Outline for Joslin Diabetes Center Bingo

Target Audience: Community groups, health fairs, senior centers, worksites

Supplies Needed:

· 3 winning cards and 1 “bogus card” (print the number of winning cards equal to the number of prizes you have to give away; the rest get bogus cards)

· Bingo daubers or markers

· Prizes

· Joslin referral forms, brochures and schedule of classes

· PowerPoint equipment, overhead or flip chart of slides

Educator Goal: Increase referrals to your program and provide community service

The Presentation

Announce the goals for today:

· Have some fun

· Learn about diabetes

· Win some prizes

· Go home with an action plan!

Bingo Rules

· This is participatory Bingo. I will be asking you some questions as we go along. It will be more fun if you help me out by responding.

· As I talk about a subject you will see the Bingo symbol that represents the subject on the screen.

· If you have that picture on your Bingo card, use your dauber to mark the picture or put an “X” over the picture.

· If you mark off 5 pictures across or down or diagonally, shout out Bingo and you will win a prize.

· Prizes will be given out at the end of the presentation.

· Everyone gets a free square in the middle.

Introduction

Raise your hand if:

· You have diabetes.

· You think you are at risk of diabetes.

o What makes you think you are at risk?

o How can you find out?

o Even if you don’t have diabetes, you’ll learn some things today that can prevent diabetes.

Okay, let’s play Bingo. Remember I need your participation. I might hold back on the prizes if you don’t answer my questions.

· It’s important to have a healthcare team to teach you the skills you need to manage your diabetes. Your team might consist of your physician, a nurse educator, a dietitian, a pharmacist and an exercise physiologist, for example. Remember that YOU are the center of your healthcare team.

o Do you have a healthcare team?

o Who is on your team?

If you have this picture of the team, mark your Bingo card.

(Repeat this reminder with every new symbol.)

Lifestyle: Eat Well, Be Active

1. I have a meal plan to help me control my blood glucose. True False

2. I use physical activity as a way to care for my diabetes. True False

Let’s talk about what you might do to change the answers to true.

· Carbohydrate foods have the most effect on your blood glucose levels. Eating too many carbohydrate foods can cause your blood glucose to go too high, and may lead to weight gain. Carbohydrate is found in starchy foods, such as rice, pasta, bread, and cereal. Other sources of carbohydrate are fruits, vegetables, milk, yogurt and desserts. Some carbohydrate is necessary for energy.

o Is your typical breakfast high in carbohydrate?

o What about lunch?

o What about dinner?

o Are you willing to decrease your carbohydrates?

· The Plate Method is a simple but helpful tool to help you plan your meals and control carbs. Aim for half of your plate to be filled with a lot of low calorie vegetables, such as broccoli, green beans, summer squash and carrots. Fill one quarter of your plate with a carbohydrate food – a small potato, or some rice or noodles. The other quarter of your plate should be filled with 3-4 ounces of lean meat, skinless poultry, or fish (but not fried fish!). Then, add either a glass of skim or low fat milk or a small piece of fruit and you have a healthy, balanced meal.

o How many of you usually have a plate like this?

o Are you willing to try it?

· It’s important to read the Nutrition Facts Label on foods. First look at serving size, and then look at total carbohydrate. One carb serving contains 15 grams of carbohydrate, the amount of carb in one slice of bread. You don’t have to look at the sugar; the sugar is part of the total carbohydrate. Remember, too, that if you eat more than one serving of a food, you’ll end up eating more calories and carbohydrate.

o How many of you routinely read food labels?

o What do you look for?

· Choose heart healthy fats, such as olive oil or canola oil. Heart healthy oils can help you lower your LDL, or bad, cholesterol. However, use these and all types of fat sparingly, as they contain a lot of calories and can lead to weight gain if you use too much of them.

o Do you have heart healthy fats in your cupboard?

o Do you bake or broil instead of frying?

· Doing regular physical activity, such as walking, can help you lower your blood glucose, blood pressure and blood cholesterol levels. Aim to go walking most days of the week for at least 30 to 45 minutes.

o How many of you usually exercise at least 30 minutes daily?

o 3-5x/wk

o 1-3x/wk

o How many of you feel like you can’t exercise?

o What gets in the way?

· Consider using a pedometer to measure your steps. The goal is to aim for about 10,000 steps each day. Ask your pharmacist or diabetes educator about how to use a pedometer.

o How many of you have tried a pedometer?

o You can probably pick one up somewhere in the exhibit hall and clip it right on. Get a baseline measure and then set a goal to improve.

· Stress can raise or lower blood glucose. Doing yoga, relaxation exercise or meditation, can also help lower your blood pressure and may help you prevent or treat depression or feelings of sadness. Yoga is also a great way to improve your flexibility, your strength and even your sleep.

o Why did I put yoga in with being active section?

o How many of you practice some relaxation exercise most days of the week?

Know Your Numbers

1. I know what my target A1C and blood glucose levels are. True False

2. I know what to do if my blood pressure goes up. True False

Let’s talk about what you might do to change the answers to true.

· Checking your blood glucose with a meter is the best way to know if your diabetes treatment plan is working for you. You can see how your food, activity and medicines are affecting your glucose levels. If you don’t have a meter or need a new one, talk with your healthcare team about the type of meter that is right for you.

o How many of you have your glucose meter with you?

o For those who don’t, how do you know how you are doing?

· Make sure you know what your blood glucose targets are and how often to check your blood glucose. For most people, blood glucose targets are 90-130 before meals, less than 160 2-3 hours after meals, and between 110-150 at bedtime. If your levels aren’t within your target range, talk with your healthcare team about changing your diabetes treatment plan.

o How many of you know your glucose targets?

o If not, how can you find out?

o How many of you know what to do if your blood glucose is out of target?

· Keep a record of your blood glucose results. Records are important to solve diabetes problems. Look for patterns of too high or too low blood glucose levels. Bring your record book to each visit with your healthcare provider.

o How many of you keep written records of your blood glucose? Food? Exercise?

o How many of you review the records regularly and try to puzzle out their meaning?

· The best way to know how you’re doing with your diabetes is to have a blood test called the A1C. The A1C is sometimes called hemoglobin A1C or glycosylated hemoglobin. The A1C is a measure of your average blood glucose levels over the past 2-3 months, and gives you a better picture of your glucose control than just the numbers on your meter. For most people with diabetes, the A1C goal is less than 7%. Lowering your A1C lowers your risk of all diabetes complications. Find out when your last A1C test was done and write down the result.

o How many of you know your last A1C result?

o Are you on the diabetes “roller coaster” – your A1C is good but your blood glucoses vary dramatically?

· Aiming to keep your blood pressure below 130/80 can lower your risk of heart disease, eye disease and kidney disease. Have your blood pressure checked at every visit with your provider and write down the results. If your blood pressure is above your target, think about purchasing a home blood pressure monitor. Talk with your healthcare team about ways to lower your blood pressure if it’s high, such as taking medicines, losing weight, eating less sodium, and being more physically active.

o How many of you know your last blood pressure result?

o How many had BP less than 130/80?

o How many of you take your BP medications as prescribed?

Taking Diabetes Medicines

1. I take my diabetes medicines as my doctor has prescribed. True False

2. I know why I am taking each of my medicines. True False

Let’s talk about what you might do to change the answers to true.

· You may need to take diabetes medicines to help you keep your blood glucose levels in a safe range. Many people with type 2 diabetes take diabetes pills. There are several types of pills. You might start out with one type, and then later add a second or third type. Different types of pills work on different organs that affect your bodies use of glucose (blood sugar). If the diabetes pill you’re taking now doesn’t seem to be doing the job, talk to your provider. You may need a different type of diabetes pill or a higher dose.

o How many of you take 1 type of diabetes pill? 2 types? 3 types?

o How many of you take your diabetes pills as prescribed?

o How many of you started with pills but now take insulin?

· People with type 1 diabetes must take insulin. Many people with type 2 diabetes take insulin, as well. Insulin is a hormone made by the body. It’s usually injected, either with a syringe, an insulin pen, or an insulin pump. A newer type of insulin is available that can be inhaled.

o How many of you have told your doctor you don’t want to take insulin?

o How many of you feel better since starting on insulin?

o How many of you were surprised how easy the injection is?

Staying Healthy

1. I’m taking action to reduce my risk of getting complications. True False

2. I know what to do to prevent a diabetes emergency. True False

Let’s talk about what you might do to change the answers to true.

· If you have diabetes, you have a higher risk for heart and blood vessel disease. Work on keeping your LDL, or bad, cholesterol under 100, along with keeping your blood pressure under 130/80. Following a heart healthy eating plan, increasing your activity, stopping smoking, and taking certain medicines can help keep your heart healthy, too.

o How many of you know your latest LDL cholesterol result?

o How many of you have an LDL less than 100?

o How many of you take your lipid lowering medication as prescribed?

· Diabetes that’s not well controlled can lead to problems with nerves and feet. That’s why it’s important to check your feet every day for cracks, cuts, redness or hot spots. If you can’t see your feet or have trouble reaching them, ask someone in your household to check them for you. Also, take off your shoes and socks each time you visit your healthcare provider so that they can be checked for feeling and blood flow.

o How many of you were aware of the connection between feet and diabetes before this program?

o How many of you look at your feet every day?

o How many of you walk barefoot?

· Have a dilated eye exam once a year, every year by an ophthalmologist. The ophthalmologist will check the back of your eye, the retina, to look for small blood vessels that may be damaged by high blood glucose levels. Keeping your A1C and blood pressure levels within your target range are important ways to keep your eyes healthy.

o How many of you have had a dilated eye exam in the last year?

· Have a urine test every year to check for microalbumin (small amounts of protein in the urine). The microalbumin test shows how well your kidneys are working and can catch any problems early on. The target number for microalbumin is 30 or lower. If your number is above 30, you may need medication to prevent kidney problems. Find out what your last microalbumin level was.

o How many of you have had a microalbumin test in the last year?

o How many of you had your most recent microalbumin result less than 30?

· People with diabetes are more prone to tooth and gum diseases. See your dentist at least twice a year for regular checkups and cleanings. You can lower your risk for gum, or periodontal, disease by brushing and flossing regularly. Keeping your blood glucose levels in your target range can also help lower your risk of tooth and gum problems.

o How many of you knew about the connection between teeth and diabetes before this program?

· If you take insulin or certain types of diabetes pills, there may be times when your blood glucose levels go too low, usually below 70. This is called hypoglycemia. Symptoms of low blood glucose include feeling shaky, dizzy or confused. If you think you might be low, check your glucose with your meter, and take 15 grams of carbohydrate, such as 4 ounces of fruit juice. Wait 15 minutes and check your blood glucose again to be sure it has come up above 80. Ask your healthcare team how to treat low blood glucose if you’re not sure.

o How many of you have ever had low blood glucose?

o How many of you on diabetes medications know if your medication can cause low blood glucose?