Becoming Self-Sufficient with Self-ManagementFriday, July 22, 2011
Amy Hess-Fischl, MS, RD, LD, BC-ADM, CDE (pictured), works with teens with diabetes and their parents to help these kids begin the process of taking responsibility for the care of their diabetes themselves.
By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net
Possibly one of the most difficult discussions a parent has to be a part of is when their child is diagnosed with a chronic disease like diabetes. Not only does the parent have to come to terms with the idea their child is going to have special care needs for the rest of the child’s life, they also have to delve into the world of diabetes management and immerse themselves into everything from insulin injections to glucose monitoring to nutrition. In some ways, parents may feel they have the disease too; they certainly own it living vicariously through their child’s struggles and small victories through the years.
The second most difficult thing for these parents may be when their kids become old enough to start managing their daily care. After many years of being in charge of their child’s diabetes care, kids grow up and want to assert their independence.
The University of Chicago’s Kovler Diabetes Center has been looking to address these very issues through its Teen Transition Program. Amy Hess-Fischl is the program coordinator and works with kids and parents in making these very adjustments to help her teen patients make the tough transition going from having their parents actively involved in their daily care and disease management to letting the kids take over that responsibility.
The Kovler Center is unique in that it provides clinical care for people with diabetes at every stage of life, from childhood through adulthood. This allows patients to have continuous care during their entire lives.
Hess-Fischl says that there are some bumps in the road when teens make the transition to their own care, but a big part of it is coming up with “realistic goals” in obtaining an understanding of the role parents need to play in consenting to their kids’ independence and also the need for children to step up and take the mantle and not rely on mom and dad for their care.
Aside from the transitional challenges, Hess-Fischl easily connects with her patients when it comes to technology. Her patients’ enthusiasm is apparent when they discuss the latest smart phone app or even in playing with the newest diabetes monitor.
In addition to her work on the teen transition program she helps kids, teens and young adults by teaching them how to use insulin pumps and continuous monitoring systems.
And if that wasn’t enough to keep her busy, Hess-Fischl recently served on a panel for a healthcare company in assessing calorie, fat and sodium counts in the healthy food options served by local restaurants during the well-known annual Chicago Food Festival.
Hess-Fischl is also active in the American Dietetic Association (ADA), and is beginning her tenure as the Chair for the association’s Diabetes Care and Education practice group.
DiabetesCare.net recently sat down with Hess-Fischl to discuss her work at Kovler, her goals for ADA, and her recent participation in the food festival.
DiabetesCare.net: In your work as the Coordinator for the Teen Transition Program at Kovler, what is the most difficult transition for a child with diabetes who is now getting old enough to be self-sufficient in the management of his or her disease? Is it effective communication with parents to give the young person more freedom to take of themselves? Is it making the young person see the importance of the responsibility of self-management?
Hess-Fischl: You hit on two important points. Our patients are coming in to learn how to slowly build confidence so they can take on the responsibility. In working with the parents, it is helping them so that they can understand the importance of their kids’ independence.
Of course, a lot of kids come in with what I call James Dean Syndrome; although a lot of kids do not know who he is anymore (laughs). They feel like they are never going to die and you have to make them understand the importance of taking care of themselves. You need to find the motivator that will help them make the change now.
I’m thinking about a patient that came in recently who was going into college and his blood sugar ranges were much higher than he should have been. He didn’t like that his parents were going to have to continue to help him with care. Sometimes, that transition can take longer.
DiabetesCare.net: You also teach kids how to use insulin pumps and continuous glucose monitoring systems. How do kids and teens fare in terms of learning these technologies?
Hess-Fischl: The kids are amazing with technology. The kids are working the controls of the pump or continuous monitor and they are five steps ahead of their parents, and the parents are like, ‘whoa what was that?’
I love technology as well. For the most part, the navigation on these devices is so easy and even with the new devices, the kids like to come in and try them out.
DiabetesCare.net: Are many of your patients beginning to utilize smart phone apps, and if they are, what are the ones that stand out?
Hess-Fischl: They are. Many of my patients have smart phones. They like to try the different apps, and they will come to me and say, ‘Amy have you seen this app?’ And so they are always trying new things out.
There are a couple of apps that standout. The two biggest ones are the Go Meals app for carb counting and the other is the Lose It app for weight loss, both free via iTunes for the iPhone.
DiabetesCare.net: You recently participated on the physician panel with Humana Healthcare for the Taste of Chicago festival in choosing the Humana Healthier Choices Food Guide. Can you explain what you did for that and what the experience overall was like?
Hess-Fischl: I grew up in Chicago, so I look forward to it every year. The breadth of food that is offered is simply amazing. This is my first year to be involved working on this.
Humana did the pre-work and had applications available for Chicago area restaurants seeing if they wanted to participate, and if they could offer foods or meals that could fit into certain calorie, fat and sodium recommendations. There were 3 additional local physicians involved on the panel as well.
In May, the panel was charged with reviewing the foods from the restaurants that applied. We had to decide if the items fit within two categories: for snacks and appetizers? Did the food have under 320 calories, under 300 mg of sodium and under 2 grams of saturated fat? For the main course, it needed to have less than or equal to 500 calories, 500 mg sodium, and 4 grams saturated fat.
During the festival, I had a chance to eat a lot of the foods options. It felt good to know I was part of that. I had some friends from out of town, who said they saw the green apple (the Humana Food Guide symbol for the healthy food selections). [Editor`s Note: That`s Amy - pictured, above - with the Green Humana Healthy Choice Apple.]
DiabetesCare.net: This festival and the involvement of local restaurants really highlights one of the bigger nutritional challenges for people when eating out, especially teens and kids with diabetes who may want to eat fast food. What are some of the biggest tips you impart to these diabetes patients when they go out to eat?
Hess-Fischl: The most important part is portion size. We have people that come in and are not going to watch their calories - they just aren’t. There are some kids that tell me, ‘Amy I am not going to be different from the other kids and I’m going to eat what they are going to eat. ‘So they say, ‘what can I do?’
We will ask them what does your plate look like? Cut it in half. That is why the new myplate.gov is so important, it is a big way we can help these kids.
For the next level we are trying to target, we go after the hidden calories like the sauces and dressings. A lot of times teens don’t want to think about these things. The goal is making small changes that will continue throughout their lifetimes.
We also try to help them deal with these things because we realize kids aren’t as active anymore.
DiabetesCare.net: You are the Chair-elect for the American Dietetic Association’s Diabetes Care and Education (DCE) practice group. What will be your responsibilities as the Chair?
Hess-Fischl: Actually, I am in the position now. The position is from June to May of next year, and I act more of a liaison than anything. We have this amazing executive committee. We are the largest practice group within the American Dietetic Association. I believe there are 6,400 of us and growing. They are 12 amazing, accomplished women on the executive committee. I may be the funnel for where everything is started, but the responsibility is shared.
DiabetesCare.net: What are your goals for the position?
Hess-Fischl: We want to work globally to find out what registered dietitians are doing around the world with diabetes. The disease is not just something that happens here in the United States. We want to collaborate with dietitians in other countries and identify best practices within their respective positions. This is a long term goal, so I merely want to start the conversation.
We also have smaller, strategic plans that we will be working on later this year for our next three year cycles for DCE. For example, we have both pre-diabetes and obesity as part of our DCE mission, and our executive committee wants to focus more on this in the coming years due to the increased prevalence of pre-diabetes.
To find out more about Kovler and the work Amy is doing at the center, go to www.kovlerdiabetescenter.org; to find out more about the ADA’s Diabetes Care and Education Group go to www.dce.org ; or to read about the Chicago Food Festival and the Humana Healthier Choices Guide go to: www.humana.com/tasteofchicago.
Originally posted by DiabetesCare.net on July 22, 2011.