Jane K. Dickinson, RN, PhD, CDCES

The Computer in the Room

Posted on June 6, 2016 by janekdickinson

When you are in a health-related appointment do you feel like the computer gets more attention from your provider (physician, nurse practitioner or physician assistant) than you do?

Back in the early 90s hospitals started converting to electronic charting. That means typing notes into a computer, rather than writing them on a paper chart. It also means documenting during visits, rather than waiting until after the patient leaves. The downside to this new(ish) practice is less eye contact with patients, and potentially more attention on a computer than a person.

This is something we discuss in classes at the Diabetes Education and Management Master’s Degree program where I teach. The person with diabetes is the center of the health care team, the most important person in the room, and the reason we do what we do. Therefore, anything that takes our attention away from that person is not what we mean to be doing.

The hard part is that various agencies require health care professionals to document all sorts of information. It really is easier to enter it into the computer right as we go – as we are asking the questions and gathering information. My endocrinologist sits at a table across from me and enters data/information in the computer as he talks to me. This has never bothered me before. The computer is off to the side, so I don’t feel like it’s in the way of our conversation. And he does look at me as well as the screen.

On the other hand, if you feel like the computer is getting in the way of your care or your relationship with your provider, say something. Then again, if you are not comfortable telling your provider that computerized charting during the visit is bothersome to you, discuss it on social media, and trust me, word will get back to health care providers in a hurry.

Diabeternity

Posted on May 30, 2016 by janekdickinson

Here’s an idea to go along with the whole “Me-ternity Leave” discussion: diabeternity. This could be interpreted as “diabetes for eternity” or as a leave of absence to get diabetes in check. Or both. Or neither.

Last month there was an article suggesting how Me-ternity Leave should go. It’s hilarious and spot on. And it made me think about Diabeternity Leave. Just like it would be nice to have time off without kids, it would be nice to take 12 weeks off of life in order to adjust to and learn about diabetes. But that’s not reality.

So instead we take it on – as patients or parents or caregivers or whatever the case may be. We don’t make excuses or ask for special privileges. We learn how to make choices and poke fingers and take medications and inject and change sets/sensors and interpret numbers and calculate doses. And make choices.

Life is about choices and so is diabetes. Although no one chose to get diabetes, those of us who have it can choose how we respond to it. So until there’s a cure there’s Diabeternity – let’s have fun with it.

Posted in diabetes motivation | Tagged choices, diabetes, maternity leave | Comments Off

New Dietary Guidelines for Americans

Posted on May 23, 2016 by janekdickinson

The U.S. Department of Health & Human Services and the U.S. Department of Agriculture have recently released their guidelines for healthy eating. These guidelines are meant to help people prevent health problems.

The guidelines emphasize the importance of eating a “wide variety of fruits, vegetables, grains, and dairy products, while staying away from processed foods heavy in saturated fats, sugar, and cholesterol” (and trans fats). They also recommend significantly reducing the amount of added sugars and sugar-sweetened beverages from the American diet.

They really highlight the importance of eating a wide variety of foods. They also acknowledge that focusing on “small shifts in what we eat and drink” makes it easier to eat healthy. Another way to make a change is to focus on patterns and not just individual food choices.

These “common sense” guidelines are equally aimed at and important for lay people and health care providers. Although they don’t contain drastically different or new information, they make a basic point about healthy eating for everyone.

Posted in diabetes and food, health care, health information | Tagged Dietary Guidelines, food, nutrition | Comments Off

Changing diabetes management in older and elderly people

Posted on May 16, 2016 by janekdickinson

The results of the DCCT and the UKPDS studies changed lives. They also changed health care practice. Since 1993 we have been carb counting and using basal-bolus insulin dosing (type 1 diabetes). We’ve been starting insulin earlier and/or using a combination of medications (type 2 diabetes). We know the importance of healthy food choices and exercise in managing both type 1 and type 2 diabetes and keeping A1Cs below 7%.

Now that we know what we know, it’s hard to think about backing off on this “intensive management” when we get older. Older people take on new risks as they age (yucky things like decreased hearing, cognitive impairment, worsening eyesight and manual dexterity). If we continue to strive for A1Cs below 7% at this point in life, we risk hypoglycemia, which can lead to falling. While low blood glucose is a nuisance for younger people, it’s downright dangerous for the elderly. Falling could mean breaking a hip or worse yet, there may not be anyone around to help us get up.

It takes the whole team – health care providers, family members and people with diabetes – to accept loosening up blood glucose and A1C numbers in older and elderly people. The trick is to do it in a way that’s not simply “throwing in the towel.” We still want to feel good and have energy, so we don’t want to run high all the time.

This is something to think about as you or your loved one with diabetes ages. And be sure to discuss it with health care providers so you get their buy-in as well. Here are the American Geriatrics Society’ Choosing Wisely treatment guidelines (#3).

Posted in about diabetes, diabetes advocacy, diabetes care, diabetes guidelines, health care providers | Tagged A1C, diabetes, elderly, guidelines | Comments Off

Individualizing care is the opposite of adherence

Posted on May 9, 2016 by janekdickinson

Both the American Diabetes Association (ADA) and the United Kingdom’s National Institute for Health and Care Excellence (NICE) have recently placed greater emphasis on individualizing care. The ADA uses “patient-centered care” in their standards, and NICE supports having individuals involved in diabetes-related decisions. We’ve been discussing putting people with diabetes at the center of their care for years, and it’s very exciting that these prestigious organizations are getting behind it.

So why are we still seeing and hearing the word “adherence”? It seems like these messages of patient-centeredness are going in one ear and out the other when health care providers still use terminology that is outdated and inappropriate in diabetes care. Adherence, like compliance, means “sticking to” something that someone else wants us to do. How is that patient-centered?

It’s time for health care professionals to take a look at our spoken and written language and figure out how we can align it with the messages we are meaning to send. If we want to give patient-centered care, then let’s also use patient-centered language. Let’s send messages that reflect an empowerment, strengths-based approach.

Some examples include “she is taking her medication about half the time” or “he takes insulin when he can afford it” rather than “she/he is not adhering to the plan” (or even “she/he is non-compliant”). And how about “medication taking” rather than “medication adherence”? These small changes add up to focusing on a person’s strengths, instead of their weaknesses.

Groups like the ADA and NICE have made giant steps toward improving care for people with diabetes, and this is to be commended! The next step is to adopt language that sends messages consistent with a patient-centered focus.

Posted in diabetes advocacy, diabetes news, diabetes-related language, health care providers | Tagged American Diabetes Association, diabetes, language, National Institute for Health and Care Excellence | Comments Off

Diabetes and Surgical Site Infections

Posted on May 2, 2016 by janekdickinson

Hopefully if you or someone you love has diabetes you already know that high blood glucose leads to infection. High blood glucose also contributes to slower healing wounds. If someone with diabetes has surgery, their risk for infection at the surgical site is higher, especially if their blood glucose level is elevated.

Many hospitals have pre-operative nurses who counsel surgery patients about what to do with their medications on the day of surgery (or the day before). They may also discuss with patients the importance of coming into surgery with a blood glucose level in (or as close as possible to) the normal range (70-110). Regardless, it’s important to have this information tucked away in your head so that if you or your loved one ever needs surgery you can plan.

Surgical site infections are a risk to everyone who undergoes surgery, but those with diabetes have a higher risk. High blood glucose puts people with diabetes at even greater risk. You can lower your risk for surgical site infection by managing your blood glucose prior to surgery.

Posted in about diabetes, diabetes advocacy, diabetes care, diabetes research | Tagged blood glucose, diabetes, infection, surgery | Comments Off

The Adolescent-to-Adult Transition in Diabetes Care

Posted on April 25, 2016 by janekdickinson

There is something referred to as “the adolescent transition,” which is actually the transition to adulthood. “Emerging adulthood” is sometimes defined as ages 18-30.

(Being an adult is mandatory; acting like one is optional.)

The point is that as a teen with diabetes, you will at some point have to “grow up” in terms of your health care. You will communicate with health insurance (oh, and get health insurance coverage), make appointments, see adult health care providers, pay bills, and other fun things like those.

Research has shown a high number of hospital admissions for DKA in those who are transitioning to adult care. There is also a tendency for A1C to go up, office visits to go down, and rates of getting kidney function checked can go down as well.

When you become an adult you get to manage your diabetes on your own. You also get to manage all aspects of your health care. Get a strong handle on how diabetes works now, while you’re still at home. Ask your parents to teach you how to navigate health insurance. Start taking a lead at your appointments while you’re a teen-ager, so it won’t be scary or foreign when you are on your own.

Use your resources. College Diabetes Network is an organization that supports emerging adults with diabetes who are heading to and attending college. The Diabetes Online Community is chock-full of support and camaraderie. Another fabulous option is to get involved in a diabetes camp. And some endocrinology offices have providers who specialize in the transition to adult care, so be sure to ask if yours does.

Most important, stay on top of your diabetes care so that you will feel good, be productive, and live well now and far, far into the future.

Posted in about diabetes, diabetes advocacy, diabetes care, diabetes research, health care, health insurance | Tagged adolescent transition, diabetes, emergencing adults, health care | Comments Off

Show up and do diabetes

Posted on April 18, 2016 by janekdickinson

Or check BG. Or exercise. I’m sure you’ve heard of writer’s block. Kids in school, authors, bloggers – everyone experiences it at some point. Same with diabetes block. This stuff gets old and we sometimes hit a wall. But showing up and getting it done really does have benefits.

How many times have you gotten diabetes block? Making diabetes management a habit – committing to it and doing it over and over every day (even when we don’t feel like it) can help. Sometimes we get the results we want and sometimes we don’t, but if we keep showing up and doing the work, it will pay off, even in small ways.

It doesn’t matter what your spouse, friend, mother-in-law, health care provider thinks. Do it for yourself. Do it for your body, your strength, your long-term health and quality of life.

Posted in about diabetes, diabetes care, diabetes motivation | Tagged block, commitment, diabetes, habit, motivation | Comments Off

Stop Doing What Isn’t Working

Posted on April 4, 2016 by janekdickinson

Some things are pretty simple and straightforward, yet we still don’t pay attention.

If something isn’t working, stop doing it. It may not seem that simple, but if we really look at every angle and use a little creative energy, it might actually be. There’s probably another way to do it, or at the very least another way to think about it.

Figure out what’s not working and change it. Even if that takes courage, or balls, or it’s really scary. Because the process of stopping what’s not working and changing it to something that does work provides hope. And it’s worth the effort.

Challenge yourself. Surprise yourself. Impress yourself.

You deserve it.

Posted in diabetes advocacy, diabetes motivation | Tagged change, courage, diabetes | Comments Off