By Aziza Awate RN,MSN
May 29, 2016

From the perspective of health and well-being: One must be in charge of their own health.

Please allow me to get to the purpose of writing this inquiry. Since I am in the health care field and focusing on health and wealth is paramount to all of us, I am willing to write about health issues such as disease prevention, intervention, and the dos/don’ts when tackling health issues. In the future the topic can be chosen by you the participants or from myself. There are many topics that we may directly or indirectly be affected by and may want to discuss or learn how to deal with; such as stress, grief, living will, high blood pressure, heart disease, mental issues diabetes, cancer, TB, Hepatitis A. B, And C, etc. Today I will be focusing on Diabetes.

Now, before I start writing about this specific health issues I briefly would like to talk about belief and culture.

As Eritreans in general, and as part of the Mensa clan we have this enormous pride. Whether we are in the East, West, or somewhere in the Middle we seem to maintain some of our health traits. One of those health traits is being supportive to each other during happy and challenging times. It is true that back home our community stands together in happy times such as weddings, and equally in times of death, loss and grief and that we support each other. Social support is a way of life and is proactive for both our culture and our health. One of our good Tigre proverbs is “Edde Bana Eietadakieh”. It is true that we need each other in order to have a healthy culture. Recently, I was able to observe the richness of this great culture during a crucial time. When social unity and support were needed our people gathered from every corners to offer their support to those who needed it. After all, we are brought together because of our humanity, our good culture, love, respect, and inclusivity towards each other. We are very lucky to have such a giving and receiving culture.

Living with the Diagnosis of Diabetes

The public in general, both young and old must become knowledgeable on the pathophysiology of Diabetes: its causes, types, sign & symptoms, and how to understand and interpret the levels of blood sugar on the body. The public must also be aware of what to do once they are diagnosed with this disease in order to control it through modifications of their diet, being physically active, checking the blood glucose (sugar) level, and adhering to the prescribed medication and other treatment that is given by the care provider.

Before I go into the details about Diabetes, I think it is fair to say that when anyone of us is diagnosed with any disease it’s our human nature to react to bad news with fear, anger, guilt, disbelief, and we tend to become very overwhelmed. As humans we always want to be in control. However, the reality of the matter is once we accept the diagnosis the right approach to take is not to succumb but to be courageous and instead learn how to live with it and lead a normal life the best we can. Although living with diabetes sounds life threatening and can change a person’s way of life and health outcomes, nonetheless with life style changes that includes family & social support, outreach and other needed modifications, this disease can be controlled which is good news for the healing process.

The goal is to manage and prepare for stressful situations, while also remaining in control. Living with Diabetes certainly can be stressful and overwhelming, but if we raise full awareness of it and equip ourselves with the needed resources of preventions and interventions, then we can control it. One thing that we need to be aware of is that in today’s world of fast paced technology and the information that is readily available. There is a lot of information out there that is both good and bad. There is information that is untested, ill researched, and nonfactual for the public to view which can scare us and add to the discomfort that we may already have.

When we learn about Diabetes the information should be taken from evidence based findings as well as researched sources that can be checked and validated if need be. People need to be informed because it is crucial for their health. In the article “Tip of the Iceberg: Most People with Prediabetes Don’t Know It” Author Bonnie Liebman explains that “Diabetes threatens nearly every part of the human body with so many different complications such as: raising the risk of memory loss, heart attack, kidney disease, and amputations”. Liebman also gives current statistics about Diabetes. She states that roughly 29 million American adults have prediabetes (you and I are included in this statistics) and those who have this trend have a 20 percent increase. It is also noted that currently 1 out of 10 American adults have Diabetes and many experts predict that this disease will effect one 1 out of 5 by the year 2030, and 1 out of 3 by the year 2050. (Liebman, 2014). The numbers are startling. In an article titled “Diabetes” written for the Journal of American Medical Association (JAMA) for their April 2009 issue, they give the statistics that 20 million adults and adolescents are affected and live with this disease. Type 1 diabetes accounts for 10% of the cases that requires lifelong insulin replacement. Type 2 Diabetes Mellitus affects 20 million adults over 30 years of age and children in the United States or 7% of the population yet there are about 6 million more of undiagnosed cases of diabetes (JAMA, 2009).

The 2 Types of Diabetes:
In their article the Journal of American Medical Association also breaks down the different types of Diabetes. While there can be stages of prediabetes, the two known types of Diabetes are called Type 1 Diabetes and Type 2 Diabetes. Type 1 diabetes, referred to as “Juvenile” diabetes or “Insulin-dependent” diabetes occurs when the body’s pancreas does not produce enough insulin (the hormone that processes glucose). Type 1 is usually diagnosed in childhood or in adolescence and requires lifelong Insulin treatment. (JAMA, 2009).

Type 2 diabetes is called “adult-onset” diabetes is more common. The authors elaborate that Type 2 diabetes is becoming more common in children and teenagers because of the increase in obesity in young people. They explain that Insulin resistance is a major issue in Type 2 diabetes, thus the body produces insulin but is unable to process glucose appropriately. However, people with Type 2 diabetes also have insulin deficiency, although not to the same degree as individuals who have Type 1 Diabetes. (JAMA, 2009).

The authors pinpoint that some of the risk factors of being diabetic include: obesity, family history, consuming drinks with excess sugar, processed foods, and living a sedentary life style.

The authors also include the typical signs and symptoms for Type 1 diabetes which are: excessive thirst, fatigue, frequent illness or infections, poor circulation (including tingling or numbness in the feet or hands), wounds that don’t heal, blurred vision, and unintentional weight loss. The authors warn the public that it is also very vital to know that many people with Type 2 diabetes have no symptoms, and that it is usually discovered after testing for other medical problems or through screening in persons who are at high risk of developing Type 2 diabetes. So what is the right approach to be in control of Diabetes?

Both types require an ideal management regimen of insulin administration especially in the treatment of Type I diabetes. While insulin plays a big role in managing Diabetes, there are other factors to control the disease. Liebman gives the statistic that 90 percent of Type 2 diabetes is preventable by lifestyle modifications. The Journal of the American Medical Association also explains that for people with Type 2 Diabetes, oral medication can be taken based on the individual’s medical needs. This means that medications should be prescribed if diet and exercise do not make improvements in blood sugar control, thus Insulin is always required to treat. The authors also give advice for the public to adhere to such as: good nutrition, daily physical exercise, smoking cessation, and monitoring of blood glucose along with regular monitoring of hemoglobin A1c (a measure of long-term blood glucose control) are cornerstones of treatment for both type 1 and type 2 diabetes. A person’s diet also plays a big role. Health field experts and dietician’s say that a healthy diet includes food rich in fiber. Foods such as: whole-grain breads and cereals, bulgur wheat, brown rice, whole-wheat pasta, fruits and vegetables, dry beans, and peas. When choosing protein, it is wise to choose healthy protein sources that are low in fat such as fish, and soy products like tofu and soymilk. Saturated and trans-fats are unhealthy and tend to raise LDL (bad) cholesterol. We need to remember that fat is always high in calories which makes a person gain weight rapidly, so modify all unhealthy fats and sugar, such as: butter/margarine, palm and coconut oil, cream, bacon, lunch meats, ice cream, sweet bakery goods, muffins and donuts, jams and jellies, candy bars, and regular sodas. These will affect our blood sugar level as well as our weight and general health.

Holistic Approach for care
In conclusion, individuals who are affected by this disease or any other diagnosis need strong coping mechanisms as well as social and familial support systems and resources. It has been proven that strong social and family support are important factors for coping with diagnosis and stress tolerance. Strong social support can reduce the impact of stressors and prevent illness or injury. I would like to conclude my thoughts by mentioning a known nursing theorist by the name of Betty Neuman who is the author of many nursing books and models. One of her models is called the Systems Model and she provides and teaches a comprehensive holistic and system-based approach to nursing that contains an element of flexibility. Neuman theory focuses on the response of the patient to actual or potential environmental stressors. This theory also focuses on the use of primary, secondary, and tertiary nursing prevention, intervention for retention, attainment, and maintenance of patient system wellness. In this model Neuman puts emphasis on the holistic practice of nursing that focuses on healing the whole person. This kind of approach recognizes that a person is not simply his or her illness. In her theory, Neuman pinpoints that holistic healing addresses the interconnectedness of the mind, body, spirit, social/cultural, emotions, relationships, context, and environment. All of these aspects are combined to create the person, so in order to heal the person the holistic nurse looks at all aspects and how they can affect the patient’s health. Holistic nurses often integrate alternative medicine and practices into their nursing care. These practices address the patient’s physical needs, as well as their psychological and spiritual needs. Holistic nursing doesn’t try to question the validity of traditional medicine practices. Instead, it tries to complement and broaden them to better help the patient during his or her recovery. Just like Neuman and other nurses like her I am a Parish nurse also and my goal as Parish nurse is to equally provide and teach comprehensive holistic and system-based approaches that foster a cooperative relationship among all those involved (individuals, family, and communities as a whole) which will lead to the attainment of strong physical, mental, emotional, social and spiritual health. Hope you enjoy reading it and it is my fervent hope that you gain something from it.

References:

Glass, R., Lynm, C., Torpy, J.J. Journal of American Medical Association. “Diabetes” 2009

Liebman, Bonnie. Nutrition Action Health Letter “Tip of the Iceberg Diabetes” 2014.

Neuman, Betty. 2013. www.nursing-theory.org. SystemTheory.