Management of Diabetes Mellitus

Management of Diabetes Mellitus

Facilitating a Support Group is a great way for a Clinical Social Worker to put all of one’s skills into practice. Having begun my professional career in 1984, I have had the opportunity to facilitate many types of such groups for individuals and/or their caregivers with a specific diagnosis, including ones with an emphasis in Alzheimer’s disease, Cancer, Diabetes, Parkinson’s, Peri-Natel Loss and Stroke. These opportunities have demonstrated to me the importance of taking a holistic approach to helping individuals and their loved ones understand and practice coping and living skills to facilitate the management of their lives, especially for Diabetics.

As professional social workers in many varied work environments, we always emphasize the importance of “starting where the client is,” as well as the critical aspect of maintaining confidentiality. Both of these concerns were crucial in my work with the Diabetic Support Group that I had co-facilitated with a Registered Nurse and a Physician at Jo Ellen Smith Hospital in New Orleans from 1988 - 1991.

An interdisciplinary team approach by all professionals either in the healthcare setting, Home Health, Support Group or otherwise optimizes the goal of educating and supporting the individuals affected by the disease, and this usually results in better client/patient/caregiver compliance with the plan of care. This column will focus on the management of Diabetes Mellitus; the September issue will specifically review Diabetic Neuropathy and how this is addressed for a home health patient.

According to Claire Townsend, RN, BSN, CDE, Certified Diabetes Education Coordinator for the Baton Rouge General’s Diabetes Center, “Diabetes is a disease that affects 20.1 million in the United States. It is a problem with the metabolism being unable to use the food that we eat for energy. This may be due to the hormone called insulin not working efficiently (insulin resistance), or the hormone is not made in sufficient quantities.”

The signs and symptoms of Diabetes are the following according to Ms. Townsend: “unusual thirst, frequent urination, blurred vision, fatigue, sexual dysfunction or slow to heal cuts and sores. Some people have symptoms, however some people are diagnosed and have never experienced any symptoms. If diabetes is not controlled it can result in complications involving the heart, kidneys, eyes, circulation and nerve function.”

According to Lydia Starns, MS, LDN, RD, Dietician at the Diabetes Center, “I find that people have difficulty making nutritional choices based on older information or misinformation. It is important to help the person with diabetes find out that it is more about what you can eat, as opposed to what you can’t.” The Diabetes Center is located on 3910 Convention Street, Baton Rouge, (225) 387-7678; its operational hours are 8 AM – 4:30 PM, Mondays through Fridays.

In the Home Health arena, such as with Pinnacle, we are a critical link for individuals who are managing diabetes directly or as a caregiver. A nurse reinforces the diabetic teaching that was initiated in the health care setting; this can be for either a new onset diabetic or an already diagnosed patient who may need to be facilitated with the care.

If needed, an MSW (Social Worker) may be ordered per Home Health to help the client/caregivers with coping issues and community resources. Also, the agency can help the patient with obtaining any necessary diabetic supplies and works closely with Diabetic Educators in the community, such as the Diabetes Center.

Home Health may begin per a doctor’s order from the clinic or when a patient is being discharged from a hospital related setting – rehab, skilled nursing, long-term acute care, etc. Normally, Diabetic Teaching occurs early enough in a healthcare stay to include Nursing, Dietician, and Social Work, so an individual and/or caregivers can learn the principles of and daily Diabetes management.

Case Managers or Discharge Planners (Social Workers or Registered Nurses) usually are involved in helping to arrange for home health per an agency like Pinnacle, as well as securing any necessary supplies, such as a blood glucose monitor, lancets and Chemstrips from a Durable Medical Equipment (DME) company. Important insurance coverage information related to the latter, particularly for MediCARE recipients, needs to be discussed for the current and ongoing management of the disease.

If insulin injections are required for the individual’s management, information will be reviewed to help with this. There have been many innovations recently involved with Diabetes management, including the possible usage of a portable pump or nasal spray methodology for insulin when appropriate, as well as non-invasive blood sugar detection devices.

In summary, it is incumbent for professionals to demonstrate and teach diabetic clients practical coping and living skills to facilitate diabetes management. Lastly, in whatever health setting that we serve in the continuum of care, we need to maintain the confidence and trust of our clients, coordinate our service delivery together and always start where the client is.
Keith Horcasitas, LCSW, MHA