Patient goal - my goal

How many times have I heard a patient say "I just want to stop taking all these medicines!"

I reply, "I can understand that goal, but will you also consider the goal - I will do what needs to be done to 'treat to target' so that I can live without complications?"

They sigh and say yes. And I wonder if I can come up with a better response. Maybe it would be better to recommend earlier insulin initiation at this point. If the patient is on Metformin, TZD, glypizide combination -- the MDI insulin could allow them to stop the TZD and glypizide, right?

It doesn't seem ethical to let them believe that with plenty of exercise and eating just right, they will eventually get off the medicine since I know that diabetes is a progressive disease.

The really sad part of each of the goals is that for many of the patients, we are not even close to reaching either one. If there is a way to bring the patient on board for 'treat to target', I'm sure it would increase the probability of reaching the goal. The patient could hold the healthteam accountable and ask for titration and adjustment of the medication to reach target. Maybe the medications would not seem like such a burden to the patient if he/she had a greater understanding of their impact and had more control of the adjustment of them to reach target.

I believe in the future, I will encourage my patients to become cheerleaders who chant "treat to target, treat to target, treat to target" and provide them information to participate in reaching that goal.

I will also seriously look at their medication list to assure that any combo drugs that are available are being used -- even reducing two pills to one combo pill would demonstrate that I heard their goal and want to help them achieve it.

Vitamin D - who knew?

If you are an AADE member, perhaps you've already read the article "Vitamin D and Diabetes. Let the Sunshine In" in the Nov/Dec 2008 issue of The Diabetes Educator.

I think the intro paragraph sums it up pretty well ... "This is an important area of study because many individuals with diabetes have decreased levels of vitamin D. And, evidence suggests that lack of vitamin D may be associated with hyperglycemia, increased hemoglobin A1c, insulin resistance, progression of diabetes, as well as hypertension, and cardiovascular disease. Treatment of low vitamin D by diet and oral supplements may be an easy and cost-effective method to improve metabolic control and prevent the serious complications associated with diabetes."

The conclusion states "It appears that diet alone will not provide sufficient amounts of vitamin D, and that treatment with supplements is probably necessary for most individuals with diabetes. However, given the possible benefit, it may be an easy and cost-effective therapy which could improve their long-term health outcomes as well as their quality of life."

Interesting article - 7 pages of information between the intro and conclusion I quoted above. Do you know your vitamin D level? Do you check your patient's levels of vitamin D?

Seems like I just read an article the other day about how much to supplement -- 1000-2000IU/day. Apparently at this dose it would be hard to become toxic. This article gave a wider range of recommendations. Have you read other recommendations. Are you currently recommending Vitamin D supplements. Why or why not?

Thanks for sharing

Publish Post

Chronic Care Model - 2

I've been thinking about an easy description to share with patients to help them understand the difference between acute care and chronic care. I'm not there yet. It is actually the topic for our support groups in September. Jana and I will be working on it between now and then. If you have any ideas you would like to share with us, please feel free to let me know. You can post on this blog or send an e-mail to me at
Brenda.09pres@gmail.com

Chronic Care Model

How do you bridge the health care you provide from 'acute care' to 'chronic care'?

I've been thinking about it. Do you agree with the theory that:

Acute Care is the healthcare professional 'fixing' the problem: i.e. prescribing medications, teaching self monitoring so that 'we can look at the numbers', prescribing food plans, exercise plans, etc.

Chronic Care is the healthcare professional learning to let go of the control and teaching the patient/family the life skills needed to live well with a chronic disease? What if the patient doesn't want to be in charge? What if we really are not willing to let go of the control or need to 'fix' things?

I'm not sure all health care providers give much thought to the different approach required for Chronic Care management. No wonder the patient doesn't get it.

Jesus taught with parables and I'm beginning to understand the importance of talking to patients in a language they might understand. I don't think that language is medical terminology. It might be fun if we could develop a large number of analogies that we think would help our patients understand diabetes in a language they can understand. I'll offer one tomorrow. Please feel free to offer one of your own as a 'post' to this blog.

Thanks for your time.

Brenda

Calling the meeting to order

How do you feel about reciting the Pledge of Allegiance at the beginning of a meeting?

It might be more fitting at more formal association meetings and less fitting at social meetings.

Is it a good transition between a social meeting and the business meeting?

If it does not work as the transition -- is there another transition to quiet the general conversation -- or does the president just keep saying "Hello? Hello? Can I have your attention? We're ready to start the meeting!" I think this approach works better for presidents who have strong, booming voices, but could possible work with the use of a good microphone.

I'm interested in your ideas. Thanks for sharing.

E-mails in January

I hope you are checking your e-mail address that you have provided to KCRADE. Webinar notices, job opportunities, KCRADE newsletter and board meeting minutes have been sent to all members.

Some e-mail notices have been returned that state a mail box is full and cannot recieve any additional e-mail at this time.

I did not receive minutes initially and had to request an update to the KCRADE yahoo list.

If you are not in the loop and would like to know what is going on in our Chapter, it is up to you to make sure you are connected.

KCRADE communications are a benefit of membership -- if you are an AADE member, you can join for free by just completeing a Chapter membership form. IF you are not an AADE member, you can join "Friends of KCRADE" for a $35 annual membership fee -- which adds you to the communication roster, and provides entrance to 6 meetings with a light supper and a 1hr continuing education session.

For more information, you can write to KCRADE@yahoo.com or Brenda.09pres@gmail.com

Happy reading.

Happy New Year

I'm looking forward to an exciting year in 2009 for KCRADE members. Hope to see you at the January 13th meeting!