LIONS DIABETIC AWARENESS FOUNDATION OF MD-35 www.dafmd35.org FLORIDA LIONS DIABETIC RETINOPATHY FOUNDATION www.fldrf.org BBLLOOOODD GGLLUUCCOOSSEE SSCCRREEEENNEERR TTRRAAIINNIINNGG AANNDD PPRROOCCEEDDUURREE MMAANNUUAALL Contact Lion Norma Callahan, PDG. [email protected] For any changes, corrections, or questions. REV 10 (March 1, 2017) 1 TRAINING Introduction 3 On-Line Resources 4 Training Objectives 5 Lions and Diabetes Awareness Why? 8 Diabetes Awareness Grant - What Is It? 9 Sight First Grant 10 Overview of Diabetes 12 Classification of Diabetes 13 Awareness/Screening for Diabetes 17 Hyperglycemia/Hypoglycemia 18 Retina Screener Training 21 What do we tell clients? 24 Diagnosis 26 Treatment 27 Lifestyle Changes/Successful Management 29 Nutrition 30, 34 Glycemic Index 32 Glycemic Load 33 Complications Caused by Diabetes 37 Understanding Diabetic Retinopathy 38 Goals for Glycemic Control 40 Childhood Obesity/Diabetes in Children 41 PROCEDURE Arrangements 47 Equipment 48 Reporting Requirements 49 Setting - Up 50 Screening Procedure 52 Counseling 54 Ordering New Supplies 57 Closing 58 Recertification/Expectations 59 Screening in Schools 60 How to Do a Finger Stick on a Child 60 How to Discuss Results with Clients 61 What to Do In An Emergency 62 APPENDIX Anatomy of the Endocrine System 63 Glossary 65 Reference 77 2 INTRODUCTION This manual will aid Lions involved in Blood Glucose screening and education to better understand the complex condition known as Diabetes. Since some personnel will be more knowledgeable and experienced than others, there is an index listing various topics for easy reference, and a glossary defining complex terminology. This manual is intended to quickly familiarize users with the disease of Diabetes. The materials provided by the Center for Disease Control and the ADA (American Diabetes Association) should also be consulted. The information will help users to more effectively present the need for this project and support fund raising at clubs and other groups. The degree of pain and suffering that can be alleviated or prevented will save individuals, families, and the health system millions of dollars. It is expected that the services given will reflect our motto "We Serve". Thank you to LCIF for giving us the ability to form our foundation and provide free Blood Glucose screening for the community. Certification is required for all Blood Glucose screeners every year. We change equipment and update our protocol as we continue to grow this program, requiring all certified screeners to re-certify annually. Lion Norma Callahan, PDG Founder of Lions Diabetes Awareness Foundation of MD 35 3 On-Line Resources For the most recent forms and information for screening go to: WWW.DAFMD35.ORG For information of the Lions program on diabetic retinopathy go to: www.fldrf.org Additional helpful web-links include: National Diabetes Prevention Program at CDC.gov/diabetes/prevention The Mayo Clinic diabetes program at MayoClinic.org The Joslin Clinic diabetes program at Joslin.org American Diabetes Association at diabetes.org 4 TRAINING OBJECTIVES OBJECTIVE 1: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. DESCRIBE WHY LIONS SCREEN FOR DIABETES 2. DISCUSS THE DIFFERENT GRANTS WHICH WE HAVE RECEIVED OBJECTIVE 2: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING 1. UNDERSTAND BASIC DIABETES 2. DIFFERENTIATE BETWEEN TYPES OF DIABETES (GENERAL) 3. UNDERSTAND WHY WE REFER HYPOGLYCEMICS 4. KNOW THE DIFFERENCE BETWEEN DIABETIC AND NON-DIABETIC HYPOGLYCEMIA Objective 3: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. UNDERSTAND RETINA SCREENER TRAINING 2. RECOMMENDED REQUIREMENTS FOR RETINA CAMERA 3. DISCUSS LIONS DIABETIC PROJECTS EXPERIENCE 4. UNDERSTAND WHAT CAN BE DONE TO PREVENT COMPLICATIONS 5. IDENTIFY OPPORTUNITIES FOR SCREENING OBJECTIVE 4: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. APPRAISE IF THE CLIENT NEEDS TO BE REFERRED 2. UNDERSTAND YOUR ROLE IN DIABETIC SCREENING 3. DESCRIBE TREATMENT AND TESTING TO IDENTIFY DIABETES (BASIC) 4. UNDERSTAND HOW TO DISCUSS HIGH BLOOD SUGARS WITH CLIENTS OBJECTIVE 5: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. DISCUSS BASIC LIFESTYLE CHANGES 2. SUCCESSFUL SELF MANAGEMENT 3. UNDERSTAND A BASIC HEALTHY DIET 4. LEARN HOW TO READ A LABEL 5 OBJECTIVE 6: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. UNDERSTAND THE COMPLICATIONS OF DIABETES 2. DESCRIBE DIABETIC RETINOPATHY (BASIC) 3. APPRECIATE THE IMPORTANCE OF A1C IN A DIABETIC 4. UNDERSTAND CHILDHOOD OBESITY AND THE PROBLEMS ASSOCIATED WITH THIS CONDITION OBJECTIVE 7: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. UNDERSTAND THE IMPORTANCE OF THE CONSENT FORM 2. DEMONSTRATE HOW TO COMPLETE THE CONSENT FORM 3. DISCUSS THE MOST COMMON ERRORS COMLETING THE FORMS 4. UNDERSTAND HOW TO RETURN FORMS OBJECTIVE 8: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. ARRANGE SETTING UP FOR SCREENING 2. IDENTIFY THE EQUIPMENT WHICH IS REQUIRED 3. UNDERSTAND DEADLINES AND ORDERING TIMES OBJECTIVE 9: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. CONDUCT A SCREENING EVENT 2. SUCCESSFULLY REFER AND COUNSEL THE CLIENT 3. DELIVER LITERATURE WHIS IS APPROPRIATE FOR THE FINDINGS OBJECTIVE 10: AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. SUCCESSFULLY REORDER SUPPLIES 2. DEMONSTRATE COMPETENCY IN USE OF LANCETS AND METER 3. UNDERSTAND WHAT TO DO IN AN EMERGENCY 6 OBJECTIVE #1 AT THE END OF THIS UNIT, YOU WILL BE ABLE TO DO THE FOLLOWING: 1. DESCRIBE WHY LIONS SCREEN FOR DIABETES 2. DISCUSS THE DIFFERENT GRANTS WHICH WE HAVE RECEIVED 7 LIONS AND DIABETES AWARENESS: WHY? DIABETES IS INCREASING AT EPIDEMIC LEVELS Free Blood Glucose screening is the only way we can reach the Diabetic population in order to prevent complications from undiagnosed Diabetes, or Diabetics out of control, and Pre-Diabetics unaware that they should take it seriously. We have also been educating Diabetics on how to take better care to prevent complications and how to get help to pay for their care. The average, newly diagnosed Type 2 Diabetic will have been a Diabetic (untreated) for at least five or more years. Therefore, this Diabetic is more than likely to have many of the serious Diabetic complications such as kidney, heart disease, neuropathy, and preventable blindness. THE LEADING CAUSE OF BLINDNESS IN ADULTS IS DIABETES. 8 DIABETES AWARENESS GRANT: WHAT WAS IT? In 2008, The Lions of Florida and the Bahamas obtained The Diabetes Awareness Grant from LCIF as a Core-4 grant to educate Lions in the fundamentals of Diabetes prevention, and to identify Diabetics by screening early, before complications occur. The grant provided funds for Lions to conduct Blood Glucose screening (particularly in underserved areas and among high risk groups in Florida and the Bahamas), to offer educational programs on prevention and care of Diabetes, and to provide nutrition guidelines. The grant also allowed many Diabetic Lions to become better informed about their own Diabetes. The original grant was assisted with the partnership of Florida Diabetic camps. We continue to work with this very important partner. Lions were able to work in schools, health events, and fairs to reach the youth population that is at such high risk of developing Diabetes, due to lifestyle changes, and the very high rate of obesity, (17%) according to the AMA. We have had several co-partners in this important work: Florida Diabetic Camps is a major donor of screening supplies including meters, test strips and lancets; Medicine Shoppe in Deland donated meters and has contributed many supplies at cost; Liberty Medical donated more than twenty-five meters and strips; a glove company donated over 8000 pairs of gloves; and Lions and friends routinely donated meters and strips, as do other medical providers. Lions Diabetes Awareness Foundation of MD-35, Inc. was formed as a 501(c) 3 tax exempt organization, to continue this project, one of the biggest hands-on projects Lions have ever undertaken. As a result, Lions have more new members, old members have been revitalized, we have visibility in new communities, and we have networked and partnered with many other health care community service groups and health departments. This grant was completed and closed in 2011. Core 4 grant was approved by LCIF in March 2008 and completed on April 30, 2011. LCIF approved $33,000 for a pilot program of education and Diabetic screening. 9 SIGHT FIRST GRANT We applied for a second LCIF grant under the Sight First Program to improve and enlarge the Diabetes work that we are doing. The purpose of the grant is to offer to our communities Free Diabetic Retinopathy screening, without dilation, along with our free blood glucose screening. This grant was approved on August 14, 2014. Due to the financial requirements of the grant agreement, The Florida Lions Diabetic Retinopathy Foundation was formed. This grant was officially started in Jan 2015 and will be completed in Jan 2018. The grant is for $179,900 to purchase DRS digital cameras and supplies, computers, and to fund EKN network access, which allows images to be uploaded to a cloud site for reading and grading by a Medical Doctor, Board Certified as a Retina Specialist. The grant originally allowed the purchase of four computerized Retina Cameras, but, due to significant cost savings achieved so far, this has been increased to five cameras and support equipment... This Diabetic Retinopathy program is a pilot project which has never been conducted before, requiring us to develop all of the forms and protocols, as well as a training program to certify Lions to conduct the screenings. As the program grows, you will notice that we will continue to update our procedures, training, and forms as we learn more about this important pilot study.