Ann Ryan Alexander: Managing Diabetes is a Group Effort
I had never heard of diabetes education before college. I’m not sure how I thought people with diabetes learned everything they needed to. Maybe the doctors or nurses who worked at the endocrinology offices. By having this opportunity, I was able to see just how vital diabetes education is to the diabetes community. Without them, these patients would not know about nutrition, exercise, medication management, sick day management, insulin pumps and glucose monitoring devices.
I spent every Tuesday and Thursday of my spring semester at the diabetes education center following the educators around. For most of the day we saw patients back to back. Occasionally we would walk over to the hospital to see patients who were currently admitted. Once a month, we walked over to the hospital and held training on the policy regarding diabetes management for the new nurses who were starting.
On Tuesday afternoons we went down to the Full Circle Clinic, which was right next door. Here we interacted with the doctors and the nurse practitioner, who are all diabetologists. This means that they are all certified to diagnose, treat and manage diabetes. At the clinic we saw patients in a more medical setting than in the education center.
Most of the patients we saw the center were older in age. They had either had diabetes for most of their lives or this was a new diagnosis for them. If it were a new diagnosis, their insurance would require them to complete the entire program. This consisted of a nutrition class, several one on one sessions, and other group classes as needed.
However, being that these patients were older in age, it meant that the technology could be confusing for them. Insulin pumps and continuous glucose monitoring devices are not something that are updated super often, but when they are, you have to undergo training to understand the new system or software.
One time we had a new patient who came in for training on his new insulin pump. This particular insulin pump had a twist off battery cap. It requires pressure to be asserted and then twisted off. Most of the time, patients use the clip that comes with the pump. Sometimes using a coin can be easier for patients. This can be difficult for some patients to manage, however, especially if they have preexisting medical conditions. The diabetes educators usually ask patients to bring someone so there is someone else to remember what was taught once it is over. However, it is not always possible. This patient did not bring anyone to his appointment. This patient came in and I could immediately tell this appointment was not going to go the way the diabetes educator and I needed it to. He was shaky and confused and he had mentioned forgetting his glasses. Nevertheless, we decided to try and see what we would accomplish.
During pump trainings, it is important that the patient does as much as possible, so they understand how things work. The first step is to get the battery cap off. We tried using the clip that comes with the pump but since the patient was so shaky, he was unable to apply the necessary force while also twisting it. After a lot of tries with the clip, the diabetes educator thought using a coin might be easier. However, he still struggled. In the end, we had to reschedule his appointment because he was unable to move past this first step.
The other main problem we saw was people thinking that they could manage their insulin pump settings on their own, without speaking to their providers. It is quite easy to go into the pumps settings system and change things, even if you don’t know what you are doing. It is also extremely dangerous because these settings are very carefully planned with a lot of different factors in mind.
For instance, we had a woman come in so that they could fix her insulin pump settings. The doctor went into the room first while the diabetes educator gave me a bit of background information on this particular patient. She wasn’t very good at managing her diabetes and had messed with her pump settings at home. When we walked into the room I could immediately tell she did not feel good. She was pale, and sweaty and you could tell just by looking at her that she felt sick. When we checked her blood sugar levels, she ended up being in DKA, diabetic ketoacidosis. This can be life threatening, so she ended up going straight to the emergency room.
Another time I had a patient who had trouble managing her insulin pump settings. She had previously had a severe low blood sugar that had left her with a few lasting side effects. This made it harder for her to remember what she needed to do in order to manage her diabetes. I saw this particular patient multiple times and each time, we had to remind her what to do. Her main goal was to get back on an insulin pump, however the cognitive effects from the low blood sugar made it hard for her to remember if she had already given herself insulin. This made it dangerous for her to be on a pump.
A lot of the patients we saw everyday were really bad at managing their diabetes. This could be for a number of reasons like lack of education, financial reasons, etc. Whatever the reason may be, they still showed up to their appointments. This shows that, while they may not be the best at managing their illness, at least they are making an effort.
This internship gave me an opportunity to see an entirely new side of nursing. I was able to see a nursing career that was not at the bedside. By going to Full Circle every week, I was able to see how the team of doctors, a nurse practitioner, and a diabetes educator all work together to help patients manage their diabetes. Managing diabetes is a group effort and without diabetes education, these patients would not have all the resources and knowledge they need.
Ann Ryan Alexander is a senior nursing major with a minor in Public Health. In the spring 2024, she completed an internship with the Self-Regional Diabetes Education Center. She plans to graduate in December 2025.