Endocrinology in Minnesota

Diabetes Services

Diabetes Center for Intensive Insulin Therapy

The Mayo Clinic offers a structured, three-day outpatient class for intensive insulin therapy called the "Diabetes Unit." Intensive insulin therapy is a mode of treatment in which the primary goal is to keep blood sugars as near normal as possible. The Diabetes Control and Complications Trial showed that tight blood sugar control prevents or slows the progressive complication of diabetes that affect the eyes, kidneys, and nerves.

Intensive insulin therapy attempts to mimic a normal pancreas by using two types of insulin: long-acting (basal) insulin and rapid-acting (bolus) insulin. Rapid-acting insulin is taken specifically to cover food eaten. Brief highlights of the class:

Day 1

• Introduction to the intensive insulin program, concepts of dose adjustment, and correctional boluses
• Introduction to the intensive insulin program and hypoglycemia treatment
• Introduction to meal planning, food exchanges, and carbohydrate counting

Day 2

• Intensive insulin program sick-day guidelines
• Use of food labels and strategies for special occasions
• Stress management

Day 3

• Intensive insulin program exercise guidelines

Arrangements for admission to the "Diabetes Unit" class can be made following a consultation with a Mayo Clinic endocrinologist.

Insulin Pump Education

The Mayo Clinic offers a one day outpatient class on insulin pump therapy. An insulin pump is a device the size of a pager that contains a syringe reservoir filled with insulin. A small flexible tube connects the reservoir of insulin to a catheter inserted under the skin in the abdomen. The pump releases rapid-acting insulin and delivers insulin in two ways: Continuously (basal) and in bursts (bolus), to cover food eaten. An insulin dose is manually programed into the pump to cover food eaten.

Eligible insulin pump candidates need to:

• Self-monitoring blood glucose 4 times a day
• Attended the Diabetes Unit class
• Physically and mentally able to manage an insulin pump
• Approval from a Mayo Clinic endocrinologist to start insulin pump therapy

Brief highlights of class:

• Insulin pump therapy and hypoglycemia
• Insulin sensitivity factor and correctional bolus
• Adjustment of basal rate and bolus insulin
• Exercise and insulin pump therapy
• Carbohydrate counting review
• Insulin to carb ratios
• Follow up

See Questions and Answers about insulin pump therapy.

Diabetes and Pregnancy

The outcome of a diabetic pregnancy now approaches the nondiabetic state when the patient is properly managed by an obstetric/diabetology team. For the past 15 years, Mayo has utilized a multidisciplinary approach to the care of patients with gestational diabetes, working with high-risk obstetricians in Maternal Fetal Medicine.

Dr. R. L. Nelson from the Division of Endocrinology serves as the diabetologist.

This multidisciplinary team manages patients as their primary physician or in consultation with the referring physician. Arrangements for consultations with the team can be made through the obstetric physicians or Dr. Nelson, who can he reached at 507-284-1600.

Diabetes Self Management Program

Mayo Clinic offers a comprehensive diabetes self-management education program for nearly 4,000 patients and their families each year. The program is a combined outpatient and inpatient treatment and education program. Referral to the program is arranged by a Mayo Clinic physician who will first evaluate the patient's diabetes and related need for education. An endocrinologist may evaluate some patients, and a nurse specializing in diabetes may assist the endocrinologist with others.

Based on the patient's condition and needs, the physician will recommend either outpatient or inpatient diabetes education.

• Outpatients receive diabetes education at the Diabetes Clinic, Desk W19C in the Mayo Building.
• Inpatients receive diabetes education at Rochester Methodist Hospital or Saint Marys Hospital.
• The Diabetes Center for Intensive Insulin Therapy (Desk W19C, Mayo Building) offers a five-day outpatient program designed specifically for management and education in intensive insulin therapy.
• Pediatric patients with newly diagnosed diabetes may receive diabetes education through a three- to five-day inpatient program at Saint Marys Hospital. The program, which is offered by the Department of Pediatric and Adolescent Medicine, is specially designed for younger patients and their families.
• Pediatric outpatient continuing care and education are provided at Desk L9A in the Mayo Building.

The diabetes education program is based upon an individualized assessment of the patient's learning needs. Therefore, the length of time required for education varies. An individualized education plan is developed by the diabetes educator in collaboration with the patient.

Using one-to-one teaching or group classes supplemented with audiovisual and printed materials, nurse and dietitian diabetes educators provide instruction as needed in program content areas relating to:

• diabetes overview
• stress and psychosocial adjustment
• family involvement and social support
• nutrition
• exercise and activity
• medications
• monitoring and use of results
• relationships among nutrition, exercise, medication, and blood glucose levels
• prevention, detection, and treatment of acute complications
• prevention, detection, and treatment of chronic complications
• foot, skin, and dental care
• behavior change strategies, goal setting, risk factor reduction, and problem solving
• benefits, risks, and management options for improving glucose control
• preconception care, pregnancy and gestational diabetes
• use of health-care systems and community resources

Following instruction, the patient is assessed to determine whether individualized learning goals have been achieved. Additional one-to-one instruction may be given until these goals are achieved. The patient is also asked to identify three diabetes self-care behaviors he/she would like to change to improve his or her health or quality of life.

Program follow-up services for reassessment and education and for determining progress in meeting behavior change goals include phone calls and continuing care or return visits. A letter may be sent to the patient's home physician or a referral may be made to the patient's next health-care provider.