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When patients can’t — or won’t — see a health care provider, they’re left to their own devices, which often leads to self-care, a practice that many people take for granted. natural remedies for blood sugar Self-care usually refers to indulgent relaxation: taking a hot bath, pouring a glass of wine or cutting an extra-large slice of cake. Individuals diagnosed with diabetes have to be careful when partaking in those practices because they can cause more stress than they relieve. open_in_new means a long-term commitment to avoiding health complications in the absence of a medical provider. This type of self-care can be overwhelming for patients experiencing diabetes, and it’s unsurprising that a study published in the Journal of General Internal Medicine open_in_new found that most of these individuals struggle with motivation and support for self-care. The link below leads to a worksheet that helps to keep track of self-care strategies and to stay accountable to health goals. Understanding Diabetes and Blood Sugar Diabetes mellitus Breaking scientific research shows that there’s a green vegetable that INFLAMES diabetes type 2 symptoms… Causing deadly spikes in blood sugar, increased fat storage, hormonal imbalances, brain fog, arterial plaque and debilitating chronic fatigue… Chronic condition characterized by hyperglycemia — also known as high blood sugar levels. Diabetes is caused by the body’s inability to create or absorb the proper amount of insulin, a hormone that regulates the amount of sugar in the blood, which is called glucose. Most often occurring in children, whose bodies create little to no insulin, diabetes forces people to rely on insulin injections that move the body’s sugar, or glucose, from the bloodstream to the cells. Only 5 percent of diabetes patients have The most common form of diabetes has historically occurred in adults though in recent years an increase in pediatric diagnoses has alarmed health care providers. People with Type 2 diabetes have developed an insulin resistance, meaning the body does not absorb insulin easily. Their high blood sugar levels can go undetected for years if symptoms such as increased thirst, frequent urination, headaches and fatigue. This condition indicates an increased risk of developing Type 2 diabetes during adulthood. Patients diagnosed with prediabetes have high blood sugar or polyuria (urinary frequency). However, the symptoms of prediabetes can be easily confused with other health complications, so it’s critical for adults to get tested. According to the American Diabetes Association, people with prediabetic symptoms
Citation preview
What Does Self-Care Mean for Individuals
With Diabetes? When patients can’t — or won’t — see a health care provider, they’re left to their
own devices, which often leads to self-care, a practice that many people take for
granted.
natural remedies for blood sugar
Self-care usually refers to indulgent relaxation: taking a hot bath, pouring a glass
of wine or cutting an extra-large slice of cake. Individuals diagnosed with
diabetes have to be careful when partaking in those practices because they can
cause more stress than they relieve.
open_in_new means a long-term commitment to avoiding health complications in
the absence of a medical provider.
This type of self-care can be overwhelming for patients experiencing diabetes,
and it’s unsurprising that a study published in the Journal of General Internal
Medicine
open_in_new found that most of these individuals struggle with motivation and
support for self-care. The link below leads to a worksheet that helps to keep track
of self-care strategies and to stay accountable to health goals.
Understanding Diabetes and Blood Sugar
Diabetes mellitus
Breaking scientific research shows that there’s a green vegetable that
INFLAMES diabetes type 2 symptoms…
Causing deadly spikes in blood sugar, increased fat storage, hormonal
imbalances, brain fog, arterial plaque and debilitating chronic fatigue…
https://85694cyhrte13ubz4-57iway5m.hop.clickbank.net/https://85694cyhrte13ubz4-57iway5m.hop.clickbank.net/
Chronic condition characterized by hyperglycemia — also known as high blood sugar
levels. Diabetes is caused by the body’s inability to create or absorb the proper amount
of insulin, a hormone that regulates the amount of sugar in the blood, which is called
glucose.
Most often occurring in children, whose bodies create little to no insulin, diabetes forces
people to rely on insulin injections that move the body’s sugar, or glucose, from the
bloodstream to the cells.
Only 5 percent of diabetes patients have The most common form of diabetes has
historically occurred in adults though in recent years an increase in pediatric diagnoses
has alarmed health care providers. People with Type 2 diabetes have developed an
insulin resistance, meaning the body does not absorb insulin easily.
Their high blood sugar levels can go undetected for years if symptoms such as
increased thirst, frequent urination, headaches and fatigue. This condition indicates an
increased risk of developing Type 2 diabetes during adulthood.
Patients diagnosed with prediabetes have high blood sugar or polyuria (urinary
frequency). However, the symptoms of prediabetes can be easily confused with other
health complications, so it’s critical for adults to get tested.
According to the American Diabetes Association, people with prediabetic symptoms
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The Importance of Self-Care Diabetes can contribute to long-term damage or failure of different organs — especially
in the eyes, kidneys, heart, nerves and blood vessels, according to the American
Diabetes Association.
Therefore, self-care is necessary to limit potential organ damage, and it can reduce the
likelihood of hospitalizations and ER visits for patients.
concluded that the following seven self-care practices help patients with diabetes avoid
hospital visits and serious health complications:
• Healthy eating
• Being physically active
• Monitoring blood sugar levels
• Complying with medications
• Using problem-solving skills
https://nursing.usc.edu/blog/self-care-with-diabetes/https://85694cyhrte13ubz4-57iway5m.hop.clickbank.net/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797383/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797383/
• Developing healthy coping skills
• Practicing risk-reduction behaviors
The above strategies have been positively correlated with blood sugar control, fewer
complications and overall improved of quality of life. However, there are several other
recommendations that are often overlooked.
Caring for feet: Check the skin and webs of the toes for any open lesions or sores, and
make sure that nails are trimmed straight across. Wearing closed-toed shoes can help
prevent foot injuries.
Reporting symptoms, especially numbness or tingling: Numbness can be a sign of
nerve damage, called peripheral neuropathy, which is dangerous for older patients who
lose feeling in their limbs and aren’t able to test if bathwater is too hot or feel an open
wound. Maintaining a healthy blood pressure and sugar level will deter symptoms
associated with peripheral neuropathy, as will curbing fat intake
“Early recognition can also help prevent some complications associated with resistant
strains of bacterial infections that may lead to kidney complications,” says Kirkland. “The
earlier symptoms are reported, the better.”
Practicing good oral hygiene: Maintaining dental health, like brushing and flossing
right after eating, can minimize the effects of gingivitis and periodontitis. If these
diseases develop, they have the potential to contribute to blood glucose irregularity.
Visiting a dentist twice a year can help catch early symptoms.
Checking the skin: Inspect skin for discoloration or dryness,
open_in_new which can make skin susceptible to scrapes and sores, especially when
the body is dehydrated. Take note of uneven hair distribution or hair loss,
open_in_new which can result from hormonal changes, increased stress or nerve
damage, and is sometimes a side-effect of insulin injections. Drinking water and staying
hydrated can keep skin strong and hair healthy.
Maintaining sexual health: In men and women, increased urination can be a sign of
complications. For women, checking for yeast infections or abnormal discharge is
critical as well. Men with diabetes are at risk for erectile dysfunction, which may
correlate with poorly controlled diabetes or high glucose levels. Patients should take
note of symptoms and ask any questions when they see a gynecologist or a primary
care provider each year.
Relying on social circles: Though self-care implies solitude, Kirkland encourages
patients to talk about their routines with family members, caregivers or friends. “It’s hard
to be motivated when you are alone,” she said. Patients can look for a support group in
their local communities or online through the American Diabetes Association.
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Reducing stress: Feeling physical or emotional stress can make it more difficult to
follow a treatment plan and can leave patients feeling hopeless or unmotivated.
Because stress reduction is different in every person, Kirkland emphasizes the
importance of discussing methods with a provider or caregiver and keeping track of
what works effectively. The guide above can be used by patients or providers to write
down their strategies each day.
The Social Determinants of Self-Care
The recommendations for diabetes management are complex and demanding;
adherence to proper health management has been alarmingly low in many studies.
However, this isn’t because patients aren’t willing or motivated to practice self-care,
according to Kirkland. They simply lack the resources.
that put patients at risk for low adherence to their medical treatment plans. According to
Kirkland, some patients might experience a variety of these social determinants at once,
which causes high stress that puts them at increased risk and, therefore, in need of
greater support from their medical providers.
:Education People with low academic achievement often have low health literacy,
meaning they have a harder time reading and understanding medical information.
Housing status: Without stable access to shelter, patients are unable to store their
medication safely. Other patients who live in apartment buildings or urban
neighborhoods are less likely to have access to safe outdoor spaces for exercise or an
accessible kitchen in which to cook their own meals.
Food security: Living in an area without regular access to a grocery store makes it
difficult to find healthy food that has valuable nutrients, like vitamins and minerals. In
2016, there were 6 million households
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open_in_newthat didn’t know where their next meal would come from.
Income: Socioeconomic status affects a person’s health care coverage, ability to
purchase nutritional food, access to transportation for appointments and more.
According to Kirkland, many patients struggle to justify time off work for medical
appointments, leaving them less able to pursue follow-up care.
Age: Older adults may have developed other chronic conditions with symptoms that
make them unable to adhere to an exercise routine or care for themselves
independently.
How Nurses Can Be Supportive In Kirkland’s experience as a nurse practitioner, she’s worked in private practices,
military hospitals and academic medical settings; now she sees patients who have
survived Hurricane Harvey, many of whom have had to perform self-care simply
because clinics were closed. Kirkland’s experience has yielded many lessons in
supporting patients who struggle to support themselves.
Cater to the patient’s learning style. “Everyone learns differently,” Kirkland says, “so
you have to make use of what works for them.” She suggests motivational interviewing
to understand what social determinants affect a patient or to discover if they have pre-
existing habits like smoking or drinking. “Auditory learners want to hear the information
like a story, but visual learners want to see their charts from the past few years to
understand how much their blood sugar is going up,” she explains. Providers can also
use the teach-back method, in which a patient can repeat back what they understood
about a conversation, to verify that they have processed the new information.
Develop long-term relationships. Seeing the patients consistently can help establish
a dialogue over time and encourage them to open up about questions they might not
have asked a new provider. “If I’ve been seeing a patient for the past few years, I really
understand their struggles, and I can be a better resource for them,” Kirkland says. “It
makes a difference to them if we can work as a team.”
Help set goals and form habits. “Lasting change is created by taking small steps,”
Kirkland explains, emphasizing the importance of creating achievable goals. “But some
patients need more help with those steps than others.” Many people with prediabetes
don’t always recognize their symptoms and understandably find it difficult to inquire
about a seemingly invisible problem. However, establishing camaraderie with others
diagnosed with diabetes can promote accountability for good self-care habits.
Don’t blame the patient. Adhering to goals and habits is difficult, and it’s important to
offer help rather than blame. Many adults just need incentives to participate, as well as
a healthy balance between treatment recommendations from their provider and
celebrating positive behaviors, Kirkland says.
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Addressing needs of diabetic patients One of the biggest challenges for health care providers today is addressing the continued needs
and demands of individuals with chronic illnesses like diabetes. The importance of regular
follow-up of diabetic patients with the health care provider is of great significance in averting
any long term complications.
Self-care in diabetes Self-care in diabetes has been defined as an evolutionary process of development of
knowledge or awareness by learning to survive with the complex nature of diabetes in a
social context. Because the vast majority of day-to-day care in diabetes is handled by
patients and or families, there is an important need for reliable and valid measures for
self-management of diabetes.
There are seven essential self-care behaviors in people with diabetes which predict good
outcomes. These are healthy eating, being physically active, monitoring of blood sugar,
compliant with medications, good problem-solving skills, healthy coping skills and risk-
reduction behaviors.
These proposed measures can be useful for both clinicians and educators treating
individual patients and for researchers evaluating new approaches to care. Self-report is
by far the most practical and cost-effective approach to self-care assessment and yet is
often seen as undependable.
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Diabetes self-care activities are behaviors undertaken by people with or at risk of diabetes
in order to successfully manage the disease on their own. All these seven behaviors have
been found to be positively correlated with good glycemic control, reduction of
complications and improvement in quality of life. In addition, it was observed that self-
care encompasses not only performing these activities but also the interrelationships
between them.
Diabetes self-care requires the patient to make many dietary and lifestyle modifications
supplemented with the supportive role of healthcare staff for maintaining a higher level
of self-confidence leading to a successful behavior change.
Diabetes self management education Though genetics play an important role in the development of diabetes, monozygotic twin
studies have certainly shown the importance of environmental influences. Individuals with
diabetes have been shown to make a dramatic impact on the progression and development of
their disease by participating in their own care.
This participation can succeed only if those with diabetes and their health care providers are
informed about taking effective care for the disease. It is expected that those with the greatest
knowledge will have a better understanding of the disease and have a better impact on the
progression of the disease and complications.
The American Association of Clinical Endocrinologists emphasizes the importance of patients
becoming active and knowledgeable participants in their care. Likewise, WHO has also
recognized the importance of patients learning to manage their diabetes. The American Diabetes
Association had reviewed the standards of diabetes self management education and found that
there was a four-fold increase in diabetic complications for those individuals with diabetes who
had not received formal education concerning self-care practices.
A meta-analysis of self-management education for adults with type-2 diabetes revealed
improvement in glycemic control at immediate follow-up. However, the observed benefit
declined one to three months after the intervention ceased, suggesting that continuing education
is necessary. A review of diabetes self-management education revealed that education is
successful in lowering glycosylated hemoglobin levels.
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Diabetes self-care activities Diabetes education is important but it must be transferred to action or self-care activities to fully
benefit the patient. Self-care activities refer to behaviors such as following a diet plan, avoiding
high fat foods, increased exercise, self-glucose monitoring, and foot care. Decreasing the
patient’s glycosylated hemoglobin level may be the ultimate goal of diabetes self-management
but it cannot be the only objective in the care of a patient. Changes in self-care activities should
also be evaluated for progress toward behavioral change.
Self-monitoring of glycemic control is a cornerstone of diabetes care that can ensure patient
participation in achieving and maintaining specific glycemic targets. The most important
objective of monitoring is the assessment of overall glycemic control and initiation of
appropriate steps in a timely manner to achieve optimum control.
Self-monitoring provides information about current glycemic status, allowing for assessment of
therapy and guiding adjustments in diet, exercise and medication in order to achieve optimal
glycemic control. Irrespective of weight loss, engaging in regular physical activity has been
found to be associated with improved health outcomes among diabetics.
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The National Institutes of Health and the American College of Sports Medicine recommend that
all adults, including those with diabetes, should engage in regular physical activity.
Compliance to self-care activities Treatment adherence in diabetes is an area of interest and concern to health professionals and
clinical researchers even though a great deal of prior research has been done in the area. In
diabetes, patients are expected to follow a complex set of behavioral actions to care for their
diabetes on a daily basis.
These actions involve engaging in positive lifestyle behaviors, including following a meal plan
and engaging in appropriate physical activity; taking medications (insulin or an oral
hypoglycemic agent) when indicated; monitoring blood glucose levels; responding to and self-
treating diabetes- related symptoms; following foot-care guidelines; and seeking individually
appropriate medical care for diabetes or other health-related problems. The proposed regimen is
further complicated by the need to integrate and sequence all of these behavioral tasks into a
patient’s daily routine.
The majority of patients with diabetes can significantly reduce the chances of developing long-
term complications by improving self-care activities. Despite this fact, compliance or adherence
to these activities has been found to be low, especially when looking at long-term changes.
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In the process of delivering adequate support, healthcare providers should not blame the patients
even when their compliance is poor. In a study conducted among people with diabetes only 30%
were compliant with drug regimens and the non-compliance was higher among the lower
socioeconomic groups. One of the realities about type-2 diabetes is that only being compliant to
self-care activities will not lead to good metabolic control.
Research work across the globe has documented that metabolic control is a combination of
many variables, not just patient compliance. In an American trial, it was found that participants
were more likely to make changes when each change was implemented individually.
Success, therefore, may vary depending on how the changes are implemented, simultaneously or
individually. Some of the researchers have even suggested that health professionals should tailor
their patient self-care support based on the degree of personal responsibility the patient is willing
to assume towards their diabetes self-care management.
Barriers to diabetes care The role of healthcare providers in care of diabetic patients has been well recognized. Socio-
demographic and cultural barriers such as poor access to drugs, high cost, patient satisfaction
with their medical care, patient provider relationship, degree of symptoms, unequal distribution
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of health providers between urban and rural areas have restricted self-care activities in
developing countries.
In a study to identify the barriers from the provider’s perspective in regard to diabetes care
factors like affordability by the patient, belief by providers that medications cannot cure patient
condition, no confidence in their own ability to alter patient behavior were identified. Another
study stressed on both patient factors (adherence, attitude, beliefs, knowledge about diabetes,
culture and language capabilities.
health literacy, financial resources, co-morbidities and social support) and clinician related
factors (attitude, beliefs and knowledge about diabetes, effective communication).
Recommendations for self-care activities Because diabetes self-care activities can have a dramatic impact on lowering glycosylated
hemoglobin levels, healthcare providers and educators should evaluate perceived patient barriers
to self-care behaviors and make recommendations with these in mind. Unfortunately, though
patients often look to healthcare providers for guidance, many healthcare providers are not
discussing self-care activities with patients.
Health care providers should begin by taking time to evaluate their patients’ perceptions and
make realistic and specific recommendations for self-care activities. Some patients may
experience difficulty in understanding and following the basics of diabetes self-care activities.
When adhering to self-care activities patients are sometimes expected to make what would in
many cases be a medical decision and many patients are not comfortable or able to make such
complex assessments.
Furthermore, these requirements or modifications should be specific for each patient and should
be altered depending on the patient’s response. It is critical that health care providers actively
involve their patients in developing self-care regimens for each individual patient. This regimen
should be the best possible combination for every individual patient plus it should sound realistic
to the patient so that he or she can follow it.
Simultaneously, health care providers should fully document the specific diabetes self-care
regimen in the patients’ medical record as it will facilitate provider-patient communication and
help in assessment of compliance. Also, the need for regular follow-up can never be
underestimated in a chronic illness like diabetes and therefore be looked upon as an integral
component of its long term management.
Implications for practice A clinician should be able to recognize patients who are prone for non-compliance and thus give
special attention to them. On a grass-root level, countries need good diabetes self-management
education programs at the primary care level with emphasis on motivating good self-care
behaviors especially lifestyle modification.
Furthermore, these programs should not happen just once, but periodic reinforcement is
necessary to achieve change in behavior and sustain the same for the long-term. While
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organizing these education programs adequate social support systems such as support groups,
should be arranged.
Implications for future research As most of the reported studies are from developed countries so there is an immense need for
extensive research in rural areas of developing nations. Concurrently, field research should be
promoted in developing countries about perceptions of patients on the effectiveness of their self-
care management so that resources for diabetes mellitus can be used efficiently.
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