DiabetesSource

by David Hite PhD

In last month’s blog I described the importance of early intervention when dealing with chronic conditions like diabetes. Early intervention at the point of diagnosis will set the stage and help your patient understand that a positive clinical outcome is a shared responsibility. Of course, to take advantage of this “Teachable Moment” you’ll need a common sense plan that’s as easy to explain as it is to understand and follow.

I introduce my patients to a plan dubbed the “5Ms of Diabetes Self-Care.” The plan focuses the patient on five factors affecting glycemic control: Monitoring-Meals-Motion-Medications-Motivation. This model shifts much of the control to the patient, and empowers them to take control of their disease. The message to patients should be clear: what they do outside the clinic to control blood sugar and improve their overall health may be as important as anything their doctor does. Diabetes is chronic, but they can live well with diabetes and reduce their risk of complications by adopting common sense lifestyle changes. The 5M plan offers both a clear roadmap and flexibility, allowing the patient to focus on individual modalities as needed, and as they are ready. They don’t have to change everything at once; simple changes add up and pay big dividends.

• Monitoring - Teach patients how to check blood sugars, not just for the sake of numbers. Explain how to use those numbers to gauge progress and know when to make healthy changes to their plan. It’s also important that they know that monitoring is more than checking numbers on meters, it’s also about monitoring changes to their body by noticing factors like sleep, mood, stress, weight, bowel, and skin changes.
• Meals - Encourage patients to eat healthy nutritious meals. Michael Pollan’s admonition “eat real food, not too much, mostly plants” is a good place to start. Introduce the plate method to reinforce the importance of balanced meals and portion control. Studies show that postprandial blood glucose levels, not fasting blood glucose, are the best predictor of cardiovascular events and all-cause mortality in people with type-2 diabetes. Encourage patients to shoot for a 2 hr post-prandial blood sugar of <180. It’s a valuable tool, and serves as a meal preparation guide.
• Motion - I view exercise as the wild card of blood sugar control. Active muscles are capable of overcoming insulin resistance, the hallmark of type-2 diabetes. Employing an exercise regimen, within the limitations of the patient’s ability, can increase energy levels, combat depression, and lessen the pressure on meal planning and medication modalities. A great tip for holiday celebrations: eat more, move more.
• Medications - Be clear about what each medication does and which ones may be most appropriate for them. This “Medication Education” will help them understand how and when to take them, so they are most effective and minimize the possibility of side effects. Sometimes a medication regimen is negotiable if glycemic control is maintained through diet and exercise. This can be a powerful motivator to encourage lifestyle change.
• Motivation - Living with a chronic condition is difficult. Many people feel overwhelmed and struggle to take action. Every day they face challenges that can wear them down. Depression is twice as common in diabetic patients as in the general population. Offer support and encouragement, and voice your belief that they can be successful making and maintaining healthy lifestyle changes.

Offering a sensible, understandable plan at this “Teachable Moment” will insure that the patient will have the necessary tools to be an active partner in their care. In the following months my blog will expand on these 5Ms, and look at strategies and ideas that will support healthy changes for each.

Sources

1. How do I get them to do what they're "supposed" to do?
   http://www.medscape.com/viewarticle/493600_4
2. Michael Pollan Offers 64 Ways to Eat Food
   http://well.blogs.nytimes.com/2010/01/08/michael-pollan-offers-64-ways-t...
3. Create Your Plate
   http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your...
4. Postprandial, but not fasting, glucose predicts CV risk in type 2 diabetes
   http://www.theheart.org/article/1278655.do
5. Diabetes Burnout: What to do when you can't take it anymore
   http://www.dlife.com/diabetes/lifestyle/diabetes-stress/diabetes_burn_out
6. The Comorbidity of Diabetes Mellitus and Depression
   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717744/

About The Author
David Hite PhD, is a lifelong educator, spending 20 years teaching biology, chemistry, and health education at the high school and community college levels, two years teaching science at Cairo American College in Egypt, and two years at Shanghai American School in China. Dr. Hite developed the patient-friendly "Take Control - Diabetes Basics," a diabetes educational DVD used by clinicians to encourage their patients to implement and maintain effective self-care strategies, and has spent the past 11 years working daily with diabetes patients as a Clinical Health Educator in the Chronic Conditions Management Department for a large non-profit healthcare provider in Sacramento, California. Dr. Hite is a member of the American Association of Diabetes Educators, and the American Diabetes Association.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of DiabetesProductSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.