LEXINGTON, Ky. (April 13, 2020) — People with diabetes must get the care and education needed despite the ongoing COVID-19 pandemic. Experts around the country are seeing a sharp decline in new diabetes diagnoses. They believe that is because people that are not yet diagnosed are avoiding hospitals or think what they are experiencing is COVID-19. Additionally, they are seeing more type 1 patients going into diabetic ketoacidosis (DKA) because they are avoiding hospitals. That is why UK HealthCare's Barnstable Brown Diabetes Center is working hard to meet patient's needs through TeleCare.
"I think this is a time when a lot of individuals and their families are feeling uncertain and vulnerable. I'm thankful that I can continue to provide care to our patients in a way that keeps them healthy at home, but still feeling supported and confident in their ability to manage diabetes," said registered dietitian and licensed diabetes educator Andrea Francis.
Francis says right now she is primarily seeing patients for diabetes education – both individually and as groups. "After our patients are diagnosed and discharged from the hospital, they follow up with a diabetes educator for more in-depth diabetes education."
That is how Francis met 8-year-old Max Coyne and his family. Max's diabetes journey is still very new, all coming to a head just as the COVID-19 pandemic was reaching Kentucky. Amy Coyne says her son hadn't been feeling well or acting like himself for about a month. "I chalked it up to our change in routine with school being canceled as a big part of the reason he was acting sad and tired. About a week into the COVID-19 outbreak, I looked at him and he was lying by the fireplace acting completely not himself."
After a visit to his pediatrician and some tests, Max was rushed to Kentucky Children's Hospital where he spent three days including one night in the pediatric ICU. Coyne says they learned Max had gone into diabetic ketoacidosis. While in the hospital the family learned about Max's diabetes diagnosis and as a family with no history of diabetes, they were given a crash course on insulin, taking blood glucose and so many other things that would become their new normal. "We felt prepared to give it a go at home and were sent home with the assurance that we would be having a meeting with the diabetes clinic and doctor shortly."
The Coynes began settling in at home as the entire state broke away from what was "normal" in response to the COVID-19 outbreak. Coyne says their first meeting at UK's Barnstable Brown Diabetes Center was rescheduled as an online video session with the diabetes educator and Max's diabetes doctor. "Learning about Max's diabetes diagnosis during a global pandemic was very stressful. We were so grateful to not have the added stress of making it physically to doctors appointments during this time and were able to utilize technology to keep us comfortable but still answer all of our questions and provide the care and support we needed at this time," said Coyne.
In the diabetes education classes at the Barnstable Brown Diabetes Center, many patients like bringing multiple caregivers with them – this is still true for the virtual classes. Max had a big support system for his first class, which included his grandparents, "They were so sad that they weren't able to come in person to help and were very grateful to be included as part of the education process. Max's siblings were also able to participate, and we were easily able to ask questions, receive information and feel more comfortable with this whole process without having to leave our home," explained Coyne.
Max's diabetes educator says his class was her first TeleCare session since making the change. Francis says it was a great example of how impactful the technology can be, "They (grandparents) had the opportunity to ask questions and gain knowledge about diabetes care so that they can support their grandchild when this child comes to visit with them in the future. They could also hear how excited their grandchild was to ask and answer questions in the class and be reminded that diabetes will not limit the great things this child will accomplish … or just being a kid!"
Francis says as with any change there have been some challenges in transitioning to TeleCare. "I've learned to adapt my teaching style – teaching in person is completely different than doing so behind a screen. So, with my first class, we used the "Chat" option to notify me when a participant had a question. We also used hand signs like a thumbs up or thumbs down for patients and their family members to communicate whether they understood a topic or to answer a question. It was great to see their reactions through the video option – I could still recognize from nonverbal cues when they had an "a-ha" moment or when they needed clarification on a skill."
She says despite some of those challenging moments, she knows this adjustment is imperative for their patients and their families. "It is important for our patient and their families to have access to us for questions and support – especially for our newly diagnosed patients - because diabetes doesn't take a break or go on a vacation when obstacles come up or a new virus changes how we go about daily life."
Max's family lived that reality. In the midst of a global pandemic, they faced a life-changing diagnosis for their son, "It was very helpful to connect with an educator despite the ongoing outbreak of COVID-19 because we are so new in this process of diabetes. We have many questions and are still learning so much. Having the education shortly after his diagnosis and being able to have extended family attend virtually was a big benefit."
Francis says without TeleCare, they would be very dependent on email and phone calls. She says missing in those means of communication would be the benefits from video capabilities. "Our patients and their families feel better supported when they have a familiar face reassuring them instead of a person typing behind a computer screen."
During the COVID-19 crisis the Barnstable Brown Diabetes Center is striving to meet your care needs. To comply with directives related to patient safety we can only see urgent patients in the clinic. To avoid exposure to the virus, patients can call the Center to schedule a TeleCare visit with a provider. Diabetes Education services are also available through TeleCare. You can learn more about these options by visiting UK TeleCare: We're Here to Care For You.
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