What Does Self-Care Mean for Individuals

With Diabetes? When patients can’t — or won’t — see a health care provider, they’re left to their

own devices, which often leads to self-care, a practice that many people take for

granted.

natural remedies for blood sugar

Self-care usually refers to indulgent relaxation: taking a hot bath, pouring a glass

of wine or cutting an extra-large slice of cake. Individuals diagnosed with

diabetes have to be careful when partaking in those practices because they can

cause more stress than they relieve.

open_in_new means a long-term commitment to avoiding health complications in

the absence of a medical provider.

This type of self-care can be overwhelming for patients experiencing diabetes,

and it’s unsurprising that a study published in the Journal of General Internal

Medicine

open_in_new found that most of these individuals struggle with motivation and

support for self-care. The link below leads to a worksheet that helps to keep track

of self-care strategies and to stay accountable to health goals.

Understanding Diabetes and Blood Sugar

Diabetes mellitus

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Chronic condition characterized by hyperglycemia — also known as high blood sugar

levels. Diabetes is caused by the body’s inability to create or absorb the proper amount

of insulin, a hormone that regulates the amount of sugar in the blood, which is called

glucose.

Most often occurring in children, whose bodies create little to no insulin, diabetes forces

people to rely on insulin injections that move the body’s sugar, or glucose, from the

bloodstream to the cells.

Only 5 percent of diabetes patients have The most common form of diabetes has

historically occurred in adults though in recent years an increase in pediatric diagnoses

has alarmed health care providers. People with Type 2 diabetes have developed an

insulin resistance, meaning the body does not absorb insulin easily.

Their high blood sugar levels can go undetected for years if symptoms such as

increased thirst, frequent urination, headaches and fatigue. This condition indicates an

increased risk of developing Type 2 diabetes during adulthood.

Patients diagnosed with prediabetes have high blood sugar or polyuria (urinary

frequency). However, the symptoms of prediabetes can be easily confused with other

health complications, so it’s critical for adults to get tested.

According to the American Diabetes Association, people with prediabetic symptoms

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The Importance of Self-Care Diabetes can contribute to long-term damage or failure of different organs — especially

in the eyes, kidneys, heart, nerves and blood vessels, according to the American

Diabetes Association.

Therefore, self-care is necessary to limit potential organ damage, and it can reduce the

likelihood of hospitalizations and ER visits for patients.

concluded that the following seven self-care practices help patients with diabetes avoid

hospital visits and serious health complications:

• Healthy eating

• Being physically active

• Monitoring blood sugar levels

• Complying with medications

• Using problem-solving skills

https://nursing.usc.edu/blog/self-care-with-diabetes/https://85694cyhrte13ubz4-57iway5m.hop.clickbank.net/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797383/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797383/

• Developing healthy coping skills

• Practicing risk-reduction behaviors

The above strategies have been positively correlated with blood sugar control, fewer

complications and overall improved of quality of life. However, there are several other

recommendations that are often overlooked.

Caring for feet: Check the skin and webs of the toes for any open lesions or sores, and

make sure that nails are trimmed straight across. Wearing closed-toed shoes can help

prevent foot injuries.

Reporting symptoms, especially numbness or tingling: Numbness can be a sign of

nerve damage, called peripheral neuropathy, which is dangerous for older patients who

lose feeling in their limbs and aren’t able to test if bathwater is too hot or feel an open

wound. Maintaining a healthy blood pressure and sugar level will deter symptoms

associated with peripheral neuropathy, as will curbing fat intake

“Early recognition can also help prevent some complications associated with resistant

strains of bacterial infections that may lead to kidney complications,” says Kirkland. “The

earlier symptoms are reported, the better.”

Practicing good oral hygiene: Maintaining dental health, like brushing and flossing

right after eating, can minimize the effects of gingivitis and periodontitis. If these

diseases develop, they have the potential to contribute to blood glucose irregularity.

Visiting a dentist twice a year can help catch early symptoms.

Checking the skin: Inspect skin for discoloration or dryness,

open_in_new which can make skin susceptible to scrapes and sores, especially when

the body is dehydrated. Take note of uneven hair distribution or hair loss,

open_in_new which can result from hormonal changes, increased stress or nerve

damage, and is sometimes a side-effect of insulin injections. Drinking water and staying

hydrated can keep skin strong and hair healthy.

Maintaining sexual health: In men and women, increased urination can be a sign of

complications. For women, checking for yeast infections or abnormal discharge is

critical as well. Men with diabetes are at risk for erectile dysfunction, which may

correlate with poorly controlled diabetes or high glucose levels. Patients should take

note of symptoms and ask any questions when they see a gynecologist or a primary

care provider each year.

Relying on social circles: Though self-care implies solitude, Kirkland encourages

patients to talk about their routines with family members, caregivers or friends. “It’s hard

to be motivated when you are alone,” she said. Patients can look for a support group in

their local communities or online through the American Diabetes Association.

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Reducing stress: Feeling physical or emotional stress can make it more difficult to

follow a treatment plan and can leave patients feeling hopeless or unmotivated.

Because stress reduction is different in every person, Kirkland emphasizes the

importance of discussing methods with a provider or caregiver and keeping track of

what works effectively. The guide above can be used by patients or providers to write

down their strategies each day.

The Social Determinants of Self-Care

The recommendations for diabetes management are complex and demanding;

adherence to proper health management has been alarmingly low in many studies.

However, this isn’t because patients aren’t willing or motivated to practice self-care,

according to Kirkland. They simply lack the resources.

that put patients at risk for low adherence to their medical treatment plans. According to

Kirkland, some patients might experience a variety of these social determinants at once,

which causes high stress that puts them at increased risk and, therefore, in need of

greater support from their medical providers.

:Education People with low academic achievement often have low health literacy,

meaning they have a harder time reading and understanding medical information.

Housing status: Without stable access to shelter, patients are unable to store their

medication safely. Other patients who live in apartment buildings or urban

neighborhoods are less likely to have access to safe outdoor spaces for exercise or an

accessible kitchen in which to cook their own meals.

Food security: Living in an area without regular access to a grocery store makes it

difficult to find healthy food that has valuable nutrients, like vitamins and minerals. In

2016, there were 6 million households

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open_in_newthat didn’t know where their next meal would come from.

Income: Socioeconomic status affects a person’s health care coverage, ability to

purchase nutritional food, access to transportation for appointments and more.

According to Kirkland, many patients struggle to justify time off work for medical

appointments, leaving them less able to pursue follow-up care.

Age: Older adults may have developed other chronic conditions with symptoms that

make them unable to adhere to an exercise routine or care for themselves

independently.

How Nurses Can Be Supportive In Kirkland’s experience as a nurse practitioner, she’s worked in private practices,

military hospitals and academic medical settings; now she sees patients who have

survived Hurricane Harvey, many of whom have had to perform self-care simply

because clinics were closed. Kirkland’s experience has yielded many lessons in

supporting patients who struggle to support themselves.

Cater to the patient’s learning style. “Everyone learns differently,” Kirkland says, “so

you have to make use of what works for them.” She suggests motivational interviewing

to understand what social determinants affect a patient or to discover if they have pre-

existing habits like smoking or drinking. “Auditory learners want to hear the information

like a story, but visual learners want to see their charts from the past few years to

understand how much their blood sugar is going up,” she explains. Providers can also

use the teach-back method, in which a patient can repeat back what they understood

about a conversation, to verify that they have processed the new information.

Develop long-term relationships. Seeing the patients consistently can help establish

a dialogue over time and encourage them to open up about questions they might not

have asked a new provider. “If I’ve been seeing a patient for the past few years, I really

understand their struggles, and I can be a better resource for them,” Kirkland says. “It

makes a difference to them if we can work as a team.”

Help set goals and form habits. “Lasting change is created by taking small steps,”

Kirkland explains, emphasizing the importance of creating achievable goals. “But some

patients need more help with those steps than others.” Many people with prediabetes

don’t always recognize their symptoms and understandably find it difficult to inquire

about a seemingly invisible problem. However, establishing camaraderie with others

diagnosed with diabetes can promote accountability for good self-care habits.

Don’t blame the patient. Adhering to goals and habits is difficult, and it’s important to

offer help rather than blame. Many adults just need incentives to participate, as well as

a healthy balance between treatment recommendations from their provider and

celebrating positive behaviors, Kirkland says.

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Addressing needs of diabetic patients One of the biggest challenges for health care providers today is addressing the continued needs

and demands of individuals with chronic illnesses like diabetes. The importance of regular

follow-up of diabetic patients with the health care provider is of great significance in averting

any long term complications.

Self-care in diabetes Self-care in diabetes has been defined as an evolutionary process of development of

knowledge or awareness by learning to survive with the complex nature of diabetes in a

social context. Because the vast majority of day-to-day care in diabetes is handled by

patients and or families, there is an important need for reliable and valid measures for

self-management of diabetes.

There are seven essential self-care behaviors in people with diabetes which predict good

outcomes. These are healthy eating, being physically active, monitoring of blood sugar,

compliant with medications, good problem-solving skills, healthy coping skills and risk-

reduction behaviors.

These proposed measures can be useful for both clinicians and educators treating

individual patients and for researchers evaluating new approaches to care. Self-report is

by far the most practical and cost-effective approach to self-care assessment and yet is

often seen as undependable.

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Diabetes self-care activities are behaviors undertaken by people with or at risk of diabetes

in order to successfully manage the disease on their own. All these seven behaviors have

been found to be positively correlated with good glycemic control, reduction of

complications and improvement in quality of life. In addition, it was observed that self-

care encompasses not only performing these activities but also the interrelationships

between them.

Diabetes self-care requires the patient to make many dietary and lifestyle modifications

supplemented with the supportive role of healthcare staff for maintaining a higher level

of self-confidence leading to a successful behavior change.

Diabetes self management education Though genetics play an important role in the development of diabetes, monozygotic twin

studies have certainly shown the importance of environmental influences. Individuals with

diabetes have been shown to make a dramatic impact on the progression and development of

their disease by participating in their own care.

This participation can succeed only if those with diabetes and their health care providers are

informed about taking effective care for the disease. It is expected that those with the greatest

knowledge will have a better understanding of the disease and have a better impact on the

progression of the disease and complications.

The American Association of Clinical Endocrinologists emphasizes the importance of patients

becoming active and knowledgeable participants in their care. Likewise, WHO has also

recognized the importance of patients learning to manage their diabetes. The American Diabetes

Association had reviewed the standards of diabetes self management education and found that

there was a four-fold increase in diabetic complications for those individuals with diabetes who

had not received formal education concerning self-care practices.

A meta-analysis of self-management education for adults with type-2 diabetes revealed

improvement in glycemic control at immediate follow-up. However, the observed benefit

declined one to three months after the intervention ceased, suggesting that continuing education

is necessary. A review of diabetes self-management education revealed that education is

successful in lowering glycosylated hemoglobin levels.

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Diabetes self-care activities Diabetes education is important but it must be transferred to action or self-care activities to fully

benefit the patient. Self-care activities refer to behaviors such as following a diet plan, avoiding

high fat foods, increased exercise, self-glucose monitoring, and foot care. Decreasing the

patient’s glycosylated hemoglobin level may be the ultimate goal of diabetes self-management

but it cannot be the only objective in the care of a patient. Changes in self-care activities should

also be evaluated for progress toward behavioral change.

Self-monitoring of glycemic control is a cornerstone of diabetes care that can ensure patient

participation in achieving and maintaining specific glycemic targets. The most important

objective of monitoring is the assessment of overall glycemic control and initiation of

appropriate steps in a timely manner to achieve optimum control.

Self-monitoring provides information about current glycemic status, allowing for assessment of

therapy and guiding adjustments in diet, exercise and medication in order to achieve optimal

glycemic control. Irrespective of weight loss, engaging in regular physical activity has been

found to be associated with improved health outcomes among diabetics.

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The National Institutes of Health and the American College of Sports Medicine recommend that

all adults, including those with diabetes, should engage in regular physical activity.

Compliance to self-care activities Treatment adherence in diabetes is an area of interest and concern to health professionals and

clinical researchers even though a great deal of prior research has been done in the area. In

diabetes, patients are expected to follow a complex set of behavioral actions to care for their

diabetes on a daily basis.

These actions involve engaging in positive lifestyle behaviors, including following a meal plan

and engaging in appropriate physical activity; taking medications (insulin or an oral

hypoglycemic agent) when indicated; monitoring blood glucose levels; responding to and self-

treating diabetes- related symptoms; following foot-care guidelines; and seeking individually

appropriate medical care for diabetes or other health-related problems. The proposed regimen is

further complicated by the need to integrate and sequence all of these behavioral tasks into a

patient’s daily routine.

The majority of patients with diabetes can significantly reduce the chances of developing long-

term complications by improving self-care activities. Despite this fact, compliance or adherence

to these activities has been found to be low, especially when looking at long-term changes.

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In the process of delivering adequate support, healthcare providers should not blame the patients

even when their compliance is poor. In a study conducted among people with diabetes only 30%

were compliant with drug regimens and the non-compliance was higher among the lower

socioeconomic groups. One of the realities about type-2 diabetes is that only being compliant to

self-care activities will not lead to good metabolic control.

Research work across the globe has documented that metabolic control is a combination of

many variables, not just patient compliance. In an American trial, it was found that participants

were more likely to make changes when each change was implemented individually.

Success, therefore, may vary depending on how the changes are implemented, simultaneously or

individually. Some of the researchers have even suggested that health professionals should tailor

their patient self-care support based on the degree of personal responsibility the patient is willing

to assume towards their diabetes self-care management.

Barriers to diabetes care The role of healthcare providers in care of diabetic patients has been well recognized. Socio-

demographic and cultural barriers such as poor access to drugs, high cost, patient satisfaction

with their medical care, patient provider relationship, degree of symptoms, unequal distribution

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of health providers between urban and rural areas have restricted self-care activities in

developing countries.

In a study to identify the barriers from the provider’s perspective in regard to diabetes care

factors like affordability by the patient, belief by providers that medications cannot cure patient

condition, no confidence in their own ability to alter patient behavior were identified. Another

study stressed on both patient factors (adherence, attitude, beliefs, knowledge about diabetes,

culture and language capabilities.

health literacy, financial resources, co-morbidities and social support) and clinician related

factors (attitude, beliefs and knowledge about diabetes, effective communication).

Recommendations for self-care activities Because diabetes self-care activities can have a dramatic impact on lowering glycosylated

hemoglobin levels, healthcare providers and educators should evaluate perceived patient barriers

to self-care behaviors and make recommendations with these in mind. Unfortunately, though

patients often look to healthcare providers for guidance, many healthcare providers are not

discussing self-care activities with patients.

Health care providers should begin by taking time to evaluate their patients’ perceptions and

make realistic and specific recommendations for self-care activities. Some patients may

experience difficulty in understanding and following the basics of diabetes self-care activities.

When adhering to self-care activities patients are sometimes expected to make what would in

many cases be a medical decision and many patients are not comfortable or able to make such

complex assessments.

Furthermore, these requirements or modifications should be specific for each patient and should

be altered depending on the patient’s response. It is critical that health care providers actively

involve their patients in developing self-care regimens for each individual patient. This regimen

should be the best possible combination for every individual patient plus it should sound realistic

to the patient so that he or she can follow it.

Simultaneously, health care providers should fully document the specific diabetes self-care

regimen in the patients’ medical record as it will facilitate provider-patient communication and

help in assessment of compliance. Also, the need for regular follow-up can never be

underestimated in a chronic illness like diabetes and therefore be looked upon as an integral

component of its long term management.

Implications for practice A clinician should be able to recognize patients who are prone for non-compliance and thus give

special attention to them. On a grass-root level, countries need good diabetes self-management

education programs at the primary care level with emphasis on motivating good self-care

behaviors especially lifestyle modification.

Furthermore, these programs should not happen just once, but periodic reinforcement is

necessary to achieve change in behavior and sustain the same for the long-term. While

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organizing these education programs adequate social support systems such as support groups,

should be arranged.

Implications for future research As most of the reported studies are from developed countries so there is an immense need for

extensive research in rural areas of developing nations. Concurrently, field research should be

promoted in developing countries about perceptions of patients on the effectiveness of their self-

care management so that resources for diabetes mellitus can be used efficiently.

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