A chronic condition that affects many of the body’s organs, diabetes can be challenging to control, requiring regular monitoring and careful control of carbohydrate intake. Although numerous medication options exist to help manage diabetes, finding the right one can take time.
Proper medical treatment is essential, however, since untreated diabetes can lead to many severe and life-threatening complications, including heart disease; poor circulation, possibly resulting in amputation of toes, feet or lower limbs; and damage to kidneys, eyes and nerves.
Sentara Martha Jefferson Hospital’s diabetes management program offers a holistic, practical approach to treating this complicated condition, giving people the skills they need to manage the condition and prevent complications.
Taking Control of Diabetes
There are three primary pathways for controlling diabetes:
•Diet: Meal planning and healthy food choices are an essential part of life for people with diabetes.
•Lifestyle: Exercise and weight control or weight loss can improve blood sugar levels and heart health.
•Medication: Oral and injectable medications lower blood sugar when diet and lifestyle changes alone aren’t enough.
Many people with diabetes can benefit from specialized care like Sentara Martha Jefferson’s diabetes management program, says Elizabeth Driscoll, MSN, PhD, FNP, BC-ADM, one of the providers on the program team. The program helps people find the right treatment plan, which could include prescription medications, pumps or glucose monitors, as well as education, nutrition support and physical therapy. Under the right circumstances, treatment could even involve reducing the number and/or frequency of medications a patient is taking to control his or her condition.
Ready for a Change
Michael Grant’s doctor suggested that he participate in a diabetes management program to help control rising blood sugar levels caused by his type 2 diabetes. Grant, 61, chose Sentara Martha Jefferson, where he also sees Erika Struble, MD, for kidney cancer treatment.
“I told my primary doctor I wanted to go to Sentara Martha Jefferson,” Grant says. “Everybody’s so friendly, and the doctors are great.”
A motorcycle officer with the Culpeper Police Department, Grant was ready to make a change. His late wife, Donna, lost several toes due to diabetes. “I saw what she went through,” he says. “I knew that if I didn’t start doing something, I would end up going down that road, too.”
Grant started seeing Driscoll for virtual telehealth visits in March 2020. She recommended he use a continuous glucose monitor (CGM), which includes a sensor to test his blood 24/7 without a fingerstick. CGMs allow people to see how food and exercise affect their blood sugar. Driscoll, who does not have diabetes, even tried using a CGM herself, just out of curiosity. She found that although her blood sugar remained level after she ate fudge on an empty stomach, it spiked after she ate a bagel. “The CGM is really useful and helps people make effective dietary changes,” she notes.
The CGM helped Grant figure out what foods weren’t working for him. “I can eat something and then check the monitor,” he explains. “If my blood sugar spikes, I know I shouldn’t be eating that.”
Driscoll also changed Grant’s diabetes medication. While many older diabetes medications can cause weight gain, newer medications can actually help people lose weight. Since March, Grant has lost 50 pounds, and he’s lowered his blood pressure and cholesterol as well. His hemoglobin A1C also dropped from 11 to 7. The A1C test, which measures a person’s average blood sugar level over the previous three months, gives more information about a patient’s diabetes control than a simple blood sugar test, and results are available at the clinic in about five minutes.
“Changing my medicine seemed to help a great deal,” says Grant, who actually had to get new work uniforms due to his substantial weight loss.
“He really responded,” says Driscoll. “We set up effective changes, including switching his medication regimen, which is easier for him to manage now and has helped him lose weight. His blood sugars are great.”
Grant appreciates the time Driscoll spent with him. “She took the time to see what was going on,” he says. “She really helped me turn things around and made my life so much easier.”
Nutrition and Exercise: Key Components of Diabetes Treatment
The diabetes management program also includes:
•A nutritionist, who helps create meal plans and teaches people which foods are beneficial and which ones aren’t. A nutritionist also can help you learn how to read food labels and figure out healthy ways to enjoy food.
•A diabetes educator, who teaches people how to use CGMs, as well as other diabetes equipment and medication.
•Referrals to physical therapy. Many insurance plans cover several appointments with a physical therapist, who will design a realistic and achievable home exercise plan. Physical therapists also modify exercises for people who have breathing issues or heart or kidney disease.
For Driscoll, it’s gratifying to see how much people like Grant benefit from the program. Her daughter was diagnosed with type 1 diabetes as a child, and now she puts her knowledge to work helping others. “I really empathize with the struggles of people with diabetes,” she says. “We live a diabetes-friendly lifestyle in my house. Although I don’t have diabetes myself, I know what it’s like to limit things and focus on healthy foods.”
Grant also credits Driscoll and the diabetes management program for his success. “Everyone at the hospital is always so professional, kind and willing to help,” he says. “They treated my wife like gold. Even if they don’t know you, they will stop and help you.”
What is Diabetes?
Our bodies turn the food we eat into glucose, or sugar, which we use for energy. The pancreas makes a hormone called insulin, which helps glucose get into our cells.
If you have diabetes, your body doesn’t make enough insulin, or it doesn’t use insulin well. This causes sugar to build up in your blood, which leads to higher-than-normal blood sugar levels. Untreated high blood sugar can lead to serious health complications.
There are two main types of diabetes:
•Type 1 diabetes is less common, often caused by genetic, autoimmune or environmental factors.
•Type 2 diabetes makes up 90 percent of all diabetes cases. Risk factors include age, obesity, family history and physical activity.
What About Prediabetes?
Prediabetes is indicated by a higher-than-normal blood sugar level that doesn’t meet the criteria for type 2 diabetes. A normal blood sugar reading is 4–5.7, while prediabetes is in the range of 5.8–6.4.
Your primary care provider or a diabetes management program can make a prediabetes diagnosis. Learning you have prediabetes is a great opportunity, through weight loss and increased activity levels, to prevent the onset of full diabetes.
You should get screened every year for prediabetes if you:
•Have a family history of diabetes
•Live a sedentary lifestyle
•Had gestational diabetes when you were pregnant
Gestational Diabetes: Be Aware
If you’re pregnant, part of your regular prenatal care likely will include a glucose tolerance test, which screens for gestational diabetes. High blood sugar levels can affect you and your baby, so be sure to follow your doctor’s instructions for treatment.
If you have gestational diabetes, your blood sugar should return to normal soon after delivery. However, women who have had gestational diabetes while pregnant are more likely to develop type 2 diabetes later in life. Driscoll recommends an annual test to make sure your blood sugar stays in the healthy range.
Contact the Diabetes Management Program:
Your primary care provider can refer you to our program.