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Help for Diabetes Care is Here!
I have been a practicing endocrinologist for more than 30 years. As with most endocrinologists, approximately 75% of my practice is diabetes related. I have thoroughly enjoyed every minute of my practice and hope to continue this job for years to come. As a Professor of Medicine and full-time faculty member at the University of Manitoba, I have spent considerable time teaching medical students, physicians in post-graduate training programs, family physicians in practice and many allied health care professionals, including Certified Diabetes Educators (CDEs), Nurse Practitioners (NPs), Physician Assistants (PAs), nurses, dietitians, pharmacists, social workers and community health workers. Along the way, I have developed the ability to translate evidence-based clinical practice guidelines into the reality of daily clinical practice in diabetes.
At the time of diagnosis, individual reactions vary. With an acute presentation of either T1 or T2 diabetes, the initial reaction may be one of disbelief, followed quickly by a form of reactive depression and sometimes anger.
It’s important to remember that diabetes care and management is chronic and life-long. It is multifaceted, affecting a person’s daily life, family, and workplace. Beyond the usual physical health impact, diabetes may carry a significant psychological burden. Successful care means whole (person) care, which can be daunting for an individual health care provider. Team care – such as a DHC team – can make a significant difference.
The Diabetes Health Care Team
Diabetes is primarily self-managed. People with diabetes must commit themselves to a daily lifestyle regimen with respect to food intake and physical activity, often in association with medications (i.e. antihyperglycemic agents [AHAs], insulin or both). These demands of daily life may be difficult to accomplish alone, both for the person with diabetes trying to cope and for the primary care provider who is trying to help them manage their diabetes. Expertise and experience in understanding diabetes and its management are required, including dietary counselling, the effect of exercise, self-monitoring of blood glucose (SMBG), insulin administration, interpreting blood glucose patterns and being aware of the ever-evolving diabetes technologies.
Diabetes was one of the first medical specialties to adopt a team approach to patient care, and the concept of the Diabetes Health Care (DHC) team is now well-accepted in clinical practice. The goal of the DHC team is to provide the person with diabetes with the skills to successfully self-manage their diabetes. While this is a tall order, and can take months or years to achieve, it has proven successful in real-world clinical care settings.
At the centre of the DHC team is the person with diabetes. Most often, the core team consists of an endocrinologist and/or a primary care provider and diabetes educators – a nurse and a dietitian – preferably Certified Diabetes Educators (CDEs), i.e. individuals who have attained a standardized certification in diabetes education. Other members that may contribute to the team include a pharmacist, an optometrist and/or ophthalmologist or retinal specialist, a podiatrist, a kinesiologist, a dentist and/or a dental hygienist and a mental health worker (i.e. psychiatrist, psychologist, or social worker) as well as trained peer supports.
Successful diabetes management occurs when the DHC team shares the care with the primary care provider. It cannot be overstated that the central team member is the person with diabetes, followed closely by their primary support network of family and friends.
Living with Diabetes
It has been said that one can never take a holiday from their diabetes. Truer words were never spoken! There is no break or remission from diabetes. Blood glucose levels continue to fluctuate with food intake, activity, and physical or emotional stress. Individuals must constantly balance the nuances of daily life with their medications, all the while attempting to maintain optimal target blood glucose as advised by their DHC team. It’s a long-term game plan to prevent or delay the development or progression of long-term diabetes complications.
At the time of diagnosis, individual reactions vary. With an acute presentation of either T1 or T2 diabetes, the initial reaction may be one of disbelief, followed quickly by a form of reactive depression and sometimes anger. Other times, the emotional reaction surfaces days or weeks later as the reality of the diagnosis sinks in. Recognizing and providing support for these reactions is crucial to the future ability of the person to manage and cope with their diabetes.
It can be very helpful if a person’s initial introduction to diabetes and all it entails is a positive one. Staying positive in the face of this often-unexpected diagnosis can be very difficult for the individual. This is where the initial interaction with the DHC team can be very useful. The team can provide that all-important initial and ongoing support as well as expert knowledge. At times, it can be very helpful to have access to a mental health counsellor, a psychologist or even a psychiatrist as an adjunct to the core DHC team. For some people with diabetes, access to experienced peer support can also prove beneficial.
I like to think that a successful diabetes self-manager is the person who “runs” their diabetes and doesn’t let diabetes “run” them.
The expectation of life-long maintenance of those key diabetes targets for blood glucose and targets to reduce the risk of complications (e.g. blood pressure, cholesterol) can take its toll on a person. The daily burden of diabetes management is added to the daily burden of life, school, job, work, and family commitments and responsibilities. Often, with other more pressing issues at hand, diabetes may drop to the bottom of a person’s priority list, only to be thought of once other issues have resolved.
I find that diabetes can take on this “roller coaster” pattern in many individuals. It helps to acknowledge that real-life stresses can stand in the way of optimal diabetes management and acknowledge as well that those roller coaster patterns of diabetes self-management are going to occur but hopefully will improve with time. The reality of barriers to successful self-management must be recognized and the person supported before their diabetes can again be addressed.
I like to think that a successful diabetes self-manager is the person who “runs” their diabetes and doesn’t let diabetes “run” them. It’s incumbent on the wider DHC team to help the person develop coping skills that will help them manage their diabetes over the long term. It’s important also to realize this is indeed a tall order and that there are no quick fixes for diabetes self-management.
Diabetes care comprises a significant amount of routine office practice for the primary care provider. As with all chronic conditions, diabetes takes time. As well, recognizing the complications associated with diabetes, it is no longer sufficient to simply review blood glucose levels with patients. A complete assessment of people with diabetes must also include a review of diabetes medications and other medication regimens, glycemic control, nutritional intake, physical activity and a discussion about stress and its detrimental effect on blood glucose control. Also, importantly, an assessment for any possible long-term micro- and macrovascular complications must be completed. All these components play a role in successful diabetes management.
Ready to read this book?
Practical Diabetes Care for Healthcare Professionals, (9780128200827) authored by Dr. Sora Ludwig, Professor, Endocrinology & Metabolism, Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada, is available to read on ScienceDirect and for purchase on the Elsevier bookstore. Use promo code STC30 and save 30% plus get free shipping on your bookstore purchase.