Diabetes continuing education course

Course Objectives

• Discuss the etiology and epidemiology of diabetes and foot disease related to diabetes.
• List the chronic complications of diabetes.
• Discuss the classification of diabetes.
• Discuss current evidence-based research trials in relation to diabetes and exercise, neuropathy, education and outcomes, drug therapy, ulcers, amputations, visual disturbances, and gait.
• Discuss the epidermal barrier and the importance of skin integrity and proper healing environment for patients with diabetes.
• Identify the function of insulin in epidermal barrier homeostasis.
• Identify specific diabetic medications and their effect on the musculoskeletal system.
• Describe AGE’s and the implication on collagen and bone.
• Identify lab values and the impact of specific values on treatment and goals.
• Describe the impact of high insulin levels on the nervous system.
• Identify peripheral and autonomic neuropathy and plan appropriate treatment programs.
• Identify visual dysfunction due to prediabetes and diabetes.
• Discuss insulin resistance and the impact on the cardiovascular and musculoskeletal system.
• Identify normal A1C and the impact of higher levels on healing.
• Perform a comprehensive foot examination and risk assessment.
• Perform a foot evaluation testing for range of motion, strength, skin integrity, foot deformities, gait dysfunction, temperature variances, protective sensation, proprioception, capillary filling time, and ABI.
• Identify sensation loss and LOPS with proper monofilament testing.
• Discuss the role of appropriate skin and foot care, education, and footwear selection in the prevention of ulceration and lower extremity amputation.
• Discuss the implications of longstanding neuropathy nerve function and recovery.
• Describe the factors that can increase the risk for diabetic ulcers and amputations.
• Educate and guide a patient through appropriate foot care and footwear selection.
• Identify objective range of motion deficits in the foot that can lead to injury and potential skin breakdown.
• Implement appropriate targeted Physical Therapy intervention for individuals with diabetic neuropathy.
• Educate patients on the tools needed to prevent the chronic complications of diabetes?ABCs of Diabetes.
• Discuss the impact of exercise on neuropathies
• Identify the stages of Charcot’s and develop a comprehensive program to address the musculoskeletal and neurological deficits for better function.
• Develop a patient education program for patients with diabetes.
• Evaluate for peripheral vascular disease.
• Identify structural foot deformities such as Charcot’s, bunions, rigid deformities, calluses
• Identify the specific range of motion needed in the lower extremity during the gait cycle to minimize events that can cause injury.
• Educate the diabetic patient on proper foot and toenail care, and the prevention of amputations.
• Educate patients on the ABC’s of diabetes management and prevention.
• Discuss studies on TaiChi, vibration therapy and specific therapeutic exercises and the impact on neuropathies, glucose levels cardiovascular health and musculoskeletal balance and strength.

Learn from the Expert Mitzi Hazard, PT, CDE, C.Ped.

Mitzi Hazard, PT, CDE, C.Ped. graduated cum laude from California State University at Long Beach with a BS in Physical Therapy in 1992. She received her national board certifications as a diabetes educator from NCBDE in May of 2003 and as a pedorthist from BCP in June 2005. Her professional passion is the achievement of techniques and programs that maximize the healing of wounds. Ms. Hazard has dedicated a major portion of her career to studying effective treatments for wound care and to the prevention and treatment of diabetic neuropathic wounds. She worked for Olympic Medical Center (OMC) in Sequim, Washington from May of 1999 until 2004. She was the manager of rehabilitation services and a diabetes educator in the OMC ADA-accredited diabetes self-management education program. She served as a wound care resource for both rehabilitation and nursing staff consulting on difficult wound cases of arterial, venous and neuropathic origin. She has developed staff education programs related to diabetes, wound care, custom foot orthotics and the diabetic foot in the geriatric population. In November 2004, she opened her own private practice, Feet First Custom Orthotics, specializing in custom foot orthotics and diabetic neuropathic ulcer management. Mitzi Hazard joined Jefferson Healthcare’s team of medical professionals in 2009 as a Physical Therapist. She is also the Clinical Supervisor and part of an expanding staff of highly skilled physical therapists in demand in eastern Jefferson County.

Understanding CDC statistics

• A1C
• Global facts
• Death rates in people with diabetes
• Exercise and diabetes
• Understanding Prediabetes
• CDC maps of population throughout US with prevalent diabetes
• Chronic complications of diabetes
• Coexisting conditions
• Cardiovascular disease
• Microvascular risk
• Blood pressure

Risk factors for Diabetes

• Insulin levels
• Metabolic syndrome
• CVD
• Autonomic neuropathy
• Heart disease
• Polyneuropathy
• Urogenital autonomic neuropathy
• Distal symmetric polyneuropathy
• AGE
• LOPS
• Ocular manifestations
• Retinopathy
• Nephropathy
• Markers- higher rates of mortality

Diabetic retinopathy

• Risk factors of retinopathy outlined-factors that affect treatment
• Diabetic proliferative retinopathy
• Small vessel disease
• UK PDS Trial
• Disordered bone metabolism

Diabetes - The Clinical Details

• What is diabetes?
• Questions/answers about glucose testing
• Discussion about testing A1C
• Lab tests to determine diagnosis of diabetes and extent
• Carbohydrates and glucose testing

Understanding A1C, Insulin and Amputation Risk

• A1C for diagnosis?
• Prediabetes
• Diabetes screening
• Food choices
• Neuropathy education
• Diabetes prevention
• Epidermal barrier
• Collagen
• Glycation
• xerosis
• Insulin and the epidermal barrier
• Diabetic foot epidemiology
• Morbidity and mortality
• Ulcer prevention
• Prevention of amputation
• Cost of diabetes

Objectives for foot assessment

• Functional status
• Preventing ulcerations
• Ulcerations
• Amputations
• Diabetic foot epidemiology
• Pathophysiology of the diabetic foot
• Risk factors
• Peripheral neuropathy
• Peripheral vascular disease
• Trauma

Limited joint mobility increase risk of ulcerations and amputation

• Limited physical activity
• Peripheral neuropathy
• Sarcopenia
• Musculoskeletal impairments
• Hyperglycemia
• Gait dysfunction

Study review on weight bearing exercise and peripheral neuropathy

• Peripheral neuropathy outcomes
• cartilage regeneration
• Ulcer recurrence
• Risk factors
• Infections
• Diabetic neuropathic osteorpathy
• Etiology of Charcot
• Charcot-etilogy
• Diagnosis
• Ohases of Charcot

Study review-aerobic exercise and peripheral nerve function in patients with diabetic peripheral neuropathy

• Second study on Tai CHI
• Benefits on neurpahy scores
• Glucose control and quality of life
• Vibration therapy
• Study review exercise and diabetes
• Benefits of exercise
• Pre-exercise assessment
• Fall risk assessment
• Medical safety training
• Gait-key mobility needed
• correcting muscle imbalances

Assessment of the Diabetic Patient

• Risk categories
• Prevention of high-risk conditions
• Education sock recommendations
• Toe nail care
• Foot inspection
• Diabetic foot assessment
• Skin assessment
• Monofilament testing
• Sensation
• Vibration
• Ankle Barachoial Index
• Capillary refill
• Range of motion
• Patient education on foot care

Course Test - Evaluate your knowledge

• Use the Healthclick proprietary online education system which provides the online student with:
• Worldwide access to high definition video, anatomical animations and images, and written information
• The highest quality film in the industry, you can see the difference!
• Stop and resume within a course, the Healthclick system will optimize your course based on your device, connection and remembers where you left off.
• Real-time course updates. We are always adding to each courses, updating content, adding animations, these are not static courses!
• Evaluate your knowledge with the course test on any device.
• Print your state course certificate for CE credit.
• Take the online test as many times as need in order to achieve a 70 % or greater score.