Benefits of this Program

People with diabetes will benefit from receiving their treatment and care from an on-going coordinated team including but not limited to physicians, nurses, nutritionists, and or dieticians, exercise physiologist, and a medical social worker. Most importantly, the leader and decision maker of the team will be the person with diabetes. Older adults with diabetes will improve their quality of life, live longer, and feel better. We seek to empower the individual to regain control of their diabetes and consequently improve their overall health and well-being. It is important to set realistic goals and recognize the old medical model of one size fits all no longer is helpful to people with diabetes.

How we can Help if you have Diabetes

  • We will conduct care planning assessment to identify problems eligibility for assistance and areas in need of assistance
  • We will meet with you and your medical service providers to ensure that services are effective and appropriate.
  • We will follow-up with home visits to you to ensure that you are receiving the support you require and revise your individualized treatment plan if not.
  • We will conduct on-going monitoring to prevent costly crises and unnecessary hospitalizations and will communicate with your doctor to make sure they are aware of your situation.
  • We will help educate you and train when necessary with up to date diabetes technology ie., pumps, sensors.
  • We will help you and your family understand the disease and help you plan for future health care needs.

Areas of Focus

Healthy Eating

  • We believe food can be medicine. We will work with you to set realistic nutrition-related goals.
  • We will educate you and your family on healthy eating choices and set realistic goals so you can be successful.

Physical Exercise

  • We will provide a comprehensive assessment of your current physical activity program and we will make recommendations for a realistic physical exercise routine. This individualized assessment will include consideration of your cardiovascular status, and other medical conditions.
  • Collaborate with your medical providers and set realistic activity goals that accommodate your interests, mental and physical abilities.

Individualized Self Management

  • We will focus on your ability to manage your diabetes and will develop an individualized plan geared towards your strengths since all diabetes is not the same.

Medication Management

  • We will work with you and your medical provider to make sure you are adhering to the best possible medication regime for your diabetes.

Reducing Risks

  • We hope to help you set realistic goals that reduce your risk for acute and chronic complications.
  • We will work with you and your medical providers to set realistic appropriate A1C and blood glucose goals.
  • We will consider you family support and suggest additional support t where needed.
  • We will screen for depression and other mental health issues that may be impacting your lifestyle and your ability to carry out your diabetic care.
  • We will assess your cognitive and functional levels and , ability to perform activities of daily living, necessary to manage their diabetes when necessary,
  • Short-term self-care learning needs are identified and appropriate Diabetes education will be provided.

Who Needs Diabetic Care Management?

For Medical Providers

Do you have a patient who just you see on a regular basis but you feel needs some additional support in managing their diabetes?
Do you have a patient who is not compliant with their diabetes management and your current interventions are not resulting in successful outcomes?

For family members

Are you worried about your family member who has diabetes and you do not know how to help them?
Do you have a family member who just does not take care of themselves and you are tired of trying to convince them to eat differently?
Are you not familiar with the diabetic diet?

For the person with diabetes

Do you feel overwhelmed and feel you need additional support in managing your diabetes?
Are you interested in learning about new technology in managing your diabetes?