Diabetes is on the rise nationally, and in Maine. According to the Maine Diabetes Prevention and Control Program, as many as 1 in 9 Maine adults may have the disease.
Fortunately, for local residents, Maine was one of the first states in the nation to start a Diabetes Control Program, and Miles Hospital was one of the first sites in the state to put the program into action.
The Miles Diabetes Education Program started in 1980. In 1992, Registered Nurse and Certified Diabetes Educator Sandra Barth joined the team, bringing with her a wealth of knowledge and a passion for educating local Mainers about diabetes prevention and control.
More recently, Barth was joined by fellow R.N. and Certified Diabetes Educator Kathy Jacques, and together, they bring over 40 years of experience to the job. Both women are extremely enthusiastic about their role as educators.
“It’s an epidemic,” said Jacques. “As many as 1 in 3 children born today will develop diabetes in their lifetime.”
Barth said the problem of diabetes has “mushroomed over the past 10 years” from 10-12 million cases nationally a decade ago, to 23.6 million cases today. Possibly more troubling is the fact that, according to Barth, 5.5 million people are unaware that they have the disease. These people often come to the hospital with clear complications of diabetes, not knowing they had it in the first place.
The complications of the disease are numerous, and serious, including heart disease, eye disease, kidney disease, nerve damage and stroke. Unfortunately, some of the most noticeable warning signs, including frequent thirst and urination, blurry vision, and cuts or sores that don’t heal, are indictors of advanced disease, and people often mistake some of the earlier signs, including fatigue and depression, as not worthy of medical attention.
Barth and Jacques recommend that people with a family history of diabetes have annual blood work and screenings after age 45, and that others over age 45 are screened every three years. “This is one of the big changes of the past 20 years,” said Barth. “We used to see this with older populations, but now we’re seeing it in much younger people.”
The old definitions of “juvenile diabetes” and “adult-onset diabetes” are no longer used, and have been replaced by Type 1 diabetes, which is caused by genetics, and often strikes earlier, and Type 2 diabetes, which is caused by a combination of genetics and life-style.
Type 1 diabetes results in a complete cessation of the body’s ability to produce insulin, and requires treatment with regular insulin injections, while Type 2 diabetes, which causes a lessening in insulin production, can often be managed with changes to lifestyle.
People with a family history of the disease and those who are overweight and have a sedentary lifestyle are most at risk for Type 2 diabetes, as well as certain minority groups, possibly, according to Barth, because they may have switched from their native diet to a modern American diet.
“We are an overfed society,” Jacques said. “We’re supersizing, and our dinner plates are more like platters.”
Diabetes control is “not about perfection,” said Jacques “it’s about a moderate lifestyle.”
Barth and Jacques recommend limiting fat and carbohydrates, and increasing fiber intake, which causes people to feel fuller, faster. One of the handouts they use in their program also encourages simple activities like walking around the house, dancing, and even marching in place during television commercial breaks, activities that most Mainers can manage, even in winter.
Maine does not have the highest rate of diabetes in the country, in part because Caucasians are less at risk than other groups, but it does have an older population, and high rates of obesity.
Regular blood sugar testing is a necessity for those with diabetes, and Jacques said, “Blood sugar monitoring has revolutionized our ability to treat diabetes.” Self testing and monitoring has allowed an “individualized approach that can prevent complications.”
Barth and Jacques talked about seeing people who have lost limbs, become blind or are on dialysis because of diabetes. “When I was in nursing school (in the 1960s), it was common to see double amputees from diabetes complications,” Barth said. “You don’t see that as much anymore.”
Still, diabetes is the leading cause of non-traumatic lower extremity amputations, making prevention all the more important.
In addition to portion control and increased exercise, those who are concerned about diabetes, or those who have already been diagnosed, should limit alcohol intake and cease use of tobacco products. “Nicotine constricts blood vessels,” said Jacques, “and has the same effect as high blood sugar,” said Jacques. “Quitting nicotine is the healthiest thing people can do for their diabetes… Diabetes “doesn’t go away, but it can be well-managed.”
Barth runs a monthly diabetes support group, and both women see patients individually.
Barth’s upcoming support group will deal with the topic of depression, which runs slightly higher in those with diabetes than those without, perhaps in part because of the lifestyle changes required of newly diagnosed patients.
Jacques said that the most rewarding part of the job “is seeing the changes people can make to their lifestyle, and working with people to stay healthy. One of the most exciting things is that we can prevent complications, and the greatest reward is seeing them leave with hope.”
For more information about the Miles Diabetes Education Program and its monthly support group, call 563-4442.
