Diabetes Education Project – Tug River Health Association
Diabetes Education Project – Tug River Health Association
Questions
Pre-Visit Questionnaire
Myths
Diabetes Pre-Visit Questionnaire
Please bring your most recent two weeks of blood sugar readings and this form to your next visit.
Diabetes Myths
Eye doctor name / Last visit
___________________________________________________
Heart doctor name / Last visit ___________________________________________________
Foot doctor name / Last visit
___________________________________________________
Diabetes specialist name / Last visit
______________________________________________
Myths
1. Diabetes is not that serious a disease.
Not true! Diabetes causes more deaths each year than breast cancer and AIDS combined! Two out of
every three people with diabetes die from heart attacks or strokes. For more on complications of
diabetes, check out our “Definition” page.
~ in conjunction with ~
Insulin Doses
(Circle types below)
Humulin R Novolin R
Humalog Novolog
Humulin N Novolin N
NPH Lente/Ultralente
2. You only get diabetes if you are fat.
Sort of true. Being overweight does put you at higher risk of getting diabetes, but there are a lot of
others like family history, age, and race. A lot of overweight people never get diabetes, and there are
many people with diabetes who are normal weight or even thin.
Lantus
3. Eating too much sugar causes diabetes.
Not true! Diabetes is caused by genetics and the way you live your life. Eating too much sugar and
being overweight does increase your chance of diabetes, but doesn’t mean you will get it for sure. If
diabetes runs in your family, eating healthy meals and exercising are good ways to lower your risk of
diabetes. For more on this, check out our “Nutrition” or our “Lifestyles” pages.
Humulin or Novolin
70/30
Humulin or Novolin
50/50
Lunch
Units
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Units
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Units
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Units
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Units
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Dinner
Units
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Units
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Units
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Units
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Units
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Bedtime
Units
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Units
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Units
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Units
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Units
______
What is the most important thing you hope to get out of your visit today?
_____________________________________________________________________________________
_____________________________________________________________________________________
4. People with diabetes have to eat special, expensive diabetic foods.
No! Healthy meals for diabetics are generally the same as healthy meals for anybody. Special “diabetics
foods” don’t add any special benefit. Meals low in fat and grease and high in fiber, grains, fruit, and
vegetables are good for anyone.
5. People with diabetes have to stop eating all the stuff that tastes good.
Not really. What type of food you eat isn’t as important as how much of it you eat. As long as the
amounts of fat, fiber, protein, and starches are balanced well, you can still eat things that taste good –
even candy sometimes. The key is portion size. Talk to your doctor about how to do this – it’s not that
hard!
Morning
Units
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Units
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Units
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Units
______
Units
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What concerns you the most about your diabetes?
_____________________________________________________________________________________
_____________________________________________________________________________________
TUG RIVER HEALTH ASSOCIATION, INC.
Current Exercise: List types of exercise you do _____________________________________________
How often do you exercise? _________________ How long do you usually exercise? _______________
If you cannot exercise, list the reasons
_____________________________________________________________________________________
_____________________________________________________________________________________
6. If you have diabetes and have to start using insulin, it means your diabetes is getting worse.
Sort of true. For most people, diabetes gets worse as they go through life. The difference is how fast it
gets worse. Sometimes medication by mouth stops being enough to help. However, using insulin to
control your blood sugar is a good thing, not a bad thing.
List any trips to emergency room, hospital admissions or surgical procedures since your last visit
_____________________________________________________________________________________
_____________________________________________________________________________________
How would you describe your overall health? Excellent
Good Fair
Poor
Please circle yes (Y) or no (N) to the following questions about your life and concerns
* For an informational video about diabetes facts, look on YouTube at:
http://www.youtube.com/watch?v=ONUj0v3SJ8U
Diabetes Education Project – Tug River Health Association
Questions
*Adapted from www.diabetes.org and www.cdc.gov
How often do you test your blood sugar? (circle answer)
Rarely When I feel bad
Once a week
1 or 2 times a week
Daily
Twice daily
4 times daily
What time do you usually test blood sugar? (circle all that apply)
Fasting After breakfast Before Lunch After Lunch Before Supper After Supper Before bedtime
How do you treat low blood sugar episodes? (Circle) Glucose tablets Juice Fruit Other ___________
Topics:
•Pre-Visit Questionnaire
•Definitions/Statistics
•Common Medications
•Common Labs
•Exercise
•Diet Tips/Nutrition
•Pediatrics & DM
•Diabetes Myths
•When to Call the Doctor
•Lifestyle Changes
•Wound Care
•Eye Care
•Sliding Scale Explained
•Resources
(circle one)
Y N
Y N
Y N
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
I have trouble doing household chores
I have missed work due to diabetes
I have trouble going up and down stairs
I have cut back on social functions (hobbies,
church, clubs)
I have trouble with my energy level
I have concerns about my sexual function
I have trouble with sleep
I have trouble affording my medications
I have trouble with concentration
I have trouble managing my medications
Y
Y
Y
Y
N
N
N
N
I am thirsty and drink a lot
I lose control of my urine and get wet
I urinate a lot
I have numbness, tingling or pain in my feet and legs
Y N
Education in
Rural Appalachia
Abilities, symptoms and concerns
Y N
Y N
Y N
Y N
I have chest pain or shortness of breath when I do
work, exercise or get upset
I get shortness of breath that limits my usual
activities; Y N I have swelling in my legs
I have pain in my legs that makes me stop when I
walk
I have lost interest in, or no longer enjoy the things I
used to enjoy doing
I would like more information about (circle all that apply )
Eating the right things
Insulin
Safe exercise
My medications
Foot care
Alcohol use and diabetes
Stopping smoking
High blood pressure
What to do if I am sick
Cholesterol
*Adapted from the Summa Health System Questionnaire at www.ahrq.gov
Diabetes Education Project – Tug River Health Association
Blood Tests
Common Blood Tests & Terms

Hemoglobin A-1-C (HEE-moh-glo-bin): a test that measures your average sugar level for the
past 2 or 3 months

Anemia (ah-NEE-mee-uh): when your red blood cells are too low

Blood Sugar: the main source of energy in your body. Too much or too little can be bad!

Cholesterol (koh-LES-ter-all): a type of fat that can build up on your blood vessel walls and
cause blockages, like heart attacks or strokes

o
HDL: the “good” cholesterol that helps store fat
o
LDL: the “bad” cholesterol that causes more fat to build up in blood vessels
Creatinine (kree-AT-ih-nin): a waste product that is usually cleared by your kidneys, but it can
build up if you have kidney damage

Fasting Blood Sugar: a check of your blood sugar when you have not had anything to eat for at
least 8 hours

Glucose Tolerance Test: a check of your blood sugar 1 or 2 hours after drinking a sugar drink

Urinalysis (yer-in-AL-ih-sis): a test of your urine for sugar, protein, blood, and dehydration

Urine Microalbumin (MY-crow-al-bue-min): a test for early kidney damage

Ketones (KEE-tones): a chemical in your blood or urine that is made when the body uses fat
instead of sugar for energy

BMP (Basic Metabolic Profile): a blood test for sodium, potassium, kidney function, and sugar

CMP (Complete Metabolic Profile): a BMP plus liver function, gallbladder function, and calcium
*Adapted from www.diabetes.org
Abstract
Introduction:
Diabetes education has long been a problem at rural health sites like Tug River Health
Association at Gary, WV. Many providers expressed a need of handouts on diabetic topics
that are both informative and written on an appropriate educational reading level for the
local population where most do not have access to internet resources at home and only half
of the county’s population has a high school diploma.
Methods:
Multiple providers were surveyed informally regarding diabetic topics that they felt needed
more attention. A total of 14 topics were identified. Information was gathered and printerfriendly handouts were created on each topic. These handouts were then posted on a
newly created webpage along with a printable home glucose log sheet and links to other
websites.
Results:
Construction of the website is still underway, therefore no results are available at time of
print. Anticipated results will be that the handouts can be printed and given to patients to
help further the understanding of their disease.
Conclusions:
Access to and comprehension of complex medical information can be challenging to
patients as well as providers in rural areas. Further work is needed to help expand the
availability of information in rural areas.
Diabetes Education Project – Tug River Health Association
Log
2-Week Glucose Logbook
Date:
Glucose / Insulin given
Glucose / Insulin given
Glucose / Insulin given
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*Check your blood sugar and call your doctor:

for any blood sugar higher than 500.

if you start feeling dizzy, light-headed, or have trouble concentrating.

if you are vomiting and can’t keep food down.

if your vision suddenly gets blurry and won’t clear up.