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Type 1 diabetes is a disease in which the body does not make enough insulin to control blood sugar levels.
Type 1 diabetes occurs when some or all of the insulin-producing cells in the pancreas are destroyed. Type 1 diabetes is not caused by the amount of sugar in a person’s diet before the disease develops.
Even after it is diagnosed and treatment is begun, type 1 diabetes can affect all body systems. Eye damage (retinopathy) — Tiny blood vessels of the retina (the back of the eye, the part that senses light) are damaged by high blood sugar.
Nerve damage (neuropathy) — High blood sugar can damage nerves, leading to pain or numbness of the affected body part. Heart and artery disease — People with type 1 diabetes are more likely to have heart disease, strokes and problems related to poor circulation. Hypoglycemia — Low blood sugar (hypoglycemia) can result from treatments to lower blood sugar, either insulin injections or pills (see Treatment section, below).
Type 1 diabetes is diagnosed by a combination of symptoms, a person’s age and blood tests.
On unusual occasions, when someone’s type 1 diabetes is very hard to control with available treatments, pancreas or islet transplantation may be performed even when kidney transplantation is not necessary.
Scientists have recently reported exciting but still experimental new ways for encouraging the pancreas to again start producing its own insulin-producing beta cells.
People with type 1 diabetes must properly regulate both their dietary intake and their dose of insulin. In order to properly regulate their insulin intake, people with type 1 diabetes need to monitor their blood sugar levels several times per day. Newer glucose monitors have test strips that take the blood directly from the spot that was pricked. Fast-acting insulin may be taken as needed, depending on the amount of carbohydrates ingested. A healthy diet and regular exercise are important for everyone—but particularly for people with diabetes.
In order to keep blood sugar levels at a normal and relatively constant level, a person with type 1 diabetes typically is advised to eat, exercise and take insulin at about the same times every day.
Call your health care professional if you experience a sudden increase in thirst and urination. If you or your child has type 1 diabetes, see your doctor regularly to make sure that you are keeping good control of your blood sugar.
People with type 1 diabetes generally adjust quickly to the time and attention that is needed to monitor blood sugar, treat the disease and maintain a normal lifestyle.
Uncontrolled diet can leads diabetic patients to blindness, nerves damage, heart attack, kidney problem, blood pressure and infections. Bread, cereals, pasta, rice, potato, corn and other grains and starches foods should be consumed 6 to 11 servings a day. Low(less than 55): This includes almost all fruits and vegetables, bread , pasta, milk, cheese, nuts and some pulse and legumes.
To realize change, rely on the knowledge and experience of a team such as the authors', which improved the care of patients with diabetes.Miriam Schwarz, MPA, RRA, Suzanne E. Introduce team members, clarify each member's role on the team (why they are there and what they think they can contribute to the process) and explain the facilitator's and team leader's roles.
Download a printable Immunization Schedule from the CDC and a free Vaccination or Immunization Record template for Microsoft Excel®. I designed this immunization and vaccination record so that you can keep an electronic record of your immunizations for yourself and each of your children and print it whenever you need to. You should keep a backup copy of your immunization record in paper form in a safe place as well.
Immunization Schedules from cdc.gov - Free printable immunization and vaccination schedules for children of various ages.
Printable Immunization Record Cards for Adults, Children, and Lifetime from immunize.org - (Click on the images of the cards to view a printable PDF) You can also order these cards on "rip-proof, smudge-proof, water-proof" paper.
You may print and distribute as many paper copies as you want to, as long as you don't make any changes to the form or template.
Disclaimer: The spreadsheet and the information on this page is for general educational use only. It is less likely to damage the body, and cause symptoms, if the blood sugar levels are well controlled by treatment. If a person takes too much insulin relative to their dietary intake, or if they forget to eat, they can develop dangerous hypoglycemia. Other patients use semiautomatic injector pens that help to measure precise amounts of insulin. Insulin pumps deliver a regulated dose of insulin through a needle implanted under the skin. Your doctor or dietitian will help you determine the best insulin and diet schedule for you or your child. Exercise protects the health of the heart and blood vessels in people with diabetes, as in everyone.


You should also be checked regularly for early signs of complications such as heart disease, eye problems and skin infections.
These may include a podiatrist to check your feet and an ophthalmologist to check your eyes for signs of diabetes complications.
But it can be reduced greatly if you strictly monitor and control your blood glucose levels. This is not a disease but a condition in which body doesn’t produce enough insulin to restore balance of sugar in blood. To understand diabetic diet you must know that almost every food can produce glucose in body. Without such infrastructure, teams run the risk of being set adrift with no clear course, no resources and no destination. Without strong endorsement, support and resources from practice leaders, teams will flounder.In larger practices, pull together an interdisciplinary oversight group, such as a quality council, that keeps the QI momentum going and provides guidance and resources to the teams. To work efficiently, QI teams need diversity: people with different skills, experience, knowledge and viewpoints. If members do not understand why they are there and what roles they can play on the team, they will be reluctant to participate.Develop team guidelines (also known as standards of behavior or ground rules). A common problem-solving approach used in QI is the FOCUS-PDSA model, which we discuss below.Begin planning baseline data collection.
We identified all patients who had had an ICD-9 code of 250 within the past year and all patients who were taking oral hypoglycemics.
With the process clearly defined and your data and literature assembled, your team should be able to choose an intervention.
The model works equally as well for other areas of improvement and requires only the formation of an interdisciplinary team and use of a few simple data collection and reporting tools.
She is also an adjunct clinical instructor at the University of North Carolina-Chapel Hill (UNC).Dr. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
I designed the template to allow you to keep an electronic record of immunizations for yourself and your children as well as print a copy whenever you need to. So, you don't have to worry as much about losing your one-and-only copy of your immunization record. Check with your physician for an exact immunization schedule and to ask any questions related to you or your child's health practices.
In type 1 diabetes, the immune system destroys insulin-producing cells (beta cells) in the pancreas. This is because the increased glucose in the blood causes the kidneys to create more urine than usual. Other monitors allow blood to be taken from the forearm, thigh or the fleshy part of the hand. For smaller practices, a physician and office manager can provide this function.Cultivate a spirit of QI within your practice that encourages everyone to improve the quality of services and programs continuously. In addition, staff members who are directly involved with the process under study should be represented on the team. Your QI efforts must be based on data that show how your practice is presently performing in the area under study.
We then audited a random sample of those patients' charts to determine our rate of ordering HbA1c tests and the average HbA1c value. In our case, we felt that to improve overall care of patients with diabetes, we needed to develop a computerized reminder flowsheet (a printout of which would appear on the first page of the medical record at every encounter with patients who have diabetes) that would organize patient data relevant to diabetes management and provide guidelines on the frequency of tests and procedures.
Measuring Quality Improvement In Healthcare: A Guide to Statistical Process Control Applications. QI has helped us provide better patient care, document our success and energize our practice to do even better. Landis is an associate chair and associate professor in the UNC Department of Family Medicine and is director of MAHEC's Division of Family Medicine.Dr.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Some pumps include a sensor that constantly measures the level of blood sugar, and adjusts the dose of insulin accordingly.
Walking, running, swimming and other light exercise can help to control diabetes and weight. Under the right circumstances, teams harness the knowledge, skills, experience and perspectives of different individuals to make lasting improvements. For example, if you were studying diabetes, you could begin by collecting data on the number of HbA1c tests performed in your practice and the range of results for patients with type-2 (non-insulin-dependent) diabetes.Develop an action plan for the team's next meeting. Remember also that the process you choose to address must be one you can measure to judge whether interventions are working. Based on the results we decided that, to improve diabetes management, we would initially try to increase the number of patients who received at least two HbA1c tests per year.Understand sources of process variation. Specifically, we hoped the flowsheet would help us increase the number of patients with at least two HbA1c tests in one year.Plan.
Rowe is an assistant professor in the UNC Department of Family Medicine and is the medical director of MAHEC's Family Health Center.The authors wish to acknowledge Scott Endsley, MD, MSc, Mary Thoesen Coleman, MD, PhD, Kathryn Stewart, MD, and James M.


Over weight person will have more suffering from diabetes and will feel difficulties even in walking. Teams are most appropriate when your process or system under study is complex, when no one person in your practice knows all the dimensions of an issue, when your process involves more than one discipline or work area, when your solution requires creativity, or when you need your employees' commitment and buy-in — in other words, virtually all QI projects. Consultants to the team might include database or medical records personnel who could help the team with data collection and implementation of improvements.As you assemble your team, try to keep it small (no more than six members). For example, we decided that we needed to improve our care of patients with diabetes, specifically by improving the process of ordering HbA1c tests.
A key premise of QI is that you cannot improve a process until you fully understand that process.
Based on our current record-keeping system, we knew we could monitor the number of HbA1c tests performed.QI overviewThis article is the second in a series on quality improvement (QI) in medical practices. The next step, then, is developing a flowchart to map out the steps of the process you are trying to improve. Also, you'll want to recruit enthusiastic members, those who are very invested or interested in the process under study. Flowcharting involves setting the process boundaries, identifying and agreeing on the major steps from beginning to end (the hardest part!), sequencing the steps and showing the flow of action.
To implement our diabetes reminder flowsheets, for example, we discovered that we needed to educate our office staff, nursing staff, lab staff and physicians about proper diabetes care and how to use the new flowsheets. Preferably, allow people to volunteer for the team rather than appointing them.You will then need to select a facilitator and a team leader. This step means bringing together the people and resources that will be most effective in making the needed change.
For our diabetes project, we brought together physicians, a lab technologist, a nurse and a staff person from our business office to form an interdisciplinary team. It's also an excellent way to bring the team together because it fosters discussion, full participation, good listening, acceptance of differing perspectives and learning. The team leader keeps everyone on track by ensuring that the team is making progress toward the charter objectives. One of the physicians assumed the role of team leader (although a staff member may also be an appropriate team leader), and a staff member who had been trained as a facilitator fulfilled that role.Clarify current knowledge. In addition, flowcharting helps teams identify key points in the process where data might be collected to shed light on what is actually happening.Our diabetes team flowcharted the process by which patients received care and HbA1c tests were ordered. Depending on the project, your practice may choose to implement its intervention on a small scale before going practice-wide.
The baseline data gives you evidence of how well your practice is performing in the area of study.
Two physicians monitored the appearance of the flowsheets in their patients' medical records to ensure that the intervention was occurring consistently.Study. The literature review gives you insights into how others have addressed similar problems.At this stage particularly, but throughout the QI project as well, good data collection is essential.
Once you have enacted your change and have allowed sufficient time for the change to take effect, review and evaluate the results. We have found that our team meetings are much more productive if the team leader and team facilitator meet briefly before each team meeting.
The data will provide your team with ongoing feedback, which if positive reinforces the intervention and energizes the staff to keep it up, or if negative motivates the staff to try harder or look to see why they are not meeting with success.Collecting data isn't always easy, however. To monitor whether our new process was improving our ordering of HbA1c tests, we used a run chart to track the monthly percentage of active patients who had received at least two HbA1c tests in the previous year. Many practices do not have computer systems that can tap the sort of data they want to follow. In those cases, you need to develop manual systems that can store the data in a readily usable format. Even if you do have computerized systems, it may take considerable creativity to get your data into usable form.Your QI team's data collection plan needs to be very specific.
In some cases, this may mean going back to the planning stage and coming up with another solution. To meet these goals, our diabetes team will explore additional interventions (such as automatic HbA1c reminders for patients and providers and educational support-group sessions for patients held at the site where blood draws are done).Using a run chartA run chart can help a QI team monitor the success of its intervention by revealing trends in the data. It is normal to see an equal number of points falling above and below the average, but do not assume that every variation in the data is significant. What you're looking for in a run chart are meaningful trends and whether the average is shifting over time — for example, when data points begin to run predominantly on one side of an existing average or when data points trend either up or down with no reversals. More information on run charts and their interpretation is available elsewhere.1,2The chart shown here depicts a steady increase in data points over time. Instead, it suggests that the authors' QI intervention has indeed improved the practice's rate of ordering HbA1c tests.



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