How to Escalate or De-escalate Diabetes Care

How can you talk to your clients about escalate or de-escalate their diabetes plan? Megan Muñoz, RN, MSN, CMSRN, CDCES creator and host of Type2andYou with Meg, was wondering the same thing. As a master's prepared nurse and diabetes care and education specialist, she set out to help clients understand why, when, and how a diabetes plan needs to be updated.

Megan explains that escalating care is pretty clear if the individual is

  • At low risk of experiencing hypoglycemia
  • Has a newer diagnosis,
  • Has a long life expectancy,
  • No complications or comorbidities,
  • Is highly motivated,
  • And has abundant resources.

"Think of it as a green traffic light. If you want to - go for it!"

However, everyone is dealing with different needs and abilities. "A client at moderate risk has more risk factors to consider, including hypoglycemia, some limitations in self-care, fewer resources, and has been dealing with managing their diabetes longer." Muñoz, explains, these individuals are represented by a yellow traffic light, which requires slight tweaks and changes in their diabetes plan.

The image also includes a red light which represents an individual who requires more relaxed goals, meaning the focus shift from blood sugar control to considering other priorities, including enjoying life.

Who typically might want more relaxed goals? An individual who is experiencing

  • Hypoglycemia or has hypoglycemia unawareness
  • Long-standing diabetes, or may have complications
  • Needs support in place for daily self-care
  • Has changing needs or requires additional help obtaining resources to manage their health
  • A desire to reduce the burden of diabetes management

When these are present, Muñoz states, "it's time to talk about adjusting the diabetes plan and relaxing care goals."

This concept has been adapted into a handout that Megan Muñoz created for professionals that makes it easy to explain that all diabetes plans are individualized! If you are a professional who would like to learn more about diabetes medication join Megan as she explains why, when, and how diabetes care plans change in the Medication: The Missing Piece in Weight Neutral Diabetes Care professional course.