It’s wonderful to hear about all the medical and technological developments in diabetes care. Recently for example, there has been the prospect of a once a day injection for type 1 diabetes and continuous blood glucose monitoring systems being made more widely available. In healthcare generally, more and more scientific developments are reported daily, which is fantastic news.
However, it takes time and specialist expertise, not to mention money, for these experiments and research to become everyday realities and while we wait, we have to do something to look after ourselves. It struck me, reading through recent health reports, that one of the main ways we can do this is cheap, extremely close to home and doesn’t require any technology or expertise at all – yes, I’m talking about the humble walk. Well, I say ‘humble’, but looking at all the benefits, I’m not sure that all of us who use it regularly shouldn’t qualify for something at least like a Nobel Prize!
For example, walking can help prevent type 2 diabetes altogether. It’s recommended as one of the main interventions in guidance from the National Institute for Health and Care Excellence (NICE) for preventing type 2 diabetes, both in the general population and among those at high risk. 30 minutes of walking of moderate intensity on 5 or more days a week is the minimum recommendation.
Most people living or working with diabetes know, through book learning or, sadly, bitter experience, that ‘diabetes rarely comes to the party alone, it brings all its friends’ as one lady with diabetes memorably described the risk or presence of diabetes related conditions such as high blood pressure and high cholesterol. Research shows that these too can be helped by walking regularly.
An increased risk when you have diabetes or other long term conditions, and sometimes even a precurser to having diabetes, is depression. Yes, there is evidence too of walking being beneficial in treating depression and even preventing it. Its mood-enhancing properties are frequently mentioned in research. In addition, when used as a social activity, walking can also be a way to combat loneliness after retirement, divorce or in older age.
Bringing together some scientific research and the benefits of activity is a recent report about the discovery of how genes can make a person biologically programmed to eat more. This is because a high risk version of a gene called FTO prevents a hunger hormone called ghrelin from falling after eating. One answer to this is to suppress ghrelin and tried and tested methods include eating protein rich meals and cycling. If cycling can work, why not walking? My guess is that it is only a matter of time for walking to be added to this list of weight gain preventive treatments in this group of people. Given that they will also be at risk of type 2 diabetes, through its link with obesity, it’s yet an other potential tick in the box of ‘benefits of walking’.
There are of course many people who for one reason or another cannot walk or walk well enough to take up even minimum guidelines. But even for you, there is good news. Walking is highly recommended as a form of activity, as we have seen, but it’s not the only one. Anything that makes you move more is helpful to health, says NICE, and the more times you move, in whatever way, is even better. So armchair movement including just your upper or lower body makes a difference. Passive or active, movement works.
So, we have the technology, in our very bodies, here and now, in any weather and at no cost, to make ourselves healthier both physically and mentally. It’s not often we can say that. Given that we should all be doing more of it, as our contribution towards this, we’ve recently added our booklet ‘SD Tips for a Lively 2013’ to our website download section, you’ll find the link to it just below. Help yourself to a copy and see if all this evidence works for you!
SD Tips for a Lively 2013! Quick, Easy and Fun Ways to Move About More.
References
BBC News. Fat boosting gene mystery ‘solved’. 15 July 2013
BBC News. Guide shows Borders walk benefits 25 June 2013
BBC News. Why retiring can be bad for your health. 16 May 2013
BBC News. Walking could be a useful took in treating depression. 14 April 2012
NICE. Preventing Type 2 diabetes – population and community interventions. May 2011
Showing posts with label successful diabetes. Show all posts
Showing posts with label successful diabetes. Show all posts
Wednesday, 17 July 2013
Tuesday, 29 January 2013
‘Difficult Patients’ – How to Manage
At a recent workshop for health professionals, a couple of the participants mentioned that some of their patients were ‘really difficult’. On exploring what they meant by this, they were frustrated by people who seemed not to contribute in consultations, or didn’t attend regularly, or when they did attend, they didn’t seem particularly interested in doing what they were asked to manage their diabetes. One also mentioned that such ‘difficult patients’ also often attended with their own agenda and questions that weren’t always relevant to the consultation.
This made me reflect on how often I hear this kind of point made and also on what a powerful, emotionally charged exclamation it is, to say that you have ‘difficult patients’. What is perhaps really being said is ‘I find it really hard to meet these peoples’ needs, so I am categorising them as difficult’.
I have heard of ‘difficult patients’ in all sorts of guises – someone with Type 2 diabetes who feels nothing the health professional suggests is worth trying, a teenager with Type 1 diabetes who sits surly and unresponsive throughout the consultation or what has been described by a fellow blogger Alison Finney as ‘a nightmare patient’ in her blog shoot up or put up , referring to someone who wants to know everything about everything and discuss the pros and cons of all advice given.
I venture the view that actually, there is no such thing as a ‘difficult patient’ but there are difficult encounters between people with diabetes and health professionals. These are characterised, in my view, by strong feelings on the part of each and yes, competing agendas, which are often only partly fulfilled.
It’s often about roles. Having diabetes certainly doesn’t make you keen to adopt or adopt unquestioningly, the behaviours recommended for keeping well. Neither does being a health professional make you all – knowing or even all-powerful. However, these are frequently the roles assigned, albeit unconsciously, in a typical consultation. Herein lies where agendas can clash.
There is also the question of expectations, if not judgements. Often, thoughts that precede the ‘difficult encounter’ will be “oh no, it’s the difficult/uncompliant/badly controlled/intense/obsessional person coming in next (health professional) or ‘I hate going to this consultation, I’m fed up of never getting anything right/not having my questions answered/not being able to get a word in edgeways/being told stuff I already know’ (person with diabetes). Hence the stage is set for a tricky, unfulfilling, and most sadly of all, ultimately pointless meeting.
I paint a dire picture, I know, but I’m guessing that it’s one you may recognise, at least in part, from your experiences of consultations. If you do recognise and would like to lessen the chances of being seen as or having a ‘difficult patient’, then I’d like to offer you a few ideas from research and experience – in no particular order of importance:
• Ask about feelings: sometimes anxiety manifests as anger and silence equals upset. Acknowledging that consultations are emotionally charged can remove a great deal of difficulty
• Plan for 1 thing – and 1 only – that you’d like to achieve from the consultation and share this with the other party, ideally before or at least at the start of the consultation
• Don’t expect your consultation to be 100% perfect or have 100% perfect outcomes. You are bound to be disappointed! Seeing this meeting as just one step on the journey of diabetes is fine
• Share your feelings – yes, both of you. Not in a ‘deep and meaningful’ way, but honestly: how about ‘I’m not sure we’re getting on so well: how can I best help you today?’ or ‘coming here always makes me feel a bit of a failure I’d like to talk about what I have been doing rather than what I’ve not done’
• Examine your motives for the consultation: are you expecting the health professional to solve or take over your diabetes? Do you want your patients to do what you tell them, unquestioningly? Either way, it’s unrealistic. Consider having a conversation about 1 thing that really matters to you both, instead
• Are you talking at cross purposes because you don’t both have the same facts at your fingertips, eg test results and their meaning? If so, would sharing test results in advance of the consultation help, so you can discuss them on equal footing?
It is certainly true that the more honesty and information sharing there is in consultations, the more worthwhile experience they seem to be. While writing this I’ve also been reminded of a comment made by a colleague, who once said ‘I see the HbA1c as an invitation to look at the person’s life with them’. Could this possibly be all that ‘difficult patient’ needs from their consultation?
This made me reflect on how often I hear this kind of point made and also on what a powerful, emotionally charged exclamation it is, to say that you have ‘difficult patients’. What is perhaps really being said is ‘I find it really hard to meet these peoples’ needs, so I am categorising them as difficult’.
I have heard of ‘difficult patients’ in all sorts of guises – someone with Type 2 diabetes who feels nothing the health professional suggests is worth trying, a teenager with Type 1 diabetes who sits surly and unresponsive throughout the consultation or what has been described by a fellow blogger Alison Finney as ‘a nightmare patient’ in her blog shoot up or put up , referring to someone who wants to know everything about everything and discuss the pros and cons of all advice given.
I venture the view that actually, there is no such thing as a ‘difficult patient’ but there are difficult encounters between people with diabetes and health professionals. These are characterised, in my view, by strong feelings on the part of each and yes, competing agendas, which are often only partly fulfilled.
It’s often about roles. Having diabetes certainly doesn’t make you keen to adopt or adopt unquestioningly, the behaviours recommended for keeping well. Neither does being a health professional make you all – knowing or even all-powerful. However, these are frequently the roles assigned, albeit unconsciously, in a typical consultation. Herein lies where agendas can clash.
There is also the question of expectations, if not judgements. Often, thoughts that precede the ‘difficult encounter’ will be “oh no, it’s the difficult/uncompliant/badly controlled/intense/obsessional person coming in next (health professional) or ‘I hate going to this consultation, I’m fed up of never getting anything right/not having my questions answered/not being able to get a word in edgeways/being told stuff I already know’ (person with diabetes). Hence the stage is set for a tricky, unfulfilling, and most sadly of all, ultimately pointless meeting.
I paint a dire picture, I know, but I’m guessing that it’s one you may recognise, at least in part, from your experiences of consultations. If you do recognise and would like to lessen the chances of being seen as or having a ‘difficult patient’, then I’d like to offer you a few ideas from research and experience – in no particular order of importance:
• Ask about feelings: sometimes anxiety manifests as anger and silence equals upset. Acknowledging that consultations are emotionally charged can remove a great deal of difficulty
• Plan for 1 thing – and 1 only – that you’d like to achieve from the consultation and share this with the other party, ideally before or at least at the start of the consultation
• Don’t expect your consultation to be 100% perfect or have 100% perfect outcomes. You are bound to be disappointed! Seeing this meeting as just one step on the journey of diabetes is fine
• Share your feelings – yes, both of you. Not in a ‘deep and meaningful’ way, but honestly: how about ‘I’m not sure we’re getting on so well: how can I best help you today?’ or ‘coming here always makes me feel a bit of a failure I’d like to talk about what I have been doing rather than what I’ve not done’
• Examine your motives for the consultation: are you expecting the health professional to solve or take over your diabetes? Do you want your patients to do what you tell them, unquestioningly? Either way, it’s unrealistic. Consider having a conversation about 1 thing that really matters to you both, instead
• Are you talking at cross purposes because you don’t both have the same facts at your fingertips, eg test results and their meaning? If so, would sharing test results in advance of the consultation help, so you can discuss them on equal footing?
It is certainly true that the more honesty and information sharing there is in consultations, the more worthwhile experience they seem to be. While writing this I’ve also been reminded of a comment made by a colleague, who once said ‘I see the HbA1c as an invitation to look at the person’s life with them’. Could this possibly be all that ‘difficult patient’ needs from their consultation?
Friday, 11 January 2013
Tops in 2012!
At the start of a new year, it’s traditional to look back on the highs and lows of the last one. In our case, we don’t really do ‘lows’ but prefer to concentrate on successes, as this has a much better track record when it comes to positive mental health. But enough of our philosophy, (which is covered in detail on our website if you’d like to know more) and here we go with some of the highlights from the last year, many of which we covered in this blog.
They get our votes because they really focussed on the people side of health and wellbeing and are consistent with all that we promote here at SD
So imagine a drum roll and let’s hear it for the following!
• The Health Foundation – released a series of practical reports and reviews in relation to making a reality of person centred consultations, helping people make decisions, collaborative healthcare and supporting self care. Absolutely vital stuff to help the new, personalised NHS achieve its objectives
• Diabetes UK – kept up a relentless focus on the basic checks people with diabetes need to have, from blood pressure to foot examinations – and reminded the world at every opportunity how these were not universally offered or taken up, despite them being ‘must do’s
• The Irish Health Service – made rolling out pump therapy for the under 5s a priority in its health budget for 2013
• The National Diabetes Audit for England and Wales for including statistics about the poor offering and uptake of diabetes structured education and giving campaigners the opportunity to wave these statistics and press for change
• Diabetes Australia – for publishing a wonderful document about awareness of language in relation to diabetes. Just creeping in from December 2011, but we’re guessing it was 2012 before anyone read it and it remains one of our favourites!
• Last but not least – anyone living or working with diabetes who has reflected on their approach, made changes or generally tried to make their diabetes or the environment in which they work a better experience during the year. As we never tire of quoting, from a dear friend with diabetes “diabetes is a marathon not a sprint; I need help to stay in the race”. Every bit of help along the way matters equally every year.
Hoping to see much more great work like this in 2013 and wishing all our readers a very happy and healthy – and Successful - new year!
Reference
www.successfuldiabetes.com
They get our votes because they really focussed on the people side of health and wellbeing and are consistent with all that we promote here at SD
So imagine a drum roll and let’s hear it for the following!
• The Health Foundation – released a series of practical reports and reviews in relation to making a reality of person centred consultations, helping people make decisions, collaborative healthcare and supporting self care. Absolutely vital stuff to help the new, personalised NHS achieve its objectives
• Diabetes UK – kept up a relentless focus on the basic checks people with diabetes need to have, from blood pressure to foot examinations – and reminded the world at every opportunity how these were not universally offered or taken up, despite them being ‘must do’s
• The Irish Health Service – made rolling out pump therapy for the under 5s a priority in its health budget for 2013
• The National Diabetes Audit for England and Wales for including statistics about the poor offering and uptake of diabetes structured education and giving campaigners the opportunity to wave these statistics and press for change
• Diabetes Australia – for publishing a wonderful document about awareness of language in relation to diabetes. Just creeping in from December 2011, but we’re guessing it was 2012 before anyone read it and it remains one of our favourites!
• Last but not least – anyone living or working with diabetes who has reflected on their approach, made changes or generally tried to make their diabetes or the environment in which they work a better experience during the year. As we never tire of quoting, from a dear friend with diabetes “diabetes is a marathon not a sprint; I need help to stay in the race”. Every bit of help along the way matters equally every year.
Hoping to see much more great work like this in 2013 and wishing all our readers a very happy and healthy – and Successful - new year!
Reference
www.successfuldiabetes.com
Subscribe to:
Posts (Atom)