Ella Brock, RN, CDE, (left) and dietitian Sallie Warren, MS, RD, LD, demonstrate proper portion sizes as part of the Diabetes Education Outreach Center’s diabetes self-management class at ETMC Henderson.
HENDERSON, Texas – “Shock” is the word Billy Sitton uses to describe his feelings following a diagnosis of type 2 diabetes.
“We could hardly drive home we were in such shock,” Sitton said of he and his wife, Janelle. Sitton was diagnosed on Aug. 3, 2009, following routine blood work done at a regular check up. The tests revealed a blood glucose (sugar) level of 240 mg/dL. A reading of 200 mg/dL on a random blood glucose test suggests diabetes.
For Ann Harris, her initial reaction wasn’t so much shock, as simple disbelief. Harris was working the registration desk at a health fair at her church, First Methodist in Henderson, in October of 2006. “I was registering people and I just went back and said, ‘Prick my finger.’” After the blood was taken, she went back to work registering others for the health fair.
Harris went back later for the results to find that her reading was high, 199 mg/dL. She credited the high reading with not having fasted before the test, but agreed to fast and have another test the following morning. The second test only confirmed the first. Her reading was 198 mg/dL.
She followed up with a visit to her physician and was officially diagnosed with type 2 diabetes. “I knew we had a family history of diabetes,” she said, “but I’d never had a problem.” Her father had it and her brother was diagnosed just two months prior to her diagnosis.
A group of diseases
Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action or both, according to the Centers for Disease Control and Prevention (CDC). Insulin is the hormone responsible for regulating sugar levels in the blood. Type 2 diabetes is the type most commonly diagnosed in adults.
Today, both Harris and Sitton have a different story to tell. Coupling medication with changes to their diet and lifestyle has resulted in diabetes that is under control for both.
At her last check up, Harris reports her hemoglobin A1c (HbA1c) level was 5.9 percent, down from 8.5 percent at the time of her diagnosis. (The HbA1c test provides an average of blood sugar control over a six- to 12-week period. The normal range for the HbA1c test is between 4 and 6 percent.) On the day of our interview, Sitton said his morning blood glucose test reading was 104 mg/dL.
Education creditedBoth credit the education they received at the Diabetes Education Outreach Center at ETMC Henderson with helping them successfully manage their diabetes. “I had a friend who was borderline,” Sitton said. “He went through the program and he said, ‘You gotta go.’ He was right. They gave us the information we needed and we’ve been following it.”
The Diabetes Education Outreach Center provides self-management education to patients diagnosed with diabetes. Patients are referred to the program by their physician. Ella Brock, RN, certified diabetes educator (CDE), and dietitian Sallie Warren, MS, RD, LD, are the instructors for the program.
The Diabetes Education Outreach Center has been Recognized by the American Diabetes Association (ADA) for Quality Self-Management Education.*
The program was first recognized in 1998 and is one of only 2,000 programs to earn the distinction in the nation. The Diabetes Education Outreach Center must undergo evaluation every three years to maintain its recognized status and to ensure the program continues to meet the standards of care set forth by the ADA.
The cost of diabetes self-management education classes offered through ADA recognized programs is covered by Medicare and most insurance providers. Scholarships are available for uninsured patients and those covered by Medicaid through the Henderson Memorial Hospital (HMH) Foundation. Each year the HMH Foundation and the center partner to sponsor a “Diabetes Walk” to raise funds for the scholarship program. Approximately $3,000 to $5,000 is raised annually through the event.
The center provides most education through group classes. A 10-hour group class begins on the first Wednesday of each month and continues on the following Wednesday. The classes cover topics such as: general diabetes facts; oral medications and insulin; nutrition; home blood glucose testing; hypo/hyperglycemia; hygiene (skin, teeth, feet); exercise; complications of diabetes; illness; community resources and psychological effects of diabetes.
“We hit them with a lot of information,” Warren said. “I’m sure it is a bit overwhelming. But, by the end of the class, I think they are pretty reassured.” Warren covers topics such as grocery shopping, portion control, reading food labels and counting carbohydrates (carbs). She also helps patients calculate their ideal daily caloric intake.
“We encourage them to set short-term, realistic goals,” she said. “This is really a behavior modification program. We want them to understand that this (managing diabetes) will change everything you do on a daily basis for the rest of your life. We try to teach the realities of it.”
A lifetime disease
Brock agrees. “This is a lifetime disease,” she said. “It has the potential to affect every organ of the body, every vessel of the body and every nerve of the body. That’s why early detection is so important. And, why learning to manage diabetes can make such a difference. We try to give them the skills they need to manage the disease, which reduces complications, improves their quality of life and increases their longevity.”
In addition to the group classes, individual instruction is available for patients with special needs, such as pre-diabetes, a condition characterized by blood glucose levels that are higher than normal, but not high enough to be classified as diabetes; gestational diabetes, a form of glucose intolerance that develops during pregnancy; or those who need instruction in insulin administration, weight management or carbohydrate counting.
Harris and Sitton agree that the education they received through the center provided them with the tools they needed to take control of their health.
“I knew I needed the education,” Harris said. “Ella did a good job. She’s really good at explaining it all. She is one of the best. She follows up with you, too. And, Sallie really opened my eyes. I read (food) labels a lot closer than I used to. I learned how much sugar different foods have and the importance of monitoring my blood glucose levels. I have my (hemoglobin) A1c tested every three months.”
“I’ve learned to watch my portions,” Sitton said. “I exercise and try to stay active.”
Harris and Sitton are just two examples of the success of the Diabetes Education Outreach Center at ETMC Henderson. Overall, patient outcomes are good, according to Brock and Warren. “We’ve seen a marked improvement in HbA1c levels among the patients that have completed the education program,” Brock said. “We’ve had a lot of good responses from our patients. None have returned with further complications,” Warren added.
Improved patient outcomes are a big reward for the program instructors. “Seeing the need in the individual and then seeing the outcomes—improved quality of life. When I see them make the changes they need to make to manage the disease, that’s very rewarding,” Brock said.
For more information on the Diabetes Education Outreach Center at ETMC Henderson, call 903-655-3795.