Educating Patients

My patient, Frank, was a diabetic. Many of his health problems stemmed from his lack of education about controlling his blood sugar. Without intervention, Frank would have become a more unstable diabetic. His demeanor was apathetic. He did not understand how bad his health could get without self-management of his diabetes. At times he seemed overwhelmed and depressed that he had this condition. My goal was to empower him and to get his wife involved so that she could support him along the way.

Meet Frank

Frank is a 67-year-old man with type 2 diabetes. He came to the hospital after several episodes of dizziness and a subsequent fall at home. He was diagnosed with diabetes but was having symptoms for 2 years before his diagnosis. He was told these symptoms, such as frequent urination and increased glucose levels, were pre-diabetic. He is overweight with a body mass index of 35.8 kg/m. A recent visit to his doctor for his yearly physical showed lab result values of fasting blood glucose level of 192 mg/dl. He was recently started on Glyburide to be taken daily but he stopped taking it because he said it made him sweaty and irritable. He also takes Lipitor daily to control his high cholesterol. In the last few months, his wife suggested taking vitamin supplements in an attempt to control his blood sugar and help him with weight loss. He stopped taking these when he did not feel any improvement.

When talking to Frank and his wife he revealed that he does not check his blood sugar at home. "I don't even own one of those gadgets to check my sugar.” He states his blood sugars always come out high so what difference would it make to check them. He says he's a "real meat and potatoes man". He also says pasta and bread are among his favorite foods. His wife says she has offered him lower-calorie foods but he describes them as "tasteless". He drinks 8 ounces of wine with dinner each evening. He does not smoke, quit 10 years ago after a 50 pack/year history.

He recently retired after 33 years as a truck driver. He lives with his wife of 40 years and has two married children. His father had diabetes but Frank still has limited knowledge about managing his own diabetes.

Since his retirement one year ago, Frank has tried to play more golf and do more gardening to try to increase his physical activity. Despite his efforts, he has gained over 20 pounds. He has never been educated about a diabetic diet.

Nurse in Action

While Frank was in the hospital I arranged for a nutrition consult. He and his wife acknowledged that they needed help to figure out dietary restrictions for glucose control and weight management. Frank's wife suggested they take a 20-minute walk after breakfast every day. She also said she was thinking of getting a treadmill so Frank could keep up his walking in bad weather. She seemed relieved that she too was feeling more empowered about how to help Frank.

Metformin was prescribed for Frank to take twice daily. I explained the gastrointestinal side effects and to take his medicine with food. During his hospitalization, he and his wife learned how to check his blood sugar. He refused a prescription for Vasotec for blood pressure control. His perception was the more medications he took, the sicker he would become. His wife wanted to try a "natural solution". They both wanted to just focus on the weight loss and glucose control.

Importance of the Role of the Nurse

My experience with this patient reinforced to me the importance of the nurse's role as part of the healthcare management team. The patient was at a point in his health status that he could have experienced worsening diabetes control had he not been educated. It really surprised me how much he did not know about his health. I got some insight into his understanding of diabetes and his health belief system.

I empowered him, I helped him take ownership of his health, and I gave him the information he needed to make better decisions about his health.

I'm no hero. My hope is that I made Frank his own hero.