The Science of Diabetes Self-Management and Care

The Biostator Glucose Controller is a closed loop artificial pancreas system which delivers insulin or dextrose to an individual while providing continu ous monitoring of the blood glucose level. The Biostator requires only a small amount of venous blood which continuously flows through the machine to analyze blood glucose concentrations. The controller's feed back system provides a printed minute by minute account of blood glucose levels as well as noting the amount of insulin or dextrose required to normal ize the glucose concentration. By al lowing the patient to exercise, and by controlling meal times, an attempt is made to simulate the patient's normal daily routine while on the machine. Thus, the Biostator aids tremendously in planning an accurate and individ ualized medical regime for the person with Type I diabetes.

The majority of patients placed on the Biostator are either brittle Type I diabetics, pregnant diabetics, or pre- pump patients. Nursing care is coupled with an interdisci plinary team approach in order to assist the patient to bal ance nutrition, exercise, and insulin requirements. Biosta tor patients are involved in an extensive diabetes education program that includes individual instruction as well as group activities. This article provides information on how diabetes patient education can be enhanced through knowledge gained from the Biostator run. Nursing care is comprehensive and complex. Although the Biostator is supervised by an endocrinologist, various procedures are performed by specially trained nurses such as set-up of the instrument, connecting the patient to the Biostator, calibrat ing the instrument, and programming the computer. The responsibilities of the monitor nurses, including drift checks, documentation, and trouble-shooting, are described in de tail. Since exercise and diet are major components of thera py for Biostator patients, the dietitian and physical therapist work closely with the monitor nurse in simulating the pa tient's normal daily activity. It has been our experience that caring for the Biostator patient involves comprehensive fol low-up. This article describes various components neces sary to accomplish this objective.

Exercise was incorporated into the treatment of diabetic patients on the Biostator. As the purpose of the Bio stator is to determine the patient's in sulin requirements over a 24 hour pe riod, activity and exercise are impor tant to normalize that 24-hour period as much as possible.

Individual exercise programs were developed for each of the patients on the Biostator. The most common ex ercise vehicle chosen was a bicycle ergometer. Physical Therapy devel oped these programs based on the pa tient's "Home Activity Assessment. " Nursing and Physical Therapy then monitored the patient's compliance with the exercise program during the "run" on the Biostator.

The Biostator print-out (see Table I, p. 13) was used in a retrospective study of the effect of exercise on the patient's blood glucose levels. It was found that the median decrease in blood sugar immediately after cessa tion of exercise was - 6mgldl and for 15 minutes after cessation of exercise was — 12mg/dl. Empirical data is im portant to the patient so that they may balance exercise, diet, and insulin to keep blood glucose levels in control.

The Biostator Glucose Controller requires a profession al team that has received specialized training in setting up the machine, monitoring, and troubleshooting the system. The training program at United Hospitals of St. Paul covers a three-day orientation, plus further education for set-up and monitoring, hands on exploration through the use of worksheets and practicum assignments, and reviews of procedures every couple of months as needed.

One expanded role for a diabetes educator is that of the Biostator Nurse Specialist, who has the overall respon sibility for the Biostator and its operation. The technical education required of the nursing staff is delineated in this article in terms of specific competencies that are required, monitoring skills, and evaluation.

A retrospective survey of a dietary education program was mailed to 23 families with IDDM children diagnosed under the age of five years. Of the 18 questionnaires returned, results showed that, once educated, the par ents of young diabetic children identi fied the majority of diet-related prob lems as: 1) managing the deviations of meal routines, 2) behavioral issues, 3) illness, and 4) special occasions.

The incidence of Type I diabetes mellitus in children less than two years of age appears to be on the increase. Management of this age group is ex tremely challenging. Education and management should be individualized and needs to focus specifically on this developmental stage.

This article will describe normal de velopmental milestones for the child less than two years of age and present the approach used at The Children's Hospital in Boston, Massachusetts in the management of Type I diabetes occurring in this age group.

Because diabetes in a child has such a dramatic impact upon the whole family, a chapter of the ADA-South Carolina Affiliate formed a Parent Support Group to offer hospital visita tion opportunities for parents to share their emotional feelings and frustra tions, and to offer support and accept ance.

The American Association of Diabetes Educa tors combines a diversity of professions and practices in its membership. To focus on the spe cial contributions of each discipline a common diabetes management or educational problem will be addressed periodically, using a team ap proach.