Non-compliant patients

[tpecina]

How do you get a patient who has high levels of glucose to monitor his blood sugars and take insulin, which he is refusing.

[Anna Flaxis, BSN, RN]

How do you get a patient who has high levels of glucose to monitor his blood sugars and take insulin, which he is refusing.

First, we should do away with the label "non-compliant". Erase it from your mind. Find out what the patient knows about diabetes and what his belief systems are regarding health maintenance.

The first thing I would do is find out what he knows about diabetes.

The next thing I would do is find out how he feels about his own health, his quality of life, and how much control he feels he has over it.

People with an external locus of control feel that things outside of themselves have more influence over their destiny than they do. People with an internal locus of control feel that they have more control over what happens to them.

The first step is to seek to understand where the person is coming from, before you slap a label on them.

[Alisonisayoshi, LVN]

I'm pre-nursing, but a diabetic. I misused my insulin for a long time. I was not non compliant in was sick, overwhelmed, with an eating disorder. I was burned out and tired of my illness,, I was not non compliant. I was in need of a greater level of care, of more empathy, more therapy, more education. Nobody just ignores an illness that can kill them, without a reason. Nobody. You, or the care team, just have to be willing to really look to find the reason.

[Anna Flaxis, BSN, RN]

Also, I've noticed that whether the person is Type 1 or Type 2 makes a difference as well. Type 1s tend to be diagnosed at an earlier age, during their development where peers have the most influence. The symptoms and adverse effects of the disease tend to be much more severe. I've taken care of many folks in their 20s and 30s who are on dialysis for end stage renal disease r/t their diabetes. I've taken care of a lot of young folks in DKA because for whatever reason, they made a choice to not take care of themselves. With Type 2, these tend to be older folks (at least, not children or adolescent when diagnosed) with a little more life experience, and the adverse effects, though potentially severe, can feel mild to the person who has DMII. It can be easy for the person with DMII to ignore the severity of their illness, because, like the person with asymptomatic HTN, they feel perfectly normal. Having a nurse wagging their finger at them to do this and do that can feel really invasive and demeaning.