Читать книгу 1,000 Years of Diabetes Wisdom - David G. Marrero - Страница 9

by Gary Scheiner, exercise physiologist, Philadelphia, PA

In modern day health care and patient education, one of the underlying rules we are told to follow is to cater to the lowest common denominator. In other words, assume that every patient we see knows nothing, has little motivation and subpar intelligence, and will do as little work as possible on their own behalf to manage their diabetes. When it comes to teaching diabetes self-management, I have found that nothing could be further from the truth.

To set low standards and low expectations is a disservice to everyone we counsel. The modern, effective techniques for managing diabetes—carbohydrate counting, insulin/medication self-adjustment, and record keeping/analysis—can be learned and implemented as easily by those in a low socioeconomic groups as those in the highest groups. In fact, because those classified as disadvantaged have traditionally been treated as such for so many years, the change in approach often inspires significant changes and great results.

One client who comes to mind is a middle-aged gentleman from the inner city who happened to have a learning disability. However, once we get past phrases like “welfare” and “3rd-grade reading level,” we come to find that this is a man who follows instructions meticulously and takes great pride in keeping good written records.

Teaching this man carb counting and insulin dosage adjustment was a snap with a few simple charts to aid in his decision making. Setting up an organized record-keeping system allowed us to fine-tune his plan. Eventually, he seemlessly transitioned from a two-shot-a-day plan (using premixed insulin), to a basal/bolus injection program, and finally to an insulin pump.

Along the way, his hypoglycemic episodes all but disappeared and his A1C stabilized at a level just above normal.

If a man like this can learn and apply modern management techniques, just about anybody can. We as health professionals must look past the superficial characteristics of our clients and aim much higher with each and every one. In other words, assume that each of your clients is intelligent, motivated, and eager to apply exactly what you teach. Then no one will be under served.