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?
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.
I couldn't agree with you more. Just think, take the statistics of NYC and transfer them around the country, into our public schools, into our public parks, into our retirement communities and states with a high retirement population. I can think of four, all located here in the deep South, that have large older, retired populations and have the smallest public funding of diabetic education and health care. And my state, Florida has one of the poorest PE requirements I have ever seen. My two youngest grandkids are in grade school. They receive one hour of PT a week and it is nothing like what I was use to. Their sister is in middle school and there, they receive 18 weeks of P.E. If they 'forget' their PE clothes, they can walk or do 'laps' around a field. Organized sports-if you consider kickball an organized sport, I guess it is all right. Why do I bring it up, you should see the number of over weight students in both schools. And my grandson is one of them. And I worry about him developing Type II.
What is scary about NYC, is that it could be any major city or community, in this country. And the apathy of the medical community and public officials is terrible. And the lack of understanding and work on the part of the medical community, including nurses, is equally terrible. And the lack of attempts to get their disease under control, by some diabetics, is terrible. Management of this disease is not entirely on the shoulders of the diabetics. It is a public health, facilities, health care communities-including physicians and nurses-management issue and problem. And it is a problem for the tax payers and insurance companies and their poor funding of preventive care.
I don't know where I stand on the issue of personal responsibility with diabetes. I think it depends on the person. Last week I saw (briefly, she wasn't my patient) a diabetic in her twenties with end stage renal disease. She was begging for a chocolate chip cookie.
Most of the family members that I suspect had diabetes, are deceased and it isn't talked about in my family. It's not considered polite. I did feel free to chime in a bit on the effects of diet on the feet, kidneys and heart when my MIL asked me to look at my FIL's feet. His feet aren't bad but I see varicose veins there and to me that's a red flag. Result? My MIL felt good to have someone agree with her and I think my poor father in law felt a bit nagged.
My patients who are elderly, set in their ways and have all the complications to deal with now, I don't really think much about their responsibility unless they are morbidly obese. Then I feel bad for wanting to be snarky with my obese patients. I don't think I actually get snarky, but I think about it. My mother made me really angry the time she was telling me that she couldn't sit for over 30 minutes at a time without cutting the circulation off to her legs with her nice rotund belly. I wanted to just yell, "ok so get up and get moving!"
I do think that if my husband ever develops these problems there may be no end to the nagging that would ensue. In my ex, I took a lack of taking care of himself as a lack of self respect, and translated that as not caring about the people in his life who might care whether he lives or dies. This wasn't something he wanted to hear. He would not listen to word one of medical advice and would say things like, "salt does not cause hypertension, smoking is okay because I can still run if my life is in danger and my blood pressure is good so I can drink, smoke and eat all I want." Uh huh. He has GERD, is morbidly obese, god knows what his liver and lungs are going through, and that "good" blood pressure won't always be that way. I look at the support that I did offer when we were married- home cooked low fat, moderate calorie meals and offers to exercise together. The result? He spent his nights at the waffle house and refused to exercise, stopped eating what I cooked and I quit cooking. No fun if people don't eat it.
So I don't get too huffy with other people about their responsibility but if it's a family member I care about, I tend to take it personally if they don't have any desire to take care of themselves.
We did have one patient post heart cath, big ole feller, with family members in the room who were more rotund than they were tall almost, talking about his niece who had heart surgery at the age of twelve. I asked if it was a congenital heart condition, he said no. That does tend to make me less sympathetic towards his entire family for subjecting a child to a lifestyle that's directly life threatening.
First of all, my husband is type II and not your stereotypical patient. He very rarely misses his DAILY workout, is not obese and loves grilled fish, salad, fresh veggies, etc. No soft drinks at all for him. He's very well controlled - his labs tell us that. He's educated about diabetes but we were bombarded with "diabetes educators" when he was hospitalized for orthopedic surgery. I'm NOT kidding, it got to the point we were avoiding them. We didn't ask for this "education". I can't believe this hospital is the only one that has this program. I know they have a monthly "class" that's completely free. They always have different speakers; healthy, but wonderful snacks, good and interesting handouts. Every single diabetic that is admitted to or treated at that large hospital is made aware, invited, encouraged and even beseeched to attend these meetings. There are usually about 20 of us and half of us are spouses.
Is that the health providers fault? I DON'T THINK SO!
I'm NOT kidding, it got to the point we were avoiding them. We didn't ask for this "education". I can't believe this hospital is the only one that has this program.
At the last couple of hospitals where I worked, there was only 1 or 2 diabetic educators for the entire hospital and they were expected to focus on outpatient teaching as well as classes for the general public. There was no education for the new diabetic or the diabetic who had a lot of questions, that had to come from the staff nurse and as you know that type of education is labor intensive. I know of several situations in which the patient was taught how to give their injections within a few hours of their discharge and given a couple of pamphlets about their disease. There's no money in diabetic teaching but there is plenty of money in bariatric surgery, cardiac surgery and women's health.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
An estimated 16 million people in America are diabetics, but half do not know they have the metabolic disorder.
Earlier this evening I was watching a reality medical examiner show on the Discovery Health Channel. A young woman was bed-bound for 3 years while her husband cared for her at home. For 3 years she received no medical atention because she hated doctors. She suddenly died in the motel room that she and her husband called home.
This woman was blind with a gangrenous leg. She had pressure ulcers all over her body and her hair was matted. She had bruises all over her body due to lack of sensation, which caused her to trip over things. For 3 years she was unaware she had uncontrolled diabetes. The medical examiner determined that she died from septicemia, and that a limb amputation would have saved her life if done only 3 days earlier.
Specializes in med-surg 18 months, respiratory 3.5 year.
My two youngest grandkids are in grade school. They receive one hour of PT a week and it is nothing like what I was use to. Their sister is in middle school and there, they receive 18 weeks of P.E. If they 'forget' their PE clothes, they can walk or do 'laps' around a field. Organized sports-if you consider kickball an organized sport, I guess it is all right. Why do I bring it up, you should see the number of over weight students in both schools. And my grandson is one of them. And I worry about him developing Type II."]
There certainly is an epidemic of precipitating factors for developing metabolic disorders in the country right now. I live with several of them personally and I see it in my own children and DH. It is a combination of inactivity (use of TV computer, video games by children), poor food choices learned from family as small children (portion sizes way too big for small kids, easy access to really bad food choices, sugary foods cheaper than good meat and fresh veggies). 3 out of 4 people in my family are overweight, currently, myself included. There was a day when I literally was in tears because I had no idea what foods I should be eating. We are bombarded by the media and advertising into believing food myths such as:
*breakfast should come in a bowl with a spoon
*a meal is not complete until there is bead and butter on the table
*the only square meals are hot and have a meat as the main subject
I think what is needed is for all of us to understand the longterm effects of giving our kids sugar and adult sized portions. I mean, would you give your kids cigarettes? No , of couse not. There is growing evidence that most diseaes are ultimately food-related. For those interested in one doctor's opinion of the link between food and chronic illnesses there is a link to her website: (as usual, no afilliation)
To Grannynurse, as adults we are responsible for our actions or inactions. It sounds to me that you need a few pats on the back or you will never find the motivation to change your life. Each small thing you do gets you that much closer:icon_hug: The next thing I would try if I were you is to get some salad with all those carbs:wink2:
My two youngest grandkids are in grade school. They receive one hour of PT a week and it is nothing like what I was use to. Their sister is in middle school and there, they receive 18 weeks of P.E. If they 'forget' their PE clothes, they can walk or do 'laps' around a field. Organized sports-if you consider kickball an organized sport, I guess it is all right. Why do I bring it up, you should see the number of over weight students in both schools. And my grandson is one of them. And I worry about him developing Type II."]
There certainly is an epidemic of precipitating factors for developing metabolic disorders in the country right now. I live with several of them personally and I see it in my own children and DH. It is a combination of inactivity (use of TV computer, video games by children), poor food choices learned from family as small children (portion sizes way too big for small kids, easy access to really bad food choices, sugary foods cheaper than good meat and fresh veggies). 3 out of 4 people in my family are overweight, currently, myself included. There was a day when I literally was in tears because I had no idea what foods I should be eating. We are bombarded by the media and advertising into believing food myths such as:
*breakfast should come in a bowl with a spoon
*a meal is not complete until there is bead and butter on the table
*the only square meals are hot and have a meat as the main subject
I think what is needed is for all of us to understand the longterm effects of giving our kids sugar and adult sized portions. I mean, would you give your kids cigarettes? No , of couse not. There is growing evidence that most diseaes are ultimately food-related. For those interested in one doctor's opinion of the link between food and chronic illnesses there is a link to her website: (as usual, no afilliation)
To Grannynurse, as adults we are responsible for our actions or inactions. It sounds to me that you need a few pats on the back or you will never find the motivation to change your life. Each small thing you do gets you that much closer:icon_hug: The next thing I would try if I were you is to get some salad with all those carbs:wink2:
Rebecca
Do you want to know what my SIL thinks my grandson's biggest problem is? Soda. And my grandson doesn't drink regular soda. But he does eat a lot of his father's startchy foods. And he has an king size after school snack. And I can't say anything because it is not my home. Unfortunately, my grandson has inherited his great grandfather's built and appetite. And I am afraid he may also have inherited my diabeties Lets see, they had three days off from school. They spent an average of eight to ten hours, out of sixteen watching TV or doing things in the house.
Thanks for the pats on the back but I really do have some of the need motivation. I lack the energy.
Specializes in Happily semi-retired; excited for the whole whammy.
My two youngest grandkids are in grade school. They receive one hour of PT a week and it is nothing like what I was use to. Their sister is in middle school and there, they receive 18 weeks of P.E. If they 'forget' their PE clothes, they can walk or do 'laps' around a field. Organized sports-if you consider kickball an organized sport, I guess it is all right. Why do I bring it up, you should see the number of over weight students in both schools. And my grandson is one of them. And I worry about him developing Type II."]
There certainly is an epidemic of precipitating factors for developing metabolic disorders in the country right now. I live with several of them personally and I see it in my own children and DH. It is a combination of inactivity (use of TV computer, video games by children), poor food choices learned from family as small children (portion sizes way too big for small kids, easy access to really bad food choices, sugary foods cheaper than good meat and fresh veggies). 3 out of 4 people in my family are overweight, currently, myself included. There was a day when I literally was in tears because I had no idea what foods I should be eating. We are bombarded by the media and advertising into believing food myths such as:
*breakfast should come in a bowl with a spoon
*a meal is not complete until there is bead and butter on the table
*the only square meals are hot and have a meat as the main subject
I think what is needed is for all of us to understand the longterm effects of giving our kids sugar and adult sized portions. I mean, would you give your kids cigarettes? No , of couse not. There is growing evidence that most diseaes are ultimately food-related. For those interested in one doctor's opinion of the link between food and chronic illnesses there is a link to her website: (as usual, no afilliation)
To Grannynurse, as adults we are responsible for our actions or inactions. It sounds to me that you need a few pats on the back or you will never find the motivation to change your life. Each small thing you do gets you that much closer:icon_hug: The next thing I would try if I were you is to get some salad with all those carbs:wink2:
Rebecca
It amazes me, but at my son's middle school, they have PE 4 days a week (and one of those days is a double period, as they have block days twice a week in which they attend only half their classes for two combined periods). They had it every day at the elementary school, too. What I wish the school would also focus on is how some healthful choices for lunch. There isn't a dark (or light) green to be found amongst the hotdog, hamburger, pizza offerings. And although they've dispensed with the soda, there are still plenty of sugary drinks like Gatorade offered up for sale.
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.
Excellent point. When I worked on the Navajo Reservation I saw many people with diabetes and other chronic diseases. Once I was having a discussion about the meaning of time with one of the Native RN's. Her idea of "stat" was "as soon as I can". It helped me understand why people were late to appointments or didn't take medication like "we" thought they should...
I am amazed at some of the responses coming from my profession.
My husband was diagnosed with Diabetes 10 years ago. Prior to a professional diagnosis he and I determined that diabetes was his problem. He immediatly stopped eating anything high in sugar/high fructose corn syrup, regular sodas, cakes, cookies, you name it. He is physically active on our farm but does not work out or participate in an exercise regimen. He is diet controlled, his HgbA1C is excellent, and he has no other physical problems other than some age related vision problems (according to his eye Dr.). This means of control for his disease process was his choice. He did not receive any information from his physician other than the generalized "New Diabetes Pt." packet. He did read some on his own as well as information I was able to provide him as an RN. HE made the choice. And yes he is very disciplined...because he chooses to be.
Working in Home Health I see so many diabetics. I live in the Appalacian mountain region and you can guess the educational level. We as Home Health nurses teach and teach and teach but the patients/families still choose to maintain the same way of life they had before. They choose not to make the necessary changes in order to live life to the fullest.
Yes, it is a choice. I love my patients, but I don't love the choices they sometimes make.
To Grannynurse - how about some simple "in your chair" yoga? Muscles burn 50-80 calories/day naturally. Try some tightening/relaxing exercises to burn a few more. And have you tried to talk to your SIL about making fresh veggies or other healthy snacks available to you so you don't feel hungry when you go to bed. Is he financing all the food you consume?
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Muscles burn 50-80 calories/day naturally. Try some tightening/relaxing exercises to burn a few more.
Actually I had been taught that each pound of muscle burns 50 calories hourly, and that each pound of adipose tissue burns 2 calories hourly. Conversely, I might be incorrect...
There is growing evidence that most diseaes are ultimately food-related. For those interested in one doctor's opinion of the link between food and chronic illnesses there is a link to her website: (as usual, no afilliation)
grannynurse FNP student
1,016 Posts
I couldn't agree with you more. Just think, take the statistics of NYC and transfer them around the country, into our public schools, into our public parks, into our retirement communities and states with a high retirement population. I can think of four, all located here in the deep South, that have large older, retired populations and have the smallest public funding of diabetic education and health care. And my state, Florida has one of the poorest PE requirements I have ever seen. My two youngest grandkids are in grade school. They receive one hour of PT a week and it is nothing like what I was use to. Their sister is in middle school and there, they receive 18 weeks of P.E. If they 'forget' their PE clothes, they can walk or do 'laps' around a field. Organized sports-if you consider kickball an organized sport, I guess it is all right. Why do I bring it up, you should see the number of over weight students in both schools. And my grandson is one of them. And I worry about him developing Type II.
What is scary about NYC, is that it could be any major city or community, in this country. And the apathy of the medical community and public officials is terrible. And the lack of understanding and work on the part of the medical community, including nurses, is equally terrible. And the lack of attempts to get their disease under control, by some diabetics, is terrible. Management of this disease is not entirely on the shoulders of the diabetics. It is a public health, facilities, health care communities-including physicians and nurses-management issue and problem. And it is a problem for the tax payers and insurance companies and their poor funding of preventive care.
Grannynurse:balloons: