According to recent research reported from the United Kingdom, over 60% of patients newly diagnosed with type 2 diabetes do not change their lifestyle habits – which should include an improved eating and exercise plan.
More than 600 patients were surveyed from 300 physician practices. The results were obtained from the United Kingdom, United States, Spain, India, Japan, and Brazil. Since it included multiple countries it was not limited to a specific culture. The survey was done to find out why patients do not make treatment changes – even after they are diagnosed and given specific goals. Even after discussion with their physician, over 75% of the patients surveyed were not worried about diabetes complications – including cardiovascular disease (heart attack or stroke), nephropathy, retinopathy or neuropathy (kidney, eye or nerve). The research concluded that there might have been a limit in understanding the diabetes information for multiple reasons. The barriers to change were:
- Being in shock at the time of diagnosis. Many patients are not prepared to hear about a chronic condition which could affect multiple aspects of their lives forever. Some patients actually do not even hear the information that follows diagnosis. Others believe there has been a mistake in the blood work and do not accept their diagnosis.
Remedy –Bring pen and paper, a smart phone or a tablet to write down information as it is being discussed. Try to have another person with you at the visit. Two sets of ears are always more effective. Consider making a follow-up appointment sooner than 3 months (which is the standard diabetes follow-up time). Request a copy and explanation of your blood work and start a file.
- Not understanding the information – why lifestyle changes help. Usually at the time of diagnosis you are told minimal information due to a time element in the physician’s office. They are trying to cover the basics without much explanation. You are given a list of “to do’s.” Many people are more apt to make changes when they understand “why” they are doing it.
Remedy –You should request a diabetes management educational skills class or individual appointment. Look for an accredited program which is listed on the American Diabetes Association (ADA) / American Association of Diabetes Educators (AADE) site. Find one that has an RN/CDE and an RD/CDE. When you understand the reasons why you should make changes, you are more willing to comply. You are entitled to education through your health insurance program including Medicare or Medicare Advantage plans. Find a diabetes support group as well to stay informed and connected.
- Being in denial of the diagnosis since you never had any symptoms of diabetes – Be aware that over 50% of patients do not experience any symptoms of diabetes including thirst, hunger, fatigue, slow healing wounds, increased urination or blurred vision. Family history, ethnicity, age, gestational diabetes, activity level and weight are important predictors of diabetes.
Remedy –Ask to have the fasting blood work repeated and an A1C blood test. Diabetes is diagnosed after 2 abnormal fasting values of 126 mg/dl or an A1C of 6.5%. If time is limited during the appointment bring blood work to your educational session or next follow up visit for a complete explanation.
- Having limited financial resources – Having a chronic illness can be expensive. Some patients just give up since they do not have the monetary funds or health insurance.
Remedy –Look into programs where drug companies offer reduced prices on repeat monthly medications. Ask your physician for generic medications. Search on-line for lower prices for diabetic supplies. Try to shop for healthy foods at discount markets or warehouse clubs. Buy in bulk and freeze. Stay on the perimeter of the market where fresh foods are placed and skip bagged or boxed foods in the center of the store. Use walking in the park or neighborhood as your exercise routine instead of paying for a gym. Take the stairs and park far away from your destination. You are often entitled to fitness programs including Silver Sneakers through your health care plans if you have Medicare or a Medicare Advantage plan. Look into catastrophic insurance plans or ACA healthcare. Find low cost clinics which base your payments on your income.
- Having an emotional or cultural /ethnic attachment to foods and behaviors.
Remedy –Although cultural differences exist in eating habits there is always room for change. Every ethnic group has their special trigger foods and celebrations. For example if you are Hispanic and live on beans and rice you never have to give it up; you must limit your amounts per meal. You can eat it 3 times a day in small portions if you choose. If you are from the islands and eat plantains daily you should boil, not fry, them and limit the total amounts. Most ethnic groups have foods which you may think are off limits – but nothing is – just watch your portion size. You need to share this with family and friends so they understand your eating plan and do not hassle you.
- Having a physical disability or limitation including back issues, arthritis, balance problems, weakness or neuropathy. Many patients think that if they can’t walk for 30 minutes they should just not exercise which is a huge component of lifestyle change for diabetes.
Remedy –Results show that short bursts of activity are beneficial like walking 10 minutes 3 times a day for 5 days a week. There are so many choices including chair exercises and stretches, physical therapy or pool exercises and swimming along with low level exercise DVDs. Always check with your physician especially if you have open wounds.
- Having unreal expectations about lifestyle changes and expecting quick results.
Remedy –Behavioral change takes time and it usually takes 21 days to change a habit. Many patients think they can lose 5-10 pounds a week and stick to that week after week. This is unrealistic and can lead to frustration and disappointment. Small steady change is much more effective. Start slowly and watch for change. Do not get discouraged about weight since blood sugar control is much more important. Understand that 5-10% of body weight loss can have a huge impact.
There are many barriers to change which may affect your ability to improve your lifestyle. Take this New Year to evaluate your barriers so you can move ahead and help manage your diabetes! Good luck!
NOTE: Consult your doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
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