Your Guide to Patient Empowerment

• Be Fully Aware
• Getting Organised
• Goals to Managing your Diabetes
• Getting the most out of the patient-doctor relationship

Patient Empowerment simply means you acquire the knowledge to understand and take care of yourself. In other words - self manage your diabetes.

Self-management means having a daily management plan, setting goals, solving problems and taking responsibility. But it certainly does not mean you are on your own. Mutual trust and respect between yourself and your doctor and other members of the health care team, as well as regular communication with them, are vital to effective self-management.

Previously, traditional care was based on doctors and health professionals being seen as the experts responsible for the diagnosis and management of care. It was accepted that people’s lives should be fitted around their diabetes with goals set by the health professionals.

But this approach is not effective. Diabetes requires daily management. Doctors are not available every day, leaving responsibility for day-to-day care on the patient and the family.

In addition, good results are difficult to achieve if the person involved is not an active participant or does not understand the reasons behind management decisions.

Patient Empowerment takes a new approach. It moves the focus from the doctor to the patient. It involves fitting diabetes into your lifestyle with you making the choices and taking charge of your management and the consequences.

Be Fully Aware

The foundation for a successful self-management plan is diabetes education. A thorough knowledge of diabetes and self-management aspects give you added confidence and motivation to carry out the task of looking after a lifetime illness.

The health professional team can help you achieve this by working together to inform you about all aspects of diabetes, establish a management plan and help you develop problem solving skills.

The discussion will cover medication, nutrition, exercise, recognising and managing potential complications and self monitoring of blood glucose levels. Other topics can include record keeping, dealing with family members, sick days, travelling and psychological aspects.

Because everyone is different and decisions need to be made frequently on a daily basis, the self-management plan needs to be tailored to best suit your medical needs and goals, taking into account your resources, culture and lifestyle. You must be an active collaborator in the process.

Your success in following the plan and reaching your goals depends on having a full understanding of what you have agreed to carry out. Once you leave your doctor’s office, you are in charge. How well you embrace the plan, how seriously you undertake your responsibilities and the decisions you make each day will determine the plan’s effectiveness.

For instance, just knowing how to test your blood glucose level (BGL) is not enough. You have to interpret the results, understand what can affect blood glucose levels and what action you need to take.

For a successful plan to work, you need to be fully aware of the reasons why your doctor or diabetes educator has advised a particular testing program, whether it is four times a day or three times a week.

There will be times when you may eat or drink too much on special occasions such as a big night out, birthday parties or Christmas. What action you take depends on the plan you have in place to cope with these events. You cannot wait until blood glucose levels reach the high ranges of 15 or 20 and then try to work out what to do.

Getting Organised

Problem solving is a vital part of a self-management plan. Because diabetes management is so complex, things can go wrong. You need to be prepared.

Have a system in place for events such as hypos (low blood glucose levels). It’s important to work out why they are occurring, treat them quickly and know what to do. Establish a support structure with family, friends, housemates or neighbours who know what to do in the case of an emergency.

Consider your emotional well being. The demands of daily diabetes care can be overwhelming and the long list of personal tasks can lead to frustration, fatigue, anger and feelings of despair. These are not uncommon for people with diabetes and dealing with them is also part of good self-management.

Goals need to be reviewed regularly and, where necessary, set new goals that are realistic and achievable without putting yourself under unnecessary pressure.

Staying motivated and positive are key in helping to cope with diabetes. It means you need to keep in regular contact with your diabetes team. A one-time education program is not sufficient to maintain the goals you have reached.

As time goes on, management requirements, medications and diabetes itself changes. The best way to update your doctor or educator since your last meeting is to keep records of your self-management program. Record BGL tests, exercise results and abnormal food or alcohol intake, so that you can freely discuss them.

Keep notes of any changes since your last visit. If you feel shaky every afternoon at four o’ clock, tell your doctor. It may require a change of medication. Have a good relationship with all the members of your diabetes team, from the GP to the podiatrist, so that you can freely and confidently discuss any matter that concerns you. Ask questions and be pro-active in gathering new information from specialist sources.

Goals to managing your diabetes

Studies show that people who take an active role have much better outcomes, but you need to set goals.

Generally, you should see your doctor at least twice a year but if your lifestyle, medication and other health problems are affecting your management, your GP may want to review you every three months.

The risk of diabetes-related complications is reduced when blood glucose levels, blood pressure and blood fats are kept as close to normal as possible.

• Target 1: Blood Glucose Levels (BGL)
Your diabetes health professional will help you decide how many tests are needed and the levels to aim for.
- The target range is normally 4 to 8mmol/L but your targets need to be negotiated with your health professional

• Target 2: HbA1c – Glycosylated haemoglobin
The HbA1c, shows an average of your BGL (expressed as a percentage) over the past 10 to 12 weeks.
- Your target level is seven per cent or lower but may be negotiated to achievable targets over time

• Target 3: Blood pressure (BP)
You should have your blood pressure checked regularly (at least every doctor’s visit) and treated if necessary.
- For someone with diabetes, the target BP is 130/80 or lower

• Target 4: Cholesterol (blood fats - lipids)
Your cholesterol level should be tested every 12 months
- The target total cholesterol level is less than 4mmol/L
- The target LDL cholesterol level is below 2.5mmol/L
- The target HDL cholesterol level is 1mmol/L or above
Triglycerides are another type of fat in your blood which is harmful.
- Your target level is less than 2mmol/L

• Target 5: Eyes
If you notice any changes in your vision, speak with your doctor or eye specialist immediately.
- Your eyes should be checked every one to two years by an ophthalmologist or an optometrist with experience in diabetes

• Target 6: Feet
Your doctor or podiatrist should also perform a thorough foot examination at least annually. You can prepare by taking off your socks and shoes while you wait.
- Check your feet every day
- See your doctor or diabetes trained podiatrist for an annual examination

• Target 7: Kidneys
Early signs of kidney problems can be detected through a urine test.
- Your kidney function should be checked yearly by a urine test ordered by your doctor

Getting the most out of the patient-doctor relationship

A good relationship with your doctor and diabetes team is critical to successful management.

The partnership needs to be based on mutual respect and collaboration. Both doctors and patients have rights and responsibilities. The doctor has a responsibility to treat and maintain the health of the patient while the person with diabetes has a responsibility to be informed about diabetes, communicate effectively and take part in the process of daily management.

What patients can do

1. Learn about diabetes
2. Keep regular appointments
3. Keep records
4. Work out what you want to say before the appointment
5. Take an active role in the management plan
6. Adopt realistic goals
7. Take responsibility