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How Education Can Support Your Diabetes Journey

Guest Bio: Nancy Peeler, RN, BSN, CDCES
Nancy Peeler, RN, BSN, CDCES, is a Certified Diabetes Care and Education Specialist (CDCES) at the Riverside Diabetes Wellness Center in Bourbonnais.
    How Education Can Support Your Diabetes Journey
    Nancy Peeler, Certified Diabetes Care and Education Specialist at Riverside Healthcare, leads an informative discussion on diabetes.

    Gabrielle Cinnamon (Host): Welcome back to the Well Within Reach podcast brought to you by Riverside Healthcare. I'm your host, Gabby Cinnamon. And today, Nancy Peeler, a Certified Diabetes Care and Education Specialist is joining me to talk about diabetes and the Riverside Diabetes Wellness Center. Thank you for joining me today, Nancy.

    Nancy Peeler, RN, BSN, CDCES (Guest): Thanks for having me.

    Host: So you're a Certified Diabetes Care and Education Specialist, as I said, can you talk about what that means and what your do?

    Nancy: So we, as education specialists, we deal with people with diabetes, trying to help inform them what to do, how to learn what the disease means, how to take care of it, what the red flags are. And so all the accompanying care that might possibly go with that. The vast majority of what we do is, education, of course, which goes in the name. So, that makes sense, right? But, we could also be doing with that, it could be teaching someone who's brand new or had diabetes for years and years all about what to do with it, as well as some prevention things for trying to prevent diabetes.

    We can teach people about the equipment that goes along with diabetes, like using sensors or insulin pumps, or even community events for helping people to understand diabetes so that we can try to manage it well, once we have it or even prevent it so that we don't have to manage it.

    Host: Okay. So it sounds like there's a lot that goes into your role. That's awesome. And kind of back to your phrase, that you said at the beginning. Can you tell us what diabetes is? Because, just the exact phrase some people don't really know.

    Nancy: Sure. It's a disease, I should say where the pancreas doesn't work right. Now, the pancreas is an organ that causes our body to have insulin and insulin opens the cells and lets blood sugar get from the bloodstream into the cells. Cells need energy. And so if they don't get that glucose, then it can't do its job and damage can happen. So, the complications that go along with diabetes, like blindness, heart attack, strokes, sexual dysfunction, kidney failure, amputations, nerve damage; those are all related to those cells not getting fed over the course of time. But if someone kept their blood sugar controlled, that means those cells are getting fed and the damage isn't happening, their risk is no worse than someone without diabetes.

    So that's why we want to try to prevent the problems. If someone can learn what it is and how to prevent it, then that's what we want for them, a longer, healthier, happier life, without the problems that go along with it.

    Host: All right. So with the right tools and education, it sounds like before it wouldn't escalate to those other problems that you had talked about, the more severe ones. So are there different types of diabetes? And if so, can you talk about the difference between them?

    Nancy: The main three are Type 1, Type 2 and gestational diabetes. As I said, the pancreas is what gives us insulin, but if it just stops working, typically an auto-immune response, but not always, but typically, that's called Type 1 diabetes. So of course, if someone doesn't make any insulin, they have to have injections to survive. Type 2 diabetes is they still make insulin, but not enough. So that's the big difference, Type 1, no insulin. Type 2 still has some. Type 2 might be someone that is on pills. They might be on insulin injections, or they might just be on lifestyle, having their blood sugars controlled with how they exercise and eat and just how they manage their stress, the whole nine yards with that. Someone with gestational diabetes is because of pregnancy. During pregnancy, the blood sugars go up with all the increased hormones during the pregnancy. What happens typically is a woman produces three to six times as much insulin during pregnancy.

    And if she can't, well, then her blood sugars go up and she gets diabetes. After the baby's born, those hormones go down. So, so do the blood sugars and the diabetes goes away. Unlike Type 1 or Type 2, but she is a high risk for Type 2 later on in life. So we teach people with gestational diabetes about what it is and, and then the things they can do to help prevent it later or try to prevent it.

    Host: Oh, wow. That's really interesting that gestational diabetes could lead to Type 2 later on. That's really interesting to hear. I feel like recently kind of we've been hearing about pre-diabetes. Can you kind of explain what pre-diabetes is?

    Nancy: Pre-diabetes is, sometimes you hear the term borderline diabetes, but we laugh. I laugh when people say that it's like, hmm, it's kinda like being borderline pregnant either you are or you aren't. You know. Just doesn't really, it's not really a great term there. So pre-diabetes is that place where you're almost at diabetes, but you're not quite there. So, let's talk about diagnosis, how someone could say, whether they have diabetes or not.

    If a fasting blood sugar is normal, it's less than a hundred, but if it's 125 or above, that's considered diabetes. So if they're in that area of 100 to 124, they're in that prediabetes range of, oops, there could be a problem. We need to watch this carefully or else we're going to go into Type 2. Other ways to diagnose an A1C 6.5% or above. Normal is considered less than 5.7.

    So if it's between that above 5.7 and 6.4. That could be pre-diabetes. So, those are some things that if we see that, we talk about insulin resistance and how we can prevent it try to keep it at bay as long as possible.

    Host: So let's say, you know, someone goes to the doctor and they've had lab work done, and it shows, the numbers that you talked about, that it could be borderline, the phrase you don't like, pre-diabetes; what can a person do to kind of get themselves out of that range and back into the normal range where they no longer be pre-diabetes?

    Nancy: So there's this thing called insulin resistance and insulin resistance is where even though insulin is present, it's not able to open those cells like it's supposed to. It can't unlock them. So even though the insulin's there, blood sugars are still high. Cells are still not getting fed. Damage is still happening. The things that cause insulin resistance are the lifestyle items that make a big difference as far as managing blood sugars once you have diabetes, as well as trying to prevent it.

    So the things that it cause it, things like smoking, that can make your insulin resistant. So there's a lot of things smoking do, including making your blood sugars higher. Inactivity, you want at least 150 minutes a week. That's about 30 minutes, five times a week of movement, exercise, whether that is doing yard work or cleaning the garage or going to the gym or walking, movement, dancing with your grandkids, some kind of movement.

    That helps a lot. Also our waistline makes a difference. For women, if your waist is 35 inches or less. That's where insulin works its best. For men, 40 inches. And guys, it is not your pants size. It is where your, where your belly button hits. The pants size are often, much smaller than your waistline.

    So that's where you, so measure it with a measuring tape at your belly button. And that should be less than 40 inches. And then lastly, stress. Stress can make your insulin more resistant. Either emotional stress. You're mad. You're sad. You're overwhelmed. You're angry, upset or physical stress. You're in pain. You've had surgery. You have a wound, you have a cold, you have sleep apnea. You're not wearing your mask. Any of those things can make your blood sugars go up because of insulin resistance. And by the way, stress can make your liver dump in more sugar into your bloodstream and make it higher that way too.

    Host: Oh, wow.

    Nancy: So, the liver can dump in sugar from stress. If you go too long without food, if you skip meals. So, breakfast really is the most important meal of the day. And, or, some people just three in the morning, the liver dumps in sugar. So there's a lot of factors going on there.

    Host: So someone let's say, has they move from that prediabetes range to diabetes; can you talk a little bit more about the complications you mentioned in the beginning that can result from diabetes, if you're not able to manage it on your own or maybe, your medication isn't doing what it's supposed to?

    Nancy: So prevention is huge. If you can keep those blood sugars controlled, then that means that those cells are getting fed, damage is not happening. But along the way, some of that damage, a lot of that damage, you don't know it's happening. For that reason we want to have our eyes checked every year. Blindness, diabetes is the number one cause of it, of new blindness. Kidney failure. Diabetes is the number one cause of kidneys going bad, and you don't know it except by looking at labs. So having that checked a urine test might called microalbumin and then some blood work, can also show information, checking your feet every day. You can lose a foot, so, check your feet every day to make sure they're healthy, that there's no problems. Every year have your cholesterol checked. ABC's of diabetes, A1C, blood pressure, cholesterol. They all work hand in hand. So sometimes I talk to people and they're like I'm in the hospital for chest pain. I don't need to talk about diabetes. And I'm like, no, those are very much related. And so people don't realize how much diabetes just really affects every part of their body.

    Host: Wow. Yeah, it does sound likeit can be impacting things that you might not even think about. So many health related things, that you find are connected and which is crazy to think about.

    Nancy: Yeah. And that's why so many people walk around with diabetes don't even know it. So, have it checked every year. See what your glucose is doing to make sure that you catch it early on and can prevent these problems.

    Host: Can you talk a little bit about what hypoglycemia is and what hyperglycemia is?

    Nancy: Sure. So hypoglycemia is defined as a low blood sugar, a blood sugar, less than 70 by definition. Hyper means high, you're above goal. So, there's definition for where we want to keep a blood sugar for diagnosis. We talked about that a moment ago, but then once we are diagnosed with diabetes, there's some different goals.

    The American Diabetes Association's goals for blood sugar before meals is 80 to 130 or two hours after meal, less than 180. Why after, because it takes about two hours for your body to process that food, blood sugar go up and start to come back down. So two hours after you eat, it should be less than 180. That's what we're looking at. If we're running above that. Well, that's hyperglycemia. So, some symptoms you might see with that are thirsty, dry skin, frequent urination, hungry, tired. If you have those symptoms, check your blood sugar. See what's going on. Drink some water, flush it out. Go for a walk, try to bring it down.

    Think about why it's high, did you eat too many carbs? Are you having more stress? Are you feeling sick today? You know, what's making it go up. Try to correct the problem. And if it's always up, talking to your doctor, trying to figure out what maybe some medications need changed or something needs to be done.

    So the reason we don't let blood sugars just go crazy high is if it went really high, you go into ketoacidosis and stop breathing. We don't want that. So that's hyperglycemia. Now hypoglycemia. Common symptoms for hypoglycemia, again, defined as blood sugar less than 70 means some common symptoms are that you are dizzy. You might feel shaky, irritable, confused. If it got low enough, you could pass out. You could have seizures, you could die from that too. So we don't want too low. We don't want too high. So, if you had those symptoms, the first thing you want to do is check your blood sugar. You never ever go by how you feel, because how you feel can be off. You might feel like it's low when it's not. You might feel like when it's high, it's not. So you have to go by the blood sugar check. If it's less than 70, we want to do, what's called the rule of 15. You want 15 grams of fast acting carbs that works in 15 minutes. So, you don't eat food. You don't sit down and have a meal. Instead you have something like four ounces of juice or four ounces of regular pop or four glucose tablets, or a tablespoon of sugar, 15 minutes later, rule of 15, 15 grams, 15 minutes, check your blood sugar. If it's above 70, then in the next hour, you want to eat a meal.

    If you're not going to eat in that time, period, if it's longer, you want to snack so your blood sugar doesn't drop again. So snack is some protein and 15 grams of carbs, like a half a sandwich or piece of fruit and cheese, four peanut butter crackers, something just to keep you from dropping until the next meal.

    Host: So would you say maybe people who have, have a diabetes diagnosis, do they learn, over time when they might be having, hypoglycemia or hyperglycemia, do they kind of recognize when that might happen or does it just depend on a situation?

    Nancy: Sometimes yes. Sometimes no. Sometimes people go low so often they don't feel it anymore, which is really dangerous. Some people go high so often that they actually feel better when it's high. I've heard people say to me, Nancy my normal is 200. No, that is not normal. That's where their body's used to it. And they might actually feel better, but they're still having damage to their body. Those same folks when they get down to 80 to 130, they're like, oh, I feel terrible. This is really low because they haven't felt it in so long. So, that's the reason you can't go by how you feel. You got to go by the numbers.

    Host: Yeah, that's really good to know. I just was curious because kind of having family members who have had diabetes and sometimes they could be like, I can tell when this is going to happen. But other times and times, as you said, I might feel like they didn't realize that this was going on. So, that's really interesting. Kind of like you've been talking about this a lot for people who have had a diabetes diagnosis is the education piece. Can you talk about how and why education can help someone with a diabetes diagnosis, even if maybe they've had this diagnosis for a long time, how education can help them?

    Nancy: Oh yeah. We have people come through all the time. Especially people who have had it like 20 plus years and are like, oh, I wish I'd known this so long ago. So our group classes, are a mixture of different people. We have group classes and individual classes but the groups, small groups like six people at the most. But some of them have come through, they're like, I wish I would've known this. Others are brand new and they're at a good spot where they can prevent a lot of problems. But you know what, for day to day, who's there if the problems, it's the patient, right who's going to be suffering if something doesn't go right. It's the patient, it's the person. So, they need to know what to do in situations, know what they can do on their own. No when they need to get help. And so we teach all of that, just a complete, comprehensive, series of classes. So, like if someone came to us and we had classes, and they went through the whole series, there's an assessment, which is just us asking them questions, checking their feet, doing measurements, all of that. There's three group classes, health and diabetes basics and advanced nutrition. And then there's two, one hour individual meetings with a dietician for their own meal plan. Cause everybody's different. And a follow-up to make sure it's going okay.

    So it's comprehensive. But people say it goes fast. We like to have fun. And we try to use a variety of teaching options, you know, so that it makes it a little more entertaining as we go. And we get really good results with that. And so then people know what to do and they're armed and then they can come back every year if they wanted to for just a refresher individual class, you know, for a couple of hours and meet with a dietician. And, we just have a lot of options available for that.

    Host: That's great. It sounds like there's something to fit everyone, kind of what you're looking for, which is amazing. Cause as you said, everyone's different, so they might need education in other aspects and less than another. So, can you explain how someone gets a referral to the Riverside Diabetes and Wellness Center?

    Very simple. Just ask your doctor to send one. So they would send a referral to the Riverside Diabetes Wellness Center. From there our staff checks your insurance, calls you up, lets you know if there's a copay, if not, or if any at all. And then, get you scheduled to start in.

    That's a very easy process.

    Nancy: I know. It's so easy.

    Host: Is there anything else you would like to add?

    Nancy: I just want to make sure everyone realizes that a little bit of education can go a very long way and, people are constantly commenting how much they learn and how much they wished they'd come sooner. And, it can be transformational, really.

    Host: Thank you so much. And that's a great place to end off on and some very great words to end on as well. So it sounds like the Diabetes Wellness Center is a great resource for those with a recent diabetes diagnosis or even someone who's had that diagnosis for a long time. So thank you so much, Nancy, for joining me today and sharing all this very important information. I really appreciate it.

    Nancy: Thanks Gabby.

    Host: And thank you listeners for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare. For more information about the Diabetes Wellness Center, visit Riversidehealthcare.org or call 815-936-6515.