Diabetes Mellitus, Type 2 Author: Sandeep Vijan, MD
Editorial changes - 2010-03-01
Author information and module status
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up
Tables
Figures
References
Glossary
What's New
Patient Information
Additional Resources
Tools
Quality Measures Quality Measures
Patient Education
  • Explain epidemiology and prognosis of microvascular disease and its close relationship to blood-sugar control.
  • Educate the patient about epidemiology and prognosis of macrovascular disease.
  • Instruct patients and family members on the signs, symptoms, and treatment of hypoglycemia.
  • Educate the patient about smoking cessation.
  • Educate the patient about the importance of diet and exercise.
  • Encourage patients to have information about their condition with them at all times.

Explain epidemiology and prognosis of microvascular disease and its close relationship to blood-sugar control. C

  • Discuss the increased risk of microvascular disease with poor glycemic control.
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Educate the patient about epidemiology and prognosis of macrovascular disease. C

  • Stress to the patient the importance of hypertension and lipid control.
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Instruct patients and family members on the signs, symptoms, and treatment of hypoglycemia. C

  • Discuss adrenergic and neurological symptoms of hypoglycemia with patients and family members:
    • Typical: Rapid heartbeat, shakiness, anxiety, perspiration, hunger
    • Severe: Change in level of consciousness; seizure
  • Advise patients and family regarding treatment:
    • Ingest sugar (e.g., hard candy, fruit juice), glucogel, or other easily absorbed glucose formulations
    • Administer subcutaneous glucagon injection in severe cases (e.g., when patient cannot take oral carbohydrates)
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Educate the patient about smoking cessation. C

  • Discuss the elevated risks involved with smoking and diabetes.
  • Educate patient on methods, including pharmacologic therapy or dedicated cessation programs, that may help patients stop smoking.
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Educate the patient about the importance of diet and exercise. C

  • Note that there is no single, specific diet for diabetes that applies to all patients; individualized planning should be the goal.
  • Consider referral to a dietician.
  • Consider the following general diet principles:
    • Stress the importance of moderation.
    • Base calorie recommendations on the goal of achieving near-ideal body weight.
    • Use a reasonable starting formula of 10 calories per pound of current body weight plus 20% for sedentary patients, 33% for those who engage in light physical activity, 50% for moderately active patients, and 75% for those who are heavily active.
    • Avoid saturated fats.
    • Follow a regular meal schedule, particularly if on insulin
    • Note that frequent small meals might aid in weight loss and in control of blood-glucose level.
    • Choose complex carbohydrates (e.g., starches, cereals) over simple sugars.
  • See the American Diabetes Association Position Statement.
  • Individualize exercise regimen to the patient.
  • Caution patients regarding hypoglycemia during and after exercise.
  • For those patients who can exercise, consider beginning with 15 minutes of low-impact aerobic exercise three times per week.
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Encourage patients to have information about their condition with them at all times. C

  • Patients with diabetes should wear a medical-alert bracelet.
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FAQs
Sandeep Vijan, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for continuing medical education grand rounds and lectures given.

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