Last week I had an opportunity to interview Lea Anne Weigel RNC, MSN, CDE, VHA-CM. She talks about how she got started with CDE and shares some great tips.
First, start off by telling us more about yourself and why you chose the career path of a CDE?
My mom was a CDE for many years before she retired. When I was very young I always knew I wanted to be a Nurse. In my teenage years I got to attend the American Diabetes Conferences with her and just found my love. I began my career as a staff nurse on a diabetes floor and it fueled my passion. I have been teaching diabetes for over 21 years and have been a CDE for over 18 years of that time. I find it so rewarding so see patients and families achieve healthy goals and success with such a hard disease to live with daily. I take care of Veterans at SAVAHCS (Southern Arizona VA in Tucson) now and have for the past 12.5 years which is my true mission. So many have diabetes and it is my way to give back to them for all the sacrifice they have done for our freedom.
Living with Diabetes can be overwhelming to say the least, is there any advice you would give to newly diagnosed individuals struggling with coming to an acceptance of this disease.
The first and most important advice is to get with a CDE and get educated. Diabetes is too complex of a disease to manage with success without education. The education will take place over several weeks to months based on how the patient is doing and his level of understanding and support. A CDE can sit down with the patient and family and truly explain every aspect of diabetes management and how to be successful. As the body changes the patient will need continued education. I try to stress to patients and families that diabetes is a lifelong disease that is very manageable, it takes hard work and dedication but you can be successful. I remind them that education is lifelong and it is not a onetime session. I always meet patients where they are in their readiness to learn. When a patient is newly diagnosed it may take several weeks to months for them to come to grips with the diagnosis, if they are in denial educating them at that time might not be productive.
One of the biggest fears of those with diabetes is long-term complications. What would you recommend in order to help prevent these complications from occurring?
One of the biggest fears by all with the diagnosis of diabetes is the complications that many have seen other get. When educating it is very important to let patients know diabetes is not a death sentence and the complications can be prevented or minimized with very good control. The management is not easy but the long term rewards are great. The importance of working with the diabetes team is having a relationship that as changes in your body occur you can discuss those changes, what they mean and what are the steps to improve or slow down the progression.
Parents with children that have Type 1 diabetes have a fear of night time. This is the time of the day where they worry most about their kids dropping low during the night and not being able to catch it ahead of time. What advice would you give to these parents?
As a parent, it is one of the greatest fears especially if the parent has every experienced a low blood sugars or knew of someone that had a low with a bad outcome. The technology now days is so good with continuous blood glucose monitoring we can have alarms and other ways to notify them if the blood sugar starts to drop to an unsafe zone. The other important factor is learning the tools needed to help the child have less lows for safety. Parents want to protect their children and their children just want to be normal. The parents and the child need to understand all the aspects of low sugars, treatment and prevention.
You have a patient, who was recently diagnosed with Type 2 diabetes. They come in for their appointments and appear to be listening to your recommendations and treatment methods, but their lab work is telling you otherwise. How would you approach this patient?
I have had several patients over the 21 years of educating that have all the right answers but their lab work does not reflect what they say to me. I usually just sit down and have a true heart to heart. I try to find out if there are things I am missing that is causing them to not be successful like underlying depression, family issues, financial issues, etc. I let them know I am very concerned that they tell me all the things I want to hear but there is a disconnect. The labs are what tells me how the body is doing, if they do not improve ultimately they will pay the price for the high sugars. I try to see how I can help me, sometimes that means starting back at the basics. One of the hardest things for a nurse who wants to heal and help is watch patients make poor decisions. You can only encourage and let them know you are always willing to help. You understand how hard it is and what can I do to help them be successful.
Going from a sedentary lifestyle to a more active one is a big change for many people. What types of activities would you recommend for someone with Type 2 diabetes who is having difficulty figuring out where to start to be more active with their life?
I really discuss how activity is so important for diabetes, weight loss, self-esteem, energy, and it will help with depression as well. I ask them what they like to do and encourage them to carve out time in their routine for that activity. We look at what they can currently do and develop a plan that helps with increasing the amount of time. I let them know where they need to be based on the guidelines and together we set realistic goals to get there. I also really encourage family to get involved if willing to help with accountability. I always remind them it takes 30 days to create a habit and then they will miss the activity when they do not do it. I encourage local community centers that offer classes as well for the social aspects and accountability as well.
We’ve had a lot of questions from readers wanting to know about going low carb with either type of diabetes. What is your opinion on this?
I do not teach low carbs which is the first thing patients think if they change it will help. Many times the low carb diets are higher in fats and not healthy on the kidneys. I stress that it is a balance meal plan with Carbs, Protein and low fat. I also let patients know that the goal is to eat healthy not only for the diabetes and weight lows but to help prevent the cardiovascular complications that are so common. When educating I am very honest with my patients about expectations from the disease, risks and consequences. I never want a patient to come back and say they were not told 100% about diabetes.
John’s wife expressed to you that she is having difficulty getting him to take his medication and fears that he on the verge of having to start insulin injections. She just knows from his lack of wanting to take pills he will just refuse to take the insulin injections. What advice would you give his wife?
I would have them come in and us sit down and talk. I never assume that someone who has had diabetes for years has truly been educated correctly. I start from the basics on every patient until I get a good understanding on the level of understanding. I have found over my career so many patients who were educated at first diagnosis and so overwhelmed they did not hear or did not understand. I also from day one let patients know if they are young enough when they get diagnosed at some point they will be on insulin. Many patients feel they caused them having to be on insulin and it is their punishment. I want to have the expectations up front that diabetes is a progressive disease and eventually insulin will be needed, it does not mean you failed in your management. I also let them know that starting insulin depends on how they control their diabetes, excellent control it could be 15-20 years down the road, no controlled could be in 1-5 depending on glucose levels and other risks.
Where do you see the field of diabetes educators in the next 10 years, given all the research on the horizon.
I think it is an exciting time with so many new products and potential for an artificial pancreas which will change diabetes management. We are getting so much better with the options for managing this disease and there have been so many positive changes in the last 21 years. I believe we are trying through research to educate more effectively and make managing diabetes not so life altering than in years past.