Each person responds differently when given the news that they have diabetes. You now have a person who has been told they have a chronic disease that they will have to manage and live with for the rest of their lives.
They may have had a family member who had diabetes and developed complications. That person may have lost a leg or went blind or wound up on dialysis from kidney failure.
They may not understand the word diabetes or the true implications and may have little or no knowledge of the condition at all.
Sometimes the situation is made worse if they have misinformation and or believe the myths surrounding diabetes. They may not be willing or able to deal with the situation at all.
Where does that leave the concerned health care provider? Where can you start? What should you teach and when?
The first thing I ask a new patient is, How do you feel about being told you have diabetes? Then I listen.
It has been my experience that patients go through the same stages, when told they have a chronic disease that Kubler-Ross identified in 1969 in her book “On Death and Dying.”
She explained the five stages relating to being given a fatal diagnosis, and it seems that many people respond the same way when first told they have diabetes.
First there is denial. Not me, it couldn’t be me I just have the flu or something. The lab work must be wrong and you mixed me up with someone else. Mistakes happen all the time and this is a mistake.
Secondly they get angry. Why me? I am a good person. How about those drug dealers or criminals? It’s not fair. I won’t talk to you. You don’t know what your doing.
Then they bargain, either with themselves, you or perhaps God. I know what. I will lose the weight you told me to and get some exercise. I will even stop smoking and then it will go away. You’ll see.
Next, the depression comes and they won’t talk about it at all.
Finally they reach the stage of acceptance and agree to deal with it. Then they are ready to learn. They may not accept it all or agree to everything but until we can get them to this stage it is very hard to motivate, educate or help them
They will go back and forth through these stages and if they are fortunate you as a health care provider will be willing to go through it with them.
Sometimes it will take months or even years for a patient to reach acceptance. During the course of their diabetes they will respond to changes in their condition by reverting to an earlier stage or by asking for help from the support system they have built to help them manage their diabetes.
I have often found that their response and progression through the above stages is directly tied to the manner in which the diagnosis was given.
If the health care provider is clear, concise and factual and gives the patient information and choices for success they will respond differently than to the provider who is vague or makes the issue seem as if it’s “no big deal.”
If the PCP helps them to make the decision to work with the entire healthcare team the stages are not as long or difficult as when they have to go through them alone.
We need to become adept at identifying which stage the patient is presenting at each visit or at changes in their diabetic status. Too many of these patients get stuck in the depression phase and this quite often goes undiagnosed. By working with your patients to identify this depression phase and knowing how to get them help will certainly improve their care.
Ginger Kanzer Lewis has been teaching people with Diabetes for almost thirty years. She is a Registered Nurse with a Masters Degree in Education from Harvard University and Certification in both Diabetes and Continuing Education and Staff Development. Ginger has spent over twenty years teaching educational methodology to health care professionals while working as Director of Staff Development or Education in Hospitals through out the North East. Ginger is the immediate Past President of AADE and is a well known national and international speaker.