Diabetes Care

YOUR ANNUAL DIABETES REVIEW

What does your diabetes annual review mean to you? Anita Parkinson is an Auckland Practice Nurse with many years’ experience specialising in diabetes care. She explains all the ins and outs of the yearly check-in, and what you will get out of the visit.

Coming into a medical practice is, for some, a considerable undertaking. This is either because the visit has to fit around work or because poor health or complicated social circumstances make it difficult to get there.

It is a common misconception that this appointment is a review of how poorly you are maintaining your health, almost akin to a visit to the headmaster’s office. This is not so. The annual diabetes review is all about how we, as health professionals, can help and enable you. We will do this without judgement or admonishment of perceived failures. You are a human being, not a machine. You are not expected to be perfect and, most of all, diabetes is not your fault. Please believe this fact.

FINDING YOUR ‘NORMAL’

I ask patients, ‘How do you manage your diet?’ The usual answer is, ‘You know, just normal.’ Finding out what you perceive as normal is the first measure of where we are heading. I ask what you usually have for breakfast, lunch, and dinner. Sometimes, I hear some shame that bad foods have been eaten. The thing to remember is there is no such thing as ‘bad’ food. It is all about balance – eating particular foods occasionally and in small quantities. But others should be eaten most days, as staple foods.

That familiar line about diet and exercise ‘Eat your greens and go for a walk’ has probably made your ears close because you’ve heard it so many times before. I acknowledge that change is really hard, particularly if you have a family to fit in with.

It is always worth giving it a try to improve your eating. Help is out there, including the Diabetes Self-Management Education programme (DSME), which is run by each region’s community coordinator. There you will meet experienced dietitians and gentle health coaches. We are all here for you, and programmes are funded.

‘YES, BUT…’

We often have barriers to doing exercise, but regular movement goes hand in hand with healthy eating. Have you heard yourself say, ‘I could do that, but my life is too busy’? All these ‘buts’ are self-imposed barriers. They are not your friend nor protector, and they inhibit you being able to move forward. In the review, I might suggest setting a small goal, such as getting out of the chair and walking around the house three times per day. Then slowly add to it.

Trying is so important. Please remember, your efforts are always worthwhile.

SELF ESTEEM

Low self-esteem can be a huge barrier to making healthy choices. It is not uncommon to find talking about one’s self-esteem a challenge in itself. I usually start by asking where patients place their selfesteem and well-being in their lives. Often, we deflect our own needs in favour of those around us. Those of us with busy lives tend to leave our health hidden and uncared for, and I often have to deflect a few ‘yes, buts’ at this stage as well. But the truth is people often don’t consider their own needs as important as those around them.

Sometimes, I invite a patient to imagine they are about to fly off on an amazing holiday. However, as the pilot introduces herself, she admits that her blood sugar is a bit high and she feels a bit off, but she’s sure she will be okay to fly a plane full of people. Would you stay on the plane? I wouldn’t. But would you drive your car?

I use this analogy to reinforce that the patient is as important as the people they care for. Then I ask them to unpack their own needs from the ‘box under the bench’. I urge them to be the ‘pilot’ of their family and to realise their importance to the people they care for.

Examining your self-worth can be very challenging, and I encourage people to say to themselves, ‘Yes, I am important, my needs are valid, and it isn’t vanity to put those needs on my daily to-do list.’

TAKING YOUR MEDS

In the review, we discuss a patient’s medications. I ask how they are coping with their medications, and do they ever miss doses? Sometimes, the burden of medication is an issue, so we look at alternative regimens. We discuss what might be improved for them and what they want going forward. Some people prefer more medication because making lifestyle changes is too difficult at that time. Whichever path a person chooses, if they are willing to optimise control, we should be able to support them.

FINALLY, THE FOOT CHECK

Let’s be honest, feet are gnarly and very often ignored. They can be too far down to reach easily. Sometimes, they can’t be seen over a belly, making them out of sight, out of mind. But feet are important and need love, just like the rest of the body, so bringing some love to the extremities is always an ambition. Even fabulously hairy hobbit feet.

Smooth, hairless feet on a hairy body is a red flag that something could be awry. All patients should be encouraged to maintain a good level of foot hygiene. You can help this happen by wearing well-fitted shoes and reporting any skin conditions early. If signs are ignored, catastrophic outcomes later down the line are a real possibility.

A health professional will examine the feeling in your feet to check for loss of sensation or numbness, then check all the pulses to make sure the circulation is healthy, and lastly the foot structure to check if loss of foot shape is causing problems. If any issues are identified, we can refer you for funded podiatry.

Prevention is always better than a cure, so engaging with professionals in self-care is paramount to good and lasting outcomes.

‘Fate’ genetics and modern living conditions all play a part in diabetes. As health professionals, we must ensure we are doing our job, encompassing all the health needs you are likely to face as a person living with diabetes. That is what you are, a person living with diabetes. Not a ‘diabetic’ or a ‘statistic’ and especially not a failure. You are a human being, not a machine, flawed and beautiful. You are not expected to be perfect.