Prediabetes Teaching for a Shift Worker With Food Insecurity
Mr. B is 54, works 12-hour night shifts at a warehouse, and has a body mass index of 31 kg/m². His most recent A1C is 6.3%, blood pressure 138/88 mmHg, and waist circumference 104 cm. He drinks three energy drinks per night, eats one large meal after his shift, and walks 20 minutes twice a week. He lives alone, has limited income, and uses a food bank twice a month. He is on a waitlist for a family physician and has no diabetes education. His father had type 2 diabetes. He says, 'I know I should eat better, but I don't have time or money, and I feel fine.' He is not currently on medication. He has never had a foot exam or eye screening. He asks whether he 'has diabetes yet.'
1. What is the priority health-promotion approach at this visit?
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Start by asking what he is willing to try, not by listing everything. Use motivational interviewing: affirm that he feels well, explain that an A1C of 6.3% is prediabetes, and link the risk to his father's diabetes. Choose one goal that fits his night shift, for example replacing one energy drink with water or taking a 10-minute walk after his shift. A specific, small, self-chosen goal is more likely to be adopted than a full diet plan. Arrange follow-up and refer to a diabetes prevention program. This is health promotion, not a lecture.
2. How should the nurse address food insecurity and shift work without judgment?
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Screen nonjudgmentally for food insecurity and ask what he actually has access to. Refer to social work and a dietitian; discuss budget-friendly proteins, canned vegetables, and food-bank resources. Plan eating around night shifts: a meal before the shift and a planned snack, rather than one large meal after. Avoid advice like buying fresh salmon. The nurse should advocate for affordable options and document the referral, because food insecurity is a barrier, not a knowledge deficit.
3. Which screening and referrals should be arranged?
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Arrange a repeat A1C in 6 to 12 months per local guideline, blood pressure and lipid screening, a foot exam, and an eye exam. Refer to a diabetes prevention program and primary care; because he is on a waitlist, ask about nurse practitioner or community health centre options. Discuss smoking and alcohol if relevant. Follow up on the chosen goal. Document the prediabetes diagnosis and the plan so the next provider does not restart from zero.