The structure of diabetes knowledge needed for insulin pump patients

  Diabetes education is divided into two blocks: systematic knowledge of diabetes education and education related to insulin pumps.?  The first block is the foundation, and the second block is the in-depth and comprehensive practice of the latter [4]. The process of diabetes education should be carried out following the principles of gradual progress, from easy to difficult, integration of theory and practice, doctor-patient interaction and quantifiability. Currently, diabetes education in China generally does not do enough on the principles of doctor-patient interaction and quantifiability. Patient-physician interaction emphasizes the active participation of the patient at each knowledge node within the framework of systematic knowledge training. The principle of quantification means that the measures must be digitally and quantitatively feasible, which is something that domestic doctors tend to ignore. For some older people, we can tell them to reduce one to two portions from the original ten portions, specifically tell them to leave two bites of rice for each meal, and for some people with high level of knowledge, we can specifically explain that each two bites of rice is equivalent to 77 kilocalories, and to reduce 1 kilogram of fat per month, we need to reduce 7000 kilocalories and other quantifiable knowledge points. For example, in the past, doctors used to talk about drinking sugar water, but now in the popularized version of diabetes guide, they talk about the concept of two 15s, 15 grams of carbohydrates and re-testing blood sugar after 15 minutes is a quantifiable and feasible plan. Soda crackers.  In the systematic diabetes education, we should focus on the interaction between diet, exercise and medication, the management of hypoglycemia, the concept of carbohydrate in food and how to calculate it, the concept of basal insulin and mealtime insulin, and the management of special critical situations, as well as the establishment of the concept of patient safety (such as identification cards and spare insulin syringes). The concepts of carbohydrate and glycemic index are particularly noted here. Carbohydrate is the factor that directly affects the rise of blood glucose after a meal, while fat and protein meals affect the subsequent blood glucose by delaying food absorption and increasing insulin resistance. The concept of carbohydrate factor (Carb factor) is commonly used overseas to guide patients on how much to eat and how many units of insulin to take. Carb factor refers to how many grams of insulin can normalize the rise in blood glucose caused by one unit of insulin within 3-4 hours. However, this is less feasible in China, because Chinese food is mostly processed mixed food it is difficult to calculate the amount of carbohydrates in food, while many foreign food packages have a food composition table indicating the carbohydrate content of each serving, which is something our country needs to learn from in the future. The glycemic index is the parameter in referring to the same amount of carbohydrates causing the glycemic effect. Foods with a high glycemic index have a rapid increase in blood sugar after intake but a relatively short maintenance time, and compared with eating the same amount of carbohydrates with a low glycemic index food, it is easy to have a postprandial hyperglycemia before the next meal in the case of a large dose injection. Education related to insulin pump mainly involves teaching patients how to fill insulin, subcutaneous placement of needles, setting the basal rate and high dose of insulin pump, and handling of common alarms, etc. Education on the advanced functions of insulin pump is often put on the patient’s proficiency in these skills and then taught one by one according to the patient’s condition.