Bill Klaproth: Overtime, diabetes can cause severe damage throughout the body, so what can be done? Here to talk with us about diabetes support and education is Marlelena Cid, diabetes education services manager at Eisenhower Health. Thanks for your time. How prevalent is diabetes particularly in certain populations in the Coachella Valley?
Marlelena Cid, MSN, RN, CDE, PHN: According to the latest national statistics for diabetes in 2017, in the United States, we have about 30.3 million people with diabetes and 84 million with prediabetes, which is a lot. In the Coachella Valley, we have over 40,000 now. HEART did a study a couple years ago and there were over 39,000, so I'm pretty sure we're way over 40,000 diagnosed with diabetes. It all depends on where we are in the area here. We mostly see Caucasian, but if we go to the Coachella area, it will be mostly Hispanics. We see those are the two that we see the most at our program.
Bill: Why do we develop diabetes? Who is most at risk for developing diabetes?
Marlelena: The risk for diabetes is people that have already family history. Someone in their family has diabetes, it's going to be a higher risk for that person. It is important that a person is maintaining their normal weight for their height that they are physically active. Age also is one of the risks. Over 44 - 45 years old, Hispanics, Asian Americans, African Americans, Native Americans have also a higher risk for diabetes.
Bill: When it comes to preventing diabetes, you just mentioned keeping a proper weight. Is there anything else as far as lifestyle goes that we can do to try to prevent getting diabetes?
Marlelena: Weight loss is very important with lifestyle change, something that can be done permanently or long-term because we do want to prevent diabetes. If they have diabetes, they will be a good way of maintaining by losing weight if they need to be physically moving. The recommendation is about 30 minutes of exercise a day, which is 150 minutes a week, and they can break it down however they like. Physical activity is very important. Monitoring their sugar, making sure they are following up with their physician to get an annual follow-up physical to make sure they catch diabetes early by going to the lab. There is a lot people can do, but mostly it's the weight loss, being physically active, especially if they know they have the risk.
Bill: You mentioned going to the doctor, especially with type 2 diabetes. Many people don't have symptoms and don't realize they have it until they go visit the doctor. Is that right?
Marlelena: Exactly. That's what we are seeing at the hospital. We see a lot of patients in the inpatient setting. The first question I ask is 'when is the last time you saw your physician,' and many of them it has been years, so they don't even know they have diabetes because they feel fine. Unfortunately, many people don't have any symptoms even if their sugar is very high in the 500s or 800s and they come to the hospital when they eventually have symptoms so they're having some wound that is not healing, so they come to the hospital for whatever other reason, but it is diabetes that they have for how many years. If they don't go to their physician and get a routine physical or lab work, they're not going to know until they need some help at the hospital, which can be managed, can be prevented, and they can prevent going to the hospital.
Bill: Speaking of getting help at the hospital, how can someone be referred to the diabetes program at Eisenhower Health?
Marlelena: Our physicians refer patients by putting a referral in, but we would like is to get a referral immediately as soon as they know the patient has prediabetes. If their sugar is not normal, get a referral immediately. The doctors that are not from Eisenhower can fax us a referral at 760-773-1880 or they can call us at 760-773-1403 and we can help them get started. We accept Medicare PPOs, we're getting a lot of HMOs now with an authorization. It is important. The key here is the education they need to receive right away, especially when they're newly diagnosed.
Bill: Education and support is very important. Let's stay on that topic. Can you tell us about the support groups and community classes offered at Eisenhower?
Marlelena: We have a type 1 support group called Tools and Tricks and Technology for Type 1. This is strictly for type 1 people that have diabetes for so many years and they still need a lot of support. We opened up this group last year and it has been very successful. We have between 25 to 35 people every month that have type 1 diabetes and many of them are on insulin pumps and many of them are not, continue glucose monitors but it's to educate them and give them the support that they still need. Sometimes we make the mistake of assuming that because they have it for so many years and they know what they're doing that they don't need any more help and that's not the case. We also offer free community classes in English and Spanish that are open to the public for those that don't have health insurance and all these support groups and the classes are free. We do it here at Eisenhower and at the Argyros Center in La Quinta. We also refer them to the volunteers and medicine clinic in Indio for those that don't have health insurance. It's a free clinic. We volunteer there to teach a Spanish class for diabetes and any patient we see in the hospital that doesn't have health insurance, we automatically refer them to the clinic so they can follow up with a physician.
Bill: That's great information. It sounds like monitoring of this is really important. As humans go, sometimes you probably start to put things off. How do you engage patients to work with them so they go see their physicians and certified diabetes educators to monitor their progress?
Marlelena: It is difficult. Many people's first reaction is to go into denial when they get a new diagnosis of not only diabetes but probably anything else. They need education, they need support and we use a non-threatening approach. We're like a coach. We like to empower them. This is their diabetes and they need to understand that this is enabling them to use information that we provide them to use it to their advantage. We discuss with them how their glucose results are affecting their body and organs, we teach them about the patterns, the medications. Many people newly diagnosed need to go on insulin injections right aware and many of them don't want it, so we monitor a lot of things that we help them to monitor like weight and nutrition and insulin pump meters. We're using all that technology in diabetes and there are many factors that affect them and that it's also monitoring their stress levels and illness and all the things that are going to affect their sugar. Coping is extremely important and that's where we want to see them right away to see how ready they are to manage this disease. The other issue is there are no endocrinologists. There's a huge shortage of endocrinologists, so we want the patient to be able to take control of their diabetes to prevent acute and long-term complications and have that close community with their physicians in us so that we can help them monitor their progress.
Bill: The good news is diabetes can be managed, and as you just said, people need to take control of this. What's the most popular way right now people monitor and manage their diabetes?
Marlelena: As soon as we see a patient, many don't want to check their sugar, but we provide them a glucose meter and we teach them how to use it and they have to bring it with them, but we are using the new technology of continuous glucose monitors, which is a sensor that they insert under the skin. It's not implanted or anything, and that transmit with a transmitter their sugar to our receiver every five minutes or they can see it on their cell phones. They don't have to check their sugar anymore if they have a sensor. It's mostly covered by all insurances now. Insulin pumps, if someone is injecting insulin so many times a day, which we are seeing a lot, we talk to them about insulin pumps. It's not implanted, it's something they can learn and we train them how to use it, they have to change it themselves, but it does help them control their diabetes a lot easier and they don't have to be checking their sugar as many times a day or injecting insulin many times a day. This works for type 1 and 2.
Bill: The new technology and tools available today are really playing an important role. Thank you so much for your time today and the wonderful information. If you want to learn more, call 760-773-1403 or visit eisenhowerhealth.org/diabetes. Once again, 760-773-1403 or go to eisenhowerhealth.org/diabetes where you can find more information about support groups and diabetes education. This is Living Well with Eisenhower Health. I'm Bill Klaproth. Thanks for listening.