The following is an excerpt from "Lifestyle Makeover for Diabetics and Pre-Diabetics."
I cannot get over what I saw one day at the pharmacy. Cedrik, a young man in a wheelchair, was trying to reach for an item from the over-the-counter section in front of the pharmacy where I was working one day. I rushed out to help him and offered my services. To my surprise, I saw a man who could not have been more than 47 or 48, with both legs amputated slightly above the knee. He was in front of the diet aid section trying to select a product to help him lose weight, since he was obese. So I started inquiring further in order to have a better understanding of what his needs were.
When I asked him whether the amputations were due to an accident or disease, he replied with a regretful tone that it was due to complications of diabetes — somehow I was expecting that answer. Then he went on to tell me that the reason he is in this mess is because he was not compliant with taking his medications regularly, he did not monitor his sugar levels daily. He only had his sugar levels monitored at the doctor’s office with every visit once every four to five months. He also made poor food choices, as he ate sweets and cookies as if there were no tomorrow. He also led a largely sedentary life (couch potato). He watched TV five to six hours a day, and at work, he sat behind a computer all day long.
Most of all, he felt that he was not properly informed about his condition and did not know that he actually could have prevented these debilitating diabetic complications. He got bits and pieces from various sources, and when he was due for a doctor’s visit, his doctor would examine him then write some prescriptions and would tell him that he would need to “lose weight” and “exercise” without going into details on how to do that.
Doctors are very busy, overworked, and do not have the luxury to spend 30 to 45 minutes with every patient and explain what foods to eat or what type of exercise to do. Doctors usually refer patients to dietitians to take care of that part. Likewise at the pharmacy, the prescription volume keeps on increasing and the technician support allocated to help the pharmacists is usually not enough. Consequently, the pharmacists have less and less time to counsel patients.
Cedrik proceeded to tell me that had he taken his condition seriously, he would be walking today and would not have lost his legs and be confined to a wheelchair. He, his wife, and their two beautiful daughters had to pull together, having to make major adjustments; they have gone through very tough times, coming to terms with this new reality. He told me if it were not for the support and love of his family, he would have given up a long time ago. I could not help but empathize and feel his deep regret.
After this introduction to him, I began counseling him about the medications he was taking and about the importance of monitoring his blood sugar and blood pressure daily. I urged him to report to his doctor any consistent fasting sugar levels above 110 and blood pressure levels above 130/80. I also pointed out that his doctor should have many medication choices to bring any and all uncontrolled readings down to the norm. I also indicated that his doctor would need to monitor his cholesterol and A1C levels periodically, every three months.
We also discussed weight loss issues that did not involve using any diet pills, but did involve making favorable lifestyle changes. I gave him tips on making food choices, focusing on foods high in fiber and low in sugar, and I urged him to have three balanced meals a day and two fruit snacks per day in between meals; I also advised him on portion control to help his sugar levels stabilize.
Since he suffered from a handicap that debilitated his legs, I customized my advice regarding activity accordingly. Since he was bound by a wheelchair, he needed to depend on arm movements to generate health and heart benefits and to prevent further disease complications. I suggested he push himself on the wheelchair in open space for 10-15 minute bouts, a couple of times a day. Also, I indicated to him that if he had access to a gym, he could use some of the machines there that are designed for upper body movement, such as hand cycling and some rowing exercises which involve most of the upper body muscles and can be operated by hand movements. He could access these machines straight from his wheelchair. We also discussed using some multilevel resistance rubber tubing, cheaply available at Wal-Mart, to work his upper body muscles two to three times a week.
Finally, I truly tried to assuage some of his discomfort by genuinely caring for him and by reassuring him that he was able to prevent further complications and damage if he took action immediately and kept all his disease parameters under control. He then shook hands with me and thanked me for the great advice I had given him, and he wished that other diabetics would learn from his lesson and become more actively involved in their health, in order to turn away all preventable complications.
Unfortunately, Cedrik’s story is mirrored by millions of diabetics every day. My main concern during pharmacy practice is to help people who suffer from chronic conditions to take more favorable actions, keep up with the various parameters that would keep their illness at bay, report to their doctor anything that is out of control, and remind them to take their medications as prescribed and to continue making better lifestyle choices, and most importantly, to prevent themselves from ending up like Cedrik.
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