Addressing barriers to good self-management
Addressing barriers to good self-management
Issues must be addressed to put education into practice
Many factors keep people from putting into practice what they have learned about diabetes. One frequent factor is that people do not make diabetes management a priority, says Teresa Benge, RN, CDE, CPT, a diabetes educator at Fairview Diabetes Care in Wyoming, MN.
For example, young working adults with families frequently say they do not have time to do all that is required. To address this barrier, educators at Fairview Diabetes Care often use motivational interviewing to help their patients figure out what they want to do with the rest of their life and how to best accomplish it. Basically, when patients identify their priorities, they realize their own health has to be No.1, explains Benge.
At Children's Medical Center Dallas, motivational interviewing is used to more formally assess such things as readiness to make certain changes. Patients and families having trouble coping with the diagnosis may need clinical counseling or psychological supportive measures, says Marsha Mackenzie, MS, RD/LD, CDE, diabetes program manager at Children's Medical Center Dallas.
A big part of teaching is understanding what frame of mind people with diabetes are in and how ready they are for the education, says Mackenzie. Many factors pose barriers, such as life circumstances, personality type, and temperament, as well as readiness to learn and apply techniques of disease management.
Janis McWilliams, RN, MSN, CDE, BC-ADM, an advanced practice diabetes specialist at the University of Pittsburgh Diabetes Institute, says depression over the diagnosis may occur, and it must be addressed, for a patient is not likely to manage diabetes well if he or she is depressed. Some consider complications from diabetes inevitable and must learn they can live a long, healthy life if they learn how to manage the disease. Those with no insurance or inadequate coverage may have financial barriers to good self-management of diabetes.
Marcia Carlson, RD, MPH, CDE, metro diabetes education manager, Fairview Health Services in Minneapolis, says often people cannot afford their medications, test strips, needles, or even nutritious food. Some cannot take breaks at work to test their blood glucose levels. She says she tries to refer patients to financial workers, pharmacy programs, and free or reduced medication programs. Also, she suggests cost-effective ways to get food.
Because people with Type 2 diabetes do not necessarily have any real symptoms when diagnosed, they may be inclined to ignore their disease. However, diabetes is not something to be ignored, says McWilliams. Failure to manage diabetes and keep blood sugar levels under control will eventually result in complications.
Today, people with diabetes can monitor their blood glucose with meters to determine how the foods they eat affect their blood sugar level either positively or negatively, says McWilliams.
Benge has patients take a blood sugar reading before a meal and then a few hours after the meal to figure out how the foods they are eating impact their blood sugar. When they take the time to check, they can figure ways to control their blood sugar, says Benge.
Diabetes management is a lifelong learning process, says McWilliams; therefore, she suggests that those diagnosed with diabetes be encouraged to build a diabetes education management team. Getting referred to a good educational program gives patients an opportunity to make contact with diabetes educators, as well as others who have been diagnosed with the chronic disease.
It is good to build a support network, says McWilliams, which might include attending a support group regularly. "It is very helpful for people to share what has worked and what has not worked with others who have diabetes," she adds.
Diabetes support groups are a good way for people to continue their education over time, says Benge. Guest speakers are invited to the support group she oversees to cover such issues as stress management for better disease control.
Patients and families may be doing very well at counting carbohydrates and checking blood sugar levels, but then something will occur that makes these same skills more difficult to perform. At this point, they may need the intervention of a health specialist or social worker, rather than at the point of diagnosis, says Mackenzie.
"It is really important to give them a schematic view of diabetes and let them know there are places in which they may need support in a new way or more in-depth way than at other points in their care," says Mackenzie.
Many factors keep people from putting into practice what they have learned about diabetes. One frequent factor is that people do not make diabetes management a priority, says Teresa Benge, RN, CDE, CPT, a diabetes educator at Fairview Diabetes Care in Wyoming, MN.Subscribe Now for Access
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