Glucose is excreted through urine in people with diabetes, this means that infections of the urinary system and genitals may need more aggressive and longer lasting antibiotic treatment than typical.

Yeast infections are more likely to need 2 rounds of oral medication and OTC treatments often only reduce symptoms, not the infection itself

 

Because of elevated yeast infx risks educate female patients on s/s of yeast infections and encourage them to seek treatment quickly, and that OTC or “holistic “ treatments have not been shown to be effective in persons with diabetes. .

 

Patients living witn incontinence are also at a far higher risk of UIT and yeast infection even when they don’t have diabetes. Combining these struggles with diabetes can be particularly problematic, so educating these patients on the importance of genitle hygiene is important. Never assume that someone has made it this far in life so they must know good bathroom hygiene! Teaching patients how to clean and dry themselves properly is more important.

 

Glucose is also secreted in the skin, educate patients on proper skin care and how to thoroughly dry between toes, under breasts and between skin folds.

Bacterial and fungal skin infections in all areas of the body may require more aggressive treatment due to reduced circulation to the areas effected as well.

 

Meanwhile skin infctions, yeast infection and UTIs tend to sharply elevate blood sugars leading to more glucose in urine etc, so aggressive treatment and tighter BG targets during treatment can work together.

 

Be sure to educate your patients with diabetes on the importance of regular dental care. The mouth is another area where glucose levels elevate and microvascular flow may suffer, making PWD more susceptible to dental infections and abscesses than the average person.

 

Sample Sick-Day Management Plan

Below is a sample sick-day management plan for a patient with diabetes.

It is important that these plans be individualized and in writing. Remember, a person with diabetes uses their “diabetes management brain all day, every day”, so it is very easy for patients to forget their sick day education.

I always recommend that patients keep a paper copy of their sick-day management plan where they keep their OTC medications. So when they are sick and reaching for something to feel better they are reminded to apply their sick-day management plan.

Summary

Today we discussed the primary goal of medication therapies for types 1 and 2 diabetes and the maintenance of an acceptable level of glycemic control, which may vary according to the patient's risks and conditions. In addition, we listed, and briefly discussed, a number of medications that may fall into several categories, including exogenous replacement of insulin, the increasing production and availability of endogenous insulin, the improvement of insulin sensitivity, the reduction of liver glucose release, and medications that slow gastric motility or other mechanisms to reduce the absorption rate of dietary carbohydrates.

We briefly discussed the barriers to both insulin and oral medication uses, including patient and non-patient factors associated with non-adherence.

 

Primary goals in treatment with diabetes medications Maintenance of glycemic control: glucose and A1c levels Categories of medications used in treatment of diabetes Insulin replacement Increase insulin production/secretion Improve insulin sensitivity Reduce liver glucose production Inhibit carbohydrate digestion Block glucagon production Slow digestion Stimulate glycosuria Be prepared to address barriers to use

 

It is my hope that through the use of the strategies and techniques outlined in this course, as well as the wide assortment of good clinical information available on the web that care for people for diabetes will continue to improve. One day we may all be able to put diabetic sick-days behind us and live our lives with diabetes as those without the burden of the disease do.