Diabetes Denial
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Diabetes Denial






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Diabetes Denial Presentation Transcript

  • 1. 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
  • 2. 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)
  • 3. 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.
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. 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
  • 8. 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.
  • 9. 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
  • 10. 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