Caring for Individuals At Risk or Diagnosed with

Diabetes and Schizophrenia or Bipolar Disorder

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Learning Points:• Know the difference between Type 1 and Type 2 diabetes• Know symptoms that members you are working with may

be experiencing due to having diabetes• Know what kind of tests members need• Know how often members should be tested • Understand the importance of good coordination of care

and integrated treatment planning

Types of Diabetes Conditions• Type 1 Diabetes

• The person does not produce insulin

• In the majority of cases, this type of diabetes appears before the patient is 40 years old. That is why this type of diabetes is also known as Juvenile Diabetes or Childhood Diabetes.

• Diabetes Type 1 onset can appear after the age of 40, but it is extremely rare.

• About 15 percent of all diabetes patients have Type 1.

• Type 2 Diabetes– Persons with Diabetes Type 2 has one of two problems, and

sometimes both:

• Not enough insulin is being produced.

• The insulin is not working properly - this is known as insulin resistance.

– The vast majority of patients who develop Type 2 do so because they are overweight and unfit, and have been overweight and unfit for some time.

– Certain types of medications can increase risk (i.e. newer antipsychotics)

– This type of diabetes tends to appear later on in life.

Signs of High and Low Blood Sugar• High Blood Sugar Symptoms:

– Extreme thirst

– Frequent urination

– Dry skin

– Hunger

– Blurred vision

– Drowsiness

– Decreased healing

• Low Blood Sugar Symptoms:– Shaking

– Hunger

– Fast heartbeat

– Impaired vision

– Sweating

– Weakness/fatigue

– Dizziness

– Headache

– Anxiety

– Irritability

Tests for Monitoring Individuals At Risk or Diagnosed with Diabetes

• Hb A1c – Hemoglobin • LCL-C (Low Density Lipoprotein)

Hemoglobin A1c Test (HbA1c)• HbA1c is the blood sugar test that tells you your average

blood sugar for the past 2 to 3 months and how well your blood sugar is being controlled over time.

• An HbA1c of 5.6% or less is normal.• The following are the results when the HbA1c is being

used to diagnose diabetes:• Normal: Less than 5.7%

• Pre-diabetes: 5.7% to 6.4%

• Diabetes: 6.5% or higher

• HbA1c is a measure of long-term diabetes control.• Members with diabetes should have an HbA1c test every

3-6 months.• The doctor may need to check more often if blood sugars

are above goal (7% or less), the HbA1c was high or there was symptoms of low blood sugar.

Low Density Lipoprotein (LDL- C) Test• The test for LDL cholesterol is one of several tests that are used to

predict risk of developing heart disease. • Cholesterol is affected by blood pressure and blood glucose. If blood

glucose and blood pressure are high, cholesterol numbers may be off as well.

• If a patient with diabetes has a high Low Density Lipoprotein (LDL), or "bad" cholesterol level, the physician can help the patient make the changes they need to lower their LDL cholesterol levels (often involving medications and/or lifestyle changes such as dietary modifications and increased exercise).

• LDL or “bad” cholesterol is not strictly due to diabetes. A patient has a higher risk when having diabetes, but it can occur alone or in conjunction with other diseases unrelated to diabetes as well.

Coordination of Care• Individuals taking atypical antipsychotic medications

have increased levels of blood lipids that can raise the risk of cardiac disease, weight gain, increased abdominal girth obesity, prediabetes, and type 2 diabetes.

• Assisting these individuals in coordinating care between their Primary Care Physician (PCP) and Behavioral Health provider is crucial to ensure these individuals are receiving appropriate screening and monitoring of their conditions.

1. Discuss member’s physical healthcare needs and incorporate goals to address them into member’s treatment/service plan.

2. Communicate with the member’s support systems. Encourage family members and friends to support member in their journey to stay healthy.

3. Facilitate cohesive relationships between member’s behavioral health and physical healthcare providers.

4. Encourage member to follow the agreed upon treatment/service plan.

5. Assist member in coordinating transportation to scheduled appointments.

6. Encourage member to take personal responsibility for their healthcare.

How to help coordinate physical and behavioral health care for these individuals

Physical Healthcare Goals for Members Diagnosed with Diabetes

• Have an HbA1c test, twice yearly.• Have an LDL-C, at least once yearly.• See an eye doctor for a retinal eye exam, yearly.• See a PCP, a minimum of 4 times per year.• Check blood sugars, as directed.• Have blood pressure checked at each healthcare

appointment.• Check feet daily for cuts and sores.

Why are these interventions needed?

• Diabetes can, over time, cause damage to many organs in the body including:

– Retinal changes– Kidney changes that can cause decreased renal

functioning– Neurological changes called neuropathy (include

nerve changes in the hands of feet)– Changes in the peripheral circulation ( neuropathy

and circulation changes may lead to foot ulcers or skin breakdown in the feet)

– Increased risks of cardiac disease

11Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Treatment Plan Example:

Helpful Tips

• UHCCP does not require members to have a PCP referral to see a specialist; however, most specialists prefer a PCP referral when accepting new members.

• Yearly retinal eye exams must be completed by a credentialed ophthalmologist. Go to the following website and conduct a provider directory search: www.uhcrivervalley.com.

• Foot exams can be administered by the member’s PCP.

• Referrals to a podiatrist should be made by the PCP when something unusual is found.

• UHCCP does have in network endocrinologists. To find a network endocrinologist, you can go to the following website and conduct a provider directory search: www.uhcrivervalley.com.

• PCP referrals are required to see an endocrinologist only when the provider is out of network within a 30-40 mile radius.

• The out of network endocrinologist must contact UHCCP customer service at 1-800-690-1606 to get approval.

  

Questions?

Behavioral HealthQuality Contacts

• Hayley Clothier, Quality Director• Phone: 615-493-9559• Email: hayley_clothier@uhc.com

• Charles Nails, Quality Analyst• Phone: 615-493-9514• Email: charles_m_nails@uhc.com

References• http://www.diabetes.org/diabetes-basics/?loc=GlobalNavDB

• http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm