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In to Out Series: Diabetes Care

August 14, 2011

Patricia Addie-Gentle RN, BSN, CDE

Sitting down to talk to Patricia Gentle gave me renewed faith in healthcare professionals. While reminiscing about Little Debra with tears in her eyes, you absolutely know that she is passionate about what she does and truly cares for those in need. Yes, Nurse Gentle truly has a name that speaks to her engaging bedside manner.  Her official title with United Healthcare is Diabetes Case Manager; however, it’s her colorful nursing career that has launched her to expert status in the field of Diabetes Education.

Patricia Addie-Gentle, RN, BSN, CDE has been a diabetes educator sense 1990. In fact, just about her entire nursing career has been as a teacher.

So Patricia, how long have you been in the nursing field?

I have been nursing since before college actually as a Certified Nurse’s Assistant (CNA). I wanted to become a teacher; however the thought of motivating students to learn did not appeal to me. But when I completed my bachelor’s at Georgia Medical College, I was recruited by the faculty of the Nursing Program at Clayton State College to be a Clinical Instructor. I then found myself doing what I loved on both fronts; and I was teaching students who were mature and self-motivated. In other words, they wanted to be there. Then I worked for Gordon College and Tuskegee University. Interestingly enough, Tuskegee students come to Georgia for clinicals. This began some time ago when African-American professionals were not allowed to work in certain hospitals; so the tradition has continued because it gives the students opportunity to venture out a bit.

In ‘98 I started work with the Diabetes Association of Atlanta, a United Way affiliate. We held community diabetes classes for 13 counties that United Way served. Then I went to DeKalb Medical as the coordinator for diabetes education for 6 years. After that I took an opportunity to work with a pharmaceutical company in 2008, after which I began working with United Healthcare.

What inspired you to become a nurse?

Well, I was an only child and always wanted someone to nurture. Moreover, science, nutrition, anatomy – these things fascinated me. So at the age of 15 or 16, I decided that I wanted to be a doctor or at least do something in the healthcare field. I became involved in a club called the Medical Explorers and received valuable exposure to the happenings of medicine in OR, Egleston, Surgery Observation, and Labs. Then from there my career as a nurse became to take shape.

Things to remember as a diabetic: your body does not fight infection like non-diabetics. It is vitally important that one fully communicates with doctors, pharmacists, and other medical professionals about other conditions that may affect your wellbeing.

What has been the most aspiring aspect of diabetes education for you?

A lot – I tend to gravitate to people who are needy more so than those who are already functioning well and doing well – although I talk to and provide education to them, it’s those who really have a need that motivates you. They may not grasp the concepts as quickly, so you feel as though you’ve made an impact when the light bulb comes on. When you get somebody who is really sick and doing everything wrong, that one minor change they make makes all the difference in the world. If they just stop drinking sodas and drinking water, the little things make a big difference. Although their A1C may not have dropped, you see progress. I get my inspiration from people who are really at need, high risk folks.

When you first asked that, my mind drifted back to when I was a pediatric nurse right out of nursing school. I had a patient, a little girl, who was a diabetic. As a matter of fact, I wanted to adopt her. She did not receive the best care from her mother and you would see her go home and come back sicker. She was in the hospital every month. When she was in the hospital she was like my child. We became very close and I wanted to adopt that little girl so bad. And people at the hospital would discourage me from pursuing that because I would be so hurt. We could just see her life deteriorating.

And this was from lack of care? Doing the wrong things?

Yes. And I think when I got the opportunity to do diabetes education my thoughts went back to her. Had I known then what I know now, I feel like I could have helped her-especially if she had been mine. I wanted that little girl, Little Debra. (Debra passed away due to diabetes complications).

What are the biggest challenges in your field, in diabetes education?

The biggest challenge in education itself is reimbursement. That’s the biggest challenge that we as educators face because we are not reimbursed for the work we do. If you are independent you are not paid. Many times we have to reach out to patients to make sure that they understand how to get their diabetes under control. I can’t get reimbursed for that.

65% of people with diabetes have coronary artery disease because their heart is trying to pump the sticky substance that is produced as a result of having diabetes. This 65% gets coronary artery disease because their diabetes is uncontrolled. So it doesn’t have to be this way. A lot of people walk around oblivious to the fact that their organs are working in overdrive because their blood sugar is too high. Yet, they will not test themselves to avoid what they perceive as limitations on their lives.

Innovative diabetes treatment – In 2008, the pharmaceutical industry came out with an FDA approved inhaled insulin that was sure to take off. Unfortunately, doctors were skeptical and did not prescribe it due to concerns of possible decrease in lung capacity. Expert nurses in the field of diabetes were tasked with educating the doctors and encouraging them to write the prescriptions for the insulin inhalant. But, understandably so, concerns arose of lung scarring and patients with pulmonary fibrosis down the line.

Diabetes is too much sugar circulating in the blood. There is Type I and Type II, what are the differences?

People with Type I diabetes cannot be treated with anything other than insulin. That’s because their pancreas is non-functioning; they cannot produce insulin at all.

Type II diabetes means the pancreas does make insulin but the body is not utilizing it. Most people with Type II are overweight; type I are typically lean. Type II patients have high cholesterol, high blood pressure, high blood sugar – The whole nine yards of metabolic syndrome.

When all of that is working against the patient, then what is known as insulin resistance develops. So the insulin that is made naturally cannot be used because the body is demanding more in other area thereby preventing the effective use of insulin. When there are high levels of sugar in the bloodstream every organ in the body is subject to damage -the heart, the eyes, kidneys, etc.

Are the symptoms of Type I and Type II the same?

Yes, extreme thirst-the body is trying to ‘rinse’ the sugar out. The brain is saying ‘you need to drink something’. People don’t realize in the beginning that high blood sugar is the cause, so they drink soda, juice. Then they urinate a lot as a result of the excessive drinking, and blurred vision. And because Type II has an onset of around 35-40, they think age is the issue and their bladder is weakening. Then the mis-associations take place. Type II is somewhat family related, but we’re realizing that it is mostly lifestyle. If you grew up in a family that tends to be sedentary, then most likely you will have those same tendencies.

Type I is usually caused by a virus; and usually in children. A virus may attack the pancreas and most children get it after a high fever – measles, mumps, or chicken pox. We used to call it juvenile diabetes because mostly children have it. But though mostly kids have, adults can get it as well brought on by maybe a traumatic injury. Type I is not really hereditary; it’s extremely rare.

Which Type is more prevalent?

Type II. If we held a convention with everyone with a diabetes diagnosis only 10-15% would have Type I. Most people have Type II. Interestingly enough, most Caucasians with a diabetes diagnosis is Type I. Type II diabetes is most prevalent among African-Americans, Hispanics, Native Americans (Pima Indians) , and Asian-Pacific islanders.

Certain physical characteristics may be observed in diabetic patients: round middle section, little arms – arms are disproportionate to the rest of the body, the neck is bigger and darker. Pear-shaped bodies are less likely to develop diabetes-think Beyoncé or Oprah.

In day-to-day life, you hear about diabetes a lot then you see the complications, blindness, dialysis, loss of limbs. Then you hear that it’s controllable. What gives?

For a few, it’s refusal to take care of one’s self. For others it’s sheer ignorance, meaning that they truly don’t know how to take care of themselves. I had a patient that believed since their father had diabetes and suffered from blindness and an amputation he would just go through the same things. He never realized that he could change his outcome.

When doctors diagnosis someone, is there a missing link?

You’re hitting on all the right things – yes. Most people with diabetes don’t make it to an endocrinologist because they are not referred. The patient assumes their primary care doctor can handle it.

Doctors typically do not come out and say ‘you have diabetes”, instead they will say ‘you have a touch of sugar’. I thought people stopped saying that. Education is key. If doctors referred patients to an educator more often outcomes would change.

A diabetes class is around 10 hours, broken down in segments- what is diabetes, monitoring and testing, how to adjust those numbers, when to exercise, when to eat, medication, etc.

There seems to be some misconceptions out there with regards to treatment. Will you dispel some of those?

Yes. There are people who think that insulin causes blindness, when in actuality the condition was allowed to get so bad before insulin treatments were started. And people who have gone on insulin end up on dialysis, but again they didn’t go on insulin early enough.

Statistics tell us that most people diagnosed with diabetes have had it for about 7 years. The symptoms have either been ignored or after the yearly physical the doctor says you’re borderline. The fasting blood work may be a little misleading.

In the US, how many Americans have Type II diabetes?

21 million Americans – a lot. In 1998, there were 14 million.

So we have another missing link. Why don’t doctors say let’s take a glucose test?

It is standard for people over 40; however it’s still misleading because it’s a fasting test. If you have a family history then the doctor may dig deeper. But then there is another problem- many people shut down when doctors interview them on family history and other information. The patient may not paint a complete picture. People don’t understand the significance of those questions.

Another missing link is literacy. I do a lot of seminars on medical literacy, and one must understand that a lot of what we do is on a form. We depend on the patient to complete the form, bring it back, and some can’t do it. The patient is then embarrassed, they cancel their appointment and don’t come back. It is so vitally important that patients receive compassion from the beginning of their visit with the receptionist to the end with the doctor.

Controlling diabetes

Type I – insulin dependent
Type II – treatment depends on the patient. Many do well with just diet and exercise, however over time the condition will begin to overtake the patient’s efforts and insulin will need to be incorporated. This does not mean that the patient hasn’t been doing the right things. About 2 years ago, diabetes educators had to change their standard to state that diabetes is progressive.

 How can family and friends be more supportive?

Classes are really good and empowering; we embrace family and friends. Not only do friends need to be knowledgeable with regards to helping to control the existing condition, but also in order to help prevent themselves from the development of diabetes.

I used to work with a group called DivaBetic, for women with diabetes from 2006-2010. We travelled around the US and had pageants and shows. DivaBetic was started by Max Szadek, Luther Vandross’ longtime assistant. This organization helps to empower women with diabetes, giving themselves a better quality of life. For more information, visit www.divabetic.org.

There is also a project called Project SUGAR in North Carolina and South Carolina, at the Medical University of South Carolina. These 2 states have an extremely high incidence of diabetes. For more information on Project SUGAR, visit http://academicdepartments.musc.edu/sugar.

In your opinion, what are the best sources for people who want to learn more on diabetic care?

The Mayo Clinic and Joslin Clinic (Harvard Medical affiliate).

Are there are any new technologies on the horizon for diabetic care that you can share?

The inhaled insulin has been the newest thing on the market lately. However there are still the tablets that either give the pancreas an added boost to create insulin, slow the absorption of carbohydrates, slow the digestive track, or slow the liver’s release of glucose. People will take pills before insulin. There are also combination pills.

Then you have islet cells that are transplanted into the pancreas of people with Type I to increase insulin production.

The artificial pancreas is another option for those with Type I. Check out this site for more information: http://www.artificialpancreasproject.com/.

Final Thoughts
Armed with the proper information, the will to be in good health, and strong support system diabetes is a controllable condition. Many people live full and productive lives from the inside out, meaning they have educated themselves, proper nutrition has been established, and a consistent exercise program is in place.

If you are not suffering from diabetes, chances are you know someone who is – be a supporter, an accountability partner.  Every little bit helps.

~Live Healthy. Look Healthy.

Please remember:
1) ***Our intention, through this series, is to help others to live a whole life in a healthy manner – not to treat any condition. **
2) All features are accessible throughout the feature series.
3) All material within this blog may used for educational purposes only, providing you retain this copyright notice and use an appropriate citation including the record URL of the information. We would like to know how you are using the material, please send notification to info@hqoshop.com.
©2011, HqO Skincare LLC. All rights reserved

Patricia Addie-Gentle, RN, BSN, CDE has been a diabetes educator sense 1990. In fact, just about her entire nursing career has been as a teacher.

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2 Comments leave one →
  1. February 19, 2012 7:28 pm

    Reblogged this on Live Healthy, Look Healthy and commented:

    I think this post is a great reminder to take care of ourselves – In to Out.

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  1. From Simple to Sublime « Live Healthy, Look Healthy

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