I decided to pose a couple of questions to my fellow Certified Diabetes Educators on the AADE (American Association of Diabetes Educators) list serve.
I was interested to see what their response would be, since our experiences as CDE’s vary based on the setting in which we work, the kind of population that we serve, and our own experiences working with people with diabetes.
The two questions I asked CDEs were:
- What are the most frequent questions PWD’s ask you, and your response?
- What are the most unusual or interesting questions PWD’s ask you, and your response?
Here are the answers
1. Chris Memering, BSN, RN, CDE, SANE-A
I don’t know, I kind of like that this question will be seen by all the NC educators. We all have awesome stories to tell, and I think I learn something each time I hear an educator talk about their patient experience. I am looking forward to seeing the “most unusual” questions asked.
I don’t think I have an unusual question, but a rare question I have had is “If I do what you are suggesting (take meds – insulin, to get blood sugar down), will it help me down there?” Meaning will it help with erectile dysfunction. Of course my answer was it should, but that is also part of the reason you are seeing an Urologist, but studies have shown that with better glucose control, ED problems can be better.
Keep up the awesome work all you awesome educators!! (Yes I may still be on the positive vibe high that comes with an AADE meeting. J)
2. Susan Mintz, BSN, RN, CDE
What can I eat ? Most think they have to completely stop all carbohydrates. I talk to them about healthy eating and ways to enjoy their favorite foods that they like to eat. Emphasis on portions, timing of meals, and right combinations of foods…
I had a young, slim girl come to our office and she was concerned she might have diabetes. I interviewed her and the unusual comment was that she could no longer wear her flip flops because her skin was so dry she could not grip the shoe. At that point I knew she had a problem, and sure enough I did a random Blood Glucose and it was over 460’s. We sent her immediately over to the emergency department, and they kept her overnight. She calls me every now and then to catch me up on how she is doing.
Hope this helps!!
3. Wannetta Harrington, RN,BSN,CDE,CCM,CDTC,CPT
The most frequent question I get asked is “What can’t I eat”? My response is “I don’t know, are you allergic to anything?” Then I proceed to tell the patient and usually “the food police” that accompany them to their apt. There are no special, forbidden or bad foods a person with diabetes can’t have, just certain foods that no one should eat every single meal every single day.
One of the most interesting questions I have had is: a patient who had just found out he was diabetic, came to me and said I don’t get it meaning he didn’t understand diabetes. This man was a auto body repair man so he had some knowledge of car mechanics, so I proceeded to explain diabetes in a language he understood with the following example: you have a car with a tank full of gas, your fuel pump goes out, what happens? His reply “ the car won’t run” I then told him he had a tank full of fuel in his body in the form of glucose or sugar, his fuel pump “the pancreas” had quit therefore the fuel is staying in the tank and not running his body. His reply “so that’s it?” I said pretty much so. We were then able to address some of the things he was willing to change in his life to live healthier with diabetes.
4. Beth Silvers, RD, CDE, MS, LDN and PWD for 53 years
One of my most interesting questions was shortly after Glucatrol or Glucotrol XL hit the market. The tablet was creamy off-white in color.
A patient asked me if he should stop taking his medication because he was spotting the whole tablet, just a bit darker in color, in his stool.
I called my drug representative, and she told me that the pill was a shell and that the medicine would be gone from it if his blood sugars had warranted needing the med. The tablets had some sponge-like material which had the medication in it.
If the blood sugar was high enough, fluid entered through a small pin hole in the shell (brown) which had been closed by the creamy colored coating.
The sponge-like material expanded and the medication was forced out–and used to lower the blood sugar. This and Amaryl were known as a “smart” oral hypoglycemic, because they worked more when the blood sugar was elevated.
The drug representative came within days, and showed me a tablet which had a small “dimple.” She then wet a finger and rubbed that area. Sure enough, there was an opening.
Always wished we had somehow cut the tablet, as I would have loved to see the sponge with the medicine in it!
5. Amy H. Brian, PharmD, CPP, CDE
I echo a lot of the most frequent questions that have been submitted thus far but more and more I have patients who have specific questions about insulin resistance. They understand the concept that their pancreas makes less insulin but don’t understand the concept of resistance. Along the same theme with Wanetta’s auto analogy, I often explain insulin resistance to me is like fuel mileage in a car…during normal operation, you may get 25 miles to the gallon with your insulin efficiency, but with insulin resistance you’re only getting maybe15 miles per gallon b/c it’s not running as efficiently.
I’m not sure about the most unusual question I’ve had, but I did have an interesting statement from a patient today that I thought was cute to share. He told me “I never was a diabetic ’til I was diagnosed with diabetes…”
6. Sarah Overholt, RDN, LDN, CDE
Most frequent…what can I eat?
Answer…you don’t have to give up your favorites. You can learn how to fit them into a healthy diet…balance and moderation are key.
Unusual…usually oriented around medication side effects…
Answer… (if it’s really unusual) ..Make use of your pharmacist for advice, and talk with your doctor about alternatives.
7. RuthAnn Petzinger, CDE
Probably the most frequent question is: Can Type 2 diabetes be cured?
My response is, “No, but we can control it without medications if you get active and eat healthy.
But if you ever go back to the old patterns the diabetes will rear its ugly head)”
Most unusual or interesting questions are related to the supplements like It Works, Avapro or Kinyai and can they help me?
From Type 1’s, I get the question of why does exercise sometimes lower and sometimes raise my sugar?
This is tougher to answer so we talk about macro-nutrient balance and glycogen stores.
8. Carla L. Jackson RN, BSN, CDE
“I stop taking my medication because God will heal me.”
“Yes, God can do anything, but to be a good steward you need to take your medication.”
“Will the diabetes go away?”
“No, but you can manage it by diet, exercise, monitoring your blood sugars, medication if needed, and follow-up with physician.
9. Elisabeth Almekinder, RN, BA, CDE
In looking at the responses of other CDE’s, I have to say that my most frequently asked question is food related, and it is usually “What can I eat.” Many times it is “what can’t I eat.” The answer to that question is, “there is literally nothing that you cannot eat at least on occasion. There are foods that are not very good choices for you, and foods that don’t give you much bang for your buck. For example, you could have 3 cups of plain air popped popcorn for a snack, or you could have a quarter of a candy bar. You will get more of a full feeling from the popcorn, so carb per carb, it provides more bang for your buck.”
For the most unusual question that I have encountered, there is one particular question that stands out above all others. A man with a fifth grade education came in for diabetes education. He asked, “Why is my blood sugar so high when I give my insulin?” In speaking with him, I found that the hospital nurses had taught him how to administer the insulin. I said to him, “Show me how you give your insulin.” He proceeded to pull out a bag of supplies. He got out his insulin pen, alcohol pad, and a small sharps container. He got out an orange. He cleaned the orange with the alcohol pad, and injected the insulin into the orange. All I could say for what seemed like the next five minutes was, “Let’s regroup.” Then I proceeded to explain that the nurses taught him to inject into the orange, but we needed to inject into his skin.
One of the entries we forgot to add….
10. Diana Jones RN BSN COHN-S CDE
My most frequently asked question is “I want to do what it takes to get off my diabetes medicine” most of the time it is women. Some are only taking Metformin!! Simply answer I give is: your liver is compromising you being able to get off of medication. Also your beta cells are pooped out!!
Is it just getting them to believe this not going to happen even if they lose “some” weight?
Over to you
I didn’t receive quite as many responses from the AADE list serve as I thought I would. That’s why I am opening up this article for further comments from other Certified Diabetes Educators. Please provide your most frequently asked questions and most unusual questions asked by people with diabetes in the comments section below.
As we receive new information from CDE’s, we will add them to this article.
Very informative article! I like that you added the comment by Elisabeth Almekinder, which discusses the question about what people with diabetes should eat. I didn’t realize that these people can basically eat anything, but there are things that are better for them to eat. I can see why knowing this would be important.