I am insulin dependent diabetic and have a vested interest in this topic but I am interested in hearing the experiences and opinions of my peers on this topic. For the past three days, the New York Times has run a series of articles regarding the cost of diabetic care, the impact on the city and the diabetics themselves, programs tried and one that is currently being funded by a grant. For those interested, go to their website to read the complete articles.
We all know that there has been an increase in weight, in most adults and children. And we are aware of the fact that there has been a corresponding increase in the number of Type II diabetics. We are also seeing an increase in the hospitalization of those suffering from complications of their poorly controlled diabetes. What most of us fail to realize is the following:
1. Approximately 90% of diabetics are managed by their PCP.
2. Most PCP average eight to ten minutes a visit with their diabetic patients.
3. Medicare, Medicaid and private insurance re-reimburse less for the education and preventive care, then they do for the acute care such as amputations.
4. Most diabetics receive hit and miss education about their disease.
5. Many diabetic do not look at the long term complications, not being able to focus 10 or 20 years down the road.
6. Most diabetic are unaware of the importance of theirA1c test and its importance.
Several hospitals have opened diabetic centers where their outpatients meet in groups with diabetic educators and nutritionists. And they have access to endocrinologist, ophthalmologists and podiatrist. Studies have shown in improvement in the health of those attending such programs, weight loss, reduction in A1c percentage, improved nutrition and lessening of the number of complications. All three types of patients, Medicare, Medicaid and private insurance attend these programs. Now, one would think that with such proof, everyone would be willing to fund such programs. Guess what? No, no no. All but one, at Columbia has been forced to close its doors because of the loss of dollars. Apparently all three forms of coverage would rather spend its money on complications.
What does everyone think? Do you think that one or two education sessions are enough? Do you think it is a matter entirely of personal responsibility? That the people are responsible for the management of their own disease? Do some blame the diabetic for any complication he/she develops because if they managed their disease better they wouldn't suffer complications? How do you feel about the poor funding for the management of a chronic disease like diabetes?
Like I said, I am an insulin dependent diabetes, who also suffers from hypertension and asthma. I suffered a TIA in 1998 and it scared me. I became an insulin dependent diabetic in 2001. I have a problem with controlling my blood sugar because, one I love a drink of regular soda once a day and two I have to take prednisone, which effects my blood sugar. I fortunately have not suffered any complications although I have been a diabetic for fifteen years. Am I responsible for my high blood sugar by drinking that regular soda. Or can I lay the blame on my prednisone. Actually I think it is both. And I am dependent on my SIL for one meal a day, which tends to be high in carbs. What do you all think? Do you think, as a nurse I should be able to do what I have taught other diabetics?
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. 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.
Yesterday I typed a huge, long response to this thread, went to submit and it went "poof". DM is very important to me for personal reasons. I watched someone I loved much die far too early from complications. I'm only a nursing student at the moment, but becoming a diabetic educator is something that I'm considering.
In brief, I will tell you that in my area, there are tons, tons, tons of available resources. We take every possible opportunity to educate diabetics once hospitalized with specialized nurse educators and nutritional consults. I personally beleive that every dollar spent on the front-end of education will pay tenfold if we can prevent complications and help people live longer, better.
But ultimately, grannynurse, it DOES come down to personal responsibility. I'm not begrudging anyone with DM any bit of education they want, and heck, I'll give it to them. But, and I say this gently and with respect, there are always excuses. As a school project, I held a seminar (free, of course) on living with DM. I chose a community center where I knew the membership included many people with DM. I advertised this seminar at the community center where it was to be held for one month. I made sure it was at a convenient time to maximize attendance. I gave contact information for people to contact me for more information/help with transportation/questions before hand. Wanna know how many people showed up?!?! ONE. And, she wasn't a diabetic - her husband was and she just wanted to support him. He didn't want to come.
You can't force people to take care of themselves. I would educate them forcefully - let them see what a diabetic foot ulcer looks like, make sure they know that they may go blind, or suffer kidney failure, or become dependent on dialysis. I'd take them to a dialysis clinic and make sure they knew how tortorous getting dialysis 3 times a week really is. But if they aren't coming to me, I simply cannot help them.
Should they all be managed by endocrinologists? Yes. Should their testing supplies be inexpensive, or even better, free? Absolutely. But, I can't even attempt to arrange that if they aren't coming in in the first place. I have noticed that newly graduating docs are keeping glucose under MUCH tighter control than those that have been around a bit longer. That's positive in my book. It's a start.
Now, this has all been very general, but as for you: You can't walk very far I understand. So, start with what you CAN do. Walk 50 feet three times a week. Then, make your goal 75 feet. It won't take long and your endurance will increase. Just be sure to examine your feet every night!
As for food, you know what to eat and what not to eat. You have to have your coke, go ahead and have it, but cover it. And make it a treat. Look forward to it at the end of a long day. The person cooking for you makes lots of gravies, sauces and what-not - that's really simple - SKIP IT. Eat the pot roast, just don't smother it. Restrict portions. You know all this, you just have to DO it.
Look, I'm not trying to be harsh here, but its the truth. There will always be excuses for why things aren't managed but in the long run, it's a simple decision. It's a choice. And to watch someone you love very much be unwilling to make the choice to LIVE and choose to DIE - well, it's almost too much to bear.
Yesterday I typed a huge, long response to this thread, went to submit and it went "poof". DM is very important to me for personal reasons. I watched someone I loved much die far too early from complications. I'm only a nursing student at the moment, but becoming a diabetic educator is something that I'm considering.
In brief, I will tell you that in my area, there are tons, tons, tons of available resources. We take every possible opportunity to educate diabetics once hospitalized with specialized nurse educators and nutritional consults. I personally beleive that every dollar spent on the front-end of education will pay tenfold if we can prevent complications and help people live longer, better.
But ultimately, grannynurse, it DOES come down to personal responsibility. I'm not begrudging anyone with DM any bit of education they want, and heck, I'll give it to them. But, and I say this gently and with respect, there are always excuses. As a school project, I held a seminar (free, of course) on living with DM. I chose a community center where I knew the membership included many people with DM. I advertised this seminar at the community center where it was to be held for one month. I made sure it was at a convenient time to maximize attendance. I gave contact information for people to contact me for more information/help with transportation/questions before hand. Wanna know how many people showed up?!?! ONE. And, she wasn't a diabetic - her husband was and she just wanted to support him. He didn't want to come.
You can't force people to take care of themselves. I would educate them forcefully - let them see what a diabetic foot ulcer looks like, make sure they know that they may go blind, or suffer kidney failure, or become dependent on dialysis. I'd take them to a dialysis clinic and make sure they knew how tortorous getting dialysis 3 times a week really is. But if they aren't coming to me, I simply cannot help them.
Should they all be managed by endocrinologists? Yes. Should their testing supplies be inexpensive, or even better, free? Absolutely. But, I can't even attempt to arrange that if they aren't coming in in the first place. I have noticed that newly graduating docs are keeping glucose under MUCH tighter control than those that have been around a bit longer. That's positive in my book. It's a start.
Now, this has all been very general, but as for you: You can't walk very far I understand. So, start with what you CAN do. Walk 50 feet three times a week. Then, make your goal 75 feet. It won't take long and your endurance will increase. Just be sure to examine your feet every night!
As for food, you know what to eat and what not to eat. You have to have your coke, go ahead and have it, but cover it. And make it a treat. Look forward to it at the end of a long day. The person cooking for you makes lots of gravies, sauces and what-not - that's really simple - SKIP IT. Eat the pot roast, just don't smother it. Restrict portions. You know all this, you just have to DO it.
Look, I'm not trying to be harsh here, but its the truth. There will always be excuses for why things aren't managed but in the long run, it's a simple decision. It's a choice. And to watch someone you love very much be unwilling to make the choice to LIVE and choose to DIE - well, it's almost too much to bear.
Amanda
Amanda, I do appreciate what you have said. Yes, I basically know what I can and can not eat but I no longer have the control over my meals that I had when I lived by myself. Pot roast, I wish. Here is what my SIL made this week. Meat sauce and noodles, meatballs, creamy white sauce and noddles, quesida(?) chicken, hamburger, mixed vegetables, mashed potatoes and cheese as a pie. I tried cutting down the size of my portions to the barest minimum and have gone to bed hungry every night. I don't know how long I can stick to this. I am going to explore changing my diet even more with the special assistant Medicare has promised. I offered to cook but my grandchildren would not eat what I cook.
Walk fifty feet. It causes me severe pain to walk walk thirty feet to the carport. I am not trying to excuse my lack of exercise, just trying to find a realistic way to to increase my activity without increasing my pain. And also without causing me to wheeze.
And it is not a simple decision. It is a decision that is influence by my own likes and dislikes; my families likes and dislikes; funds; other chronic health problems, to name a few. And I and other diabetics are aware of the possible complications we can face and how our own decisions impact on them. And a lot of us push them beyond our horizons. We tell ourselves that it will not happen to us.
And a word of advice, one based on personal experience and that of other diabetics, don't be too forceful; don't make it a do it or else you will suffer, we will just nod our heads and tune you out. Sorry but that is just the truth. Believe it or not, we are adults and while we sometimes make wrong choices, we are not children. But thanks again.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
As I had mentioned last night, my family history is quite 'sugary'. A disproportionate number of my relatives, first-degree and extended, are diabetics.
Honestly, it all comes down to personal responsibility. The healthcare team possesses the responsibility of educating the diabetic about his condition and treatment, and the diabetic possesses the ultimate responsibility of making the lifestyle changes that are necessary to prolong life expectancy and prevent the hellish complications.
My diabetic family members are fully aware that they should visit the podiatrist once yearly for a microfilament foot test for sensation, but they refuse to go. They know they shouldn't perform 'bathroom surgeries' on their feet, but they continue to use razor blades and sandpaper to reduce the calluses, corns and bunions. They know they should visit the eye doctor regularly for exams, but they insist on going once every 5 years when blurriness is no longer being corrected with their old glasses.
The family members know that exercise will help their bodies utilize the excess blood glucose, but they refuse to make that lifestyle change (even though they are all able to exercise). My parents, both diabetics, continue to smoke a pack of cigarettes daily, though they fully know that smoking and diabetes equals an early death sentence. My father, a type 1 diabetic, continues to drink a 6-pack of beer daily, though he knows the alcohol is reducing his liver and kidney function slowly.
Specializes in Endocrine (Diabetes), Pediatric Psych.
Ditto to everything said in the post below.
I have diabetes myself (Type 1, 15 years come March '06), and I think I'm coming from a slightly different point of view than others here, as I'm 20 y/o, but any way you look at it, a lot of the factors are the same. I ultimately agree, it does come down to personal responsibility in the end. I was really lucky, and I KNOW I was lucky - I was diagnosed at 5 years old, so I had people helping me out from the beginning, not to mention that the two diabetes teams I went to are definitely one of the best ones in the state (Atlanta, GA) - and it scares the heck out of me that some PCPs only spend 10 minutes w/their patients - shows what I could be taking for granted when I get a minimum of 50 minutes with a CDE.
Also said in the quote - the whole "excuses" thing - agreed, granted, there are some that are easier to fix than others. Everybody's going to mess up with the food every now and again, I'd be lying if I said I hadn't, lol! The thing with the food/weight/etc. is that an endo/PCP can tell you all of this, but you just have to do it - in my case, it was checking blood sugars more than 4x/day (I'm on an insulin pump - my baby ), and I've had my bad points (not testing for 1.5 months, gotta love that denial), but I finally listened, so I'm ok there, but I have my bad days, and that's ok - I move on and say I'll do better tomorrow.
On the other hand, the supplies...again, got lucky - basic supplies are expensive enough, insulin pump supplies in themselves are incredibly expensive, and they also double what you need in basic supplies. Example: if I didn't have insurance, an insulin pump w/3 months of supplies for me would be roughly $9,000, and roughly $2,000 every three months after initial purchase...so basically, it's an expensive disease, and this is one of the main reasons people can't take care of themselves, b/c they can't afford the treatment, let alone top of the line treatment, and yes, that's upsetting to me. And like someone mentioned before, there's no way there is this much money in a cure.
Exercise-wise, can't say too much on this - I do have bad knees, and I eventually found swimming/water aerobics to be my forte, amazingly, as I was always a not-so-good swimmer, but I was forced to learn by the PE requirement at school, and was stunned at the results, so it stuck - it's anti-gravity, so to speak, so the knees don't mind it - that's my on that. And I definitely understand the medicine/blood sugar thing, granted I have the opposite problem - winter for me is always a rollercoaster of sorts b/c Sudafed is equivalent to insulin to my system - can be sitting on the sofa doing absolutely nothing, glucose 360, 2 hours after taking a Sudafed, 50 mg/dl - guess that's diabetic life for us! :uhoh21:
So, yeah, personal responsibility is what I think it ultimately comes down to, and from personal experience, it's not easy, quite frankly, it's far from! And even if you have the best of the best of diabetes educators, the only person that can put what they are saying into effect is the patient. (One of my pet peeves, diabetes educators that think they are GOD and can change everything about you...won't happen, only person that can change a person is themselves, hence why we diabetics can tune the ultra-forceful CDE out!) But you don't have to be Superman/Wonderwoman while doing it - baby steps are the key, just start little, they can and will get you somewhere, trust me, I've been there!
~Adria (Hopefully RN in 2008, CDE in 2010)
Yesterday I typed a huge, long response to this thread, went to submit and it went "poof". DM is very important to me for personal reasons. I watched someone I loved much die far too early from complications. I'm only a nursing student at the moment, but becoming a diabetic educator is something that I'm considering.
In brief, I will tell you that in my area, there are tons, tons, tons of available resources. We take every possible opportunity to educate diabetics once hospitalized with specialized nurse educators and nutritional consults. I personally beleive that every dollar spent on the front-end of education will pay tenfold if we can prevent complications and help people live longer, better.
But ultimately, grannynurse, it DOES come down to personal responsibility. I'm not begrudging anyone with DM any bit of education they want, and heck, I'll give it to them. But, and I say this gently and with respect, there are always excuses. As a school project, I held a seminar (free, of course) on living with DM. I chose a community center where I knew the membership included many people with DM. I advertised this seminar at the community center where it was to be held for one month. I made sure it was at a convenient time to maximize attendance. I gave contact information for people to contact me for more information/help with transportation/questions before hand. Wanna know how many people showed up?!?! ONE. And, she wasn't a diabetic - her husband was and she just wanted to support him. He didn't want to come.
You can't force people to take care of themselves. I would educate them forcefully - let them see what a diabetic foot ulcer looks like, make sure they know that they may go blind, or suffer kidney failure, or become dependent on dialysis. I'd take them to a dialysis clinic and make sure they knew how tortorous getting dialysis 3 times a week really is. But if they aren't coming to me, I simply cannot help them.
Should they all be managed by endocrinologists? Yes. Should their testing supplies be inexpensive, or even better, free? Absolutely. But, I can't even attempt to arrange that if they aren't coming in in the first place. I have noticed that newly graduating docs are keeping glucose under MUCH tighter control than those that have been around a bit longer. That's positive in my book. It's a start.
Now, this has all been very general, but as for you: You can't walk very far I understand. So, start with what you CAN do. Walk 50 feet three times a week. Then, make your goal 75 feet. It won't take long and your endurance will increase. Just be sure to examine your feet every night!
As for food, you know what to eat and what not to eat. You have to have your coke, go ahead and have it, but cover it. And make it a treat. Look forward to it at the end of a long day. The person cooking for you makes lots of gravies, sauces and what-not - that's really simple - SKIP IT. Eat the pot roast, just don't smother it. Restrict portions. You know all this, you just have to DO it.
Look, I'm not trying to be harsh here, but its the truth. There will always be excuses for why things aren't managed but in the long run, it's a simple decision. It's a choice. And to watch someone you love very much be unwilling to make the choice to LIVE and choose to DIE - well, it's almost too much to bear.
Making changes in your life is a very difficult thing to do. It is easier if you take one step at a time. Don't try to change everything at once, that's a sure fire recipe for failure. With your physical disabilities try one of those armchair exercises. Just do what you are able to do. If you can, do it two or three times a day. Eventually you will build up stamina. Where diet is concerned, does your husband truly understand the long and short term consequences of noncompliance? Maybe you can get him to make just one change at a time to help both of you adjust before you make another one.
I hope these suggestions help. I am a fairly new diabetic myself and I too find it hard to change my life habits. We all need all the support we can get. Good luck Grannynurse and let us know how things are going with you.
I was diagnosed type 2 in 1998, when I weighed 98 lbs (at 5'4''), so it's just not about obesity....I am now 190 lbs-quit smoking 6 yrs ago-work 6p-6a (trying to get on 6a-6p) 4 or 5 nights a week due to low staffing, go to school 2 nights a week, and try to fit in a walk with dogs if I get that extra day off a week-they love it, so do I!-I wonder if anyone has advice-other than stop sleeping-on how I can start getting the weight back off. I don't ever want to be 98 lbs again, but a nice comfortable 120-135 lbs would be great, plus I want to lose it the right way, not some fly by night crash diet or unhealthy regimen..... BTW, I am a nutrition buff, nearly a vegetarian (only eat meat/fish 1 or 2 days a week, and try to avoid red meat like it's the devil!), and lactose intolerant to boot.....Any ideas. I'm sure I'm not the only one like me out here
My schedule is very busy too, and my dietary preferences sounds fairly similar to yours. I'm not a vegetarian, but I rarely eat red meat. I keep frozen salmon filets in the freezer - I buy these at Sam's - they defrost quickly and I can cook several and take them to work/school with me the next day. Also, once a week, I clean and cut up veggies for salads. I keep lettuce in a big container, and the other stuff that I like in little bags. When I'm hungry, it's VERY easy to make a salad when it's all ready. It's even easier than making a sandwich, so that helps. I'm a coffee and chocolate addict, so I'm a fan of "Skinny Cow" desserts, and I just switched to Splenda which I don't love, but I am learning to tolerate for my coffee. I also made the big leap to non-fat milk. I dislike milk intensely, but I'm also sort of the poster-child for osteoporosis, so I'm forcing myself to drink it. I'm also skipping salt, which I love. That's the worst for me.
I also love Morningstar Farms veggie burger and I eat a lot of things most people wouldn't consider "dinner". But, I'll eat asparagus, broccoli or brussels sprouts and call it dinner. So, I am very well behaved for a couple of weeks, then I go out and splurge on something I've been craving. It's not the most fun way of eating, I'll admit. Plus, I'm a foodie and I love to cook, so it's extra boring for me, but it's what I have to do right now. Once I reach my ideal weight maintaining it won't be nearly as hard.
As far as exercise, take stairs at work when you can instead of the elevator. If someone needs something from another area and you have a minute, volunteer to be the runner. Every little bit helps.
Weight was never an issue for me, but after my second baby, it's been really tough to lose the extra. I'm getting there slowly but surely, and it's very, very hard work.
I have diabetes myself (Type 1, 15 years come March '06), and I think I'm coming from a slightly different point of view than others here, as I'm 20 y/o, but any way you look at it, a lot of the factors are the same. I ultimately agree, it does come down to personal responsibility in the end. I was really lucky, and I KNOW I was lucky - I was diagnosed at 5 years old, so I had people helping me out from the beginning, not to mention that the two diabetes teams I went to are definitely one of the best ones in the state (Atlanta, GA) - and it scares the heck out of me that some PCPs only spend 10 minutes w/their patients - shows what I could be taking for granted when I get a minimum of 50 minutes with a CDE.
Also said in the quote - the whole "excuses" thing - agreed, granted, there are some that are easier to fix than others. Everybody's going to mess up with the food every now and again, I'd be lying if I said I hadn't, lol! The thing with the food/weight/etc. is that an endo/PCP can tell you all of this, but you just have to do it - in my case, it was checking blood sugars more than 4x/day (I'm on an insulin pump - my baby ), and I've had my bad points (not testing for 1.5 months, gotta love that denial), but I finally listened, so I'm ok there, but I have my bad days, and that's ok - I move on and say I'll do better tomorrow.
On the other hand, the supplies...again, got lucky - basic supplies are expensive enough, insulin pump supplies in themselves are incredibly expensive, and they also double what you need in basic supplies. Example: if I didn't have insurance, an insulin pump w/3 months of supplies for me would be roughly $9,000, and roughly $2,000 every three months after initial purchase...so basically, it's an expensive disease, and this is one of the main reasons people can't take care of themselves, b/c they can't afford the treatment, let alone top of the line treatment, and yes, that's upsetting to me. And like someone mentioned before, there's no way there is this much money in a cure.
Exercise-wise, can't say too much on this - I do have bad knees, and I eventually found swimming/water aerobics to be my forte, amazingly, as I was always a not-so-good swimmer, but I was forced to learn by the PE requirement at school, and was stunned at the results, so it stuck - it's anti-gravity, so to speak, so the knees don't mind it - that's my on that. And I definitely understand the medicine/blood sugar thing, granted I have the opposite problem - winter for me is always a rollercoaster of sorts b/c Sudafed is equivalent to insulin to my system - can be sitting on the sofa doing absolutely nothing, glucose 360, 2 hours after taking a Sudafed, 50 mg/dl - guess that's diabetic life for us! :uhoh21:
So, yeah, personal responsibility is what I think it ultimately comes down to, and from personal experience, it's not easy, quite frankly, it's far from! And even if you have the best of the best of diabetes educators, the only person that can put what they are saying into effect is the patient. (One of my pet peeves, diabetes educators that think they are GOD and can change everything about you...won't happen, only person that can change a person is themselves, hence why we diabetics can tune the ultra-forceful CDE out!) But you don't have to be Superman/Wonderwoman while doing it - baby steps are the key, just start little, they can and will get you somewhere, trust me, I've been there!
~Adria (Hopefully RN in 2008, CDE in 2010)
Thank you for your imput and sharing of your life and experiences. I would like to point out a few things. Type I's are generally diagnosed as toddlers or youngesters. Unlike Type II, they are not faced with a life time of wrongly learned foods and behaviors. And your life literally depends on control of your intake and blood sugars. I would suggest your speaking with several Type I's of my generation but that is impossible. Most Type I's, from my generation, are no longer alive. Most long ago die from complications from their disease. When I first started out in nursing, strict dietary control was mandated. We hate Halloween, Christmas and Easter for the obvious reasons. Type I's are, if you will pradon my assumption, having an easier time of it. In my day, you wouldn't have even been considered for nursing school.
I and others realize the importance of self control and self regulation and personal responsibility. Unfortunately, we generally don't have the access to the team you did. And many of us are fighting a lifetime or atleast a generation or two of learned behaviors. And most of our peers seem to believe these are and can be easily changed.
Thanks for the swiming suggestion. I will see how much the Y will charge me for a pool membership.
I am truly encouraged and happy by the posts I've read this morning. And by the number of private messages I've received. It is nice to know I am not out here along; not the only one fighting the battle; not the only one struggling against a life time of learned behaviors.
By the way, I would like to share a story. A patient came into an ER, high blood sugar, poor control. And to top it off, she was fighting her nurses, try to strack and bite her care givers. I forgot to mention, she is a 15 year old cat. Guess even animal diabetic have problems:rotfl:
I and others realize the importance of self control and self regulation and personal responsibility. Unfortunately, we generally don't have the access to the team you did. And many of us are fighting a lifetime or atleast a generation or two of learned behaviors. And most of our peers seem to believe these are and can be easily changed.
Just for the record, I don't think making changes, especially when it comes to a lifetime of lifestyle preferences, is easy. It's not easy at all, and I completely realize that.
Just for the record, I don't think making changes, especially when it comes to a lifetime of lifestyle preferences, is easy. It's not easy at all, and I completely realize that.
Amanda
I realize that you do Amanda. It is my other peers that seemed to think control is just a matter of taking personal responsibility. I have found that things are not as simple as the appear. I don't know how many times, during my active career and since, that I have attempted to educate my peers and physicians into the realization that non-compliance, in the course of any type of treatment, is much more then a patient failing to take personal responsibility. And I have stopped counting the number of times that I have been told I am wrong, I am just making excuses.
A patient comes into an ER, for the forth time, with an extremely high blood sugar. The staff lectures him on his diet, testing his blood, controlling his blood sugar. Then, after getting his blood sugar under control, discharges him. No one has asked him about his health care coverage; his type of work' even if he does work; who does his shopping and cooking; asked him to explain just what he knows about his diet, to name a few reasons for his non-compliance. One nurse has related about her dh who is a truck driver and his difficulty with his diabetes. If it were a matter of self responsibility, he should be able to control his disease, shouldn't"t he? Let me tell you, things are not what they appear. Ever stop and read the menu at a truck stop eatery? I have, not actually heart or diabetic friendly. And what about those long hours on the road, not much time for exercise. And even if he only hauls within the state, he spends time living alone and is not really up on cooking. And it is easier to eat out. I'm not making excuses for him but I am asking others to take a deeper look into their patients non-compliance, even when it takes numerous looks.
First, I HIGHLY recommend this series in the nytimes. You do need to register to read, but it is free (at least most of the site including this series). The articles are a great combo of factual info and anectdotal stories.
Second, I read the series with great concern about the lack of resources being devoted and even more worry over stats that say 1 in 3 children born 5 years ago with get diabetes in their lifetime and 1 in 2 of Latino/Hispanic background. But, I also thought, I don't think I could ever be a home nurse or outreach worker with this population because the frustration level would be so high. Personally, I don't know that I could adapt to the lifestyle changes necessary, but it would still be challenging to keep trying to get people to change. Especially those who are most resistant. That fact of preventive treatment is important because we need to find ways to provide incentives for working with at risk population and the financial resources to fund it.
Third, the stats in the articles that most hit me:
1 in 8 NY-ers has diabetes with rates as high as 1 in 3 in some neighborhoods.
In NYC the public health department devotes $27 million to TB which affected 1,000 people last year and only $950,000 to diabetes affecting over 800,000 people.
One doctor said looking at rates of diabetes, it is effective to think of the number of cases in a 24 hour period.
4,100 people are diagnosed
230 amputations occur
120 enter end stage kidney disease
55 go blind
The arguments on the nytimes website feedback are all about "shoulds". What people should do, personal responsibility etc... But, I see no way "shoulds" will resolve the problem. Some type of action needs to be taken. The ultimate costs to society in every way are so high. Now figuring out what to actually do, that is a whole other debate.
), and I've had my bad points (not testing for 1.5 months, gotta love that denial), but I finally listened, so I'm ok there, but I have my bad days, and that's ok - I move on and say I'll do better tomorrow. 
on that. And I definitely understand the medicine/blood sugar thing, granted I have the opposite problem - winter for me is always a rollercoaster of sorts b/c Sudafed is equivalent to insulin to my system - can be sitting on the sofa doing absolutely nothing, glucose 360, 2 hours after taking a Sudafed, 50 mg/dl - guess that's diabetic life for us! :uhoh21: 
mandana
347 Posts
Yesterday I typed a huge, long response to this thread, went to submit and it went "poof". DM is very important to me for personal reasons. I watched someone I loved much die far too early from complications. I'm only a nursing student at the moment, but becoming a diabetic educator is something that I'm considering.
In brief, I will tell you that in my area, there are tons, tons, tons of available resources. We take every possible opportunity to educate diabetics once hospitalized with specialized nurse educators and nutritional consults. I personally beleive that every dollar spent on the front-end of education will pay tenfold if we can prevent complications and help people live longer, better.
But ultimately, grannynurse, it DOES come down to personal responsibility. I'm not begrudging anyone with DM any bit of education they want, and heck, I'll give it to them. But, and I say this gently and with respect, there are always excuses. As a school project, I held a seminar (free, of course) on living with DM. I chose a community center where I knew the membership included many people with DM. I advertised this seminar at the community center where it was to be held for one month. I made sure it was at a convenient time to maximize attendance. I gave contact information for people to contact me for more information/help with transportation/questions before hand. Wanna know how many people showed up?!?! ONE. And, she wasn't a diabetic - her husband was and she just wanted to support him. He didn't want to come.
You can't force people to take care of themselves. I would educate them forcefully - let them see what a diabetic foot ulcer looks like, make sure they know that they may go blind, or suffer kidney failure, or become dependent on dialysis. I'd take them to a dialysis clinic and make sure they knew how tortorous getting dialysis 3 times a week really is. But if they aren't coming to me, I simply cannot help them.
Should they all be managed by endocrinologists? Yes. Should their testing supplies be inexpensive, or even better, free? Absolutely. But, I can't even attempt to arrange that if they aren't coming in in the first place. I have noticed that newly graduating docs are keeping glucose under MUCH tighter control than those that have been around a bit longer. That's positive in my book. It's a start.
Now, this has all been very general, but as for you: You can't walk very far I understand. So, start with what you CAN do. Walk 50 feet three times a week. Then, make your goal 75 feet. It won't take long and your endurance will increase. Just be sure to examine your feet every night!
As for food, you know what to eat and what not to eat. You have to have your coke, go ahead and have it, but cover it. And make it a treat. Look forward to it at the end of a long day. The person cooking for you makes lots of gravies, sauces and what-not - that's really simple - SKIP IT. Eat the pot roast, just don't smother it. Restrict portions. You know all this, you just have to DO it.
Look, I'm not trying to be harsh here, but its the truth. There will always be excuses for why things aren't managed but in the long run, it's a simple decision. It's a choice. And to watch someone you love very much be unwilling to make the choice to LIVE and choose to DIE - well, it's almost too much to bear.
Amanda