Diabetes can be hard work, but you’re the best one to do it
Research has shown that people with diabetes trust their GP and community care team more than the specialist diabetes team. You can build a relationship with your patient that recognises the whole person, rather than just the diabetes. A trusting relationship is where good diabetes control grows from.
These are some strategies that may help you make the most of your short consultation time.
How your communication style can help
The words that are traditionally used to describe people with diabetes are judgmental and negative. It’s easy to slip into this, but they help no one – least of all your patients.
Consider these traditional words and what they might really mean:
|Old fashioned description||A possible explanation|
|Brittle diabetic||The insulin regimen is not the right match|
|Non-compliant||Injection technique is not quite right|
|Poorly controlled||Gastroparesis is interfering with the match between diet and insulin|
|Bad diabetic||Your patient is depressed, or stressed with other priorities|
|Your patient has gaps in their diabetes knowledge|
What it’s like for your patient
As a healthcare professional, you know diabetes as a disease.
For your patient, it is their every day. Diabetes affects their self-esteem, their relationships and their job prospects. Every day, they have to think about glucose levels and insulin doses whenever they eat or do exercise. It is likely that they have had to endure the judgment of well-meaning doctors and nurses, so your patient may be defensive or reluctant to engage. It can be hard work. Understanding the person is the first step to achieving good diabetes control.
You can see that judging your patient or being negative is going to be unhelpful. Bombarding them with instructions and information can be overwhelming.
Your patient may respond better to consultations that aim to:
So, be kind. Look for ways to mentor your patient and their family. With social media and online communities, your patient has opportunities to find supportive groups of people who understand what it’s like to have diabetes. If your patient is interested in joining these groups, guide them to sites and groups that are monitored, so the advice they get isn’t dangerous. Your support will be valuable to your patient.
Psychology of self-care and food
Self-care for chronic disease assumes that you care about yourself. It’s not hard to see that if you have a poor self-esteem or suffer depression, your commitment to self-care may be hard to maintain. Your patient may benefit from psychosocial support and counselling as part of their diabetes plan. Your diabetes plan is much more likely to be successful when your patient is able to care for them self.
When it comes to food, it can be a very emotional experience. Maslow’s hierarchy of needs clearly defines food as the very foundation of someone’s survival. So, when we question what someone eats, or try to change it as part of their diabetes care plan, we are at it risk of attacking that person, not just the food. For some people, cooking food for someone is a way to show care and love. If we come in to criticize or change it, there is a chance that we affect more than the food on the table. It’s important to tread carefully, recognise the emotions involved and to include family members in the discussions about food.
Successful behaviour change
Having diabetes requires a range of new habits to manage it successfully. We ask people to check their glucose levels, take insulin, eat differently, go to bed earlier and start doing some exercise. This is a lot to ask of someone, so it’s important to set things up for success.
For any new behaviour change to be successful, it needs to be achievable and meaningful. Your patient needs to be able to see the difference and know that it was worth the effort. Arrange follow-up appointments in 2-3 weeks to consolidate any new knowledge and reinforce the behaviour change.