MS in Diabetes Education and Management

Posted on September 7, 2011 by janekdickinson

Something big happened today. The Master of Science in Diabetes Education and Management program at Teachers College Columbia University started! This is the first program of its kind in the country (if not the world).

It all started in 2005, when two nurses discussed the idea of starting a program that would provide a more professional path to the certified diabetes educator. Six years later, many proposals written and approved, curriculum developed, hoops jumped through, and here we are. Nine nurses and two registered dietitians (one is also a nurse) are starting their journey to an advanced degree in Diabetes Education and Management. This group of students is dedicated to improving the lives of those who live with diabetes and enhancing the role of the diabetes educator, by shaping the future of diabetes education.

The Diabetes Education and Management Program is a 36-credit Master of Science, and it is offered entirely online. Our first group of students represent nine different states, and may only step foot on the campus of Columbia University for graduation!

This is an exciting day in the diabetes education world. Please spread the word!

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Education or Indictment?

Posted on September 3, 2011 by janekdickinson

When I was at the AADE (American Association of Diabetes Educators) conference last month, one of the speakers referred to needing more “sticks” and less “carrots” with regard to people with diabetes. I have to admit I’m not much of a “stick” person, so that statement really didn’t sit well with me.

I’m reading a book called, Last Call, by Daniel Okrent. It’s about Prohibition: what led up to it, what happened while it was in place, and life after it was repealed. The other night I read a part that discussed what was happening with the enforcers of Prohibition. Some wanted to educate people about why being “dry” was better (healthier, safer, cheaper); others just wanted to arrest everyone who was drinking or bootlegging (they were breaking the law, after all).

So how does this relate to diabetes? It dawned on me that one approach is to educate people – teach them how to take care of themselves, what’s going on in their bodies, what their medications do, the benefits of exercise, examples of healthy foods, and so on. That would be a proactive approach, maybe even prevention. On the other hand, we can let it go and wait for people to get sick, experience complications, or end up in the emergency room and then “treat” them. This reactive approach is often accompanied by an attitude of “it was their fault.” Kind of like being arrested and indicted, but in a different way.

I tend to be more of an educator than an indicter. Maybe to a fault. I do not support scare tactics because I don’t like them myself. I had an experience where a physician told me I was going to have to experience my goals posthumously because I would die from diabetes complications before achieving them. At the time I was extremely upset by that. I felt that physician did not recognize the steps I had been taking in managing my health, but just condemned me for what I wasn’t doing. On the other hand, I do have to admit that I went home and started doing a lot more from that day on (to this day). I did not go back to that physician, though.

Then there’s Mike Huckabee. I once heard him give a talk about his experience being diagnosed with type 2 diabetes. He said his physician sat him down and gave him the top ten list of how he was going to die (a slow, painful death) due to his obesity and poor health. He said that it was a very effective approach for him, and he made changes immediately. He went on to lose a lot of weight and manage his diabetes.

I know that everyone is different, and that’s a good thing. I suppose every diabetes professional is unique in their own way too. I try to be the diabetes educator that I would want to work with. I also recognize that my style does not work for everyone else. Those who want to be scared into action might not like working with me. I struggle with how to best combine those approaches. Or is it ok to just be one or the other? I worry that people often don’t realize they can work with someone else if their provider is not a good fit. But sometimes they don’t have that option because of their location or their insurance coverage.

I’m curious how many people out there know what kind of health care professional is most effective for them. Do you?

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Phytochemicals and such

Posted on September 1, 2011 by janekdickinson

Red wine and chocolate are both foods that contain phytochemicals that are “bioactive.”  This means that they have a function in the body (not just taste or color). Polyphenols are phytochemicals (they are actually a sub group called “flavonoids”) found in red wine and dark chocolate (and many other plant-based foods) and they are antioxidants. Antioxidants are important because they fight inflammation. Inflammation is the destructive process that leads to heart disease, etc (although inflammation also helps us to heal in other circumstances). In order to get these phytochemicals it is very important to eat fruits, vegetables, and whole grains. One could write a dissertation on this (I’m sure many have), but here’s an interesting article about phytochemicals.

So red wine contains more polyphenols than white wine (and red grapes therefore have more health benefits than green grapes). Some people complain of red wine causing headaches. If red gives you headaches (or you are concerned that it might) then white wine is still a healthier choice than mixed drinks (because of the high calorie mixers). I’m also told that the drier the wine the better, in terms of health benefits.

Dark chocolate is healthy in that it offers antioxidants, and it contains fats that are heart healthy; however, it still has unhealthy fat and calories which can lead to weight gain if over-consumed. I think it comes down to dark chocolate being a better option than milk or white chocolate. It’s still not something we want to overindulge in just because we think it’s “good for us.” Plus, it’s really expensive. Thank you, Kathy, for requesting more information about this!

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Benefits of Dark Chocolate

Posted on August 31, 2011 by janekdickinson

I had a conversation with two Registered Dietitians today. They were updating me on the latest thoughts in Nutrition World. We talked about the benefits of wine (red is better than white, but we still agree that people shouldn’t necessarily start drinking wine just for the benefits if they don’t even like it). I learned that beer is now thought to be beneficial as well. One drink per day (12 oz. beer or 5 oz. wine) can be healthy.

We also discussed dark chocolate, which has flavanols. Flavanols act as antioxidants, which are protective. Dark chocolate can help us lower our LDL and maintain our HDL. The catch is that the dark chocolate needs to contain 65% or higher cacao to have these heart-healthy benefits. I did a quick search on dark chocolate, specifically trying to find a cacao content for my Dove Promises, but unfortunately I could not. Dove does have a well-marked dark chocolate bar with 71% cacao, but since the cacao content of Promises isn’t well documented, I suspect it’s not high.

One of the reasons dark chocolate is healthier is because out of the three types of fat in dark chocolate, only one causes an increase in cholesterol levels. The catch with all this dark-chocolate-is-healthy stuff is that, just like anything else, if we eat too much of it we get too many calories, which can lead to weight gain and all the health problems that go with it. So it’s back to everything in moderation, including dark chocolate. Here’s an article that gives a great explanation on dark chocolate.

I think the point in the article about avoiding dark chocolate that also contains caramel or such high-calorie fillers. Darn – those are so tasty, but it does defeat the purpose. I also learned, from my RD friends, that the price of chocolate has gone up in the last six months. So if anyone finds a high quality (high cacao content) dark chocolate that is reasonably priced, please let me know!

 

 

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BG on Stage

Posted on August 29, 2011 by janekdickinson

I’ve mentioned before that stress tends to raise blood glucose levels. This is why stress management is one of the key parts of diabetes management. Keeping stress in check can actually help keep blood glucose levels more stable.

Getting up in front of a group is stressful for many people. I like speaking to a group; however, I do tend to get stressed. It definitely gets easier with practice and I’m always more comfortable if I know the topic better than my audience. There are several common recommendations for making public speaking easier or more comfortable: take deep breaths, visualize, picture the audience in their underwear, etc. Another one, for those of us with diabetes, is to be aware of our blood glucose level.

It’s never fun to have a low blood glucose event during a presentation. I don’t think this has ever happened to me, though, because I tend to run high. When I’m on top of things I even take an extra unit of insulin before a talk. When I’m on a pump I use the extended/square wave bolus and let that extra unit go in the whole time I’m up there. And sometimes I come out right where I want to be afterward! If my blood glucose is high beforehand, I will give at least a partial correction. If I’m low, I will treat, but perhaps with slightly less carbohydrate than usual. Just as practice makes presenting easier, practice also makes managing blood glucose easier.

The key is to know what your blood glucose level is – and not make the mistake of guessing. I had a very stressful experience at diabetes camp many (many!) summers ago. I was about to perform a trio in a Talent Show at the BOYS’ CAMP. Right before I was to go on stage, I felt low. I quickly sucked down a packet of Monojel (who remembers that stuff?) and headed into the spotlight. We sang our number and I checked my blood glucose immediately after: 300-something. Truth is, I hadn’t been low at all – just nervous. Did I mention there was a very cute counselor in the audience? Stress.

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Finish Line

Posted on August 26, 2011 by janekdickinson

This afternoon the USA Pro Cycling Challenge came to Steamboat Springs, Colorado, the town where I live with my family. Steamboat has long been known as “Ski Town USA,” and trains more Olympic athletes than any other US town. I’ve been to two Olympic Send-offs since moving here in 1998.

More recently, Steamboat Springs has been working on being designated “Bike Town USA.”  Today the USA Pro Cycling Challenge came to town: Stage 4 began in Avon, Colorado, and finished up in Steamboat Springs. I have to admit I wasn’t all that excited about it, in fact, I considered not going, but I figured it was a big deal and the kids should see it. The finish line was in downtown Steamboat Springs, and our plan was to watch from the roof of my husband’s business, which is on the main street (Lincoln Avenue).

Yesterday we started getting messages that they were expecting 30,000 people in our little “downtown.” Randall and his associates were told they could each bring two guests. We have two children and I was also going to have two neighbor kids with me, so I offered to stay downstairs. My plan was to bring a book.

Luckily, I did not bring a book, and there was room for all of us. People were lined up on both sides of the street behind barriers. People were on every rooftop in view. The sun was blazing and a huge screen TV was showing live footage of the cyclists heading toward Steamboat. The excitement was contagious! We were getting updates every few minutes: “they’re in Oak Creek” (the next town), “they’re at Haymaker” (a golf course), “they’re on River Road” (the road that would lead them to town). There was a helicopter above the riders, and once we could see that, we knew exactly how far away they were. Pace cars were coming in one after the other and then motorcycles with camera people on the back. One of the last ones had a sign that said “45 miles per hour.”

When the bikers finally arrived the crowd went wild. It was all over in seconds (literally), and wow, was it worth it to be there. These types of events remind me of how fun it is to live in this community. It was also pretty inspiring to be among top athletes like those riders. I was hoping to see Team Type1, but wasn’t even sure how I would know it was them. After the race was over, we all walked around Lincoln Avenue, where there were several tents with bike gear for sale or just to look at. My husband spotted some cyclists, so we followed him. One biker came by and started signing autographs for a group of kids. I happened to see “sanofi” on his shirt so I asked, “Are you Team Type1?” and he nodded yes! A very exciting day, I must say. So glad we went. So inspired by people who push themselves to accomplish athletic feats like this. So intimated at the thought of attempting anything like it.

I am, however, going to volunteer for the local triathlon which takes place on Sunday. My kids and I have served as bike course marshals for the past two years and I was planning to take a break this year. However, I received several emails in the last two days, saying they still needed help. After today’s excitement, how could I say no? If you are even considering doing something athletic, check out Team Wild or DESA (Diabetes Exercise and Sports Association). If nothing else, volunteer to help at an athletic event and you might just get inspired. Who knows what could happen…

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Balsamic Vinaigrette

Posted on August 24, 2011 by janekdickinson

The scary thing about blogging is that all my “quirks” are open to the public. Well, here comes another one: I judge restaurants by whether or not they offer balsamic vinaigrette on their menu.

In my experience, having balsamic vinaigrette is a sign of a more sophisticated (food-wise) eating establishment. It’s also a sign that there may be a tendency toward more healthy food options.

I don’t eat cream-based salad dressing. I eat salads because I feel they are healthy – and because I enjoy them (especially with lots of veggies). Putting a cream-based dressing on something healthy just doesn’t work for me. If I am eating Buffalo Wings – absolutely – bring on the blue cheese! It’s just a matter of being consistent, I guess.

I have actually experienced restaurants that have an entire menu section with all their salad options…and then offer only cream-based dressings. I am not kidding. One of these places even touted their salads as “Weight Watcher” items. I asked the server if they had any oil-based dressings and the answer was no. In that case, I tend to go with honey mustard, or not have a salad. If there is no balsamic vinaigrette, I will choose the herb vinaigrette or the house dressing, which is often a vinaigrette of some sort. Unfortunately, I’m not a fan of raspberry vinaigrette. If there is nothing else, I will opt for Italian dressing.

Another thing that bums me out in the dressing department is when I ask for balsamic vinaigrette and they say, “yes, we have that,” and then they bring me oil and vinegar. Clearly they don’t realize that the whole purpose of a vinaigrette is all the extra herbs and flavors or whatever goes into them. I have no idea how to measure the oil and vinegar and it invariably comes out tasting horrible (usually too heavy on the vinegar).

At home I stick with red wine vinaigrette, made with olive oil. I realize that grocery stores sell all sorts of low-fat, low-carb, etc., dressings. I also realize that I have no idea what really goes into those restaurant dressings. For all I know the blue cheese is healthier than what I’m getting. But it’s all about how I feel in my head, right? So I choose balsamic vinaigrette.

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Cruise Control

Posted on August 22, 2011 by janekdickinson

I recently drove across many of the United States with my husband and kids. We drove over 3000 miles and saw some very impressive and powerful sights (starting with the Statue of Liberty and Ellis Island and finishing up with Mount Rushmore – need I say more?).

I have thought a lot, over the past few days, about how our drive related to diabetes. This may be a stretch, but maybe not.

The only unfortunate part of the trip back to Colorado was the fact that our cruise control stopped working pretty much right at the start of the trip. I realized that driving without cruise control is a lot like managing diabetes day in and day out. It can be a pain! Driving without the cruise control actually caused me pain in my right leg. Luckily, my husband did most of the driving, and he didn’t mention if he pulled any muscles…

When the cruise control isn’t working, we have no choice but to keep a foot on the pedal. With diabetes management, there’s no break either. We can certainly choose to blow it off. But just as taking our foot off the pedal would cause us to slow down and eventually stop moving, ignoring diabetes would also stop our progress. Lack of attention to diabetes can lead to devastating complications.

I choose not to focus on the down side of diabetes, including complications. Instead I choose to focus on taking care of myself and being positive. I do, however, acknowledge that a break would be nice. Sometimes the way I deal with that is to check my blood glucose a few less times a day when I’m on vacation. Or I may eat something that I would usually choose not to eat. A good example is ice cream. I do not eat ice cream routinely, and I honestly can take it or leave it in my “usual” life. For some reason, though, when I’m on vacation I tend to have ice cream. I’m not sure what that’s about. I always feel better when I choose not to get my own ice cream and instead finish up my daughter’s (she inevitably has leftover ice cream).

I was happy to have only ordered my own ice cream twice during the time I was on vacation. It tasted good and it felt good. And it was my choice.

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The technology debate

Posted on August 5, 2011 by janekdickinson

Today is day three (ish) of the AADE (American Association of Diabetes Educators) Annual Meeting. As you can imagine, there has been a lot of talk about technology. Today I attended a very interesting (and entertaining) session about teaching adults and the use of technology in doing so.

A few minutes ago I read an intriguing article about technology. A man who wears an insulin pump has discovered that it is possible to hack the pump system (see this article http://www.startribune.com/lifestyle/wellness/128160618.html) and change the insulin delivery settings. Although I don’t want to be an alarmist, I find this somewhat disconcerting and wonder what others think. I don’t imagine there are too many people sitting around airports waiting for pump wearers to walk by, but you never know.

So back to teaching and technology. Some very good suggestions were made at the session, for using technology when teaching people with diabetes. I heard from at least two diabetes educators, however, that we just don’t have time. We don’t have time to develop the fancy, hi-tech tools, and we don’t have time to incorporate technology into a patient visit.

I think that once we learn how to develop and utilize technology, it becomes more and more simple and straightforward (as does anything, with experience). I’m curious what other thoughts are out there? Do you like to have technology incorporated into your health care appointments? Do you fear hackers if you wear a pump or use a continuous glucose monitoring system?

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Support for the Positive Approach

Posted on August 4, 2011 by janekdickinson

I am currently attending the Annual Meeting of the American Association of Diabetes Educators in Las Vegas, Nevada. Luckily, the buildings are sufficiently air conditioned, as it is a balmy 102 outside.

Anyway, today I attended a session entitled, “Positive Attitude: The key to wellness and peak performance.” I was very pleased to hear the speaker tell us about all the benefits of a positive attitude.  I was even more pleased to see a huge room filled to capacity with diabetes educators who wanted to hear about this important topic.

We heard that a positive attitude is contagious: be positive and those around you will catch on! We heard a fun mantra: “if it’s to be, it’s up to me.” And we heard that “action is power.” What we do is more important than what we know.

We learned that our attitude is based on our perception of something, and our perception is selective. We find what we’re looking for, so we need to focus on good things in order to find good things. “Frequently, what we expect is what happens.”

Interestingly (but not surprising), we learned that positive people live longer, get sick less often, heal faster, and succeed faster. Negative begets negative. Positive begets positive.

The speaker’s name is Wolf Rinke, and he has published a book called, Make it a Winning Life, in case you want to check it out.

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