Wednesday, November 4, 2015

Diabetes Dilemma

I was working with a patient with diabetes (when you call a patient with diabetes a diabetic, it doesn't put the person at the center as a whole person so in nursing we like to say patient with their disease instead of diabetic/hypertensive/epileptic/etc.) and forgot something really important in our conversation. He had been hospitalized due to a serious skin infection that went down to the bone. I had talked with him about he should change his diet, exercise more, and come see his doctor. What I didn't know, is that he had already lost a lot of weight and had already changed his diet (from 5 to 2 tortillas!). He had already seen a dietitian from another clinic and felt that what had to be done was too hard. I asked him why he never went back and he said that he just wasn't into taking care of his health. We talked about normalizing sugars by eating every couple of hours, but his job didn't permit him to do so. Despite laws to protect people with health problems, this patient told me that his employer had a records of firing people for small problems and that there are cameras to watch. Something as simple as giving this patient extra restroom breaks or extra snack break is impossible with this company. While it doesn't help, this patient worked at night (and we know that totally messes with health). At a subsequent visit, I learned that while had had the diagnoses for several years, he was going through a relationship break-up. I often notice that many of my Latino patients struggle with the diabetes diagnosis and don't really process it. They are shocked and act as if it was never there until they get a bone-deep infected wound. Overall, it wasn't as easy to just tell a patient to eat better, exercise more, and see the doctor, I really needed to make more questions about what the patient had done to improve his health and what more he felt he could do to improve his own health.

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