Diet

Dietary advice is a key component of the diabetes self-management courses. All patients diagnosed with type should attend a self-management course. If a person with diabetes is unable to access a self-management course dietiyian referral may be appropriate.

Diabetes Nutrition Guidelines

On Diagnosis of Type 2 Diabetes

• Give booklet "Diabetes & Healthy Food Choices" - Diabetes NZ 0800 Diabetes (0800 342 238) - www.diabetes.org.nz/food_and_nutrition/
  
  
• Refer to Dietitian
  
  
  • Western Bay of Plenty - Refer to PHO Dietitian - WBOP Dietitian Services
  • NMO - Referral Form - Krystal Somner - Te Manu Toroa 07 577 4193 Email: k.somner@temanutoroa.org.nz
  • Eastern Bay of Plenty - Refer all patients to the Hospital Dietitian Service. Referral letter.
    Whakatane Hospital Dietitians - 07 306 0817
    (Those that fit the criteria for the PHO Dietitian service will passed onto the PHO.

Exercise

Assess current level of physical activity

Ask the patient if they are doing the recommended 30 minutes of moderate intensity physical activity 5 or more days a week.

Moderate Intensity Physical Activity is defined as: Activity which makes a person breathe a little harder than normal.

If YES:

• Congratulate and encourage continuation

If NO:

• Are they medically stable to tolerate moderate physical activity?
  
  

Patients who are not medically stable should have their condition stabilised before commencing an exercise programme.

Green Prescriptions are available as a Medtech template or using a prescription pad available from Sport Bay of Plenty.

Contact local Sport BOP office for options available in the community if required.
Eastern Bay of Plenty: Ph 07 308 8304
Western Bay of Plenty: Ph 07 578 0016

Referrals should be faxed to:
EBOP: Fax 07 308 8461
WBOP: Fax 07 571 8463

Physical Activity Assessment

Tai Chi classes Bay of Plenty/Rotorua

For more information about the locations, dates and times of ACC-funded modified Tai Chi classes in the Bay of Plenty/Rotorua region, please contact the coordinator for each location.  Rotorua clients can access through Tauranga contact:

 

Sexual Health and Diabetes

Introduction

Sexual problems are common in the general population but people with diabetes are at an increased risk. The biological effects of diabetes can affect both men and women although the correlation between diabetes and sexual function in women is poorly understood. It is important to ask both male and female patients if they are experiencing any issues regarding their sexual functioning.
Please note: If patient in child bearing years discuss contraception or pre-conceptual advice.

Common issues related to sexual function and diabetes include:

Women

• Thrush
• Vaginal dryness
• Discomfort/painful intercourse
• Decreased libido
• Body image

Men

• Erectile dysfunction (ED)
• Retrograde ejaculation
• Balanitis
• Performance anxiety
• Body image
  
  

General diabetes related factors can include:

• Hypoglycaemia during intercourse
• Tiredness and decreased libido due to hyperglycaemia
• Mood disorders, depression, other psychological disorders
• Autonomic neuropathy
• Medications such as beta blockers, anti depressants and thiazide diuretics.
  
  

http://diabetes.niddk.nih.gov/dm/pubs/sup/

Estimates of the prevalence of erectile dysfunction in men with diabetes vary widely, ranging from 20 to 75 percent. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes.

ED is a failure to obtain/maintain penile erection sufficient for intercourse is more prevalent in men with diabetes and increases with age.  It is important to distinguish erectile failure from premature ejaculation, decreased libido and other problems as these have different causes and treatment. ED in diabetes is largely due to failure of vascular smooth muscle relaxation secondary to endothelial dysfunction and/or autonomic neuropathy.

http://www.bpac.org.nz/resources/bt/2010/sept.asp?page=1#erectile

For Pre Conceptual counselling for patients with diabetes please refer to the Diabetes Specialist Nurses via The Referral Centre (BOPDHB).

Psycho-Social

Considerations

Diabetes is an illness that can have an influence far beyond direct physical effects on an individual. Healthcare workers supporting people who have diabetes should consider and in some circumstances screen for issues including:

• Depression
• Employment
• Benefit entitlements
• Housing issues
• Effects on family / whanau
  
  

People with diabetes may be able to seek help from whanau ora orientated providers.