In our series of on-going CDE voice, I had a chance to interview Phyllis Carr MS, RD, LD, CDE who is consultant at Arkansas Department of Health Chronic Disease Management.
Let’s start off by telling us more about yourself and why you choose to follow the career path of a CDE?
Well, I guess it started when I was diagnosed with gestational diabetes 44 years ago. I wasn’t told a lot about my condition or how I could help myself. I was only told that I would probably have diabetes the rest of my life. When I look back now at the non-existent treatment available then, I am happy for the changes that we have seen in the field and the information that is provided to people today. And, because I refused to accept what I was told at that time, I am still diabetes-free. It made me want to be able to teach others that there is something you can do to prevent or delay type 2 diabetes and the complications that accompany the diagnosis.
What group of patients do you work with closely, Type 1, Type 2, or a mix of both?
Currently, I am a consultant for diabetes education programs in my state, helping them to improve / sustain their programs. When I was an educator at hospitals and clinics, I mainly saw persons with type 2 DM.
How do you help your patients incorporate new technologies, such as SMART phone apps, Continuous Glucose Monitors, and the like?
Again, I do not see patients in my current job, but I do encourage the programs that I work with to reach out to new patients with the new apps that are available. Some of our programs work with CGM and are having great success with that.
How do you feel about the artificial or bionic pancreas coming out in 2017? Do you think that you will feel comfortable working with patients with an artificial pancreas? How do you think it might help the patient?
I am all for medical advances in the treatment of diabetes. I am anxious to see how they work.
What do you consider to be the most important recent research that may affect diabetes outcomes later on?
This is not REAL recent, but the findings with the bariatric surgeries in which patients’ diabetes was totally reversed independent of weight loss was a significant finding with many treatment possibilities.
A patient with new diagnosis of diabetes comes in with an extreme fear of needles, and will not self-inject or check blood sugars. How do you handle this situation?
A patient who is newly diagnosed should be focusing on diet and exercise and weight loss if indicated. I would stress that lifestyle changes can help to avoid advancing to poorly-controlled diabetes requiring insulin use.
You have a new patient referred with a new kind of insulin pump. Describe your experience with teaching patients to use their insulin pumps, and how you were able to teach them to use their new device.
I no longer work with individual patients and am not familiar with the newer pumps. We used to teach carbohydrate counting in order to use their bolus feature correctly, but with the newer models, it is much easier to calculate.
You need to plan a community health fair during Diabetes Month in November. Describe what your theme would be, who you would invite to exhibit, what kinds of events you would have going on during the fair, and how you would market it to your community.
My theme would be “Living Your Best Life with Diabetes”. I would invite my workplace as well as the local community by putting up flyers at area gathering places as well as local Health Care Units. I would ask area physicians, Weight Watchers, and community health centers to assist. We would provide prediabetes screening to the general public as well as blood glucose and blood pressure testing. I would also provide information about Diabetes Self-Management Training programs in the area.
What is one area of diabetes management that you find to be the most challenging?
Definitely motivation and changing behaviors. You can teach the principles of management to people, but motivating them and KEEPING them motivated is another matter.
What advice would you give to a patient who is struggling with consistency in their diabetes management?
I would tell them it’s OK to have an off day when you don’t eat like you should or get in the exercise you need. Just get back on your schedule the next day. It’s what you do MOST of the time that makes a difference.
You have a patient whose loved ones/ spouse is not understanding the importance of family support in managing their disease. How would you handle this situation?
I would ask them to attend Diabetes Self-Management Training with their spouse so they understand the importance of family support.