“We’ll stop by McDonald’s once I get out of the hospital,” Arturo told his brother. Arturo (not his real name) was 21 years old and had just been diagnosed with diabetes. He and his brother loved fast food, McDonald’s being one of their most frequent haunts. Unfortunately, this new diagnosis was likely to change that.
This was Arturo’s first health problem, ever. He had a few days of being extremely thirsty but needing to urinate every hour or two. Then, for about a day he couldn’t keep anything down. Vomiting, his belly aching, he came into the ER with his brother.
I admitted him to the intensive care unit for a dangerous condition called ketoacidosis. Without insulin, his cells couldn’t absorb glucose, leading to a paradoxical situation — his cells were starving for sugar despite high levels of glucose in his blood. To compensate, his cells were making acid, a life-threatening condition if left untreated.
Now that he was in the hospital, the medical aspects of Arturo’s case were clear. There are textbook guidelines on what type of IV fluids he needed, how often to check his blood, and how much insulin to give him to safely transition his blood from acidic back to normal.
But the most challenging aspect of diabetes is the care that comes later. It’s tough for anyone who was never concerned about their health to monitor what they eat, check their blood sugar multiple times a day, and give themselves injections of insulin. It can be tougher for a 21-year-old who bonds with his brother by going out to fast-food restaurants.
The importance of family and friends as part of your “healthcare team”
I was reminded of Arturo when I read a recent article in the New England Journal of Medicine called “Engineering Social Incentives for Health” by David Asch and Roy Rosin at the Center for Health Care Innovation at the University of Pennsylvania.
In their article, Asch and Rosin explain how we might engage patients like Arturo. In our healthcare system, our interactions with doctors or nurses are usually infrequent and brief. It is no surprise that most of our discussions about health take place with our friends and family as we struggle with our health problems on a day-to-day basis.
We are rarely conscious of it, but those closest to us heavily affect many of our health decisions. “People are strongly influenced by what others do and by what others think of them, which means that our behavior can change or affect others’ behavior when it’s made visible,” Asch and Rosin write. But these social interactions can be used to help patients make healthier choices, a process they call “social engagement.”
Of course, there are the individual things that nudge us into healthier choices, like walking to work instead of driving, or joining a gym that’s on the way home from work rather than a 15-minute drive away.
But we can also make our desire for certain healthy choices more visible to those around us. Being public about certain activities, the idea goes, makes us more aware when we’re making unhealthy choices and helps others be supportive of our healthy choices. For example, some studies show that telling family and friends the date that a smoker will quit smoking helps make them aware and support the decision.
This involves explicitly engaging family and friends in our healthy efforts. Simply asking loved ones to call and remind us to take our medications, or asking the household grocery buyer to avoid bringing home tempting sweets, can go a long way to pushing us toward healthy choices.
Group commitments and competitions can increase social accountability for our healthy choices too. Having a family competition to reach a certain number of steps per day, or committing to go to the gym with a friend three times per week, helps meld healthy behaviors into activities that strengthen relationships.
Social connections toward better health are important, but not always easy
Arturo’s situation reminded me how, even with social engagement, diabetes is a long road. During the two days he was in the ICU, our nurses and case managers had a number of discussions with Arturo and his family on how to treat diabetes: avoiding foods like bread that were high in the starch and carbohydrates that would raise his blood sugar. I also chatted with his brother about finding other ways the two could hang out rather than over fast food. I could sense his skepticism: “He has diabetes; I don’t,” he told me.
It seemed to slowly dawn on Arturo just how many changes he’d have to make to his life. His brother was supportive, offering to help check his blood sugar. But cutting out fast food was, for now, a step too far. On his last night in the hospital, I overheard Arturo and his brother talking about what McDonald’s burgers they would get on the way home.
Related Information: Caregiver’s Handbook: A guide to caring for the ill,…
Below are spiritual recipe for health and wellness: Matthew E. McLaren
“Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable–if anything is excellent or praiseworthy–think about such things.” – Philippians 4:8
“Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours.” – Mark 11:24
“Anxiety weighs down the heart, but a kind word cheers it up.” – Proverbs 12:25
“Who of you by worrying can add a single hour to your life?” – Luke 12:25
“For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.” – Jeremiah 29:11
“If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him!” – Matthew 7:11
“A cheerful heart is good medicine, but a crushed spirit dries up the bones.” – Proverbs 17:22
“Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.” – Philippians 4:6
“Above all else, guard your heart, for everything you do flows from it.” – Proverbs 4:23
“For God has not given us a spirit of fear, but of power and of love and of a sound mind.” – 2 Timothy 1:7
“Consider it pure joy, my brothers and sisters,[a] whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance.” – James 1:2-3
“In all your ways acknowledge him, and he will make straight your paths.” – Proverbs 3:6
“Commit your actions to the LORD, and your plans will succeed.”- Proverbs 16:3
“Consider the ravens: They do not sow or reap, they have no storeroom or barn; yet God feeds them. And how much more valuable you are than birds!” Luke 12:24 – Luke 12:24
“It’s not what goes into your mouth that defiles you; you are defiled by the words that come out of your mouth.” – Matthew 15:11
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