I recently completed co-teaching my first DSME class series. Until now, I have been one of the last hold-outs for one-on-one education. I have to admit, I really enjoyed the class, the interactions were positive, and everyone came to each session. But as I review our agenda, I wonder if we were too enthusiastic.
We want so much for our patients to understand diabetes as we do, but it can be too overwhelming for most initially. What is our true initial goal? It should be to help patients find their route to normalize blood glucose values, for high blood sugars are maiming and killing our patients.
So as I reflect on the agenda, I step back and look at what is necessary for the patient to know and understand, initially. The patients may want to dig down and learn as much as they can about their disease over time, but we are there to help them understand what is essential to get them through the first months of diabetes care.
It might not be possible to cover all of the AADE7 behaviors, but we can get patients started with self-care - gently. Here are the things that I feel are important for patients to grasp in the first few months after diagnosis:
-- Patients need to understand the basics of the disease, and that they are in the driver’s seat. It may be many layers of lifestyle changes and medication, but normal blood sugars are possible and will help to prevent the complications they so often fear. Remind them that diabetes is truly a team sport, and diabetes educators as well as physicians, physical therapists, psychologists and pharmacists are all available to help them meet their goals.
-- Food should be enjoyable, but favorite recipes may need to be changed to meet what is healthy for all of us, not just people with diabetes. Including whole grains, colorful vegetables and fruit, lean protein sources and oily fats and nuts should be the focus, rather than counting every gram of carbohydrate, saturated fat and transfat.
-- The role of exercise and health must be part of the conversation, and we should encourage patients to find a way to do something most days of the week, rather than stipulating minutes and intensities. Allowing group members to share what they have accomplished in each session may be helpful.
-- Discuss monitoring blood glucose and why it is helpful. Go over the appropriate times to check blood sugar and make sure everyone can use their meter. Patients and support persons must understand this is not a report card, but an aid to problem solving and treatment adjustments.
-- Reflect on coping with the diagnosis and finding a support system. Encouraging patients to be involved in organizations such as the American Diabetes Association and Juvenile Diabetes Research Foundation may help them find a “home.” If they choose to volunteer and reach out to help others it may indeed help them.
-- Allocate time for group members to chat about their own problem-solving experiences and encourage ideas from others within the group.
-- And if time allows, discuss other risk factors that contribute additionally to the disease process. Or perhaps, that will be for another day.
Diabetes is a very complicated and frightening disease with possible dire consequences. However, we may try to provide too much information too quickly, overwhelming the patient. This may drive the patients away if they start to feel helpless and hopeless, rather an integral player in their own destiny.
Please share your thoughts and experiences. What are the first few things that you focus on in your DSME classes?