Best Ideas for Facilitating Self Management?

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    Hi everyone!

    At the clinic I work in I am the primary educator for our diabetics. I work with the newly diagnosed and "veteran" diabetics alike as well as organize and teach in a monthly diabetes education/awareness program we host at our clinic.

    I'm curious about what teaching styles, tools, and techniques you guys have the most success with and response to?

    I would describe my style as something that borders on partnership, empowerment, and coaching. I don't like preaching to or "parenting" our patients (even the noncompliants who can be frustrating), but I place a heavy emphasis on facts. Iím pretty aggressive on scheduling follow up visits and all but harassing the patients to come back in.

    I think my biggest challenge is keeping everyone motivated in an instant gratification society. One new thing Iíve started doing is utilizing Health Vault from the ADA. I sign them up in the office and show them how to use it, but instead of leaving it to them to keep it maintained, I take the log of their blood sugars I ask them to keep and I enter it into Health Vault for them. The best feature is the graph it compiles of the results. I pull that up during their visit and show them that they are making progress rather than them just having various numbers and my word to go on. I can point out the upward and downward trends and help them identify patterns. Itís a little more work for me, but Iím finding that it has an awesomely positive effect on compliance and highly recommend it. A lot of the patients are eager to keep and bring in the log to see how far theyíre coming along.

    What are some things you guys do to help promote compliance? What do you view as the biggest hindrance?
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  3. 2 Comments so far...

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    I coach the patient into accepting responsibility for their own actions by asking what happened here when your BS was high, what could have been done differently, what do you expect when "X" occurs, what is preventing you from doing this, how does this make you feel (don't laugh! If I find out they are frustrated or angry then we deal with why). Denial is a part of grieving and I sense that many new diabetics just don't want to deal with it. Consider studying the stages of grief to see if there is a lesson in there to assist your teaching. Good luck. I find it to be a challenge every day.
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    With diabetes knowledge is power. A lot of diabetics feel hopeless or stick their heads in the sand. I've been a type 1 for over 30 years and had ups and downs in my diabetes management. I've sat through countless hours with ineffective diabetes educators and dieticians showing me plastic food of sample portions. Or telling me I need to test more or will have complications. None of that helped. What has helped me is to figure out what will work in my life. People have different personalities and deal with the stress and day to day D responsibilities differently.

    For example, I love the little One Touch Ultra Mini glucose monitors and have them all over my house, in my purse, and at work. Makes it easier to test and they're a little cooler than most meters. I'm also a big fan of the Track 3 diabetes app and the Glooko cable that attaches my meter to my iPhone. The best way to get someone to test is to make sure they understand the meter isn't a judge, it's just a tool that shows if they need to take a little more insulin, back off on carbs, or eat a snack.

    If you have someone who is computer savvy, encourage them to post at www.juvenation.org for type 1 or www.dlife.org for type 2s. Great information and emotional support. If you have any type 1s, encourage them to check out Gary Scheiner's
    online classes at www.type1university.com

    It also helped me to seek out books on my own. Frankly, the ADA is often a little behind the times and expects patients to be diabetic robots. I haven't found their materials very interesting or inspiring. Reading books like those I've listed below have been way more encouraging and given me ideas on small changes I can make.
    50 Diabetes Myths That Can Ruin Your Life; And the 50 Diabetes Truths That Can Save It by Riva Greenberg
    50 Secrets of the Longest Living People with Diabetes by Sheri Colberg
    The Diabetic Athlete by Sheri Colberg
    Using Insulin by John Walsh
    Pumping Insulin by John Walsh
    Diabetes Burnout: What To Do When You Can't Take It Anymore by William Polonsky
    Think Like a Pancreas by Gary Scheiner (for type 1s)

    The Pink Panther Diabetes book is intended for kids, but I've found it super helpful in giving diabetes info in a straight forward way. An online version can be viewed free at Understanding Diabetes | School of Medicine | University of Colorado Denver

    This article is a couple years old and is from the perspective of a mother of type 1, but think it does a good job explaining the emotion behind noncompliance for any diabetic. Teens with Diabetes: Freedom is Their Secret Drug : DiabetesMine: the all things diabetes blog
    In it the diabetic says, “It’s like I go to bed at night and I say, ‘Tomorrow morning I’m going to wake up and start new and do what I am supposed to do. I’m going to check regularly and take my insulin. I’m going to bolus every time I eat. And starting tomorrow, it will be fine.’ But then I wake up and I just cannot do it, Mom. Does that make any sense?'”Ummmm. That explains the success of the Weight Watchers Program. We mere humans want to do right and start fresh. We know well what we have to do, and yet… we stumble. Of course I understood."

    It's great that you're seeking new ways to help your clients and are trying to tailor diabetes management to their lives. That's the only way to make it work long term. Take care.


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