October 22, 2019 Making life easier

Certified diabetes educators are an important part of your diabetes team, especially if you are newly diagnosed with diabetes or are experiencing changes in your diabetes treatment, general health, or life circumstances, As Garry Mallel and his mother, Hilda, learned firsthand, they can play an important role in helping you set goals, and can identify strategies that will help you or your loved ones manage diabetes and live a happier and healthier life.

Dealing with memory issues

Garry Mallel was worried about his mother, Hilda, who has lived with type 1 diabetes since she was diagnosed at age six. Hilda, now 82, has age-related memory loss, which means she would often forget to take her insulin or, more commonly, would give herself too many doses. Her son’s concern was natural given that Hilda was constantly in and out of hospital. Once, she even broke her hip due to a fall she suffered because of low blood sugar. “We got so used to her going to the hospital that it became the new normal,” says Garry, 60, who lives in Vancouver, not far from the seniors’ building where his mother lives in her own apartment. “I felt like she was in constant danger.”

Garry made an appointment for his mother to see endocrinologist Dr. Tom Elliott of BC Diabetes, a diabetes specialty clinic. To help Hilda better manage her diabetes, last year Elliott assigned Gerri Klein, a registered nurse and certified diabetes educator, to her case. “The first thing I did was a home visit, and I found all these little notes around the house that Hilda had written to remind herself to take her medication,” says Gerri, who discovered that Hilda was taking too much insulin. “She would check her blood sugar, see that it was high, forget that she had already taken her insulin and give herself another dose.”

Finding helpful solutions

With the family’s permission, Gerri used a lockbox to prevent Hilda from taking her insulin on her own, and put a plan in place to ensure her medication is carefully monitored. Now Hilda’s insulin is placed inside the lockbox, which has a combination that can only be opened by one of the licensed practical nurses on staff at Pier Health Resource Centre pharmacy, who visit daily to check Hilda’s blood sugar and administer her insulin. (The $33 daily fee for this service is covered by the income-based B.C. Fair PharmaCare Plan.) Hilda also now wears a flash glucose monitor, which automatically measures and stores blood sugar readings for up to eight hours. “The pharmacy staff drills into this data and contacts me to let me know if she is on target, and we make adjustments to her dosage accordingly,” says Gerri, who also makes regular home visits. “This is a real partnership,” says Gerri. “The nature of my job is to take on patients who require extra care. I love the challenge.”

The system means Hilda can continue to live in her apartment rather than going into a long-term care residence.

“Her life has really improved,” says Garry, although he admits that his mother is sometimes frustrated by the fact that she can no longer access her medication on her own. “For more than 74 years she’s had total control over her insulin usage, and now someone has to unlock it for her.” But Hilda knows this is for her safety. “Everything is locked up now and I don’t know the code. But that means I won’t give myself any extra injections. When I broke my hip, I had low blood sugar and fell off my chair. My neighbour heard me screaming and called the paramedics. I feel a lot more confident now.”

Life is now easier and less stressful for both Hilda and Garry. “Gerri has helped my mom by the system she has implemented,” says Garry. They used to have to call 911 or visit the hospital emergency room “at least once a month” because of Hilda’s low blood sugar levels—something they have not had to do since Gerri set up the new system. “This enables her to continue living independently,” Garry says. “It also means I don’t have to panic if I don’t hear from her by a certain time.”

Make the most of expert advice

The Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada offer key messages to help people with diabetes better manage the disease, including:

Ask for diabetes self-management education and support when you are first diagnosed, as well as whenever there are changes in your diabetes treatment, general health, or life.  

Work with your diabetes team to get personalized goals for caring for your diabetes and overall health.

Choose the learning approach that works for you: A variety of diabetes education and support programs are available, including group classes and individual counselling sessions, as well as strategies that use technology (such as Internet-based computer programs and mobile phone apps).

Did you know?

2021 marks the 100th anniversary of the discovery of insulin. Today, more Canadians have diabetes than ever before. Diabetes or prediabetes affects one in three Canadians. One in two young adults will develop diabetes in their remaining lifetime. We cannot wait another 100 years to End Diabetes. Visit 100 Years of Insulin to learn more, including how you can support those living with or at risk for the disease.

This article appeared in Diabetes Dialogue, Autumn 2019.