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Diabetes Mellitus Type 2

Clinical Care

Diabetes Nurse Clinician

Alvin contacted the Diabetes Center and was scheduled for a series of classes, beginning within the week. He was glad to hear that his wife was welcome to attend with him. At the first class, taught by a registered nurse and a clinical dietitian, Alvin learned the signs and symptoms of diabetes, how the diagnosis is made, and the common treatments. He also found out that the long-term complications of diabetes include eye problems, heart and blood vessel disease, kidney disease, foot problems, nerve damage and sexual dysfunction.

The nurse, Maureen Ireland, taught the class to use their glucose monitors. She observed the testing technique of each patient, and emphasized the need for hand washing before each test. This would be especially important for Alvin, given his work as a car mechanic. She noted that his particular brand of monitor is approved for alternative site testing, and taught him how to test on his forearm, as well.

Nurse Ireland showed the class how to record the results of their testing in a diary. She suggested that everyone test each morning, and before and after one meal a day, alternating which meal they chose. She said the morning, or fasting, blood sugar indicates overall metabolic control, while the tests before and after a meal will tell how the person responds to carbohydrate intake.

Nurse Ireland told the class that the target range for blood glucose tests is between 80 -- 120 mg/dL before meals and below 140 mg/dL two hours after meals. She said that the goal is to have at least 50% of test results in this range.

After class, Alvin stayed to ask Nurse Ireland a question about his HbA1c reading of 16.4%. He was scared that his result was so far from normal. He talked about his mother and her kidney failure, because in class he had learned that kidney failure can be caused by diabetes. Nurse Ireland reassured him that although kidney disease is a long-term complication of diabetes, we now know it can be prevented with good management. She emphasized the importance of self-blood glucose monitoring, a breakthrough that came too late for his mother.

She told Alvin they would review his test results in two weeks, at his second class, and that he could call her in the meantime if he had concerns.