Scott Webb (Host): A diagnosis of diabetes is never easy, but there is lots of help available. And today, I'm joined by Registered Nurse Kathy Winslow; she's a Certified Diabetes Care and Education Specialist. I'm also joined by Registered Dietitian Susan Morris, she's also a Certified Diabetes Care and Education Specialist. Both are here today to clarify some diabetes-related terms and, mostly, offer tips and suggestions for managing diabetes. 

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. So, I want to thank you both for joining me today. We're going to talk about some game-changing tips for living with diabetes. And I'm going to start with you, Kathy. What is CDCES? That's a lot of letters, but I know it stands for something. So, I'll start with you. What does that stand for? 

Kathy Winslow: So, CDCES stands for a Certified Diabetes Care and Education Specialist. So basically, this is a health care professional, who could be a registered nurse like myself, or a registered dietitian like my friend, Sue. It could be a physical therapist, a podiatrist, a pharmacist, an optometrist, so many different health care professionals who possess comprehensive knowledge of an experience with helping people to manage their diabetes, prevent diabetes. People who will qualify for this title have worked several years in the field and then they'll sit for a certification exam. 

Host: I see. So, lots of folks could be certified. Good to know. We have options in terms of who we see and who can help us. And oftentimes, I know it's sort of a team approach, a multidisciplinary team approach. I've got some more letters for you, Kathy. What does DSMES stand for?

Kathy Winslow: So, it stands for Diabetes Self-Management Education and Support. This encompasses learning the knowledge and the skills to be able to take responsibility for your diabetes self-management. And we're going to talk a little bit more when we get to our tips section. But essentially, someone who's receiving DSMES is going to work on topics about healthy eating, being active, taking medications, monitoring their diabetes, problem-solving, risk reduction, and most importantly, healthy coping, because we're asking a lot of people to manage this chronic illness. 

Host: Yeah, for sure. And I know things have come a long way. My grandfather had diabetes, but this is back in the '70s. And I know my mom would try to help him. And things have changed a lot, especially thanks to technology, smart watches, things like that. So, we're going to get to all that. Before we do those, Sue, what is MNT? 

Susan Morris: So, MNT stands for Medical Nutrition Therapy. And Medical Nutrition Therapy is the use of nutrition as therapy to improve someone's health and quality of life. Medical Nutrition Therapy consists of nutritional interventions by a registered dietician nutritionist, and it includes, individualized nutrition assessment and assistance with patient lifestyle management and dietary modifications.

Host: Yeah. And Sue, we're going to get in now to the diabetes seven self-care behaviors. And as Kathy was mentioning there, it is a big responsibility. It's a lot, of course. So, we're going to give folks some of these tips today, go through this list, a couple of tips for each one. I'll start with you. Let's start with healthy eating.

Susan Morris: Okay. So, clients usually have a lot of questions about making healthy food choices, you know, such as how to include favorite foods and beverages, eating-out questions, preparing healthy meals and snacks, and even what to do at family events. And a great way to approach this is just thinking of the healthy divided plate method. It's basically a way to eat a balanced carb-controlled meal. And basically, half the plate are your non-starchy vegetables, a quarter of the plate is a source of protein. And you have a quarter of a plate for a carbohydrate that you'd enjoy. 

Kathy Winslow: Another way that I always talk to people is about having smaller portions of some of their favorite foods. One of the tips that I always like is eating meals off of smaller plates. Do you realize if you can change your dinner plate, that standard 12-inch plate, to a lunch-sized plate, that 9-inch plate, that's going to reduce your portion about 22%. That can be huge to helping you on your goals with your healthy eating. 

Scott Webb: Yeah, you know, my wife does that. when we're getting the dinner plates out for dinner, she'll always ask me to give her a small plate. And I'm like, "Okay. Sure, you know, this meal seems big enough that. Maybe a big plate would be needed," but she says no. A smaller plate and smaller portions, are good for her. So, I totally get that. How about being active, Sue? 

Susan Morris: The general recommendations for activity is about 150 minutes per week, and that includes strength training two times a week. But this can be divided up into 30 minutes, five days a week, and even into 10-minute intervals, three times a day. 

Kathy Winslow: I always talk to people about just trying to move more. One of my favorite things to do is to use some of these smart tracker devices. Many people have heard, you know, the recommendation, 10,000 steps a day. That's great if you can get 10,000 steps. There was a recent NIH study that showed when you compare people who are getting 8,000 steps a day to people who are only getting 4,000 steps a day, you could reduce your risk of cardiovascular disease and cancer over the next 10 years by 50%. If you could bump that physical activity up to 12,000 steps a day, you could have a 65% reduction. So, I just talk to people about what can you do to sit less and move a little bit more. So, sometimes even just setting a timer on my phone to remind me to get up once an hour and to walk to another room in my office or my home or go outside quickly, walk down the street and back, get more activity in.

Host: Yeah, I love that. Sit less, move more. My phone always reminds me to breathe, and I feel like, you know, I am breathing, because it's involuntary, but I get the point that it's more just about taking a moment for yourself, as you're saying here, maybe use these devices to remind us to get up and get moving. So, Kathy, how about taking medications? Take us through that. 

Kathy Winslow: So, medications can be a big part of managing your diabetes. But I always remind people that our medications are great, but we need that foundation of healthy eating and being active. So, medications help with it. What's really important to me is people know the name of their medication, that there are actually two names to all of our medications. We have a trade name and we have a generic name. It's important to know both of them, know why you're taking a medication, when you should be taking that medication, how to be taking that medication. That becomes incredibly important for injectables to make sure that you're using that device correctly. So periodically, I like people to show me how do they take their medications, and I ask them why they are taking those medications.

Susan Morris: And also, remembering to take the medications. Some people really need prompting in that, especially if they're on a lot of medications. So, you know, filling the pillbox daily with the medications or setting aside a week in pillboxes, putting a reminder on your phone to take medication, having family or friends support involved, and helping a client remember, and also placing medications where you see them. You know, many people like a cup of coffee in the morning, so putting their morning medications beside their Keurig could help prompt them to remember. 

Host: It's so funny you say that, because I do have a reminder in my phone every night to take the couple of meds that I take. And I remember, when I was a kid, my grandparents used to put out two paper towels and they just had this mound of pills on each of them, you know, to remind each of them so they would do it before they went to bed. And that way, when they woke up, there's my pile, there's your pile. I don't know if folks take piles of meds anymore the way they used to. But Kathy, how about monitoring our diabetes and everything related? 

Kathy Winslow: So, there are so many things that we're monitoring and keeping track of in diabetes and we've all had experience with different monitorings. For instance, we monitor our weight. We notice are we higher than we were before. Are we lower than we were before? Maybe talking to our provider about where we should be. 

When we're talking about diabetes, we start talking a lot about glucose monitoring. When people go to see their provider, they'll often get blood work done and they'll check something called an A1c, which gives us a three-month overall average of how you are doing. We're trying to keep that A1c below 7%. We also talk a lot about the home monitoring, so most people with diabetes will have a glucometer, that finger stick meter, to find out what is their glucose. So, the American Diabetes Association says glucose before meals should be between 80 and 130. Two hours after eating, trying to keep it less than 180. Those are the general guidelines. Each person is going to be a little bit different, so talking to your provider is also important.

One of the newer things we're seeing a lot in diabetes is we're adding more technology. We're doing a lot of continuous glucose sensors. These devices are great. They can check our glucose every one to five minutes. They can print out beautiful reports for us to look at. And when people are wearing continuous glucose sensors, I start talking about time and range, which is 70 to 180. How much of the time can you stay in that range? Higher is always better, so we're trying for at least 70%. But in diabetes, we worry a lot about low glucose reactions, numbers below 70. So, I always talk about, you know, it's great to get that time in range higher, but we also want to make sure we're not having a lot of low blood sugar reactions. 

Susan Morris: And there are so many good reasons to monitor blood sugar, the monitoring of blood sugar helps to reveal how different meals and snacks affects a client's blood sugar. They learn how carbohydrates, fruits, vegetables, grains affect the blood sugar and how, you know, lean protein, heart-healthy fat, non-starchy vegetables really don't spike the blood sugar. So, they learn what foods spike their sugar and what foods help their blood sugars stay within range. They see how physical activity can really help the blood sugars, and it really becomes a positive reinforcer to be active. And also, they see how their diabetic medications are affecting their blood sugar. And especially if there's a recent change in a diabetic medication, you know, we always recommend monitor your blood sugar so we can see how this is working. And of course, always carrying the glucometer with the person; it is very important if you're eating out or going to be exercising outside. If you don't feel right, you always have your meter where you can check your blood sugar and see possibly, is your sugar low or is your sugar high? It's a great tool.

Host: Yeah, it really is. And Kathy, let's talk about reducing risks. What are the risks and how do we reduce them? 

Kathy Winslow: So, unfortunately, diabetes can lead to many long-term complications. We worry about heart disease, heart attacks, and strokes. We worry about eye damage. We worry about kidney damage. We worry about nerve damage. So, one thing that, again, we're monitoring to reduce risk is I talk a lot about the ABCs. A stands for that A1c. What's that? Average glucose over the past three or so months. Keeping it below 7%. Talking about blood pressure. The American Diabetes Association is recommending we keep our blood pressure less than 130/80 for people with diabetes. And cholesterol, and we really focus in on that LDL cholesterol. There are so many risks. I always encourage people to talk to their doctor about how are their numbers looking and do we maybe need to adjust lifestyle medications to improve those numbers.

Susan Morris: And of course, smoking is a big risk factor for health issues, and there are so many resources to help clients who are trying to stop smoking, like the 1-800-QUIT-NOW number. What's really important too is regular follow-ups with their primary care and the endocrinologist for this preventative care. And of course, these providers would be the ones checking the labs, checking the A1c and the cholesterol and blood pressure. So, it's so important to have regular follow-ups. 

Host: Yeah. It definitely is. And staying with you, Sue, let's talk about problem solving. What are the problems and how do we solve them?

Susan Morris: Okay. Well, you know, when you have diabetes, you can follow your treatment plan and check your blood sugar often and still find that you don't always get the results you hope for. Diabetes does change over time, so you may need new ways to manage it. And using problem-solving techniques can definitely help. 

Number one is identifying what the problem is, finding the solution, and then putting the solution in action. Of course, the more a client learns, the easier the problem-solving will come. An example of a problem might be weight gain over the holidays. Usually, people have issues with weight gain over the holidays, starting from Thanksgiving all the way through to New Year's. And many times, clients have more difficulty controlling their blood sugars. So, there are some things that a client can do to help problem solve during this time of year. 

Kathy Winslow: One of the ones I always like to do is there can be so many wonderful treats at a party, and I often hear people say, "I just can't find anything healthy to eat. I've been at parties that I look and it's all treats, and I go, 'Oh, there's no vegetables here.'" So, my tip is to bring a healthy dish. I like to bring a salad to a party, because I know I can fill my plate with half of salad. 

Susan Morris: And even a fresh fruit bowl, many times people like that. And you'll find at events, people are grateful, because usually there's not just one person there that have health issues where diet affects these health issues. So, people are usually very appreciative when you bring a healthy dish. 

Also, something to consider is alcohol over the holidays. Alcohol, it has a lot of calories, similar to calories in fat. So, being careful with intake of alcoholic beverages can definitely help decrease the risk of weight gain. And also, alcohol does pose some problems with interaction with medications, especially diabetic medications. So, it really is something to, be considerate of when you're going out to events.

Kathy Winslow: Even though, you know, I might have brought my salad to have half my plate, I might have overindulged in some of those sweet treats that I love so much. So, another tip I always say is, if you had a little bit more than maybe you should have, why not go take a walk? At my family's holiday celebrations, after we all eat dinner, before we start washing the dishes, we grab our dogs and we all go for a quick walk around the block.

Susan Morris: And also, remembering that divided plate method. Just try to set your plate up like that when you're at these social events can be really helpful in helping a person control their blood sugars and also prevent excessive weight gain. Picking a few dishes that you normally don't have is certainly fine too, but then loading up with that protein and non-starchy vegetables definitely helps. And also, if you're the host, send the leftover treats home with the guests. If it's sitting in the house day after day, it's so much more of a temptation to be overindulging.

Host: Yeah. I'm always happy to send things home, except pumpkin pie. For whatever reason, the pumpkin pie usually stays at our house and they can feel free to take everything else. It's been really great today. Good to go through all these behaviors. We've got one left here, Kathy. Tell us about healthy coping.

Kathy Winslow: I'll tell you about healthy coping. But before I tell you about healthy coping, I also love pumpkin pie, Scott. One of my tricks is, do you realize you can make a pumpkin pie, but you don't have to put all the sugar that the recipe calls for? So, my mother makes the most amazing low-sugar pumpkin pie. It's delicious.

Host: I'm going to have you email me that recipe. Please do. 

Kathy Winslow: Will do. 

Scott Webb: Thanks.

Kathy Winslow: So, when it comes to healthy coping, we're asking a lot of people with diabetes. It can be very overwhelming to try to balance what you're eating, what you're doing for activity, monitoring glucoses and weight and taking all these medications as prescribed. People are often very overwhelmed with this. Family members are often very overwhelmed. So, it's important that we get help with this and we are surrounding ourselves with support. Sue, you want to give us some ideas on support? 

Susan Morris: Yeah. And diabetes can affect both your body and your emotions. And these emotions can affect a person's ability to manage their daily life and their condition. And it's not uncommon to feel distressed or depressed due to the emotional burden or the daily demands and the fears that go along with long-term problems. 

So, one of the biggest supports is surrounding yourself with family support, friends, and also the diabetes health care team. You know, we're here for clients, also support groups. And even, there are some peer support groups on social media that can be very, very encouraging for patients too. And one small change every week can really make a big difference at the end of the year. Sometimes people get overwhelmed with trying to make too many changes all at once. And we don't really have to do that. You start off one small change and it really does add up over time.

Host: Yeah. It sure seems so. And I really appreciated this today. My mom has diabetes. As I said, my grandpa had diabetes when I was a kid. I'm 55. So, you know, stands to reason perhaps. So, it's always great to have experts on, get your compassionate expertise, words of wisdom, tips, and so on. So, thank you both and you both stay well. 

Kathy Winslow: Same to you. 

Susan Morris: Thank you, Scott.

Host: And for more information, go to snhhealth.org/our-services/diabetes-care, and if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.