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Social demands on people with diabetes can limit time for self-care
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In seeing patients on a daily basis, it has been very clear to me, as an educator, that the environment that one lives in is more important than having a diagnosis of diabetes.
It is all those things that are hard to control that make many of the simple things of diabetes self-care unbearable and not easy to do. For example, if a patient has completed a program for self-management of diabetes and has established goals of eating vegetables and fruits and all of a sudden the patient is faced with loss of income and/or medical coverage, how can that patient be in control? The loss of income creates a feeling or powerlessness that becomes so unbearable that the patient may tend to forget about diabetes self-care; all the patient is trying to do is survive. If a patient is placed on insulin but there is no insurance coverage, how can a patient attain control when the patient can not go to doctor’s visits and/or buy necessary prescribed supplies.
Some of the issues being faced by some people with diabetes is the lack of insurance, lack of transportation, lack of a job or the skills needed to apply for a job, lack of proper language skills, decreased level of education, lack of self-esteem, substance abuse, immigration status, troubled home (jailing of a member of the family), lack of knowledge regarding available resources in their community and insecure home environment.
For the Hispanic population this all can be a common occurrence and can create a fatalistic view of what is coming down the line when someone is diagnosed with diabetes. When it comes to lack of health insurance, I have seen people placed on medication that cannot be afforded without any regard to whether they are able to purchase the medication. The lack of accessibility to proper medical care and treatment results in many wasted dollars in health care cost due to acute complications and the slow development of chronic complication. Coupled with that is poor quality of life for people with diabetes facing some of these issues. Diabetes is a chronic disease that needs to be treated on a daily basis with a specific treatment regimen. It requires that people with diabetes are able to make appropriate choices once skills have been learned to do self-care. This disease is not one that people can take care of for many years by trial and error because its complications are many. Proper self-management skills are needed to attain glucose control, but when someone is not even given the resources on where to go for help, they are destined for failure. I have seen patients that come in with as many as 30 years of diabetes without even knowing what type of diabetes they need to fight. This issue is a common one that comes up during patient assessment time, along with do I have the “bad one or the good one.”
 Guadalupe C. Heredia |
When someone has diabetes, it is a stress in itself. A lot of the time this issue is not assessed properly when health care is provided and the patient goes home with many medications and a regimen that will be close to impossible to follow. When the patient goes to the doctor’s office, the lack of motivation and enthusiasm on the patient’s part is probably viewed as the dreaded word “noncompliance.” It is not noncompliance but lack of stability when it comes to a patient’s surroundings or environment they live in. If we as health care providers started looking at some of the issues that are being faced by some patients we would get a clear picture of why the patient can only eat one or two meals per day, cannot test as recommended, is not taking the medications as ordered, is not returning for follow-up visits, and is not having the energy to do all of the above. Lack of resources for some of these folks does not constitute noncompliance. The daily economic impact and the social demands and pressures cut down the time, money and energy one can put into self-care. When people carry or face the burden of emotional pain and anxiety they look for an easy way out of their misery; some will resort to eating (not healthy foods), possibly some form of substance abuse or hide themselves in their feelings.
The environment has changed not only for people with diabetes, but for all. This change, coupled with the lack of good physical, psychological, social and economic health, can be disastrous for all that are facing a chronic illness like diabetes. There is a much needed public health approach so that all of us can work together in a close circle and make the center of the circle the patient. With this in mind will be the hope that together quality of life for patients will improve.
Guadalupe C. Heredia, RN, CDE, BSN, PHN, is a Diabetes Educator at the Diabetes Education and Self-Management Center and the Director for El Centro Regional Medical Center, California.