Scott Webb (Host): Diabetes in its various forms is common and highly treatable, especially when you work with someone like my guest today. I'm joined today by Lois Felton. She's a registered nurse and certified diabetes care and education specialist with Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Lois, it's so nice to have you here today. We're going to talk about diabetes. But really, we're going to talk about the emotions, the emotional side of living with diabetes. So, maybe just as a foundational thing here, maybe you can share some background on the basics of diabetes.

Lois Felton: it's actually very complex. But the basics with diabetes is that there's a hormone in our body called insulin. When a person has diabetes, their pancreas is either not making enough insulin, not making any insulin at all, or is making some insulin, but the insulin that it makes isn't actually working properly in the body.

Host: Right. As you say, we could do an entire conversation about type 1, type 2, you know, pre-diabetes, and the whole thing, of course. But just very basically, just to have a sense of what diabetes is and what happens in folks bodies, I just want to have you explain your role as a certified diabetes care and education specialist and how you help patients manage their diabetes.

Lois Felton: As a certified diabetes care and education specialist, I believe education is really the key within almost any illness, but it's a key in helping to understand for a diabetic patient the very nature of their disease. Unfortunately, quite often, a patient's diagnosed, and this is one of those rare diseases where the person is making most of the decisions about what to do with their blood sugars. Their blood sugars are changing all the time. There's 42 things that affect your blood sugar. So, it's very difficult to manage. You have control over a few of those things. But by helping them understand what they do have control over, what they should do when their sugar is high, let's say, or what the proper treatment of a low blood sugar is, the more they understand, the less fearful they are.

And I often start with a patient and I explain, you know, they have so many numbers coming at them all the time, don't they? And they're often misjudged by people, too. I remember, and you know, I'm diabetic too for 43 years, I'm a nurse as well, and I've actually talked to other nurses that didn't understand a lot about diabetes themselves. There's a lot of misinformation out there.

So, quite often, I feel like patients are frustrated because they're trying to do the best they can with a very difficult situation. So, let's say that you got a job, and you didn't ask for the job, but the job's yours now, Scott. Now, you don't get any days off. You don't get vacation. You don't get paid for this job. This job is 24/7, kind of like being on-call all the time, I guess. So, you have this tremendously difficult job, and you're doing the best you can with the little bit of information or training you've gotten for the job, but not really having a full sense of what you should do or need to do. And then, people who mean well, maybe family, friends, even doctors, are kind of criticizing you for the job you're doing when you were never really given a lot of proper tools to do it with. So, it can be very frustrating, and it can lead to diabetes burnout very often.

I'm a big advocate for do not use the term non-compliant. It's a hard job. And I think that diabetics try the best they can to do the best they can, but the toll it takes on them to have that constant decision-making. And, you know, I read that we make 180 decisions more per day than a non-diabetic. So, it's taxing. So to go through that, and then, you know, that can lead to diabetes burnout, which is just at the point where the patient just feels like, "You know, I just don't know what I'm doing. I'm going to do what I do. I'm going to hope the diabetes is okay." And when they meet me, I do try to talk with them about not attaching emotions to numbers. I want them to kind of look at the number as information. And I tell them, "A 250 blood sugar after lunch does not mean you're a "bad diabetic. It means that your insulin dose probably needs to be adjusted." So, we want to start detaching emotionally from the numbers and teach them what to do. So then, their diabetes starts getting better control and then hopefully that will kind of help them with their burnout when they start seeing those results.

Host: Yeah. Well, first of all, you know, you also living with diabetes I'm sure informs so much of your interactions, you know, with patients and helping them, because you have that same job, so to speak, as we're saying, right? And I wanted to stay with that, just talk a little bit more about diabetes burnout. I hadn't heard that term before. I understand why you're trying to get away from the sort of using the expression non-compliance or something, you know, because making it feel like people have done something wrong, which is not the goal here. So, maybe you can just elaborate a little bit sort of where diabetes burnout came from and how do you help patients overcome that?

Lois Felton: I found a book called Diabetes Burnout, and it's by Dr. William Polonsky. So, this is what made me aware of the term, but the American Diabetes Association recognizes it now too. And, actually, we include it in our classroom talks now at the end of the month. We have a class once a month, and it's on Monday, Wednesday, Friday. Friday, we do talk about that, and we talk about the diagnosis story of that person, whatever they want to share. And actually, I got the privilege of talking to Dr. Polonsky on the phone for about an hour. He is the leading expert in the country. He's in California. He actually has a website too that I share with patients and I share in class. So, the Diabetes Behavioral Institute, he is a co-founder of that. That is a wonderful resource for patients. They actually have tests on there.

So, quite often, if you're a diabetic, you are diagnosed with depression. What we're finding is that depression is actually diabetes burnout. So, he has these wonderful tests that the patient can take, their family member can take it, because it is a family disease. I call loved ones the diabetics type threes, because they're in the ring with us. They see the lows, they see the highs, they see us struggling, they see us, you know, trying our best to plan out, even with really good education. For example, exercise, we've always been taught can make your blood sugar go down, but it actually depends on the type of exercise. So, they see us trying to figure, "Okay, if I do weights first, my sugar will come up. Then, if I do cardio afterward, it should come back down, and I should end up without a low." But then, they have the low, or they the post-exercise elevation. So, the type threes, those family members and loved ones, are really with us, and they have quizzes for them. And quite often, when couples take these quizzes, the spouse is more stressed than the diabetic is.

Host: That is ironic.

Lois Felton: It's interesting, right?

Host: Yeah.

Lois Felton: !So, diabetes burnout was not a thing when I was diagnosed. When I was diagnosed, there were no meters that you could take your blood sugar with at home. So, this is a newer thing, and I just became aware of it maybe in the last six years. So, I'm glad the ADA is aware of it now and that it is required to be included in class.

Host: Yeah. Well, as you say, education is so key in all of this. And we certainly hope that podcasts like this help us to achieve that goal. And, you know, we've been sort of talking around here the emotions of diabetes. And I just want to give you an opportunity to talk about how you help patients, maybe yourself at times, you know, your type three situation, of course, as you're saying, family and friends, just to help patients with these emotional challenges that they undoubtedly, as you're saying, are going to experience as they try to manage their diabetes.

Lois Felton: Well, quite often, just talking to another diabetic, just talking to me, they say, "It helps me quite a bit just to know that I'm not the only one who's afraid of a low, and I'm not the only one who feels like, 'Wow, why did I end up with that high blood sugar?'" So quite often, it's just the education that I give them and the tools they need to adjust to those ever-changing blood sugars and to make appropriate decisions really helps with that burnout.

Quite often too, one of my goals is to make a diabetic's life easier in whatever way I can. So, if I have a diabetic, let's say, that says, "I'm poking my fingers four times a day and they're bruised and they're sore," or "I'm afraid of needles," just helping them with that. For example, if they are having trouble getting blood on to a strip, because they have lost some eyesight and they waste five sticks trying to get that one little drop on there, then I suggest a continuous glucose monitor, because we can hook that up to the patient's phone and they can simply ask Siri, they can say, "What's my blood sugar?" And she'll tell them, instead of them kind of poking five and six times and not really being able to see the end of that test strip.

So, whenever they come to me, whatever their biggest challenge is, that's the thing I try to work on first and just talking to them, just hearing them really helps. So just hearing, "You didn't cause your disease." You know, "This is not your fault. If you want to blame someone, blame mom and dad, it runs in the genes." Just kind of talking to them and just doing basic education is so helpful. So, quite often, I think they get really motivated just by having someone that actually, you know, they say, "I'm so glad I don't have to explain what a low feels like to you." You know, so, they think that helped.

Host: Someone who's in the trenches with them, so to speak.

Lois Felton: Yeah, I think it helps. And then, in class, the first class we did actually, two of our students made friends and they walk together now. You get two diabetics in a room, and they're going to talk, and they're going to help each other.

Host: Right. Yeah, that's great. And we could also do another podcast just on the technology for those suffering with diabetes now and how much easier it is to manage diabetes, but we'll stay focused today. How does a patient get referred for diabetes education?

Lois Felton: Well, for the classes, they just ask their doctor to actually write a referral to diabetes class. Once they get the referral, they can call our office and actually schedule. And again, it's Monday, Wednesday, Friday, once a month. We also are going to be adding some more classes, like tech classes, pumps, and CGMs. We're going to be adding a pregnancy and diabetes class. So, they'll have a lot of options, but just for the class, all they have to do is ask their primary care provider, really, for a referral. We do have Nicole. So to be certified by the ADA, you have to have a dietician and a nurse who are both certified diabetes care and education specialists. Now, they can refer straight to her for nutrition.

Host: Okay. Yeah, it's great. It sounds easy enough and a lot of value, obviously, and going to be adding more. And again, we could do another podcast on gestational diabetes, which is a whole other thing. I'd give you an opportunity here at the end, Lois, just best advice that you give your patients about diabetes education and management.

Lois Felton: The best advice is this is hard. You're doing a good job. And whatever issues we're having, we can work on them. I guess my most important message to my patients is you are not in this fight by yourself. We're here with you. We have great doctors. We have nurses. You Have a whole staff that is in your corner. So, you are not in this fight by yourself.

Host: Yeah, that's perfect and comforting. And just great to know that patients have you and everyone else there at Franciscan Health. So, thank you so much.

Lois Felton: Oh, thank you so much, ,Scott for your time. I appreciate it.

Host: And for more information, visit franciscanhealth.org and search diabetes and endocrinology. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.