Taking control of diabetes
Already the fifth leading killer of Americans, diabetes is increasing at a record pace. About 7 percent of the population – nearly 15 million Americans – has been diagnosed, while an estimated 6 million more don’t know they have the disease. And all these numbers are expected to rise.
Progressive and incurable, diabetes can wreak havoc on every major organ and lead to blindness, limb amputation and kidney failure. But since symptoms of elevated blood sugar may not be obvious for years, some with diabetes don’t take it seriously until it’s taken a toll on their health.
Ready for some good news? Most diabetics have the power to take charge of the disease. They have the tools to live longer, healthier lives. People diagnosed as pre-diabetic may even manage to outsmart the disease altogether.
“Patients can play a big role in preventing the complications of diabetes,” explains Dodie Ruzicki, PhD, RN, Sacred Heart’s director of Educational Services. “They’re the only ones really who can manage their day-to-day care. They’re the ones in control. So it’s extremely important they have the knowledge and skills to do so.”
At Sacred Heart, enthusiastic diabetes experts are banding together in an effort to curb complications from the disease and empower patients to take control before diabetes does.
Two programs created last fall are beginning to improve the lives and care of people with diabetes facing some especially challenging situations—pregnancy, surgery and hospitalization.
with diabetic patients
Katherine Griffing, MD, knows diabetes and heart problems can go hand in hand. But when the physician director of Sacred Heart’s new Diabetes Service evaluated her first 20 heart patients in November, 2007, the results surprised her: 7 had diabetes, 9 were pre-diabetic, and some had never been diagnosed.
That experience reaffirmed a new mission at Sacred Heart: to improve patient outcomes by better controlling their blood sugar levels during hospital stays and beyond.
“Good blood sugar control during hospitalization significantly affects good outcomes,” says Dr. Griffing. “Patients heal faster when their blood sugars are wellcontrolled.”
Dr. Griffing is leading an effort to quickly identify patients with hyperglycemia—excessive sugar in the blood—and control it from the start. Ultimately, such patients will go home with the skills to keep their blood sugar on track.
“We have a huge mountain and we’re just starting to climb it,” says Dr. Griffing. “We’ll get there step by step.”
Initially, Dr. Griffing focused on stroke patients and those undergoing coronary artery bypass grafts, who especially benefit from good blood sugar management.
“Controlling blood sugars in patients after bypass surgery was our first goal, and we have achieved it with remarkable speed (less than six months) and safety, thanks to the hard work of the nurses who manage insulin infusions,” explains Dr. Griffing.She is exceptionally pleased with these outcomes, especially since Sacred Heart began developing the program well before the Institute for Healthcare Improvement announced glucose control as a new quality improvement goal for hospitals nationwide.
For years, she says, “it was an assumption that high blood sugar was part of being sick and wasn’t harmful. You just shrugged and did nothing.” But research now shows patients with controlled blood sugar recover from surgery faster and with fewer serious infections.
“There’s evidence that it really makes a difference with stroke and heart attack patients. The size of the dead tissue of the heart or brain correlates with whether the blood sugar was high or low,” Dr. Griffing says. “It’s very astonishing data that drives this.”
One landmark study showed strict glycemic control lowered death rates in surgical intensive care patients by about a third, Dr. Griffing says. For some patients, that means receiving insulin through an IV drip for three days after surgery to keep sugar levels stable.
Organizers expect Sacred Heart’s program to eventually shorten hospital stays and cut treatment costs while improving the health of patients.
Two nurse practitioners will oversee the day-to-day medical management of hyperglycemic patients as the program expands to other departments. Like Dr. Griffing, they’ll evaluate patients, set treatment plans and coordinate care with patients’ primary care doctors. One of the nurse practitioners was hired recently and the search is underway for a second.
Dodie Ruzicki, who co-manages the Diabetes Service with Dr. Griffing, leads an education component that employs three diabetes educators to meet with patients throughout the hospital.
Doctors and nursing staff refer patients to the educators, who teach people with diabetes such skills as using a blood glucose meter and managing their medications.
“We’re here to help patients get the survival skills they need upon discharge from the hospital and to link them to outpatient resources for lifestyle changes they’ll need long-term,” Dodie says.
Those lifestyle changes might include exercising, meal planning, label reading and carbohydrate counting—critical skills that will help balance blood sugar throughout their lives.
Patients with diabetes may be connected with resources in the community, including the O.C. Olson Diabetes Education Center and other programs at Rockwood Clinic and Group Health.
“It’s not until after the patients go home that they have all the questions. They start living with this, and they really do need the support of an outpatient program,” says Dodie.
“We don’t want to lose them between the cracks. We really want them to get the support they need from hospital to home.”
“I’m Hispanic, so I’ve had to make a major change in what I take in,” says Corrina, a 35-year-old waitress.
She relies on the new perinatal diabetes team at the Sacred Heart Center for Maternal-Fetal Medicine to guide her through pregnancy with gestational diabetes.
Controlling diabetes is critical during pregnancy, says Megan Bolam, RD, the certified diabetes educator who directs the program.
“Our goal is to help women have the healthiest babies possible. We want to see fewer complications during the pregnancy and delivery,
fewer large babies and fewer stays in the Neonatal Intensive Care Unit. If the glucose is uncontrolled, the baby can be very large, setting up the child for obesity and related complications.”
Like Corrina, all women in the program are referred by their doctors. Some see their regular obstetrician as well as the diabetes educators. Others—often women who have had problem pregnancies before—receive all their prenatal care through the Center for Maternal-Fetal Medicine.
As needed, the mothers-to-be meet with the program’s nurse, a specialist in maternal-fetal medicine, and Megan, who’s also a registered dietitian.
The sooner women enroll in the program, the better. Megan prefers to see diabetic patients even before they’re pregnant, since there is a greater risk of birth defects and miscarriages with high blood sugar during the first trimester. “All the organs are being formed during the first two months of pregnancy,” Megan says. “That’s a very important time to have your blood sugar in control.”
Initially, most patients are in touch weekly for close monitoring and training in blood sugar control. Care plans are tailored to each woman, whether she already had diabetes or developed it while pregnant.
Gestational diabetes, which occurs during pregnancy, affects 4 percent of pregnant women and adds an unexpected extra layer to pregnancy’s usual challenges. It starts when a woman’s body can’t make and use all the insulin needed during pregnancy.
“It really entails quite a bit of education,” says Megan.
Women learn to check their own blood sugar with a glucose meter and receive medications, if needed. Eating habits and activity levels are assessed, and they take home a realistic plan for a healthy diet and appropriate exercise.
“I didn’t really have an understanding of what I needed to do,” says Corrina, 34 weeks into her pregnancy. “Megan absolutely customizes it to me, to what I need to be doing.”
Megan is thrilled each time a new mother leaves the program understanding and embracing the power she has in controlling her diabetes—and thus, her life. Those skills are important even for women with gestational diabetes, which usually goes away after pregnancy, because many of those women develop type 2 diabetes later in life.
“Some women who haven’t really taken care of themselves before pregnancy do a very good job after we help them understand what to do and why it’s so important,” she says. “It’s all about helping the mother help herself and her unborn child.”
Corrina, who has a 5-year-old son, didn’t need prodding. She lost her second pregnancy to a malformation shortly after learning she was diabetic.
“Whether it had anything to do with the diabetes, I just didn’t want to take that chance. I’m not even going to play around. You want me to poke myself 8 times a day, I’ll do it,” says Corrina, referring to blood sugar monitoring at home.
“A baby’s a beautiful thing to have in your life. There’s no point in chancing it.”Diabetes 101
| Diabetes is a condition in which the body does not produce enough insulin, the hormone needed to transport sugar (glucose) into body cells which then provide energy needed for daily life. It is associated with an increased risk of heart disease, blindness, nerve problems and kidney damage. But, with a commitment to eating right, exercising and staying in touch with a medical professional, people with diabetes can reduce those dangers and enjoy long, healthy lives. |
Preventing Type 2 diabetes
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| Type 1 diabetes – previously known as “juvenile diabetes” because it is usually diagnosed in children and young adults. These patients require insulin to stay alive. Type 2 diabetes – the most common form of diabetes, occuring in adulthood. Gestational diabetes – develops during some pregnancies and goes away after the baby is born. Pre-diabetes – a new classification, this includes people whose blood sugar levels are higher than normal, but not yet high enough to officially be considered diabetic. With weight loss and exercise, these individuals can delay the progression to diabetes. |
Signs & Symptoms
To learn more, visit www.diabetes.org
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