Diabetic Education
A Lifelong Learning Process
This article was first published in Health View, November 2001.
Jill Perry would like nothing better than to find a huge crowd in the second floor classroom at Carolinas Hospital System on November 16. It would thrill the registered nurse to see the room filled with men and women getting their blood sugar screened, having their blood pressure taken, and checking out the latest innovations in glucose monitors.
As a Certified Diabetes Educator, Perry views the hospital's annual diabetes fair (from 2:00 to 4:00 p.m. on November 16) as an opportunity to identify some of the many people who are at risk for diabetes or who have the disease without knowing it. While an estimated 10.3 million people in the United States have been diagnosed with diabetes, the American Diabetes Association asserts that probably as many as 5.4 million more Americans aren't aware that they have the disease.
For people already living with diabetes, the various screening tests available at the fair can alert them to some of the potential problems that are associated with the disease. The event also allows the hospital to showcase a variety of specialized health care products that can be useful on a daily basis.
When an individual has diabetes, his or her body lacks the ability to make insulin, doesn't produce enough of it or cannot properly use it. Insulin is a hormone that enables cells to convert food into the energy needed for everyday life. Some people seek medical attention after being plagued by frequent urination, unusual thirst, extreme hunger or unusual weight loss. (See box for a detailed list of warning signs.) Others have no symptoms at all, and the disease may go undetected for years. That's why Perry feels so strongly about increasing the awareness of diabetes and its symptoms in the Pee Dee Region.
While there are two major types of diabetes, Type 1 and Type 2, the vast majority of Americans with the disease (90 to 95 percent) have Type 2, which generally occurs after age 45. "Yet what's really frightening is that Type 2 is even starting to show up in children," said Perry, citing factors like decreases in children's activity levels and increases in the amount of junk food that today's children consume. Despite the appearance of the disease at younger ages, Perry is encouraged by recent research findings, which contend that making early lifestyle changes can either prevent or delay the onset of Type 2 diabetes. She is quick to emphasize the importance of education both for people at risk to develop the disease and for those already diagnosed with it.
The hospital's monthly diabetes support group is one way that Carolinas Hospital System plays an active role in providing education. Guest speakers address issues from exercise to holiday food preparation. Sharing frustrations and strategies is encouraged in the informal environment. "Attending the group helps empower them to be more informed consumers and advocates for their own health care," said Perry. "It also helps them know that they are not the only individuals out there going through these problems," she added.
When patients are first diagnosed with diabetes, Perry or Laura Hope, RN, Diabetic Nurse meet with them in the hospital to begin a learning process that will continue for the rest of their lives. "A lot of times they don't even know what questions to ask," Perry said, noting that common inquiries initially revolve around what foods they will have to cut down on or eliminate altogether. "Food is such a big part of our society. Any family gathering or church social or holiday get-together centers around food," she said.
What a diabetic eats can make a huge difference in his/her health. So can the amount of exercise and how well he/she controls their weight and monitors their blood sugar level. Keeping the blood sugar level within a normal range can delay or lessen the severity of a whole host of complications, including kidney disease, blindness, nerve disease and amputations. Diabetics are also two to four times more likely to develop heart disease and/or suffer a stroke. "Diabetes is such a complex disease, one in which patients make decisions on a day-to-day basis that can impact the disease. It can be as simple as, ‘Am I going to eat that piece of cake?'" said Perry. "Our goal for the patients we work with is for them to manage their disease. They are the captains of their ship. We are just on board trying to guide them a little bit," she said.
Some inpatients are referred to the diabetic educators when a screening test indicates they're not handling their care as well as they need to be. "If three or more problems are identified with their management, such as they don't know the name of their medications or they aren't checking their feet regularly for blisters or sores that could become more serious, then we come in to talk with the patient," Perry said. "We try to see what they know, give them updated information, and make referrals to other services that may be needed," she said.
Patients are also referred on an outpatient basis when their physician feels that additional education would be beneficial to them. The diabetes educators conduct one-on-one assessments with such patients, during which Perry finds that many are not aware of the numerous ways that diabetes can affect their bodies. "One of the aspects of self-management education is to empower people to know these things, like getting their eyes examined yearly and maintaining a normal blood pressure," said Perry.
Perry and her staff also work with each patient on crafting behavior changes to create healthier lifestyles. "In the South, we have a tendency not to want to get rid of the fat in our diet, which keeps the sugars in the body for a longer period of time," she said. The next step for the department will be adding group classes as a follow-up to the individual consultations. The classes will support the American Diabetes Association's recommendation that every diabetic have continuing education on an annual basis. "It's an ongoing process. New information is constantly becoming available that helps us treat the disease better," Perry said.
By Diane J. Epperly, Contributing Writer.
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