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Certified diabetes educators are an important part of your diabetes team, especially if you are newly diagnosed with diabetes or are experiencing changes in your diabetes treatment, general health, or life circumstances, They can play an important role in helping you set goals, and can identify strategies that will help you manage your diabetes and live a happier and healthier life.

Dealing with memory issues

Garry Mallel was worried about his mother, Hilda, who has lived with type 1 diabetes since she was diagnosed at age six. Hilda, now 80, has age-related memory loss, which means she would often forget to take her insulin or, more commonly, would give herself too many doses. Her son’s concern was natural given that Hilda was constantly in and out of hospital. Once, she even broke her hip due to a fall she suffered because of low blood sugar. “We got so used to her going to the hospital that it became the new normal,” says Garry, 58, who lives in Vancouver, not far from the seniors’ building where his mother lives in her own apartment. “I felt like she was in constant danger.”

Garry made an appointment for his mother to see endocrinologist Dr. Tom Elliott of BC Diabetes, a diabetes specialty clinic. To help Hilda better manage her diabetes, last year Elliott assigned Gerri Klein, a registered nurse and certified diabetes educator, to her case. “The first thing I did was a home visit, and I found all these little notes around the house that Hilda had written to remind herself to take her medication,” says Klein, who discovered that Hilda was taking too much insulin. “She would check her blood sugar, see that it was high, forget that she had already taken her insulin and give herself another dose.”

With the family’s permission, Klein used a lockbox to prevent Hilda from taking her insulin on her own, and put a plan in place to ensure her medication is carefully monitored. Now Hilda’s insulin is placed inside the lockbox, which has a combination that can only be opened by one of the licensed practical nurses on staff at Pier Health Resource Centre pharmacy, who visit daily to check Hilda’s blood sugar and administer her insulin. (The $33 daily fee for this service is covered by the income-based B.C. Fair PharmaCare Plan.) Hilda also now wears a flash glucose monitor, which automatically measures and stores blood sugar readings for up to eight hours. “The pharmacy staff drills into this data and contacts me to let me know if she is on target, and we make adjustments to her dosage accordingly,” says Klein, who also does a home visit with Hilda once a month. “This is a real partnership,” says Klein. “The nature of my job is to take on patients who require extra care. I love the challenge.”

The system means Hilda can continue to live in her apartment rather than going into a long-term care residence.

“Her life has really improved,” says Garry, although he admits that his mother is sometimes frustrated by the fact that she can no longer access her medication on her own. “For 74 years she’s had total control over her insulin usage, and now someone has to unlock it for her.” But Hilda knows this is for her safety. “Everything is locked up now and I don’t know the code. But that means I won’t give myself any extra injections. When I broke my hip, I had low blood sugar and fell off my chair. My neighbour heard me screaming and called the paramedics. I feel a lot more confident now.”

Life is now easier and less stressful for both Hilda and Garry. “Gerri has helped my mom by the system she has implemented,” says Garry. They used to have to call 911 or visit the hospital emergency room “at least once a month” because of Hilda’s low blood sugar levels—something they have not had to do since Klein set up the new system. “This enables her to continue living independently,” Garry says. “It also means I don’t have to panic if I don’t hear from her by a certain time.”

A full-team approach

Alanna Quewezance, a member of the Yellow Quill First Nation, is more confident about managing her health today thanks to the help she has received from Calysta Priddy, a registered dietitian and certified diabetes educator at the Westside Community Clinic in Saskatoon. After being diagnosed with type 2 diabetes at the age of 18 and then suffering a stroke two years ago at age 31 that left her with a feeling of weakness in her legs, Quewezance wanted help getting back on her feet so she could go back to her job as an educational assistant at the Catholic school board in Saskatoon.

Priddy did a chronic disease management assessment for Quewezance, and discovered she was frequently experiencing low blood sugars that were causing dizziness. “She was having a lot of anxiety around having these lows and with her history of stroke, this made her anxiety even higher,” says Priddy, who recommended that Quewezance be switched to a newer once-a-day insulin that has stabilized her blood sugars. Currently, Quewezance’s care team is looking at adding an SGLT-2 inhibitor (which reduces sugar levels in the body by increasing the amount

Priddy, along with other members of the diabetes team, also helped to connect Quewezance with an occupational therapist who arranged access to a scooter to allow for greater independence, and a physical therapist to improve her physical strength. She is now able to walk short distances, and is working on building her strength by using the treadmill at her local gym and swimming at the YMCA.

Priddy describes herself as a “non-diet/weight-inclusive dietitian” who works with her clients to emphasize healthy living strategies such as carb counting, meal balance, and mindful eating. “Many clients struggle with body image and may feel blamed or shamed for their weight. It’s important to remember that healthy bodies come in all shapes and sizes and we need to take the focus off the number on the scale,” she says. “Part of my role is to help clients understand the aspects of their lives that they can build upon that will bring them joy and help them feel their best. If we build healthy behaviours, we will see improvements in health independent of weight loss.”

Quewezance feels hopeful about the future, and is determined to work at improving her health and building her strength so she can go back to her job.

Working with Priddy “has been amazing,” she says. “I am doing so much better—my energy level is good and I am getting back to my old self.”

Priddy describes their relationship this way: “We are driving in the same car—Alanna is the driver and I’m along for the ride. Sometimes I’ll point out something interesting or we’ll decide together to take a different path. Sometimes I provide the directions when [Alanna] needs help,” she says. “At the end of the day, my job is to help patients like Alanna have the knowledge they need to support good self-management.”

Make the most of expert advice

The Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada offer key messages to help people with diabetes better manage the disease, including:

Ask for diabetes self-management education and support when you are first diagnosed, as well as whenever there are changes in your diabetes treatment, general health, or life.  

Work with your diabetes team to get personalized goals for caring for your diabetes and overall health.

Choose the learning approach that works for you: A variety of diabetes education and support programs are available, including group classes and individual counselling sessions, as well as strategies that use technology (such as Internet-based computer programs and mobile phone apps).

For more information, go to Self-Management Education & Support.

Did you know?

You can find information on everything from tips on meal planning, reducing stress, and diabetes-related complications, to webinars with expert speakers and inspirational stories at Managing My Diabetes.

(This article appeared in Diabetes Dialogue, Autumn 2019)

Author: Anne Bokma

Category Tags: Healthy Living;

Region: National

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