Joey Wahler (Host): It helps patients manage their conditions. We're discussing diabetes education. Our guests, Alexandra Hubbard, RDN, LN, CDCES, a registered dietician, nutritionist, and Diabetes Program Coordinator; Allison Hendry, RDN, LDN, CDCES, Registered Dietitian, Certified Diabetes Care and Education Specialist; and Jim Williams, who's been their diabetic patient.

This is Health Matters from Southeast Georgia Health System. Thanks so much for joining us. I'm Joey Wahler. Alex, Allison, Jimmy, welcome to you all.

Allison Hendry, RDN, LDN, CDCES: Thank you. Welcome.

Host: Great to have you aboard. So to get us started, Alex, in a nutshell, how did you choose to specialize in your field and what first brought you to the area?

Alexandra Hubbard, RDN, LN, CDCES: What first brought me to the area is my husband was given the opportunity to move down here two years ago. And we lived in Savannah and Hilton Head for a little bit a few years prior. I grew up in New York and my husband grew up in Pennsylvania. We've moved a lot for his career. So when we were given this opportunity to come to the warm weather, we jumped on it. And now, we're making a life here.

As far as why I wanted to become a dietician, I grew up in a very Italian household where everything revolved around food. And I love food, I love cooking and all of the things. And I saw firsthand how food can be used as a treatment for medical conditions and how it can also hinder our health a little bit.

So, I took that love for food and my love for health and helping people and turned it into a career. I worked in long-term care for a lot of years IN that space as a dietician. And then, I've always had a big interest in diabetes just because of my family history. And I saw this opportunity to get into this space, and it's been the biggest blessing and I love learning and helping people every single day because we have such a big population of people with diabetes. So, it's just been the biggest blessing to be able to help others.

Host: That's awesome. How about you, Allison?

Allison Hendry, RDN, LDN, CDCES: I am from Louisiana, and I moved to St. Simon's Island in about 1996 to work for Sea Island Company as registered dietician for the resort, and ended up meeting my husband who was from here. And I have lived here ever since. I loved the area. I didn't even know Georgia had a beach. So, I was quite surprised when I arrived and found that we had a beach here. So, I loved it. And I've been here ever since. But I've always had an interest in healthy eating, exercising, and that's kind of what motivated me to become a registered dietician. I wanted to help others. I wanted to encourage and motivate others to do the same thing. And I did take a break for a little bit to raise my family.

But when I came back into working at the hospital again, every other patient of mine had diabetes. It had just exploded, and there was just so many questions. They wanted to know how to do better, how to eat better. And so, I really wanted to go back and get specialized in diabetes. And so, I could help other's and help them manage their blood sugar, answer their questions and work with them and motivate them to have a healthy lifestyle.

Host: Certainly makes sense. So Jim, when did you first notice symptoms and get diagnosed with diabetes? And can you recall what that first moment of being aware you had it was like for you emotionally and such?

Jim Williams: Well, it was October the 14th of 2016, a day that would live in infamy in my mind that I was told I was diabetic. It was a little bit of disbelief to be honest. Like, these ladies that have already spoken, I had a great interest in food, just how much I could eat in a given day without, you know, exploding.

And that was not helping me very much. But along with the diabetes in the ,background, I had other medical issues going on that I didn't really comprehend. So, that was masking some of the efforts of dealing with diabetes. I was having severe AFib and also, in the background, unbeknownst I was having heart attacks. And so, all of these things kind of snowballed. That was a big ball of wax there for a while to try and get your hands around.

Host: And how it certainly sounds like it. And so, with all that going on already for you, Jim, when you find out you have diabetes, what was the biggest change from that point on in your day-to-day life, would you say?

Jim Williams: The biggest change possibly was realizing what I was doing to myself. It was up to me to do something, and a lot of that knowledge came through one of the classes almost immediately. I mean, within three weeks after the diabetes diagnosis, I was enrolled in a conversations about diabetes course through the hospital. And that was, as I recall, a four-week event.

And it really outlined, "Okay, this is what diabetes is. These are things that affect it. These are things that you can do." I was getting all this great input, but it wasn't all sticking. But it all came down to the bottom line eventually that I had to do something myself about it that no one else could really fix. It had to be me. And they gave me the tools, you know, to do it

Host: Speaking of which, Alex, how do these programs, like the Diabetes Education Program—and Jim mentioned the Healthy Me Support Group—how do they provide this more personalized approach compared to maybe the typical diabetes care that people have come to expect?

Alexandra Hubbard, RDN, LN, CDCES: People learn in different ways. So, we have a lot of options for each patient to kind of individualize what they want to come to. So, we have our group classes and some people love the group environment. And it's a three-week session and it's two hours long.

And the first class, we go over what is diabetes, how to manage it, how to check your blood sugars, what should your blood sugars be all the different basics of the daily diabetes care. And then, the second class, we go over all of how to eat a bunch of different ways on how to manage your diet. We teach different ways, whether it's carb counting or using a plate as a visual tool. Different things that are tailored to different people and the way they learn. And then, the third class, we teach about all of the potential long-term complications that can come with diabetes if we don't manage it, if we don't keep our blood sugars in a good, healthy range, all the potential things that can come from that and how to prevent it, how to make sure we're going to be our best self and advocate for ourself as much as we can to prevent long-term damage.

So, we have that. And then, we also have one-on-one diabetes education appointments where if a person cannot attend the group classes because of their schedule, or they have hearing issues or whatever their reasoning for not coming to group classes. We do diabetic education where we do the same information on a one-on-one basis. And then, we also can go even further as registered dieticians. Allison and I can do medical nutrition therapy appointments, and that's for people who want to really dive deep into their eating and their eating habits. And we can look at other health conditions that can come along with diabetes to really tailor a plan specifically for one person rather than just a general group class.

And then, we also have our Healthy Me Support group, and that is our monthly support group meeting that we have. And you don't even have to be diabetic to come to that. Most of our participants are or have been or been touched by diabetes to some extent. But it's just anybody who wants to come and learn how to live a healthier life or be a healthier me. And we have a really great group of people, Jim being one of them, and he's one of our core people that come. And it's just a really informal—we play games, we do all these things, and that does not require doctor referral.

All of our other classes, one-on-ones, do require a referral, but the Healthy Me, you don't have to sign up. You can just come, you can come one month, not come another, or you can come whenever. There's no signing up, no registering. Just come as you want. We have a lot of different options to try to make it as accessible as we can for our community And what they need and how they learn best. And we also do it in both campuses. So, we have Camden and Brunswick, we have all of the same options for both communities.

Host: Allison, how about the medical nutrition therapy that's offered, also called MNT, which integrates with diabetes education to promote better health outcomes for patients?

Allison Hendry, RDN, LDN, CDCES: MNT is a great way to get a more personalized individual approach to your diabetes. It is covered by Medicare and most insurances. So, I really like those one-on-one appointments because I like to work with where you're at to help you create like a realistic healthy lifestyle goal for you.

When you have diabetes, what you eat truly matters. And I feel like there's a substitution for everything. So, I really like working with you individually. And everybody's different. Everybody has a different lifestyle and individual eating plan. So, I really like to focus on that and kind of help you manage your blood sugar through diet, because the goal is to decrease medication to get your A1c down. And Jim is just a testament to that. His A1c is excellent, he's lost weight. His A1c is at goal. And so, what he did was watch what he was eating and followed a healthy lifestyle, and he's just a testament to that.

So, I'm just so proud of him for being here and talking about this today. But MNT really can help you one-on-one and work with you individually and we can try to get you on the right track for a healthier lifestyle.

Host: All right, Mr. Testament—I mean, Jim. You figured out various things along the way. Like, I know you mentioned figuring out why you were eating, what you were eating and as much as you were eating. What would you say is the biggest change in lifestyle diet or just your routine in general that's had the biggest impact on your improved health? What's been the biggest change?

Jim Williams: The biggest change will sound simple, but through the classes—in fact, Alex hooked me up with an app called MyFitnessPal and it just coordinates so well with all of the teachings that they had already installed in me. It is so easy to track what I'm eating. And if you are getting close to your goal and you know you've still got, say, two meals to go, well, that's not good.

So to address the fact it's more of a what you eat, but being aware of what you eat, because I would do a lot of what I would call mindless or habitual eating. I would sit down in the evening and that would be a time for a can of Pringles or, you know, a couple of Guinness and things like this. And they're not doing me any good. They taste good, you know, and I get a temporary, "Oh, that feels nice," I suppose. But long-term, it's doing a lot of harm. You have to decide that you don't want that condition, and then you can do something about it. But it is up to the individual. It is a lot easier if you've been given the education of, "This is what's going on in your system, these are things that affect that, and these are things you can do to improve that situation."

Host: Very well said. So Alex, what strategies are taught in these classes to help patients manage blood glucose levels effectively, which is so important here?

Alexandra Hubbard, RDN, LN, CDCES: We make sure they know what they should be, because sometimes patients come and they don't know where their blood sugar should be. They aren't there taking then and they're doing what they need to do, but they don't know if it's good, bad, or what it should be.

So first, we start with the basics. Make sure we know when to check your blood sugar. What the different goals are at different times of the day. Then, we go over, you know, the different kind of meters. There are the new technology. We review all of that. We review the continuous glucose monitors, the wearable sensors that you can wear and how to look at those. And we even put them on for people. So, we teach them different ways that work for different people in order to manage that. We go over all the different apps. We go over the different websites. We give them just a lot of resources on how to manage it a little bit better. Of course, we teach them how to eat and different goals for each person on what they're eating should be like.

But, you know, just teach them tools rather than us giving them a meal plan of this is what you should eat every single day. We teach them how to create that. We teach them to know what their numbers should be and kind of give them a more sense of control within their daily care because, I mean, diabetes, it's a daily decision. Every single day, you have to decide with every meal if this is the right thing. So, we just kind of empower them and teach them how to make those right decisions and how to know how things are affecting their blood sugar.

Host: Allison, as you well know, special occasions like holidays or birthdays can really disrupt a diabetic's intended routine. So, what's your biggest piece of advice for handling that if you had to offer one tip there?

Allison Hendry, RDN, LDN, CDCES: Oh, one tip. Oh gosh. Well, I think the biggest piece, and Jim just said, don't let this run your life and there's going to be ups and downs with this. Don't stress about these events going to these parties. Your focus is to enjoy the event, not worry about the food and how you're going to manage it. You can plan ahead for sure. And you don't ever want to arrive to a party hungry because you'll overeat. But the most part is to not let this stress you out. Let this be about the people you're about to see and enjoy and let the food be an afterthought. And I think that's the best piece of advice I would give

Host: Great advice indeed. And so in summary here, Jim, kind of a two-part question to wrap things up for us. What would you say to someone newly diagnosed with diabetes or they're supporting loved ones about how to stay motivated and doing the right thing. And what keeps you motivated to keep doing what you need to do to live a healthy life?

Jim Williams: Well, I've enjoyed being here today and I want to be here tomorrow. So, to do that, you have to take the responsibility to learn. If someone says you're diabetic, if you're the caregiver or you're the patient, you need to learn, "What does that mean, and what type of diabetes do I have?" There are different types, okay? "So, I've got that. What can I do to manage that?"

To stay motivated, mainly you need to realize that This is within my abilities to do something about this, and these are the tools I have. And if you're not clear about those tools, then you get with folks like Allison and Alex and let them explain it to you.

Host: Well, folks, we trust you are now more familiar and motivated by hearing of diabetes education. Alex, Allison, keep up all your great work. Jim, as a fellow Pringles lover, my hats off to you for finding a better way.

Jim Williams: Thank you.

Host: Absolutely. Continued great health to you and yours. And for more information, please visit sghs.org/diabetes-education. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of Health Matters from Southeast Georgia Health System.