Helping Patients with Pattern Management

Many of my patients understand the importance of monitoring their blood sugars. Many will even write them down and a few will even remember to take them to their diabetes visits with their physician. When I start discussing pattern management with my patients they often give me a blank look. After checking their blood sugars, they seem to know very little about where to go from there.

What do these numbers mean? What is the purpose beyond “that’s what my Dr. wants me to do?” Pattern management is not something that physicians often have the time to teach at their 10 minute encounters, and is one way in which CDEs can be very helpful. Sitting down with a patient and reviewing blood sugar records is of vital importance for patients to better understand their diabetes.

When looking at a blood sugar record keeping it well organized is key to making sense of the maze of numbers. It’s also very important to write the blood value in relationship to a meal. Was it before a meal? After a meal? 2 hours after or 10 minutes after? All these details are very important to understanding a glucose log and working to finding patterns. I’ve found many of my patients will write the time of day they check their blood sugar, but it’s impossible to tell if this is before breakfast, after breakfast, after exercise, etc. These details are so important to pattern management.

I always ask my patients to give me a good idea of their fasting numbers. Once they’ve established a good range or their individualized range, then we typically move on to testing 2 hours after the start of a meal. Also, I ask them to vary the meals they test after to give added information. I have them write all of their values down and return to me for follow-up. When the patient walks in my office we work to begin to “decode” the log. We look at reasons a fasting number might have been high. Next, we look at after meals and evaluate what was eaten to decode the “spike” after dinner. We also look at how stress and exercise affected the numbers.

I can almost see their eyes opening and they begin to understand those numbers versus just writing them down. They start to understand why it was lower and why it may have “spiked.” Those “light bulb” moments are the reason CDEs do the work they do and with passion. Teaching patients to begin working to manage their own disease is the goal. Decoding the numbers and working to understand their diabetes better is rewarding for them. For a patient to really understand why they are checking their blood sugar and what the purpose of each number means helps motivate them toward better care.

I think that sometimes as educators we get caught up in the things we “need to teach.” I find that pattern management is always something we can touch on with our patients no matter the duration of their diabetes or where they’re at now. It’s all about baby steps. You may ask them to begin testing once a week and move up from there. It may not always be the smooth process we envision, but be sure to focus on their accomplishments with their diabetes care. Just the fact that they came to see you shows they’re motivated toward better care!

 

Written by:

Jessica Miller, RD, CDE

Fit4D CDE

Connecting with Patients: My Role as a Fit4D Diabetes Educator

Feeling the need to “re-charge” my diabetes educator batteries, I recently attended a continuing education program which provided several excellent sessions.   Joe Solowiejczyk, RN, MSW, CDE , “Coping and Thriving with Diabetes: It’s just not a numbers game”   presented some very practical suggestions in talking with patients and “connecting” with them. He offered that there are many roles of a diabetes educator, while all are important I believe acting as a facilitator best describes our jobs as Diabetes Health Coaches for Fit4D.

 

Feelings and Emotions

So far, in my experience with Fit4D, emotional issues, in some form or another, are present in almost all of our interactions. Whether a second insulin has been added to their diabetes management, they are newly diagnosed, have financial concerns, worry about long-term outcomes, fearful of disappointing their family or health care providers, or simply “I am doing everything right, and my blood sugars are still not where they need to be”. Probing with the patient to find out the source of their frustrations or negative feelings is essential to being able to provide the best possible information for the patient. Joe’s presentation offered some clues that patients may say can help identify some of these issues:

  • Fear of “giving in” is as a sign of defeat!
  • “If I fall apart, I’ll never pick myself up again”
  • “I have to stay strong for my kid(s), for my family”
  • Pretending is better than Feeling
  • “I’m smart & competent – I should be doing better”
  • Fear of acknowledging feelings of powerlessness

 

Conveying Empathy

As a Fit4D Coach, while I’m talking to the patient, they are my sole focus of attention. They do not have to be strong for me, I am here only for them and want to help them. While this may be somewhat easier to do face-to-face, learning to convey that empathy and compassion over the telephone is skillset in itself. Until the patient knows/feels/senses that empathy and compassion from me, they will not accept the suggestions I have to offer.

 

Healer NOT a Fixer

One of the most difficult aspects of being a Coach, is wanting to “fix” all the patient’s problems, quickly and effectively. Consciously, I know that this is impossible under any circumstance or in any job. I’ve started to see myself as a healer NOT fixer, and seek to understand that it’s not my responsibility to ‘fix” anyone, but to provide the tools and support to allow the patient to succeed.

 

I’d love to hear your thoughts on how you connect with your patients!

Written by:

Elise Swenson, RPh, MS, MAOM, CDE