Diabetes Awareness Day is on November 14: are you up to speed on one of our longer-running pandemics? The second part of our two-part interview with diabetes specialists Debra Dudley, RN, CDN, BS and Lori Weiss, BSN, RN, CPN, CDCES focuses on the challenges of caring for diabetics, advances in treatment, and reliable sources of diabetes information for nurses. Click to see Part One of this interview.
DN: What are the greatest challenges nurses face when working with diabetic patients?
“Time.”
—Debra Dudley, RN, CDN, BS and Lori Weiss, BSN, RN, CPN, CDCES
Debra Dudley: “One of the greatest challenges I have consistently faced over the course of my 50-year career is the lack of time. Time is more essential than ever because the nursing shortage has left many of us overworked. I would love to have daily visits with each patient – even if it’s just a few minutes – to help guide them on their journey because there isn’t always going to be a teachable moment with them during infrequent interactions. This leads to long-term consequences because so many of our diabetic patients return with the same issues. We aren’t able to dedicate the necessary time to provide them with the appropriate education on adequate self-care.”
Lori Weiss: “Time remains the most significant challenge for nurses because they are busy, they are experiencing an increased patient workload, and those patients often have complications that are compounded by their diabetes. Patient safety is imperative, and nurses must balance safety with efficiency in order to treat as many people in need as possible. In order to overcome these obstacles, processes must be implemented that improve workflows and simplify the ability for nurses to do the right thing.”
DN: What technological advances have had the greatest impact on diabetes treatment?
D. Dudley: “There have been significant developments in technology over the course of my career, especially when you consider that early in my career we would place tablets into tubes of urine to measure blood sugar. From an outpatient perspective, the evolution of the continuous glucose monitor has been the most important. It allows a person to check their blood sugar every five minutes, identify if the blood glucose is trending up or down, and make an adjustment based on that trend. There are also mobile applications that help with carb counting, meal planning and exercise tracking – and many of those are free to download.
As far as the inpatient setting, the eGMS insulin dosing software system has been amazing. Once a nurse inputs a blood glucose reading, its algorithms automatically calculate insulin adjustments in real-time. It takes into account a patient’s current blood glucose, their food intake, and how they have reacted to previous doses. This reduces the amount of time a nurse has to spend adjusting doses because they no longer have to reach out to a patient’s provider to make a dose change. Before using this technology, our staff was making a minimum of 3,000 calls per month to providers just for dose adjustments. The amount of time wasted processing dose adjustments was both staggering and frustrating. The use of the Glucommander eGMS has reduced our amount of monthly calls by 95% – from over 3,000 to 150 – and alleviated a significant amount of nurse burden.”
“It’s not uncommon now for patients to inform their nurse or provider of a new app that is helping them manage their diabetes.”
—Lori Weiss, BSN, RN, CPN, CDCES
L. Weiss: “While many of the foundational concepts and approaches to diabetes education and support have remained the same, the tools and resources at our disposal continue to change. Outpatient technology has experienced the highest volume of technological advancements. The most notable [developments] have been the personal and professional Continuous Glucose Monitors, the variety of insulin pumps designed to meet pediatric and adult patient needs, and the explosion of digital and mobile solutions. This has provided patients with more access to information and a deeper understanding of how their decisions impact their disease. It’s not uncommon now for patients to inform their nurse or provider of a new app that is helping them manage their diabetes.
Although the outpatient setting has been most affected by these advancements, the inpatient setting has been able to leverage technology as well. As a Certified Diabetes Care and Education Specialist (CDCES), it is difficult to stay current with all the changes in diabetes care and nearly impossible for a busy bedside nurse to keep track. The eGMS insulin dosing software system has provided busy bedside nurses with an easy and effective way to care for patients. It increases patient safety by eliminating human dosing calculations, streamlines workflow because the algorithms automatically calculate insulin adjustments in real-time, and reduces adverse outcomes associated with hypoglycemia and hyperglycemia.”
DN: What are the most useful sources of information for nurses providing care for diabetic patients?
L. Weiss: “There are many reputable sources both online and in print to assist nurses caring for diabetic patients, but I find the best sources of information to be from the American Diabetes Association and the American Association of Diabetes Care and Education Specialists. The ADA issues its annual “Standards of Medical Care in Diabetes” to help guide nurses and physicians on how to best treat patients with diabetes and glycemic management issues. This is available for free online and includes best practice information on topics that range from nutrition therapy to pharmacologic approaches and recommendations for use of technology. The ADCES provides online courses, practice tools and documents, and webinars from industry experts to share a wealth of knowledge in an ever-changing field.”
Click here to see Part One of this interview.
Debra Dudley, RN, CDN, BS: Debra’s nursing career has spanned 50 years and she has spent the past 25 specializing in diabetes education and glycemic management. She is currently the Clinical Diabetes Educator for AdventHealth Waterman in Tavares, Florida, and has extensive experience in Pediatrics, NICU, and Maternal Child Health. Debra is an industry leader in providing support for those with a diagnosis of diabetes or pre-diabetes and improving their self-management through informative discussions, classes, and support groups.
Lori Weiss, BSN, RN, CPN, CDCES: After spending more than 20 years on the frontlines as a nurse at health systems in Wisconsin and Dallas, Lori Weiss is now applying her field expertise at the insulin management software company, Glytec, where she serves as the Clinical Project Lead. Lori understands the complex processes, risks, and challenges providers face titrating insulin.
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