Living with Diabetes: An Occupational Therapy Perspective
Almost half the population of India suffers from diabetes. It is also one of the fastest growing diseases and comes under the category of lifestyle diseases. Diabetes can affect any person, irrespective of age, gender, occupation, and region. It is believed to be a ‘silent killer’ by many as the complications caused by the disease are varied and can affect any part of the body causing major damage, if left untreated or neglected. Most of us believe that only medicines need to be prescribed and the disease will be taken care off. Though that is a very important aspect of treatment, a person diagnosed with diabetes also needs to have a good quality of life (QOL) in order to ensure healthy living and compliance with treatment protocols.
The field of Occupational Therapy (OT) looks into the daily activities of the person with diabetes and analyzes ‘how’ it is being done. Not only does the activity need to be done using the correct posture, but it should also not be physically taxing. Over and above, the activity must be done ‘safely’. Occupational therapists help by training the person with diabetes modify habits and routines. If required, a new routine and method can be prescribed in order to ensure independence without putting the person at risk.
OT can help patients develop simple, concrete, measurable, and achievable self-management goals consistent with the seven behaviors advocated by the American Association of Diabetes Educators (AADE). These AADE 7™ Self-Care Behaviours are: (1) healthy eating, (2) being active, (3) monitoring, (4) taking medication, (5) problem solving, (6) healthy coping, and (7) reducing risks.
The whole process of ‘eating right’ starts with buying the ‘correct’ food. Planning and then preparing a meal using suitable ingredients is just as important. Healthy eating is essential. Cutting down on your favorite sweets may be a real challenge. However, in today’s day and age, there are several substitutes available in the market. Monitoring carbohydrate intake, avoiding sweets, sweetened drinks and trans-fats is essential to keeping diabetes under control.
Staying active through physical exercise and continuing to do as many tasks by yourself will not only ensure that your body remains toned up but, will also ensure optimal utilization of the sugar you may have eaten and release of ‘happy hormones’ such as dopamine, serotonin, oxytocin, estrogen, and progesterone. Setting realistic and do-able goals will give a sense of achievement, for example ‘today I will tidy up my cupboard’ (dopamine); reducing stress by spending quality time with loved ones and pursuing a hobby, a physical exercise routine (yoga, going for a walk, dancing, etc.) and meditation are some ways to improve the levels of ‘happy hormones’ in the body.
Monitoring and Taking Medication
This can be easily achieved by encouraging the person with diabetes to have a schedule. Keeping fixed times for meals and medication decreases the chances of ‘forgetting’. Reminders in the form of alarms (phone and clock) are both useful. Keeping your medicines at a place where you can see them is crucial to compliance. Making a checklist and ticking each item off as you complete the task on a daily basis can also help elderly persons who may have memory issues. Family members to have a major role to play in monitoring and taking medication. ‘Cheating’ on food issues reduces drastically if someone else is monitoring and if the foods to be avoided are kept either out of reach of the person (for example, under lock and key) or not kept in the house at all.
Coping in a Healthy Manner
Persons with diabetes have to face the challenge of living their lives with the knowledge that their condition is incurable. This can have a major psychological impact on the person. With information on the disease available freely, a person may be overwhelmed by the complications that might occur. Family members need to be supportive in order to ensure that the person with diabetes follows the treatment prescribed and stays positive about his or her future. Increasing awareness to the family members is crucial for prevention of complications. Participating in activities that are purposeful, nurturing a hobby, spending time with loved ones, doing the mundane but important things of life such as ironing, dusting helps maintain a routine and is crucial for a good quality of life.
A person with diabetes sometimes might even feel helpless. Helping him or her to become a problem solver is an important component to ensure independence for a longer duration of time. This means that instead of always looking around for someone else to do your job or find a solution for a challenge simply ‘DO IT YOURSELF’. For example, if you are unable to go grocery shopping by yourself, think about home delivery options. So, all you need to do is pick up the phone and call your local grocery seller or order online!
Wound healing takes longer in a person with diabetes. Hence, it is important to reduce the risk of injuries at all times. An occupational therapist can carry out a ‘floor slipperiness’ assessment, incident, and injury survey, and hazard surveillance to reduce the risk of an injury or a fall. For example, a person with diabetic neuropathy – a complication which causes the nerves to be affected resulting in less feeling in terms of pain, temperature (hot or cold) or pressure (tight or loose). Such a person is at a major risk of getting injured. Burns during cooking are common as the person is unable to feel a ‘hot’ utensil. A simple modification like microwave cooking/heating or using protective gloves can prevent any foreseeable injury. Removing potential hazards such as loose wires and carpets in addition to wearing slip-resistant footwear and placing non-skid mats at strategic places can prevent falls.
Occupational therapists also prescribe, train and educate persons with diabetes in a suitable household as well as environmental adaptations. For example, a person with diabetic retinopathy – a complication when the blood vessels of the retina in the eye get damaged leading to loss of vision – is prescribed, trained and educated in the use of visual aids such as magnifying glasses and using closed circuit TV. The importance of reducing glare, using contrast images, bright colors and appropriate lighting to improve the seeing ability is emphasized. These methods are also incorporated at doors, stairs, and other potential fall areas. Organizing things around the house so the patient can easily find things helps not only patients with vision impairments but also patients with memory issues.
It is essential that any person with a chronic condition such as diabetes continues to lead a normal life. This helps retain meaning and purpose to their lives. Helping the person with diabetes plan and maintain a routine which has time slots for all essential elements in the care of diabetes such as mealtime, when to take the medication, exercise, work and leisure activities, is one of the most important areas of Occupational Therapy. Helping the person understand that there are various ways that one can maintain one’s independence without compromising on the quality of life or safety is the key to living with diabetes. All that is required is a little discipline and lots of care.
About the Author
Dr. Monika Kundu Srivastava is an experienced Occupational Therapist with specialization in Neurologic conditions. She is currently working in a hospital set-up. Besides being a clinician, Monika is also an experienced writer and editor.