Curing Diabetes

Your patient’s medical history may help you uncover risk factors for diabetes, complications of diabetes, and problems that may affect her ability to manage the disease.Risk factors for diabetes include obesity (especially central or android obesity in which weight accumulates around the abdomen, giving the patient an apple shape), impaired glucose tolerance, previous gestational diabetes, and delivery of a baby weighing more than 9 pounds. Pancreatic surgery or a history of pancreatitis may also increase your patient’s risk of diabetes. Medical conditions that may be complications of diabetes include cardiovascular disease such as atherosclerosis, vision loss, neuropathies, and kidney disease.

Although allergies aren’t considered a risk factor for diabetes, they may pose a problem in managing the disease. For example, a patient who needs insulin therapy but is allergic to beef or pork can use only human insulin. A patient who’s allergic to sulfa will not be able to take sulfonylureas.

Because managing diabetes requires the patient to master several skills, you should ask about injuries and impairments. A patient who has poor eyesight or a hand injury may not be able to draw up the correct dose of insulin, inject insulin, or monitor her blood glucose levels without help from someone else or the use of assistive devices, such as magnifiers or dose aids. Knowing about your patient’s injuries and impairments will help you individualize her treatment plan.

Also, gather information about the patient’s diet, medications, level of activity, and use of alcohol and tobacco.

Diet is one of the cornerstones of diabetes management. And noncompliance and lack of knowledge are two key causes of uncontrolled diabetes. To find out about your patient’s eating habits, have her do a 3-day diet recall. For variety and accuracy, one of the days should be a non-workday. Explore your patient’s likes and dislikes, the types and quantities of food she eats, her mealtimes, and snack habits. Assess her knowledge of nutrition, her attitudes about food, and her understanding of food’s relationship to obesity. Eating disorders such as an­orexia nervosa and bulimia can make glucose control especially difficult. The following ques­tions may help you uncover these disorders:

• What concerns do you have about your weight?
• Have you ever made yourself vomit or used laxatives to control your weight?
• What do you think of your body when you look in the mirror?

Your patient’s current drugs may interact with drugs used to treat diabetes. Or they may cause hyperglycemia or hypoglycemia, making it difficult for her to control her blood glucose levels .

A sedentary lifestyle is also a risk factor for diabetes. Ask your patient about her exercise habits and the activities she performs on workdays and non-workdays. Ask her about exercise likes and dislikes and any exercise programs that she has undertaken in the past. This information will help when you and she plan the exercise portion of her long-term treatment. Your patient is more likely to comply with her exercise program if she gets to choose an activity that she enjoys.

Finally, ask your patient about her use of alcohol and tobacco. Alcohol can alter blood glucose levels in a patient with diabetes and place her at risk for hypoglycemia and hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar non ketotic (HHNK) syndrome. Smoking decreases insulin’s effectiveness. It also increases the risk of amputation if your patient already has peripheral vascular disease as a result of undiagnosed or poorly managed diabetes.

Filed under: Diabetes