In a very regular basis and in order to do a diabetes assessment, people are questioned about their diabetes control: “Are keeping diabetes under control?, “How are the blood sugars?”, “Are you testing it?”, “How many times?”, and so on.
What does it mean, being under control?
There is no right answer for this question. It is very important that everyone sees each person, diagnosed or not diagnosed with diabetes, as an individual. Each person has their own needs, routines, habits, job and fears. Each person has a very unique life.
As a healthcare provider you must see each and every one of your patients as unique. Targets with blood glucose levels that you establish. The care plan you follow with them must be agreed with your patients or even mostly decided by them.
This can be very general advice but the truth is that for patients diagnosed with diabetes, if you don’t know who they are and what they are willing to achieve, they will never engage with your diabetes assessment and its care.
I understand that your main goal is just to keep their blood glucose within a pre-establish target and keep your patients safe. But there are much more to do before you achieve this.
In diabetes management, we can’t go quickly. There is no way to achieve it all in one go. There is the need to do small changes, go step by step and slowly. Empowering and engaging is a very difficult task.
Take this into account in your patient diabetes assessment
When the patient understands that you care for them, you listen them and you are not there just to do the same old questions, the relationship will build up and be grounded in trust and confidence.
I’m not stating that the following tips are the only key for success. But I’m sure that they will help in the process and will make you think out of the box.
The following list shows some small but important tips to keep in mind when accessing your patients.
1. Always ask for the glucose meter
Sometimes, the change of the glucose meter is the one thing that will change the patient’s attitude towards the blood glucose monitoring. Also, it makes them excited or just able to start checking the blood glucose more frequently. Three examples:
- Patients that have eye sight compromise: You must be sensible to understand if the glucose meter the patient is using is appropriate for him/her.
Ask the questions – “Do you see the strip port?” and “Can you read the numbers?”;
- Patients with compromised fine motor skills: Think about a meter that is bigger, with easy strip insertion, easy blood drop appliance, bigger lancet device and also easy to change its needles;
- Patients that have a very busy, modern and tech-wise life: Think about a meter that needs less effort to maintain, easy to carry and with more features.
There is a vast number of models. You can get models with different features, sizes and colours that will give the response to the patient’s needs. Sometimes, a simple meter change is good enough to make the patient more engaged and check the blood glucose more often.
It is very important to understand if the patient is comfortable and knows how to use the meter. It is a good practice to ask the patient to check their blood glucose while in the clinic with you so you can understand if there is any concerns with that.
Request your patients to bring the meter to the appointments so you are able do the diabetes assessment by assessing the meter condition, if it is properly set up and if the blood glucose readings are the same as the ones in the diary.
2. Blood glucose monitoring
Always explain the importance of the home blood glucose monitoring.
Between your need to know the blood glucose reading results and the patient motivation to do so, agree on a blood glucose check plan. Ask how many times per day, and how many days per week they are able to check the blood glucose and go from there.
It is really important that you ask questions about the patient’s routines and suit the blood glucose monitoring to these routines.
You will be surprised to see patients that in one appointment were just checking the blood glucose three times per week and after seeing you they will start checking it more regularly.
3. Tablets schedule
This happens very often.
Patients are not informed of the tablets purpose and schedules. Putting this together with the tablets side-effects and they end up making their own decision and stop taking them.
This situation is very common with some tablets, being Metformin and Gliclazide among of them. Metformin should be taken with food to avoid the most common side effects and Gliclazide before meals.
It is very important that you inform the patients about how important the tablets are and how they help with the diabetes management.
You can always advise them to restart taking the tablets in lower doses and increase along the time if no concerns are raised. Doing so, you may avoid the interruption of the treatment once again
4. Think about polypharmacy
Patients with diabetes are very likely to be taking a big amount of tablets for all the other health problems they have.
It is a huge concern for patients so you must keep in mind when you are considering escalating the medication regimen. Always ask what is the patient opinion and start the discussion about the options and make a decision that will give an answer for the patient needs.
A good tip: when you have a long term plan for a patient that will for sure evolve insulin administration, consider non-insulin injectable therapies (GLP-1) if there are no contraindications for its initiation. The first good thing is that you avoid tablets and on the other hand you are introducing an injectable therapy for this patient.
Another tip: nowadays the needles length is smaller. A good way to help patients to accept injectables is to show them the needle. They will be surprised on how small it is. You can ever ask if they want to try the injection on the skin.
As you may be aware, one of the most common concerns of patients regarding insulin is the injection itself. Starting an injectable therapy will make them more approachable when the “insulin talk” arises.
5. Provide Positive Feedback
Always make sure to give positive feedback to the patient’s effort and how good it is for them to be engaged with their diabetes.
Sometimes I use the sandwich feedback method. As you know every appointment means making a change, even if it is small. The sandwich feedback method is the ability to provide a positive feedback followed by a negative on. In this case, it is followed by the introduction of a small change you want the patient to think about and finishing with positive feedback again.
With this approach, the patient will keep motivated and also keen to keep engaged and he is open to decide about that change discussed. Be aware that this feedback method may not work with some patients or might not be appropriate for some moments. You must be sensible enough to know your patient and to understand that this appointment is all about positive feedback.
These tips can make a difference and will make you more empowered when it regards to your decision making.
Tomorrow, when you assess your patients keep this list in mind and thrive.