What strategies do you employ to motivate a diabetic who does not adhere to the prescribed treatment regimen of daily fingersticks? The diabetic in this case is an educated young adult who feels that as long as there is "nothing wrong with me" other than elevated blood glucose levels, there is no need to do fingersticks.

Show her a blind amputee hooked up to a dialysis machine.

pyschomania, good idea.

But it takes a while to get to that point.

Take her to the deli and show her how salami is cut, it keeps getting smaller. Tell her that is how it works until she is an AKA.

And on dialysis, with a couple of shunt revisions, etc.

Or if a guy, be blunt. I tell young men who may be hypertensive to follow their pressure and to get medical attention. Not doing so results in kidney failure, blindness and impotency. The last one usually gets their attention. Being a guy I usually throw in the words "limp dick forever" after they say, "What is that?".

I can not tell you how many young adult IDDM we get into the ER with a BS > 600-700. Because when they go drinking, they get drunk and forget to take the extra insulin they brought with them just for that reason. So we have a drunk with an elevated BS, and they usually get a bed for a day or two.

I hope you can impress on your pt the importance of daily monitoring. If not, do not beat yourself up over it. As you said, they are a young, educated person and their health has to be their own responsibility, not yours. This person is not the first one to ignore good health behaviors, and will not be the last.

bob

I like the one about limp syndrome. I've used that on a guy, too, and it's very effective!

Being a nurse and a diabetic, I think, sometimes gives me some insight that "normal" nurses don't have.

I think the first thing to do is to sit down with your patient and try to figure out what the resistance to testing is for that person. There can be several causes. For example:

-- statistically with the rest of the population, diabetics have a higher incidence of prolonged and chronic depression. Depression causes a diabetic simply not to care or have the motivation, incentive, or desire to self-test;

-- diabetics are often shamed into not following a treatment regimen. Failures at control are often blamed on the diabetic who frequently does not have the understanding to control their blood sugars. Physicians often place diabetics on a set dosage of their anti-glycemic medication and do not give the diabetic the tools at self-regulation.

-- diabetics are often hounded. "You shouldn't be eating that." "You're a diabetic!" The entire world believes they have a right to monitor what a diabetic eats. The consequences is resentment and failure to follow treatment regimens.

-- diabetics are encouraged to live a life that is separate and different from their peers and colleagues. Smoking, alcohol use, a spontaneous invitation to go to the movies and eat some popcorn are all "not allowed" for the diabetic. Consequently, the diabetic must isolate themselves from their peers to follow a treatment regimen. This happens because proper education and teaching has not been done, so the diabetic never learns how to adjust medications and lifestyles so that he/she can live a "normal" life.

I could go on. But, I think you can see my point. When you understand WHY your patient is resistant to the treatment plan, you can start dealing with the problem instead of its symptom. A very effective technique is to allow the patient to decide on his/her treatment plan instead of the healthcare workers. Let your patient decide what goals he/she wants to meet. Don't say, "test yourself four times a day." Say instead, "I'd like to monitor your blood sugars more closely. Is this something you would like to do?" If the answer is no, ask what you can do to help THEM with their diabetes. If you ask WHY, it conveys a subtle judgment, so just ask what you can do. Tiny steps builds confidence and self-esteem. Forcing and shaming will get you no where.

Thanks for letting me soapbox. What I've just said is my opinion after being on the other end of diabetes: as a patient. :)

Thanks! Coming from the perspectives of both diabetic and nurse, your letter is particularly helpful. I didn't realize the correlation between diabetes and depression. I've done some research and discovered that there is a five times higher incidence of depression in diabetics than in the general population. Wow!

Youda ! You are soooooo kool. LOVED your response! :)

From one who works in dialysis, I see the non-compliance all the time with the fluids issue, and it is heartbreaking to see some of these people making the choices they make. It gets old, and sometimes you feel you're doing SO much for nothing ! But in the end, your response is really all we can do. Allow the patient to make these choices themselves, and GUIDE them by figuring out just what is is that's bugging them...and give them some control back in their life... just knowing they're allowed to HAVE some control will work wonders sometimes. I often wonder how I would feel if I were sitting in that chair 3-4 hrs. for three days every week the rest of my life and then be told every 5 minutes what I may eat, what not, and while everyone is enjoying ice tea and watermelon on a hot summer day, I'm only allowed my skimpy little ration of 32 oz. !!! I think I'd get tired of hearing it from family, friends, nurses and docs, too !

You hit the nail on the head... and I know I must remind myself more often of your words... THANK YOU !

Wow. Thanks jnette! :blushkiss

Something I try to get orders for on any restricted diet patient is a diet holiday order, frequency to be determined by the doc. It's my personal opinion that to expect anyone to adhere to restrictions for a lifetime is an impossible and unrealistic expectation. Meds can be adjusted easily to accommodate a weekly "diet holiday" but it is hard to adjust meds for unplanned, after-the-fact "noncompliance."

I came to this conclusion watching my own behavior objectively (if that is entirely possible). If I tried not to "cheat" on my diet, I'd do a really good job of it for awhile. Then, I'd go on a binge, even knowing what the consequences would be (hyper-glycemia with nausea, vomiting, headaches, etc.) Once on a binge, by the nature of diabetes, the body would think it was "starving" because it wasn't getting any nourishment, but high levels of blood glucose. When the body thinks it's starving, a diabetic starts to crave (in the worse possible way) carbohydrates. So, the problem would esculate until I was so out-of-control . . .

But, before long, I'd binge again, and back on the upward spiral I'd go.

To stop this pattern, I gave myself "permission" to have a sweet everyday, and adjusted my insulin a little to accommodate MY TREAT. Now, I happily have a couple of cookies after dinner, or a small bowl of ice cream, or a donut at work . . . not only is my BGs in much better control, but I'm happier. No binging for quite sometime now, and I don't feel deprived or resentful anymore.

It's easy as nurses and doctors to just look at the physical effects of diet and compliance "cheating." But, it is my belief that if the health care profession doesn't also look at the psychosocial effects of chronic illnesses, we set our patients up for failure and frustration, not to mention the frustration it causes to us when we see our patients doing things we know are destructive. Nothing is destruction, though, in controlled, moderate amounts.

Soapboxing again. Thank you all again, for allowing me to speak about a subject near and dear to my heart! :)

Diabetes is such a complicated issue these days, especially to our senior citizens. If I get a new onset diabetic today, then I can coach them on NEW issues, and teach them what to expect so they will know they aren't failing etc. But as for my older group who has had diabetes for years, I have to really work at it to get them to uderstand that just because you skipped that candy bar that dont mean you can have beans,potatoes,cornbread and buttermilk for supper. Your sugar is going to sky rocket. All they understand is that they didnt eat the SUGAR. I have to work so hard to get them to understand that you can bake a potato, hull it out and fill it with sugar and have the same amt. of sugar if you had left the potato in it. Its like anything else I guess. It has to be an education thing and a life change. Anyway my $0.02

Youda--good points, as usual.

One more I would add is that it HURTS to do these fingersticks every day. There is a new kind of machine that does a forearm stick that is supposed to hurt a lot less. Anyone have experience with the available brands of this?

That's sure true, andrewsgranny!! Any diabetic educators out there? Do you even teach glycemic index of foods to patients?

sjoe, I've never used one of those 'stick anywhere' glucometers. My brother has one, and he likes it (my family proves that diabetes runs in families!)

I keep hoping for the FDA to approve the non-invasive glucometers, which work like a pulse-ox (oximeter). Last I heard, they were still having problems with accuracy . . . it looks like an ordinary wrist watch . . . still in clinical trials, I think.