The Importance of Diabetes Education and Self Management


Tanner: You also serve on the VA’s National
Diabetes Group. Why is diabetes awareness and education currently
important for Veterans in today’s day and age? Mary: Oh my goodness. I, I think that there’s, there are so many
components to diabetes management, and really be able – and most of diabetes is self-managed. And having the education and tools required
for self-management are… are… of such importance. We want to avoid extremes. We want patients to be able to avoid extremely
high blood glucoses and extremely low blood glucoses. Tanner: Yeah. Mary: The risk of low blood gluclose, the
hypoglycemia, that loss of consciousness is actually very, very serious. And you know, if somebody is driving when
that occurs, that can be very, VERY, VERY serious, life threatening. Tanner: Sure. Mary: And we’ve all heard stories where
that’s occurred. So yes, we want to avoid the extreme lows,
but with the extreme highs, you know, those long-term complications; the complications
of nerve damage and kidney damage, heart damage. They’re very real and we… By improving control, we can help reduce the
risk of the long-term complications. And that truly is, is important for people
with diabetes. Tanner: And, and you were saying, you know,
a quarter of Veterans are getting diagnosed with diabetes. Mary: Yeah. Tanner: That’s, that’s an, that’s an
amazing number. Is it Type 1? Type 2? A mixture? Mary: Well, I think it’s not a quarter of
people with… that are Veterans have the diagnosis of diabetes, but rather 25 percent
of Veterans that receive care within the VA have the diagnosis of diabetes. Tanner: Gotch you, gotch you. Mary: Well many Veterans, you know, receive
their care in the private sector, but those that receive their care within the VA… Tanner: A quarter of them. Mary: 25 percent of them have the diagnosis
of diabetes. Tanner: I… I mean any way you slice it, it’s an amazing
number. Mary: One in 11 Americans actually has the
diagnosis… Tanner: Wow. Mary: Of diabetes. Tanner: Wow. Say… I just got diagnosed with Type 1 diabetes. Mary: Yes sir. Tanner: And I’m with my VA doctor. What’s the, what are the first steps…
what first steps that I should take in making sure I can start managing this correctly? Mary: The first step really is to work very
closely with your primary care provider. And to use the monitoring tools that are available. To work very closely with the registered dietician,
and to explore the various technologies that are out there to help you best manager your
diabetes. Tanner: Gotch you. Should I start making an appointment with
certain specialists? Mary: I, I… I would make an appointment, first with your
primary care doc so that he or she can guide you to the appropriate specialist. Tanner: Okay. Mary: Yes. Tanner: Gotch you, gotch you. Now, what can Veterans with diabetes, I mean
in your blog you talk about ‘this is my drill.’ What’s your drill? What type of education is necessary for those
with diabetes? Mary: Yeah, we… we do have a diabetes self-management
education and support program. This is actually a program in which, really
individuals are… are given eight very specific educational topics. Tanner: And any Veteran in the VA system can,
can ask for this? Mary: Yes. Tanner: Okay. Mary: So it’s an… there’s a diabetes
overview. There’s diabetes monitoring; diabetes insured
decision-making; diabetes and medication; diabetes and physical activity; diabetes and
complications. And all of these are important topics for
Veterans to at least have an understanding of. Tanner: Interesting. Very interesting. Mary: From that standpoint, we’re actually
in the process of building a virtual medical center, both the VA and the Department of
Defense. Which will allow patients access to the materials
24/7, 365 days of the year. So that they can do their own self-learning. Tanner: Not only them… or… if there’s…. Mary: If they’re… Tanner: If they’re stubborn about it, their
family members can get on there. Mary: Yes. Tanner: That’s cool, great. Mary: For places where they don’t have a
structured program, you know, we have pharmacists, and many of the pharmacists really are stellar
at providing guidance on medication management, medication education, medication titration. We are very, very fortunate to have, you know,
an amazing pharmacy team. Nursing. We have many nurses that are also dually credentialed
and certified diabetes educators and, and a true asset to Veterans with the diagnosis
of diabetes. So, you know, it’s a very nice system. Tanner: Very good. In your blog, you talked about serving sizes,
blood glucose before meals, carbohydrate to insulin ratio. Why do numbers matter, and are they different
for each person? I’m sure a person’s weight probably affects
that number? I’m guessing. Mary: You’re absolutely correct. Tanner: Okay. Mary: One of the things we really focus on
is health literacy. And within health literacy, we look at, you
know, cultural components of health literacy. We look at, you know, a person’s ability
to speak, a person’s ability to listen to information. We look at that person’s ability to read
and write. With diabetes, we also look at numeracy. A numeracy is truly, you know… just, just
very important. If, if there’s an error in numbers, somebody
can really end up in trouble. Tanner: Yeah. Mary: And again, I go back to how I met the
pope. You know, just the timing of that occasion,
and the timing when you’re crossing, when you’re travelling or crossing time zones. Being able to manage that correctly can, can
really put somebody in jeopardy of a pretty significant, acute event. I am a registered dietician. And the reason I became a dietician, again,
was because I was diagnosed with Type 1 diabetes when I was in high school. Tanner: Wow. Mary: Back when I was in high school, well,
the tools that we had, were very, very different than the tools we have today. The insulins today are very different… but
something like monitoring, you know it used to be just testing your urine. It wasn’t until the 1990s that, you know,
blood glucose monitors became widely available to the public. So, you know, right now, anybody that’s
diagnosed gets, gets a blood glucose monitor. In, in the 1970s, from a nutrition standpoint,
I think nutrition is something that has truly evolved. Back in the… before insulin was discovered,
Elliott Joslin was one of the doctors that treated individuals with diabetes. He found that they would have to have a very
disciplined lifestyle. Tanner: Hmm. Mary: Disciplined exercise, disciplined diet. And that if they overate, they would end up
with very, very high blood sugars. But he did indeed; kind of instill that first
focus on that disciplined lifestyle. Tanner: Think about Veterans and discipline. I hope that, hey some of that discipline has
carried over from service; this is something you should be able to manage. You know, chuckle. Sometimes, but sometimes Veterans drop that
discipline as soon as they get out. [chuckle] Mary: It’s actually a very nice population
to work with because they do have that history of discipline. And sometimes they just need to know, you
know, get that education on why this disciple is important. Tanner: Yeah. Mary: For me, once I learned, you know, again,
monitoring was using, you know, was urine back in the 1970s. And many of our Veterans were first diagnosed
in the 70s or even 80s, before, you know, we had the widespread blood glucose monitoring. Tanner: So, blood glue, blood glucose monitors,
excuse me, is that something that if you’re in the VA system and have diabetes, you can
go and pick one up? Mary: With the diagnosis of diabetes, you
would be issued a blood glucose monitor, yes. Tanner: Wow. Wow. Eating healthy; you always hear that when
someone is diagnosed with diabetes. You know, they always say ‘hey you gotta
watch your, gotta watch your diet. What should you be eating? What shouldn’t you be eating? And, you know, Veterans gotta figure out,
is there a way to cheat the system? Mary: What you should be eating is actually
a very complex question. Usual… we have gotten… somewhat away from
the rigid discipline that had to occur back, you know… 50, 60 years ago because of more
advanced medications. First and foremost, you know, that weight,
being within a target weight for someone who is newly diagnosed with Type 2 diabetes is
very important. Tanner: Got it. Mary: Exercise; also very important. We are… there’s metabolic benefits of
exercise, and there’s cardiovascular benefits of meta… exercise. For metabolic benefits, it… even if you
walk for five minutes, there’s a metabolic benefit to that. And we want people to just start with the
goal of getting up to 10,000 steps per day. That’s when you really reap the metabolic
benefits of exercise. Nutritionally, once we’re in target weight,
we can actually see the impact of various foods on a person’s blood glucose. Tanner: You, you’ve heard about people who
do that more exercise and eat better can actually, they can actually lower their insulin dosage. Is that true? Mary: That’s very true. It’s very true. Exercise is very, very metabolically beneficial. And for some people, they can actually put
their diabetes in to remission, if they have Type 2 diabetes. Tanner: Wow. Wow. Mary: Yes. Through exercise and weight management. Tanner: Wow. Mary: When we talk about carbohydrate insulin
ratios, we talk about the help for our patients both Type 1, and insulin-requiring Type 2. Tanner: Okay. Mary: And one of the simplest things we start
with is one unit of insulin covers about 15 grams of carbohydrates. That is… so people have to understand which
foods are carbohydrates, and they have to be able to quantify the amount of carbohydrates
in, you know, various serving sizes, and also mixed meals in order to appropriately dose
their insulin, their mealtime insulin. Tanner: Wow. So you have to be really careful. So that’s, that’s where it goes into the
label reading and the, and all of that. You gotta understand it. Mary: Yes, correct.

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