NOVEMBER 2020
Koren Thomas
Diabetes nurses work on the frontlines in the fight against an ongoing epidemic/pandemic that will continue to afflict over 13% of the US population long after COVID-19 recedes into the background. The diabetes pandemic has been mounting rapidly in the early 21st century. In 2003, 194 million adults worldwide between the ages of 20 and 79 had diabetes. By 2025, it is estimated that some 333 million of the world’s adults will be diabetic.
Nurses have long played a vital role in diabetes care, and studies suggest that patients fare better and have lower glucose levels when nurses are closely involved in the treatment of diabetes. As expert communicators and patient educators, nurses help America’s 27+ million diabetes patients understand how the disease and its complications affect the body, explain the treatment plan, keep them motivated, and advise them on adapting their diet and lifestyle to keep the disease under control.
As November is American Diabetes Month, this is a good time to take a look at how nurses are fighting this disease and assess the latest developments in treatment. DailyNurse asked Debra Dudley, RN, CDE, BS and Lori Weiss, BSN, RN, CPN, CDCES to share their first-hand knowledge about the key issues facing nurses on the frontlines of one of the world’s longest-running pandemics. Debra Dudley has specialized in diabetes care and glycemic management for 25 years and is currently the Clinical Diabetes Educator for AdventHealth Waterman in Tavares, Florida. Lori Weiss, a Clinical Services Coordinator for the insulin management software firm Glytec, spent over 20 years as a nurse and is an expert on the process of titrating insulin. This is Part One of a two-part interview. Click here to see Part Two.
DailyNurse: How did nurses come to take a leading role in diabetes treatment?
Debra Dudley: “The role of the nurse has really evolved from basic bedside care to a leader in diabetes treatment and education during the mid-1990s. At that time, providers realized they needed to change their methodology of treating people with diabetes from provider disease management to patient self-management. In doing so, nurses were tasked with educating people with diabetes about the disease and how to treat it. This role is critically important because it helps improve long-term health, lower hospital admissions and reduce the chronic complications associated with poor glucose control.”
DN: What are the most important areas of knowledge for nurses who work with diabetic patients?
Dudley: “It’s important to understand that diabetes is probably the only chronic disease that puts the patient in charge of their own healthcare. Each time a patient measures their blood glucose, it is their responsibility to make a decision about if and what they need to do about it. Whenever a patient eats or exercises, they need to make an informed decision on how it will impact their blood sugar. Nurses need to understand that poor blood glucose control is the cause of significant adverse reactions, and communicating that to their patients is critical in helping them manage the disease.”
Dudley, continued: “A toxic blood glucose level is 180 milligrams per deciliter (mg/dL), and the body cannot make healthy new cells in a toxic environment. As a result, many patients with diabetes develop wounds that won’t heal, experience repeated hospital admissions and have a higher risk of infection. In fact, diabetes causes 80,000 amputations, 60,000 people to lose kidney function, and 5,000 people to go blind every year. The broad impact poor glycemic management can have on an individual is alarming, and it’s important for nurses to process that information and find effective ways to communicate it with their patients.”
Lori Weiss: “I’m often amazed at how limited a nurses’ knowledge is about diabetes, diabetes medications and available resources to care for people with diabetes. But, when I stop and consider how much general information bedside nurses need to process on a wide range of topics, it makes sense why they lack this specialized clinical knowledge. Nurses must understand that insulin, while commonly used, is one of the most dangerous and mismanaged drugs. Insulin is associated with 50% of all medication errors, therefore, properly dosing it in the hospital and providing adequate guidance on self-administration is crucial for patient safety. Additionally, the adverse health effects of poor glycemic management include a higher risk of infection, increased length of stay in the hospital and a greater chance for readmission.”
DN: How can nurses assist in preventing diabetes?
Dudley: “The only way we can achieve prevention is through education. We must educate our patients, our community and our country as a whole on how their decision making and behavioral patterns impact their health. Over 30 million people in the United States are affected by diabetes, which means one out of every three patients a nurse will see over the course of his or her career will be impacted by the disease. Through education, we can help patients and community members understand the potential outcomes of their choices, empower them to make the decision that lead to desired results, and positively change healthcare as a whole.”
Weiss: “Nurses, and especially Certified Diabetes Care Education Specialists, can assist in preventing diabetes by helping patients process and understand information that can directly impact their management of blood glucose. For those living with diabetes, nurses can assist them in navigating the continued advancements and challenges associated with diabetes to help them enjoy a high-quality life and manage their diseases.”
Part Two
DN: What are the greatest challenges nurses face when working with diabetic patients?
Debra Dudley: “One of the greatest challenges I have consistently faced over the course of my 50-year career is the lack of time. Time is more essential than ever because the nursing shortage has left many of us overworked. I would love to have daily visits with each patient – even if it’s just a few minutes – to help guide them on their journey because there isn’t always going to be a teachable moment with them during infrequent interactions. This leads to long-term consequences because so many of our diabetic patients return with the same issues. We aren’t able to dedicate the necessary time to provide them with the appropriate education on adequate self-care.”
Lori Weiss: “Time remains the most significant challenge for nurses because they are busy, they are experiencing an increased patient workload, and those patients often have complications that are compounded by their diabetes. Patient safety is imperative, and nurses must balance safety with efficiency in order to treat as many people in need as possible. In order to overcome these obstacles, processes must be implemented that improve workflows and simplify the ability for nurses to do the right thing.”
DN: What technological advances have had the greatest impact on diabetes treatment?
Dudley: “There have been significant developments in technology over the course of my career, especially when you consider that early in my career we would place tablets into tubes of urine to measure blood sugar. From an outpatient perspective, the evolution of the continuous glucose monitorhas been the most important. It allows a person to check their blood sugar every five minutes, identify if the blood glucose is trending up or down, and make an adjustment based on that trend. There are also mobile applications that help with carb counting, meal planning and exercise tracking – and many of those are free to download.
As far as the inpatient setting, the eGMS insulin dosing software system has been amazing. Once a nurse inputs a blood glucose reading, its algorithms automatically calculate insulin adjustments in real-time. It takes into account a patient’s current blood glucose, their food intake, and how they have reacted to previous doses. This reduces the amount of time a nurse has to spend adjusting doses because they no longer have to reach out to a patient’s provider to make a dose change. Before using this technology, our staff was making a minimum of 3,000 calls per month to providers just for dose adjustments. The amount of time wasted processing dose adjustments was both staggering and frustrating. The use of the Glucommander eGMS has reduced our amount of monthly calls by 95% – from over 3,000 to 150 – and alleviated a significant amount of nurse burden.”
Weiss: “While many of the foundational concepts and approaches to diabetes education and support have remained the same, the tools and resources at our disposal continue to change. Outpatient technology has experienced the highest volume of technological advancements. The most notable [developments] have been the personal and professional Continuous Glucose Monitors, the variety of insulin pumps designed to meet pediatric and adult patient needs, and the explosion of digital and mobile solutions. This has provided patients with more access to information and a deeper understanding of how their decisions impact their disease. It’s not uncommon now for patients to inform their nurse or provider of a new app that is helping them manage their diabetes.
Although the outpatient setting has been most affected by these advancements, the inpatient setting has been able to leverage technology as well. As a Certified Diabetes Care and Education Specialist (CDCES), it is difficult to stay current with all the changes in diabetes care and nearly impossible for a busy bedside nurse to keep track. The eGMS insulin dosing software system has provided busy bedside nurses with an easy and effective way to care for patients. It increases patient safety by eliminating human dosing calculations, streamlines workflow because the algorithms automatically calculate insulin adjustments in real-time, and reduces adverse outcomes associated with hypoglycemia and hyperglycemia.”
DN: What are the most useful sources of information for nurses providing care for diabetic patients?
Weiss: “There are many reputable sources both online and in print to assist nurses caring for diabetic patients, but I find the best sources of information to be from the American Diabetes Associationand the American Association of Diabetes Care and Education Specialists. The ADA issues its annual “Standards of Medical Care in Diabetes” to help guide nurses and physicians on how to best treat patients with diabetes and glycemic management issues. This is available for free online and includes best practice information on topics that range from nutrition therapy to pharmacologic approaches and recommendations for use of technology. The ADCES provides online courses, practice tools and documents, and webinars from industry experts to share a wealth of knowledge in an ever-changing field.”
Debra Dudley, RN, CDN, BS: Debra’s nursing career has spanned 50 years and she has spent the past 25 specializing in diabetes education and glycemic management. She is currently the Clinical Diabetes Educator for AdventHealth Waterman in Tavares, Florida, and has extensive experience in Pediatrics, NICU, and Maternal Child Health. Debra is an industry leader in providing support for those with a diagnosis of diabetes or pre-diabetes and improving their self-management through informative discussions, classes, and support groups.
Lori Weiss, BSN, RN, CPN, CDCES: After spending more than 20 years on the frontlines as a nurse at health systems in Wisconsin and Dallas, Lori Weiss is now applying her field expertise at the insulin management software company, Glytec, where she serves as the Clinical Project Lead. Lori understands the complex processes, risks, and challenges providers face titrating insulin.
- This article originally appeared on DailyNurse.
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