Think you know Diabetes? Think Again

Interview questions:
Gwen Rogerson,MPH,BSN,RN,CDE

1. First, I found some of the statistics given in your talk on diabetes eye opening to say the least. Could you briefly give a few of the stats on the prevalence of diabetes both nationally and in Polk County specifically?

There are 23.6 million people in the U.S. with diabetes. 5.7 million out of the 23.6 million people with diabetes are unaware they have diabetes. There are an additional 57 million people in the U.S. who have pre-diabetes.

In Polk County alone, there are 55,000 people with diabetes. The lifetime risk of developing diabetes for everyone is now estimated to be 1 in 3.

2. In your work at LRMC, how many diabetics do you see a week and have you seen this grow over the past several years?

On the average we see approximately 60-80 in-patients a week. However approximately 1/3 of the patients on any day in the hospital has diabetes. Due to the large number of diabetics in the hospital, the diabetes educators focus on seeing patients: newly diagnosed with diabetes, new to insulin, wearing insulin pumps, referred by the physician, pregnant with diabetes including gestational diabetes, and admissions with diabetic ketoacidosis.

We have seen a large increase in the number of consults we are receiving for new diabetics as well as patients on insulin pumps. The bedside nurses educate the other diabetics in the hospital. Other than in-patients, we also see out-patients for more intense education on a one-on-one basis as well as group classes.

3. Dealing specifically with children, have you seen the number of new cases increase in younger populations? If so, please speculate on the factors behind this?

Statistics show an increase in the number of children world-wide who have diabetes. The biggest change over the years is the type of diabetes that children are being diagnosed with.

We used to only see children diagnosed with type 1 diabetes. Now frequently children are diagnosed with type 2 diabetes. Some of the reasons that have been given for the increased risk of type 2 diabetes in children besides family history are increased weight, nutrition habits, and sedentary lifestyle. 3 major factors of the sedentary lifestyle include limited physical education in school, the amount of television children watch, and the amount of time spent on a computer.

4. Please briefly describe the various types of diabetes and how they are acquired?

The 3 main types of diabetes are type 1, type 2 and gestational diabetes. In type 1 diabetes, the pancreas quits working and the person is required to take insulin every day in order to live. Type 1 used to be called juvenile diabetes. They really are not sure what causes type 1-some of the theories are that it is an auto-immune disease brought on by a virus.

When a person gets type 1 diabetes, they get very ill very fast and usually end up in the emergency room. Only about 10% of the population has type 1 diabetes. In type 2 diabetes, the onset is very gradual and usually runs in the family. Type 2 diabetes occurs in approximately 90% of people with diabetes.

It can take up to 9 years to develop symptoms of type 2 diabetes. This is why it is so important for people over the age of 30 and with a family history of diabetes to get their blood glucose checked once a year. Often by the time a person is diagnosed with type 2 diabetes, complications have already occurred.

The other type of diabetes is gestational diabetes. This occurs in pregnant women usually around 24-28 weeks gestation. In gestational diabetes, the blood sugars go back to normal after delivery. Unfortunately, the woman sometimes has undiagnosed type 2 diabetes prior to getting pregnant. In this situation, the diabetes does not go away after the baby is born. Women with gestational diabetes have up to a 60% chance of developing type 2 diabetes 5 to 10 years after delivery.

5. What are some factors which may qualify someone as at risk for diabetes?

The main risk for type 2 is having a family member who has it. Once that risk is present, being overweight and not exercising increases their risk even more. We have a lot of overweight patients and a lot of patients who do not exercise that do not have diabetes.

We also have patients that are the perfect size, exercise every day, and still get diabetes. Diabetes does not discriminate. Family genes seem to play a big part with type 2 diabetes. However if you do have a family history of diabetes, watching what you eat and exercise can often delay and/or prevent diabetes.

6. For those at risk of diabetes, how often do you recommend being checked?

If the person is over the age of 30 and has a family history, at least once a year. And I would recommend being checked if symptoms develop.

7. One stat which stood out to me in your talk were the number of individuals who do not know they have diabetes. What are some of the symptoms associated with this problem?

I cannot emphasize enough not to wait for symptoms to present themselves since it can take up to 9 years to develop symptoms. The symptoms of diabetes are increased thirst, frequent urination, blurred vision, feeling tired all the time, nausea or hunger, wound that will not heal, and with women, frequent yeast infections.

8. How long does it take for "pre" diabetes to become full blown type 2?

This is one of the areas where nutrition and exercise can make a huge impact. Many people develop type 2 within a year. What is really scary is that people with pre-diabetes are at the same risk of complications as people with diabetes.

The guidelines for diagnosing pre-diabetes and diabetes have recently changed. Hopefully people are being diagnosed much earlier now. The earlier a person is diagnosed, the better chance they have of making changes to prevent complications.

9. In your talk, you mentioned that blood sugar is unaffected by food if you are not at risk for diabetes. Could you please elaborate on this idea?

I am often told by people that they were misdiagnosed with diabetes because they had just eaten a huge meal or a large piece of cake or just gotten off vacation. My answer to them is that when you do not have diabetes you can eat whatever you want and your blood glucose is still going to be perfect.

When diabetes is not present, the pancreas makes enough insulin to cover whatever you eat. You could eat a whole chocolate cake by yourself (I do not recommend this!) and your blood glucose would still be perfect if you do not have diabetes.

10. In looking at the way blood sugar is affected in diabetics, talk about the
logic behind counting carbs versus sugars when looking at ones diet?

Advertisements for foods can be very tricky. Carbohydrates raise a person’s blood glucose when they are diabetic. Often labels will read no sugar added but the food has natural sugar that includes carbohydrates. Our nutritionist tells patients to not even look at the sugar part on the label.

A good serving size is going to be approximately 15 grams of carbohydrates. The general recommendation for most people is to eat 45-60 grams of carbohydrates a meal and many men are told as many as 75 grams a meal. A nutritionist, preferably a registered dietitian, can individualize the amount of carbohydrates. Anything that says diet is usually more expensive and the regular food might actually have fewer carbohydrates. We always teach our patients the importance of reading labels.

11. Please describe treatment procedure for someone who has been newly diagnosed with diabetes.

When they are newly diagnosed at the hospital, they are usually seen by a diabetes nurse educator as well as nutritionist. We are more concerned with the basics at that point including how to test their blood sugars, medications they will be on, what to eat, importance of exercise, how to take insulin if needed, and when to call the MD with blood sugars.

Then when they are feeling better, we encourage them to attend out-patient diabetes class for a more in-depth education. Our out-patient classes consist of a 1-hour individualized appointment with the diabetes nurse educator and dietitian, followed by a 9-hour group class. We offer out-patient group classes twice a month. Times vary including three 3-hour sessions in the morning, afternoon or evening, as well as an all day class.

12. Please give some general recommendations for controlling diabetes with fitness/nutrition?

We are thrilled when our patients are already exercising when we see them. We encourage some type of activity for at least 30-45 minutes at least 3-4 times a week. Some of the cardiac groups are encouraging at least an hour 7 days a week.

Our major push at the beginning is just to increase their base-line activity. Exercise has many benefits for our patients with diabetes including: lowered blood glucose for up to 24 hours, reduced stress, increased weight loss and improved cardiac function. As for weight loss, just losing 5-10 pounds improves insulin sensitivity of the body which usually results in less need for medication.

13. For those who may be at risk of diabetes, please provide some information on
the services offered at LRMC and how they may be of benefit to readers?

The out-patient classes previously discussed are recognized by the American Diabetes Association which means we have strict guidelines that we adhere to. Most of our educators are certified diabetes educators. We also offer individualized classes for gestational diabetics, diabetes with pregnancy and Spanish speaking patients.

We offer a Diabetes Support Group in collaboration with Watson Clinic that is held once a month from October through May and alternates between Lakeland Regional Medical Center and Watson Clinic. There are approximately 100 people who attend each support group meeting. More information on diabetes class and support group can be obtained by calling (863) 284-1604.