Diabetes management requires patients to practice what they learn
Chronic disease management is a lifetime pursuit - not a one-time class
"We don't say it is always easy to manage diabetes, but we do say that diabetes is a manageable disease," says Janis McWilliams, RN, MSN, CDE, BC-ADM, an advance practice diabetes specialist at the University of Pittsburgh (PA) Diabetes Institute.
The best way for people diagnosed with diabetes to learn self-management is to become knowledgeable about the chronic disease. Attending a diabetes education program helps a patient get off to a good start, she adds.
Sue McLaughlin, RD, CDE, president of Health Care and Education at the American Diabetes Association in Alexandria, VA, agrees. She says people diagnosed with diabetes need to become educated from a reputable source about diabetes management initially and continue to get updated about new therapies and approaches that promote successful management and healthy coping. She identifies reputable sources, such as the ADA (www.diabetes.org), certified diabetes educators, and providers who regularly attend seminars on diabetes management.
Patients, especially those newly diagnosed, should look for reputable information and discuss everything they learn with their provider and educators, according to Marcia Carlson, RD, MPH, CDE, Metro Diabetes Education Manager, Fairview Health Services in Minneapolis.
Often patients get information from family, friends, or the Internet and get bogged down in details that may not apply to them. Newly diagnosed patients often do not understand that diabetes is different for everyone, she adds.
Also important is an understanding that there is a difference between Type 1 and Type 2 diabetes, and that means the steps required to treat the chronic disease may differ according to the type, says Marsha Mackenzie, MS, RD/LD, CDE, diabetes program manager at Children's Medical Center Dallas (TX).
About 90% of people diagnosed with diabetes are Type 2; however, children are more frequently diagnosed with Type 1 diabetes. Mackenzie says a lot of media focus is on the treatment of Type 2 diabetes, with coverage of such lifestyle changes as diet and exercise. However, with Type 1 diabetes, especially with children, the diet plan includes carbohydrates they would normally eat, promoting consistency, with an emphasis on normal growth and development, she explains.
"I think knowing what type of diabetes they have is instrumental in helping them manage," says Mackenzie.
Yet whether the diagnosis is Type 1 or Type 2, it is important that all people with diabetes acknowledge it as a chronic disease.
"A person can't just take a pill and forget about it," says McLaughlin. The management that promotes good control of blood glucose (sugar) and other aspects of the disease is for life and requires constant attention and adjustment.
"People need to know that it does take a lot of time, thought, and support to have healthy outcomes and a long healthy life," adds McLaughlin.
Mackenzie helps families being treated at Children's Medical Center Dallas wrap their mind around the idea that diabetes is a chronic disease by telling them there will be seasons, stages, or cycles when it will be more difficult to manage the diabetes. For example, a child's mother might return to the workforce after staying at home for a time, and, therefore, is not always available to help with food choices and other decisions.
"The challenges of caring for the disease throughout life make it such that we have to constantly work on different ways to cope and readjust and then make small strides to successful management," says Mackenzie.
Lessons in application
Yet small steps equal big successes, says Cris Hartley, RD, CDE, manager of diabetes and nutrition information at Gwinnett Medical Center Glancy Campus in Duluth, GA.
"In our diabetes classes, we help people to acknowledge the emotions that go along with the diagnosis, to listen, learn, and discuss what diabetes management is all about - then choose one small area in their lifestyles that they feel they might be able to tweak to start to move toward a healthier lifestyle," she adds.
When newly diagnosed, people with diabetes experience a wide range of emotions from anxiety and fear to being overwhelmed, and they often try to do too much too fast, she explains.
To determine a good plan for diabetes self-management, people need to learn about themselves, says Hartley. They need a basic understanding of what their own needs are in relation to their diabetes and how it affects them. They need to be able to identify areas in their lifestyle that may not be conducive to good diabetes management. They need to know what motivates them to make a change.
"Our best tool for helping patients overcome barriers is teaching them how to problem-solve. Identify what is getting in the way or causing a certain behavior, then doing some brainstorming to eliminate or reduce the barrier," says Hartley.
According to Teresa Benge, RN, CDE, CPT, a diabetes educator at Fairview Diabetes Care in Wyoming, MN, her job as an educator is all about problem-solving. She studies a patient's chart before they come in for education to identify the problem areas and try to come up with solutions.
"If you are genuinely trying to help and are willing to work with them, they are more willing to work with you," says Benge.
She has brainstormed strategies with many patients. For example, one patient liked to eat in fast food restaurants and did not want to change her lifestyle. Therefore, Benge helped her go through a calorie book to figure out the best choices in the restaurants she frequented. The patient keeps the information on a notepad in her purse, so she has a meal plan figured out ahead of time.
McWilliams has found diabetes education conversation maps useful in classes. These 4x6-foot maps, produced by a company called Healthy Interactions, cover different aspects of diabetes education and initiate a conversation among the participants. Included are activities that help people retain what they learn, says McWilliams.
Food models are another favorite educational tool for diabetes educators, says McWilliams. She says they help teach patients about portions. For example, patients would be able to see what size apple is a proper portion to help with counting carbohydrates.
Often, patients will need help when applying the information they are learning to real-life situations, especially when newly diagnosed, says Mackenzie. For example, a child might have low blood sugar after exercising, and families want to know why that occurred and how to handle the situation. Families are encouraged to e-mail or fax blood sugar numbers to the diabetes center during the first several weeks of treatment, so educators can review them and offer suggestions.
In the diabetes classes at Children's Medical Center Dallas, many hands-on exercises are included to help families apply the information to real-life scenarios and learn to solve problems. For example, class participants practice reading food labels. In a class called "Take Charge," families learn more about insulin-to-carbohydrate ratios and trends of blood sugar and how to adjust the insulin based on the center's guidelines.
Education for Type 1 diabetes is different from Type 2 diabetes in that patients and families must be taught core survival skills quickly that include checking blood sugar, proper administration of diabetes medication, how to treat high and low blood sugar, and basic carbohydrate counting, says Mackenzie. At Children's Medical Center Dallas, families begin classes a couple of weeks after diagnosis to learn more about the survival skills, and at that time new topics are added, such as how to successfully eat out at restaurants and how to navigate holidays.
Mackenzie says what makes diabetes education challenging is that every patient's take on it and ability is unique, so educators must fashion the information in a way that helps each achieve success.
"We try to make these real-life scenarios play out for them, but we are constantly learning that there are some situations where we may be able to do it a little better next time - or that particular family needed to be approached from a different way. So, diabetes education is an art as much as a science, because you really have to fashion it so that the families feel empowered," says Mackenzie.
SOURCES
For more information on education strategies for teaching patients and families to manage diabetes contact:
Teresa Benge, RN, CDE, CPT, Fairview Diabetes Care, 5200 Fairview Blvd. Wyoming, MN 53092. Telephone: (651) 982-7787. E-mail: TBENGE1@ Fairview.org.
Marcia Carlson, RD, MPH, CDE, Metro Diabetes Education Manager, Fairview Health Services Corporate Office Building, Minneapolis, MN. Telephone: (612) 672-2820. E-mail: [email protected].
Cris Hartley, RD, CDE, Manager, Diabetes & Nutiriton Education, Gwinnett Medical Center Glancy Campus, 3215 McClure Bridge Road, Duluth, GA 30096. Telephone: (678) 312-6045. E-mail: [email protected].
Marsha Mackenzie, MS, RD/LD, CDE, Diabetes Program manager, Children's Medical Center Dallas, Telephone: (214) 456-8532. E-mail: MARSHA. [email protected].
Sue McLaughlin, RD, CDE, President, Health Care and Education, American Diabetes Association, 1701 North Beauregard St., Alexandria, VA 22311. E-mail: [email protected].
Janis McWilliams, RN, MSN, CDE, BC-ADM, Advance Practice Diabetes Specialist, University of Pittsburgh Diabetes Institute, Quantum One, 2 Hot Metal St., Suite E290, Pittsburgh, PA 15213. Telephone: (412) 864-0159. E-mail: [email protected].
"We don't say it is always easy to manage diabetes, but we do say that diabetes is a manageable disease," says Janis McWilliams, RN, MSN, CDE, BC-ADM, an advance practice diabetes specialist at the University of Pittsburgh (PA) Diabetes Institute.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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