Congress Abstracts 2005

89

MANAGING DIABETES IN THE ONCOLOGY PATIENT: PATIENT EDUCATION STRATEGIES. Ellen Coonerty, RN, BSN, CDE, Memorial Sloan-Kettering Cancer Center, New York, NY.

Glucose intolerance is one of the first metabolic consequences of cancer. Since successful management of this condition depends upon the patient’s level of involvement, the oncology nurse has a unique opportunity to act as both teacher and liaison with the team charged with preventing glycemic derangements.

Recent studies show that hyperglycemia increases morbidity and mortality in hospitalized patients and increases lengths of stay by one to three days (Van de Berghe et al., 2001). Additionally, hyperglycemia increases sepsis, acute renal failure, critical illness-related polyneuropathies, and is an independent risk factor for adverse outcomes and repeat hospitalizations (American College of Endocrinology, 2004). At this NCI designated cancer center, during a two-week period in October 2003, 25% of patients had one or more blood glucose levels greater than or equal to 200 mg/dL. Both hyper- and hypoglycemia can impair the quality of life for the oncology patient and may alter the patient’s ability to interact with family members and caregivers.

Successful treatment of hyperglycemia employs the oncology nurse and the patient/caregiver as integral members of the diabetes team. Basic anatomy and physiology, graphic designs, case scenarios, and story-telling techniques are all strategies developed to explain hyperglycemia and help motivate the patient/caregiver to become active and willing participants in the diabetes plan of care. The nurse who uses these illustrations and methods can instrument positive changes in behaviors surrounding glucose control and effect better physiologic outcomes.

Nurses and the previously naïve/resistant patients’ reaction to the occurrence of hyperglycemia have embraced these educational tools with new motivation and feelings of empowerment. Both begin to look at the hyperglycemic state as manageable with some modifications, as compared with cancer, where physiologic control is frequently unpredictable.

Education is tantamount to optimal glycemic control and the prevention of adverse outcomes. The complex diagnosis of diabetes must be taught and understood by the patient/caregiver to actively enlist their participation and maintain near normal glycemia. This presentation will empower the oncology nurse with meaningful and understandable information that the nurse as teacher and nurturer can impart to the patient/caregiver.