Christine Manga, a diabetes nurse educator (DNE), explains what her job entails and shares some of the challenges faced as well as the pluses.

I am a diabetes nurse educator. I use this title without much thought. My mistake, not everyone knows what DNE stands for, let alone what we do. So, let me explain what a diabetes nurse educator is, why we are necessary, and what an average day routine consists of.

Part of a team

DNE is an acronym for diabetes nurse educator. A DNE is a healthcare professional who possesses comprehensive knowledge, skills and experience in diabetes management. We work as part of a diabetes management team, along with doctors, podiatrists, dietitians and ophthalmologists. Patients tend to spend more time with their diabetes nurse educator than any other of the team members.

Role

Our role, as DNEs, is to assist patients to effectively manage their own diabetes. We strive to do this through education, coaching and support. Being non-judgemental is of paramount importance.

Because diabetes is a chronic condition – patients have to live with it 24/7 365 – it’s not surprising that managing diabetes effectively requires a lot of time and effort. Patients are required to take various medications at multiple times in the day. These may be tablets or injectables. Regular structured glucose testing is recommended. Constantly being aware of what they’re eating is tiring. It is therefore imperative that DNEs equip these patients with the tools and coping mechanisms to master self-management. We know that each patient is unique, hence we tailor a management plan around this.

First consultation

During the first consultation, a DNE does a thorough history taking. From this information, we can assess diabetes duration, comorbidities, medication, diet, lifestyle, and patient motivation level.

Working within the South African guidelines for diabetes management and taking into account the patient’s preferences and habits, together we can formulate a management plan.

General information is given to all patients. This includes explaining what diabetes is. Many patients are not aware of what diabetes is and the serious complications that can occur without good control. A lot of time is spent correcting misconceptions. We explain the various targets that they should be aiming for.

Basic dietary information including meal planning, portion sizes and timing of meals are explored. Small changes to these choices can result in improved glucose control. Educating patients on blood glucose testing technique, injection technique, needle and site rotation is key to good management.

Explaining how the medication works in the body, what side effects to expect, and what medication may need to be used in the future seems to have improved medication compliance in my patients. Highlighting the importance of exercise and quitting smoking is vital to incorporate.

This generic information is given to all patients. Without the basics, one cannot easily progress.

SMART goals

In future consultations, DNEs coach patients on how to set a Specific, Measurable, Attainable, Realistic and Time-based (SMART) goals. Once the patient has set goals, we sit together and discuss how he/she can attain these goals. These goals are much more than just achieving a good blood glucose reading.

It’s the patient who needs to formulate a plan; a DNE will assist or give potential options that he/she may not have been aware of. By coming up with the solutions themselves, it empowers them and builds self-confidence. It encourages self-management, which is what we are aiming for.

Daily routine

A routine day consists of consultations, checking and responding to patient emails and, in most cases, managing an emergency hotline. Remember, diabetes doesn’t go away after office hours.

Though, saying a day is routine is not very accurate. No two patients ever present in the same way. So, although saying a consultation is routine is true, the content will never be routine. The patient may be in a bad space – unrelated to diabetes – resulting in 90% of the consultation being spent on that issue.

A DNE needs to be flexible. A consultation should have structure, but the content should be led by the patient. Our agenda may not meet the patient’s needs. We need to be attentive to where the patient is leading us.

Pros and cons

As with every profession, there are both rewarding and challenging moments. The most challenging issues being language differences, financial constraints, and a general resistance (from patients) to change.

These changes include lifestyle modification, increasing, changing or adding medication. Resistance is also common when initiating insulin. Financial constraints affect the choice of medication, the amount of testing strips that a patient can use as well as food that can be purchased. All of these have an effect on the way the patient responds to the recommendations.

On the up side, I love being the first person to interact with a newly diagnosed patient. Being able to allay the fear these patients feel is extremely rewarding. Many people are scared when they have been diagnosed with diabetes. They also fear being judged.

As time goes on and my patients come for follow-up appointments, it is wonderful to see how many of them have embraced the diagnosis, worked through and with it. Their self-esteem appears to blossom.

Sadly, this is unfortunately not the case with all patients. At the end of the day, we are all human. Helping one person might not change the world, but it could change the world for one person.

MEET OUR EXPERT - Christine Manga

Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

Nokusa Matlhabe (50) is a divorcee. She lives in Lakeside, Vereeniging, Gauteng with her 18-year-old son. She has Type 2 diabetes.

Diagnosed by gynaecologist

At the age of 32, Nokusa was initially diagnosed by her gynaecologist after giving birth to her second child. Her second daughter was considered a large baby, weighing 4,5kg. This fact, known as macrosomia, made Nokusa’s gynae think she had diabetes.

Being in complete denial, Nokusa ignored what her gynae told her and focused on her new born. Sadly, her second child died three months later due to a heart problem. The brave mother grieved and dealt with the trauma of losing a child, but was overjoyed when she fell pregnant with her third child shortly afterwards. She gave birth to a healthy baby boy, who is currently doing his matric year.

Life carried on and because the mother was asymptomatic she never once gave her ‘so-called diagnosis’ a second thought. However, eleven years later in 2010, the mother paid the price for this choice. She collapsed at home due to diabetic ketoacidosis. Her eldest daughter, who was 20 years old at that time, rushed her to hospital. Nokusa was admitted into high care. She went partially blind and suffered all the complications of uncontrolled diabetes. The doctor at the hospital introduced her to sliding scale insulin treatment. It was time for Nokusa to finally admit and accept that she had Type 2 diabetes.

It was a slow journey to recovery but with the support of her children and her positive attitude she succeeded in her acceptance and self-care. In no time, she was back living her life as normal – only this time taking medication and changing her diet for health purposes.

Control

The theatre scrub nurse is currently on insulin and metformin, and has her diabetes under good control. She will inject before she leaves for work to avoid experiencing a low while driving to work. She tries to eat before her theatre list starts, and loves her Future Life products.

She does, however, find it difficult to maintain her eating times at work (she needs to eats at specific times due to being insulin dependent). This is because she is scrubbed up and can’t find a colleague to relieve her, and can’t leave her duties unattended.

When this happens, she will ask a colleague to fetch her Future Life Smart Drink or Future Life Cereal from her bag. She will have a quick sip or mouthful in order to keep her going. She also keeps sweets or bananas in her bag in case of these situations.

Stress

Even though, her diabetes in under control, the stress of either delaying theatre lists or being late for work due to her check-up days is an issue she struggles with. “Working in the health sector, one would expect colleagues to understand such conditions but it’s not like that. Instead, they think you’re faking it,” Nokusa explains.

Ignoring such behaviour and comments has allowed Nokusa to persevere through her career. “I know I am not faking it and know the importance of eating every three hours, so I just ignore them. Plus, the doctors, like the surgeons, and anesthetists etc. who I work with are incredible. They are understanding and so supportive.”

Hospital employee wellness programmes

Even though the nurse works at a hospital, she says she has never been invited or seen ‘diabetes awareness programmes’ at work. “If there was, I would love to go and get more support from my workplace,” Nokusa says.

Exercise

Nokusa honestly admits she doesn’t exercise as she should. “I have to walk a lot at work and always choose the stairs rather than taking the lift. But, even though, I could walk to the shop from my house, I choose to drive in my car. We get lazy.”

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A day in the life of a diabetes nurse educator