How Westchester Medical Center Health Network’s diabetes educators are fighting this epidemic
BY ALI JACKSON-JOLLEY
The drivers of diabetes, the single-fastest-growing chronic disease of our time, are lurking in seemingly innocuous places — in everyday foods, in overeating, in too much sitting at work, at home and everywhere in-between. Diabetes will occur in one-third of all Americans by 2050, according to the U.S. Center for Disease Control and Prevention. At the forefront of the fight against diabetes in our region are Certified Diabetes Educators (CDEs) with Westchester Medical Center Health Network (WMCHealth), who provide critical education through six diabetes programs (see sidebar). We convened four of these WMCHealth experts in the field (at right) to offer advice about managing the diabetes epidemic and insights about the nature of the disease for those who may be most at risk
What are the common misconceptions you have to correct with patients who have diabetes?
Judy Shishmanian: I have to teach them that diabetes is not a sentence of chronic health problems. I encourage people not to be afraid to get tested and not to be afraid of a positive test. The old adage: “What you don’t know won’t hurt you” is not true. What you do know can make a significant difference!
Lourdes Braadt: Diabetes doesn’t hurt. You could have diabetes, and your blood sugar could be running in the 200s (normal blood sugar or blood glucose is <99 fasting and <139 nonfasting), and it just doesn’t hurt; no bells going off telling you something is wrong. But then as your numbers start going even higher, and you start getting symptoms, for some people, some damage has already been done. So see your doctor, get your annual exam and, if you are over 40, overweight and have family history of diabetes, get your fasting blood sugar tested.
How are we doing in the fight against the pediatric diabetes epidemic in the Hudson Valley?
Annette Pergamo: While Type 2 diabetes was once a phenomenon of mainly older age, we are now seeing children as young as 12 and 13 being diagnosed with it. I think we are just starting to realize the devastating effects that this epidemic will have on our children and on society as a whole, and this has slowly been leading to new programs and services. In the meantime, we must work on identifying and screening those who are at risk for diabetes and providing the interventions needed to help them make healthier choices and prevent the development of uncontrolled diabetes. There is a strong correspondence to the increase in Type 2 diabetes and lifestyle changes — specifically that combination of both poor diet and lack of exercise. And while Type 1 diabetes was once considered the “more dangerous” diagnosis, recent research is finding that children and adolescents diagnosed with Type 2 diabetes have far worse complications at much earlier ages and at greater frequencies.
DIABETES EDUCATION AT WMCHEALTH
At Westchester Medical Center (WMC), Joanne Conlin-Kurylas works as part of the Glycemic Management Team – a unique team made up of dieticians, nursing administrators, clinical nurse specialists, and pediatric and adult endocrinologists, all of whom are focused on advancing care for diabetic patients at WMC.
Bon Secours Charity Health System houses three out-patient diabetes centers (in Port Jervis, Suffern, and Warwick) staffed by Certified Diabetes Educators, among them Lourdes Braadt—who explains that her mission is to teach her patients and families to manage (and sometimes even reverse) their diabetes through healthy eating, active lifestyles, blood sugar monitoring, problem solving, coping, and proper use of medications.
At Maria Fareri Children’s Hospital, Annette Pergamo works as the inpatient nurse practitioner, providing education, support and resources to help families better manage their children’s diabetes at home.
And at MidHudson Regional Hospital, Judy Shishmanian works within the Diabetes Self-Management Program, the only American Diabetes Association recognized outpatient program in Dutchess County.
And how are we doing in the fight against diabetes in adults?
Joanne Conlin-Kurylas: Today, 25 percent of Westchester Medical Center patients have hyperglycemia while admitted to the acute-care setting. Westchester Medical Center is being proactive in the fight against diabetes, by individualizing diabetes care for our patients. Our critical care areas use GlucoCare for patients requiring intensive insulin and monitoring.As patient conditions stabilize, diabetes control improves as varied therapies ready the patient for home. The Diabetes Educator acts as a resource to nursing staff and patients who may be newly diagnosed, have impaired glucose levels during a cardiac event, or are new to insulin therapy. The Glycemic Management Team (in place since 2012) and Diabetes Program Manager (new in July) have been fine-tuning diabetes care for these specialized patients.
Do you provide the same education for patients with Type 1 and Type 2 diabetes?
AP: The education services are very similar, because a healthy lifestyle is the core theme in the education provided for both Type 1 and Type 2 diabetes.
How can patients manage their glucose levels?
JS: Test your blood glucose every day, get regular exercise, eat healthy meals and keep getting educated. Attend a diabetes education program, or access information from sites like the ADA (www.diabetes.org). With apps such as GoMeals for smartphones, it’s easy to receive nutrition information while tracking and recording your blood glucose levels.
Is it possible to fully manage or even reverse diabetes through lifestyle changes alone?
LB: Yes! When you have been given a pre-diabetes diagnosis, you can reverse it. You can halt diabetes by being active, keeping your weight down, keeping your cholesterol down and keeping your blood pressure in place. Even when you have diabetes newly diagnosed you can bring your [glycemic level] numbers back to normal, and you can maintain it that way for many, many years.
JCK: When patients are hospitalized, typical Type 2 diabetes management changes. Lifestyle modification is strongly encouraged [healthy eating, weight management, increased activity, smoking cessation, managing stress and healthy coping]. Lifestyle modification can manage and delay progression of their diabetes.
What are some things patients can do to prevent long-term complications of diabetes?
JS: Have your eyes checked every year with an eye exam that dilates the pupils; have a comprehensive foot exam each year; have blood lipids, like cholesterol and triglycerides, checked at least once a year; and see the dentists for an exam and cleaning every six months.”
Who faces the highest risk of developing diabetes?
JS: Increased risk factors include obesity, family history and women who have had gestational diabetes. People from certain ethnic background are also at higher risk, including Asian Pacific Islanders, Latinos, African Americans and people of Indian descent. Those at higher risk should be sure to get tested regularly.
What is the best advice you can give someone who has been newly diagnosed with diabetes?
LB: If there was one thing I could tell patients to do, it is to move! Get up every hour and move around, and of course do that 20 minutes of cardio a day!
JCK: You can do this! Patients are overwhelmed. It’s not easy, but I encourage my patients to set reasonable expectations.
JS: Even a modest weight loss can make a huge difference. So while the recommended exercise goal is 150 minutes a week, I encourage people to increase activity as they are able to, so they aren’t overwhelmed.
AP: Our chief endocrinologist Dr. Richard Noto always tells our newly diagnosed patients, “Diabetes is the one disease in which you can control what happens to you.” I think this is excellent advice. Newly diagnosed diabetics should know that with proper management, they can live perfectly normal and healthy lives. They have the power to control the outcome of their diabetes diagnosis, and I think this can be very empowering for patients. •