[TheCommuter]

Originally Posted by SharonH, RN

Also you have to look at the people who are most affected by Type II diabetes: African-Americans, Mexican-Americans, Native Americans, the overweight and the elderly. This is not a segment of society that is typically cherished. Someone is going to scream that I am not being fair but I think I am right to a certain extent.

Actually, I think you are being very fair by raising this point.

As a person of color, I will also mention another point that may be construed as controversial. The aforementioned ethnic groups tend to be very present-oriented, meaning that they take the day as it comes and avoid pondering the future too intensely. If the doctor attempts to tell the minority diabetic patient that heart disease, hypertension, kidney failure, blindness, and amputation are future complications of uncontrolled diabetes, the patient may often avoid doing the necessary things to prevent these future afflictions. The doctor may see this as noncompliance, but the patient is merely doing something that is culturally ingrained.

Perhaps healthcare providers could utilize cultural sensitivity when attempting to provide effective patient education.

[Spidey's mom]

Originally Posted by TheCommuter

I have a sugary family history, too. Both parents are diabetics and they are ages 47 and 49. All 4 grandparents were diabetics. Several aunts, uncles, and cousins are diabetics.

I have found that my relatives are reasonably educated about the complications of diabetes, but willingly choose to not control it very well. To them, keeping tight control over their condition is a vexing inconvenience. They would rather continue to eat the high-fat diet, drink regular sodas and alcohol beverages, and avoid exercise. My diabetic family members are very noncompliant.

My maternal grandmother died 3 years ago, weighing 411 pounds and sporting a gangrenous leg. She had been a diabetic since 1980. She continued to eat a pork-laden diet and drink regular Pepsi sodas until the day of her death, though she knew she was being noncompliant.

My father, a type 1 diabetic, drank a 6-pack of beer daily until very recently. He is notoriously noncompliant by refusing to take his Lipitor, eating sugary cereals, and not taking his antibiotics for the full course (he wants to save some for the next infection in a few months).

My relatives have received the education, but they simply do not comply. There is only so much the healthcare team can do, so the diabetic needs to put the information to good use by making the necessary lifestyle changes.

I see this too.

My husband is a smart man. High IQ. Knows what he needs to do. Still chooses not to.

He has a 4 year old son who adores him (his 23, 21 and 16 year old kids kinda like him too). Even that is not enough to keep him from getting serious.

I am all for education. But I still think in the end it is up to the individual person.

steph

[grannynurse FNP student]

Originally Posted by stevielynn

Regarding soda . . . my dh also drank alot of Pepsi for most of his adult life. I've always disliked sugared sodas - too cloyingly sweet for me. I also drink my iced tea with only lemon.

I did get my husband to drink diet sodas and he swore he would never be able to do it - hated the taste. However over time, he has adjusted and now regular soda tastes too sweet to him too.

It is like when I switched to non-fat milk . .. .I had to start by going from whole to 2% to 1% to non-fat. Now anything other than non-fat tastes too creamy for me.

I believe you can retrain your taste buds.

steph

Actually, you cannot retrain your taste buds. Your taste buds are arranged on your tongue in a certain manner. So many for certain taste. While as you get old your loss some of the taste, in your taste buds, you cannot retrain them. Check it out in a pathophysiology book. And it is not the taste that I do not like but the after taste. And likewise, I do not care for nor will I drink skin milk. It taste like water. And it always has since I was a child.

Grannynurse

[TheCommuter]

I shall add another point: there's no money to be made with the cure. There's no money to be made with prevention.

Treatment for diabetes is a constant momey-maker for pharmaceutical firms, medical supply businesses, doctors, and others who possess an interest. If diabetes were prevented or cured, all of this cash flow would dry up. I know there's no pharmacological cure for diabetes, but the drug companies aren't necessarily in a hurry to come up with one.

The money is to be made with treatment.

[grannynurse FNP student]

Originally Posted by SharonH, RN

How very, very, very coincidental that you should bring this up as we were just discussing this very item at work yesterday. I was complaining about the lack of education and awareness about diabetes. You hear lots and lots about heart disease and breast cancer but is there really a widespread campaign to educate the general public about diabetes? NO. If you think about it, there does not seem to be an urgency about diabetes from the medical community and I think that people, diabetics and nondiabetics alike pick that up. Even if intellectually they hear it, they don't HEAR it.


Breast cancer is a CAUSE. People wear pink ribbons and have 3 day walks to raise money for it. Heart disease is a CAUSE. There are national wear red days and the cereal companies promote their products as a means to reduce cholesterol and be "heart healthy". AIDS is a CAUSE. There are AIDS walks and fundraisers and plenty of media coverage of the AIDS crisis. But not so for diabetes.

I do not think that the general public realizes that diabetes will kill you just as slowly and painfully as the aforementioned diseases and people die of diabetes-related complications in large numbers every year. I bet you the average person has never heard of the terms prediabetes and metabolic syndrome. And I also bet that most people do not realize that type II diabetes is largely preventable and that even if you have prediabetes, that you can delay the progression into full blow diabetes by an average of 7 years with diet and activity changes. How many people realize that hypertension and heart disease are a comorbidity of diabetes? I am sure that many do not. Lately there have been a couple of commercials talking about that but that is fairly recent.


To answer your question, I don't know why. That is what we were pondering. My grad school advisor often mentions that some diseases don't get as much coverage as others because they are not "sexy" enough. And I think she's right. Also you have to look at the people who are most affected by Type II diabetes: African-Americans, Mexican-Americans, Native Americans, the overweight and the elderly. This is not a segment of society that is typically cherished. Someone is going to scream that I am not being fair but I think I am right to a certain extent.

My supervisor challenged me to do something about it, ya know: put up or shut up. So I am going to be a series of Diabetes Awareness topics over the next 6 months at work, that's my little drop in the bucket.

Good for you. A few suggestions. If your facility has a nurse educator meet with her and the dietican responsible for diabetic education. They can be a source of information. Also check with your home health agencies regarding their diabetic education and how to make a home referral. And also check with your county's public health agency about any clinics that they may sponsor. Less then 15% of known diabetics are Type I. The remaining 85% to 90% are Type II. Type II has spread, like wildfire among our children and young adults. We are short changing them, only to pay for the complications at a later date. Complications that are much more expensive then providing adequate routine care, education and follow up.

Grannynurse

[fergus51]

Originally Posted by stevielynn

I see this too.

My husband is a smart man. High IQ. Knows what he needs to do. Still chooses not to.

He has a 4 year old son who adores him (his 23, 21 and 16 year old kids kinda like him too). Even that is not enough to keep him from getting serious.

I am all for education. But I still think in the end it is up to the individual person.

steph

This describes a lot of my family (and me). My grandfather was diabetic, even lost a leg from it, but still snuck candy bars behind grandma's back. He knew he shouldn't, he knew the complications that could happen, he had very good education and all the supports in the world (I'd love to have my grandma make me healthy meals!), but made some bad choices in spite of it.

Don't we all do that? I know, I gained weight when I went to night shifts and here I am three years later I've finally gotten serious about my health and lost enough to be at a healthy weight. Now I need surgery because of that. If I hadn't gained any weight in the first place, I wouldn't be dealing with any problems now. It's similar with diabetes. We could avoid many cases of diabetes along with heart disease, cancer, etc. but lifestyle change is hard and it's hard to get motivated when you don't see an immediate effect.

[grannynurse FNP student]

Originally Posted by TheCommuter

I have a sugary family history, too. Both parents are diabetics and they are ages 47 and 49. All 4 grandparents were diabetics. Several aunts, uncles, and cousins are diabetics.

I have found that my relatives are reasonably educated about the complications of diabetes, but willingly choose to not control it very well. To them, keeping tight control over their condition is a vexing inconvenience. They would rather continue to eat the high-fat diet, drink regular sodas and alcohol beverages, and avoid exercise. My diabetic family members are very noncompliant.

My maternal grandmother died 3 years ago, weighing 411 pounds and sporting a gangrenous leg. She had been a diabetic since 1980. She continued to eat a pork-laden diet and drink regular Pepsi sodas until the day of her death, though she knew she was being noncompliant.

My father, a type 1 diabetic, drank a 6-pack of beer daily until very recently. He is notoriously noncompliant by refusing to take his Lipitor, eating sugary cereals, and not taking his antibiotics for the full course (he wants to save some for the next infection in a few months).

My relatives have received the education, but they simply do not comply. There is only so much the healthcare team can do, so the diabetic needs to put the information to good use by making the necessary lifestyle changes.

I am an RN. I am certainly well educated,holding an MS. While I am generally complient, there are times when I am weak and noncomplient. Does that mean that I should be written off? Should I be written off because I drink several regular sodas a week? Or should I be offered some more support in terms of a peer group? Should I and others like me, be offered more education? Should a nutritionist and educator sit down with me, after I've keep a food diary for several weeks, go over my mistakes, help me choose food that I like and fit into my diet plan? How should I increase my physical activity? I have a partial herniated L4-5 disc on the left side. I suffer from SOB because of the weather changes. I can't walk more then 50 to 75 feet. I can't stand for more then a few minutes. I am open to any suggestions. Please bear in mind that I cannot afford to join a gym, not even the Y. I have very limited resources to invest in equipment.

Your family may be well educated but I venture to say they are feeling overwlemed by their disease and it's complications. And because of this they feel they have little power to control their disease. Has anyone set down with one or two of them and tried to learn what their dietary likes are and how it can be worked into an acceptable diet? What is the depth and quality of their education? Have they been encourage to take part, not belittle or just lectured to?

Diabetes, care, education, compliance is not as simple as some appear to believe it is. And it certainly isn't entirely a matter of self responsibility.

Grannynurse

[SharonH, RN]

Originally Posted by TheCommuter

I shall add another point: there's no money to be made with the cure. There's no money to be made with prevention.

Treatment for diabetes is a constant momey-maker for pharmaceutical firms, medical supply businesses, doctors, and others who possess an interest. If diabetes were prevented or cured, all of this cash flow would dry up. I know there's no pharmacological cure for diabetes, but the drug companies aren't necessarily in a hurry to come up with one.

The money is to be made with treatment.

Heh-heh, I'm in a cynical mood tonight. I was just coming back to raise a similar point. Prevention of diabetes and diabetes-related complications is boring and cheap. Diet and lifestyle changes are not high-tech enough for a lot of people and it certainly is harder than taking a pill. We as a society have become so accustomed to putting our faith in technology, that some believe that it must not be worth doing if it's within our reach. It's cheap because there are no fancy or expensive diagnostic procedures and no expensive surgeries to correct the condition. And for sure, the pharmaceutical companies are not interested in something that is going to reduce the billions they make yearly from diabetes and related conditions and complications.

[grannynurse FNP student]

I have enjoyed reading all of your replies. And I realize that I have been confrontational regarding personal responsibility. But I also hope that my questions have caused some to stop and think and examine their attitudes.

Grannynurse

[Spidey's mom]

Originally Posted by grannynurse FNP student

Actually, you cannot retrain your taste buds. Your taste buds are arranged on your tongue in a certain manner. So many for certain taste. While as you get old your loss some of the taste, in your taste buds, you cannot retrain them. Check it out in a pathophysiology book. And it is not the taste that I do not like but the after taste. And likewise, I do not care for nor will I drink skin milk. It taste like water. And it always has since I was a child.

Grannynurse

Retraining does not mean rearranging.

We acquire tastes for things. Salt for one. You can retrain yourself to lighten up on the salt by slowly reducing the amount you use.

Many cultures don't use sugar and salt like we do. Their tastebuds are the same as ours. They have just been "trained" to taste what they are used to.

If we are raised on non-fat milk and never tasted whole milk, we would never know the difference.

The aftertaste of diet soda is not noticed by me anymore - I do remember it initially. My husband still doesn't notice it unless he thinks about it.

We do actually get used to certain flavors - otherwise we would all still be eating as children - Kraft Macaroni and Cheese and hot dogs and hamburgers. I'd have never tried sauted mushrooms as a child but I tried them as a teenager and liked them right away. Other things took awhile - I used to hate onions but I love them now.

I think you can retrain your tastebuds - desensitize them to things.

Rearranging your taste buds on your tongue - no.

steph