Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And today, we're exploring type 1 and type 2 diabetes. Joining me is Shelli Calhoun. She's a registered nurse and a diabetes educator at Prairie Center Medical Clinic, Grand Island Regional Medical Center.

Shelli, thank you so much for joining us today. I'd like you to start by telling us what diabetes is. We hear about it so much now.

Shelli Calhoun, RN: Thank you for having me, Melanie. Well, diabetes, it's a condition where your cells can't use the glucose that's swimming around in your blood, and it can cause high amounts of glucose or sugar in the bloodstream, and the cells aren't getting the energy that they need.

Melanie Cole, MS: So, it's a disease where the body is not able to make or process what we need. Now, this is insulin that we're talking about. Can you explain to the listeners a little bit about insulin, what it is?

Shelli Calhoun, RN: Well, insulin is a hormone. So, it's a messenger. And in this case, it's kind of like a key to unlock the cell so that the cell opens up for the glucose and that provides the energy for the cell.

Melanie Cole, MS: So Shelli, we hear type 1 and type 2. Tell us what the difference is between type 1 and type 2. Why do they have different names? What's different about them?

Shelli Calhoun, RN: Type 1 is where your autoimmune system kicks in and sees the beta cells on your pancreas as a threat, and it attacks and kills the beta cells. The beta cells are what produces the insulin. So once that happens, your body is no longer producing the insulin, so the cells aren't going to open up and allow the glucose to come in to be used for energy.

So type 1 diabetics, they're insulin dependent. They require outside sources of insulin in order for the cells to open up for the glucose. Type 2 diabetes is where the body doesn't use the insulin that's being produced. The cells aren't opening up unless you have more and more insulin. And eventually, your beta cells, they try to make extra insulin. But unfortunately, eventually, they kind of peter out and blood sugar goes up.

Melanie Cole, MS: Well, thank you for that. So, that was an excellent explanation you just gave us. And speak a little bit about causes. Do we know is there a genetic component to diabetes?

Shelli Calhoun, RN: So, genetics does play a big factor, especially in type 2 diabetes. They're not really sure with type 1. I know autoimmune diseases can play a factor, and genetics can play a factor in that. So if your family has a history of autoimmune diseases, you can be at risk for type 1 because it is an autoimmune disease. Type 2, it's genetics. If you're overweight. It could be in age, it can even be prevalent with your ethnicity or races, ethnic groups such as African Americans, Hispanic Americans, Native Americans, and even some Asian Americans. And then, there's also a lifestyle factor, whether you're sedentary and even a poor diet.

Melanie Cole, MS: So, now tell us about symptoms. How does somebody know? I mean, we're getting our A1c checked at our blood work. But other than that, how does someone know? Is there some symptoms, red flags you'd like to point to?

Shelli Calhoun, RN: Yeah. So, a lot of type 2 diabetics we're noticing complaint of blurred vision. They may have just been to the eye doctor, they got a new prescription, they're wearing their glasses. And all of a sudden, they're starting to have blurred vision. That could be a red flag. Going to the bathroom more than usual, urinating more often. Feeling extremely thirsty or hungry can be a sign and symptom. Cuts or bruises that aren't healing or take an extra long time to heal. If you're feeling extra tired and sleepy, and tingling pain or numbness in either both hands and/or both feet .

Melanie Cole, MS: Thank you for telling us about those. So, tell us about the diabetes education program. How do patients receive your services? What can they expect? Tell us about your team

Shelli Calhoun, RN: So, they'll need a diabetes referral from their provider. And then, really, diabetes education, I consider it a partnership. I consider it something between me and the patient. We focus a lot on some practical tools that they could use. I offer support and I give them as much information as they can handle so that they themselves can make good decisions about their health and help them as best as I can to make the best choices for themselves.

Melanie Cole, MS: Tell us a little bit about what you do with them because there are no one-size-fits-all rules and it is a lot of lifestyle. I mean, obviously, there's medication involved, but there's a lot of lifestyle. So, tell us how you help them manage it.

Shelli Calhoun, RN: Well, we go over, you know, how often are they checking their blood sugar? Are they checking their blood sugars? What are they eating? How often are they exercising? What are they doing for exercise? Are they doing anything? It could be something as simple as I joke around about taking tours of their house. So, if they're not comfortable going outside of their home or, you know, if they're just not able to, you know, something as simple as once they've gone to the bathroom, just walking into each room of their house and taking a walk around their house, simple as that, or it can be something where they just go and take advantage of a free track where they can just walk laps. Or whether they just go outside and they walk around their house, or they go outside and they go for a small walk. It could be almost anything, and it can be something where they go to the gym three, four times a week.

There's a booklet they could use with a resistance band and there are exercises they can do sitting down or standing up. So, it's just based off of whatever that individual, that patient can handle, what they feel that is realistic for them that they can do.

Melanie Cole, MS: And where does nutrition fit into that picture then? As you're working with them about their lifestyle, their activity, their exercise, all those things, where does nutrition and that sort of management fit into this picture of how you're helping them? Because they certainly do have to look at their diet, maybe weight loss. There's a bunch of things involved.

Shelli Calhoun, RN: We go over carbohydrates and how they can affect the blood sugar. We also go over protein. We discuss healthy fats versus not healthy fats, and eating carbohydrates in moderation. I tell them it's all up to them. A lot of them come in thinking that they got this diabetes from eating too much sugar. So, we kind of go over that and we talk about carbohydrates versus just sugar alone, and some ways that they can maybe eat healthy, get what they need, the essential nutrients, and we just have conversations based on that. And we play a lot. I have fake food that I get out, and we go over how to kind of simply carb count and make sure they get their protein and their healthy vegetables and fruits and fiber and all the good stuff.

Melanie Cole, MS: And so, Shelli, what would you like them to understand about this condition, about living with diabetes, that it's manageable and that they can take control of this and you can help them do that.

Shelli Calhoun, RN: I just want people to understand that it's not always about eating too much sugar. It's not necessarily always about making poor choices. Baby steps are still steps moving forward. So, it doesn't matter if it's something teeny-tiny small that you feel is going to help you be successful, or if it's something really big that you feel you can handle. It doesn't matter what it is, just moving forward to help you control your diabetes so you don't have the risk of comorbidities.

Melanie Cole, MS: Thank you so much, Shelli, for telling us about how you are helping people living with diabetes. Thank you so much again. And I'd like to thank our Bryan Foundation partner, Eide Bailly. To listen to more podcasts from our experts, please visit bryanhealth.org/podcasts. That concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. Until next time, I'm Melanie Cole.