Martha's Vineyard Hospital dietician helps diabetics cope
Photo by Ralph Stewart
With a diagnosis of diabetes comes a process of education about managing a chronic condition through individualized diet and lifestyle changes.
As is the case with anything new, there is a learning curve as diabetics familiarize themselves with medical terminology, get the hang of self-testing blood sugar, and adjust their food choices and exercise based on the numbers.
To make what can be an overwhelming process easier and take some of the mystery out of it, Martha's Vineyard Hospital registered dietician Mary Gross recently took the initiative to launch a series of free workshops called "Diabetes 101." At the first workshop on April 7, Ms. Gross said that over the 24 years she has worked at the hospital, "diabetes has gone crazy" with a significant increase in the number of people diagnosed with type 2.
One of the reasons is earlier diagnosis, and also new and improved medications, she said. Despite that, by the time many people are diagnosed with diabetes, they probably had gone undiagnosed for five years on average, she added.
As Ms. Gross explained, when someone eats, carbohydrates in food are broken down into glucose, or sugar, in the pancreas. Sugar travels in the blood to fuel the body's cells, aided by insulin, a hormone produced in the pancreas.
In the case of type 1 diabetes, the pancreas stops producing insulin. In type 2, which is more common, the pancreas is not making enough insulin and the body prevents insulin it does make from getting into the cells. As a result, glucose remains in the blood.
High blood sugar over time, if not managed, can lead to problems such as heart attack and stroke, eye, kidney, and nerve disease, infections, and circulatory problems in the legs and feet.
Ms. Gross estimates about one-third of her day is spent in counseling outpatients about diabetes who are referred to her from doctors. Diabetics also make up a significant percentage of patients she sees in the hospital in acute care and dialysis, as well as residents in Windemere Nursing and Rehabilitation Center.
As a result, Ms. Gross said she finds that many people are missing the basics in diabetes education and management. One of the most common misperceptions is that eating sugar causes diabetes, she noted.
"It takes time at the beginning," Ms. Gross said in encouragement to the workshop participants. "If we can just get people to make it a priority for a while, they figure it out."
Part of the increase in the number of diabetics is due to earlier diagnosis and the hemoglobin A1C test, Ms. Gross said. The A1C test measures a person's estimated average blood sugar level over the last two to three months.
To gauge what it means when someone is told, "Your sugar's a little high," Ms. Gross said a fasting blood sugar level over 126 is considered diabetic. Blood sugar levels considered normal would be between 70 and 115.
Discussion about food choices prompted the most questions among the 8 men and 17 women who attended the workshop held in the main lobby of the medical office building.
Some seemed surprised to learn from Ms. Gross that foods they thought were forbidden for diabetics are not. Depending on a person's blood sugar readings, she said, pasta, pizza, or a glass of wine may figure into an occasional meal.
"Carbohydrates are not the most awful thing; you need carbs throughout the day," Ms. Gross said.
The key is to understand when and what type of carbohydrates to eat, based on blood-sugar levels. Ms. Gross said a piece of fruit, for example, takes longer to digest and enters the bloodstream more slowly, as opposed to a glass of fruit juice, which is on her "no" list for diabetics because it is absorbed quickly and causes blood sugar to spike.
Since weight loss makes a difference in type 2 diabetes control, she provided sample daily meal plans tailored differently for men and women, and also a list of diabetic food meal combinations with calorie counts.
The distribution of those calories throughout the day and portion control also are important, Ms. Gross added.
"A salad for lunch is one of my pet peeves," she said. "Every person who has a salad for lunch and no protein is eating the wallpaper by 4 pm."
Ms. Gross said at the next workshop, scheduled for July 7, she might focus on portion control and how to read nutritional information on food labels.
Two more workshops will be offered October 6 and February 2, 2012. Information is available online at www.mvhospital.com. Call 508-957-9473 to preregister.
Ms. Gross said she was inspired to start the workshops to share what she learned with the Island community after attending a seminar about diabetes management off-Island.
Tim Walsh, hospital CEO, said the diabetes program is an example of important community outreach designed to help keep people out of the hospital.
"Mary is doing a great job, she deserves a lot of credit, " Mr. Walsh said. "Diabetes is a growing problem in health care. It is a tough disease to live with and has many wide-ranging effects. By focusing on the diet side we can give people the tools to control their sugar and prevent or minimize health problems related to diabetes."
Ms. Gross is available for outpatient counseling on diabetes at MVH by referral from a doctor.
The American Diabetes Association offers additional information and resources online at www.diabetes.org.