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    1,000 Years of Diabetes Wisdom
    1,000 Years of Diabetes Wisdom
    1,000 Years of Diabetes Wisdom
    Ebook147 pages1 hour

    1,000 Years of Diabetes Wisdom

    By David G. Marrero

    ()

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    About this ebook

    An anthology of more than 50 stories about the other side of treating diabeteswhat health care providers can learn from patients. With more than 1,000 combined years of working with patients, the contributors share their knowledge and the life-altering experiences that both challenge and change the way health care professionals provide care to their patients. This inspirational work proves that knowledge can be learned from books, but wisdom can only be gained through years of experience.
    LanguageEnglish
    PublisherAmerican Diabetes Association
    Release dateFeb 1, 2008
    ISBN9781580403429
    1,000 Years of Diabetes Wisdom

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      Book preview

      1,000 Years of Diabetes Wisdom - David G. Marrero

      INTRODUCTION

      This book is a collection of stories told by health care professionals about special experiences that transformed how they regard their work in diabetes. Why stories? Stories are a powerful way to teach and to learn. In fact, storytelling is one of the oldest forms of education. Throughout history, listening to stories has provided us with a way to connect the actions and experiences of others to use in our own lives.

      Through stories that we share, we make our own memories and experiences available to others. Stories can make empathetic connections, helping us to more closely identify with others who share our world, yet are exposed to different forces that influence how they move through it. This is an essential ingredient for helping others to develop strategies to transform their lives so they can effectively adapt to a chronic illness. Stories can also help us clarify and examine our value system. Storytelling is central to the expression of the human condition. Without stories to give us a sense of connectedness to the earth and its inhabitants, we would be stripped of the awareness of who and what we are.

      The stories told here were collected from a wide range of health care professionals who work in diabetes. Many of them are well known, and others less so, but they all share with us stories of memorable experiences that helped to shape how they viewed themselves, diabetes care, and their patients.

      We invite you to share in their stories and in doing so we hope that you will reflect upon the relationships you have with your patients and the ways in which you relate to them. We hope that you too can relate their experiences to your own practice and hopefully gain a better understanding of the way in which our patients shape and enrich our lives.

      We spend years acquiring the knowledge to be experts, problem solvers, and teachers so that we can help our patients. We are committed to helping the patients who come to us with problems they cannot solve on their own. Our ability to help others is a source of pride and satisfaction, however, if we listen, really listen, to our patients, we may discover that they are also experts, problem solvers, and teachers. If we allow our patients to also be our teachers, we may someday realize that although we began with knowledge, we ended up with wisdom.

      David G. Marrero, PhD

      Robert Anderson, EdD

      Martha M. Funnell, MS, RN, CDE

      Melinda D. Maryniuk, MEd, RD, CDE

      CHAPTER 1

      Underestimating Patients

      Determination Is the Key

      by Joyce Green Pastors, dietitian,

      and Terry Saunders, psychologist, Charlottsville, VA

      Over the past few years, we have been providing lifestyle change counseling to selective patients with diabetes. These patients have agreed to be videotaped with the purpose of using segments of the videos for a professional education workshop.

      Our first videotaped patient was a complex case—a 48-year-old female, severely obese, with a history of yo-yo dieting, an eight-year history of type 2 diabetes, and very insulin resistant. The patient had a history of hypertension, heart disease, and depression and had been a smoker since age 16. Along with these factors, she had a complicated challenging social and financial situation, with three children ranging in age from 12 to 28, all living in the same home, and a husband who had died of cancer six years previously.

      We began our first taping session just before Thanksgiving, which we initially thought was a mistake given the challenge of making lifestyle changes during the holiday season. We completed a lifestyle assessment and set some initial goals regarding awareness—determining a baseline of physical activity and becoming aware of late-night snacking patterns. The patient wanted to focus on just getting through the holiday.

      We suggested working together to develop a plan for handling the holidays—something she could commit herself to and feel confident about. Specific aspects she was concerned about were baking, eating pies, and buffet-style eating throughout the day. Based on our philosophy of developing patient-centered goals and beginning with small, realistic, and achievable goals, we identified and agreed on three behavioral goals—eating two pieces of pie during the Christmas week, drinking sips of water while baking, and eating meals sitting down.

      Her house was a focal point for visits by family and friends, who always dropped in expecting to find good things to eat. We discussed the possibility of having a family conversation to solicit support and develop some alternatives to the family traditions.

      All of this sounded good in theory, but at the end of that session, we both had a sinking feeling that very little would be achieved. So much was stacked against the possibility of success—her history of weight gain during past holiday seasons, her pattern of overindulgence and sedentary living, and the long history of unhealthy family eating traditions. We really wanted her to succeed, but we didn’t have a lot of hope.

      The videotape of our next session after the holidays is a classic example of body language speaking louder than words. To our surprise and jubilation, she went on to report that she had lost four pounds and bubbled over with excitement as she told us about her successes and new family traditions. She had talked with her children before Christmas about the behavioral goals we had agreed on, commented on how difficult it would be, and mentioned that it would be nice if they could just forego tradition. They proceeded to make suggestions about how they could add a fruit platter and fresh vegetable tray to the table instead of other high-calorie and high-fat choices.

      And here was the holiday gift for us. For years, we had been casting ourselves as firm believers in empowerment and the patient-centered approach to behavior change. But what this showed us was that however much we might have believed intellectually in the approach, we still didn’t fully believe that people can change their habits. This was an especially powerful realization because we would be the first to point out how little confidence others, the prime example being physicians, often show in the possibility of positive behavior change. We were reminded to look inward, re-examine our own beliefs, and recognize our own capacity to stereotype people based on their weight, past history, personal preferences, and family traditions.

      Underestimating Is Under Serving

      by Gary Scheiner, exercise physiologist, Philadelphia, PA

      In modern day health care and patient education, one of the underlying rules we are told to follow is to cater to the lowest common denominator. In other words, assume that every patient we see knows nothing, has little motivation and subpar intelligence, and will do as little work as possible on their own behalf to manage their diabetes. When it comes to teaching diabetes self-management, I have found that nothing could be further from the truth.

      To set low standards and low expectations is a disservice to everyone we counsel. The modern, effective techniques for managing diabetes—carbohydrate counting, insulin/medication self-adjustment, and record keeping/analysis—can be learned and implemented as easily by those in a low socioeconomic groups as those in the highest groups. In fact, because those classified as disadvantaged have traditionally been treated as such for so many years, the change in approach often inspires significant changes and great results.

      One client who comes to mind is a middle-aged gentleman from the inner city who happened to have a learning disability. However, once we get past phrases like welfare and 3rd-grade reading level, we come to find that this is a man who follows instructions meticulously and takes great pride in keeping good written records.

      Teaching this man carb counting and insulin dosage adjustment was a snap with a few simple charts to aid in his decision making. Setting up an organized record-keeping system allowed us to fine-tune his plan. Eventually, he seemlessly transitioned from a two-shot-a-day plan (using premixed insulin), to a basal/bolus injection program,

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