As a nurse for 36 years, I’ve always enjoyed caring for patients with diabetes. But for many of them, this disease isn’t their only health problem. Many also have hypertension, high cholesterol levels, and renal insufficiency.
Plenty of literature, patient handouts, and other forms of advice are available to help diabetic patients live with their disease. In a visual aid I developed to show patients a new way to view diabetes control, I compare the patient to a flowering tree with deep roots. (See Diabetes tree: A visual aid.) The six major roots are:
- risk factors
- • knowledge
- • coexisting health problems
- • condition of vital organs
- • nutrition
- • family support system.
To grow a healthy tree and gain control over diabetes, all six roots must receive attention.
Patients need to understand their diabetes risk factors, particularly those they can control. This can help motivate them to adhere to the treatment plan.
A family history of diabetes, especially in a parent or sibling, increases the risk of type 2 diabetes two- to sixfold. Hispanics, African-Americans, Asians, and persons older than age 45 also are at higher risk. Other risk factors include a history of polycystic ovary disease or vascular disease (such as stroke) and a body mass index of 30 or greater. In persons between ages 20 and 44, obesity increases the risk of type 2 diabetes fourfold.
Knowledge of how diet and physical activity affect diabetes is invaluable—not just for those already diagnosed with the disease but also for people with prediabetes (also called impaired glucose tolerance). Several studies, including the Diabetes Prevention Program (funded by the National Institutes of Health to determine the safety and efficacy of certain interventions in delaying diabetes in high-risk persons), have found that in people with prediabetes, dietary changes (leading to weight reduction by 5% to 10% as needed) and exercise (30 minutes of moderate exercise daily, 5 days a week) can prevent or delay diabetes. Teaching patients about these findings helps them grasp the need for meal planning and physical activity, including exercise.
Coexisting health problems
Besides such risk factors as obesity, patients with diabetes commonly have comorbidities, including heart disease, hypertension, gallbladder disease, and sleep apnea and a higher risk of endometrial or colon cancer. Patients must understand the relationships among among all their health problems and learn how to manage these effectively.
Condition of vital organs
Diabetes complications can impair wound healing and affect the eyes, kidneys, nervous system, cardiovascular system, joints, bones, and GI tract. Interventions such as meal planning, exercise, and medication are important ways to help the body properly metabolize food and avoid organ damage.
Diet is a vital part of controlling or even preventing diabetes. Americans have been eating out more and consuming more prepared foods; also, portion size has increased. On the positive side, some restaurants and fast food chains are divulging the sodium, fat, and calorie content of their meals.
For some patients, financial limitations and poor availability of healthy foods must be considered when developing the meal plan. Also, many diabetic patients don’t prepare their own meals, so the person responsible for meal preparation requires dietary teaching.
Major types of meal-planning systems for diabetics include the diabetes food pyramid, the U.S. government’s dietary guidelines for Americans, sample menus of what to prepare, and exchange lists. Thanks to the several types of artificial sweeteners available, diabetics can enjoy many desserts. But be sure to convey the message that they must still maintain proper nutrition.
I’ve found that patients use various strategies to adhere to their meal planning. One patient tells me at every visit that he’s following his diet; his hemoglobin A1c level went from 12% to 7% in 6 months. His secret: He keeps his favorite foods and candy in the house, but doesn’t eat them. Just knowing they’re around but being able to resist them gives him a feeling of control. Another way to keep patients motivated is to advise them to reward themselves for reaching certain goals—say, for instance, they’ve stuck to their meal plan for a week or lost 5 lb that month. The trick is to keep the goals small and attainable at first and to ensure that the rewards are realistic and meaningful. Eventually, they can “sweeten” the rewards to make the effort worth the lifestyle changes they’ve made.
Having support from family members is vital to controlling diabetes. Patients who follow the recommended diet, get regular exercise, check their feet and skin for breakdown, and take prescribed drugs correctly usually can control the disease and avoid or minimize complications. Family and friends can provide encouragement, and, if necessary, may be able to assist with any tasks the patient has difficulty performing.
Setting mutual goals
When using the diabetes tree as a teaching tool, I offer patients help in setting goals and making self-directed behavior changes. Establishing goals mutually with the patient is more likely to yield realistic, measurable goals than when the diabetes educator alone establishes goals. Being involved in goal-setting makes patients feel they’re making their own decisions, rather than being told what they can and can’t do.
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Burant CF. Medical Management of Type 2 Diabetes. 5th ed. Alexandria, VA: American Diabetes Association; 2004.
Life with Diabetes. 3rd ed. Alexandria, VA: American Diabetes Association; 2004.
Medical Crossfire: Debates, peer exchanges, and insights in medicine. Paradigm shifts in diabetes management: breaking down barriers and achieving team goals. Special edition. 2003;4(16).
Porte D, Sherwin RS, Baron A. Ellenberg & Rifkin’s Diabetes Mellitus. 6th ed. New York, NY: McGraw-Hill; 2003.
Cathey Meller Creel works in home-based primary care for the Department of Veterans Affairs in Lake City, Florida.