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Learning to Manage Diabetes

The diabetes self-management program offered by St. Luke’s Cornwall Hospital empowers patients to understand and live with the disease. While careful monitoring and certain adjustments are necessary, many diabetics lead full and active lifestyles, even with diabetes.

Dorothea Lever, PhD is here to assure you that our team approach will help you understand all the factors that go into managing the day-to-day realities of living with diabetes. By enrolling in the program you will have the opportunity to learn important coping skills to live with and manage your diabetes.
Learning to Manage Diabetes
Dorothea Lever, PhD
Dorothea Lever, PhD, joined the RCC faculty in 1995 and served as department Chair from 2007 to 2012. Among the courses she has taught are Fundamentals of Nursing, Medical/Surgical Nursing, and Calculations for Pharmacology. She earned her PhD in Nursing from Binghamton University, SUNY, completing her doctoral dissertation on “The Patient’s Perspective of the Need for Intense Nurse Coaching Following Completion of a Standardized Diabetes Education Program.”

Learn more about Dorothea Lever, PhD

Melanie Cole (Host): According to the Centers for Disease Control and Prevention, as many as 29 million people in the United States have diabetes, but up to 8 million may be undiagnosed and unaware of their condition. The diabetes self-management program offered by St. Luke's Cornwall Hospital empowers patients to understand and live with the disease. While careful monitoring and certain adjustments are necessary, many people lead full and active lifestyles even with diabetes. Here to tell us about living with and managing diabetes is Dorothy Lever, Ph.D. She's the coordinator of the diabetes self-management program at St. Luke’s Cornwall Hospital. Welcome to the show. What is type 2 diabetes?

Dr. Dorothy Lever (Guest): Good morning. Thank you for having us. Type 2 diabetes is a condition that historically occurred in older people, now we’re seeing it more and more in the younger population because one of the primary risk factors for type 2 diabetes is being overweight. That’s an epidemic in our country and so we’re seeing more and more younger people with type 2 diabetes, but what is, is the patient has difficulty using their insulin. Their cells are resistant to insulin so that they're not using their insulin the way they should be. The insulin is the hormone in our body that we use to metabolize carbohydrates. Ultimately, what happens is the patient develops a high blood sugar and that in a nutshell is what type 2 diabetes is.

Melanie: Who would be at risk for this type of diabetes?

Dr. Lever: Historically, we’ve seen it mostly in people as they age. One of the reasons that it’s in epidemic proportions is thank goodness we’re living longer, but along with it, we see a higher incidence of type 2 diabetes in the country. The older you get, the more likely you are to develop type 2 diabetes. People are that overweight; the fatter cells that you have, the more likely you are to develop type 2 diabetes. It goes along with certain ethnic populations so that Hispanic population and American Indian population in our country, and the black population in our country has a higher incidence. Typically, we see a higher incidence around the age of 50 in women – higher incidence in women than we do in men. Men usually develop at a later age.

Melanie: Let’s talk about symptoms a little bit. How would somebody even know? Are there some symptoms, some signs, red flags, that would even send them to the doctor, and then how is it diagnosed?

Dr. Lever: There are some symptoms. Typically, though, people with type 2 diabetes, the onset is gradual, so a lot of times, it’s not recognized. What we see as typical signs and symptoms of diabetes are frequent urination, thirst – a patient gets very thirsty, I’ll have patients tell me that they just can't stop drinking, they feel like they can drink a pool. I had one patient tell me that he felt like he could take a straw in a swimming pool and drink the whole pool. Fatigue, particularly after meals, blurred vision, and sometimes people feel hungry because they're not using their carbohydrates the way they should be, so they crave food, they crave sweets – they feel like they're not satisfied. Those are the typical signs and symptoms that we see in people with type 2 and type 1 diabetes as a matter of fact.

Melanie: If somebody comes to you with some of those complaints, then what tests do you use to figure out this is what's going on?

Dr. Lever: We use two tests primarily. The first is a fasting blood sugar. Fasting blood sugars are typically done with chemistries when the nurse practitioner or the physician orders blood chemistry for patients. Blood sugar is considered elevated if it’s more than 100 fasting and it would be looked into further. The other test that we use is something called a hemoglobin A1C. Hemoglobin A1C is really a three-month average of your blood sugar, so if your provider looks at both the hemoglobin A1C and sees that it’s elevated, or the fasting. Some people are okay with their fasting, but when they're challenged with carbohydrates, so it may not show up in your fasting blood sugar, but looking at them will tell the provider whether or not the blood sugar’s gone up at any time. In other words, you're getting a multidimensional look at what the blood sugar looks like over that three-month period.

Melanie: What is the most important bit of information you tell somebody if they've been told that they have prediabetes or full-blown diabetes?

Dr. Lever: What prediabetes is, is the patient has a challenge with carbohydrates – they're not able to metabolize carbohydrates the way they should so we see a slight elevation in blood sugar. Diabetes itself would be diagnosed with a fasting blood sugar of 127 or greater, and I just said that a blood sugar of more than 100 is considered an issue. Those sugars that are falling somewhere between 111 and 126, so if I have a fasting blood sugar of 111 to 126, what that means is that I have a diagnosis of prediabetes. It would be looked into further, but prediabetes, we didn’t know until probably 10 years ago – we thought maybe, but we weren’t absolutely positive – that we could prevent type 2 diabetes from happening, or if not prevent it, completely postpone it until the patient is well into their 70s or 80s. The longer we can postpone diabetes, the less likely the patient has developed complications, which is the biggest problem that comes from diabetes.

I always tell patients that diabetes is a pain in the neck because you have to exercise and you have to eat right – the way we’re all supposed to be doing – but the biggest problem with diabetes is the complications. If we can get people to be chemically like people that don’t have diabetes, they're less likely to develop the complications. With prediabetes, the goal is either to prevent it from happening completely or postpone the onset of it. We can do that with diet and exercise. The research shows that diet and exercise, lifestyle changes, are effective in delaying or preventing the onset of type 2. The CDC has actually put out a diabetes prevention program that is the model for helping people to prevent diabetes – people that have been diagnosed with prediabetes or to be at high risk for type 2 diabetes – and we’re going to be starting that at St. Luke’s close to the new year. We haven't got a start date, a positive start date, as of yet but we’re going to be starting that, so if anybody’s interested in that program, please feel free to call me in the office and I’ll explain it further.

Melanie: Speak about some of the other resources available at St. Luke’s Cornwall Hospital to learn how to manage your diabetes once you’ve been diagnosed, and tell us a little bit about the importance for follow-up after taking any classes and educational seminars to maintaining that contact with the diabetes educators.

Dr. Lever: The program that we have at St. Luke’s is an eight-hour program and it’s recognized by the American Diabetes Association, meaning that it meets all of the standards, all the criteria, for sustenance and the curriculum requirements. We’ve been running it since the end of the 90s and what it is, is our program is eight hours in length. Typically, programs are somewhere between eight to ten hours in length, and they're usually group programs for the most part. We do see patients individually an hour before they begin their program, and the program talks about what is diabetes, what's the difference between type 1 and type 2, what are the complications of diabetes, who get diabetes, how do we treat it, how do we prevent the complications. I'm a nurse and I do the complication component of it and the pathophysiology.

It’s multidisciplinary, meaning that we have other people taking part of it. A pharmacist talks about medication in diabetes – what are the types of medications that we use to treat diabetes. We have a social worker who talks about stress and diabetes and family support. The physical therapist talked about exercise and what does exercise do to control diabetes and what to do to prevent diabetes. And of course, the dietician talks about carb counting and how do we use diet to control diabetes. That program usually requires referral and physicians or nurse practitioners refer patients if they're newly diagnosed, if they’ve had a change in their treatment regimen, meaning they weren’t on medications and now they are, or if they’ve had a change in their hemoglobin A1C that would cause them to come back to the program. That would be why somebody would go to an eight-hour program. Once they’ve gone to the eight-hour program, research shows that people need to have reinforcement afterward, so most of the insurances will pay for patients to come back for two follow-up visits a year with the certified diabetes educators that we have at St. Luke's.  

A lot of insurances will also pay for two hours of what’s called medical nutrition therapy. If a patient identifies that they're just fine with all of the other aspects of their diabetes care but they need to have reinforcement about their diet or they're slipping somehow in their diet or they uncovered another food allergy or something like that, they might go to use their follow-up for medical nutrition therapy. At St. Luke's, I said that we have those eight-hour programs. We do it in two ways. We can do it all in one day, and we do schedule some programs throughout the year that are eight hours in length and people come in for the full eight hours. We also do four-hour blocks. We have three certified diabetes educators at St. Luke's. One is one of our dietitians and the other two, myself and a nurse, and we do office hours as well, so patient call and make special arrangements to come in during office hours throughout the year.

Melanie: If someone is living with diabetes, whom should they ask for help in regards to insurance and Medicare for this nutritional counseling, these programs, and the follow-up? how can help them weave through the web?

Dr. Lever: At St. Luke’s, we have what's called our preaccess department and as soon as a patient’s been referred to the program, typically they either call us and we refer them to preaccess or they're referred right away to preaccess. What preaccess services does is first they look and see what their prescription is for and they talk to the patient about whether or not it’s a covered service – they check with the patients and insurer, and they look to see if it’s covered for the patient, is there a copay – whatever needs to be done, what needs to be in place so they can establish if it’s a covered service for the patient.

Melanie: In summary, what would you like people to know about diabetes and living with and managing those systems?

Dr. Lever: Diabetes is a disorder that has an effect on blood sugar and diabetes is, as I said before, is a pain in the neck because you have to diet and you have to exercise – things that we all have to do that we should be doing – but the biggest problems are the complications. I know that when patients know how to take care of their diabetes, they do well. We've had great success stories, so the more you know, the better off you are in managing it. Diabetes is a disorder that can be self-managed. Patients are in charge of their diabetes. It’s not a disorder that you have to rely on others to manage for you. This is something that you take charge of and if you know what you're doing or you bring yourself to the point where you know what you're doing and you're able to identify what's going to increase your blood sugar, what's going to decrease your blood sugar and how you can best manage it, how you can take diabetes and put it in cadence in your life, you're going to be way ahead.

Melanie: Thank you so much for being with us today. It’s great information. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit That’s I'm Melanie Cole. Thanks so much for listening.