George Mellows is aged 55. He lives with his wife and his two teenage children, aged 15 and 19.

George works Monday to Friday 8.30 am until 4.30 pm . He works at a desk in a sedentary role, getting minimal activity in his working day. George has not played any sport for some time, but he does enjoy playing lawn bowls.

*** Previous Posts: Part 1 here ; Part 2 here ; Part 3 here ***

George has now had diabetes 3 months. He has had a consultation with his dietitian and found some healthy choices to make that not only fit with his diabetes self care plan but also things he enjoys!

This past 2 weeks George has been measuring his blood glucose level with a view of discussing the results with the diabetes educator. George feels confident that he can identify the causes of hyperglycaemia

On diagnosis, George’s doctor commenced George on Metformin 500mg in the evening with dinner. This has not changed.

The table below is his most recent blood glucose levels. George has highlighted the blood glucose levels that are over his target in red.

The Visit

“Self-management means having a daily management plan, setting goals, solving problems and taking responsibility. But it certainly does not mean you are on your own. Mutual trust and respect between yourself and your doctor and other members of the health care team, as well as regular communication with them, are vital to effective self-management.

Previously, traditional care was based on doctors and health professionals being seen as the experts responsible for the diagnosis and management of care. It was accepted that people’s lives should be fitted around their diabetes with goals set by the health professionals.

But this approach is not effective. Diabetes requires daily management. Doctors are not available every day, leaving responsibility for day-to-day care on the patient and the family.

In addition, good results are difficult to achieve if the person involved is not an active participant or does not understand the reasons behind management decisions.

Patient Empowerment takes a new approach. It moves the focus from the doctor to the patient. It involves fitting diabetes into your lifestyle with you making the choices and taking charge of your management and the consequences.” Diabetes Australia

Tools

On arrival in the consultation room George was asked by the receptionist to complete:

* The Diabetes Distress Scale (download here DDS and HERE )

* The Diabetes Knowledge Questionnaire (download here DIABETES KNOWLEDGE QUESTIONNAIRE (old rtf format) )

George felt a little uncomfortable initially using these ‘tools‘ to complete these ‘tests’. However, the diabetes educator saw George acting a little uncomfortable in the waiting room and explained that the purpose of these tools would be to individualise the visit based on the knowledge and needs of George.

George felt more comfortable with this explanation, and managed to complete both before the visit started in person. *He also felt that it might have been good to complete these at home before the visit.*

“How did you feel about completing those tools George?” the diabetes educator asked as they sat down to start the session.

” At first it was a little like being in school; but when you saw I was puzzled about them, and explained how we could use them in this session, I felt like I was going to be listened to, not just spoken at and told what I should and shouldn’t do” replied George.

The diabetes educator then used these with George to open and lead the session. George was also a little surprised at this, expecting the diabetes educator to be focussed on his blood glucose levels.

The diabetes educator started with the knowledge questionnaire, only asking George about the question he had gotten incorrect. By the end of the first 20minutes George was feeling that he was learning new things despite al of the reading and research he had been doing on the internet.

George hadn’t even considered the importance of foot-care, despite being aware that diabetes can effect the nerves and the blood supply to parts of the body.

Diabetes Distress

Diabetes may lead to specific problems and increased stress, which we often call “diabetes distress”.

Daily life and general stress levels can affect your diabetes control. How well your diabetes is going can in turn affect your general stress levels – so it is a bit of a chicken and egg. It is very important to get the general stress in your life under control, as this will assist with your diabetes management. Likewise, feeling settled with your diabetes management will decrease your overall stress.

If you are struggling with stress at work, or in your personal life, it can be harder to manage diabetes and it suffers. We all experience stress and life would be boring without some stress! People say they would rather not have stress in their lives, but in fact we need a balance between just enough stress and not too much, to keep us alive and active. Not all stress is bad believe it or not.

Some of the things that can lead to diabetes distress are:

• Worry about food changes
• Management of blood glucose levels
• Weight management
• Going onto insulin/medication
• Hypos (low BGL)
• Depression & mood swings – have been shown to be higher in people with diabetes
• Relationship & sexual problems
• Work stress, discrimination in relation to your diabetes
• Disclosure – wondering if you should tell people about your diabetes
• Lack of understanding or support from family/friends
• Guilt, fear, worry, panic & anxiety about diabetes and your future
• Risk of Complications
• Feeling alone and isolated
• Seeing or hearing about all the things that can go wrong
• Feeling out of control
• Other mental health problems such as an eating disorder
• Feeling overwhelmed and exhausted
• Lack of information

Blood Glucose Levels

Towards the end of the session the diabetes educator and George decided to take a careful look at the blood glucose levels that George had been measuring.

The diabetes educator asked “George, why do you test your blood glucose level?”

George was a little taken aback by this question. He thought that everybody just had to, that it was a part of having diabetes.

After a moment he said: ” To determine if my diabetes self care plan is working well, or if there needs to be some changes to my meal planning, or my exercise, or to my diabetes medication.”

George identified clearly the things that would impact on his blood glucose level, and also identified that weekdays at lunchtimes when he didn’t move very much was a problem for him.

Future Planning

The plan at the end of the session was to make an appointment with an exercise physiologist and a podiatrist, and then return to the diabetes educator in 6 months (unless he felt the need to return sooner).

George also had a plan to talk with his manager to have 60 minutes for lunch and go for a 20 minute walk each working day after he had eaten. This meant that he would have to work back an extra 30 minutes. But he also felt it was well worth it if it meant having a better quality of life, and potentially a longer working life (by minimising the risks to his health caused by high blood glucose levels).

 

George felt that he had achieved quite a lot in his first few months of living with diabetes, but was also aware that this was only the beginning of a lifelong journey.