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Complete, personalized diabetes care under one roof.™ |
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The DiabetesAmerica™ Team
Interview with Cheryl Winter M.S., R.D., R.N., C.D.E.
Texas Medical Center/Kirby Glen
What is diabetes and what are the consequences of diabetes?
Type 1 diabetes is a condition where the body no longer produces insulin. In type 2 diabetes, the body does not make as much insulin as it needs and/or you don't use the insulin in the right way. Signs and symptoms of uncontrolled diabetes can be fatigue or blurry vision. You just don't feel good, or you may feel sick. Wounds may not heal properly. Long-term consequences of uncontrolled diabetes can include loss of eyesight or kidney problems. Neuropathy is another long term complication which can lead to amputations. We try to prevent complications at DiabetesAmerica™.
Why do you work at DiabetesAmerica?
I've been a dietitian for about nine years. I came to DiabetesAmerica™ because I really like the organization’s vision. In my previous background, diabetes educators worked separately from physicians and from lab assistants. DiabetesAmerica™ has the whole picture. What really drew me here was that patients can get seamless care with physicians, nurses, dietitians, and those that work in the lab. I'm a diabetes educator. That means after the physician visits with the patient, they talk to us about what they've discovered and what they think is going to work best for a patient’s treatment, including nutrition, exercise, medication and any follow-up testing. Next I visit with the patient. I listen to their goals, their fears, and try to help them envision a plan of care that works with their lifestyle. Diabetes educators are on the patient’s side. I'm there to be their advocate. I help them to navigate through the complexities of diabetes care and get the help that they need.
Healthcare tends to be very fragmented. With traditional diabetes care, there is a lot of inefficiency. Typically, a patient finds out that they have diabetes and the physician says, “Here's where you need to go.” The patient is left with a list of procedures and lab tests that they need to complete. They may have to go to a pharmacy and pick out a glucometer and try to figure out how to use it. They may make an appointment with an ophthalmologist to get eye care. Next, they may go to see an educator and sit in a group where they sometimes don't get all of their questions answered. So it's a fragmented system where not all the players are constantly in agreement, or talking to one another about that particular patient's case.
What are diabetes management and treatment like at DiabetesAmerica™?
DiabetesAmerica™ is one of a kind. It is a closed-loop system where a patient can get everything they need in one stop. Although the first appointment is typically longer, the patient walks away with a better understanding of what diabetes is. They come in and have their labs done, they visit with an educator to help them establish a diabetes management plan. They see a physician who determines the best medications, lifestyle, exercise, and nutrition choices. Patients establish a relationship with a team of people and I think that that's the best type of care a patient can ask for. At DiabetesAmerica™, we communicate with each other. And it's a one-stop-shop - everything's done at one time. The patient goes out knowing what the do and having all their questions answered. We want people to know that we're on their side. When they come here or when they call here, any time, they're always going to have a person that answers the phone that knows them and knows their plan.
We always talk with patients about nutrition. And that conversation is different for everybody. Because what I may want them to eat is not necessarily what they have even heard of or be willing to eat. So we listen to them and we find out what works best for them. And then I work with them to get a plan of care that's going to work for their lifestyle with their family. I think one way we can measure our effectiveness as educators is to hear our patients say, "Wow, nobody's ever told me that." And "Wow, I understand it." And so, everybody learns something new.
We give our patients the time that they need. The first thing we do to make sure that our time is well-spent is we listen to the patient. Sometimes one or two specific points will meet that person's need and sometimes we talk about all kinds of different things. Patients really appreciate the time that they spend here. It's time that they actually learn about themselves or learn a little bit more about diabetes.
Most patients often experience great improvements. We follow recommended guidelines and we make sure to measure our outcomes to assure that our patients are getting the appropriate treatment plans.
When our new patients come in, generally their diabetes knowledge is somewhat limited. And when they leave, the first improvement is that they know about their condition and they know what to do. We teach them how to use a glucometer and we make sure that they don't leave until we know they can use it. We teach them about their caloric needs by doing a metabolic test. As they come back, we can see labs again and we can see and track improvements. And we can adjust anything that isn’t working well.
Self-management is key when it comes to diabetes because we can't go home with patients. So we try to maximize their knowledge of what to do at home. Patients know when they're supposed to check their blood sugar, and what that number is supposed to be. They know how to prepare the next meal. The other thing about self-management is that people start to see their blood sugars coming down. They start to see that what they're eating is making a difference. Maybe even in their waistline. People see over time that maybe they didn't meet the goal yesterday, but they're getting closer to the goal. And they know why the goal is important. And that provides the motivation to continue.
What are the Four Cornerstones of diabetes management at DiabetesAmerica™?
Medicine is the first cornerstone of diabetes care. We have to be cutting edge. We have to be on top of things like what new medications and combinations of medications are working the best. That's something that is an ongoing learning process for all of us. But since diabetes is our soul focus, we are able to quickly identify the regimes that work the best. We also use state-of-the-art medical technologies. For example, we use a device called a continuous glucose monitor. A patient can wear a device home that measures their glucose every five minutes and plots it on a 72-hour graph. It can expose problems that we're not catching with regular glucometer testing. We also perform metabolic testing to capture calories burned in a day. In ten minutes, we can get results that show actual metabolic rate. We can work from there to plan meals around that.
One of the things that most people miss in traditional medicine is the education. Most of our new patients report the only education they received was a ten-minute quip by a physician that says, “This is diabetes, go to this website and learn more about that, or go to this support group.” At DiabetesAmerica™, we pride ourselves on the education that we provide - both the level and the depth. Not only does it involve nutrition, but it also involves exercise, it involves medications, and managing blood sugar. The education part is also technology, so we talk a lot about the most current technology. It may involve learning how to use devices, whether it's a glucometer or an insulin pen. What's out there that's going to make a person's life easier? Maybe they've always used an insulin syringe instead of using an insulin pen. Maybe using an insulin pump versus using insulin pens makes their life a little bit easier because now they have the freedom to adjust their insulin and exercise without having hypoglycemia. In addition, we encourage utilization of a lot of resources, such as a website or a book. We try to stay in contact with our patients and we are accessible 24 hours a day, seven days a week. Education needs arise at different times. Patients can log on to our website and get answers to commonly asked questions. They can also call if they need somebody to answer a quick question.
Nutrition is another cornerstone of diabetes care. Patients must learn how food affects their blood sugar. In nutrition, we talk about everything from basics of nutrition to how to get started carbohydrate counting. We tailor the nutrition information and recommendations that we make directly to that person. Everybody is going to make different nutrition choices for themselves. We want to make the choices as safe and as beneficial as possible. Nutritionists can make all the recommendations in the world, but what's going to work is what works for that patient. We understand that. We have a variety of patients from many different ethnic groups. So for example, a recommendation for a typical Asian diet is not going to be the same as for a typical American diet. But we make sure that patients understand that food, portions, and meals work together.
The fourth cornerstone of diabetes care is lifestyle. We want to make recommendations that fit with a person's lifestyle. For example, we may find out that a patient isn’t very active because they have a job where they work 12 hours a day. We have to find a solution for them. Maybe it's walking at lunchtime. Or maybe it's walking 15 minutes before work and 15 minutes after work. Another barrier for people to engage in the process is a lack of social support or support from their family. We discuss these barriers and help patients to find solutions to overcome them.
How do you empower and motivate patients?
We engage people to try to keep them motivated. Whether it's a phone call or a follow-up email after an appointment, we ask them, “How are things going? You know, we've had this conversation, and we've made these recommendations, what's working for you? What are you finding that you're having problems with?” Regardless of the communication medium, we can give them brief follow-up pieces of information that help to catch patients before they really get off-track. If they're having a lot of problems, then the Diabetes Cares service can be of help. We can refer them to the 24-hour, seven days a week, Diabetes Cares line.
When you're working with a patient and you hear what their problems are, you start to realize their barriers and how that works for them. What you have to do is to start to negotiate. You have to talk to that person about making a small change, and maybe changing a few other things down the line. But let's just work on one priority right now. As they become successful with maintaining those good results, then they start to buy into the process. One of the little things that can help people to stay on track, for example, is if they're having problems with low blood sugar, they may need to know what to keep on hand or in the car. We may discuss three healthy snacks that they've not thought of that they could just pre-package and put in their car. To stay motivated with exercise, we encourage patients to listen to music or to track their progress using a pedometer. Little changes can help in big ways to get past the pitfalls and get patients back on track.
DiabetesAmerica™ has a very personal touch. We help people to get to their visit. Whether it's scheduling a better time for them to come or having one of our van drivers go pick them up. We have patients send their glucometer results over email if they just can't come in. Or fax it in. We try to remove the barriers of how we want to receive the information. We try to make this as easy as possible for patients.
Is there a financial benefit to treatment at DiabetesAmerica™?
I also think having one co-pay is wonderful. That way, patients can get the medical help that they need and have the educator visit. They have their labs, they have their eye exam, and they have a metabolic test. They have everything done and it saves them a significant amount of money and a significant amount of stops along their way.
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Meet the rest of the DiabetesAmerica™ team:
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