A Disease Management Plan for T2sFriday, October 26, 2012
The Blood Sugar Basics Game Plan, developed by the American College of Endocrinology (ACE) and American Association of Clinical Endocrinologists (AACE) with support from Merck, provides four “goals” and interactive resources to help people set up a personalized plan in order to help get their diabetes under control.
By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net
The day of diagnosis. A person walks into their PCP’s office and the provider reads off their blood sugar numbers, and declares the person has type 2 diabetes. The patient is hit with a wall of cascading feelings, including fear, anger, uncertainty. The patient struggles with not only the emotional component of being diagnosed with a terrible disease but also has to try to listen to the provider instruct him or her on what to do next.
And while some providers are very good at being able to explain information and give patients the counseling and follow-up they need, many people with type 2 diabetes are not getting the necessary consistent care or instruction to manage their diabetes properly.
Samantha Heller, MS, RD, CDN, (pictured lower left) believes one of the most valuable things a medical provider can do is deconstruct diabetes, especially at the time of diagnosis. She believes getting the education, support, and setting goals are vital to disease management.
That’s why as part of her practice, Heller urges her type 2 diabetes patients to use the Blood Sugar Basics Game Plan.
The Game Plan is a four part program that teaches nutritional strategies, provides exercise tips and ways to get active, and helps patients check their progress along the way. Heller really likes the ability to collaborate with patients by sitting down with them and going over the individual steps of the plan and working together to set and achieve goals.
In addition to Heller’s practice, she is the author of Get Smart: Samantha Heller`s Nutrition Prescription for Boosting Brain Power & Optimizing Total Body, radio host of “Doctor Radio,” on SiriusXM Radio, clinical nutrition coordinator at the Center for Cancer Care at Griffin Hospital in Derby, Conn. and currently works with the NYU Langone Medical Center for Musculoskeletal Care.
DiabetesCare.net spoke with Heller about how the Blood Sugar Basics plan works and how she uses it in her practice.
DiabetesCare.net: Can you provide an overview of the Blood Sugar Basics plan and how you use it in your practice?
Heller: Many people who come into my office who have type 2 diabetes have no idea what it is. They might go to their primary care provider who says, ‘you have diabetes; take this medication,’ and many of these patients don’t realize that certain diabetes medications can cause low blood sugar, and that skipping meals and drastic increases in exercise are also causes.
I like the idea of giving people a very simple place to go get organized and get educated. To manage type 2 diabetes you need to have a plan.
Blood Sugar Basics is a free, easily accessible, and simple four step plan to follow and help manage diabetes. It is not a comprehensive plan, but it is a springboard into the lifestyle changes that they need to make.
People don’t know what to ask their providers, and so you go to the Blood Sugar Basics website and you have goal number one, “Huddle,” which gives them the questions to ask their doctor. The Game Plan also encourages people to come up with questions on their own to ask their diabetes healthcare team (including your primary care provider, endocrinologist and/or diabetes educator).
I will sit down with patients and pull up the site so we go through it together. Education for people with diabetes is critical. There is so much guesswork involved, and we don’t want that. We want them to be informed and clear about what they should be doing.
For example, we want them to know the ABCs of diabetes (A1C, blood pressure, cholesterol.) They often don’t know what A1C means. I have patients who come in and say, ‘my doctor says I don’t have to check my blood sugars, and the doctor checks it every few months.’ When I ask them, ‘do you know what they are checking?’ and they say, ‘no,’ I then explain what hemoglobin A1C is.
DiabetesCare.net: Can you talk about some of the nutrition strategies and tips you provide for people in using the plan?
Heller: In goal #2 of The Game Plan, “Enter the Nutrition Zone,” (pictured below here) we start by swapping out foods. I will give people bulleted points to go right down the list to give them specific tips, step-by-step. For example, I will suggest to switch from white carbs to whole grains.
I will also help people to comprehend nutrition and food overall. What is really confusing and can be intimidating in nutrition are the terms that are used. The words are based on biochemistry. Take for example a word like “unsaturated.” It refers to the molecular structure of the fat. I explain these types of terms, and so people will get a better understanding.
I’m doing a segment on TV this week on health haloes. I will bring in two jars of peanut butter, and one is reduced fat and the other is a regular type of peanut butter. Everyone is buying reduced fat peanut butter these days, and I tell people you have to look at the label and look at the calories. The calories are virtually identical for a tablespoon of peanut butter--whether it is reduced fat or regular. So what happened here? They took out the fat and added sugar. And you are better off with the healthy fats than the sugar.
Another thing is that a lot of people don’t realize the importance of combining a little bit of protein in every meal. That will help manage sugars, weight, and satiety.
I always tell people they need to write down what they eat. When you write down everything, you become responsible for it and you become a more mindful eater. The Blood Sugar Basics Game Plan has a Healthy Meals and Snacks Planner to help keep a journal of what is being eaten on a daily basis.
DiabetesCare.net: What are the biggest struggles for people who are first diagnosed with type 2 diabetes?
Heller: They need a clear understanding of what type 2 diabetes is. Yet, when people are first diagnosed they are a bit shell-shocked in processing the news. And while their provider may be offering them some education, and giving them handouts, patients are so stunned the information doesn’t necessarily sink in.
They need ongoing support and education. The good news is there are so many things we can do to manage diabetes and live well with it. People can seek out resources like BloodSugarBasics.com and diabetes educators to support them.
Diabetescare.net: What types of tips and strategies do you recommend for exercise?
Heller: Exercise is so helpful for people with type 2 diabetes. It helps lower blood sugar and manage so many of the other health factors such as weight and mood.
I always recommend they start with walking and make a commitment to do that. Goal #3, “Get in the Game,” features a Weekly Activity Tracker to see what people are burning calorie-wise. I think it is really fun to track your exercise.
One of the important elements of the Blood Sugar Basics program is hypoglycemia. And I don’t think many people understand that. We talk about the symptoms of it and how to prevent it from happening, including having glucose tablets in your bag and having food with you. This can really help people who might need something if their glucose drops too low during some sort of rigorous exercise.
DiabetesCare.net: How can this program help medical providers who have patients with type 2 diabetes?
Heller: For medical providers they can go to the BloodSugarBasics.com, and see The Game Plan that is laid out for their patients and they can help their patients fill in the blanks. They can see what questions are there.
It is a nice way to be in partnership with your healthcare practitioner. It can help providers and patients work together to set up mutual goals.
DiabetesCare.net: Why the decision to partner with Merck on this program?
Heller: I’m so glad to be working with Merck, ACE and AACE to get the right information to those in need. I get so distressed when I see patients worried and uncertain about what they should do and not realize there are answers.
I want patients to lead healthier, happier lives. And The Game Plan talks about nutrition, exercise, and involving your healthcare providers. It is easy to do, and yet, so many people do not have the knowledge and the support of the resources, so I really like the idea of having a free, available tool like this program.
And for those patients who don’t have a computer, I can always print stuff out for them and they can bring it home and fill it out on paper.
You can do a 180 degree turn when you can get your diabetes under control, especially with just some very simple changes, focus, and support that you get with this program.
DiabetesCare.net: What do you hope to achieve in being part of this program?
Heller: I want to help bring about a greater awareness to the general public about what good diabetes management is and that it’s accessible. When people are diagnosed with type 2 diabetes, I want them to know there are resources out there to help them take the guesswork out of managing this disease and live well. I want people to take back their lives and control their diabetes.
For anyone interested in finding out more about Samantha Heller and her practice, she can be followed on Twitter at @samanthaheller, or reached through Linkedin under her name.