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?
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.
When I started middle school (junior high), in San Diego, in 1958 we had one hour of physical education a day. Forty-five minutes was spent in actual physical activity, softball, tennis, basketball, volleyball. And we had it through the 7th, 8th and 9th grades. High school it was the same thing. The only time you could be excused was if you had a sprain or a broken bone. Forget your gym clothes? Not to worry, the school had spares in all sizes. Lunch, at my grandkids schools are similar to yours. I wonder if they use the same provider. Fruit is a mandatory addition but I wonder how many kids eat their. My grandkids get to eat Friday's lunch, the rest of the week, it is home prepared.
The only time I got excused was, I really didn't get excused, I spent my time practicing my gymnastics routine. And that didn't include an hour before school and a two hours after school. Gym like music and art are no longer important. Only the "No child left behind bull" is.
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?
No, my SIL is not financing all the food I consume. As a matter of fact, I give them $500 a month (for those figuring, my SSDI plus an annuity). My daughter and I had a talk this morning. I'm going to keep a food diet for two weeks and see what my actual food intake is, and what it is comprised of. I am waiting for the Medicare sponsored person to contact me. Will look into the yoga. One of the problems is we do not eat dinner until 7pm or later.
My 26 year old sister in law had Diabetes since she was a pre-teen.
She wore a pump and just got a new pump in Oct. Her blood sugar levels would get so low that she would pass out or would not wake up on her own in the mornings.
My brother and her wanted to have a baby and talked it over several times with her Diabetes doc and family hysician and with the docs blessings, they got pregnant. The docs words of advice to her was to "maintain low blood sugar counts." This didn't make a lot of sence to me since low sugar counts was a bad problem for her. But I figured they knew what was best...
Well, in Nov. 2005, at 13 weeks pregnant, she passed away. She was found clothed in their bathrub submerged under water. We do not know why or how. But the autopsy revealed that she passed out due to diabetes and drowned.
Though she tried to maintain what the docs suggested, it didn't work out in her situation.
And though the cause of death in the coroner's report is drowning, she wouldn't have drowned if she hadn't of passed out due to the Diabetes.
At work I test blood sugar levels on people who complain about having it done. I stress to them the importance, now more than ever, of keeping a good eye on the counts. It does mean the difference between life and death.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Well, in Nov. 2005, at 13 weeks pregnant, she passed away. She was found clothed in their bathrub submerged under water. We do not know why or how. But the autopsy revealed that she passed out due to diabetes and drowned.
Diabetes is like any other chronic health problem. You only have control to a certain degree, but diabetics can improve their quality of life.
I come from a family of diabetics-grandparents, aunt, cousin, and father. I know that I'm high risk for getting this disease regardless of what I do. However, I've chosen to be proactive. I watch my weight and excercise.
My relatives with this disease refuse to follow any diet/ lose weight/ or excercize. As a result, they are experiencing the complications of this disease-stroke/heart disease/eye problems/ etc, They are very well versed on what they need to do enhance their lives, but refuse. They have seen for themselves what has happened to our family members with this disease, who are non compliant
You can not "make" someone comply. The patient, who is successful, is one is motivated to make changes.
Diabetes is like any other chronic health problem. You only have control to a certain degree, but diabetics can improve their quality of life.
I come from a family of diabetics-grandparents, aunt, cousin, and father. I know that I'm high risk for getting this disease regardless of what I do. However, I've chosen to be proactive. I watch my weight and excercise.
My relatives with this disease refuse to follow any diet/ lose weight/ or excercize. As a result, they are experiencing the complications of this disease-stroke/heart disease/eye problems/ etc, They are very well versed on what they need to do enhance their lives, but refuse. They have seen for themselves what has happened to our family members with this disease, who are non compliant
You can not "make" someone comply. The patient, who is successful, is one is motivated to make changes.
I am wondering if your non-compliant relatives are non-compliant because they have seen all the complications and feel they have no control? They have given up because of what they have seen? No, you cannot make someone comply but you should explore all the reasons for their non-compliance and attempt to work with them. And by work with them, I do not mean scold, constantly point out the failures, etc, etc, but give them positive feedback no matter how small.
I am a Type II diabetic that just recently started insulin. I was very non-compliant for a few years. I too had every excuse known to man for not taking better care of myself. As a nurse I should have known better. It took me becoming gravely ill with a 500 blood sugar to finally start DOING it. I also was a Coke Classic addict. I have not had one in over 2 months. Am I proud of that? YOU BET!!!
I was bitter and angry the first couple of days in the hospital. Then I made the CHOICE to make this a positive for myself and my family. This is my chance to get healthier as well as my families. (after all if I cook healthier, it can also help them).
Granny I have noticed that all of your responses have been bitter and argumentative. There have been many posts that I felt were kind and helpful, yet you attacked them with bitterness and "I can'ts". It seems to me that a good portion of the problem is in your mindset. Only YOU can change that. Noone can help you unless you want to open your mind and heart to it.
I am sure I am the next to be chastised or berated by you. And that is ok. Because nothing you say will affect my life or attitude. I wish you well on your diabetic journey. But only you will determine your outcome. :)
Granny - I'm pleased that you and your daughter are discussing food. It's a great idea to start with a food diary and see what you are actually consuming. You might be surprised - either way - with what is actually going in. Here's a :yelclap: for you.
ERNURSE4ill - CONGRATULATIONS! That's wonderful. I know it's not easy but living a good life makes those sacrifices pretty insignificant doesn't it? I think that's what keeps my DH focused. He can project long term benefits vs short term gratification. I try hard to do my part - no delayed meals, healthy food and fresh strawberries or another fresh fruit for dessert.
I'm so glad you made the choice for yourself and in fact, for your family, too.
I am a Type II diabetic that just recently started insulin. I was very non-compliant for a few years. I too had every excuse known to man for not taking better care of myself. As a nurse I should have known better. It took me becoming gravely ill with a 500 blood sugar to finally start DOING it. I also was a Coke Classic addict. I have not had one in over 2 months. Am I proud of that? YOU BET!!!
I was bitter and angry the first couple of days in the hospital. Then I made the CHOICE to make this a positive for myself and my family. This is my chance to get healthier as well as my families. (after all if I cook healthier, it can also help them).
Granny I have noticed that all of your responses have been bitter and argumentative. There have been many posts that I felt were kind and helpful, yet you attacked them with bitterness and "I can'ts". It seems to me that a good portion of the problem is in your mindset. Only YOU can change that. Noone can help you unless you want to open your mind and heart to it.
I am sure I am the next to be chastised or berated by you. And that is ok. Because nothing you say will affect my life or attitude. I wish you well on your diabetic journey. But only you will determine your outcome. :)
I am sorry that you believe my responses are all bitter and argumentative. At the risk of being argumentative, I have to disagree with you. I am argumentative with those that present their solutions as being simple and purely a matter of personal responsibility because I find that a simplistic response. It goes along with those who complain about non compliant patients without ever exploring the reason for their non-compliance. I do not find just give up your sodas or get more exercise particularly helpful. My "I can'ts" are based on the reality of my life. And it is the life of many diabetics. I received several e-mails from other nurses who are experiencing or have experienced what I have. One of the reasons several gave for not posting was the judgmental, simplistic attitude of many of our peers. And if you have noticed, I have thanked several who gave me and others reasonable suggestions. One of the things that the NYT article points out is the failure of mainstream medicine to meet the needs of Type II diabetes. And the failure of insurance to meet the needs of us. It is easier to blame the diabetic for all of his complications and meet his needs when they have occurred, then to take the time and money to adequately educate and support him. The three clinics that did such, noted a downturn in complications and an increase in compliance , weight loss and increase in exercise. Unfortunately reimbursement was much less then that for complications. And the clinics were forced to close. So, please excuse me for sounding bitter and argumentative, I am. I am when the only diabetic educator available is a dietitian, in my county. And where there are no support groups, in my county. And this despite the population of my county being 60% over the age of 60. Perhaps I will make it my mission to start a support group or two, if I can find someone to donate a room.
Granny - I'm pleased that you and your daughter are discussing food. It's a great idea to start with a food diary and see what you are actually consuming. You might be surprised - either way - with what is actually going in. Here's a :yelclap: for you.
Amanda
Thanks. It is a start. Now I think I will look into one or two of our hospitals donating a room for meetings. And talk to Wal-mart, K-mart and others about putting up notices.
And where there are no support groups, in my county. And this despite the population of my county being 60% over the age of 60. Perhaps I will make it my mission to start a support group or two, if I can find someone to donate a room.
Grannynurse:balloons:
here ya go granny (et al)!
a few links that are strictly dedicated to diabetic support/chat rooms...
grannynurse FNP student
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