Self-Management and Education are Critical in Learning to Control Diabetes

Diabetes self-management training should be considered for every patient diagnosed with the disease. Whether you’re newly diagnosed or have had diabetes for years, education is the key to being successful.

Diabetes educators specialize in helping people learn to self-manage their diabetes. They include nurses, dietitians, pharmacists and podiatrists among others. These health care professionals can help you resolve problems and develop coping strategies.

The American Association of Diabetes Educators (AADE) has identified seven actions that are critical to diabetes self-management. They are called AADE7 Self-Care Behaviors and include:

· Healthy eating
· Being active
· Monitoring
· Taking medication
· Problem solving
· Reducing risks
· Healthy coping

What does this mean for you? It means that your diabetes educator will:

· Teach you how to work healthful eating and physical activity into your daily activities
· Teach you to check your blood sugar
· Help you understand how your medicines work
· Give you the ability to solve problems and adjust emotionally to diabetes.

Healthy Eating and Being Active: Making healthful food choices, understanding portion sizes and learning the best times to eat are important in managing diabetes. Obesity is often linked to amputations and other health problems because it decreases circulation (blood flow). With proper meal planning and enough physical activity, you can largely lower your risk for these problems.

Monitoring: It’s critical to check blood sugar every day. Diabetes educators can help you determine which blood-sugar meter best meets your needs, show you how to test your blood-sugar level and teach you to use the test results to adjust your self-management routine.

Taking Medicine: Your health care team will determine which medicines you are taking as well as explain to you where and how they work to keep your blood sugars in good range.

Problem Solving: Managing changes in blood-sugar levels is vital to managing diabetes. Diabetes educators can help you move from beginner to expert as you learn to recognize and respond to hypoglycemia (very low blood sugar), hyperglycemia (very high blood sugar) and sick days.

Reducing Risks: Because of your increased risk for many health problems, you need regular eye exams, foot and dental exams. You also need to learn how to do regular self-exams. In this case, the word ‘regular’ depends on the advice of your health care professional. For instance, daily foot exams are vital if you have lost some or all feeling in your feet.

Healthy Coping: A diabetes educator can help you identify problems you might face while treating your diabetes. They can provide support by encouraging you to talk about your concerns and fears. They can also help you learn what you can control and offer ways for you to cope with what you cannot control.

Regardless of the situation, diabetes educators can give you the tools and strategies you need to live your life to the fullest. If you feel as though you would benefit from coming to our diabetes self-management program, please call us…we’ll take care of the rest!

-- Maureen Daniello, RN, CDE
Program Coordinator for Diabetes Education

Am I at Risk for Diabetes? Ask Yourself These Questions to Determine Risk

The question of “am I at risk for diabetes”can begin to be answered by asking a few questions and understanding some key risk factors, signs and symptoms.

First, are you overweight? If so, you are certainly not alone. Unfortunately, this condition puts you at greater risk for getting type 2 diabetes and the many other health problems related to it. In fact, like millions of other Americans, you might already have the disease and not even know it. The human cost of diabetes alone is devastating: It’s the sixth leading cause of death in the United States.

Diabetes is sometimes called the “silent killer” because it can slowly harm your body over a long period of time, which can happen without you even realizing it.

Over time, diabetes can lead to many other health problems, including:

• Heart disease
• Nerve problems
• Stroke
• Blindness
• Erectile dysfunction
• Amputation
• Kidney disease
• Gum infections

Other risk factors other than being overweight associated with type 2 diabetes include:

• Older age
• Having been diagnosed with gestational diabetes
• History of diabetes in the family
• Lack of physical activity
• Impaired glucose tolerance
• Native American, African American, or Hispanic heritage

What are the symptoms of diabetes? You might have no signs or symptoms, or your symptoms might be so mild that you don’t notice them, or have some symptoms but not suspect that they are related to diabetes. The following is a list of some of the symptoms you may encounter.

• Increased thirst
• Increased hunger
• Fatigue much of the time
• Increased urination, especially at night
• Weight loss
• Blurred vision
• Numbness or tingling in hands or feet
• Dry skin
• Increased infections or sores that won’t heal

If you are over 45, you should get tested for diabetes. Diabetes is initially diagnosed with a blood test after you haven’t eaten for eight hours, usually overnight. If your results are high, you and your doctor can start to bring them down through changes in diet and exercise and, if necessary, with the help of medications.

If you are younger than 45, you can still ask to be tested for diabetes. You should make getting tested a priority if you are overweight or obese and have one or more of the risk factors listed above.

Understanding what type 2 diabetes is and whether you are at risk will help you make decisions about your long-term health needs.

Until next time, keep moving, watch your portions and live your life to the fullest!

--Maureen Daniello RN, CDE
Program Coordinator, Diabetes Education
Center for Health & Healing

Dealing with Diabetes: First Step in Managing it is Knowing, What is Diabetes?

Hello and welcome to your bi-weekly informational blog on diabetes. My name is Maureen Daniello, and I am a registered nurse and certified diabetes educator. I’m also the program coordinator of the diabetes education department here at Martin Memorial.

My objective is to inform you about this disease, how it is diagnosed and the different options available to treat diabetes. Also, I will be keeping you up to date with the latest developments in the management of diabetes.

Although you will be able to find excellent resources for diabetes through the blog, this is not to replace your physician visits, lab tests or nutrition counseling. Research has shown that managing blood glucose (sugar), blood pressure and cholesterol protects your future health. Making good choices, learning all you can and working closely with your health care team will help you prevent or delay complications from diabetes.

With that being said I welcome you and hope you enjoy reading about the different topics which will be presented throughout the year. If you have any questions or concerns, please feel free to e-mail me at info@mmhs-fla.org.

What is diabetes?

Diabetes is a disease in which blood-glucose levels are above normal. When we eat, most of the food turns into glucose (sugar). Our bodies then use this the glucose for energy. An organ in our body, the pancreas, makes a hormone called insulin. This hormone helps the sugar get into our cells.

If you have diabetes, your pancreas doesn’t produce any insulin, doesn’t use the insulin properly or, not enough insulin. So without insulin, or the insulin not working properly, your blood glucose rises. As a result, sugar builds up to dangerous levels in your blood.

Diabetes can lead to serious complications and premature death. However, if you have diabetes, you can take steps to control the disease and lower the risk of related health problems. You can still lead a long, healthy life with diabetes; it is self manageable and ultimately it’s up to you to take charge.

There are three major types of diabetes:

· Type 1 diabetes used to be called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells. These are the only cells in the body that make the hormone insulin that regulates blood sugar. If you have type 1 diabetes you must have insulin delivered to your body by injection or a pump in order to live.

· Type 2 diabetes used to be called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes accounts for about 90 to 95 percent of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.

· Gestational diabetes is a form of glucose intolerance diagnosed in some women during pregnancy. Women who have had gestational diabetes have a 20 to 50 percent chance of developing diabetes in the next five to 10 years.

· Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections and other illnesses. Such types of diabetes account for one to five percent of all diagnosed cases.

· Pre-diabetes is the stage that occurs before a person is diagnosed with type 2 diabetes. Blood sugar levels are higher than normal, but they are not high enough to be diagnosed with ‘diabetes.’

So, as you can see, there are many types of diabetes which can affect people at any age. I hope this helps you understand the basics of how the human body works and the different varieties of this disease. My next segment will discuss who is at risk for developing diabetes, what the symptoms are, how it is diagnosed, along with who should be tested.

Until next time my friends, keep moving, watch your portions and live your life to the fullest!
--Maureen Daniello, RN, CDE
Program Coordinator, Diabetes Education

For Diabetics, Holidays Can Be A Challenge

Here we are again. The holiday season is here with its colorful decorations, its never-ending shopping, abundance of parties and especially and abundance of food! We will roll into our cars the day of Thanksgiving feeling as stuffed as the turkey we just ate.

It is a difficult time for everyone in trying to stay healthy, particularly for people who have health conditions like high blood pressure, cholesterol or diabetes.

Diabetics have to be especially careful as they are two to four times more likely to develop cardiovascular disease like heart attack or stroke. It is the leading cause if death among people with diabetes. I know someone who just found out that she has diabetes and she really has to be careful of her diet, which is a very big challenge during the holidays.

At Martin Memorial Health Systems we have a program that helps people manage their diabetes. Our program coordinator, Maureen Daniello, R.N., C.D.E., answers some of my questions on diabetes and its link to heart disease:

What does it means if I have diabetes?
Diabetes develops when the pancreas does not make enough insulin and/or the cells in the body aren’t using the insulin properly. As a result, the amount of glucose in the blood increases while the cells are starving for energy.

What’s the connection between diabetes and heart disease?
High blood pressure levels damage nerves and blood vessels, leading to complications such as heart disease. High blood glucose levels over time can lead to increased deposits of fatty materials on the inside of the blood vessel walls, which can affect blood flow, increasing the chance of clogging and hardening of the blood vessels. Because diabetes increases the levels of cholesterol and fat in your blood, more than 75 percent of people with uncontrolled diabetes die from some form of heart disease.

What are the risk factors?
Family history is an important one, especially if one or more members of your family had a heart attack at an early age. You can’t change your family history, but you can control the other risk factors for heart disease.

What are the medical conditions you have to be aware of?
Elevated waist circumference; elevated levels of triglycerides; low level of good cholesterol (HDL); elevated blood pressure levels; elevated fasting blood glucose levels.

What should people do to stay healthy and control their diabetes?
See a registered dietitian. Increase fiber in your diet by looking for oat bran, oatmeal, whole grain breads and cereals, or dried beans. Also, cut down on saturated fat like meats, poultry skin, butter or dairy products with fat. Reach and maintain a healthy body weight. One of the most important things you can do is the three E’s: Exercise, exercise, exercis. Aim for at least 30 minutes of exercise most days of the week.

If you smoke: quit!
Keep track of your ABC’s: A stands for A1c, have an A1c test at least twice a year; B is for blood pressure, the target is to be below 130/80 mm; C is for cholesterol, have it checked at least once a year.

If you think you may need assistance controlling your diabetes, click here to find out how the diabetes education program at Martin Memorial can help.

--Sophie Sawicki
Marketing Representative

Study: Diabetes Rates Surge in South

By now most people know that diabetes is a problem in the United States. They know that obesity rates are climbing and that Type 2 diabetes – which accounts for approximately 90 percent of the cases – is often linked to being overweight.

Most people know that diet and exercise can reduce those levels. They know that diabetes can lead to countless health problems, including heart disease, stroke, blindness and kidney disease.

And yet, a report this week from the Centers for Disease Control and Prevention indicates that the rate of new diabetes cases nearly doubled in the United States over the past decade. In West Virginia, which saw the highest rates, roughly 13 out of every 1,000 adults were diagnosed with the disease. In Minnesota, which was lowest in the study, five of every 1,000 had diabetes.

The study did a state-by-state review of new diagnoses, which revealed that southern states saw the greatest surge in new cases. That included Florida, which had the third highest number of annual new cases from 2005-07 with approximately 139,000.

Unfortunately, this is nothing new. The rate of diabetes, in particular Type 2, continues to grow. That’s why people who are most at risk – people who are overweight, sedentary, have a family history or genetic predisposition such as race – need to monitor themselves.

After reading the study results and knowing that I have a family history for diabetes, I took this test on the American Diabetes Association’s Web site. My risk currently is low, though I need to lose some weight. But as the ADA notes, there are nearly 24 million Americans with diabetes and nearly a quarter are unaware they have the disease.

Studies like this should be a wakeup call. Take this quick, easy test to see if you’re at risk. If you are, talk to your doctor and work to modify your lifestyle as necessary, rather than become another statistic in the next study.

--Scott Samples
Public Information Coordinator

The Power of Prevention

According to a survey published by the U.S. Department of Health and Human Services a few years back, Americans have never felt more vulnerable. We are more fearful of unpredictable, mainly random events such as terrorist attacks, anthrax exposure, West Nile virus, violence and crime and other uncontrollable threats such as a plane crash than we are of largely preventable life-threatening diseases.

The risks of illness or death from chronic disease, however, are far greater. While many Americans are aware of the seriousness of chronic illness, most of us have not changed our lifestyles sufficiently to reduce their risk of death or illness.

The top five chronic diseases – heart disease, cancer, stroke, chronic obstructive pulmonary disease and diabetes – cause more than two thirds of all deaths each year. This epidemic is not limited to older adults: a third of the years of potential life lost before age 65 are due to chronic disease.

The number of deaths alone fails to convey the full picture of the toll of chronic disease. More than 125 million Americans live with chronic conditions, with millions of cases diagnosed each year. These disabling conditions (such as arthritis, stroke and diabetes) cause major limitations in activity for one of every 10 Americans. And almost everyone is adversely affected by chronic disease in one way or another – through the death of a loved one; a family member’s struggle with lifelong illness, disability or compromised quality of life; or the huge personal and societal financial burden brought on by chronic disease.

We cannot afford to ignore the urgency of chronic disease. Although this epidemic is the most common and costly of all health problems, it is also the most preventable. Access to high-quality and affordable prevention measures (including screening and appropriate follow-up) is essential if we are to saves lives and reduce medical care costs.

Three modifiable health-damaging behaviors – tobacco use, lack of physical activity, and poor eating habits – are responsible for much of our chronic disease. That’s why Martin Memorial has put resources in place to help fight these diseases:

Effective Oct. 1, we will be a smoke-free campus. To assist our patients and Associates, we are conducting more than our typical offering of cessation classes for day and evening availability.

We have comprehensive weight-management and diabetes-education programs.

We have on-site fitness centers.

We will be conducting biometric screenings (blood pressure, glucose, BMI and cholesterol) for our Associates during our benefits open-enrollment period in the summer and fall.

Our health promotion team is working with our cafeteria vendor for healthy menu options.

We have youth weight-management classes.

We conduct resilience workshops.

These are key ingredients for helping to create a healthier, prevention-centric mindset and will provide impact toward a better quality workforce and community.

-- Lani Kee, MS
Manager, Martin Memorial Center for Health and Healing
and Treasure Coast Health and Fitness Center

Rewriting a Family History of Diabetes

The finger prick was quick and relatively painless, the needle darting suddenly from a small lancing device to break the skin on my index finger.

Maureen Daniello, program coordinator for diabetes education at Martin Memorial, let some of the blood dribble onto a test strip that fed into a glucose meter. It was a routine I’d seen my mother do countless times, the daily monitoring of blood sugar levels that many diabetics must perform.

The numbers flashed on the meter as 117 milligrams/deciliter – well below the 160 mg/dl limit since I’d eaten just two hours prior to the test. That meant I’m holding diabetes at bay – at least for now.

I had been listening to Maureen talk about diabetes as we recorded this week’s Martin Memorial Healthcast, along with a friend of mine who is also our podcast guru. It was a sobering conversation for both of us, given our family histories, our penchant for eating stuff we shouldn’t eat, as well as the extra weight hanging around our guts.

All three are major contributors to diabetes – facts we both conveniently ignore. Still, for people like us it’s hard to pretend we’re not at risk given the family histories: my mother is diabetic, her father was, some of my mom’s brothers have it, my father’s mother had it; both of my friend’s parents were also diagnosed with it.

After our talk with Maureen, my friend tested his fasting blood sugar level and recorded a 132 and a 137 – higher than the range of 80-120 recommended. The numbers may also serve as a wakeup call.

Diabetes is a horrible disease that can affect everything from your eyesight to your feet. It is a leading contributor to strokes, heart attacks and kidney disease. And the problem is growing by the day.

According to the American Diabetes Association, nearly 21 million Americans have diabetes – including an estimated 6.2 million people who don’t know they have the disease. Another 54 million Americans are considered pre-diabetic. The total estimated cost of treating diabetes in 2007 was estimated at around $174 billion.

That’s a hefty price to pay for a disease that, in many cases, is entirely preventable. I intend to do whatever it takes to make sure I don’t get added to the list.

-- Scott Samples
Public Information Coordinator

Listen to Maureen Daniello discuss diabetes, including ways you can prevent the disease, by visiting Martin Memorial Healthcast at www.mmhs.com/content/healthcasts.htm

Understanding Diabetes

November is Diabetes Awareness Month, so we thought we’d provide some information to help you decipher the signs and symptoms of this invisible epidemic. Read the post from Maureen Daniello, Martin Memorial’s diabetes education program coordinator, to learn more or take this diabetes quiz to test your knowledge. Check out the Palm Beach Post’s report on our weight management programs, aimed at preventing type 2 diabetes in teens and adults.

When you have diabetes, the food you eat cannot be used for energy either because your body is not making enough of a hormone called insulin, or the insulin you have is not working the way it should.

Either way, sugar cannot get into your body’s cells. Instead of entering the cells, it stays trapped in the bloodstream, raising the amount of sugar in your blood to abnormally high levels.

There are some tell-tale signs of diabetes. Because your body is not getting the sugar it needs, you are likely to feel tired. You may urinate more often than usual, you may be very thirsty, or you may lose weight even though you are eating the way you normally do.

If you are diagnosed with diabetes, keeping your blood sugar low is crucial. According to the American Diabetes Association, a normal fasting blood sugar range for a person who does not have diabetes is less than 100 mg/dL and the target blood sugar for most people with diabetes is 90-130 mg/dL .

Unfortunately, your body cannot lower blood sugar by itself. You have to help, by balancing what you eat with regular exercise, medications (if prescribed) and weight loss (if you are overweight). Knowing what to eat and how it affects your blood sugar is vital to controlling diabetes.

Martin Memorial’s diabetes education program can help you learn how to live with diabetes. For more information, call (772) 223-2822.

--Maureen Daniello, RN
Program Coordinator, Diabetes Education
Martin Memorial Center for Health and Healing

A Weighty Study

Feeling guilty about eating that third burrito from Taco Bell? Don’t! Gut bursting from one too many slices of greasy sausage pizza? Relax!

After years of being advised to eat healthy, get exercise and reduce our weight, along comes a scientific study conducted for all of us who’ve been fattening up like grizzly bears ready for hibernation feel just a little better about ourselves.

The study, which came out last week in the Journal of the American Medical Association, suggests that carrying a few extra pounds may not be catastrophic to your health and can actually protect you against some diseases.

While being overweight can contribute to things like diabetes and kidney disease, it may not have any correlation with heart disease or cancer. (That’s not the case, however, for people who are obese.)

Some health experts instantly disputed the new findings. Others supported it. Still others couldn’t comment, their mouths filled with chicken wings.

I found the findings to be fantastic news as I crammed my face into a platter of cookies (visual evidence at left) that one of my coworkers brought in – all in the name of health, of course.

Granted, you can’t swing a dead cat without hitting a new study that claims to have all the answers to all our health questions. Picking and choosing which study to believe just because you want to keep doing the things you’re already doing isn’t necessarily a sound health strategy.

And really, just because you might be OK with a few extra pounds doesn’t mean you’d be better off without that additional weight. Besides, in a couple more days another study will come along discounting the previous one, and we’ll be freaking out about the five pounds we gained after believing heart and soul in the previous study.

Until then, however, I’ve got a plate of nachos calling my name. I think I can still fit a couple more pounds under my belt.
--Scott Samples