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Care for patients with diabetes must be individualized
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ATLANTA – While physical activity is crucial to keeping patients with diabetes healthier, those with uncontrolled proliferative retinopathy should be cautioned against any exercise that could increase IOP, according to a speaker here at the SECO meeting.
Joan Hill, RD, CDE, LDN, a Certified Diabetes Educator, shared the nuances of diabetes care in a continuing education symposium sponsored by Primary Care Optometry News. Internist David Shein, MD, was her co-presenter.
“If people at risk of proliferative retinopathy are doing weight training, it could change the pressure in the eye, so they should be advised to keep their head up and watch their blood pressure,” Hill said.
Shein stressed the importance of the eye care provider communicating the patient’s ocular status to the primary care physician or diabetes educator.
“I need to know if there’s evidence of hypertensive disease or any manifestation of systemic diseases and if they have cataracts or glaucoma,” he said. “I also need to know if you don’t find anything in the eye exam.”
Hill agreed. “As a diabetes educator, it’s important for me to know the patient’s ocular status because they need to be able to see to self-medicate,” she said.
Patients have a number of different options for administering their medication, including vial and syringe, pen, pump and insulin patches, she said.
The pen contains a cartridge, and the patient must dial the dose.
“With patients who are visually impaired, this is a nearly impossible way to deliver insulin,” Hill said.
She noted that she can sometimes advise patients to listen for clicks when adjusting the dose.
Individual patients’ goals must also be considered in treatment, Hill said.
“Diabetes self management education incorporates needs, goals, life experiences and evidence-based medicine,” she said. “Life experiences are completely different. Each different stage of one’s life brings opportunities as well as barriers to achieving goals. I’ve treated a 3-year-old with type 1 diabetes and a 93-year-old with type 1.”
She attributed a quote to Elliott P. Joslin, MD, founder of the Joslin Diabetes Center: an educated patient lives a longer and healthier life.