professionals who demonstrate a solid understanding of the principles of diabetes care and education is inadequate to meet the needs of the growing number of people with or at risk for diabetes worldwide. The KiDS project is an education program designed for the following target groups: Teachers grades ; School nurses and school staff; School students aged years ; Parents; Policy makers and Government officials.

The KiDS information pack is divided in two sections: Please read the KiDS information pack guidelines before downloading the pack.

The International Diabetes Federation IDF recognises the urgent need to reach a great number of healthcare providers with the best diabetes education materials to promote improved daily diabetes management and care skills and prevent disabling complications. Innovative, appropriate educational tools are key to engage and motivate all learners and facilitate effective learning.

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