Diabetes from Both Sides of the Exam Table
An new perspective in Diabetes care and management
About Kristine
Kristine Batty, PhD., APRN, BC-ADM, CDCES is an award winning expert in Diabetes care and management. As a specialist in Diabetes care for 2 decades and a person with diabetes for over 40 years, she has an advantageous perspective in the care for Diabetes. Over the years, she has heard hundreds of stories of how difficult it is for medical providers to treat Diabetes and how people with Diabetes struggle to manage Diabetes and live with the stigma of Diabetes. She has experienced both perspectives firsthand. What has Kristine learned? The key to successfully managing Diabetes comes from the perspective of both sides of the exam table. Join her as she shares her insights from both sides of the exam table in the medical treatment and self-management of diabetes.
Words of Wisdom
Yet
There is one word that makes me truly sad when I hear my patients use it. That word is “yet”. This word needs to be removed form the language of Diabetes.
There is no question that the diagnosis of diabetes carries a high risk of developing terrible complications. People with diabetes have considerable worry of developing complications such as vision loss, having lower extremity amputation or needing dialysis. It is the Sword of Damocles hanging over their head. In fact, if you listen to people with Diabetes when asked if they have any complications of Diabetes, they will often answer “not YET”.
As discussed in Diabetes From Both Sides of the Exam Table “A1c” discussion, people with Diabetes often have anxiety waiting for the A1c result. It is no different when having an eye exam, having kidney function testing or even the monofilament test to their feet. Waiting to hear the words “you do not have retinopathy”, “you do not have kidney disease” or “you have good feeling in your feet” is a stressful event. Once those words are spoken, a big sigh of relief and smile is common.
It has been more than 3 decades since DCCT and UKPDS landmark research studies demonstrated that the development of Diabetes related complications can be substantially reduced with glucose in target range. As healthcare providers, we must inform people with Diabetes that they do not need to use the term “yet” regarding development of Diabetes complications. We must not use the development of these complications to force “compliance”. Instead, providing education on risk reduction and eliminating the term “yet” from their Diabetes related vocabulary is the mandate.
Diet
One of the more frustrating aspects of diabetes is the “diabetic diet”. People with diabetes are often judged on how they eat (“should you be eating that?” Add finger wag here) People with Diabetes struggle with “eating healthy”, just like everyone. Take a moment to think about what you have eaten over the past 48 hrs. Were all your food and drink choices healthy? Did you eat whole grains, lean proteins, fruits and vegetables? Something to think about….yes, part of managing/treating Diabetes is adopting heathy eating habits. However, everyone, even those without Diabetes, should practice healthy eating habits to avoid obesity and cardiovascular disease. Remember, people with Diabetes can have birthday cake or an ice cream with the grandchildren. Moderation is the key for EVERYONE. Be sure to refer your patients to a Registered Dietician and Certified Diabetes Care and Education Specialist to learn about and be counseled on heathy eating habits.
A1c
Let’s face it the A1c can be one of the most anxiety provoking parts of treating and living with Diabetes. As a provider, if your patient’s A1c is above target, you may have a few reactions: UGH!, What is going on?, What are they not doing?. A thought about non-compliance may cross your mind. Let’s sit on the other side of the exam table. The person with Diabetes, is holding their breath waiting to hear that A1c. They are anxious that it is not what it should be. They are already reprimanding themselves for not doing better and fearful of what their provider will think and say. Something to consider: the A1c reflects 90 day average and does not tell the story of a recent change in medications or lifestyle. Have you looked at the A1c in terms of improvement and not purely target? What is the target? (Check out this link: https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes ). Consider what contributed to the result the contributors to the result (illness, steroid therapy, inability to access medications, major life stress). Give positive feedback on their hard work on improvement. Have you acknowledged that they may be disappointed in the result? Has an adjustment in therapy been considered. Be sure to have a conversation about ALL of these things. The A1c is complex, don’t view it as the end all and be all of Diabetes management and cannot be interpreted in a vacuum. Remember, no one with Diabetes wants a high/above target A1c or to be “sick”.
