If you don’t have diabetes, you probably know someone who does.
An estimated 23.6 million people in the United States have diabetes. According to the Centers for Disease Control (CDC), it is a major cause of heart disease and stroke and can lead to other complications, such as vision loss, kidney failure, and amputations of legs or feet.
Effective glucose control, as measured by A1c levels, and blood pressure control can prevent or delay these complications. Summit Medical Group’s Certified Diabetes Educator, Margaret Eckler, gives advice for the prevention and management of diabetes.
Selected Podcast
Diabetes
Featured Speaker:
Ms. Eckler notes, "I have learned the importance of listening and being flexible to each patient's individual needs. I find out how much patients know about their condition and help them make gradual changes that they can sustain. Although this approach takes time and patience, the rewards can be long lasting."
MORE ON OUR DIABETES LIVE WELL PROGRAM
Margaret Eckler, RD, CDE
Margaret Eckler, RD, CDE, has more than 20 years' experience helping people with diabetes manage their disease. At Summit Medical Group, Ms. Eckler helps patients improve their health through positive lifestyle and behavioral changes. In addition, she consults with endocrinologists and primary care physicians to help develop treatment strategies for patients with diabetes. She is a certified insulin pump trainer and a member of the American Association of Diabetes Educators.Ms. Eckler notes, "I have learned the importance of listening and being flexible to each patient's individual needs. I find out how much patients know about their condition and help them make gradual changes that they can sustain. Although this approach takes time and patience, the rewards can be long lasting."
MORE ON OUR DIABETES LIVE WELL PROGRAM
Transcription:
Diabetes
Melanie Cole (Host): If you don't have diabetes, you probably know someone who does. An estimated 23.6 million people in the United States have diabetes, and according to the Center for Disease Control, it's a major cause of heart disease, stroke, and can lead to other complications. My guest is Margaret Eckler. She is a registered dietician and a certified diabetes educator at Summit Medical Group. Welcome to the show, Margaret. Tell us a little bit about the Live Well Program at Summit Medical Group.
Margaret Eckler (Guest): Well, the Live Well Program is basically a multidisciplinary approach that includes certain endocrinologists and primary care doctors as well as specialists as needed. We make referrals for eye exams, for foot care, for ophthalmology, and then, of course, there is myself. I'm a registered dietician and certified diabetes educator, and I do a lot of the hands-on work with patients, just in terms of teaching them the diet and talking about exercise, talking about their medications. I work with the Type 1s who are on insulin pumps, men, and also pregnant women who have gestational diabetes. So, we do offer a full range of services related to the management of diabetes.
Melanie: Speaking of diabetes management, tell our listeners a little bit about controlling their blood sugar levels through diet and exercise and medication if necessary.
Margaret: Right. Well, I like to say that the order should be exercise and diet, although they're both important. I am a big believer in the power of exercise, and unfortunately that's something that is a difficult sell for a lot of people because of busy lives and sometimes disabilities of one kind or another. But I really try hard to work with people to find something that they can commit to doing on an on-going basis. We have—I'm not sure you're aware—that our program has what's called recognition from the American Diabetes Association and that is a status that's conferred upon programs who meet certain very high level of quality in terms of their provision of diabetes education. Certainly I need to make sure that all the various areas that are considered important in the management of diabetes are discussed and mutually agreed upon with the patient.
Melanie: When it comes to self-blood-glucose-monitoring, Margaret, what do you want people to know about their numbers? Because you hear different numbers and there's products on the market, at Walgreens, that you can get to help you monitor your blood glucose. What do you think about some of them? And tell our listeners how you really monitor your blood glucose. What are the numbers you're looking for?
Margaret: Okay. Well, the first thing I want to say is that commercial that says "I don't have to prick my fingers anymore" is a little misleading because I get a lot of people asking me about that, and the reason they say that is because you do have to prick your arm instead of your finger. Unfortunately, the technology has just not evolved to the point where we can test blood sugar any way besides getting a drop of blood or something invasive to actually analyse blood. In terms of what are considered reasonable goals for diabetes—and I do want to emphasize that this can vary based upon a number of medical issues, so it's always important that people ask their doctor or their diabetes educator what their particular goals are—but in general, for people with diabetes, the goals are: for a pre-meal blood sugar, the goals would be somewhere between 70-80 up to about 130. The reason I say 70-80 is it depends on the kind of medication you're under. There are some people who I would not target 70 as the low end of the desirable range because that's a little bit too low. But let's say 80-130. Then I also ask people to test their blood sugar two hours after the start of their largest meal of the day, and the goal there is under 180. Now, of course, you may see numbers higher than 180 on occasion but I always consider that a learning experience for patients, because they will learn that certain foods or certain portions are just not working well within their diabetes management efforts because they're making their blood sugar too high. I think you asked me about the different meters that are out there. I like to say that they're all equally inaccurate. None of them is a precision instrument. They're meant to give you a trend. Sometimes people get confused and upset by the fact that they test their blood sugar two times in a row and they see two numbers that are, they think, rather different, but the results can vary by certainly as much as 15% even from one minute to the next. So, I tell people to “don't be too hung up in the actual numbers” and also to use one given meter and don't jump around between meters.
Melanie: Margaret, Type 2 diabetes used to be called adult onset. It's not anymore. We're seeing it in children as young as 7 and 8 years of age. Give parents and adults the best advice you can for prevention because it is one of the more preventable and controllable of the types of diabetes. So give your best advice for prevention and lifestyle management of Type 2 diabetes.
Margaret: Sure. Sure. I do want to correct one thing that was said earlier by the way. The CDC just came out with some new statistics about diabetes, and in fact there are now 29 million people in this country with diabetes and there are also 86 million that have pre-diabetes and are at very high risk to develop diabetes. Those rates have increased 10% over the last couple of years. You're right that a lot of it is seen in children who unfortunately, compared to 20 or 30 or 40 years ago, are much more obese and inactive than they used to be. The thing I find ironic is that I will have maybe some young parents in my office as patients and one of them has diabetes and they're eating cookies or they're eating ice cream and they're eating chips, and they're eating stuff like that which is around the house all the time. Basically, the reasoning is, well, it has to be there for the children. Given that one in three children born nowadays is likely to get diabetes in their lifetime, I think we're sending a very bad message to our children by sort of training them to eat foods that in 20 years or so, they're going to become into somebody like me who's going to tell them, "stop eating those foods." So I would rather what I call “problem foods” are not even in the house. They should be sort of occasional treats but not something that we train our children to expect to have around. The other thing that is of paramount importance with children is exercise. We don’t really want go for aggressive weight loss in children but what we want to do is sort of keep their weight stable and let them grow into it as they grow taller, and what is very important is keeping them as active as possible. I don't work with children specifically but people ask me about their kids sometimes, and I always say, “Try to find a sport or activity that they really enjoy and make sure they're doing it ideally at least an hour a day,” is the recommendation.
Melanie: So really you're saying that parents have to role model for their children, and if the family eats healthier together, whether one of them has diabetes or not, it will work well for all the family members.
Margaret: Absolutely. When I mention the statistics about one in three children developing diabetes in their lifetime, I mean that really puts it in perspective. Anybody's child is at high risk for developing diabetes.
Melanie: Well, certainly we have this issue in this country where diabetes is just becoming more and more prevalent. So, in just the last couple of minutes for us, Margaret, tell the listeners why they should come to Summit Medical Group and get involved in the Diabetes Live Well Plan.
Margaret: Well, certainly the big overarching reason is to live healthier and hopefully reduce the risk of any long-term complications, but I always like to say to patients, “In my vote, the best reason to do a lot of these things we recommend is because you will feel better day to day.” You'll have more energy; you'll have better perspective on life in general. To me, that's its own reward. I want to also highlight just for a moment that I do see a lot of people too with pre-diabetes. We can maybe not totally prevent diabetes but we certainly can reduce the risk, and I think it's very important that people who have tested with a high blood sugar come in and seek some care and meet with somebody like me to help reduce the risk of actually becoming diabetic. Because once you have diabetes, that is forever. You can't go back on that diagnosis.
Melanie: Thank you so much, Margaret Eckler. The Diabetes Live Well Plan at Summit Medical Group provides outstanding medical and educational services for adults with diabetes and the family members who care for them. For more information about the Diabetes Live Well Plan, you can go to summitmedicalgroup.com. That's summitmedicalgroup.com. You're listening to SMG Radio. This is Melanie Cole. Thanks for listening. Have a great day.
Diabetes
Melanie Cole (Host): If you don't have diabetes, you probably know someone who does. An estimated 23.6 million people in the United States have diabetes, and according to the Center for Disease Control, it's a major cause of heart disease, stroke, and can lead to other complications. My guest is Margaret Eckler. She is a registered dietician and a certified diabetes educator at Summit Medical Group. Welcome to the show, Margaret. Tell us a little bit about the Live Well Program at Summit Medical Group.
Margaret Eckler (Guest): Well, the Live Well Program is basically a multidisciplinary approach that includes certain endocrinologists and primary care doctors as well as specialists as needed. We make referrals for eye exams, for foot care, for ophthalmology, and then, of course, there is myself. I'm a registered dietician and certified diabetes educator, and I do a lot of the hands-on work with patients, just in terms of teaching them the diet and talking about exercise, talking about their medications. I work with the Type 1s who are on insulin pumps, men, and also pregnant women who have gestational diabetes. So, we do offer a full range of services related to the management of diabetes.
Melanie: Speaking of diabetes management, tell our listeners a little bit about controlling their blood sugar levels through diet and exercise and medication if necessary.
Margaret: Right. Well, I like to say that the order should be exercise and diet, although they're both important. I am a big believer in the power of exercise, and unfortunately that's something that is a difficult sell for a lot of people because of busy lives and sometimes disabilities of one kind or another. But I really try hard to work with people to find something that they can commit to doing on an on-going basis. We have—I'm not sure you're aware—that our program has what's called recognition from the American Diabetes Association and that is a status that's conferred upon programs who meet certain very high level of quality in terms of their provision of diabetes education. Certainly I need to make sure that all the various areas that are considered important in the management of diabetes are discussed and mutually agreed upon with the patient.
Melanie: When it comes to self-blood-glucose-monitoring, Margaret, what do you want people to know about their numbers? Because you hear different numbers and there's products on the market, at Walgreens, that you can get to help you monitor your blood glucose. What do you think about some of them? And tell our listeners how you really monitor your blood glucose. What are the numbers you're looking for?
Margaret: Okay. Well, the first thing I want to say is that commercial that says "I don't have to prick my fingers anymore" is a little misleading because I get a lot of people asking me about that, and the reason they say that is because you do have to prick your arm instead of your finger. Unfortunately, the technology has just not evolved to the point where we can test blood sugar any way besides getting a drop of blood or something invasive to actually analyse blood. In terms of what are considered reasonable goals for diabetes—and I do want to emphasize that this can vary based upon a number of medical issues, so it's always important that people ask their doctor or their diabetes educator what their particular goals are—but in general, for people with diabetes, the goals are: for a pre-meal blood sugar, the goals would be somewhere between 70-80 up to about 130. The reason I say 70-80 is it depends on the kind of medication you're under. There are some people who I would not target 70 as the low end of the desirable range because that's a little bit too low. But let's say 80-130. Then I also ask people to test their blood sugar two hours after the start of their largest meal of the day, and the goal there is under 180. Now, of course, you may see numbers higher than 180 on occasion but I always consider that a learning experience for patients, because they will learn that certain foods or certain portions are just not working well within their diabetes management efforts because they're making their blood sugar too high. I think you asked me about the different meters that are out there. I like to say that they're all equally inaccurate. None of them is a precision instrument. They're meant to give you a trend. Sometimes people get confused and upset by the fact that they test their blood sugar two times in a row and they see two numbers that are, they think, rather different, but the results can vary by certainly as much as 15% even from one minute to the next. So, I tell people to “don't be too hung up in the actual numbers” and also to use one given meter and don't jump around between meters.
Melanie: Margaret, Type 2 diabetes used to be called adult onset. It's not anymore. We're seeing it in children as young as 7 and 8 years of age. Give parents and adults the best advice you can for prevention because it is one of the more preventable and controllable of the types of diabetes. So give your best advice for prevention and lifestyle management of Type 2 diabetes.
Margaret: Sure. Sure. I do want to correct one thing that was said earlier by the way. The CDC just came out with some new statistics about diabetes, and in fact there are now 29 million people in this country with diabetes and there are also 86 million that have pre-diabetes and are at very high risk to develop diabetes. Those rates have increased 10% over the last couple of years. You're right that a lot of it is seen in children who unfortunately, compared to 20 or 30 or 40 years ago, are much more obese and inactive than they used to be. The thing I find ironic is that I will have maybe some young parents in my office as patients and one of them has diabetes and they're eating cookies or they're eating ice cream and they're eating chips, and they're eating stuff like that which is around the house all the time. Basically, the reasoning is, well, it has to be there for the children. Given that one in three children born nowadays is likely to get diabetes in their lifetime, I think we're sending a very bad message to our children by sort of training them to eat foods that in 20 years or so, they're going to become into somebody like me who's going to tell them, "stop eating those foods." So I would rather what I call “problem foods” are not even in the house. They should be sort of occasional treats but not something that we train our children to expect to have around. The other thing that is of paramount importance with children is exercise. We don’t really want go for aggressive weight loss in children but what we want to do is sort of keep their weight stable and let them grow into it as they grow taller, and what is very important is keeping them as active as possible. I don't work with children specifically but people ask me about their kids sometimes, and I always say, “Try to find a sport or activity that they really enjoy and make sure they're doing it ideally at least an hour a day,” is the recommendation.
Melanie: So really you're saying that parents have to role model for their children, and if the family eats healthier together, whether one of them has diabetes or not, it will work well for all the family members.
Margaret: Absolutely. When I mention the statistics about one in three children developing diabetes in their lifetime, I mean that really puts it in perspective. Anybody's child is at high risk for developing diabetes.
Melanie: Well, certainly we have this issue in this country where diabetes is just becoming more and more prevalent. So, in just the last couple of minutes for us, Margaret, tell the listeners why they should come to Summit Medical Group and get involved in the Diabetes Live Well Plan.
Margaret: Well, certainly the big overarching reason is to live healthier and hopefully reduce the risk of any long-term complications, but I always like to say to patients, “In my vote, the best reason to do a lot of these things we recommend is because you will feel better day to day.” You'll have more energy; you'll have better perspective on life in general. To me, that's its own reward. I want to also highlight just for a moment that I do see a lot of people too with pre-diabetes. We can maybe not totally prevent diabetes but we certainly can reduce the risk, and I think it's very important that people who have tested with a high blood sugar come in and seek some care and meet with somebody like me to help reduce the risk of actually becoming diabetic. Because once you have diabetes, that is forever. You can't go back on that diagnosis.
Melanie: Thank you so much, Margaret Eckler. The Diabetes Live Well Plan at Summit Medical Group provides outstanding medical and educational services for adults with diabetes and the family members who care for them. For more information about the Diabetes Live Well Plan, you can go to summitmedicalgroup.com. That's summitmedicalgroup.com. You're listening to SMG Radio. This is Melanie Cole. Thanks for listening. Have a great day.