FINAL LESSON PLAN Title: Managing Type 2 Diabetes Target Audience: Newly diagnosed type 2 diabetic patients Class

Size: 10 Terminal Objective Methods Used: Graffiti Lecture Terminal Concept

After completing this course, patients will be able to implement the three approaches to managing type two diabetes mellitus (T2DM).

T2DM can be managed by combing medications, exercise, and carbohydrate control.

Domain: Affective, cognitive

Taxonomic Level: Application

References: http://www.diabetes.org/food-and-fitness/food/planning-meals/carb-counting/

http://dtc.ucsf.edu/living-with-diabetes/diet-and-nutrition/understanding-carbohydrates/counting-carbohydrates/carbohydrateexchanges/
Preparation: Create 6 graffiti walls with pictures of metformin, insulin, exercise, physical activity, chocolate cake, and fruits and vegetables. Hang up graffiti walls around the room. Bring one marker per patient. Pre-assessment Introduction

Graffiti lesson- place 6 graffiti walls around the room with one picture per wall including: metformin, insulin, exercise, physical activity, chocolate cake, fruits and vegetables. Have patients come up and individually write on each board their thoughts regarding each heading.
Time (if in class): 7 min Supporting Objectives

Introductions: have the each member in the class say their name, where they are from and something about themself Introduce the graffiti wall and tell patients to write their thoughts about each picture on the wall.

Content Outline

Time: 6 min Time Learning Experiences

Patients will be able to explain that cells are insulin resistant during T2DM

Cells are insulin resistant during T2DM. Thought insulin is present in the body; the cells are not able to recognize it.

4min

Refer to power point slides. Show the slides with the gas station analogy and explain to students what insulins role is during T2DM. Gas station analogy: In Oregon gas station attendants come and fill your car with gas. In the body, insulin comes to put glucose into cells (slide

1). If a tank were to pull up to the gas station, the attendant would not know where to put in the gas (slide 2). In our body, this is what happens in T2DM. Insulin (the attendant) is not able to put glucose into cells. 2min Have the class pair up. Patient 1: Explain what the normal function of insulin is in the body. Patient 2: Explain what happens to the bodys cells during T2DM. Answer any questions. Show power point slide (slide 3) including the three pronged approached to managing T2DM. Explain to patients that this is the overview and we will discuss each individually, starting with medication. Reorganize the graffiti boards in the front of the classroom in the following order: Metformin, Insulin, Exercise, Physical Activity, Chocolate Cake, Fruits and Vegetables. Refer to the graffiti boards about Metformin and Insulin. Read some of the comments and transition to the power point slides. Show power point slide (slide 4) including metformins purpose in the body. Explain the purpose and that insulin is currently not needed unless the cells become more insulin resistant. 4min Refer to the graffiti boards about exercise and physical activity. Read some of the comments and

1min Patients will be able to list the three approaches to managing T2DM. The three approaches to managing 1min T2DM are appropriately using medications, forming regular exercise habits and balance carbohydrate intake. 1min

Patients will be able to explain medications role in treating T2DM

Metformin allows cells to recognize insulin. This process reduces insulin resistance. Insulin injections are not needed to treat T2DM but could be needed in later stages.

4min

Patients will be able to list the benefits of physical

Physical activity has multiple benefits in T2DM. Not only does it help to manage

activity in treating T2DM

weight, but it also increases insulin sensitivity both during and after exercise. Physical Activity should be pleasant. 2min

transition to the power point slides. Show power point (slide 5) explaining the role of exercise in T2DM. Discuss with the class the benefits of exercise. Physical activity should be enjoyable. Put up another graffiti wall and ask the patients to list some of their favorite physical activities. Choose one activity suggested by a patient that could act out or be completed in the class. Have patients do this activity together. Refer to the graffiti boards about chocolate cake and fruits and vegetables. Read some of the comments and transition to the power point slides. Show power point (slide 6) regarding carbohydrates. Explain the role of carbohydrates in raising blood glucose. By managing carbohydrates, we can manage blood sugar levels. Explain that carbohydrates come from grains, milk, fruit and vegetables. Show 10 different pictures of commonly eaten foods and have students pick which foods/parts of the food have carbohydrates. Show patients food models/pictures of serving sizes for starchy foods, dairy foods and fruit. Give patients a hypothetical meal and have them count the amount of exchanges in that meal.

1min

Patients will be able to explain the benefits of carbohydrate counting and identify carbohydrate sources.

Carbohydrate foods raise blood glucose. 4min By keeping track of how many grams of carbohydrate are eating, one is able to manage blood glucose levels at the target range. Carbohydrates come from grains, milk, fruit, and vegetables. 3min

Patients will be able to identity and track carbohydrate exchanges.

Carbohydrates sources are quantified in exchanges. One exchange equals 15g of carbohydrate. Starchy Foods: 1 exchange= 1 slice bread 1/3 cup rice, pasta hamburger bun, hotdog, muffin cup oatmeal cup beans 1 small tortilla

3min 3min

3 cups popcorn Dairy Foods: 1 exchange= 1 cup milk 2/3 cup yogurt Fruit: 1 exchange= 1 small fruit cup applesauce cup fruit juice cup berries Patients will be able to create meals using 1-3 exchanges per meal. Planning meals based on exchanges helps to regulate blood glucose. 5min Activity: Divide the class into two groups. Give each group 2 paper plates and an envelope with 15 different food pictures. Have each group work on creating 2 different meals with 3 carbohydrate exchanges per meal. Have each student write down a typical dinner and have them change this breakfast to incorporate only 1-3 exchanges. Have the students share their breakfast ideas. (Walk around and help the students create a dinner)

Patients will be able to adjust their current eating habits by focusing on getting 1-3 exchanges per meal.

By adjusting current eating habits, those 8min with T2DM will be able to better regulate blood sugar and plan better meals.

Assessment

As students share their meal plans check for accuracy and understanding.
Closure (1 min)

Give Exchanges handout for take-home use. Emphasize the importance of using diet, exercise, and medication all together. Let them know that they have control over their diabetes, and be encouraging!