WPADE.org

Two men encounter a bear in the forest. One of the men pulls his running shoes out of his knapsack and puts them on. The other man says, incredulously, “You don’t think that those shoes are going to help yo outrun that bear?” The other man replies, “I don’t have to outrun the bear, I only have to outrun you!”

The candidate has been talking on and on for about an hour. Finally, he said “Now are there any questions?” “Yes”, came a voice from the rear, “Who else is running?”

The good thing about being young is that you are not experienced enough to know you cannot possibly do the things you are doing.

It is impossible to support both the government and family on one salary.

Annette Karnash

Haphazard pillbox use can lead to errors. In a study, over three quarters of older adults who used pillboxes did not follow recommended practices, such as using different compartments for different days, consulting written directions or medication labels for dosage regimens or having a second party check that they had filled the box correctly.

Annette Karnash

There is a definite correlation between arthritis and diabetes. Studies have shown there is double the number of diabetics with arthritis (52%) as compared to the general population (27%). Arthritis affects 52% of people with diabetes in the 45-64 age group and 62% of those 65 and older- significantly higher than in these populations as a whole. Surprisingly, arthritis affects about 28% of individuals with diabetes who are 18-44 years old. This is 2 1/2 times the rate for that age group in the general population.

Consequently, individuals with diabetes alone are more physically active than those who have diabetes and arthritis. Despite this, exercise is most important in both conditions- to control weight and blood gugar levels for diabetes and to maintain mobility and control the pain of arthritis. Those individuals with both diseases, unfortunately, are reluctant to get as involved as is needed with exercise because of painful, still joints and the fear of further injuring these joints.

Annette Karnash

There are 16 drugs in 9 different pharmacologic classes that are approved by the FDA for the management of type 2 diabetes because they lower blood sugar and glycosolated hemoglobin levels in the blood. These test are used to diagnosis, monitor and are the baisi to approve new drugs to treat type 2 diabetes.

A recent article in Worst Pills, Best Pills addressed several concerns. Diabetes places people at risk for macrovascular long term complications, but there is no evidence that type 2 diabetes drugs currently on the market reduce these risks. The FDA even requires package inserts to warn prescribers that;

There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with any oral anti-diabetes drug.

It should not be assumed that lowering blood sugar levels means that a patient’s diabetes is under control and that in turn reduces the risk of developing complications. The article suggests that this is an inadequate way to determine which drugs should be approved and approval should be based upon the ability of the drug to decrease long term complications as a condition of approval.

The FDA has recently required that manufacturers prove that new type 2 diabetes drugs do not present an unacceptable level of heart risk, but they have not required that the studies be completed prior to marketing.

The article states that one reason that the lifestyle changes, such as proper diet, exercise and weight reduction, are not heavily promoted to prevent and manage type 2 diabetes, amy be that the only one who would profit would be the patient. However, they did advise not to stop taking any diabetes medications without first consulting the prescriber.

Annette Karnash

We are all living longer today. This represents an increasing challenge to diabetes educators. With the influx of older people, we will be seeing more older diabetics who need to learn aobut their care.

As part of the aging process, normal physiological changes occur in the brain. Older adults are susceptible to abnormal changes that can affect cognition, such as Alzheimer’s disease, T.I. A.’s and the use of multiple medications. Therefore it is important as diabetic educators to assess their cognition status prior to implementing a teaching plan, helping to ensure that the patient is capable of learning what you are about to teach.

There are alterations in the ability to learn new knowledge quickly. We as educators need to realize that as we age, reading, verbal skills and general knowledge continue to improve. In assessing the level of attention, memory, alertness, emotional status and visual spatial skills should be identified. If a person falls asleep or is lethargic, this should be brought to the attention of the physician because it is not normal int he elderly population. Their reading, writing, spelling skills, comprehension and coordination should be evaluated to determine the ability of the elderly patient to learn and use this knowledge in their care. The educational experience should be paced according to their needs and abilities. A slow, methodical approach, that includes repetition and stimulus material saves time in the end.

Often we think that the patient is compliant but not necessarily so. Rather than simply imparting knowledge, education should focus on changing behaviors. Telling is not teaching. Unless you see a change in behavior, the individual has not learned. Changing behavior represents rewarding improvements in self care, especially in view of the consequence of non-compliance i.e. elevated glycosolated hemoglobin, hypoglycemia, hyperglycemia, ketoacidosis. They need to see that a give behavior will lead to a favorable outcome. When a patient sees that practicing a partiular skill or behavior leads to a favorable outcome, this may lead to a behavior change. They then will sense a feeling of self-efficiency and enable them to observe favorable improvements in physical functioning. Demonstrating to the patient that the behavior of glucose testing and adjusting the diet correlates with the outcome of the blood sugar and how this affects the control of diabetes. This in and of itself should act as a motivator. Positive reinforcement is the strongest form of behavior change and it involves a reward– a sense of accomplishment.

And finally, we should be realistic in establishing criteria for success. Asking the patient to do too much at one time will lead to failure. One behavior at a time should be addressed. There is a multitude of issues and options to consider. Armed with this, we can offer the patient, in most instances, a acceptable quality of life and ability to pursue their desired interests.
Annette Karnash