Making Diabetes Self-Management Education (DSME) Classes Fun

I taught my first DSME class last month. I loved it. Part of being a nurse is being an educator---to patients, families, and colleagues. I hadn't had the opportunity to teach this class before because I had two nurses who were committed to teaching it as their role within a primary care clinic. But one nurse went to Iraq and the other transferred to Washington state. That left me to teach until I can get another cadre of experts trained. I went ahead and joined the American Academy of Diabetes Educators so I can learn and add to my credibility. I don't want to pass the wrong information to these patients who are relying on me.

I am in the process of trying to establish a DSME committee that would have physician oversight with a multi-disciplinary membership. My hope is that the training would continue to be evidence-based and provide a pool of qualified and respected instructors.

A wonderful resource for teaching is found on the University of Michigan web site. While I was waiting for everyone to show for class, I had them fill out this questionnaire on concerns that might interfere with learning about or managing their diabetes. I was amazed at the responses and so gratified that these individuals would trust me with this private information.

One of my colleagues in the Health Promotions Department is more jaded and cynical. I had two no-shows for this class and I contacted them afterwards to discover what barriers or obstacles prevented them from coming. My colleague said, "If you offered bingo along with the class, a $100 pay-out and free cards, you wouldn't have anyone making excuses for not attending. In fact, they would call in sick to work in order to attend!"

I don't want to believe that of my patients. I would prefer to believe that they have other needs more pressing that prevent them from making their healthcare a priority in their lives: grandchildren who must be reared, power bills that must be paid (and no money to pay), fears and worries that so overwhelm them that no action is preferable to making the wrong decision. And so, I am entering this contest to win a book, "The Big Book of Diabetic Desserts, written by Jackie Mills MS, RD. My hope is to have a prize to offer one of my patients. Our Health Promotions Department has funds for purchasing patient education materials, but they cannot fund giveaways or incentives. Consequently, I buy trinkets out of my own pocket. I currently have about 950 Unite for Diabetes pins to distribute to my patients (I started with 1,000 pins). Of course, they're not purchased from the Diabetes web site; I had them made by a Chinese company in Shenzhen, just across from Hong Kong, because a 10-pack of pins cost 30 Euros.

Too Sick to Take Meds

From the Chicago Tribune:

"In a new study published Thursday, a group of University of Chicago doctors found many diabetics believe that the inconvenience and discomfort of their treatments, especially multiple daily insulin injections, were as bad as the complications that can result from not treating their disease.

"Some patients, 10 percent to 18 percent of the total, said their treatments were so arduous that they would be willing to die sooner -- some said up to 10 years earlier -- if they could stop their medications.

""Some of this might be lack of education and people not understanding the disease process," said Dr. Holly Mattix-Kramer, a specialist in preventive medicine and kidney disease at Loyola University Chicago Stritch School of Medicine. "We need to do a better job educating our patients about what preventive care means and how it may affect their life span.""

I wonder if the providers evaluated these patients for depression.

There is a lot of support given to patients who are diagnosed with cancer. We have cancer support groups, we hold fund-raisers, and we generally don't fault these people for getting cancer (well, maybe we think smokers have it coming....).

In any case, there is no support for diabetics. Many diabetics have made lifestyle choices that have predisposed them to diabetes and, for some, lifestyle choices may have delayed but did not prevent the onset of diabetes. So others look at these people and "should" all over them. "You should have watched your diet. You should have lost weight. You should have..."

You cannot be dumb when you have a chronic illness. You have to track all sorts of medications, the timing, the changes in your diet and lifestyle (to include exercise and stress management as well as checking your feet every night) and then tweak your dosages when the next evidence-based practices are published. This means multiple visits to your provider and pharmacy and maybe visits to the emergency department when you take too much or too little of a medication. Think about all the time spent on managing this illness...

A multitude of factors comes into play here---psychological costs as well as very real physical costs. My only hope, as an adult nurse practitioner and clinical nurse specialist in adult health, is that these patients make INFORMED decisions---that is, they understand the full ramifications of the radical steps they are about to make and understand they may not be able to change their minds once they start down that path.

If they are honestly able to make this decision (and not just overwhelmed with the sheer agony of it all), then we as fellow humans have an obligation to support them in their decision and to allow them to die with dignity and grace.