And So It Begins...

Monday mornings are always a little bit rough, but this Monday, the Health for America Fellows had an even more challenging start to our week. Our Type 2 Diabetes Simulation has begun! As part of our human-centered design process, we're immersing ourselves for the next two weeks in the world of blood glucose testing, medication management, carb counting, and more. We're doing so in an effort to better understand the experiences, challenges, and motivations of those living with type 2 diabetes. This simulation certainly won't be the be-all end-all of our diabetes education, but our hope is that it will be a springboard into even more meaningful conversations with the patients, providers, and caregivers we encounter.

To get us started and to provide some parameters for our simulation, each Fellow has been assigned a patient profile. These profiles, in their entirety, are in-depth and complex--just as any real life patient would be. Here's the short version:

Dan's Patient Profile

• 75 year old male living with type 2 diabetes, glaucoma, diabetic retinopathy, diabetic neuropathy, chronic kidney disease, history of coronary bypass surgery

• Limited physical activity, with a preference for light household activities

May's Patient Profile

• 62 year old female living with type 2 diabetes, hypertension, high cholesterol and hearing deficits

• Unemployed, lives in section 8 housing, primary mode of transportation is the bus

Jake's Patient Profile

• 34 year old male living with type 2 diabetes and asthma

• Computer programmer who recently lost job, only can work out on weekends, living alone

Amanda's Patient Profile

• 50 year old female living with type 2 diabetes, history of stroke, anxiety/depression, hypertension, high cholesterol, hepatitis C, and multiple other medical problems

• Lives with multiple family members while dealing with recent job loss

Over the next two weeks, you'll hear a bit from each Fellow about what it's like to live as these patients. To get you started, here's a sense of how the simulation will play out in terms of medication management, exercise, and diet.

Medication Management

Because comorbidities are common among people living with type 2 diabetes, each Fellow will be managing between 5-13 medications/medical devices everyday. While we'll all be using substitutes in the place of real pills (Mike and Ikes anyone?), some of us will also be settling into a routine of finger pricking and blood glucose testing.

Exercise 

A health, active lifestyle is paramount in diabetes management, so the Fellows will be following the American Diabetes Association's recommendations of 30 minutes of aerobic activity 5 days per week with 2 days of strength training. Because we're already a fairly active bunch, we'll be adding additional exercise into our lives to simulate the relative challenge of taking on new fitness habits.

Diet

Again, the Fellows will be following the ADA's dietary recommendations which include eating three consistent meals per day as well as limiting consumption of sugary foods and beverages. We're also adhering to the ADA's carbohydrate recommendations of 45-60 grams/meal for women and 60-75 grams/meal for men. Our team is purposefully not sharing tactics for meal planning and nutrition management so we're able to compare the relative success of our individual strategies. What we are sharing are the confusions and frustrations that come with understanding, integrating, and maintaining these new dietary plans.

(Jake, while proofreading this blog: "*Sigh*... I want carbs so badly right now.")

So, why are we doing this again? 

We're walking into this simulation with a lot of questions, and I suspect our list will grow throughout the next two weeks. And we recognize not all of our questions will be answered by this experience alone. There are, of course, major limitations to our ability to simulate the complex challenges inherent in managing a chronic illness like type 2 diabetes. So as the list below grows, we'll continue our conversations with the experts--the patients, providers, caregivers, and more who are tackling this challenge every day. For now, here are just a few of the questions we're asking:

• What resources and tools are most accessible and helpful to a person learning to manage diabetes?

• How does a person with type 2 diabetes understand, manage, and integrate vast amounts of health information?

• How does type 2 diabetes management fit into an already busy life?

• What factors might make or break adherence to a diabetes management plan?

• What are the impacts of this chronic illness and its management on social engagement and mental health?