A type 2 diabetes diagnosis from her primary care physician shocked Kay Nurse when she was in her 30s. Although she was experiencing some extra thirst and exhaustion, she remembers thinking, “This is an ‘old people disease.’ It can’t be happening to me.”
Through diet, exercise and medication, Ms. Nurse says she was “semi-successful” in managing her diabetes. But the changes she had to make were difficult. After several years of limiting her sugar intake and having her A1C tested every three months (the primary blood test used to diagnose and manage diabetes), Ms. Nurse found herself not keeping up the lifestyle choices that initially helped control her disease.
She started to feel depressed and discouraged. And then she learned at an appointment with her primary care physician that her A1C level had reached an all-time high of 11 percent. A normal A1C level for someone who doesn’t have diabetes is 5.7 percent or lower. An A1C level above 8 percent indicates diabetes that has been uncontrolled for a long time.
“My sugar level was so high that my primary care doctor almost sent me straight to the hospital,” Ms. Nurse said.
Ms. Nurse realized she needed to do something different, and her primary care doctor referred her to Pascual De Santis, M.D., [1] an endocrinologist with Baptist Health Medical Group.
When to See an Endocrinologist for Diabetes
One of the first things Dr. De Santis discussed with Ms. Nurse was the likelihood of starting insulin shots to help get her diabetes under control. When she told him she was terrified of needles, Ms. Nurse was relieved to hear Dr. De Santis say that he was open to other options.
Emphasizing the need to tackle her condition aggressively, Dr. De Santis explained how different medications, eating a certain diet and regular exercise could help her. He added to Ms. Nurse’s care plan Janumet, an oral drug that is used along with diet and exercise to control high blood sugar levels caused by type 2 diabetes.
“If you have a 9.7 A1C, medication alone is not sufficient,” Dr. De Santis said. “You have to make lifestyle changes, such as an improved, low-carb diet and regular exercise.”
Primary Care Diabetes Education
Learning [2] about diabetes beyond the basics was also important to Ms. Nurse overcoming the dangerous point she had reached with type 2 diabetes. Once under the care of Dr. De Santis, Ms. Nurse also starting seeing Cathy Clark-Reyes, a registered dietitian and certified diabetes educator with Baptist Health Primary Care [3]. Because Dr. De Santis and Ms. Clark-Reyes are located in the same primary care office, Ms. Nurse was able to schedule “combo” appointments, first seeing the endocrinologist followed by meeting with the dietitian.
“Cathy would see my test results to know where we were at [clinically] and then give me nutrition goals based on my latest numbers,” Ms. Nurse said. “The goals were realistic which made them easier to achieve.”
A comprehensive team approach through Baptist Health Primary Care helped Ms. Nurse achieve the goals set for her.
“Education is a big part of dealing with diabetes. Cathy taught me how not to not ‘hate’ food by giving me meal planning tips and teaching me how to eat when you have type 2 diabetes,” she said. “With her help and taking diabetes education classes, I learned moderation is key and how you eat makes a big difference in keeping diabetes under control.”
Family Support and Diabetes
As with many chronic illnesses, family support is key to successful outcomes. Family members are an integral part of the daily management of chronically ill patients, according to research published in the Journal of the American Board of Family Medicine. They can influence meal choices and preparation, provide emotional support and make sure the patient takes medication properly. Research published in The Diabetes Educator found more than 50 percent of people with diabetes or heart failure say their family is involved with planning their diet and taking medications.
“My family support system has been great,” Ms. Nurse said. “When exercise had to become part of my life, my husband Avery started to walk with me. Then my mother, Cora, started joining me on walks, and now my sister-in-law does too!”
Losing some weight as a result of increased exercise is an added plus to having her diabetes under control, Ms. Nurse added. She says the way she feels about herself and her diabetes is “like night and day,” when she compares today to a few years ago.
“You don’t need that much weight loss to really improve your glycemic control,” Dr. De Santis said.
Managing Diabetes
Ms. Nurse, now 43, feels the best she has in a long time thanks to the changes she has made in her diet, exercise and mind. With the help of Dr. De Santis and Ms. Clark-Reyes, Ms. Nurse’s most recent A1C measured 5.9, a huge drop from the level at which she was when she started to see the endocrinologist.
“I was in shock but really happy!” Ms. Nurse said.
Treating someone who’s been living with diabetes for a while is different, and can sometimes be more challenging, than someone who is newly diagnosed with diabetes, Dr. De Santis says.
“With a person who has had diabetes for more than 10 years, you presume that their pancreatic reserve has been diminishing over time. So that’s a person, unfortunately, who will usually see limited success, if any, with mostly just lifestyle changes,” Dr. De Santis explains. “Clearly, she proved us wrong. She initiated significant lifestyle changes and was able, with only one extra pill, to drop a significant percentage in her A1C.”
One of the most important lessons Ms. Nurse has learned through her diabetes journey is the power having the “right” mindset can have.
“You can’t stay in the same place – you have to change your mindset,” she says. “Acceptance is first. You know you have diabetes – and it’s not going anywhere – but you can manage it.”