Diabetes Empowerment

 Guest Post David Mapletoft, Diabetes Educator

“Traditionally, the success of patients to manage their diabetes has been judged by their ability to adhere to a prescribed therapeutic regimen. A great deal of effort has been spent in developing methods for measuring compliance and techniques and strategies to promote adherence. Unfortunately, this approach does not match the reality of diabetes care. The serious and chronic nature of diabetes, the complexity of its management, and the multiple daily self-care decisions that diabetes requires mean that being adherent to a predetermined care program is generally not adequate over the course of a person’s life with diabetes. This is particularly true when the self-management plan has been designed to fit patients’ diabetes, but has not been tailored to fit their priorities, goals, resources, culture, and lifestyle. To manage diabetes successfully, patients must be able to set goals and make frequent daily decisions that are both effective and fit their values and lifestyles, while taking into account multiple physiological and personal psychosocial factors. Intervention strategies that enable patients to make decisions about goals, therapeutic options, and self-care behaviors and to assume responsibility for daily diabetes care are effective in helping patients care for themselves. Empowerment is a patient-centered, collaborative approach tailored to match the fundamental realities of diabetes care. Patient empowerment is defined as helping patients discover and develop the inherent capacity to be responsible for one’s own life. Since initially proposed in diabetes, there has been a growing recognition that, although health professionals are experts on diabetes care, patients are the experts on their own lives. This approach recognises that knowing about an illness is not the same as knowing about a person’s life and that, by default, patients are the primary decision-makers in control of the daily self-management of their diabetes.”

From (my heroes Martha Funnell and Bob Anderson) @ http://clinical.diabetesjournals.org/content/22/3/123.long

Knowledge and Understanding

Knowledge is power. It is possible that the more you share with your health care providers about your life – your needs, your goals and your dreams – the closer the relationship and the more successful you are likely to be in meeting your needs. Asking those simple questions, the ones you feel embarrassed to ask. By asking YOUR questions, you then get to know the answers. If you don’t understand, say so.

Understanding your needs helps me as a health professional to guide you towards a diabetes self care plan that work for you. When I first started working as a diabetes educator a wise lecturer in education told the phrase:

“A diabetes educator works like a guide on the side; not a sage on the stage” 

Today this is how I still aim to practice.

Your Plan: Your Priorities

“……..but has not been tailored to fit their priorities, goals, resources, culture, and lifestyle.” You know your life. You know that diabetes is high on the list of ‘things to do’. As John Lennon once said: Life is what happens while you are making other plans.

Can You Be Proactive….……in how you use your health care team?

Have you ever considered how many hours per year you spend with you whole healthcare team? Not many. Maybe less than 10 hours per year? Yet you spend 24 hours a day with your diabetes.

It may be helpful to take to your appointments with each member of your health care team a written plan sharing:

  1. the things in your care plan that are working,
  2. your short and long term goals,
  3. and questions relevant to that particular health care professional?

For example, an appointment with your dietitian may look like this:  

Working well:

  • Regular meals based on advice from last appointment
  • Enjoying a wide range of foods I enjoy
  • Have tried some new recipes and enjoying them.

Short Term Goal:

  • Reduce frequency of hypos
  • Maintain body weight

Long Term Goals:

  • Reach xKg
  • Reach HbA1c of less than 7%
  • Be able to afford this plan long term
  • Have my family follow this healthy meal plan with me

Questions:

  • Can I eat chocolate?
  • What are the health benefits of walnuts?
  • Can I eat even less fat than I currently have in my meal plan?
  • How can I mange my diabetes meal plan in my workplace?

How could you use this empowerment approach this with your endocrinologist? Your diabetes educator? Your podiatrist? What questions might you ask?

Some Comments from people living with diabetes when asked:

What do you do to prepare for a visit to your health care professionals:

(The responses are almost all directed to a visit to a doctor).

“when I go to certain one ones I am usually there about 21/2 to 3 hours .I take food and drinks and then raise hell at them for take so long”

“Write it down, any question you may have!
”

“First off I make sure the clothing and shoes I am wearing give him easy access to the things he will be checking on. I also ask if there is any new information he can give to me and I often bring a chart of my blood sugar readings along with the food I ate for his review and comments.
”

“Sugar log book and sometimes take the meter you use the most. Snacks are a must if your there a long time or have a long traveling time.
”

“I write down questions. One doctor told me ‘that’s a lot of stuff.’

“I will be taking my wife with me on my next visit. It will be my second visit, I just found out last week with a 300 count. So a second set of ears will help understand what I or we need to do. and because she is a BIG part in my life she needs to know also…
”

“Always good to have your partner covering your back!”

“My doctor always answers my questions and if he tries to avert…. I keep pressing until I get my answer. Remember who is paying his salary”

“Mine mostly ignores my questions – he’s known me long enough to believe I’m setting traps -he’s usually right
” “I think my GP knows that I know he doesn’t know much about Diabetes! “I would bring my BS log, some food logs, Any questions I have, if I want to try new meds I would bring info on that. I also wear my lightest clothing for weigh in.. LOL
”

“I keep forgetting to ask my mate if he’d like to come into the appointment with me I go in to all of hir appointments. I’m just so use to doing it on my own. But outside of that I bring my chart of numbers n have questions on my phone to ask or reminders to tell him about including low or high feelings (got a boot load for next visit to talk about for sure).”

“About a week beforehand I start a Word file on my computer of all the things I have to go over. Med refills. Questions. Test results. Symptoms. Every time I think of something I add it to the file and then print it out the morning of the appointment. My PCP appreciates that I don’t waste his time and we get and out fast and efficiently.”

“I pray I don’t get in trouble”

Which of these comments do you think might be in line with an empowerment approach? What do you include in your diabetes self care plan?

David – Diabetes Educator

4 Comments

  1. Sue on February 5, 2014 at 6:32 pm

    Brilliant opening quote David. The first 3 sentences say it all about the quaint, outmoded ‘control’ paradigm, the rest says it all about the so much more relevant ‘management’ paradigm.

    For some years I used to email my bgl diary for the previous couple of weeks, and have an agenda in mind that consisted of questions to help meet my goals. I didn’t print stuff because I didn’t have a functioning printer for several years. It hadn’t occurred to me to print stuff as you suggest in this post, but I will be trying that strategy with my new endo. Having printed material to look at might help to get them on the same page.

    Recently I took a printed copy of the Diabetes Knowledge Questionaire to a first appointment with a new allied HCP, and earned instant respect. It saved all that hassle of having to explain that I know all the basics, I’ve been doing this a long time etc. I’ll be doing that again.

  2. Imagine_David on February 5, 2014 at 9:53 pm

    Great news Sue. Well done. ‘Control’, like (its funny, I must have done a good job blocking this following word out of my mind, I can think of it easily) ‘non-compliant’ are best left out of the diabetes dictionary I think.

    Its imposible to ‘control’ your bodily functions 100%, no matter how hard you try. To me manage is a better word as it gives the power to you, the person dealing with diabetes every day.

    If any health professional says that word ‘non-compliant’ to me my blood goes to a high simmer (it used to boil 🙂 )

    Its great that your pro-active approach yielded such positives results and made for a good relationship from the outset.

    Regards, David DE Diabetes Counselling Online

  3. Sue on February 6, 2014 at 3:39 pm

    Yes, ‘control’ makes my blood boil, it is all the more offensive because in my long experience it is usually bundled with ignorant judgement and blame. Especially when it comes from HCP’s who have no concept of the day-to-day reality of diabetes.
    Cheers,
    Sue.

    • Helen-Edwards on February 6, 2014 at 4:14 pm

      thanks for sharing Sue, it is very hard when people talk about getting “control” with little insight into what that may actually mean in the real world 🙂

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