Jane K. Dickinson, RN, PhD, CDCES

Health Beliefs

Posted on December 19, 2018 by janekdickinson

“Religion, culture, beliefs, and ethnic customs can influence how people understand health concepts, how they take care of their health, and how they make decisions related to their health” (AHRQ). Health beliefs often overlap with cultural and religious beliefs, as well as customs. Sometimes health beliefs are the result of a lack of information.

Another *CRS Q/A Question was How do you quickly assess patients’ health beliefs?

The answer is to ask the person, What’s one thing that really bugs you about diabetes?

This acknowledges that diabetes isn’t easy and that you care about how they are doing with it. This simple question will also give you insight about what matters to the person, or what they believe about their health and health practices.

If you have diabetes and are struggling with aspects of your care, take a look at your own beliefs about your health. How are those beliefs affecting your daily management? What changes or adjustments can you make? Are you getting the help/support you need?

Posted in diabetes advocacy, diabetes care, health beliefs | Tagged diabetes, health beliefs | Comments Off

People who want to be told what to do

Posted on December 12, 2018 by janekdickinson

doctors-prescription-pad (2) *CRS Q/A Question: What is the best strategy (or a suggestion) to provide person-centered care to somebody who is more “old-school” – e.g. “Doctor, just write me a prescription,” without wanting to take any responsibility for their own care?

First off, we can never assume that someone doesn’t want to take any responsibility for their own care. By nature humans want to be healthy. Second, in the words of the great Susan J. Guzman, PhD, “there are always good reasons.” Third, the person-centered approach (including language) is appropriate for everyone, regardless of what or how they are doing.

Person-centered care means focusing on the person, the whole person. Find out what’s going on for them – what’s working. Identify their strengths and help them figure out how to apply those strengths in areas that aren’t working as well.

Give people the benefit of the doubt and as much autonomy as possible. Use shared decision making to give people the information they need to understand their options.

When we’ve taken those steps, we find that, other than those who simply don’t have the mental or physical capacity to care for themselves, most people are interested in taking some responsibility for their own care. They may have never been given the opportunity or the skills or the time to do so. Please, please, please. Let’s change that.

I often compare diabetes care and education to parenting: just as parents’ job is to nurture, support, and grow their children into well-adjusted, productive adults and launch them into the world, it’s our job to “launch” people with diabetes into life.

If someone says, “just write me a prescription,” maybe they need a shot of hope. You can be the person who believes in them. And the way you talk to them will send that message.

Posted in diabetes care, diabetes motivation, diabetes-related language, health care providers | Tagged diabetes, independence, launch, person-centered care, person-centered language, success | Comments Off

Diabetes Distress Resources

Posted on December 5, 2018 by janekdickinson

16992-PB6-R1 *CRS Q/A Question: The ADA and APA offer a mental health provider education program, but it is in-person only and will be given only three times in 2019. What resources do you recommend to help our clinic’s behavioral health providers become proficient in managing diabetes distress?

Image credit: http://tp.amegroups.com/article/view/16992/17492

First of all, thank you for this awesome question, and for caring about diabetes distress.

According to Dr. Lawrence Fisher, diabetes distress refers to all the fears and worries that people with diabetes experience on a daily basis. Fear of complications or the fear of hypoglycemia are examples of the types of concerns that may cause diabetes distress.

Diabetes distress happens in people with both type 1 and type 2 diabetes, and can lead to isolation, diminished self-care, and higher A1C.

One of the best sources of information on diabetes distress is the Behavioral Diabetes Institute in San Diego. Their website has products and resources that you may find helpful. As with anything, awareness is the first step. Providers need to be aware just as much as people living with diabetes. Supporting people through diabetes distress is very important work and not to be taken lightly.

I helped out with an interview study recently, where we asked about diabetes distress. I was amazed at how few health care providers were not familiar with that term. So please spread the word!

Thanks again for bringing up this important topic!

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Night shift and risk of type 2 diabetes

Posted on November 30, 2018 by janekdickinson

images I can’t even imagine how hard it would be to work nights and still have a healthy lifestyle. I have worked two night shifts in my career and they were both torture. I admit I am not cut out for that life. I have the utmost respect for nurses and others who work nights, because someone has to do it, and they step up. Thank you!!

In the meantime, this article says nurses who work rotating night shifts have a 31% higher risk of developing type 2 diabetes.

Because I honestly don’t know how to address this, I’m seeking answers from anyone out there who might know. Do you work night shifts? If so, how do you maintain health? How do you get enough sleep, make food choices (meal times, foods, etc.), exercise, and fit in all those health-related habits?

I’m sure a lot of people could benefit from hearing some tricks of the trade.

Posted in diabetes news, diabetes research, health care | Tagged diabetes, health, night shift, sleep | Comments Off

ACES and diabetes

Posted on November 28, 2018 by janekdickinson

Three types of adversity that make for a tough childhood.

*CRS Q/A Question: What are your thoughts and experience with screening for adverse childhood experiences (ACES) and use of trauma-informed care as one way to improve diabetes outcomes (our experience suggests that ACES are different from PHQ depression and diabetes distress)?

Wow. Great question. Although I am not an expert in this area, I know that ACES are becoming more and more of a focus in the care of children – and rightly so. Kids who have experienced trauma respond in a variety of ways and it makes sense for health care professionals to know how to effectively approach and work with them.

I have heard horror stories about people who’ve been turned away from diabetes providers because they haven’t been seen in over a year. This makes absolutely no sense. If someone is making the effort to be seen, after a long time away is precisely when they need an appointment the most! Not being seen for an extended period of time could be an indicator of a traumatic event in their life. As diabetes professionals, we can be aware of small clues like this and make people feel welcome.

The strengths-based approach encourages us to identify what people are doing well – or at all – and focusing on that. We can even apply those strengths to other areas that need work or improvement. This could be an effective way to work with those with ACES.

According to the Adverse Childhood Experiences — ACE — study, the rougher your childhood, the higher your score is likely to be and the higher your risk for various health problems later.

All people need hope in their lives. I can only imagine how badly people who’ve experienced trauma need hope. The way we interact with and speak to those with ACES can make a big difference. As always, awareness is the first step.

Images Credit: Robert Wood Johnson Foundation; Source: CDC.

Posted in diabetes advocacy, health information | Tagged ACES, awareness, diabetes, hope, strengths-based | Comments Off

A gift for people with diabetes and others

Posted on November 21, 2018 by janekdickinson

I want to let everyone know about a wonderful resource. The diaTribe Foundation puts out a newsletter with the tagline, Making Sense of Diabetes. Their mission is to help individuals better understand their diabetes and to make our readers happier and healthier. In my humble opinion, this newsletter does just that. It offers understandable explanations of important everyday topics for managing diabetes, as well as the latest and greatest in diabetes gadgets and gizmos (aka technology). They break down everything from managing diabetes in the hospital, to suggestions for healthy meals.

The current issue of the newsletter has a list of tips for the holidays that I found very relevant and valuable. I get tired of seeing “tips for the holidays” posts around this time of year. They seem to say the same thing over and over, and it gets old. diaTribe’s list is more innovative, thoughtful, and a good variety of topics. I agree with the point about “moderation” not being easy for everyone. The thing about managing diabetes is that no two people are the same, and we each have to find and do what works best for us as an individual. diaTribe’s newsletter makes it just a little easier to figure all that out and feel good about the process.

I do have two concerns in an effort to be completely transparent:

Today’s issue had a pop-up window with a testimony from a parent of a person who “lowered his A1C from 11-something to 4.9%.” That made me cringe a little. While it is possible (especially with current technology) to run blood glucose levels consistently in a lower range, having an A1C of 4.9% often means one of the following: you don’t have diabetes; you are having – or are at risk for – a lot of low blood glucose events (PSA: hypoglycemia can be dangerous in the short and long term, especially if it’s happening repeatedly); you have diabetes and you are still making some insulin. I wouldn’t want people to think they will magically lower their A1C to the non-diabetes range by reading this newsletter.
Some of the articles are too long for me. I admit that age, work, life, and societal norms have driven me to a very short attention span. I own it. However, if it’s a long article on a topic I’m interested in, I’ll just break up my reading of it (and that makes me happier and healthier).

Check it out! I believe you have to become a member of diaTribe in order to receive the newsletter. It’s all free!

Posted in diabetes care, diabetes news, diabetes products | Tagged diabetes, diaTribe, information, newsletter | Comments Off

Three choices

Posted on November 10, 2018 by janekdickinson

The American Diabetes Association says we have three choices for living with diabetes. Here’s my take on those choices:

Manage it. Yes! We have many tools and resources available to help us manage and live well with diabetes. Check out the Diabetes Online Community. Get in touch with a diabetes educator. Find a health care provider who’s a good fit and gives you the information, support, and guidance you need to successfully manage your diabetes. For me, managing diabetes means checking blood glucose levels (now using CGM), taking insulin, exercising, and making food choices to keep my blood glucose in a range that gives me energy to live my life. It also means managing stress and getting enough sleep so that it’s possible to make those healthier choices.

Thrive in spite of it. While I truly believe in thriving, I don’t think of it as being in spite of diabetes. I think of it more as thriving with diabetes. Diabetes is just one little part of me. It may take a lot of thought, planning, and action; however, it’s still just one part of me and not the most important part. I thrive with diabetes because I want to live my life to the fullest. I realize that sounds cheesy, and I honestly stand by it.

Support those living with it. There are many ways to support people living with diabetes. Family members can be informed and aware and don’t (or stop) nag(ging). Find out what is helpful, and what is not. Communicate openly. People with type 1 diabetes can support those with type 2 diabetes by asking questions, getting informed, welcoming them into the social media space, and not ever referring to having “the kind that’s not my fault.” No one is to blame for having diabetes. Everyone, everywhere, can support people living with diabetes by changing the attitudes and language around diabetes. Take away the shame and judgment and replace it with acceptance.

Posted in about diabetes, diabetes advocacy | Tagged choices, diabetes, National Diabetes Month | Comments Off

One Day Every Year

Posted on October 31, 2018 by janekdickinson

My dog has a jack-o-lantern collar, which means he’s stylish one day out of every year. Today’s the day, folks!

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It’s also a day when kids with diabetes may wish they didn’t have it. The cool thing about 2018, though, is that we now know kids can work some candy into their eating plan. Kids with diabetes don’t have to be singled out or treated differently. The thing to keep in mind is “what would you do for your kids without diabetes?” Do the same thing!

The goal is healthy eating for all. Eating tons of candy isn’t a great choice for any of us, and we all can work some in here and there and be just fine. There are different ways to do this:

eat one piece a day until it’s gone (depending on where you trick or treat, this could take all year)
eat one piece a day for a week and get rid of the rest
eat a few pieces at one time and give away the rest
do a trade (parents get to make the rules for that – every house may be different)
eat so much candy that you get sick and are turned off from it for at least a year (probably not the greatest option)
something else entirely (please share)

Regardless, Halloween is one day of the year. Make it fun. Don’t dwell on it. Focus on friends, activities, being active, whatever else there is besides candy. And then it’s over. And the leash is out of style again.

Posted in diabetes advocacy, diabetes and food | Tagged candy, diabetes, dog leash, Halloween, healthy choices | Comments Off