Diabetes Alert Day was introduced in 1988 and for decades has helped raise awareness about diabetes this significant medical condition.
During her early years as a nurse, Kim Ellis MSN, FNP-C, CDCES and founder of Ellis Diabetes Education & Consulting, LLC, discovered there was a big need for diabetes information in the communities she served, so she focused her specialty in helping folks with the condition and sharing education. She’s now known as the Diabetes NP (check out the Diabetes NP YouTube videos) and helps patients and nurses learn as much as possible about diabetes.
As nurses know, successful diabetes management is complex and looks different for every patient. Understanding your patient populations, their culture, and their traditions around food and activity can help nurses and patients create a successful plan, says Ellis. Nurses who are mindful and have cultural competence around the specific patient populations will be able to connect with patients and understand their motivations and any sources of resistance to better health.
“I always tell people it’s not always about the 1 to 10 steps,” she says. “Always be curious about your patient. Always keep yourself as a student, because learning doesn’t stop when you graduate.”
To help understand patients, Ellis recommends asking questions so that you can really learn about their culture. You’re less likely to offend someone when you are authentically interested in what they have to say and you are being open about trying to learn, she says. “Always ask permission when you want to ask questions. People appreciate that.”
Nurses don’t need to know every cultural tradition, but they do need to understand the ones they might encounter. “You typically have two or three cultures to come into your practice,” she says. “Make it your business to know those.” Getting out into the community where you work so you meet people where they are and begin to understand some lifestyle specifics will make a difference in how you and your patients relate to each other.
What are some things nurses might want to ask about? Ellis says ask about food, festivals, and the meanings of any food traditions. “I need to know that to come up with goals and plans,” she says. “And one that’s not coming from a place of restriction.” Ellis might be able to help people identify the best food choices and show them how to balance out something that a diabetes plan wouldn’t typically include, like a special event, but where people are going to eat.
Maybe the patient will want to be particularly mindful of food choices and check their blood sugar before they go to a family party and have a special indulgence. Then maybe they can go for a walk or incorporate some kind of movement after eating and check their blood sugar again. “We can adjust,” says Ellis, so the patient doesn’t feel like they are making a bad choice or one that they need to hide from her.
She advocates for being equipped with knowledge to help manage diabetes successfully. People can learn to load up on protein and drink lots of water to help make them feel full and keep their blood sugar more stable before they have lots of carbs. Carbs raise blood sugar and don’t create lasting fullness, so she tells patients how just making adjustments can help them eat foods they want to eat while also keeping their health front and center.
Knowing that your patients need flexibility will go a long way to building their trust. “I like it when the light bulb goes off and people realize we don’t need to do some elaborate plan,” says Ellis. “A little can go a long way. Nurses can think outside the box to sculpt what will work for them.”
And whether you are trying to educate patients about prevention or about managing their diabetes successfully, Ellis recommends giving them the facts without being confusing. “Remind them of why their health is important to them,” she says. “Everyone has a why–whether that’s children, grandchildren, travel.”
According to the Centers for Disease Control, more than 100 million Americans have diabetes or pre-diabetes, making it the seventh leading cause of death in the U.S. as of 2015. As a result, a number of nurses work with patients who have this disease.
Joyce M. Knestrick, PhD, APRN, CFNP, FAANP, president of the American Association of Nurse Practitioners (AANP), says that one of the most alarming and interesting factors is that many patients who come to see their nurse practitioners (NP) have no idea that they have the disease. “Roughly a third of Americans with the disease do not know it, and every 21 seconds, another person is diagnosed. And it is for this reason that diabetes is called the ‘silent killer,’” explains Knestrick.
What can nurses do to help these patients? “As NPs, we discuss things like obesity, poor eating, and bad exercise habits as risk factors that drastically increase patients’ chances of becoming pre-diabetic or diabetic. That’s really what we do on a daily basis—examine patients for warning signs; get to know them by discussing their history, their lifestyles, and their families; and, if need be, order various tests to help us gain more information that allows us to put patients on a proper track towards better health,” explains Knestrick. “As NPs, the key is threefold: active listening to your patients, adaptability to each patient’s unique set of needs, and the flexibility to lead or assist a care team all the way through the patient’s care continuum. So it is really NPs who are on the front lines, so to speak, with the patients battling this disease, and we work very closely with organizations who are working hard to raise awareness about diabetes and how it can be prevented, mitigated, and treated.”
Diabetes, Knestrick says, has devastating effects on patients’ bodies. “NPs have a daily responsibility to understand the risk factors and work with patients to mitigate those risks before they become diabetic. Like with so many diseases, NPs help patients focus intensely on prevention efforts and ways to take better control of their daily health,” she says.
In addition to what diabetes can do to people’s bodies and affect their overall health, Knestrick also points out that there are also astronomical economic costs associated with this disease. “A lack of overall awareness had led to over $322 billion spent annually treating diabetes. This means that health care costs are almost two-and-a-half times higher for someone with diabetes, and that is largely because of additional and devastating complications that result,” she says. “That is why we cannot emphasize enough that it is not just about people with diabetes, but that everyone has a responsibility to elevate awareness so we can avoid the human and economic costs of this terrible disease.”
With nearly 30 million people nationwide living with diabetes nationwide, it’s no wonder that the disease is a national issue. But diabetes hits racial and ethnic minority populations especially hard, so it’s helpful to take the time to help your patients who might be more vulnerable to diabetes.
November is designated as National Diabetes Month – a great opportunity to remind patients with diabetes of the importance of self-care and consistent medical care. But it’s also an opportunity to speak with patients who don’t have the disease but are at a higher risk for it about prevention and being alert to any trouble.
Because it’s silent, many people don’t take the potential complications from diabetes seriously enough until it’s too late. Urging all patients to keep their blood sugar in check is essential, but according to the FDA, minority populations also need to know that their heritage can put them at an even greater risk of not only having diabetes, but also experiencing more severe complications and having worse outcomes.
According to CDC survey results, Hispanic or Latino adults and non-Hispanic or Latino black adults have a 13.9 and 13.8 percent of the population with diabetes compared to 6.6 percent for non-Hispanic or Latino white populations. With such a disparity, it’s clear that education and care are crucial to keeping diabetes symptoms in control.
As usual, discussions about healthy habits like eating well, exercising, getting enough sleep, stress management, and being monitored for any problems or complications can’t be neglected.
Easy enough, but every nurse knows that patients often hear what they want to hear. Or maybe they hear it, but their cultural expectations or beliefs, living situations, or other barriers interfere with what they need to do.
This month, take the extra time to dig deeper and find out what your patients might have getting in the way of good diabetes management or self care in general. Do they have access to fresh foods? Transportation to doctor’s appointments? A comfortable, quiet place to sleep? Are they experiencing any pain that’s keeping them from exercising?
By asking a few more questions, you might be able to uncover important information that can give you insight into your patients’ lives and can help you find solutions for them. You might not be able to fix everything, but if you can fix something, it can be an enormous help. And when a patient feels listened to, the trust you build is especially valuable.
Health is defined as the state of being free from illness or injury. Health is what keeps all individuals in a state of harmony and balance because when our health is good, we are good. However, the state of being free from illness or injury is not equal across all spectrums of the human species. Some of you may deal with health related issues on a daily basis, occasionally, or rarely. Despite your frequency, it’s doubtful time allows you to look up interesting facts and figures on this topic. For instance, did you know that black women have a shorter life expectancy than White women by 5 years, 50% higher all-cause mortality rates, and death rates from major causes such as heart disease, cerebrovascular diseases, and diabetes that are often 2 to 3 times higher than those for Caucasian women? Knowledge is power, so here are a few interesting facts and figures about the health of minority women that make you go hmmm.
Caucasian women are more likely to develop breast cancer than African American women. But African Ameri- can women are more likely to die of this cancer because their cancers are often diagnosed later and at an advanced stage when they are harder to treat and cure. There is also some question about whether African American women have more aggressive tumors.
African American women between the ages of 35-44, have an increased breast cancer death rate of more than twice the rate of White women in the same age group—20.02 deaths per 100,000 com- pared to 10.2 deaths per 100,000.
Black women develop high blood pressure earlier in life and have higher average blood pressures compared with white women. About 37 percent of black women have high blood pressure.
About 5.8% of all white women, 7.6% of black women, and 5.6% of Mexican American women have coronary heart disease.
A 2011 Journal of Women’s study indicated that 57 percent of Latina women, 40 percent of African American women, and 32 percent of white women had three or more risk factors for having a heart attack.
According to the article published by the Diabetes Sisters, the prevalence of diabetes is at least 2-4 times higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women.
One in four African American women over 55 years of age has diabetes.
With more than 86 million Americans living with prediabetes and nearly 90% of them unaware of it, the American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC) announced in March that they have joined forces to take urgent action to prevent diabetes and are urging others to join in this critical effort.
Prevent Diabetes STAT: Screen, Test, Act – Today™, is a multi-year initiative that expands on the robust work each organization has already begun to reach more Americans with prediabetes and stop the progression to type 2 diabetes, one of the nation’s most debilitating chronic diseases. Through this initiative, the AMA and CDC are sounding an alarm and shining a light on prediabetes as a critical and serious medical condition.
“It’s time that the nation comes together to take immediate action to help prevent diabetes before it starts,” says AMA President Robert M. Wah, MD. “Type 2 diabetes is one of our nation’s leading causes of suffering and death—with one out of three people at risk of developing the disease in their lifetime. To address and reverse this alarming national trend, America needs frontline physicians and other health care professionals as well as key stakeholders such as employers, insurers, and community organizations to mobilize and create stronger linkages between the care delivery system, our communities, and the patients we serve.”
People with prediabetes have higher-than-normal blood glucose levels but not high enough yet to be considered type 2 diabetes. Research shows that 15% to 30% of overweight people with prediabetes will develop type 2 diabetes within five years unless they lose weight through healthy eating and increased physical activity.
As an immediate result of this partnership, the AMA and CDC have co-developed a toolkit to serve as a guide for physicians and other health care providers on the best methods to screen and refer high-risk patients to diabetes prevention programs in their communities. The toolkit along with additional information on how physicians and other key stakeholders can Prevent Diabetes STAT is available online at www.preventdiabetesstat.org.
Over the past two years, both the CDC and the AMA have been laying the groundwork for this national effort. In 2012, the CDC launched its National Diabetes Prevention Program based on research led by the National Institutes of Health, which showed that high-risk individuals who participated in lifestyle change programs, like those recognized by the CDC, saw a significant reduction in the incidence of type 2 diabetes. Today, there are more than 500 of these programs across the country, including online options.
The AMA launched its Improving Health Outcomes initiative in 2013 aimed at preventing both type 2 diabetes and heart disease. That work includes a partnership with the YMCA of the USA to increase the number of physicians who screen patients for prediabetes and refer them to diabetes prevention programs offered by local YMCAs that are part of the CDC’s recognition program. This joint effort included 11 physician practice pilot sites in four states, where care teams helped to inform the development of the AMA and CDC’s toolkit. In the coming months, the AMA will be identifying states in which to strengthen the linkages between the clinical care setting and communities to reduce the incidence of diabetes.
“Long-term, we are confident that this important and necessary work will improve health outcomes and reduce the staggering burden associated with the public health epidemic of type 2 diabetes,” says Wah.