Living with Diabetes
On the second Tuesday of every month they gather at the hospital. The time they spend together provides them with far more than the instruction they receive on topics like exercise, meal planning and proper foot care. For the men and women who participate in Carolinas Hospital System's Diabetes Support Group, they have made a choice to do something that is literally saving their lives. They're taking control of their diabetes.
Gerome Williams is one of those people. Before the 60-year-old resident of the rural St. James community in Marion County came to the group at Carolinas, he hadn't been feeling particularly well. Although he had been diagnosed 11 years earlier, he hadn't been managing his diabetes properly. It also looked like he might be developing kidney trouble, a complication that can arise from the disease. His physician referred him to the group in the hopes that Williams could learn to take better care of himself.
One of the most important steps for Williams or any diabetic in controlling their disease is to understand how it affects their body. The human body has glucose, or sugar, in the bloodstream, which comes from foods that are eaten. After foods are digested, the glucose goes into the bloodstream and will eventually provide energy to the body's cells. Before it can do this, the glucose needs the help of insulin, a hormone that is produced in the pancreas. There are two major types of diabetes. In Type 1, the body produces little or no insulin. People with this type must take daily injections of insulin. In Type 2, diabetics like Williams, the body cannot make enough insulin or is unable to respond to insulin properly. Their disease is often treated with medication, but in some cases, insulin injections become necessary. In both types of diabetes, healthy eating habits, adequate exercise and good overall care are essential. "Diabetes is one disease process that the individual must participate in and take part in their care plan. You can't do it for them," said Dr. Gerald B. Miele, an endocrinologist on staff at Carolinas Hospital System.
Learning A Better Way To Manage Diabetes
What Williams soon found out at the self management class was that contrary to what he thought, he wasn't handling the day-to-day care of his diabetes the way he was supposed to be doing. "He was just doing everything backwards," said Donna Driggers, R.N., M.S.N., a certified diabetes educator and coordinator of Diabetes Services at Carolinas. As she works with diabetics on a one-on-one basis, in group sessions and at the support group meetings, Driggers showed Williams what he was doing incorrectly. He was taking his insulin and checking his blood glucose level at the incorrect times, as well as eating the wrong foods and too much of them.
"I learned so much," Williams said about the meetings, which provide a place for participants to share common concerns. "Now, I don't eat like I used to, I don't think like I used to," he said. The retired General Electric supervisor found that half the battle was cutting down on the amount of food he consumed. He also admitted that sweets used to be a big problem. "Sugar, sugar, sugar. I'd buy big packs of muffins and then sit down and eat two at a time," he said.
Williams also discovered in the group that he was not alone with diabetes and the challenges it can present. The American Diabetes Association estimates that across the United States almost 16 million people have diabetes. The state of South Carolina ranks sixth in the country in the incidence of diabetes, and the disease has a high incidence in the Pee Dee Region. The vast majority of diabetics have Type 2, with some five to ten percent diagnosed with Type 1. Type 1 most often occurs in children and young adults, but can occur at any age. People with Type 2 usually develop diabetes after age 45, and the risk for the disease increases with age.
"Little by little, they will come for medical attention. They may say that they've been having more colds and infections, that they're tired or experiencing blurry vision," said Dr. Miele. "Eventually the cause of their symptoms will be identified; the problem is how sick they may get before their diabetes is identified. Some have come to the emergency room with blood sugar levels of 1000 or more," he said.
The normal range for a fasting (or pre-meal) blood sugar is between 70 and 120. This is determined through a blood test, a procedure that diabetics are well acquainted with since they must monitor their blood sugar on a regular basis. Williams's kit to check his sugar fits in a compact sleeve that looks like a pocket calculator. About four times a day, he pricks a fingertip to produce a few drops of blood. The blood is put on a thin testing strip, which is inserted into a meter. The number that immediately registers on the display lets him know if his sugar is within range or if an excess of food, overexertion or a stressful situation caused the level to jump too high.
Keeping the blood sugar level within range is critical to reducing the risk of complications of diabetes, which include blindness, kidney disease, nerve disease, amputations, heart disease and stroke. "The major reason you want to diagnose diabetes earlier is that diabetics have four times greater the risk of heart attack and cardiovascular disease than the average person. That clock starts ticking when diabetes starts developing and people are accumulating risk. If you start treating them earlier and get their blood sugars down to true normal ranges, then you can dramatically reverse the trend," said Dr. Miele.
Dr. Miele has found that innovations in diabetes treatment offer expanded and better options for diabetics. "It used to be that one particular drug was used to treat Type 2, and that was it. If you wanted to get fancy, you could combine a pill with insulin," he said. New medications that have emerged over the last five to ten years have allowed physicians to use a combination of drugs that in some cases can replace the need for insulin. "Combination therapy used to be unheard of, yet it's a major step because each medication attacks the diabetes from a different angle," Dr. Miele said.
Patients with Type 1 diabetes are also benefiting from new types of insulin that are being produced and different ways to take it. Insulin pumps deliver the insulin through a tube, which is connected to a needle or catheter under the skin. Instead of having to inject themselves for every dose, diabetics change the needle or catheter every few days. Some models even use a remote control device to activate the pump. "You don't have to disrobe when you want to use your pump. It's a real plus," said Dr. Miele. Insulin pens contain a ready-to-dispense dose in a compact device. "They're easily transportable and disposable, so they're convenient for the working person and for going out of town," explained Driggers.
Education Is Key To Maintaining Good Health
While research and technology have provided improved treatment options, both Dr. Miele and Driggers emphasize that understanding diabetes and being provided with adequate information about the disease is paramount. "I've seen patients labeled as having poor compliance, but they did not have a good knowledge base and for years didn't know what they were supposed to do," said Driggers. "That's where diabetic education really helps," said Dr. Miele. " I get patients who say, 'There's nothing new you can tell me, Doc.' I tell them that I have to go through a learning process on a daily basis, and I have to go to continuing education and so do they." Dr. Miele added that he sends all of his patients for nutritional counseling. "It's a lot more than diet. We always focus on diet, diet. The word 'diet' imposes restrictions. It's not a 'diet,' it's a healthy meal plan," he said.
At Carolinas, diabetic education is provided in a two-day comprehensive class on self-care, as well as in individual sessions when necessary. Driggers and the two other registered nurses in the Diabetes Services Department develop individualized plans of care for inpatients and outpatients that help them learn to effectively manage the disease and to minimize complications. Family members are often an integral part of this process. "It's very difficult for patients who have an unsupportive family. I encourage them to bring a family member or friend to the class and the support group so they also can gain a better understanding of the disease," Driggers said.
Diabetes Services also provides counseling to adolescent diabetics, patients adjusting to the use of insulin pumps and women with gestational diabetes. "They're really afraid of what will happen with their baby if they don't maintain control of the diabetes," Driggers said of the pregnant patients she counsels. "I reassure them that if they have good control of the condition, the outcome will be good for them and the baby," she said.
Regardless of the type of diabetes, adopting a healthy lifestyle is a common denominator in maintaining good health and lowering the risk of complications that can be life-threatening. To Williams, that lifestyle has become second nature, so much so that he's acutely aware of inconsistencies around him. When he attends monthly senior citizen luncheons he now pays careful attention to what he puts on his plate. He can't say the same for a number of the other seniors in attendance who are also diabetics. "So much of the food has sugar in it, and they're eating it all," he said with amazement. That's not to say that Williams doesn't crave sweets anymore. "I work it out some kind of way," he said. "I buy sugar-free cookies and go that way. I used to bake cakes, but not anymore," he said.
Williams credits the Diabetic Support Group meetings with how well he feels these days, noting, "If I hadn't gone, I don't know what I would be going through right now." He also feels compelled to share his newfound insights. "He wants to be a mentor to others, and he takes on the role of sharing his story, letting people know how better control of his diabetes has helped him," said Driggers. Williams added, "The group at Carolinas is fantastic. I just wish everyone who needs it could experience it."
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