Interview with certified diabetes educator Suzanne S. Laws from Florida’s Children Medical Services, Panama City, FL.
What made you decide to get into the career path of a CDE?
I took a job teaching college after I received my master’s degree as I could not get a job in Tallahassee as a clinical dietitian. I had a blind student in one of my classes who could not read Braille and I had to read all of her assignments to her as well as the tests. I became close to her and learned that she was blind as a result of diabetic retinopathy. She and her parents had no diabetes education, only taught survival skills. My interest was piqued and I had the opportunity to get involved in a pilot project diabetes education program sponsored by the Center for disease Control in Valdosta, GA.
Are you connected to diabetes personally, via a family member or yourself?
My mother was diagnosed, by me, with diabetes at 70 year of age. My husband was the last of four sons to be diagnosed with diabetes. He we diagnosed eight years late than his twin brother. His grandmother died from a diabetic coma. She was in the hospital with pneumonia and there was no mention of her having diabetes on her chart.
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You have a newly diagnosed patient with Type 2 diabetes, they are feeling a bit over-whelmed with everything and want to know what they can do to reverse it or get rid of it. How do you answer them?
Once you are diagnosed with diabetes, you can control it; but you cannot reverse it or get rid of it. I know there is a lot of information for you to learn, but we can take one step at a time beginning with the things you need to know to survive. As you get more comfortable with your management plan, we will build your diabetes management portfolio.
What would you tell a patient with type 1 diabetes about adjusting insulin for higher fat meal?
It would depend upon the patient’s insulin regimen and the percentage of fat calories in the meals. If the patient is consuming a meal pattern that consists of more than 40% of the calories from fat and they are on a basal/bolus insulin regimen, I would work with them in adjusting the insulin for the extra fat. I would teach them the TAG method.
Could you explain to our readers more about being prediabetic, what this means, and what they should do if their doctor tells them they are prediabetic?
Having prediabetes means that you may be at a greater risk of developing type 2 diabetes in the future. The Diabetes Prevention Program demonstrated that intensive lifestyle changes could reduce the incidence of developing type 2 diabetes by as much as 58% over a 3-year period of time. Your physician can refer you to one of the Center for Disease Control’s National Diabetes Prevention Programs in your area. One of these programs will arm you with the necessary information regarding healthy eating, and active lifestyle and medication that can help you become healthier, and possibly, avoid developing type 2 diabetes later in life.
You have a patient who isn’t able to afford their testing strips. They are given some expired ones from a family member and ask you about using these and their accuracy. How do you answer them and how would you guide them for getting?
I would discourage them from trying to use expired strips. I would find out if they have any health insurance that might cover the expense of a glucose meter and strips. If they do not have insurance, I would refer to them to a free clinic in the area where they could get these supplies.
Your patient has been working to lose weight unsuccessfully, they have type 2 diabetes and come to you asking for advice and approval on starting a vegan diet. How do you answer?
First of all, I would assess their eating and activity patterns for the past few months and see if we can figure out why they have not been successful in weight loss. I would go over the current medications they are taking to see if any of them present a problem with weight loss. I would inquire as to why they are considering a vegan meal pattern at this time. Do they think a vegan meal pattern will make them? successful in weight loss? After a thorough assessment, I would then determine if I thought they would be more successful losing weight on a vegan meal pattern or making adjustment to their present meal and activity patterns. If they are determined to switch to a vegan meal patter, then I would instruct them how to successfully follow a healthy vegan meal pattern.
Many diabetes patients both type 1 and type 2 use carbohydrate counting in them diabetes management. What about the Gl Index and would this benefit both types of patients if introduced into their diabetes management plan? If so, how?
First of all, you cannot calculate a bolus dose of insulin busing the glycemic index. If you are using carbohydrate counting to calculate bolus insulin doses, I would assume that you are on a basal/bolus insulin regimen. If you are not on a basal/bolus insulin regimen, then you must be using carbohydrate counting to either limit carbohydrate to a certain amount or using it to make sure you are consistent with carbohydrate content of each meal. The glycemic index can be used to choose more low glycemic food over high glycemic ones. You have to be careful when looking at the glycemic index of different foods as some foods that have a low glycemic index are not necessarily the most healthful ones to choose.
The glycemic index of a food changes with the variety of that food, the freshness of that food, the cooking method used, and if that food is eaten alone or in combination with another food. The glycemic load is more helpful for meal planning. The glycemic index can be a tool to use to help improve upon your meal pattern, but it cannot replace carbohydrate counting for calculating bolus insulin dosage.
Are there any supplements/vitamins you recommend for both type 1 and type 2 diabetes patients to take?
Unless there is lab work to show an underling deficiency of a particular vitamin or mineral, I do not recommend supplementation. If an assessment shows the patient is taking metformin and is not taking a vitamin B12 supplement, I would recommend that. At this time there is not sufficient evidence to support the indiscriminate use of vitamin/mineral supplementation.
Could you please explain to our readers the importance in protein in blood glucose control?
First of all, I would like to say that diabetes is not only a disease of carbohydrate metabolism; but also, a disease of protein and fat metabolism. Everything are interrelated. You must have adequate protein intake for proper growth can cell maintenance. Dietary protein appears to increase insulin response without increasing blood glucose concentrations. This is one reason that hypoglycemia should not be treated with a high protein food source. Dietary protein may influence glucose metabolism by altering insulin and counter regulatory hormone secretion.
Are people with diabetes at a higher risk for oral problems such as gum disease and tooth decay? If so why is this and what can they do to reduce their chances of developing it?
People with diabetes are at a higher risk for oral problems because elevated blood glucose contributes to all of these problems. The mouth is the perfect place for bacterial growth due to the temperature and moisture. When you blood glucose is elevated it can promote bacterial growth in the mouth which contributes to tooth decay and gum disease. Everyone with diabetes should receive annual assessment by a dentist and practice good dental hygiene at all times.
A patient’s adult child comes to you with concern that their parent isn’t taking their medications properly or testing as much as recommended. How would you handle this situation?
I would thank the person for letting me know this and discuss with them how they they think this problem should be approached. I would recommend a joint session with the patient and adult child and discuss changes that could be made to the patient’s diabetes management plan that would increase more success in taking medications and testing. Perhaps all that is needed is to find ways to remind the patient to take medications properly and test as prescribed.
A patient with type 2 diabetes has asked you how they can avoid being put on an insulin treatment regime. How do you respond?
I tell patient with type 2 diabetes from the beginning that they have a progressive disease and it they live long enough; they will probably need insulin at some point to have good blood glucose control. I point out that living long enough to require insulin is preferable to the alternative of not living. People with type 2 diabetes who require insulin are not failing in their diabetes management, they are taking ownership of it and managing it well so they can live a long, healthy life.