Today I was able to interview Marielena Cid, RN, CDE, BSN, PHN, the Eisenhower Medical Center’s Diabetes Program Manager. Marielena was kind enough to speak with me about her experience in diabetes patient care.
Start by telling us about yourself and what your interests are related to diabetes, or if you, yourself are affected by diabetes personally or through a family member?
I have been a nurse since 2004 and I became a diabetes educator in 2009. Received my BSN in 2012 and currently working towards my Master of Science Degree, Diabetes Nursing at Capella University. I anticipate that I would be graduating in 2018.
I personally do not have diabetes but my Mother has diabetes for over 15 years and she is on dialysis. Unfortunately, diabetes educators cannot always help their own family. I love helping people with diabetes. I believe that I am able to provide a valuable service for the diabetes community that truly needs and wants help. Working with the diabetes community, is very rewarding.
What is your area of expertise in Diabetes?
My role as a diabetes educator is to teach my patients on a 1:1 meeting or a group class about how to manage their diabetes. We follow the American Diabetes Association Guidelines.
My role as a CDE is to teach glucose meter and insulin training, and train patients how to use their pumps as a Certified Pump Trainer. I am the only one at the hospital if not in the Coachella Valley, that is an expert in Insulin Pump Training on all 5 insulin pumps. I am also the manager now at the Diabetes Education Program at EMC and it is my responsibility to make sure that the program is meeting the ADA guidelines for recognition by submitting reports required by the ADA. I manage RN, CDEs a Registered Dietitian and a secretary. That is now my expertise in diabetes management also.
What are some challenges you have experienced while working with Diabetes patients?
It is always challenging to see a patient that has diabetes for a long time and is still struggling with accepting the diagnosis and not taking diabetes seriously. Many have misconceptions that they had carried over from generation to generation and it makes it very challenging for us to help.
Many patients show up to see us and already have diabetes complications that could have been prevented. It always makes me very sad to see that. Obviously nurses have many roles and one important one is to find a way to provide psychological therapy to help the patients and the family. Helping them by any means to understand the seriousness of the disease is extremely important.
In reference to family support, what would you tell family members just learning about their loved one’s diagnosis?
I usually let the patient know that diabetes is a very serious disease and that they need to take it very seriously even if they don’t feel any symptoms. To the family, the sooner they accept their loved one’s diagnosis the better for the family. Having family support is crucial. This is a disease that affects the entire family. By supporting the family member with diabetes, attending diabetes education and learning how to make a healthy lifestyle change, they can all benefit. The ones that don’t have diabetes can prevent it by making small simple lifestyle changes. I refrain from telling people right away about diabetes complications. I usually wait until they are ready to hear it. However, many need to learn about it right away.
Give an example of a time where you constructively dealt with disappointment, and turned it into a learning experience.
Having seen many patients on insulin pumps and not having the means to help them, became not only disappointing but dangerous with this group of people. I knew that I need to do something so I had all the pump reps certify me on insulin pump therapy and now I have a monthly insulin pump class open to the community. I have been helping so many now with insulin pump therapy. When they are well trained and understand the diabetes process and how to use their insulin pump, they can manage it so much easier.
What made you decide to choose the career path of a CDE?
I ended up in the diabetes education department due to health reasons. I needed less stress than working at the bedside. I had to hit the floor running when it came to learning about diabetes as the diabetes coordinator was retiring and they needed an educator fast. I learned how to teach patients with diabetes first and then diabetes became my passion. Deep down I thought that if I could not help my own mother who was spiraling out of control, then I need it to try to help as many people as possible so they didn’t end up like my mother. As a nurse, I am committed to help others no matter what and I truly enjoy doing that.
What is/are the most important elements of consistency in Diabetes management and control?
Checking blood glucose, maintaining the hemoglobin A1c within normal range, following a healthy balanced and individualized meal plan, getting physical activity, taking medications if necessary, and dealing with emotional and social issues right away at the time of diagnosis is extremely important. I think that convincing the physician that the patient should be starting insulin if their A1c is high, is a very important element of managing diabetes. Unfortunately, we still struggle with that and patients delay treatment and end up with serious problems.
What would you say are the best methods of treating a low blood sugar?
Number one, check blood glucose and treat with 15 grams of simple carbohydrates (such as juice, pop, tbsp of honey) if glucose is below 70 mg/dl even if asymptomatic. Wait 15 minutes and recheck glucose always! It is very important to follow the rule of 15/15. Many times patients only treat low glucose if they have symptoms and most of the times forget to re-check. There are so many poor habits that people develop with time that gets them in trouble and sometimes very serious trouble. This is a very important component that we stress in our diabetes education program to prevent accidents and hospital re-admissions and even prevent deaths.
What is one area of diabetes management you feel is the most challenging?
I think that finding the motivation that patients need to make a lifestyle change and change their eating habits. No one likes change, and dealing with diabetes makes it one hundred times more challenging. Enabling them to take responsibility and take control of their diabetes by attending Diabetes Self-Management Education and seeing a Registered Dietitian is crucial.
Especially when newly diagnosed. Getting people to attend annual follow up visits to refresh on diabetes management, and updating them to newer information is very challenging. Unfortunately, many don’t come back to see us for years and they have many issues from uncontrolled diabetes by the time we see them again.
What would you say to someone struggling with coming to an acceptance about having this disease?
That it is going to get better. Do not restrict carbohydrates too much. It can be difficult to manage this disease alone and they would benefit from family and friends support. Do whatever it takes to get diabetes under control as soon as possible. Do not wait too long to accept the diagnosis as it could be very dangerous.
What advice would you give to a parent having difficulty with their teenage child who has Type 1 diabetes and has been sneaking food and not properly bolusing/ giving insulin for the food?
The best thing is to stop telling a teenager what to do. With family its difficult because they are always arguing about what they need or should be doing and they don’t get anywhere. Also, you are not going to help by being the food police or being in their face about what they need to do. That rarely works. They may not listen to a family member but if you can convince them to attend diabetes education or see the dietitian, they may be more receptive to education they need. If teenagers have a good relationship with their diabetes educator, it would make it a lot easier to help them with their insulin management. Educators use psychology which works well sometimes without them even knowing it. Meaning that we figure out how to get them to do what is important for them at that time such as getting them to inject insulin. As health care professionals, we can figure out ways of dealing with a teenager, you need to leave room to negotiate.
Marielena Cid, RN, CDE, BSN, PHN
Manager, Diabetes Program Eisenhower Medical Center
39000 Bob Hope Drive Probst 100-B
Rancho Mirage, CA 92270
760-837-8718 Ext: 8718