Runnymede Healthcare Centre’s collaborative approach to managing diabetes

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At Runnymede Healthcare Centre, about 40 per cent of patients have an endocrine, metabolic or nutritional disease, such as diabetes, which can affect numerous parts of the body and lead to increased health complications—such as heart disease, stroke and kidney disease—if improperly managed or left untreated. To ensure patients live long, productive lives, Runnymede takes a proactive, interprofessional team approach to treating and managing diabetes.

“Every clinical discipline—from physicians and nurses to physiotherapists and pharmacists—has an important role to play in chronic disease management at Runnymede Healthcare Centre,” says Raj Sewda, Chief Nursing Executive. “Our innovative, collaborative approach to care means that we can deliver comprehensive clinical services to an increasingly complex patient population under one roof. This ensures that our staff work to the full scope of their practice and that our patients receive the holistic care they need.”

Runnymede’s team of professionals, led by physicians, deliver a multifaceted healthcare plan that addresses things such as medication, diet, exercise, foot and wound care.

While Type I diabetes is treated with insulin, Type II diabetes is typically treated with a combination of diet, exercise and insulin to more effectively control blood glucose levels. In addition to monitoring a patient’s blood glucose two to three times daily to ensure target levels are being met, nurses assist with managing and administering medication prescribed by the hospital’s pharmacists. The pharmacy team also monitors the effectiveness of medication on an ongoing basis to ensure diabetic patients achieve optimal blood glucose control without experiencing side effects, like hypoglycemia, commonly associated with insulin use.

What, when and how much you eat plays a significant role in managing blood glucose levels for individuals with diabetes. To meet daily nutritional requirements and assist with optimal blood sugar control, the clinical dietitians at Runnymede Healthcare Centre complete a comprehensive nutritional assessment before ordering an appropriate therapeutic diet and supplements or enteral regimen based on the patient’s needs. If a patient’s sugar levels are too low or too high, his/her diet is adjusted accordingly and monitored regularly to ensure optimal health.

Regular physical activity helps the body lower and regulate blood glucose levels, making exercise a key component in the long-term management of diabetes. Many diabetic patients at Runnymede have decreased mobility though, making intense physical activity a challenge. To compensate, physio- and occupational therapists prescribe a lower impact routine that promotes safety and utilizes various adaptive equipment to get patients moving. For instance, daily walking using hip protectors to prevent falls for patients with impaired balance. The therapists also recommend proper footwear, splints and/or orthotics to offload pressure from wounds or heel ulcers, common injuries in diabetic individuals.

The Canadian Association of Wound Care estimates that 15 per cnet of Canadians with diabetes will develop a diabetic foot ulcer in their lifetime, as the disease causes various complications that make it harder for wounds to heal. This can include neuropathy or nerve damage which reduces sensation in the hands or feet, making it harder to feel a cut or blister; clogged or narrow arteries which decrease blood flow to a wound, slowing the healing process; and/or a weakened immune system which can cause even a minor wound to become infected more easily.

Runnymede’s new Inpatient Wound Care Program dedicated to the treatment of complex wounds allows patients to benefit from the expertise of a core team of wound care specialists. The team includes an experienced enterostomal therapy (ET) nurse and takes a unique approach to treating wounds that is based on applying early interventions to ensure a wound remains stable, circulation is improved and mobility is restored. The hospital’s patients also have access to an on site, independently-operated foot care centre with a chiropodist who focuses on treating high-risk foot conditions that result from diabetes, such as ulcers, corns and calluses.

To successfully manage diabetes on a long-term basis, patients must be involved in the process. As a result, the hospital’s clinical staff provides diabetes education to patients and their families. Nursing and pharmacy staff work together to teach patients how to monitor their blood glucose levels and administer insulin injections. Dietitians provide tips on healthy eating and weight management. Occupational therapists discuss ways to prevent falls during daily activities. The physiotherapy and wound care teams instruct patients on proper foot inspection, including how to check for cuts and/or bruising, and preventing foot lesions by thoroughly drying feet after bathing and regularly moisturizing skin to prevent cracks that may cause infections.

By providing ongoing support that focuses on managing chronic diseases and promoting wellness to prevent further illness or injury, Runnymede Healthcare Centre greatly improves the quality of life of patients every day.