Diabetes Control Affected by Attitude and Communication.

I find it difficult at times to pare down an article into something that will be meaningful to you (I hope.) As a diabetes educator, I sometimes get distracted with the interesting nitty gritty. And as a person with diabetes, I get distracted by my personal take on things - my diabetes attitude. This article, although summarizing a recent survey, has more of my personal opinions than usual but also some suggestions for you near the bottom.

BACKGROUND

Despite advances in diabetes treatments over the years, diabetes remains the most costly health condition in westernized countries because about 1/2 of people with known diabetes do not have adequate control. This is frightening news for governments when you realize that the World Health Organization estimates that by 2030 there will be double the people with diabetes (or 370 million).

For individuals, the scare comes in the complications that uncontrolled diabetes can bring. It is really the individual's view of diabetes that plays the biggest and most important role here, as you'll see.

THIS STUDY AND DIABETES ATTITUDE. . .

This study was actually an international survey of 5000 people with diabetes and 4000 diabetes care providers. It was called DAWN - for Diabetes Attitudes, Wishes and Needs. The international DAWN community of experts meets annually to discuss methods to focus more on the person behind the diabetes and review gaps in diabetes management internationally.

WHAT THEY FOUND WAS . . .

Numerous items were surveyed but a few of the highlights found were:

• People with a poor psychological reaction to diabetes have poorer quality of life and poorer health.
• 73.6% of the 5000 surveyed had at least one diabetes-related distress in their life (fear or burden).
• Psychological and social concerns prevent people with diabetes from caring well for themselves. . . . (I'm sorry for the pause, but as a person with diabetes I'm trying very, very, very hard to refrain from saying "duh".)..
• About half of the 5000 surveyed had poor well-being according to the World Health Organization's "well-being index".
• Despite such widely occuring diabetes distress, only 3.3% of 5000 received psychological treatment for diabetes related concerns in the past 5 years.
• More than 4 out of 5 people with diabetes reported that they did not completely "comply with" the prescribed meds and lifestyle changes. (I hate this "complied with" lingo, but I took it from the article. "Complied with" - blech!!. My diabetes does not COMPLY WITH my life!!! Yes - this is a much truer statement. Never mind me not complying with my diabetes regime. Let's get it right, shall we.)
• People with diabetes and health care providers on whole are not eager to use medications to reach target blood sugars, which can result in poorer diabetes control.

WHAT THEY CONCLUDED . ..

People with diabetes need more:

1. Psychological care
2. Self management strategies and skills
3. Communication with diabetes health care professionals

   (I read this to mean that health care professsionals need to listen MORE to what you have to say. This seems fundamental. How can I as an educator know the main issue for you and your diabetes since I don't live in your shoes? I have my own diabetes and how it fits into my life, my fears, my priorities is different than how your diabetes fits into your life. How can I show you that managing diabetes will help you with your priorities in life. What tools can I offer that will work for you in your life?

4. Communication and co-ordination amongst health care professionals.

   (I read this to mean that more people should be referred to diabetes education centres and / or psychological professionals.These folks need to talk to each other to come up with similar plans that you the patient agrees on and has set as a priority. There is no sense in each professional telling you to do something different when you want to do none or only one of these things. And perhaps what you really want to do, nobody has asked you. How many directions can you be pulled in? And wouldn't it be nice if most people helped pull you in a direction you chose?)

MY CONCLUSIONS . . .

Diabetes is work.

Nobody asks for it, nobody wants it.

Life is hard enough without diabetes.

Diabetes makes it hard to enjoy the moment when we are worried about the uncertainty of the future.

Those of us with diabetes need help :

• in putting things into perspective
• in teaching us ways to manage our own diabetes
• in understanding why we want to do this
• in overcoming the things that get in the way of caring for ourselves
• in managing our thoughts, worries, concerns and extra workload (I'm telling ya, there is work involved here with diabetes)
• in managing our spouses, friends, family (because none of us likes "diabetes police").
• in managing others' expectations of our diabetes
• in appreciating that we CAN make a difference to our health and happiness
• in succeeding for ourselves
• in identifying our successes and feeling good.

YOUR NEXT DIABETES APPOINTMENT, CONSIDER THESE. . .

Educators and health care professionals have much to learn to help you. Actually, it's a two way street. People with diabetes - me included- need to learn ways to better communicate our needs.

I'll never forget swearing at my poor endocrinologist. There I was - pregnant, nauseous and with great blood sugars. He told me I was testing my blood sugars too much for him to understand. Did I mention I was also hormonal? Yes, well - errr - I'll leave out the cuss words. Basically, I told him I was testing my sugars for me because I was vomitting, nauseous, couldn't tell a low sugar from a high and wanted to stay safe and keep my child safe. I WAS NOT testing to please him. OK. I got my point across but I could have done it without all the hormonal swearing. Poor guy.

Anyway. In an effort to help you help yourself and to help your educator understand your needs, you might consider some of the following:

• Tell your health care professional what would make life easier for you (no, don't ask for the diabetes to be taken away - that's in the same category as asking to win the lottery).
  
  Finish this sentence: "The hardest part about having diabetes is . . . ".
  
  Whatever fills the blank is what you might ask for help with. Maybe it can't go away, but maybe the "blank" can be made easier.
• Recognize the help you need might be financial, emotional, educational or supportive. It might not even be specific to diabetes. But, it might help clear your emotional or physical workload to make room to manage your diabetes.
• If you disagree with something - say so, and why.
• If you can't see yourself doing something - don't agree to doing it. And tell them why.
• Tell them what you understand about your visit - just so they can be sure they got the right message across.
• If you don't know why - ask.
• If you need help from someone else - ask.
• Listen to see how the information being given to you can help you with your priorities, your life, your future.
• If you're not ready for some information - say so.
• Know that you can't be perfect and they don't expect you to be.
• Know that educators respect your right to stand up for yourself.
• Know that you are not alone.
• Understand that health care professionals do NOT know it all.
• Know that diabetes is progressive and yes, will likely need more medication over the years. That doesn't mean the diabetes is worse. Think of those meds like grey hairs. You're just bound to get them.
• Gage your diabetes control by the glucose numbers - not by the number of pills you take.

If you've got comments you'd like to have posted regarding this page or your diabetes, I'd love to hear them. Please write me by clicking here.

Looking for some self management strategies?

Consider:

Tips to lower fasting blood sugars.
Tips to lower lunch blood sugars.
How to lower supper glucose readings.
How to lower bedtime glucose levels.

Diabetes News & Nuggets is a light-hearted but informative look at diabetes research and newsworthy items. See here for more.

REFERENCE:

Skovlund, SE. et al. The diabetes Attitudes, Wishes, and Needs (DAWN) Program: A new Approach ot Improving OUtcomes of Diabetes Care, Diabetes Spectrum 2005: Vol. 18 (3): 136-141.