This list is a comprehensive collection of recommendations for healthcare providers managing type 1 diabetes. It was derived from detailed discussions on the Juicebox Podcast’s Grand Rounds series and insights shared at juiceboxpodcast.com/physicians. The goal of the list is to offer practical, actionable guidance covering every aspect of diabetes care—from effective communication and accurate diagnosis to ongoing education, technology integration, nutritional counseling, and support for caregivers. It is designed to help endocrinologists, primary care doctors, nurses, and diabetes educators provide patient-centered, effective care while also offering a framework that patients can use to understand what they should expect and ask for in their treatment.
Communication, Empathy, and Collaborative Attitude
Communicate with Precision and Empathy:
– When delivering a new diabetes diagnosis, clearly explain that the initial management is based on understanding insulin and that early instructions are meant to get the patient through an emergency phase. Avoid language that minimizes the diagnosis or instills undue fear.Acknowledge the Limits of Your Expertise:
– If you are not a diabetes management specialist, be honest about your limitations and offer to help the patient get connected with an endocrinologist.Promote Collaborative Care:
– Recognize that the emergency care provider is often the first—and sometimes only—healthcare professional the patient encounters. Coordinate with specialists to move toward a comprehensive management plan.Empower Patient Advocacy:
– Encourage patients to ask questions and seek clarification about their condition, and let them know it’s acceptable to request a second opinion or additional resources.Avoid Overgeneralization and Scare Tactics:
– Refrain from using one-size-fits-all statements or dramatic anecdotes; tailor your communication to the patient’s specific situation to keep advice realistic and supportive.Personalize the Approach:
– Acknowledge the emotional and psychological impact of a new diabetes diagnosis by beginning consultations with personal questions that build trust and ensure patients feel heard.Tailor the Conversation to the Patient’s Context:
– Ask about the patient’s symptoms, daily routines, and personal challenges (such as school schedules for children) to individualize dosing recommendations, and address their emotional state with empathy.Foster a Culture of Open Communication:
– Encourage patients to ask questions and report changes in their condition, and let them know that both they and the clinician can say “I don’t know” while working together for answers.Collaborate and Utilize Specialist Resources:
– In settings with limited time or resources, refer patients promptly to diabetes educators or endocrinologists and work with allied health professionals to distribute clear educational materials.Emphasize the Humanity in Diabetes Management:
– Recognize that patients are more than just numbers by addressing their mental health, relationships, and daily challenges.Adopt a Collaborative, Non-Judgmental Approach:
– Instead of using blaming language (such as “What happened here?”), guide conversations with empathy, offer positive reinforcement for progress, and help patients set realistic short-term goals.
Diagnostic Protocols, Initial Testing, and Early Education
Provide a Clear Baseline for Education:
– Emphasize that initial treatment (such as starting doses of insulin) is only the beginning, and that insulin needs and management strategies will evolve over time.Develop and Follow Emergency Protocols:
– Establish clear protocols for handling newly diagnosed patients in emergency or urgent care settings, including standardized education and early referral pathways.Thorough Symptom Assessment:
– When a patient presents with concerning symptoms (e.g., weight loss, frequent urination, feeling rundown), ask for specific details and use checklists to catch subtle red flags.Immediate and Appropriate Testing:
– If classic diabetes symptoms are reported, perform rapid diagnostic tests (such as a urinalysis or finger-stick glucose test) even in a non-emergent setting to avoid missing an early diagnosis.Provide Immediate Educational Resources:
– Recognize that newly diagnosed patients may turn to the Internet; offer reputable, easy-to-understand materials (pamphlets, website links) to guide them while they await specialist care.Timely Referral and Team Handoff:
– Quickly refer patients to a diabetes specialist or endocrinologist, and use a formal “handoff” process with clear instructions and scheduled follow-up to prevent gaps in care.Provide Comprehensive Initial Education:
– Explain the full action profile of rapid‐acting insulin (onset, peak, and duration) and define key terms (e.g., “stacking,” “pre‐bolus”) so patients understand their treatment.Set Clear Expectations from Day One:
– Inform patients that their insulin regimen is a starting point that will be adjusted over time and that initial guidance is only the first step toward long‑term management.Establish Standardized Protocols for Evaluation and Follow-Up:
– Develop clear checklists and protocols (e.g., using finger-stick glucose tests or urinalysis) and provide take-home resources that outline what to expect and when to follow up.Clarify Early Insulin Education:
– Explain that “up to five grams” of carbs per snack isn’t a blanket rule and emphasize the action profile of rapid‑acting insulin so patients know when a bolus is needed.Incorporate Multidisciplinary Education Early:
– Ensure newly diagnosed patients (especially children and teens) receive education from a dietitian or certified diabetes educator, using clear, practical resources to reinforce key messages.Set Realistic Expectations and Follow-Up Plans:
– Inform patients that their insulin settings are a starting point requiring adjustments as they learn to balance food intake, activity, and insulin, and schedule structured follow‑up sessions to reinforce learning.Address Misconceptions Head On:
– Acknowledge that oversimplified messages (such as “eat whatever you want” or “no need to bolus under five grams”) can lead to mismanagement, and encourage reporting of unexpected blood sugar changes.Provide Context and Clarity About Treatment Targets:
– Explain that initial target ranges are starting points that will be narrowed with follow-up, detail why stability is crucial, and document these discussions for continuity of care.
Ongoing Follow-Up, Continuous Education, and Team Collaboration
Follow-Up and Continuous Education:
– Ensure patients understand that diabetes management is ongoing by arranging timely follow-up appointments and reinforcing that early guidance is part of a larger, evolving treatment plan.Regular Protocol Review and Interdisciplinary Collaboration:
– Hold periodic meetings with your clinical team to review recent cases and refine diagnostic protocols based on feedback from both staff and patients.Continuously Improve Your Own Knowledge:
– Stay updated with educational resources and patient feedback (for example, via community groups) to refine your approach to diabetes management.Frame Education as an Ongoing Process:
– Schedule regular follow-up sessions where changes in insulin needs and nutrition strategies are reviewed and fine-tuned, providing information that builds over time.Emphasize the Need for Individualized, Ongoing Education (Tech Focus):
– Encourage regular, personalized follow-up that addresses both technical aspects (data, device settings) and personal factors (emotional and lifestyle), with clear explanations for any treatment changes.Facilitate a Culture of Continuous Learning and Feedback:
– Encourage open dialogue by admitting when you don’t have all the answers, using follow-up visits or electronic communication to review patient data and routines, and considering shadowing sessions to better understand day-to-day challenges.
Technology, Device Education, and Data Management
Review and Communicate Device Differences:
– Explain that blood glucose meters (BGMs) can vary in accuracy based on insurance or other factors, and discuss the pros and cons of various BGMs and continuous glucose monitors (CGMs).Emphasize Proper Testing Technique:
– Instruct patients on proper hand hygiene before testing to avoid false readings and reinforce that even with CGMs, a reliable BGM is necessary for calibration.Educate on Technology and Data Interpretation:
– Encourage clinicians to learn about current diabetes technologies (including CGMs and pump systems) and advise that understanding data trends is crucial for informed insulin dosing and lifestyle adjustments.Adopt a Patient-Centered Approach to Pump Selection:
– Recognize that pump technology isn’t one-size-fits-all; discuss all available pump options with patients and help them choose based on their lifestyle and needs.Facilitate In-Office Technology Education:
– Integrate practical sessions on using BGMs and CGMs into patient visits and consider “ride-alongs” or case reviews of patient data to provide personalized guidance.Promote Ongoing Follow-Up and Feedback (Technology):
– Schedule regular follow-up appointments to review device data, address discrepancies between CGM and BGM readings, and adjust treatment plans promptly.Ensure Transparency about Device Limitations:
– Inform patients that even the best meters have limitations (such as adhesive or sensor-skin issues) and advise them to report any inconsistencies for troubleshooting.Emphasize Precise Insulin Delivery:
– Explain that an insulin pump provides more precise dosing than injections by allowing fine control over basal rates, extended boluses, and customizable patterns.Discuss the Role of Continuous Glucose Monitors (CGMs):
– Stress that CGMs provide frequent glucose trend updates, encourage their use for proactive insulin adjustments, and explain that discrepancies with finger-stick values require further evaluation.Empower Patients with Technology Knowledge:
– Advise physicians to familiarize themselves with current diabetes technologies and consider practical “ride-alongs” or case reviews to better understand patient challenges.Clarify Advanced Pump Features:
– Educate patients on smart pump features (temporary basal rates, extended boluses, square-wave or dual-wave boluses) and explain how algorithm-driven adjustments can prevent prolonged highs or lows.Foster Collaborative Decision-Making (Technology):
– Ensure that the care team (endocrinologists, diabetes educators, and technology specialists) works together and involves patients in decisions regarding technology adjustments.Clarify the Role of Technology in Treatment:
– Explain that devices like CGMs and insulin pumps not only replace injections but also offer precise control over insulin delivery, with CGMs providing detailed glucose trends and BGMs remaining essential for calibration.Provide Detailed Device Education:
– Discuss differences among blood glucose meters, reinforce proper testing techniques (such as cleaning hands before testing), and outline the smart features of pumps to improve control.Integrate Technology Education into Clinical Practice:
– Develop routines that incorporate technology (for example, using pill minder apps alongside device data) and ensure that office staff are knowledgeable about current diabetes technology.Foster a Non-Judgmental Environment (Technology Data):
– Provide grace when reviewing device data (e.g., high blood sugars or missed boluses) by avoiding accusatory language and instead guiding conversations to understand underlying lifestyle factors.Educate Patients on the Integration of Technology into Daily Life:
– Explain that devices (CGMs, pumps, BGMs) are tools for fine-tuning insulin delivery, emphasize accurate device use (such as proper hand cleaning before tests), and highlight the importance of cross-checking data.Empower Patients to Understand and Manage Their Technology:
– Educate patients about the benefits and limitations of BGMs, CGMs, and insulin pumps, and provide clear instructions and demonstrations on how to interpret and act on device data.
Nutritional Guidance, Lifestyle, and Special Populations (Pregnancy/Preconception)
Individualize Nutritional Guidance:
– Provide clear, personalized advice on portion control, taking into account variations by age, activity level, and metabolism, and discuss the differences between “real food” and processed options.Initiate Early, Honest Conversations (for Pregnancy):
– Address the possibility of future pregnancy early (even during adolescence) and explain that pregnancy introduces additional variables (hormonal changes, shifting insulin needs) that are manageable with proper planning.Provide Comprehensive Preconception Counseling:
– Ensure young women and their care teams understand the impact of diabetes on fertility, pregnancy, and postpartum management, and emphasize the importance of preconception planning with a multidisciplinary team.Empower Patient Autonomy in Diabetes Management (Pregnancy Focus):
– Teach patients how to adjust insulin settings (such as pre‑bolus timing and basal adjustments) so they can react to hormonal shifts during pregnancy, and reassure them about making informed decisions.Educate on the Dynamic Nature of Insulin Needs During Pregnancy and Postpartum:
– Explain that insulin requirements can change significantly throughout pregnancy and that early education should highlight that adjustments are a natural part of the process; also stress the need for a new management strategy postpartum.Emphasize the Role of a Dedicated Care Team (Pregnancy):
– Work with patients to clearly define their care team—from endocrinologists to OB‑GYNs—and ensure that each member understands the unique challenges of pregnancy in type 1 diabetes.Discuss Lifestyle and Nutritional Adjustments (Pregnancy):
– Address misconceptions (e.g., “protein is free food” or that snacks below a certain carb threshold never need bolusing) and offer practical advice on maintaining balanced nutrition during pregnancy.
Support for Caregivers and Family Involvement
Support and Empower Both Patients and Their Caregivers:
– Recognize the role of caregivers, offer them clear guidance and support, and build a resource network to ensure everyone involved is well-informed.Support Caregivers and Family Involvement:
– Recognize that caregivers (especially parents of children with diabetes) need support and clear guidance, and provide resources or referrals (such as nutrition counseling or mental health services) to help manage the demands of diabetes care.
Thank you for taking the time to understand the lives of people living with type 1 diabetes
You can listen to the Grand Rounds series here, the series includes:
#1080 SERIES INTRODUCTION
#1097 HOSPITALS, URGENT CARE & INITIAL CONTACT
#1102 DIAGNOSING DIABETES
#1107 INSULIN AND SAFETY
#1112 FOOD AND NUTRITION
#1118 PREGNANCY
#1125 TECHNOLOGY PART I
#1126 TECHNOLOGY PART II
#1130 HUMAN STORY
#1139 COMMUNICATION
#1148 DIABETES MANAGEMENT
#1151 JON ODEN, M.D.
#1155 SCHOOL NURSE
#1162 HODGEPODGE
#1173 DR. MAGGIE MUELLER
#1192 DR. MARWA
#1228 DR. JESSICA HUTCHINS
#1231 ONCOLOGIST
#1249 DR. NADER KASIM
#1259 GAS PASSER
#1277 DR. TARLOW