The 5Ms of Diabetes Self-Care: A Patient-Centered Empowerment Plan

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by David Hite PhD

Point of diagnosis educational interventions are powerful "teachable moments" that set the stage for positive change and help your diabetic patients understand that a positive clinical outcome is a shared responsibility. I introduce my patients to a plan I call the 5Ms of Diabetes Self-Care.1 It's a common sense plan that's as easy to explain as it is to understand and follow.

The plan focuses the patient on five factors affecting glycemic control: Monitoring, Meals, Motion, Medications, and Motivation. This model shifts much of the control to the patient and empowers them to take control of their disease. The message to patients should be clear: what they do outside the clinic to control blood sugar and improve their overall health may be as important as anything their doctor does. Diabetes is chronic, but they can live well with diabetes and reduce their risk of complications by adopting common sense lifestyle changes. The 5M plan that follows offers a clear roadmap for change with the flexibility that allows the patient to focus on individual modalities as needed and as they are ready. Patients don't have to change everything at once; simple changes add up and pay big dividends.

Monitoring – Teach patients how to check blood sugars, not just for the sake of numbers. Explain how to use those numbers to gauge their progress and know when to make healthy changes to their plan. It's also important that they know that monitoring is more than numbers on meters, it's also about monitoring changes to their body by noticing factors like sleep, mood, stress, weight, bowel movements, and skin changes.

Meals – Encourage patients to eat healthy nutritious meals, by avoiding refined and highly processed foods. Michael Pollan's admonition to "eat real food, not too much, mostly plants"2 is a good place to start. Introduce the plate method3 to reinforce the importance of balanced meals and portion control. Studies show that postprandial blood glucose levels, not fasting blood glucose, are the best predictor of cardiovascular events and all-cause mortality in people with type-2 diabetes.4 Encourage patients to shoot for a 2 hour post-prandial blood sugar of less than 180. This turns their meter into a valuable feedback tool, and serves as a meal preparation guide for the future.

Motion – Active muscles are capable of overcoming insulin resistance,5 the hallmark of type-2 diabetes. Employing an exercise regimen, always within the limitations of their ability, can help them grow in strength, increase energy levels, and combat depression. In addition, adding daily exercise often takes some of the pressure off of the Meal planning and Medication modalities.

Medications – Be clear about what each medication does and which ones may be most appropriate for them and why. This "medication education" will help patients understand how and when to take them so they are most effective and minimize the possibility of side effects. Sometimes a medication regimen is negotiable if good glycemic control can be maintained through diet and exercise. This can be a powerful motivator to encourage lifestyle change.

Motivation – Living with a chronic condition is difficult. Many people feel overwhelmed and struggle to take action. Every day they face challenges that can wear them down.6 Depression is twice as common in diabetic patients as in the general population.7 Offer support and encouragement, and voice your belief that they can be successful making and maintaining healthy lifestyle changes.

Offering a sensible, understandable plan at this "teachable moment" will insure that the patient has the necessary tools to be an active partner in their care and lower their risk of diabetic complications.

Sources
1. Hite D. Take Control: Diabetes Basics [DVD]. HealthDoc.org .

2. Parker-Pope T. Michael Pollan Offers 64 Ways to Eat Food. The New York Times.
http://well.blogs.nytimes.com/2010/01/08/michael-pollan-offers-64-ways-t.... Published January 8, 2010. Accessed January 27, 2013.

3. American Diabetes Association. Create Your Plate. American Diabetes Association. http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your.... Accessed January 27, 2013.

4. Wood S. Postprandial, but not fasting, glucose predicts CV risk in type 2 diabetes. theheart.org. http://www.theheart.org/article/1278655.do. Published September 15, 2011. Accessed January 27, 2013.

5. Balasubramanyam A. Exercise: How Does It Promote Insulin Sensitivity? Medscape Education. http://www.medscape.org/viewarticle/438372. Accessed January 27, 2013.

6. Polonsky WH. Diabetes Burnout: What To Do When You Can't Take It Anymore. dLife. http://www.dlife.com/diabetes/lifestyle/diabetes-stress/diabetes_burn_out. Updated November 27, 2012. Accessed January 27, 2013.

7. Katon WJ. The Comorbidity of Diabetes Mellitus and Depression. Am J Med. 2008 November;121(11 Suppl 2):S8-15. doi: 10.1016/j.amjmed.2008.09.008

About The Author
David Hite PhD, is a lifelong educator, spending 20 years teaching biology, chemistry, and health education at the high school and community college levels, two years teaching science at Cairo American College in Egypt, and two years at Shanghai American School in China. Dr. Hite developed the patient-friendly "Take Control - Diabetes Basics", a diabetes educational DVD used by clinicians to encourage their patients to implement and maintain effective self-care strategies, and has spent the past 11 years working daily with diabetes patients as a Clinical Health Educator in the Chronic Conditions Management Department for a large non-profit healthcare provider in Sacramento, California. Dr. Hite is a member of the American Association of Diabetes Educators, and the American Diabetes Association.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of DiabetesProductSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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