Association of Diabetes Care & Education Specialists

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Dealing with the Complications of Diabetes

Feb 23, 2012

How do we teach about the complications of diabetes? How do our patients deal with their risk for complications?

This blog is a bit of an extension from my previous one on support groups, and how we address the issue of complications and motivate the individuals we care for to make positive behavior changes. 

Everyone seems to deal with the idea of complications differently. Some people may accept them as inevitable. “I am sure I’ll get an amputation at some point. Everyone in my family with diabetes ended up with one.” Some have a great fear that may be helpful or may get in the way. Others have an attitude that they will do anything possible to conquer diabetes and avoid complications. And other reactions cover everything in between...

The large diabetes trials that evaluated the importance of good blood glucose control to decrease or avoid complications tell us that there is much people can do to avoid them. Of course, we as diabetes educators know that some people can ignore diabetes, not manage blood glucoses, skip medications, live a sedentary life, and never have a problem. Then, others seem to do all the “right” things and still get complications. Everyone is different. We can certainly educate each person about the importance of good control to avoid complications and hope for the best.

But what is it that motivates people to follow the recommendations? Is it fear? Or a more positive approach?

I saw a horrendous video a couple of days ago. Someone asked a nurse educator in our office for feedback on a video he'd created for people with diabetes. It was a cartoon describing what could happen if a person with diabetes does not do the "right" things, and it shows images like someone sawing off a leg. It was disgusting. The educator clearly told the person that scare tactics do not work. I have to agree. In 28 years of physical therapy and 16 years of diabetes education, I have never found the need to threaten a person. You can get more bees with honey…

That's why I was so excited to get my mail yesterday and see a big envelop from AADE. There was the new Diabetes Prompt Deck focused on this topic with the tagline: “Stack the Deck Against Diabetes Complications.”

The deck is very proactive with lots of positive ideas of how to help people with diabetes avoid complications. But, that does not mean that the information is sugarcoated (pardon the expression). The questions and activities in the deck are supposed to help educators have open and honest--and motivational--conversations with their patients about behaviors that can help them avoid or delay complications.

I worked on this project with a team of others, including some fellow bloggers. I felt that it was very important to try to be positive when creating the items found in the deck. I do think most people with diabetes are well aware of the possibility of problems. They do not need to be told about losing a limb or their eyesight if they do not shape up. But engaging in discussion around these potential problems can be motivational and positive. I think we did a great job.

Have you gotten your deck yet??

I am anxious to hear what you think about the deck and how you plan to use it. Thanks to AADE and the sponsors for providing another tool that we can use to interact and engage our patients!


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  1. Mar 19, 2012

    I am not a diabetes educator, but I've been living with type 1 diabetes for 16 years now. I've become very interested in Diabetes Education, because I really think that mentorship is the biggest key to empowering a Diabetic to fight diabetes rather than simply treat it. For me, scare tactics never worked. I've always known what possible issues I could face down the road, but scare tactics only succeeded in making me feel helpless and hopeless. It made my diabetes feel bigger than myself as a person. It wasn't until I felt bigger than my diabetes that I really turned my health around in my mid 20's. I've also seen this in children. For 10 years I worked as a camp counselor at a camp for kids with diabetes. When you become intimately involved with the care of 10 other kids 24/7 you do start to notice patterns between children with better control, and children with little control. The child that always struggled the most with high blood sugars, diet, or taking their medication properly were the children that were depressed about their diabetes. Often they would admit to me that they felt no matter what they did, it wouldn't matter because they've already done such a poor job that they're probably going to end up sick as an adult anyway. They had given up on the possibility of a full life with diabetes. Another common theme, and this was true for myself in my worst years, was the logic that by defying my diabetes regiment, and refusing to let it dictate my life style, I would simply chose to ignore it. This is what most teens struggle with. They don't want anyone to tell them what to do, and they certainly aren't going to listen to their diabetes. What changed that for me was realizing that by not taking care of my diabetes, I was allowing it to take total control of my life. It was making me feels sick and interrupting the things I wanted to do. I was constantly having to do clean up work later on. But it wasn't the fear that I was going to loose a leg later in life that turned it around permanently. That fear never goes away, no matter what kind of control you have. At best scare tactics worked on me for about a week but the results are never lasting. Eventually I became just as worn down and defeated, and the fear only added to those emotions. When I realized that messing up, and making mistakes were okay, and I allowed myself to not be angry if I had bad moments, it was easier for me to bounce back. I had to learn to let go of my guilt. I had to learn to take one day at a time. When I was okay with myself I was able to take on my diabetes, and had much greater success in it's management. The focus has to be how managing diabetes is rewarding now, not later. How it can make you feel happier, and healthier. How taking care of diabetes can make you feel stronger right now. Focusing on a distant future creates something too far to reach, and too abstract to comprehend. It is too uncertain. How a person can feel when they wake up in the morning, or when they go out with friends this weekend, that is something managable. That is a goal that can be set and achieved. With each small achievement, the bigger stuff becomes less daunting.
  2. Mar 15, 2012

    One thing I'd like to see included in discussions about complications is how to treat and live well with complications. Even with the best care and avoidance of-the-all-too-numerous barriers to glycemic, blood pressure, and lipids control, many people who live long enough with diabetes will have some complications. A person who is free of complications is no better than a person living with complications--just luckier. I hope in the very important battle to prevent complications, we also acknowledge better ways to treat and live with any complications that do occur. Thanks for your work on the new deck.
  3. Mar 01, 2012

    Does anybody take novolog-I am looking for a scale of the amount of insulin you take depending on your sugar count, as I want to compare it to my Doctors?.
  4. Feb 27, 2012

    Thank you for your optimism. Iwould like to address your questions first then and share some thoughts about my perspectives. COMPLICATIONS: Its seem's that one of my most effective avenues to open up this topic in group or one on one, is it to ask if they knows anyone with diabetes. It's a start. Also, if an opportunity comes up to quote some of the land mark trials in diabetes research, I can state the outcomes and the percent that risk was reduced, ie macro and micro vascular complication. DEALING WITH COMPLICATIONS: It seems like recently my new patients just are not communicating they get "it". But you know the learning curve is different for everyone. I hope they continue the learning journey with me or another educator. I do like the big envelopes too! AADE keep those training tools coming. From my perspective, the AADE has got it right. The guidelines from the evidence is there for the trained educators to follow. I find confidence and satisfaction in them. When I hear a non-educator tell a patient, "Sugar is like battery acid in your body", I shake my head. When I need to redirect my patients learning sessions, I will use the deck as a point of reference (an authority) to make the point. Sometimes when I need to fill in sometime, I'll use it. Be Well, Thank you.

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