Dr. Ricardo Louro

Specialist in Internal Medicine

Enf.ª Mara Rohrborn

Head Nurse for Outpatient Exams and Special Exams

Dr.ª Marina Estêvão 

Nutritionist
 

Diabetes Day Hospital
Three visions, one common purpose

HPA Magazine 7

DOCTOR
Diabetes is predicted to be one of the epidemics of the coming years, a reflection not only of our genetic pattern but also of our socio-cultural environment, which favours an unbalanced and excessive diet and the constant decline in the practice of physical activity.
A diabetic is a “patient with several illnesses”, which is to say, Diabetes Mellitus entails a risk of development of various macro- and micro-vascular complications requiring multidisciplinary intervention.
The Diabetes Day Hospital combines a multidisciplinary team with its own space, dedicated to the treatment of the patients in such a way as they feel integrated and supported throughout the stages of their illness.  Besides periodic medical consultation, there is also an assessment by the nursing team before the consultation, various training and awareness sessions, but above all and most important, a close Care Team-Patient relationship.
The HPA Health Group has created a multidisciplinary structure that aims to integrate and support diabetics in their own illness, consequently achieving a better adhesion to pharmaceutical or non-pharmaceutical measures and consequently improve its metabolic control, thus trying to avoid the inherent complications.
In this way, education of patients will also constitute a pillar of the Day Hospital, where group as well as individualised sessions will be given. The complementarity of these sessions with the instruction given during medical consultations optimises the knowledge of the patients and promotes independence in their treatment.
Therefore, the opening of the Day Hospital promotes quality health care for diabetics, through a multidisciplinary team that is there to help them every step of the way.

NUTRITIONIST
In order to successfully control diabetes, a set of factors is necessary, such as: adjusted medication, regular physical exercise and a proper, personalised diet. However, for this set of factors to produce a result, it is always necessary to have periodic monitoring by a multidisciplinary team made up of a doctor, nurse, podiatrist, nutritionist, physiotherapist and of course, the diabetic him/herself.
Following the consultation with the doctor, it is of the utmost importance that a nutritionist monitors the diabetic. During this follow-up, several strategies are given and a dietary plan that is adequate for the individual necessities of each patient is drawn up. Eating habits, tastes, lifestyles, analytic values and prescribed medication are taken into consideration. Continuity of this monitoring has shown to be a fundamental factor for the successful management the disease. 
The training as well as frequent dietary adjustment in accordance with medication and exercise are of extreme importance for good metabolic control, the objective of which is to increase confidence and security, so that the individual can deal with day-to-day difficulties.
With the Day Hospital, diabetics will have the opportunity to clear up their doubts whenever necessary and actively collaborate in the control of the disease. This will also be a place where they can attend dietary training sessions and share their experiences and difficulties with other diabetics.
Several initiatives will be promoted in this ambit as group sessions: diet and physical activity, counting carbohydrates or how to treat hypoglycaemia and hyperglycaemia. At the end of the sessions, there will be an educational lunch during which patients will have the opportunity to put into practice what they learned through the preparation of their own meal.
 

NURSE
Implementing nursing consultation for Diabetes has emerged as a viable primary healthcare project, answering to the necessities of various clients in our community, promoting its acceptance and building a good patient-family relationship, in harmony with the objectives and strategies outlined by the politics of health for the problem of diabetes.
The nursing consultation functions in connection with the medical consultation, which guides the patients to training, namely to control and register glycaemia, what to do in cases of hypoglycaemia and the use/self-administration of insulin, relying on demonstration and interrogation teaching methods, assessing comprehension and retention of the message, and interacting with the patient where doubts and fears can be demystified. 
Besides these clarifications, various other issues are addressed during the nursing consultation, e.g.: what is Diabetes, the desired values of glycaemia, the necessity of glycaemic self-control, how to prevent and proceed, with emphasis on individualised physical exercise and also foot screening.
Assessing the foot is one of the essential monitoring aspects of diabetes, the reason for which we dedicate a special place to it: the type of footwear, use of socks (seamless non-binding) is checked, deformities, callouses, thickness of toenails, fissures and sensitivity are evaluated. This is specifically assessed using techniques of perception of pressure with Semmes-Weinstein monofilaments, of vibration through a tuning fork and temperature sensitivity with cold and warm objects.
Education concerning foot care is aimed towards the self-conscience of the patients and the implications for the foot, but above all the capacity of individuals to guide their own control process and prevention of complications.