What is diabetes education?

Debby Nowack
Nurse and Certified Diabetes Educator, Outpatient Nutrition and Diabetes Education Center

What is diabetes education anyway? The American Diabetes Association and American Association of Diabetes Educators have established guidelines for information taught in diabetes education programs. 

Man on a bicycleLuckily, diabetes education is not about someone telling you what you can and can’t eat. Rather, diabetes education includes suggestions about how much of various foods is recommended, but you pick the food. Diabetes education also includes the knowledge and skills for daily routines such as when to take diabetes medication and how and when to check blood sugars as well as daily foot care and safety tips for physical activity. Diabetes education can help patients understand what to do when blood sugars run too low or too high, how to read food labels, how to improve cholesterol and blood pressure (very important for many people with diabetes) and when to call your doctor. 

Durham Regional offers diabetes and nutrition programs at our Outpatient Nutrition and Diabetes Education Center, located at 407 Crutchfield Street in Durham. For 2012-13, we have been recognized by U.S. News & World Report as one of the best hospitals in North Carolina. Our diabetes care received special recognition as a high-performing area. To learn more, visit our website.

These are some of the comments participants have made after attending our diabetes education classes:

“The instructors and classes were great and easy to understand. I really learned a lot of important information that will help me improve my diabetes and overall health.”

“Everyone who has diabetes needs this class. It helps give you confidence and accept the disease. It has helped me a lot.”

“I was very nervous at first because I was unfamiliar with diabetes. The more classes I attended the easier it got and the smarter my wife and I got.”

“Very excellent instructors and materials. Class is well worth the time. It helps you understand diabetes and how to deal with the stress and problems of the disease.”

“Very helpful. Comfortable setting! Calmed my fears and answered all my concerns and questions! What a blessing!”

“All the classes were helpful and presented in an understanding manner. There was always adequate time for questions and discussion.”

Acetaminophen: How much is too much?

Pat Lester
Nursing Program Coordinator, Unit 7-1 Orthopaedics/Neurosurgery

We use acetaminophen to relieve headaches, backaches, arthritis pain, cold symptoms and fever.  But do you know how much is too much? The following scenarios show how someone like me might take acetaminophen throughout the day.

I have been meaning to make an appointment for this darn knee. It’s so achy and stiff that I take a few Tylenol, and walk out to the car and drive to work. The car is covered in pollen, and I swear I can see clouds of it in the air. Oh boy, my eyes are starting to itch already. I dig through my bag in search of my Sudafed Sinus. There it is. I wonder briefly if it’s ok to wash it down with coffee. Well, it’s all I have. Today promises to be another busy day.

A few hours later, I have walked several miles on the unit; I have pushed and lifted what feels like a ton at least. My feet are sore and my back aches. One of my co-workers has some Excedrin Back and Body that she swears by. I take a few to get through the rest of my 12-hour shift.

Home at last! I eat some leftovers and watch a few episodes of my favorite reality show, and then it’s bedtime. I stare at the ceiling thinking I shouldn’t have had that last cup of coffee. I’m exhausted but can’t sleep and that stupid knee is aching again. Sighing, I head to the bathroom for some Goody’s PM. Tomorrow I am making that appointment!

So how much acetaminophen is too much? According to MedlinePlus, the average adult should take a maximum of 4,000 milligrams (mg) of acetaminophen in 24 hours. That’s two tablets (650 mg) every four hours. Sounds easy enough to stay below the limit, doesn’t it? But did you know that acetaminophen is an ingredient in many different products? For example, Alka-Seltzer Cold, Midol PMS, Nyquil Cold and Flu, Sominex Pain and Triaminic Cold and Fever all have acetaminophen as a main ingredient. Pain medications like Norco, Percocet and Ultracet combine another pain reliever with acetaminophen. You can see from the scenario above how easy it can be to exceed the daily limit.

When pain strikes, be sure to read the labels of all medications you are taking to stay below the daily limit! Ask your doctor or pharmacist if you have questions about acetaminophen or other medications.

Visit MedlinePlus, a service of the U.S. National Library of Medicine and National Institutes of Health, for a list of medications that contain acetaminophen.

Durham Regional receives award for heart attack care

Michael Komada, MD
Cardiologist

At Durham Regional, we are dedicated to providing timely, expert care to heart attack patients. This takes a team and great collaboration across many departments within the hospital, as well as with local EMS and other facilities.

2012 Mission: Lifeline Silver AwardDurham Regional recently received the American Heart Association’s Mission: Lifeline Silver Receiving Quality Achievement Award. This award recognizes the hospital’s commitment and success in implementing an exceptional standard of care for heart attack patients.

We are excited to be recognized for this achievement, and I am proud of our dedication to continuous improvement in cardiac care.

Each year in the United States, nearly 300,000 people have a STEMI, or ST-segment elevation myocardial infarction, the most severe form of heart attack. A STEMI occurs when a blood clot completely blocks an artery to the heart. To prevent death, it’s critical to immediately restore blood flow, either by surgically opening the blocked vessel or by giving clot-busting medication.

Hospitals involved in Mission: Lifeline are part of a system that makes sure STEMI patients get the right care they need as quickly as possible. Mission: Lifeline focuses on improving the system of care for these patients and at the same time improving care for all heart attack patients.

As a “STEMI Receiving Hospital,” Durham Regional meets high standards of performance in quick and appropriate treatment of STEMI patients to open the blocked artery. Before discharge, patients start aggressive risk-reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers, and they receive smoking cessation counseling if needed. Hospitals must adhere to these guidelines-based measures at a set level for a designated period of time to be eligible for the achievement awards.

In 2011, Durham Regional received the Bronze Quality Achievement Award. Bronze represented one quarter of meeting or exceeding quality measures. By receiving Silver, Durham Regional achieved four quarters (or one year) of consecutively meeting all the goals outlined by the American Heart Association with the focus on first medical contact to angioplasty in less than 90 minutes.

For information about our heart services, visit durhamregional.org/heart.

Supplements before surgery? Talk to your doctor

Pat Lester
Nursing Program Coordinator, Unit 7-1 Orthopaedics/Neurosurgery

Not long ago, I read the March/April 2012 issue of Arthritis Today. I was surprised to learn some ordinary herbs and supplements, like glucosamine and chondroitin, can cause complications after surgery. Complications like slow healing and bleeding can occur when these herbs or supplements are taken along with anticoagulant medications your doctor has prescribed (such as aspirin, Coumadin, Lovenox or Xarelto). Since many knee and hip replacement patients are prescribed these anticoagulants after surgery to reduce the chance of developing blood clots, I did a little investigating. 

Assortment of pills and supplementsFish oil, garlic, ginger, ginkgo, red clover, turmeric and Vitamin E are other dietary supplements that can increase the risk of bleeding when taken with Coumadin, Lovenox or Xarelto. St. John’s wort, taken for centuries to combat depression and anxiety, can reduce the effectiveness of anticoagulants. Coenzyme Q10, rice bran and rhubarb also block the absorption of anticoagulants, increasing your risk of developing a blood clot after surgery.

If you or a loved one is planning to have surgery, remember to tell your doctor about any herbal and over-the-counter medications. According to my favorite sources—our own Durham Regional physicians— the rule of thumb is to stop taking these supplements two weeks before surgery; then ask your doctor before taking them again.

FAQ about breastfeeding

Ellen Byars,
Clinical Nurse I
, Unit 4-3 Mother/Baby

These are three of the top questions asked about breastfeeding in Women’s Services at Durham Regional Hospital.

Why won’t my baby wake up to feed?
Women's Services at Durham Regional HospitalBabies aren’t too hungry the first day of life because they fed continuously for nine months before delivery. Offer the breast when your baby shows feeding cues or every two to three hours. Feeding cues include sucking or bringing hands to mouth, rooting, smacking sounds, lip licking and general alertness. Expect only three to five good feeds during the first 24 hours of life. After that, your baby will “wake up,” and you should be able to get him or her interested in going to the breast every two to three hours or more. Feed on demand as your baby shows cues. You can also try to rouse your baby by holding him or her skin-to-skin and changing his or her diaper before a feed. (Skin-to-skin means no shirt, hat and blanket; only a diaper. This keeps the baby from feeling too cozy and thinking he or she can just settle in for a nap instead of work hard and breastfeed.)

It hurts when I breastfeed. What can I do to keep from hurting?
The initial latch may hurt or pinch for the first minute or so of feedings, and then you should only feel a strong tug. If you continue to be in pain throughout the feeding, question the latch as it may not be deep enough. Ask your nurse or lactation consultant in the hospital for help latching and with positioning. It’s what we are here to do, and we’re happy to help!

My milk isn’t in yet, so my baby must be starving! Is my baby getting enough to eat?
Babies’ tummies are the size of a marble, so it takes only a small amount of nutrient-dense colostrum to fill them up and give them exactly what they need. Colostrum is available for your baby until your milk arrives. You will know if the baby is getting enough to eat by the number of wet and dirty diapers, audible swallows (sounds like a soft “k”) and weight. However, some weight loss is expected—up to 10 percent loss of birth weight is okay.

Do you have questions about breastfeeding? Leave them in the comments below!

Breast or bottle: We support new moms

Ellen Byars,
Clinical Nurse I
, Unit 4-3 Mother/Baby

When expectant parents arrive at Durham Regional Hospital to have their baby, they receive excellent labor and delivery, nursery and postpartum care. There are many decisions to make before and after the baby arrives, including how to feed your little one: breast or bottle?

Women's Services at Durham Regional HospitalSome moms mull over this question before the baby arrives; others ask for the support of their care team. In Women’s Services, we are committed to helping moms make the best choice for themselves and their newborn, and we stand behind your family’s choice.

If you are considering breastfeeding your baby, keep in mind that breastfeeding is nutritionally better and offers complete sustenance for your newborn. All our nurses are trained to assist moms with positioning, education and resources to be as successful as possible with breastfeeding.

Earlier this year, Durham Regional was awarded three stars by the North Carolina Maternity Center as a “breastfeeding friendly” hospital. This means our hospital met certain criteria in our promotion of breastfeeding for moms, which ultimately leads to positive outcomes for moms and babies. The Women’s Services team is proud of this distinction. Read more about it at durhamregional.org.

Coming soon: Answers to the most frequently asked questions about breastfeeding.