Diabetes Denial

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Diabetes Denial

  1. 1. Management of chronic diseases <ul><li>Nature </li></ul><ul><li>Incurable </li></ul><ul><li>Mostly silent </li></ul><ul><li>Persisting pain if at all </li></ul><ul><li>No correlation between complaints and lab data. </li></ul><ul><li>Uncertain progress </li></ul><ul><li>Lifestyle related </li></ul><ul><li>Treatment </li></ul><ul><li>Important </li></ul><ul><li>Variable effects </li></ul><ul><li>Patients need self discipline </li></ul><ul><li>Costs are mental, professional, social and financial </li></ul><ul><li>Patients </li></ul><ul><li>Need to control it even though incurable </li></ul><ul><li>Juggle between treatment and life </li></ul><ul><li>As vigilance lessens problems increase </li></ul><ul><li>Has to be trained to handle acute crisis. </li></ul><ul><li>Doctors </li></ul><ul><li>Prescribe but not control fully </li></ul><ul><li>Need to share knowledge and foster attitudes </li></ul><ul><li>Intervene in emergency </li></ul><ul><li>Detect complications early </li></ul><ul><li>Should work in a team </li></ul>
  2. 2. Two types of responses to initial shock of chronic illness* <ul><li>Integration Process </li></ul><ul><li>Disbelief </li></ul><ul><li>Revolt (accusation) </li></ul><ul><li>Depression (sadness for health lost) </li></ul><ul><li>Confronting reality </li></ul><ul><li>Consenting (coping) with serenity </li></ul>*Lacroix A., Therapeutic Education 2003 <ul><li>Distancing Process </li></ul><ul><li>Anguish (medical team could cause it) </li></ul><ul><li>Denial of emotions (sense of shame/ suffer in silence) </li></ul><ul><li>Passive resignation </li></ul><ul><li>Meloncholia (may need psychiatric help) </li></ul>
  3. 3. Doctor’s role of patient’s health belief model <ul><li>Patient should be convinced that he is ill. </li></ul><ul><li>He must believe there could be serious consequences because of this illness </li></ul><ul><li>He must believe treatment will be beneficial </li></ul><ul><li>He must believe that the benefits will be more than psycho-social and financial side effects of the treatment. </li></ul><ul><li>These can be discovered only by “semi directive interviews” which convince the patient that interest being shown in him is not merely biological. </li></ul><ul><li>This shifts the locus of control to the patient. </li></ul>
  4. 4. Empathy is the key to success <ul><li>Empathy is not sympathy </li></ul><ul><li>Empathy is adult to adult </li></ul><ul><li>Empathy demands sincerity </li></ul><ul><li>Empathy demands dedication </li></ul><ul><li>Empathy creates trust and loyalty </li></ul>
  5. 5. Th. Arrivaali (the knowlegeble) <ul><li>Believes prevention is better than cure </li></ul><ul><li>Likes to be independent </li></ul><ul><li>Positive about life despite diabetes. Follows diet and leads a disciplined life </li></ul><ul><li>Well-informed: collects printed articles on diabetes & attends seminars </li></ul><ul><li>Motivated enough to exercise regularly, believes in timely medication, does not add sugar to food </li></ul><ul><li>Practices self monitoring and self injection, visits doctor less often, family involvement is very high, calm and collected during hypos - knows what to do. </li></ul><ul><li>Knows the severity of the ailment </li></ul>Age: 55-60 years Diagnosed since at least 8 -9 yrs. <ul><li>Gender: </li></ul><ul><li>Mostly males/some females in south </li></ul><ul><li>Also seen in diabetic couples </li></ul><ul><li>Region: </li></ul><ul><li>Mainly South India </li></ul>
  6. 6. Th. Bhayanthavar (the Scared) Recently diagnosed <ul><li>Gender: </li></ul><ul><li>Equal proportion </li></ul><ul><li>of males & females </li></ul>Age: 40-45 years Region: Northern & Western India but a rare case in the south <ul><li>Constantly curses his fate ‘Why me??’ </li></ul><ul><li>Apathy in gaining knowledge about diabetes </li></ul><ul><li>Dependence on others …lack of faith in self </li></ul><ul><li>Looks upon diabetes as a demon controlling his life </li></ul><ul><li>Resents the rigid lifestyle. Claims that he feels dead from within. </li></ul><ul><li>Visits the doctor every 7 - 15 days and hoping to achieve better sugar control thereby </li></ul><ul><li>Cannot overcome the craving for sugar and sweets, family involvement in managing diabetes in low </li></ul><ul><li>Dependence on others for taking insulin injections </li></ul>
  7. 7. Th. Parkalaam (the casual) Living with the disease for long <ul><li>Gender: </li></ul><ul><li>higher proportion amongst housewives than males </li></ul>Age: 40 +years Region: Northern & Western India but a rare case in the south <ul><li>Relaxed attitude towards self care, health and diabetes…no drive to seek knowledge </li></ul><ul><li>Feels defeated. Dislikes rigid and disciplined lifestyle </li></ul><ul><li>Considers self as least important member of the family. Family too attaches low importance to her health. </li></ul><ul><li>Believes, “God gives so he will manage it…” </li></ul><ul><li>Ignores diabetes until complications set in </li></ul><ul><li>No exercise, poor compliance to dosage schedule and no diet control </li></ul><ul><li>Visits doctor only for emergencies </li></ul>
  8. 8. Th. Kurukku vazhi (the myopic) <ul><li>Gender: </li></ul><ul><li>Equal proportion amongst Males and Females </li></ul>Age: 5 0 - 60 years Region: Spread across regions, fewer in south Diagnosed since at least 8 -9 yrs. <ul><li>Convenience very important, looks for excuses to postpone treatment </li></ul><ul><li>Low awareness and lacks interest to increase it. Looks for ways to end the treatment. Keeps asking how long treatment will go on </li></ul><ul><li>Wants maximum results with minimum effort. Thinks only of short term </li></ul><ul><li>Convinces the doctor to postpone insulin treatment, continues on orals even when they have failed </li></ul><ul><li>Does not find even 10 minutes for regular exercise, cites paucity of time as main reason </li></ul><ul><li>Maintains good diet control. Avoids oil and sugar completely. </li></ul>
  9. 9. Th. Yavum Arivom ( I Know it all) Recently diagnosed <ul><li>Gender: </li></ul><ul><li>Mainly Males </li></ul>Age: 40 - 45 years Region: Not very region specific, but none found in South <ul><li>Low awareness, but claims knowledge </li></ul><ul><li>Experiments with different medications without the doctor’s consent </li></ul><ul><li>Gets information from diabetic friends & relatives rather than professionals </li></ul><ul><li>Takes risk. Will try all the possible remedies including unproven and herbal </li></ul><ul><li>Avoids visiting the doctor to labs; feels it is a waste of money </li></ul>
  10. 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

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