Background
The individual’s experience of diabetes mellitus, particularly when complications are established can affect their ability to self-manage. The experience of diabetic foot ulceration is challenging due to wound duration, underlying chronic disease and complexity of treatment, including optimising glucose control. An element of the treatment for foot pathologies is rest which directly competes with usual diabetes care.
An inability to achieve goals set by Health Professionals can result in frustration and ambivalence. Health coaching may assist in re-engaging these patients however a specific catalyst for change is needed.
Patient’s experience
Basil is a 63year old male who lives alone. He was referred to High Risk Foot Clinic [HRFC] post-discharge with cellulitis secondary to chronic right hallux ulcer.
Past medical history included poorly controlled type 2 diabetes [HbA1c over 11%, 98mmol/mol], peripheral neuropathy [PN], renal impairment, previous traumatic amputation of right 2nd toe, IHD & NAFLD
Diabetes medication: Metformin, Humalog TDS, Lantus BD.
Basil’s self-management skills were assessed as satisfactory at referral to HRFC.
Basil attended the HRFC for a period of more than 3years with little improvement to wound or glucose control. It was noted that he had several minor burns on both hands, probably due to PN. He did not provide self-blood glucose monitoring [SBGM] results. On close questioning Basil expressed frustration with SBGM due to expense and yielding little information as he wasted test strips.
A trial of flash technology changed Basil’s ability to see SBGM in real time and with health coaching he has now developed insight into actions affecting glucose control and ulcer healing.
Basil’s reflection on flash technology was “For the 1st time I feel as if I can control my diabetes- everything just got lighter!”
Reflection
Flash technology can be the key to improving diabetes self-management in even the most challenging of circumstances.