November 21, 2024 • 40 mins
Centered on Health 11-21-24 - What you should know about Diabetes with Shana Nicholson, RN
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Episode Transcript
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Speaker 1 (00:00):
How do you feel when you switch to Geico and
save on your car insurance? It's like going to work
on one Thursday morning and thinking to yourself, just one
more day until Friday. But then somebody in the elevator
says happy Friday. Then you check your phone quickly and
discover today's actually Friday. So yes, happy Friday, random stranger
(00:21):
in the elevator, Happy Friday. Indeed yep. Switching and saving
with Geico feels just like that. Get more with Geico.
It's now time for Centered on Health with Baptis's Health
on US Radio. Wait forty tejs Now, here's doctor Jeff Tumbler.
Speaker 2 (00:41):
Good evening, everyone, and thanks for joining us tonight on
tonight's episode of Centered on Health with Baptis Health Here
on news radio eight forty whas. I'm your host, doctor
Jeff Publin, and tonight we're talking with Sanna Nicholson, who
I'm going to introduce you to in just a moment,
and we're talking about diabetes. But as always, our producer,
(01:02):
mister Jncent is on standby to take your calls and
ask questions of tonight's guests. Our phone number is five
oh two five seven one eight four eighty four if
you want to call in and be a part of
tonight's conversation. So, thirty eight million Americans have diabetes, and
that doesn't even consider those who might have three diabetes.
(01:23):
One out of five people don't even know that they
have diabetes before they're diagnosed. And by the year twenty thirty,
it's estimated that one in eight people, or six hundred
and forty million people worldwide will have diabetes. So our
guest tonight is Shana Nicholson. She is a Master level
registered nurse and a certified Diabetes Care and Education Specialer,
(01:47):
a Master Licensed Diabetes Educator, lifestyle coach, and Progressive Care
certified nurse. She's a manager of the Diabetes Education and
Nutrition Counseling program for Baptist Louisville and Lagrain Means. She's
currently the Kentucky Diabetic Network President and she worked with
the Kentucky Statewide Diabetes Strategic Planning Committee. She cares for
(02:11):
patients with an interdisciplinary and holistic approach and we are
so fortunate to have her tonight to talk to us
about diabetes. Welcome to Center on Health, Shana, Thank you.
Speaker 3 (02:22):
Doctor Tavlin. I'm so excited to be here.
Speaker 2 (02:25):
Well, we are absolutely thrilled to have you in your expertise.
I just was going through all of these things that
you're doing actively in our community with diabetes, and I
just want to start off by asking you, what is
a master level of diabetes educator.
Speaker 3 (02:41):
Well, the master I actually have a master in nursing,
but I am a certified diabetes care and education specialist
and that means that I have the knowledge and skill
set that weren't sort of location in that field of study.
Speaker 2 (03:03):
Well, we are just going to pick your brain, and
of course diabetes is an enormous topic and we're going
to cover as much as we can. But I'm really
fascinated at some of these roles from your from your
bio about what you're currently doing. And so even before
we jump into the diabetes tell us what your role
(03:24):
is as the Kentucky Diabetes Network President and tell us
about the strategic plan that you work on.
Speaker 3 (03:31):
Yeah, so the Kentucky Diabetes Network is actually across the
entire state of Kentucky is a collaborative group. We work
with the state and local organizations all centered around diabetes
in the Commonwealth. So we have events such as learning
(03:57):
events that we do as statewide symposium one the year
along with the Kentucky Diabetes the kd p c P
which is run by the state, and we also have
Diabetes Day at the Capitol. We host that because advocacy
is a huge part of diabetes. And then on the street. Yeah,
(04:22):
oh so just advocating for people at risk and also
living with diabetes, for access to care, for affordability and
things that are important.
Speaker 2 (04:39):
That's fantastic and what and the strategic plan is all
about the future. Is that is that what you're working
on with that plan and what does that look like?
Speaker 3 (04:49):
We are we have goals that are centered on diabetes prevention,
diabetes self management, and collaborative efforts. And so we are
right now coming up with the next strategic plan, which
will be the next five year goals. I'm centered on
(05:12):
everything that is important to people living with diabetes or
at risk for diabetes.
Speaker 2 (05:21):
Wow. So we hear people say I have diabetes or
sometimes we tell people you know you have diabetes. What
does that mean? What is having diabetes mean?
Speaker 3 (05:33):
Well, diabetes is really a chronic disease that affects the
body's ability to produce or respond to insulin. Insulin is
a hormone that's produced by the pancreas and it allows
sugar to enter the cell to be used for energy.
So really it's something to do with the body's ability
to produce or respond to that insulin to manage blood sugar.
Speaker 2 (05:57):
And you mentioned you just answered about six of my
questions in one statement, so that was amazing. What what
do you mean by a chronic condition?
Speaker 3 (06:09):
So diabetes is chronic condition. It is actually a progressive condition.
So our goal is to manage diabetes well to prevent
health complications. But it's something just kind of like hypertension.
Once you have a diagnosis of diabetes, it stays with you,
(06:31):
but our goal is to manage it.
Speaker 2 (06:35):
And we hear about diabetes and sometimes we hear the
term type one diabetes. Sometimes we hear the term type
two diabetes. What's the difference and why is it important
to know the difference? Human? True?
Speaker 3 (06:51):
So they are actually different. So about five to ten
percent if patients with type with diabetes have type one.
We used to call that child onset or juvenile diabetes
because we traditionally found that in children. We now know
that it can develop anytime throughout the lifespan. It's actually
(07:12):
an autoimmune disorder. It's where your body has attacked those
beta cells of the pancreas, but that produce insulin to
where you're no longer able to produce insulin. So that's
type one and then about ninety to ninety five percent
of patients with diabetes have type two diabetes, and that's
(07:33):
more multifactorial. Pancreas doesn't produce enough insulin, and then the
cells in our body are resistant to that insulin, so
we can't use the blood sugar to adequately within the
cell to power our body.
Speaker 2 (07:52):
That's at a great explanation. What so, how would somebody
first think of maybe they have diabetes or what would
a provider be listening to in terms of symptoms that
might trigger them to think about diabetes. What are the
presenting symptoms?
Speaker 3 (08:07):
Oftentimes, yes, the classic symptoms of high blood sugar are
extreme thirst, need to urinate very frequently, possibly blurry vision,
risk for infection, risk for slow healing wounds. Those are
(08:28):
the main symptoms of high blood sugar. Hopefully, though, you
would before you even have those signs. That's why it's
so important to follow with a primary care provider on
a regular basis and have blood work done, so that
(08:49):
is that something they could patch just by routine blood work.
Speaker 2 (08:52):
That's sort of a warning sign even before these symptoms present.
Speaker 3 (08:57):
Yes, sometimes because it is a progressive state, then oftentimes
we will see it. You know, you will have when
you have your fasting labs drawn in the morning when
you go in to see your primary care provider. We
look at the blood sugar amount, so the glucose is
(09:18):
the technical term of that that blood sample, and so
that gives us a lot of clues. So, for instance,
no evidence of diabetes would be a fasting blood sugar
of less than one hundred. A pre diabetes blood sugar
traditionally is between one hundred and one hundred and twenty five.
(09:39):
Diabetes range would be a fasting blood sugar of one
hundred and twenty six are greater. So that kind of
gives a red flag and warrants some additional testing such
as like a hemoglobin A one C level to determine
if it's a one time thing or if it's actually diabetes.
Speaker 2 (10:03):
Well, that is that's good for us to know. I
want to ask you about that human globin A onec.
We're going to jump in with that when we come back.
We're going to take a very short break here. I
want to remind everybody you're listening to Centered on Health
with Baptist Health here on news radio eight forty wh as.
Our phone number five oh two, five seven one, eight
(10:23):
four eighty four. If you'd like to call in, we're
talking diabetes and we're talking with Sane and Nicholson about
diabetes and the treatment of diabetes. We'll be right back.
(10:48):
I want to welcome everyone back to Centerate on Health
with Baptist Help here on news radio eight forty whas.
I'm your host, doctor Jeff Peblin, and tonight we're talking
with Sane and Nicholson about understanding diabetes, treatment of diabetes,
and the management Our phone numbers five oh two, five
seven one, eight four eight four. Our producer, mister Jimsen
(11:10):
is ready to take your calls to ask any questions
about diabetes. We hope to hear from you and Shane.
Welcome back. Before we went to commercial, you gave us
some nice ranges of blood sugars and sort of how
they correspond to different stages of diabetes, and we did
have somebody submit to review what would be considered pre diabetes.
(11:36):
Could you maybe just go through those levels again one
more time.
Speaker 3 (11:41):
Sure, so pre diabetes would be a fasting blood sugar
between one hundred and one hundred and twenty five. And
then when we look at the A one C level,
it would be an A one C of five point
seven to six point four.
Speaker 1 (11:56):
How do you feel when you switch to Geico and
save on your car enture? It's not going to work
on one Thursday morning and thinking to yourself, just one
more day until Friday. But then somebody in the elevator says,
happy Fria. Then you check your phone quickly and discover
today's actually Friday. So yes, happy friya, random stranger in
(12:17):
the elevator, Happy Friya. Indeed yep. Switching and saving with
Geico fields just like that, get more with Geico.
Speaker 2 (12:27):
And how we hear that on the commercials? I mean
we've all seen and heard these jingles on the commercials
about lowering our A and C and all of that.
What exactly does the A and C represent and what's
the target range?
Speaker 3 (12:42):
Yes, so A and C isn't actual, so when you
test your blood sugar, that's what your blood sugar is
right at that minute, that second. But in A and
C gives us an average of the last two to
three months. So it's a little bit of a longer
(13:02):
snapshot of how what our blood sugar averages have been
over that last two to three months.
Speaker 2 (13:09):
And what are we shooting for, Like what's what's a
good A one seed to have or a reasonable one
that a provider would be hearing a patient with diabetes
forwards achieving.
Speaker 3 (13:21):
Yes, So if we go by the American Diabetes Association recommendations,
that would be once you have a diagnosis of type
two or type one diabetes, then the A one C
goal is between six and seven percent. That's been shown
through research to prevent complications as best as we can
(13:42):
known to diabetes.
Speaker 2 (13:45):
And how often should someone have it checked?
Speaker 3 (13:50):
So the recommendations traditionally against that by the American Diabetes
Association would be an A one seed level if you
are above seven every three months. Once you obtain a
goal of between six and seven percent, it would be
every six months.
Speaker 2 (14:08):
Okay, And do you find that most diabetes is managed
by a patient's primary care physician. Do you find that
they get referred out to endophenology when is it appropriate?
I guess in what you see for patients to be
managed simply in their primary care office or maybe we
(14:28):
referred to assessor.
Speaker 3 (14:31):
So it's well within the scope of a primary care
provider to manage diabetes, although for more challenging cases, or
if we have a provider that is not comfortable with diabetes,
then it's absolutely recommended to send a patient to an endochronologist,
which is that specialty in diabetes.
Speaker 2 (14:55):
And how do you get involved? Does somebody call you
and say, hey, I want you to see this person
or the education and all the wonderful things that you're
going to tell us about that you do. How does
somebody get into your world?
Speaker 3 (15:11):
Yes, So it's normally based on referral and that could
be really from any provider taking care of that patient.
They can send a referral to diabetes education and that's
mainly how most people end up seeing a diabetes educator. Sadly,
(15:33):
not everybody who has a diagnosis of diabetes ends up
being able to take advantage of seeing somebody who is
a diabetes educator. So knowing that that is available, asking
those providers for those referrals is the best way to
be able to gain that knowledge that you need to
self manage diabetes.
Speaker 2 (15:56):
So walk us through sort of a patient experience with you.
So somebody is referred to a diabetes educator, what's the
first visit, like, what's your process, how do you assess them?
And then how do you decide your plan of approach.
Speaker 3 (16:15):
So there are a couple different options. There are classes
which are traditionally with a group, and there would be
classes that are really focused on somebody who has a
new diagnosis of diabetes. Those classes traditionally follow the Association
of Diabetes Care and Education Specialist seven self care behaviors
(16:40):
that are associated with diabetes self management. That's the focus
of the class. There are also one on one appointments
that you sit down a little bit more tailored too,
if you're experiencing any issues with your diabetes, uncovering barriers
to diabetes self management and how to overcome those barriers
(17:02):
for better blood sugar management. So there are options for
either individual or group. It really depends on the patient
and what we try to We try to make it
very patient specific so we're able to give them the
exact education that they need.
Speaker 2 (17:25):
And when you say education, are you talking about what
the disease means, or how to prevent complications or diet
or all of this. What what kinds of education do
you provide through your services?
Speaker 3 (17:39):
All the about so it's you know that, what does
it mean to have diabetes? How does inspect your body?
What you need to do to help prevent complications of diabetes?
Certainly diet and activity plays a big role. Medications, how
to take the medications, how to test blood sugar, what
(18:01):
high blood sugar is, how to treat that, low blood sugar,
what that is, how to treat it? All those things
that are associated with diabetes, self management, to promote health
and prevent complications.
Speaker 2 (18:19):
And is there something that in your day to day
experience that surprises you the most about what people do
or don't know about diabetes? Like is there something where
you constantly find that you have to educate about that
we listening might assume we already know.
Speaker 3 (18:42):
That's a very good question. I won't say that I'm surprised.
I think knowledge that these classes and these one on
one training sessions are available, knowing what your community options are,
those are the things that I want everybody to know
(19:05):
that is available.
Speaker 2 (19:07):
Well, yeah, I hope everybody that that's listening definitely take that,
because yeah, I didn't know that all these things were
out there for our patients until you know, obviously we
talk about them. So yeah, we want everybody to know
that these resources exist. So, without myself getting political or anything,
do you find that there's a disparity out there between
(19:30):
access to care for diabetes?
Speaker 3 (19:37):
There are certainly disparities to care in trying to equalize
those is really a goal of mine to make sure
that everybody throughout Kentucky and the surrounding states and counties
have access to diabetes self managed. That that is quality access.
Speaker 2 (20:00):
Mhm.
Speaker 3 (20:00):
That that's quite important. So that's the that's the nice
thing about my role is I'm able to cross those
barriers and make sure that the patient gets what they need.
Speaker 2 (20:14):
And having you on all of these you know, Kentucky
state wide committees where you know, we're so fortunate to
have you advocating for all of those things. What about
financially is this does this become a major burden on patients?
And are there barriers that you see for for the
financial aspects?
Speaker 3 (20:33):
Sure, I mean, diabetes can be expensive. You know when
we talk about things like insulin, insulin is not a luxury,
it's a necessity. So the affordability is a huge topic
and something again that I'm very passionate about. So knowing
that patient if they go to the pharmacy and they're told,
(20:57):
you know, five six seven, kind of hundred dollars, that's
a little bit of a red flag. Reach out to
somebody to help overcome that barrier, such as a diabetes
educator or your diabetes team to help you are a pharmacist.
That's also a really good contact to help you overcome
(21:19):
that financial barrier. You know, a lot of the medicines
they're they're great, and we can make beautiful plants for patients,
but if they can't afford it, it doesn't.
Speaker 2 (21:30):
Do any good, absolutely true. So you know, we want
to make sure you know, people are aware of that.
But yes, keep we keep reinforcing tonight, these educators are
out there and these services are out there. When we
get back, we're going to talk about the symptoms, the complications,
the medicine. We're going to get into picking your brain
(21:51):
about all that chanina. So stick with us. We're going
to be right back. You're listening to Center It on
Health with Bactic Health here on news radio ad Wahas.
I'm your host, doctor Jeff Publin. We're talking with Shane
Nicholson about diabetes, diabetes management and treatment and our phone
number five oh two, five seven to one, eight four
(22:12):
eight four if you want to call in and ask
the question, We'll be right back. I want to welcome
everybody back to Center It on Health with Baptist Help
here on news radio eight forty Wahas. I'm your host,
(22:37):
doctor Jeff Publin, and tonight we're talking about diabetes. Thirty
eight million adults with diabetes in the United States and
by the year twenty thirty and estimated six hundred and
forty million people worldwide. And SHANEA. Nicholson is here to
educate us about diabetes and all sorts of questions. It's
still time to call in at five oh two five
seven one eighty four eight four if you want to
(22:59):
ask a question. Shana, welcome back. Thank you so much
for kind of educating us about all of these resources.
But I do want to talk a little bit about
the diabetes.
Speaker 1 (23:11):
How do you feel when you switch to Geico and
save on your car insurance. It's not going to work
on one Thursday morning and thinking to yourself, just one
more day until Friday, But then somebody in the elevator
says happy Friday. Then you check your phone quickly and
discover today's actually Friday. So yes, happy Friday. Random stranger
(23:32):
in the elevator, Happy Friye indeed yep. Switching and saving
with Geico feels just like that. Get more with Geico themselves.
Speaker 2 (23:41):
And I think people oftentimes wonder how do you get diabetes?
I mean I remember people saying when we were growing up,
don't eat all that sugar or you'll get diabetes or
things like that. So how do people get diabetes?
Speaker 3 (23:56):
Well, if we focus on type to diet, you know
we have modifiable and non modifiable risk factors. So some
of those non modifiable risk factors are age being greater
than forty five years old and history family history of diabetes.
We know that it runs in families, So those are
(24:17):
our non modifiable risk factors. For modifiable risk factors, it's
things such as being overweight, inactive, eating a poor diet, smoking,
not getting adequate sleep, things that put stress on the body.
(24:41):
So those are some of those non modifiable risks or
some of the modifiable risk factors we talk about to
help prevent diabetes or manage diabetes.
Speaker 2 (24:51):
So I love the way that you just categorize that
between those modifiable and non modifiable, So they're you know,
those things that you know, we can't control our age
and think, you know, family history, but those things that
we can and you know, we do live in a
state which I'm sure you know with your work with
the state that you know the tobacco rate is high,
the easy rate is high, and so these are things
(25:13):
that we are constantly working on as a medical community
and it's great to know that those are modifiable. So
have you seen patients that are either in this sort
of pre diabetic state or early diabetes that just by
modifying those modifiable factors alone, that they can prevent having
to go on medicine.
Speaker 3 (25:36):
Absolutely. You know, again it is very individualized, but we
know that, for instance, we also have the National Diabetes
Prevention Program and the goal of that program is a
modest weight loss at five to seven percent in one
hundred and fifty minutes of moderate activity a week. We
(26:00):
know that those modifiable risk factors of diet and activity,
modest weight loss helps prevent progression of pre diabetes to
type two diabetes as well as help manage type two diabetes.
Speaker 2 (26:17):
That very encouraging. So you talk obviously, you know all
of this is to prevent, well, we want to treat it,
but we also want to prevent complications. Talk to us
a little bit about what some of those complications of
diabetes are and why then it's so important to keep
these bloodshirters of a control.
Speaker 3 (26:38):
Yes, so complications that are typically associated with diabetes over
time is a higher risk of heart attack and strokes,
so cardiovascular risk, risk of diabetic retinopathy, which is of
the eye that can lead division loss. There's diabetic nephropathy,
(27:02):
which is kidney damage. You have peripheral neuropathy, which is
a numbness tingling of hands or feet. So those are
really things that we focus on on being really proactive
to prevent complications.
Speaker 2 (27:22):
And is it just prevention or if you have some
of these things, are they can they be improved by
treating the diabetes or is it fine? On one do
you have any of these it's kind of too late.
Speaker 3 (27:34):
Oh no, Certainly, good blood glucose management and diabetes management
helps not only prevent but helps your health overall. Really,
when we talk about preventative also, it's that yearly eye
exam to look for potential changes of the eye due
(27:59):
to diabetes or related diabetic retinopathy that can be treated.
You know, dental health is important. Gum disease. We know
that there's a risk of gum disease to floss. So again,
prevented of dental care being your primary care on a
regular basis, All those things really help prevent complications known
(28:24):
to diabetes. You know, taking care of your blood pressure
if you're if you have high blood pressure and diabetes,
those cardiovascular risks are a little bit higher. So managing
your blood pressure and your blood sugar helps prevent that risk.
Speaker 2 (28:43):
And do you does your work involve the diet recommendations
or do you refer people through dietitians or you know,
I know people can be very overwhelmed. Sometimes the diet
they want to do for weight loss, which is important
for diabetes, doesn't match with there the diabetes and there
can be a visious cycle. So how how does the
(29:05):
nutritional aspect of it get provide education? Is that for you?
Or do you refer to a dietitian or how does
that work?
Speaker 3 (29:13):
Yeah, so the good news is is that there are
registered dietitians who are also certified diabetes care and education specialists,
And I am very fortunate to work with two of those.
And so while I'm based as a nurse, of course
I can do basic diet modification for diabetes, but really
I like it to come from that specialist, registered dietitian
(29:36):
who's also a diabetes educator to make sure that that
patient is getting exactly what they need.
Speaker 2 (29:44):
Fantastic. Now, I know this question that probably isn't as
straightforward as as I'm asking it, But can diabetes be cured?
Speaker 3 (29:54):
Somewhat similar to like hypertension, it's not curable our as
well managed diabetes. You can have somewhat what you might
hear as a diabetes remission, meaning that you can get
your A one C and blood sugar levels below diabetes range.
(30:16):
But when that all that good work stops, or medication
stops and all that good work stops, those blood sugars
are going to go right back up. So it's not durable,
but it's manageable and you can live a very long
healthy life with diabetes.
Speaker 2 (30:33):
That that's always very encouraging. Now. I know you did
some work before with with tancreds and with the total
tancretectomy and isletself transplants. That's a lot of complicated words,
But can you just briefly talk to us about the
work you did with that? Sure?
Speaker 3 (30:52):
So, my of course, my really, my focus as part
of that interdisciplinary team of care is entered on diabetes
education and training for that patient. But yes, I have
in my past worked with transplant patients. A lot of
the transplant medications, the anti rejection medications normally involve steroids.
(31:16):
We know steroids really increase blood sugar, so it's not
unusual have higher blood sugar. I've also worked with the
patients who have had the islet transplant, which is where
those islet cells that produce insulin are given to the patient,
which is amazing, and also kidney and pancreas transplants as well,
(31:42):
so those things are available. And it really, again that
interdisciplinary team approach, not only with the provider and the pharmacist,
social work educators such as myself. It really it's a
it takes a it takes that that holistic approach to
really give the patient what they need.
Speaker 2 (32:06):
I mean, yeah, it takes it takes a village yet
to get all of this stuff to take care of
these patients. Now, big topic is medications and we're going
to tackle that our in our last segment because you know,
some of these medications are getting very popular now for
uses outside of diabetes, but I do want to focus
on what they're doing to treat the diabetes. So we're
(32:28):
going to talk medications when we come back. We're going
to take our final break, and I want to remind
everybody that you're listening to Centered on Health with Baptist
Health here on news Radio A forty whas. Our guest
tonight is Shana Nicholson, who's teaching us all about diabetes.
And if you miss any part of this show or
you want to hear all of the excellent information in
(32:50):
its entirety, this gets posted as a podcast on the
iHeartRadio app. It's free, it's easy to use, and it
gives you access to tonight's show. We'll be right b app.
(33:15):
Welcome back everyone to Center It on Health with Baptist
Health here on news radio eight forty WAHS. I'm your host,
doctor Jeff Coblin, and we are talking tonight all things
diabetes with Sana Nicholson. We have been talked all about
the symptoms and the complications, and you need to talk
about the treatments. But I want to remind everybody to
(33:37):
download the iHeartRadio app to listen to this or any
of our previous segments, and to access all the other
features that the app has to offer. So, Shana, we've
talked a lot about all of this diabetes, and you know,
when it's time for somebody to be put on medications.
I know this has been an evolving process over the
years of different types of medicines. What are the most
(34:00):
common types of medicines you're seeing out there that are
being used for diabetes.
Speaker 3 (34:08):
Well, there's of course the tread and true It's been
used for years met foreman, and that one is is
one of the arsenal of the first line oral medications.
Then we have the newer ones, uh to the diabetes
treatment that I think most everybody is interested in hearing
(34:33):
about are the g l P ones which end in tide,
so semi glue tide and trezeppa tide or one of
the bigger one of the newer ones. And then there's
also the new class of the s g l T
two inhibitors which end in flosen. So did you have
(34:57):
any particular questions you would like me to answer about
any of the medications in general?
Speaker 2 (35:05):
Well, how how in general, do you feel the providers
that send patents to you how they choose between them.
Is it a matter of how how high the blood
sugar is, is it based on other factors, or how
do you see people getting the choice of which ones
would be to use.
Speaker 3 (35:25):
Sure, so, traditionally there's a there is an algorithm of
care in diabetes, and that's kind of what helps guide
the treatment. It's what is research based and what's recommended
by the American Diabetes Association, by the American Association of
Clinical Endocrinologists, of those diabetes specialists. And again, it's not
(35:49):
a one size fits all, so it really is. It's
it It is determined by the provider based on things
such as ris. So for somebody who has a cardiovascular
risk or a kidney disease risk, that would point the
provider in a direction of possibly like the g LP
(36:12):
ones or the SGLT twos.
Speaker 2 (36:16):
Yeah, oh no, I was just yeah, thank you. So
in your role, I would imagine that, you know, So,
they get put on these medications and then they get
sent to you for education. Are you the one that
typically talk to them about the potential side effects of
these medicines or today often report them to you and
(36:38):
what are some of the side effects that you see
on some of these medications.
Speaker 3 (36:43):
Yeah, so we educate based on what the provider has
put the patient on. We educate on those medications, including
how to take it, when to take it, what the
action of it is, what the potential side effects are,
and everything to do with that medication. So some of
(37:05):
the some of the side effects of some of the
newer medications that we see, for instance with the g
lp ones because it does slow down gastric emptying, is
some nausea with the with Matt Foreman. One of the
common side effects of that is gastro intestinal distress such
(37:29):
as diarrhea. So those are the things that we try
to help. What I can say, what I always encourage
if a patient is experiencing a side effect to please
reach out to the provider discuss that with them. You know,
we sometimes we think, oh, we can just stop the medication,
(37:50):
but it's really always important to contact your provider to
discuss those things.
Speaker 2 (37:55):
What that is great advice because you know, stopping any
of these medicines, want to do that without obviously talking
about it with you with your provider. So you mentioned
earlier a couple of things about blood sugar is being
too low and blood sugar is being too high. Talk
to us a little bit about what too low means
(38:17):
and what some of the symptoms are. What somebody should
do if their blood sugar is too low and they're
taking these medicines.
Speaker 3 (38:25):
Right, So, if they're taking these medicines or they've had
some they've they've had a lot of activity that has
lowered their blood sugar. Traditionally, our body's really pretty good
about recognizing low blood sugar. You might start feeling shaky
or sweaty. Those are the two main symptoms. It could
(38:46):
be light headed, dizzy, feel weak or tired, hungry, nervous, upset,
something is wrong. So I always encourage patients listen to
your body. If something is in doubt, check your blood sugar,
see where it's at. Anything. Let a blood sugar of
less than seventy is considered too low. So then we
(39:06):
really talk about how to treat that low blood sugar.
What they had need to have on them to be
really proactive about being able to treat that low blood
sugar for safety.
Speaker 2 (39:19):
That's great advice. We have about a minute and a
half left, which I know is not enough time to
tackle this next topic, But if you could talk to
us a little bit about a special type of diabetes,
which is gestational diabetes. Do you counsel pations with.
Speaker 3 (39:36):
That, Yes, we do so. Gestational diabetes it is a pregnancy.
It normally does not affect pregnancy until the later stages,
so somewhere around twenty six to twenty eight weeks, that's
when somebody would normally have what's called a glucose tolerance test,
So it's something that you drink about one hundred seventy
(39:59):
five to one hundred grains of a sweet drink and
then they measure your blood sugar to see how your
body's able to handle that. Just stational diabetes is actually
caused from the pregnancy hormones, but the placenta releases it
is traditionally goes away after birth of the baby and
(40:20):
those pregnancy hormones go away. But what it tells us
it is an increased risk of developing type two diabetes
later in life. So that's really powerfulation for a mom
to know.
Speaker 2 (40:32):
Yeah, that's interesting, and can it happen in subsequent pregnancies?
Is that something they need to be concerned of for
the future.
Speaker 3 (40:42):
Yeah, it's a higher.
Speaker 2 (40:43):
Risk of.
Speaker 3 (40:46):
Developing gestational diabetes with subsequent pregnancies. So some of those
risk factors are having given birth to a baby that
weighed greater than nine pounds in the acts or twenty
five or older, in the history of type two diabetes
and family.
Speaker 2 (41:03):
Well, Shana, thank you so much. I know this is
a huge topic and you have just been able to
give us so much information. I want to thank you
so much for joining us tonight. That's going to do
it for tonight's segment of Centered on Health with Baptist Health.
I'm your host, doctor Jeff Hovlin. I want to thank
our guest Shana Nicholson for teaching us everything we needed
(41:23):
to know, and I want to thank our producers to
Jim then you the listener. Join us every Thursday night
for another segment, and I hope everybody has a healthy
and safe weekend. We'll see you next group.
Speaker 1 (41:45):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment.
Speaker 2 (41:57):
This show is not designed to replace a physician's medical
assessment and medical judgment.
Speaker 1 (42:02):
Always seek the advice of your physician with any questions
or concerns you may have related to your personal health
or regarding specific medical conditions. To find a Baptist health provider,
please visit Baptist heealth dot com.
How do you feel when you switch to Geico and
save on your car insurance? It's like going to work
on one Thursday morning and thinking to yourself, just one
more day until Friday. But then somebody in the elevator
says happy Friday. Then you check your phone quickly and
discover today's actually Friday. So yes, happy Friday, random stranger
(00:21):
in the elevator, Happy Friday. Indeed yep. Switching and saving
with Geico feels just like that. Get more with Geico.
It's now time for Centered on Health with Baptis's Health
on US Radio. Wait forty tejs Now, here's doctor Jeff Tumbler.
Speaker 2 (00:41):
Good evening, everyone, and thanks for joining us tonight on
tonight's episode of Centered on Health with Baptis Health Here
on news radio eight forty whas. I'm your host, doctor
Jeff Publin, and tonight we're talking with Sanna Nicholson, who
I'm going to introduce you to in just a moment,
and we're talking about diabetes. But as always, our producer,
(01:02):
mister Jncent is on standby to take your calls and
ask questions of tonight's guests. Our phone number is five
oh two five seven one eight four eighty four if
you want to call in and be a part of
tonight's conversation. So, thirty eight million Americans have diabetes, and
that doesn't even consider those who might have three diabetes.
(01:23):
One out of five people don't even know that they
have diabetes before they're diagnosed. And by the year twenty thirty,
it's estimated that one in eight people, or six hundred
and forty million people worldwide will have diabetes. So our
guest tonight is Shana Nicholson. She is a Master level
registered nurse and a certified Diabetes Care and Education Specialer,
(01:47):
a Master Licensed Diabetes Educator, lifestyle coach, and Progressive Care
certified nurse. She's a manager of the Diabetes Education and
Nutrition Counseling program for Baptist Louisville and Lagrain Means. She's
currently the Kentucky Diabetic Network President and she worked with
the Kentucky Statewide Diabetes Strategic Planning Committee. She cares for
(02:11):
patients with an interdisciplinary and holistic approach and we are
so fortunate to have her tonight to talk to us
about diabetes. Welcome to Center on Health, Shana, Thank you.
Speaker 3 (02:22):
Doctor Tavlin. I'm so excited to be here.
Speaker 2 (02:25):
Well, we are absolutely thrilled to have you in your expertise.
I just was going through all of these things that
you're doing actively in our community with diabetes, and I
just want to start off by asking you, what is
a master level of diabetes educator.
Speaker 3 (02:41):
Well, the master I actually have a master in nursing,
but I am a certified diabetes care and education specialist
and that means that I have the knowledge and skill
set that weren't sort of location in that field of study.
Speaker 2 (03:03):
Well, we are just going to pick your brain, and
of course diabetes is an enormous topic and we're going
to cover as much as we can. But I'm really
fascinated at some of these roles from your from your
bio about what you're currently doing. And so even before
we jump into the diabetes tell us what your role
(03:24):
is as the Kentucky Diabetes Network President and tell us
about the strategic plan that you work on.
Speaker 3 (03:31):
Yeah, so the Kentucky Diabetes Network is actually across the
entire state of Kentucky is a collaborative group. We work
with the state and local organizations all centered around diabetes
in the Commonwealth. So we have events such as learning
(03:57):
events that we do as statewide symposium one the year
along with the Kentucky Diabetes the kd p c P
which is run by the state, and we also have
Diabetes Day at the Capitol. We host that because advocacy
is a huge part of diabetes. And then on the street. Yeah,
(04:22):
oh so just advocating for people at risk and also
living with diabetes, for access to care, for affordability and
things that are important.
Speaker 2 (04:39):
That's fantastic and what and the strategic plan is all
about the future. Is that is that what you're working
on with that plan and what does that look like?
Speaker 3 (04:49):
We are we have goals that are centered on diabetes prevention,
diabetes self management, and collaborative efforts. And so we are
right now coming up with the next strategic plan, which
will be the next five year goals. I'm centered on
(05:12):
everything that is important to people living with diabetes or
at risk for diabetes.
Speaker 2 (05:21):
Wow. So we hear people say I have diabetes or
sometimes we tell people you know you have diabetes. What
does that mean? What is having diabetes mean?
Speaker 3 (05:33):
Well, diabetes is really a chronic disease that affects the
body's ability to produce or respond to insulin. Insulin is
a hormone that's produced by the pancreas and it allows
sugar to enter the cell to be used for energy.
So really it's something to do with the body's ability
to produce or respond to that insulin to manage blood sugar.
Speaker 2 (05:57):
And you mentioned you just answered about six of my
questions in one statement, so that was amazing. What what
do you mean by a chronic condition?
Speaker 3 (06:09):
So diabetes is chronic condition. It is actually a progressive condition.
So our goal is to manage diabetes well to prevent
health complications. But it's something just kind of like hypertension.
Once you have a diagnosis of diabetes, it stays with you,
(06:31):
but our goal is to manage it.
Speaker 2 (06:35):
And we hear about diabetes and sometimes we hear the
term type one diabetes. Sometimes we hear the term type
two diabetes. What's the difference and why is it important
to know the difference? Human? True?
Speaker 3 (06:51):
So they are actually different. So about five to ten
percent if patients with type with diabetes have type one.
We used to call that child onset or juvenile diabetes
because we traditionally found that in children. We now know
that it can develop anytime throughout the lifespan. It's actually
(07:12):
an autoimmune disorder. It's where your body has attacked those
beta cells of the pancreas, but that produce insulin to
where you're no longer able to produce insulin. So that's
type one and then about ninety to ninety five percent
of patients with diabetes have type two diabetes, and that's
(07:33):
more multifactorial. Pancreas doesn't produce enough insulin, and then the
cells in our body are resistant to that insulin, so
we can't use the blood sugar to adequately within the
cell to power our body.
Speaker 2 (07:52):
That's at a great explanation. What so, how would somebody
first think of maybe they have diabetes or what would
a provider be listening to in terms of symptoms that
might trigger them to think about diabetes. What are the
presenting symptoms?
Speaker 3 (08:07):
Oftentimes, yes, the classic symptoms of high blood sugar are
extreme thirst, need to urinate very frequently, possibly blurry vision,
risk for infection, risk for slow healing wounds. Those are
(08:28):
the main symptoms of high blood sugar. Hopefully, though, you
would before you even have those signs. That's why it's
so important to follow with a primary care provider on
a regular basis and have blood work done, so that
(08:49):
is that something they could patch just by routine blood work.
Speaker 2 (08:52):
That's sort of a warning sign even before these symptoms present.
Speaker 3 (08:57):
Yes, sometimes because it is a progressive state, then oftentimes
we will see it. You know, you will have when
you have your fasting labs drawn in the morning when
you go in to see your primary care provider. We
look at the blood sugar amount, so the glucose is
(09:18):
the technical term of that that blood sample, and so
that gives us a lot of clues. So, for instance,
no evidence of diabetes would be a fasting blood sugar
of less than one hundred. A pre diabetes blood sugar
traditionally is between one hundred and one hundred and twenty five.
(09:39):
Diabetes range would be a fasting blood sugar of one
hundred and twenty six are greater. So that kind of
gives a red flag and warrants some additional testing such
as like a hemoglobin A one C level to determine
if it's a one time thing or if it's actually diabetes.
Speaker 2 (10:03):
Well, that is that's good for us to know. I
want to ask you about that human globin A onec.
We're going to jump in with that when we come back.
We're going to take a very short break here. I
want to remind everybody you're listening to Centered on Health
with Baptist Health here on news radio eight forty wh as.
Our phone number five oh two, five seven one, eight
(10:23):
four eighty four. If you'd like to call in, we're
talking diabetes and we're talking with Sane and Nicholson about
diabetes and the treatment of diabetes. We'll be right back.
(10:48):
I want to welcome everyone back to Centerate on Health
with Baptist Help here on news radio eight forty whas.
I'm your host, doctor Jeff Peblin, and tonight we're talking
with Sane and Nicholson about understanding diabetes, treatment of diabetes,
and the management Our phone numbers five oh two, five
seven one, eight four eight four. Our producer, mister Jimsen
(11:10):
is ready to take your calls to ask any questions
about diabetes. We hope to hear from you and Shane.
Welcome back. Before we went to commercial, you gave us
some nice ranges of blood sugars and sort of how
they correspond to different stages of diabetes, and we did
have somebody submit to review what would be considered pre diabetes.
(11:36):
Could you maybe just go through those levels again one
more time.
Speaker 3 (11:41):
Sure, so pre diabetes would be a fasting blood sugar
between one hundred and one hundred and twenty five. And
then when we look at the A one C level,
it would be an A one C of five point
seven to six point four.
Speaker 1 (11:56):
How do you feel when you switch to Geico and
save on your car enture? It's not going to work
on one Thursday morning and thinking to yourself, just one
more day until Friday. But then somebody in the elevator says,
happy Fria. Then you check your phone quickly and discover
today's actually Friday. So yes, happy friya, random stranger in
(12:17):
the elevator, Happy Friya. Indeed yep. Switching and saving with
Geico fields just like that, get more with Geico.
Speaker 2 (12:27):
And how we hear that on the commercials? I mean
we've all seen and heard these jingles on the commercials
about lowering our A and C and all of that.
What exactly does the A and C represent and what's
the target range?
Speaker 3 (12:42):
Yes, so A and C isn't actual, so when you
test your blood sugar, that's what your blood sugar is
right at that minute, that second. But in A and
C gives us an average of the last two to
three months. So it's a little bit of a longer
(13:02):
snapshot of how what our blood sugar averages have been
over that last two to three months.
Speaker 2 (13:09):
And what are we shooting for, Like what's what's a
good A one seed to have or a reasonable one
that a provider would be hearing a patient with diabetes
forwards achieving.
Speaker 3 (13:21):
Yes, So if we go by the American Diabetes Association recommendations,
that would be once you have a diagnosis of type
two or type one diabetes, then the A one C
goal is between six and seven percent. That's been shown
through research to prevent complications as best as we can
(13:42):
known to diabetes.
Speaker 2 (13:45):
And how often should someone have it checked?
Speaker 3 (13:50):
So the recommendations traditionally against that by the American Diabetes
Association would be an A one seed level if you
are above seven every three months. Once you obtain a
goal of between six and seven percent, it would be
every six months.
Speaker 2 (14:08):
Okay, And do you find that most diabetes is managed
by a patient's primary care physician. Do you find that
they get referred out to endophenology when is it appropriate?
I guess in what you see for patients to be
managed simply in their primary care office or maybe we
(14:28):
referred to assessor.
Speaker 3 (14:31):
So it's well within the scope of a primary care
provider to manage diabetes, although for more challenging cases, or
if we have a provider that is not comfortable with diabetes,
then it's absolutely recommended to send a patient to an endochronologist,
which is that specialty in diabetes.
Speaker 2 (14:55):
And how do you get involved? Does somebody call you
and say, hey, I want you to see this person
or the education and all the wonderful things that you're
going to tell us about that you do. How does
somebody get into your world?
Speaker 3 (15:11):
Yes, So it's normally based on referral and that could
be really from any provider taking care of that patient.
They can send a referral to diabetes education and that's
mainly how most people end up seeing a diabetes educator. Sadly,
(15:33):
not everybody who has a diagnosis of diabetes ends up
being able to take advantage of seeing somebody who is
a diabetes educator. So knowing that that is available, asking
those providers for those referrals is the best way to
be able to gain that knowledge that you need to
self manage diabetes.
Speaker 2 (15:56):
So walk us through sort of a patient experience with you.
So somebody is referred to a diabetes educator, what's the
first visit, like, what's your process, how do you assess them?
And then how do you decide your plan of approach.
Speaker 3 (16:15):
So there are a couple different options. There are classes
which are traditionally with a group, and there would be
classes that are really focused on somebody who has a
new diagnosis of diabetes. Those classes traditionally follow the Association
of Diabetes Care and Education Specialist seven self care behaviors
(16:40):
that are associated with diabetes self management. That's the focus
of the class. There are also one on one appointments
that you sit down a little bit more tailored too,
if you're experiencing any issues with your diabetes, uncovering barriers
to diabetes self management and how to overcome those barriers
(17:02):
for better blood sugar management. So there are options for
either individual or group. It really depends on the patient
and what we try to We try to make it
very patient specific so we're able to give them the
exact education that they need.
Speaker 2 (17:25):
And when you say education, are you talking about what
the disease means, or how to prevent complications or diet
or all of this. What what kinds of education do
you provide through your services?
Speaker 3 (17:39):
All the about so it's you know that, what does
it mean to have diabetes? How does inspect your body?
What you need to do to help prevent complications of diabetes?
Certainly diet and activity plays a big role. Medications, how
to take the medications, how to test blood sugar, what
(18:01):
high blood sugar is, how to treat that, low blood sugar,
what that is, how to treat it? All those things
that are associated with diabetes, self management, to promote health
and prevent complications.
Speaker 2 (18:19):
And is there something that in your day to day
experience that surprises you the most about what people do
or don't know about diabetes? Like is there something where
you constantly find that you have to educate about that
we listening might assume we already know.
Speaker 3 (18:42):
That's a very good question. I won't say that I'm surprised.
I think knowledge that these classes and these one on
one training sessions are available, knowing what your community options are,
those are the things that I want everybody to know
(19:05):
that is available.
Speaker 2 (19:07):
Well, yeah, I hope everybody that that's listening definitely take that,
because yeah, I didn't know that all these things were
out there for our patients until you know, obviously we
talk about them. So yeah, we want everybody to know
that these resources exist. So, without myself getting political or anything,
do you find that there's a disparity out there between
(19:30):
access to care for diabetes?
Speaker 3 (19:37):
There are certainly disparities to care in trying to equalize
those is really a goal of mine to make sure
that everybody throughout Kentucky and the surrounding states and counties
have access to diabetes self managed. That that is quality access.
Speaker 2 (20:00):
Mhm.
Speaker 3 (20:00):
That that's quite important. So that's the that's the nice
thing about my role is I'm able to cross those
barriers and make sure that the patient gets what they need.
Speaker 2 (20:14):
And having you on all of these you know, Kentucky
state wide committees where you know, we're so fortunate to
have you advocating for all of those things. What about
financially is this does this become a major burden on patients?
And are there barriers that you see for for the
financial aspects?
Speaker 3 (20:33):
Sure, I mean, diabetes can be expensive. You know when
we talk about things like insulin, insulin is not a luxury,
it's a necessity. So the affordability is a huge topic
and something again that I'm very passionate about. So knowing
that patient if they go to the pharmacy and they're told,
(20:57):
you know, five six seven, kind of hundred dollars, that's
a little bit of a red flag. Reach out to
somebody to help overcome that barrier, such as a diabetes
educator or your diabetes team to help you are a pharmacist.
That's also a really good contact to help you overcome
(21:19):
that financial barrier. You know, a lot of the medicines
they're they're great, and we can make beautiful plants for patients,
but if they can't afford it, it doesn't.
Speaker 2 (21:30):
Do any good, absolutely true. So you know, we want
to make sure you know, people are aware of that.
But yes, keep we keep reinforcing tonight, these educators are
out there and these services are out there. When we
get back, we're going to talk about the symptoms, the complications,
the medicine. We're going to get into picking your brain
(21:51):
about all that chanina. So stick with us. We're going
to be right back. You're listening to Center It on
Health with Bactic Health here on news radio ad Wahas.
I'm your host, doctor Jeff Publin. We're talking with Shane
Nicholson about diabetes, diabetes management and treatment and our phone
number five oh two, five seven to one, eight four
(22:12):
eight four if you want to call in and ask
the question, We'll be right back. I want to welcome
everybody back to Center It on Health with Baptist Help
here on news radio eight forty Wahas. I'm your host,
(22:37):
doctor Jeff Publin, and tonight we're talking about diabetes. Thirty
eight million adults with diabetes in the United States and
by the year twenty thirty and estimated six hundred and
forty million people worldwide. And SHANEA. Nicholson is here to
educate us about diabetes and all sorts of questions. It's
still time to call in at five oh two five
seven one eighty four eight four if you want to
(22:59):
ask a question. Shana, welcome back. Thank you so much
for kind of educating us about all of these resources.
But I do want to talk a little bit about
the diabetes.
Speaker 1 (23:11):
How do you feel when you switch to Geico and
save on your car insurance. It's not going to work
on one Thursday morning and thinking to yourself, just one
more day until Friday, But then somebody in the elevator
says happy Friday. Then you check your phone quickly and
discover today's actually Friday. So yes, happy Friday. Random stranger
(23:32):
in the elevator, Happy Friye indeed yep. Switching and saving
with Geico feels just like that. Get more with Geico themselves.
Speaker 2 (23:41):
And I think people oftentimes wonder how do you get diabetes?
I mean I remember people saying when we were growing up,
don't eat all that sugar or you'll get diabetes or
things like that. So how do people get diabetes?
Speaker 3 (23:56):
Well, if we focus on type to diet, you know
we have modifiable and non modifiable risk factors. So some
of those non modifiable risk factors are age being greater
than forty five years old and history family history of diabetes.
We know that it runs in families, So those are
(24:17):
our non modifiable risk factors. For modifiable risk factors, it's
things such as being overweight, inactive, eating a poor diet, smoking,
not getting adequate sleep, things that put stress on the body.
(24:41):
So those are some of those non modifiable risks or
some of the modifiable risk factors we talk about to
help prevent diabetes or manage diabetes.
Speaker 2 (24:51):
So I love the way that you just categorize that
between those modifiable and non modifiable, So they're you know,
those things that you know, we can't control our age
and think, you know, family history, but those things that
we can and you know, we do live in a
state which I'm sure you know with your work with
the state that you know the tobacco rate is high,
the easy rate is high, and so these are things
(25:13):
that we are constantly working on as a medical community
and it's great to know that those are modifiable. So
have you seen patients that are either in this sort
of pre diabetic state or early diabetes that just by
modifying those modifiable factors alone, that they can prevent having
to go on medicine.
Speaker 3 (25:36):
Absolutely. You know, again it is very individualized, but we
know that, for instance, we also have the National Diabetes
Prevention Program and the goal of that program is a
modest weight loss at five to seven percent in one
hundred and fifty minutes of moderate activity a week. We
(26:00):
know that those modifiable risk factors of diet and activity,
modest weight loss helps prevent progression of pre diabetes to
type two diabetes as well as help manage type two diabetes.
Speaker 2 (26:17):
That very encouraging. So you talk obviously, you know all
of this is to prevent, well, we want to treat it,
but we also want to prevent complications. Talk to us
a little bit about what some of those complications of
diabetes are and why then it's so important to keep
these bloodshirters of a control.
Speaker 3 (26:38):
Yes, so complications that are typically associated with diabetes over
time is a higher risk of heart attack and strokes,
so cardiovascular risk, risk of diabetic retinopathy, which is of
the eye that can lead division loss. There's diabetic nephropathy,
(27:02):
which is kidney damage. You have peripheral neuropathy, which is
a numbness tingling of hands or feet. So those are
really things that we focus on on being really proactive
to prevent complications.
Speaker 2 (27:22):
And is it just prevention or if you have some
of these things, are they can they be improved by
treating the diabetes or is it fine? On one do
you have any of these it's kind of too late.
Speaker 3 (27:34):
Oh no, Certainly, good blood glucose management and diabetes management
helps not only prevent but helps your health overall. Really,
when we talk about preventative also, it's that yearly eye
exam to look for potential changes of the eye due
(27:59):
to diabetes or related diabetic retinopathy that can be treated.
You know, dental health is important. Gum disease. We know
that there's a risk of gum disease to floss. So again,
prevented of dental care being your primary care on a
regular basis, All those things really help prevent complications known
(28:24):
to diabetes. You know, taking care of your blood pressure
if you're if you have high blood pressure and diabetes,
those cardiovascular risks are a little bit higher. So managing
your blood pressure and your blood sugar helps prevent that risk.
Speaker 2 (28:43):
And do you does your work involve the diet recommendations
or do you refer people through dietitians or you know,
I know people can be very overwhelmed. Sometimes the diet
they want to do for weight loss, which is important
for diabetes, doesn't match with there the diabetes and there
can be a visious cycle. So how how does the
(29:05):
nutritional aspect of it get provide education? Is that for you?
Or do you refer to a dietitian or how does
that work?
Speaker 3 (29:13):
Yeah, so the good news is is that there are
registered dietitians who are also certified diabetes care and education specialists,
And I am very fortunate to work with two of those.
And so while I'm based as a nurse, of course
I can do basic diet modification for diabetes, but really
I like it to come from that specialist, registered dietitian
(29:36):
who's also a diabetes educator to make sure that that
patient is getting exactly what they need.
Speaker 2 (29:44):
Fantastic. Now, I know this question that probably isn't as
straightforward as as I'm asking it, But can diabetes be cured?
Speaker 3 (29:54):
Somewhat similar to like hypertension, it's not curable our as
well managed diabetes. You can have somewhat what you might
hear as a diabetes remission, meaning that you can get
your A one C and blood sugar levels below diabetes range.
(30:16):
But when that all that good work stops, or medication
stops and all that good work stops, those blood sugars
are going to go right back up. So it's not durable,
but it's manageable and you can live a very long
healthy life with diabetes.
Speaker 2 (30:33):
That that's always very encouraging. Now. I know you did
some work before with with tancreds and with the total
tancretectomy and isletself transplants. That's a lot of complicated words,
But can you just briefly talk to us about the
work you did with that? Sure?
Speaker 3 (30:52):
So, my of course, my really, my focus as part
of that interdisciplinary team of care is entered on diabetes
education and training for that patient. But yes, I have
in my past worked with transplant patients. A lot of
the transplant medications, the anti rejection medications normally involve steroids.
(31:16):
We know steroids really increase blood sugar, so it's not
unusual have higher blood sugar. I've also worked with the
patients who have had the islet transplant, which is where
those islet cells that produce insulin are given to the patient,
which is amazing, and also kidney and pancreas transplants as well,
(31:42):
so those things are available. And it really, again that
interdisciplinary team approach, not only with the provider and the pharmacist,
social work educators such as myself. It really it's a
it takes a it takes that that holistic approach to
really give the patient what they need.
Speaker 2 (32:06):
I mean, yeah, it takes it takes a village yet
to get all of this stuff to take care of
these patients. Now, big topic is medications and we're going
to tackle that our in our last segment because you know,
some of these medications are getting very popular now for
uses outside of diabetes, but I do want to focus
on what they're doing to treat the diabetes. So we're
(32:28):
going to talk medications when we come back. We're going
to take our final break, and I want to remind
everybody that you're listening to Centered on Health with Baptist
Health here on news Radio A forty whas. Our guest
tonight is Shana Nicholson, who's teaching us all about diabetes.
And if you miss any part of this show or
you want to hear all of the excellent information in
(32:50):
its entirety, this gets posted as a podcast on the
iHeartRadio app. It's free, it's easy to use, and it
gives you access to tonight's show. We'll be right b app.
(33:15):
Welcome back everyone to Center It on Health with Baptist
Health here on news radio eight forty WAHS. I'm your host,
doctor Jeff Coblin, and we are talking tonight all things
diabetes with Sana Nicholson. We have been talked all about
the symptoms and the complications, and you need to talk
about the treatments. But I want to remind everybody to
(33:37):
download the iHeartRadio app to listen to this or any
of our previous segments, and to access all the other
features that the app has to offer. So, Shana, we've
talked a lot about all of this diabetes, and you know,
when it's time for somebody to be put on medications.
I know this has been an evolving process over the
years of different types of medicines. What are the most
(34:00):
common types of medicines you're seeing out there that are
being used for diabetes.
Speaker 3 (34:08):
Well, there's of course the tread and true It's been
used for years met foreman, and that one is is
one of the arsenal of the first line oral medications.
Then we have the newer ones, uh to the diabetes
treatment that I think most everybody is interested in hearing
(34:33):
about are the g l P ones which end in tide,
so semi glue tide and trezeppa tide or one of
the bigger one of the newer ones. And then there's
also the new class of the s g l T
two inhibitors which end in flosen. So did you have
(34:57):
any particular questions you would like me to answer about
any of the medications in general?
Speaker 2 (35:05):
Well, how how in general, do you feel the providers
that send patents to you how they choose between them.
Is it a matter of how how high the blood
sugar is, is it based on other factors, or how
do you see people getting the choice of which ones
would be to use.
Speaker 3 (35:25):
Sure, so, traditionally there's a there is an algorithm of
care in diabetes, and that's kind of what helps guide
the treatment. It's what is research based and what's recommended
by the American Diabetes Association, by the American Association of
Clinical Endocrinologists, of those diabetes specialists. And again, it's not
(35:49):
a one size fits all, so it really is. It's
it It is determined by the provider based on things
such as ris. So for somebody who has a cardiovascular
risk or a kidney disease risk, that would point the
provider in a direction of possibly like the g LP
(36:12):
ones or the SGLT twos.
Speaker 2 (36:16):
Yeah, oh no, I was just yeah, thank you. So
in your role, I would imagine that, you know, So,
they get put on these medications and then they get
sent to you for education. Are you the one that
typically talk to them about the potential side effects of
these medicines or today often report them to you and
(36:38):
what are some of the side effects that you see
on some of these medications.
Speaker 3 (36:43):
Yeah, so we educate based on what the provider has
put the patient on. We educate on those medications, including
how to take it, when to take it, what the
action of it is, what the potential side effects are,
and everything to do with that medication. So some of
(37:05):
the some of the side effects of some of the
newer medications that we see, for instance with the g
lp ones because it does slow down gastric emptying, is
some nausea with the with Matt Foreman. One of the
common side effects of that is gastro intestinal distress such
(37:29):
as diarrhea. So those are the things that we try
to help. What I can say, what I always encourage
if a patient is experiencing a side effect to please
reach out to the provider discuss that with them. You know,
we sometimes we think, oh, we can just stop the medication,
(37:50):
but it's really always important to contact your provider to
discuss those things.
Speaker 2 (37:55):
What that is great advice because you know, stopping any
of these medicines, want to do that without obviously talking
about it with you with your provider. So you mentioned
earlier a couple of things about blood sugar is being
too low and blood sugar is being too high. Talk
to us a little bit about what too low means
(38:17):
and what some of the symptoms are. What somebody should
do if their blood sugar is too low and they're
taking these medicines.
Speaker 3 (38:25):
Right, So, if they're taking these medicines or they've had
some they've they've had a lot of activity that has
lowered their blood sugar. Traditionally, our body's really pretty good
about recognizing low blood sugar. You might start feeling shaky
or sweaty. Those are the two main symptoms. It could
(38:46):
be light headed, dizzy, feel weak or tired, hungry, nervous, upset,
something is wrong. So I always encourage patients listen to
your body. If something is in doubt, check your blood sugar,
see where it's at. Anything. Let a blood sugar of
less than seventy is considered too low. So then we
(39:06):
really talk about how to treat that low blood sugar.
What they had need to have on them to be
really proactive about being able to treat that low blood
sugar for safety.
Speaker 2 (39:19):
That's great advice. We have about a minute and a
half left, which I know is not enough time to
tackle this next topic, But if you could talk to
us a little bit about a special type of diabetes,
which is gestational diabetes. Do you counsel pations with.
Speaker 3 (39:36):
That, Yes, we do so. Gestational diabetes it is a pregnancy.
It normally does not affect pregnancy until the later stages,
so somewhere around twenty six to twenty eight weeks, that's
when somebody would normally have what's called a glucose tolerance test,
So it's something that you drink about one hundred seventy
(39:59):
five to one hundred grains of a sweet drink and
then they measure your blood sugar to see how your
body's able to handle that. Just stational diabetes is actually
caused from the pregnancy hormones, but the placenta releases it
is traditionally goes away after birth of the baby and
(40:20):
those pregnancy hormones go away. But what it tells us
it is an increased risk of developing type two diabetes
later in life. So that's really powerfulation for a mom
to know.
Speaker 2 (40:32):
Yeah, that's interesting, and can it happen in subsequent pregnancies?
Is that something they need to be concerned of for
the future.
Speaker 3 (40:42):
Yeah, it's a higher.
Speaker 2 (40:43):
Risk of.
Speaker 3 (40:46):
Developing gestational diabetes with subsequent pregnancies. So some of those
risk factors are having given birth to a baby that
weighed greater than nine pounds in the acts or twenty
five or older, in the history of type two diabetes
and family.
Speaker 2 (41:03):
Well, Shana, thank you so much. I know this is
a huge topic and you have just been able to
give us so much information. I want to thank you
so much for joining us tonight. That's going to do
it for tonight's segment of Centered on Health with Baptist Health.
I'm your host, doctor Jeff Hovlin. I want to thank
our guest Shana Nicholson for teaching us everything we needed
(41:23):
to know, and I want to thank our producers to
Jim then you the listener. Join us every Thursday night
for another segment, and I hope everybody has a healthy
and safe weekend. We'll see you next group.
Speaker 1 (41:45):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment.
Speaker 2 (41:57):
This show is not designed to replace a physician's medical
assessment and medical judgment.
Speaker 1 (42:02):
Always seek the advice of your physician with any questions
or concerns you may have related to your personal health
or regarding specific medical conditions. To find a Baptist health provider,
please visit Baptist heealth dot com.
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