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Helping Patients Get Back on Track

Jan 15, 2013

Typically with the New Year come new resolutions and new beginnings. People set new goals (or maybe just recycle their old goals from last year).  I have heard my share of recycled goals.

But over the past 15 days of the New Year, I made an interesting observation.  I have been a nurse and CDE for 25+ years (since the 7th grade), and I am sure this has come up before but for some reason I just don’t think it has been quite as blatant as it is this year. 

I understand we are in “turbulent times.” I realize that many people are concerned regarding their jobs, health insurance and financial status. For the past two weeks while seeing my patients in clinic, I have been struck by how many of my patients are depressed and very willing to admit it.  Blood sugars are totally above goals and weights have gone up. People acknowledge they have not been monitoring their blood sugars, not taking their medications and not following their dietary restrictions. They are really struggling to keep it all together.

When I ask my patients about the past month or two, many of them had less than “happy” holidays.  Family members were unable to get together because of the rising prices of travel.  Many family members could not take days off from work.  Of those who were able to get together, my patients relayed that there was a lot of tension between family members. This tension contributed to their lack of motivation and adherence to diabetes treatment plan. I am not referring to patients who “blew” their diet on one or two days during the holidays, but for the entire season.

I have been doing a lot of exploring, creative talking and cajoling of my patients trying to help them get back on course. We have talked about the “whys” of totally losing control of their diabetes.  We have talked about what family issues tend to “trigger” the conflicts. Some issues are very deep rooted and some are fairly recent as in the addition of new family members. We have explored whether the tensions will continue or were just aggravated by the extra stress of the holidays.

Some patients were able to identify major issues or pinpoint what they perceive as the problem. We have explored and discussed some ideas on how patients can get past their problems, move on and develop new ideas for managing their diabetes.  Some issues are too deeply rooted in family dynamics and beyond my capabilities.  I have memorized the psychologist’s phone number through my frequent calling to get more professional advice for those patients interested and willing to seek more help. Unfortunately, finances and insurance coverage also play a part in whether or not patients seek further help.

I did not set out to make this blog to be “dark” or depressing, but rather to bring what I consider a major issue to the forefront and to shed light on some ideas.  Just wondering if anyone else has noticed this and what ideas you used to help your patients “get back on track?”


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  1. Mar 07, 2013

    To experiment with the new year's goals and how often they fail, I offered a pilot "program" that began in November so pariticpants established their new years goals and were prepared for the new years rather than waiting for the "bell to drop". For most of the participants this worked well and my follow-up with them in Feb and March showed them still achieiving their goals and still motivated. I will try this again this year.
  2. Feb 22, 2013

    I am searching for validated research tools with the AADE7 system theme. If you have any references, ideas, it would be much appreciated. We are working on validating a pre- post- test with diabetic education sessions.
  3. Jan 15, 2013

    I am trying to really focus on this issue with the support groups. So often, I think centers try to find a "topic" for support groups, but really, there does not need to be one. The topic is, "support." Giving the attendees a non-threatening, free speech environment to express their feelings and ideas is so important. I don't think there is a time more important than now to encourage our patients to find a support group. This is just one idea.

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