OTHER CONSULTATIONS AT THE DIABETES CENTER

OTHER CONSULTATIONS AT THE DIABETES CENTER

A number of other medical services at Hospital da Luz Lisboa play a key role in the Diabetes Center.

The following consultations are available through the Diabetes Center:

  • Nursing Consultation

    Diabetes Mellitus is a chronic disease implying behavioral changes and, frequently, the learning of a number of techniques, such as measuring capillary blood glucose, insulin or glucagon administration, the use of continuous insulin pump systems and continuous blood glucose monitoring. In order to teach these techniques, close monitoring is required not only to ensure that these new interventions are being carried out correctly, but also to guarantee a higher level of safety for diabetic people and their family members.

    Patient education and close monitoring are both performed during diabetes nursing consultations. These consultations are geared towards helping diabetic people maintain autonomy, thus acting as a connection between the medical consultations and the individual in treatment. The nurses responsible for this consultation are specifically trained in differentiated and personalized monitoring of diabetic patients, and are equally attentive to the emergence of secondary complications related to this disease, such as diabetic foot wounds

    Recording of weight

    Weight is one of the most important parameters in the monitoring of diabetes. Record your weight, preferably using the same scale and the table here, which may be printed.

    Hemoglobin A1c

    The Hemoglobin A1c value represents the average blood glucose levels over the three months prior to its measurement. It is an essential value for monitoring the disease. Record your value using the table here, which may be printed.

    Insulin injection sites

    Insulin injection sites should be varied. When always injected in the same place, there is a risk of insulin accumulation: in some cases insulin is not absorbed (resulting in an increase in blood glucose levels), while in others an excessive release of insulin has been found in the blood stream (resulting in a drop of blood glucose levels).

    Rapid acting insulin should be injected into the abdomen, where absorption is slower. If this type of insulin is administered in parts of the body where absorption is quicker, such as the thighs or upper limbs, absorption may be too rapid and induce hypoglycemia. Therefore, these areas should be reserved for the use of slower acting insulin.

    For those who have practiced exercise with the lower limbs (running or power-walking, for example), injection of insulin into the thigh area should be avoided (due to the risk of excessively rapid absorption). If exercise involves mainly the upper limbs, for the same motive, insulin injection is not recommended in those areas.

    The image available here, which may be printed, indicates the possible sites for insulin injection. Remember to find out from your doctor and nurse what the best and most appropriate technique and options are.

  • Nutrition Consultation

    Nutrition in diabetes does not mean that a standard diet should be followed by all diabetic individuals. 

    Individual characteristics and goals need to be acknowledged by adapting the diet to the needs of each patient. This, in addition to taking the medical assessment into consideration, is the ideal way to establish a successful plan for the future.

    Overall, it is generally accepted that nutritional therapy in diabetes is grounded on the principles of attaining a healthy weight, nutritional balance and suitable control of blood glucose levels.

    In addition to defining the overall nutritional strategy for each patient in this consultation, it is also important to define strategies for the different situations that emerge in daily life. Adaptations may be developed based on level of physical exercise, travelling, parties and special occasions, for example.

    Carbohydrate counting is a particularly useful tool for calculating the insulin doses needed for treatment of Diabetes Mellitus Type 1.

    The special needs caused by excess weight are also relevant. The monitoring of individuals who have been subject to bariatric surgery, an option made available to those with type 2 diabetes, is highly specialized and calls for the intervention of a team with vast experience in this area. The exchange of experience among health professionals, brought about by the proximity between medical and nutrition consultations fosters important gains in terms of assistance and the options available to those who participate in the nutrition consultation.

    Moreover, and perhaps more importantly, the nutrition consultation provides an trained interlocutor to clarify emerging doubts related to appropriate nutrition, for those with diabetes and for other professionals. The goal is always to provide improved levels of monitoring in the present and the future.

    Carbohydrate counting

    The counting of carbohydrates is a very useful tool for calculating the insulin dosage required for treatment of Diabetes Mellitus Type 1.

    Mealtimes are moments in the day when blood glucose levels may rise. The aim of injecting rapid acting insulin helps avoid such situations, without the occurrence of hypoglycemia. In order to attain a more accurate calculation of the real need for rapid acting insulin, the carbohydrates in the meal are counted.

    It should be noted that, since insulin is generally injected before a meal, it is important to know what the meal contains. Carbohydrates that will not be eaten should not be counted (as in this case the insulin dosage would be excessive, and could trigger hypoglycemia), and food that was not included in the count calculation should not be eaten (which would result in higher levels of blood glucose).

    In order to obtain a list of equivalences of carbohydrate portions that may be used in this count.

    Further information may be provided in the Diabetes Consultation or the Nutrition Consultation.

    o Nutrition (for more information on team members and their areas of specialization 
    o Contacts and other ways to book an appointment (click here)

     

  • Psychology Consultation

     

    For optimal monitoring of diabetes, it is fundamental for diabetic individuals to manage their options in life and behavior in a healthy, conscious and balanced manner. Furthermore, they need to implement therapeutic and self management measures correctly.
    This adaptation process may require more specialized support which is available by means of a psychology consultation.

  • Podiatry Consultation

     

    Podiatry is an area of medicine that specializes in the research, prevention, diagnosis and treatment of alterations of the foot and ankle, and is performed by qualified podiatrists.
    Management of diabetic foot is one of the principal areas of podiatry intervention.
    Foot care, such as regular self-examination and the implementation of some simple measures, are crucial to health maintenance and early identification of alterations.
    Hence, general guidelines recommend the following self care:

    • Maintain a good standard of foot hygiene
    • Keep toenails short and clean
    • Avoid walking barefoot
    • Choose leather footwear and cotton socks or fibers that prevent excessive perspiration
    • Wear comfortable footwear, with length and width measurements tailored to foot size
    • Examine footwear to ensure there are no seams, irregular edges or foreign objects that may hurt your feet
    • Practice physical exercise on a regular basis
    • Stick to a healthy diet
    • Do not smoke