Small steps and realistic goals control diabetes

Don’t overwhelm patients with lofty expectations

Helping your diabetic patient stabilize blood sugar levels and improve control of the disease doesn’t necessarily mean new medications, significant weight loss, or a major change in their lifestyle, according to experts interviewed by Hospital Home Health. Don’t present your patient with a lengthy list of dos and don’ts, most of which will be ignored because the patient thinks that there is no way he or she can do what is needed, says Janine M. Vogel, RN, CDE, a diabetes educator for Lake Regional Health System in Osage Beach, MO. "It is like making your New Year’s resolutions. If your list is too ambitious and too long, you’ll end up not keeping any of them," she points out.

The first step to helping a patient set his or her goals is to talk with them, Vogel says. "Find out what kind of person the patient is." Some patients, especially older patients, will have the attitude that amputation is inevitable so why bother changing the way they live, she says. "Find out what the person knows about diabetes, monitoring blood sugar, medication, nutrition, and control of diabetes," she recommends. After you have a good idea of the patient’s attitude toward the disease and the level of knowledge the patient possesses, then you can begin to set goals, Vogel adds.

Keep the goals realistic and make sure the patient has the resources to meet them, Vogel says. "For example, can the patient afford test strips or is there running water in the home for hand washing?" she asks. This is an important step because if the patient is noncompliant because there is no one to pick up supplies for him, you don’t want to just write him off, Vogel adds.

Be sure to address stress as a factor that affects diabetic control, she continues. "I have patients who will be controlling their blood sugar levels with no problems until their children come to visit," she says.

The stress of some family dynamics or just the disruption of a comfortable routine not only affect a patient’s diet, exercise, and schedule for testing, but the stress itself affects blood sugar levels, Vogel adds. "Build stress management techniques into your teaching so patients can learn to recognize and handle their stressful situations."

While losing weight is a great benefit to overweight diabetic patients, it may only take as little as 5% to 10% of weight loss to make a difference in the ability to control blood glucose levels, says Joy Pape, RN, BSN, CDE, president of Enjoy Life Health Consulting in Columbia, MO. "Reducing calorie intake by decreasing starchy foods and increasing protein doesn’t have to mean a giving up all foods a patient enjoys so the diet is easier to maintain," she says. Patients also need to increase their activity level, Pape adds. "Home care patients with some mobility can do little things like walking to the kitchen for a glass of water or just walking around a chair or dining room table," she says.

Some patients turn to herbs to help themselves lose weight or to control their blood sugar, Vogel explains. "While herbs and complementary therapies can be beneficial, it’s important for the home care nurse to find out if the patient is using an alternative therapy. One study showed that 60% of 2,000 diabetic patients interviewed were using alternative therapies but less than 2% shared the information with their physician because they didn’t think the physician would agree with use of the therapy or herb," she says.

This can be dangerous for patients who choose herbs that interact with medications they are currently taking, Vogel adds. "Chromium picolinate is the most dangerous for diabetics even though [some believe] that the supplement can be used to control diabetes and help with weight loss. This supplement works by lowering blood sugar levels and that is very dangerous for patients who are already taking insulin," she adds.

Don’t forget that insulin is the best way to control diabetes; and although it is often viewed as a last resort, home care nurses should present the possibility of insulin in a positive light, says Vogel. "Patients who are prescribed insulin after a period of trying to control the diabetes with lifestyle, diet, and exercise changes often feel as if they’ve failed," she explains. "This can lead to a pattern of noncompliance during which patients forget to get prescriptions filled or lose syringes," she says.

Home care nurses can help patients deal with their reluctance to take insulin by introducing the idea of insulin long before it is prescribed, Vogel suggests. "Explain that diabetes is a progressive disease to your new diabetic patients. Be sure to say that while they may not be on insulin right now, they will probably need it at some time in the future," she recommends. By talking about insulin early on in patients’ education, the home care nurse can prepare them emotionally so that they won’t feel like failures, she adds.

"The main idea to communicate to patients is that they can make an difference in the progress and control of their disease," Pape stresses. "It’s important that home care nurses stay on top of information about diabetes so they can share with their patients."

"If the nurse can offer practical, realistic advice on how they can manage diabetes on a day-to-day basis, patients will meet their goals and enjoy good outcomes," she adds.

[For more information on diabetes control, contact:

Janine M. Vogel, RN, CDE, Diabetes Educator, Lake Regional Health System, 54 Hospital Drive, Osage Beach, MO 65065. Phone: (573) 302-2736. E-mail:

Joy Pape, RN, BSN, CDE, President, Enjoy Life Health Consulting, 202 S. Glenwood, Columbia, MO 65203. Phone: (573) 874-5285. Fax: (573) 874-9946. E-mail:]