Taking control of diabetes one patient at a time
By: Brenda Payne, RD, CDE | November 11, 2016
One nurse educator’s perspective on listening to patients living with diabetes.
As we observe World Diabetes Day coming up on November 14, my thoughts will center on the many individuals with whom I interact in my role as a Certified Diabetes Educator (CDE). Working in the field as a member of a national team affords me the opportunity to inform and support patients to better manage their chronic disease.
Often I learn that the diabetes education class I conduct is the first in-depth class about the disease that a patient receives. The reality is that physicians and office staff try to see as many patients they can each day, which doesn’t allow for ample time to devote to patient education. We as clinical educators frequently bridge the gap between healthcare providers and patients as we focus on enhancing and clarifying the providers’ instructions regarding lifestyle changes and drug therapies.
Any of us who work with the diabetes population know the statistics. We’ve read the studies and seen the numbers. We are aware that diabetes has reached epic proportions globally. We are also armed with a wealth of therapies to combat the disease. The healthcare team is equipped like never before to offer patients a variety of excellent medications, devices and supplies for monitoring their blood glucose. Of course, these innovations are vital and improve the probability that the individual with diabetes will have a better quality of life with improved outcomes. However, this formula alone will not ensure those living with diabetes will reap all of the benefits. People with diabetes must have a true understanding of their disease and how to control it if they want to positively affect their lives.
An attendee of one my recent class sessions comes to mind. I’ll call him Sam. He shared that he had been making every effort to control his blood sugar while taking an oral medication. Sam’s main goal in coming to my class was to learn how to eat better. As I reviewed healthy blood glucose goals with the class, it was obvious to me by his comments that his numbers were not in a healthy range. I further explained how oral medications work and then transitioned into an explanation of basal insulin.
Blood sugar is normally measured in milligrams of glucose per deciliter of blood (mg/dl). The American Diabetes Association (ADA) advises that people with diabetes should keep their blood sugar levels before meals from 80–130 mg/dl and under 180 mg/dl for up to two hours after meals. Near the end of the class, Sam offered up his logbook and asked me to review his blood glucose numbers. Incredibly, all of his blood sugar readings for the previous three weeks were in the 250-450 mg/dl range — a clear indication that his body was not producing sufficient insulin. It was apparent that he didn’t really understand his diabetes and that these high numbers were causing his excessive thirst, frequent urination, blurred vision and extreme fatigue. Left untreated, Sam’s hyperglycemia could lead to more severe consequences.
I knew that Sam likely needed insulin — something he indicated previously he wanted to avoid. Fortunately, he was scheduled to see his physician right after class. I was able to meet with his doctor beforehand to share my concern and what I had learned about Sam’s blood sugar numbers. His physician agreed that Sam needed to start taking insulin.
So the next thing I knew, I was teaching Sam how to give himself a daily basal insulin injection and a rapid-acting insulin three times each day before meals. He struggled to process this turn of events, but I assured him that he would begin to feel more “normal” and that he would see the benefits of insulin therapy. At a follow-up session, Sam told me that the insulin was working as he felt better and more energetic, and he was excited to share that his blood glucose readings were approaching his goal.
My interaction with Sam is not an unfamiliar scenario. Anyone who dons the hat of “clinical educator” has similar stories. It is our passion to empower people who live with a chronic condition such as diabetes; to inspire them to stay the course.
I would challenge all of us within the healthcare industry to listen to patients more. Perhaps we will hear something that no one else has heard. Maybe our portfolio of patient stories will create a solution for the patient sitting before us now. May each patient interaction give us a fresh perspective and help our patients have healthier lives as a result.