Association of Diabetes Care & Education Specialists

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Diabetes Education is not always about educating; It's about listening.

Aug 23, 2011

It’s been a long day. In addition to seeing patients, I have filled out insulin pump request forms, called patients to discuss blood sugars and worked on developing a new intake form. The phone rings, and it is a distraught parent whose child’s blood glucose values are sky high and dad is so frustrated. The situation is not under his control; his child has been in the adolescent unit due to psychiatric issues, and her insulin pump has been removed. The nurse is following the insulin protocol, but dad is watching, and she does not seem to know how to use an insulin pen. The nurse gets angry when dad makes suggestions. Dad does have a history of anger and blame. There is also the question of a past history of dad sneaking food into the unit resulting in carbohydrates that are not included in insulin dosing.

I’m really ready to go home, but the voice inside me says, “you are his link, the one he trusts and you need to listen.” How many times during the day do you find yourself getting away from the diabetes instructor, and becoming the “one they can trust?” In some cases, you are the person they have seen multiple times over the course of their child’s life. The one who tries to understand the age of rebellion from testing, the frustration and unfairness of multiple chronic disease diagnoses and the tedious nature of type 1 diabetes. I love working with families with children with diabetes, and when I think about going home when they are in need, I think of the fact that they cannot go home. Their home is the constant day to day struggle with blood sugars along with all the other co-diagnoses.

So I listen. I make a few phone calls, talk with the endocrinologist I work with, and we think through the possibility that this could be a nurse new to diabetes care and unsure of how to use the insulin pen. On this nurse watch, BG values have risen precipitously. Dad may be right. And so he is. The technique for injecting was incorrect, and the insulin dose was not completely administered. But...this is not the story of a problem nurse. It’s difficult to reach all the new staff on everything they need to know about caring for a patient with diabetes. This is a story of listening. Had the nurse been willing to take some coaching from dad, she might have learned. If I had not listened, the blame may have continued to be on sneaking food and inappropriate behavior on dad or his child’s part. If the endocrinologist had not listened, the problem would not have been resolved.

Listening and caring: it is what diabetes educators do all day. The education piece is a fraction of our job. We listen, problem-solve and help patients to achieve their own best management goals within the context of their lives and abilities. What a challenging but worthwhile profession!


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  1. Sep 17, 2011

    Great article supporting the concept of using telehealth in DSMT to make diabetes education more available and cost-effective! I am the CDE for, and we have also been doing this with success. It's about time!
  2. Sep 06, 2011

    Carla: I agree 100%. I was part of an "education Committee" while I worked at a community hospital & once fellow RN's knew I had an insulin pump myself and they had attended a "Nurse'd Ed day" program I taught on "Key diabetes Survival Skills" I was asked to see many patients about pump issues. Nurses need to LISTEN to what a patient or a Family member is saying.... and they need to admit the limits to their Knowledge and Take Tips from those in the Know. It is not an issue of a bad nurse. Any nurse may have Knowledge deficits. I would not attempt to direct a woman in her 3rd trimester about issues I have no knowledge of, and Will admit it! The ability to accept our weaknesses is NOT something taught----- it may be something learned. Thanks for sharing the story! Val G.
  3. Sep 06, 2011

    Indeed, listening is so very important. So is scientifically accurate information. I just watched new documentary - Forks Over Knives - it's the health/nutrition piece all educators (heck, all people!) need to really help patients understand, manage and promote their health.
  4. Sep 02, 2011

    I am working with a 27 year old type 1 PWD with severe gastroparesis. A G-J tube was placed this week. The only way I can think of to help him be prepared for moderate hypoglycemia is glucose gel subligually. Oral route is out of the question completely. Any suggestions or experience in this area?
  5. Aug 31, 2011

    Yes, I agree it is a challenging and worthwhile profession. I work in a primary care clinic. The system I work in includes other clinics each of which has a RN CDE Case Manager. Management wants to add unrelated duties to these individuals. Is there any literature you are aware of that can support the need for continuation of the RN CDE Case Manager Role in Primary Care Clinic? Thank you for any help you can provide.
  6. Aug 30, 2011

    I find the role of detective in our jobs to be the most rewarding! Great article. Thanks for the timely reminder of the importance of our role as listener.
  7. Aug 23, 2011

    Great article!!
  8. Aug 23, 2011

    Great point carla, and how would our clients know we are listening? And can we hear their strength and what is working in their lives.

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