Diabetes Denial

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Information about Diabetes Denial

Published on June 22, 2008

Author: arpanbhattacharya

Source: slideshare.net

Management of chronic diseases Nature Incurable Mostly silent Persisting pain if at all No correlation between complaints and lab data. Uncertain progress Lifestyle related Treatment Important Variable effects Patients need self discipline Costs are mental, professional, social and financial Patients Need to control it even though incurable Juggle between treatment and life As vigilance lessens problems increase Has to be trained to handle acute crisis. Doctors Prescribe but not control fully Need to share knowledge and foster attitudes Intervene in emergency Detect complications early Should work in a team

Nature

Incurable

Mostly silent

Persisting pain if at all

No correlation between complaints and lab data.

Uncertain progress

Lifestyle related

Treatment

Important

Variable effects

Patients need self discipline

Costs are mental, professional, social and financial

Patients

Need to control it even though incurable

Juggle between treatment and life

As vigilance lessens problems increase

Has to be trained to handle acute crisis.

Doctors

Prescribe but not control fully

Need to share knowledge and foster attitudes

Intervene in emergency

Detect complications early

Should work in a team

Two types of responses to initial shock of chronic illness* Integration Process Disbelief Revolt (accusation) Depression (sadness for health lost) Confronting reality Consenting (coping) with serenity *Lacroix A., Therapeutic Education 2003 Distancing Process Anguish (medical team could cause it) Denial of emotions (sense of shame/ suffer in silence) Passive resignation Meloncholia (may need psychiatric help)

Integration Process

Disbelief

Revolt (accusation)

Depression (sadness for health lost)

Confronting reality

Consenting (coping) with serenity

Distancing Process

Anguish (medical team could cause it)

Denial of emotions (sense of shame/ suffer in silence)

Passive resignation

Meloncholia (may need psychiatric help)

Doctor’s role of patient’s health belief model Patient should be convinced that he is ill. He must believe there could be serious consequences because of this illness He must believe treatment will be beneficial He must believe that the benefits will be more than psycho-social and financial side effects of the treatment. These can be discovered only by “semi directive interviews” which convince the patient that interest being shown in him is not merely biological. This shifts the locus of control to the patient.

Patient should be convinced that he is ill.

He must believe there could be serious consequences because of this illness

He must believe treatment will be beneficial

He must believe that the benefits will be more than psycho-social and financial side effects of the treatment.

These can be discovered only by “semi directive interviews” which convince the patient that interest being shown in him is not merely biological.

This shifts the locus of control to the patient.

Empathy is the key to success Empathy is not sympathy Empathy is adult to adult Empathy demands sincerity Empathy demands dedication Empathy creates trust and loyalty

Empathy is not sympathy

Empathy is adult to adult

Empathy demands sincerity

Empathy demands dedication

Empathy creates trust and loyalty

Th. Arrivaali (the knowlegeble) Believes prevention is better than cure Likes to be independent Positive about life despite diabetes. Follows diet and leads a disciplined life Well-informed: collects printed articles on diabetes & attends seminars Motivated enough to exercise regularly, believes in timely medication, does not add sugar to food Practices self monitoring and self injection, visits doctor less often, family involvement is very high, calm and collected during hypos - knows what to do. Knows the severity of the ailment Age: 55-60 years Diagnosed since at least 8 -9 yrs. Gender: Mostly males/some females in south Also seen in diabetic couples Region: Mainly South India

Believes prevention is better than cure

Likes to be independent

Positive about life despite diabetes. Follows diet and leads a disciplined life

Well-informed: collects printed articles on diabetes & attends seminars

Motivated enough to exercise regularly, believes in timely medication, does not add sugar to food

Practices self monitoring and self injection, visits doctor less often, family involvement is very high, calm and collected during hypos - knows what to do.

Knows the severity of the ailment

Gender:

Mostly males/some females in south

Also seen in diabetic couples

Region:

Mainly South India

Th. Bhayanthavar (the Scared) Recently diagnosed Gender: Equal proportion of males & females Age: 40-45 years Region: Northern & Western India but a rare case in the south Constantly curses his fate ‘Why me??’ Apathy in gaining knowledge about diabetes Dependence on others …lack of faith in self Looks upon diabetes as a demon controlling his life Resents the rigid lifestyle. Claims that he feels dead from within. Visits the doctor every 7 - 15 days and hoping to achieve better sugar control thereby Cannot overcome the craving for sugar and sweets, family involvement in managing diabetes in low Dependence on others for taking insulin injections

Gender:

Equal proportion

of males & females

Constantly curses his fate ‘Why me??’

Apathy in gaining knowledge about diabetes

Dependence on others …lack of faith in self

Looks upon diabetes as a demon controlling his life

Resents the rigid lifestyle. Claims that he feels dead from within.

Visits the doctor every 7 - 15 days and hoping to achieve better sugar control thereby

Cannot overcome the craving for sugar and sweets, family involvement in managing diabetes in low

Dependence on others for taking insulin injections

Th. Parkalaam (the casual) Living with the disease for long Gender: higher proportion amongst housewives than males Age: 40 +years Region: Northern & Western India but a rare case in the south Relaxed attitude towards self care, health and diabetes…no drive to seek knowledge Feels defeated. Dislikes rigid and disciplined lifestyle Considers self as least important member of the family. Family too attaches low importance to her health. Believes, “God gives so he will manage it…” Ignores diabetes until complications set in No exercise, poor compliance to dosage schedule and no diet control Visits doctor only for emergencies

Gender:

higher proportion amongst housewives than males

Relaxed attitude towards self care, health and diabetes…no drive to seek knowledge

Feels defeated. Dislikes rigid and disciplined lifestyle

Considers self as least important member of the family. Family too attaches low importance to her health.

Believes, “God gives so he will manage it…”

Ignores diabetes until complications set in

No exercise, poor compliance to dosage schedule and no diet control

Visits doctor only for emergencies

Th. Kurukku vazhi (the myopic) Gender: Equal proportion amongst Males and Females Age: 5 0 - 60 years Region: Spread across regions, fewer in south Diagnosed since at least 8 -9 yrs. Convenience very important, looks for excuses to postpone treatment Low awareness and lacks interest to increase it. Looks for ways to end the treatment. Keeps asking how long treatment will go on Wants maximum results with minimum effort. Thinks only of short term Convinces the doctor to postpone insulin treatment, continues on orals even when they have failed Does not find even 10 minutes for regular exercise, cites paucity of time as main reason Maintains good diet control. Avoids oil and sugar completely.

Gender:

Equal proportion amongst Males and Females

Convenience very important, looks for excuses to postpone treatment

Low awareness and lacks interest to increase it. Looks for ways to end the treatment. Keeps asking how long treatment will go on

Wants maximum results with minimum effort. Thinks only of short term

Convinces the doctor to postpone insulin treatment, continues on orals even when they have failed

Does not find even 10 minutes for regular exercise, cites paucity of time as main reason

Maintains good diet control. Avoids oil and sugar completely.

Th. Yavum Arivom ( I Know it all) Recently diagnosed Gender: Mainly Males Age: 40 - 45 years Region: Not very region specific, but none found in South Low awareness, but claims knowledge Experiments with different medications without the doctor’s consent Gets information from diabetic friends & relatives rather than professionals Takes risk. Will try all the possible remedies including unproven and herbal Avoids visiting the doctor to labs; feels it is a waste of money

Gender:

Mainly Males

Low awareness, but claims knowledge

Experiments with different medications without the doctor’s consent

Gets information from diabetic friends & relatives rather than professionals

Takes risk. Will try all the possible remedies including unproven and herbal

Avoids visiting the doctor to labs; feels it is a waste of money

Patient segments Positive attitude to treatment Scared Negative attitude to treatment Knowledgeable Low levels of awareness Myopic I Know it all Casual High levels of awareness

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