Inner-City Hospital Tackles Diabetes Control

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Finally! The weather cooperated, and I made it to rehab yesterday. I began by taking two steps before crying “UNCLE!” but then progressed to five steps, 10, 15, and, finally, 20 (a couple of times). I went forward, backward, and did some U-turns. For my last trip, nobody bothered to count steps. The student intern put my scooter up ahead of me. My goal was to walk to it. My reward was, when I made it I could leave.

It was the first time I’d walked since November 16, when my left leg was amputated below the knee. It was exhilarating, but man, am I tired and sore!

I also did some in-service at the physical therapist’s request: I discussed insulin pumps, continuous glucose monitors, the purpose of insulin, and how I started with a ruptured Achilles tendon and wound up with a short leg. The therapist said the intern might as well hear it from the horse’s mouth. Besides, I carry the props with me.

But enough about me. I was thinking about Mom and her experience at the hospital after she put too many nitroglycerin patches on herself. Then I thought about a blog entry I wrote in May 2008 about the possibility of people with poorly controlled diabetes being left to die in the event of a widespread medical disaster.

In that blog post, I stressed the importance of diabetes self-management education so you know how to maintain control. But what I didn’t mention — didn’t even think about — was the importance of a good diet and exercise. Which is difficult for some people to do.

It happens that a good friend of mine is Karen Chalmers, MS, RD, CDE, and Diabetes Services Program Manager at Boston Medical Center on the south end of Boston. It’s a mammoth institution, covering six city blocks and licensed for 639 beds. Oh, and you don’t want to live on the south end of Boston. It isn’t all that healthy.

“There are no supermarkets in the middle of the city,” Karen says. “People are forced to buy groceries at the corner store. The prices are exorbitant and the foods are like those found in convenience stores.”

As far as exercise goes, “they can’t go out at night, or even sometimes during the day,” Karen says. Doing so is unsafe.

Then there’s the low literacy. Thirty percent of the hospital’s patients don’t speak English. English is not the first language for another 60%.

But these are all things you need if you’re to manage your diabetes. You need healthful foods, you need to exercise, and you need to be able to understand instructions.

Oh, yeah. There’s that money thing. Money for medicines and for equipment to check your blood glucose. If I recall correctly, even Medicaid has you pay $5 per prescription, and $5 can be a lot of money if your circumstances are dire. And it’s usually not just $5 and that’s the end of it: Those of us who have diabetes tend to take more than one medicine for diabetes, not to mention for blood pressure, cholesterol, and the other things that we’re at higher risk for.

What to do… Well, Boston Medical Center has a huge food pantry inside the hospital, with food donated by several places, including Whole Foods and Trader Joe’s.

“When a patient [in need] comes in, any one of us can go to the electronic medical record and see what diet they’re on,” Karen says. The patient is given a slip to take to the food pantry and is given two bags of food. From then on, the person can go every two weeks and receive two bags of food for the family.

The food matches the person’s dietary needs as much as possible but, with donations, it isn’t always perfect. However, Karen says, “they might not always get the best selections, but they get food and have it for their family, too.”

As far as exercise goes, it may not always be wise to walk around the neighborhood, but they can walk around their apartment — or their apartment building — and they can go up and down any steps that are available. Karen’s former suggestion to walk around a mall doesn’t work in her current job: There are no malls in the inner city and her patients at Boston Medical Center don’t have cars.

As for the literacy situation, Karen herself has developed 55 pieces of material in four languages common in the area — English, Spanish, Portugese-Creole and French-Creole — that address diabetes-related subjects in simple terms. “There are a lot of pictures,” she says.

The innovations have had an impact, she says. People with HbA1cs approaching 16% are coming in six months later in the 7% to 8% range. “We look like miracle workers,” Karen says.

Is that all it takes? Nutritious food, working out an exercise program that fits the person’s lifestyle, instructions that can be understood and having people understand the importance of taking their medicines?

Actually, she says, “when talking about an A1C coming down, it is usually just the result of making a single, simple change to a behavior like understanding how to take a medication or learning how to check their blood glucose or learning how walking can decrease blood glucose levels.” Also, she adds, “It is easy to decrease A1C when taking meds correctly!”

It seems so simple, doesn’t it? How can we take it nationwide?

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