Are you newly diagnosed with diabetes, or struggling to control your blood sugar? If so, DMSE/S programs can help!October 17, 2016 at 9:43 am | Posted in Announcements | Leave a comment
Tags: Diabetes, DSME, health, healthy lifestyle, Medications, nutrition
Diabetes is a chronic, complex disease. Self management is key, but what does that even mean? Where do you start? Self Management is the ‘taking of responsibility for one’s own behavior and well being.’ Living well with diabetes means you need to learn new skills and behaviors. This can seem overwhelming during an already stressful time. DSME/S programs teach you the self management skills you need to truly thrive.
You will first see a nurse or nurse practitioner (who is often usually a Certified Diabetes Educator or CDE). You will either continue to see that clinician by yourself or attend group classes with other people just like you. Group classes are a great way to learn and be supported by people who know what you’re going through. You are not alone! During appointments or classes, you will learn about important topics like nutrition, exercise, medications and more. You will also set specific behavioral goals to work towards between each visit.
Research has shown that DSME/S works. It can lower your A1C and stop complications from happening or getting worse. Attending can also improve your quality of life and keep you out of the hospital. Major organizations like the American Diabetes Association, American Association of Diabetes Educators and the Academy of Nutrition and Dietetics all believe that everyone with diabetes should have DSME/S at some time in their life.
Mass General DSME/S programs are offered at Chelsea, Revere, Charlestown, Internal Medicine Associates, Diabetes Associates and Bulfinch Medical Group. For more information, contact Jen Searl at firstname.lastname@example.org.
Tags: care team, Diabetes, Diabetes management, DSME, family, health literacy, healthy eating, my story, nutrition, Type 2 Diabetes
My grandmother is a tenacious and vibrant woman who was diagnosed with type 2 diabetes earlier this year. She had uncontrolled blood sugar levels along with other health issues and limited mobility. With no formal educational background, she doesn’t know much about diabetes or possible complications. Her low health literacy makes it difficult for her to utilize diabetes related health care resources. “There are too many rules in my diet!” she would exclaim in Twi, her native dialect. She also has low nutritional knowledge and at times would reduce her consumption of certain staple foods. She assumed that eating less of these foods would cure her body from the disease. Her daily diet in Ghana is mostly starchy and sugary foods with low nutritional benefits. One staple meal that she eats quite often is called fufu: a soft dough-like mix of cassava, plantain, and other flours served with different types of warm soups full of meat and/or fish. Fufu is relatively high in carbohydrates and has a significant and rapid effect on my grandmother’s blood sugar levels.
As my grandmother’s caregiver, I provided diabetes care management and education. My goal was to help her avoid blood sugar spikes keep her blood sugar in a healthy range before she went back to Ghana. Every day I checked her fasting blood sugar in the morning and again two hours after eating. These results were reviewed by her PCP and nurse case manager. I modified my grandmother’s meals and incorporated more green leafy vegetables, fiber-rich foods, whole-grain breads and old-fashioned oatmeal with almond milk and honey for added sweetness. I also introduced her to cooked quinoa and cauliflower rice as substitutes for fufu, white rice, and other fufu-like foods to give her meals a nutritional boost. After a meal, I would encourage her to take a walk to the local shopping plaza or to circle around the neighborhood for an hour. Despite her stubbornness and fiery temper towards changes to her diet, we were able to improve her eating habits by stressing the importance of portion control.
My grandmother does not know how to pronounce diabetes or manage her care on her own, but making sure she understood that her medications, changes to her diet, and daily walks to her favorite consignment stores are effective tools for managing her blood sugar levels were key components to her care plan. My experience as a caregiver was a wonderful opportunity to spend time with my grandmother, and it also highlighted the importance of diabetes education in following a care plan and reducing risk of complications. I also learned how that approaching care in a culturally tailored manner that respects individual preferences, opinions and ideas is necessary for reaching optimal health.
Tags: Diabetes, DSME, healthy eating, nutrition, quinoa, recipe, whole grains, Whole Grains Month
Celebrate Whole Grains Month with this easy grain salad. One serving is a good source of iron.
1 cup of water
½ cup uncooked quinoa, rinsed
3 tbsp fresh lemon juice
1 tbsp olive oil
1 tbsp honey
¼ tsp salt
¼ tsp black pepper
¾ cup fresh parsley, roughly chopped
½ cup thinly sliced celery
½ cup thinly sliced green onion
½ cup finely chopped dried apricots
¼ cup pumpkin seeds
Bring water and quinoa to a boil in a medium saucepan; cover, reduce heat and simmer for 20 minutes or until the liquid is absorbed. While the quinoa is cooking, whisk the lemon juice, olive oil, honey, salt and pepper together in a small bowl.
Fluff the quinoa with a fork and place in a bowl. Add the parsley, celery, onion, and apricots. Toss with the dressing to coat and top with pumpkin seeds.
Yield: Serves 4
Serving Size:about 2/3 cup. Nutrition Information Per Serving:
Calories: 195 calories • Protein: 5 g • Sodium: 160 mg • Carbohydrate: 33 g
Fiber: 4 g • Fat: 6 g • Sat Fat: 1 g
Recipe adapted from Cooking Light. Originally posted on mghbefit.com.
Tags: cooking, Diabetes Education, DSME, healthy eating, home cooking, vegetables
I never used to cook at home. In fact I HATED cooking. I had no confidence in the kitchen and burned everything, even toast. Time was another reason I didn’t cook often. I always thought cooking a meal had to take a ton of time; I really just wanted my food to appear in front of me. At the same time, I wanted to eat healthier but had no idea where to start or what to do with things like vegetables and spices. Then a coworker mentioned she had signed up for Plated [a subscription meal service] and suggested I give it a try. It sounded like an interesting concept, so I went for it.
What I like most is that it saves time and effort. Everything you need to make the dish is included and portioned out for you. Some recipes use ingredients I never would have bought on my own because I didn’t know how to use them, so it’s a great way to try new things. I also discovered that cooking doesn’t take up as much time as I thought. We typically cook at home 3-4 times a week (usually dinner). We’re definitely eating as a family more often, and I enjoy getting to spend time with loved ones while preparing meals.
We’ve been using Plated for about a year now and I feel much better about my cooking skills. I know if I made a recipe once I can do it again. You get to keep the recipe cards, so we’ll usually do a little experimenting the next time we make the dish. I’m eating healthier now, too. Before, I never really ate vegetables (or if I did they were just raw). I’d go into the grocery store and see all these wonderful looking vegetables but feel intimidated not knowing what to do with them. Now that I have a better idea how to cook them, I include vegetables with my meals often.
I recommend signing up for something like Plated if you don’t have much confidence with cooking. The recipes are easy and they tell you about how much time it takes to make. You’ll learn how to cook new things and different types of vegetables. My parents actually signed up for another meal delivery service, Blue Apron, because of my experience with Plated.
Tags: bug bites, Diabetes, DSME, health, mosquito, prevention, summer, zika
By Eileen B. Wyner, NP
Bulfinch Medical Group
I have lots of fond summertime memories from my childhood. We could play outside really late, Hoodsie® Cups were allowed even if it wasn’t a birthday party, and mosquito bites made me scratch so much I got the evil eye from my mother because I was so annoying. That was the extent of thought anyone gave to bug bites. So what has changed? Playing tag until dark has been replaced with my commuter rail commute and Hoodsie® Cups are too hard to find in the supermarket these days. But the biggest change is that now if I get a mosquito bite it doesn’t itch so much as cause anxiety.
Mosquitos are more than annoying. They potentially carry serious and life threatening disease. We all have to try harder to avoid being bitten. The best way to avoid bug bites and the possible illness (as well as the associated anxiety they may cause), is being informed about the recent facts concerning mosquitoes. What you need to know about illnesses spread by mosquitoes:
- West Nile Virus (WNV): This is a virus that often causes no symptoms. It is most common between the months of June and September, but people are at risk until the first frost.
- Eastern Equine Encephalitis Virus (EEE): EEE is a rare and severe mosquito transmitted virus that carries a 33% mortality rate. EEE may have no symptoms, but in some cases it can cause serious inflammation of the brain that can lead to coma. EEE is also present until the first frost.
- Chikungunya: This is a virus caused by mosquito bites that always causes some sort of symptoms; usually fever, joint pain and sometimes a rash. Chikungunya can affect people of all ages but the symptoms can be greater in the very young, the elderly, or those with chronic diseases such as heart disease and diabetes. Treatment is possible and people usually feel better within a couple of weeks. This illness has not been found in mosquitoes in the United States BUT it has been seen in many other countries including the Caribbean. People who travel to infected areas can be bitten and develop illness when they return home.
- Zika Virus: Zika has been front page news over the last few months, but it was first identified in 1947 in monkeys in Uganda. It is now frequently mentioned by the media as it has been accompanied by a rise in cases of microcephaly (a birth defect that affects the growth of the brain that is spread to the fetus during pregnancy and possibly at birth) and Guillain-Barré syndrome in South America. This past week CDC announced that infected mosquitoes have been located in parts of Miami, Florida and published guidelines for travelers to the area. Visit the CDC website for more information about Zika. The possible symptoms are very nonspecific, such as feeling tired, fever, rash, and conjunctivitis. People may be infected and not know it. There are tests available to see if Zika is the cause of the illness, but they are performed under very specialized circumstances. Ask your healthcare provider for more information. There is no treatment for Zika, but the symptoms can be treated as needed.
The best treatment for any of these viruses is PREVENTION:
- Mosquitoes breed in moist spaces. It is important to remove standing water such as watering cans, wading pools, or rubbish cans.
- Mosquitoes are known to be most active at dawn and dusk. However, Zika infected mosquitoes are mostly DAYTIME biters. It is still the best idea to make sure that window screens are intact. Close windows and use air conditioning if possible.
- Wear protective clothing (e.g. long sleeves, pant legs tucked into socks) when outside during potential peak activity hours.
- Use mosquito repellent. Products that include DEET, picaridin, oil of eucalyptus, or para-menthane-diol are appropriate to use. It is important to read the directions as many of these products are harmful to infants and children.
- Zika presents another challenge as far as prevention. Zika can be spread through sexual activity, so it is necessary to observe safe sex practices if there is any chance of infection.
This is a beautiful time of year in the Northeast and sooner than I care to think about, I’ll be worrying about ice dams. I hope that you will all join me and go outside and play. Just don’t forget to add the right clothing and some bug spray in your backpack.
Tags: commitment, Diabetes, DSME, exercise, exercise buddy, fitness, friends, routine
By Jahnelle Bray
Population Health Coordinator
One of my old coworkers made a commitment to get up early every morning to go spinning. She always had so much energy during her day I thought I’ve got to try this! When a spinning studio opened across the street, I got a group of friends together and that’s what we did. That first class was tough and I had really mixed emotions when it was over. I was sweaty and sore, but also really energized. A little while later I introduced another friend to spinning and she LOVED it. She also suggested we go to a class every week. This was great for me because it has helped me build consistency with my workouts.
If you struggle with staying in shape or sticking with exercise, finding an exercise buddy is really helpful. When you’re by yourself, it’s easy to talk yourself out of exercising or just do the bare minimum. When you make plans with someone else, you’ve made a commitment to be there and do your best. You don’t want to feel like you’re letting them down.
Your exercise buddy can push you to keep going when your muscles start to hurt. If I start to feel like I’m ready to give up, I’ll look over and see how my friends are doing. Seeing them going for it when I’m flagging really motivates me to stick with it. Thinking about the class as a group effort also helps. Everyone is there for the same reason and we’re all going to get through this together. I don’t want to be the only person not doing anything, so I tell myself if they can do it, so can I!
It was great finding someone who loved spinning as much as I do and wanted to go regularly. We have a routine now where we text each other every week to decide what day we’ll go. It’s been about a month since we started doing this, and I’m much less sore than I was after that first time! I look forward to class. It’s a chance for me to disconnect and recharge my body and mind. If I miss a week, I don’t feel my best. Working out is a great accomplishment. If you don’t finish anything else in your day, at least you’ve done that.
Tags: Diabetes, DSME, fitness, outdoors, summer, walking
By Chrisanne Sikora, Sr. Project Specialist
Diabetes Self-Management Education Program
By now you’ve probably heard of Pokémon GO, the Augmented Reality mobile game where players “catch” virtual creatures in the real world. Out of curiosity, I downloaded the app while I was on vacation. After about a week of playing around with the game I still don’t quite get many of the details about leveling up your Pokémon or challenging other players to competitions (yet). Finding and catching Pokémon, though? THAT I get and it ties in with what I find most appealing about the game: it encourages you to get up and get active.
The game uses your phone’s GPS to track your location and movements. As you move, your character in the game moves as well. Places where Pokémon will appear are marked on the map and when you get close, you “catch” them using the phone’s camera. While you may be able to find a couple in your home like I did, catching all 100+ different types of creatures (one of the goals of the game) means heading outside and exploring. The more you walk around, the more likely you are to find new and different types of Pokémon.
While you’re out catching Pokémon, you’ll also encounter “Pokéstops” where you can pick up useful items. These places usually match up with real life landmarks or interesting sites. The more of these sites you visit, the more items you’ll collect (and the more walking you’ll do). Eggs are one type of item you can find at these stops. To find out what’s inside your egg, all you have to do is walk. After a certain distance (the app tracks it for you), it will hatch. There may even be a Pokémon inside!
It’s a cute way to spend time with friends and family, or jazz up your regular routine if playing solo. I had the app open when I went walking the other day and found several Pokémon and Pokéstops along one of my regular walking routes. If you do decide to try it, make sure to pay attention to what’s around you and be respectful of other people’s property.
Tags: cookout, Diabetes, easy side dish, fourth of July, recipe, summer, vegetables, veggies
A quick and easy side dish to bring to this weekend’s cookout. Miso is typically found in the refrigerated food section, often either by the dairy or chilled salad dressings.
1½ tbsp sesame seeds, roasted
2 tbsp white miso
1 tbsp rice vinegar
1 tbsp honey
1 tsp crushed red pepper
1 tbsp dark sesame oil
4 cups thinly sliced cucumber
Combine the first 6 ingredients and whisk in 1 tbsp hot water. Add cucumber and toss to coat.
Yield: 5 servings
Nutrition Information Per Serving:
Calories: 100 • Protein: 2 g • Sodium: 260 mg • Carbohydrate: 13 g • Fiber: 2 g
Fat: 5 g • Sat Fat: 1 g
Recipe adapted from Cookinglight.com. Originally posted on mghbefit.com.
Tags: Diabetes, fitness, practice, summer, swimming
By Sara Evans, Aquatics Supervisor
The Clubs at Charles River Park
Swimming is a great, total body exercise for building strength in your muscles as well as your heart and lungs. Swimming is also a safe activity for anyone. Because you’re weightless in the water, there’s less wear on your joints and you don’t need to worry about tripping or losing feeling in your feet. Unless your healthcare provider says no, there’s no reason not to try swimming.
Swimming uses every muscle in your body, but especially your core. A strong core is needed to keep your head above water, and will help improve your posture in other activities like running or walking. Since the whole body is used to pull you through the water, swimming is a great time saver workout. Just 30 minutes in the pool is about the same as at 45-minute run on the treadmill. You can also adjust how hard you work by making small changes to your hand positions. For instance, keeping your hands flat adds resistance and challenge.
If you’re new to swimming, the first steps are learning to float and developing good breath control in the water. Most of all you’ll need to have confidence about swimming in the deep end. The best way to build confidence is through practice. I recommend beginners start with 15 minutes twice a week at either the beginning (warm up) or end (cool down) of your workout. Remember, swimming is much different than running so it’s best to take it easy to start so you don’t wear yourself out. As you get stronger, you can increase how long and how often you swim. Eventually you’ll be able to swim every day of the week if you want! Swimming is a life-long activity and there’s no risk of injury from overuse.
One last thought: There’s no one “right” way to swim. You’ll soon develop a style that works for you. Be comfortable with your stroke, even if it’s different from someone else’s. The best fit for you is whatever gets you to the other end of the pool and back.
Tags: community, Diabetes, Diabetes Education, knowledge sharing, Mass General Hospital, peer to peer
In April of this year, MGH Back Bay began trying out a new model for delivering care and education for their diabetes community: shared group medical visits. Led by a nurse practitioner, a diabetes nurse educator and a registered dietitian, these shared visits are offered to people with prediabetes or Type 2 Diabetes (newly diagnosed or anyone needing a little extra help bringing blood sugars under control). Visits are divided into two sessions, two weeks apart. The first session focuses on diabetes basics and nutrition; the second covers nutrition in more detail and reviews complications.
At the beginning of each session, the nurse practitioner meets with each participant for a short individual visit. A larger group discussion takes place afterwards. Although there is a curriculum with prepared material about A1C, blood pressure and cholesterol (LDL), the discussion is allowed to grow organically. Questions are encouraged and participants are welcome to share personal stories if they wish. Opportunities for hands-on learning are woven into the session, such as exercises on reading food labels or using rice in a shoe to illustrate symptoms of neuropathy. At the end of the second session, participants are asked to identify and write down one or two goals to work on. The diabetes nurse educator mails these goals two months after the group as a reminder of what was motivating them during the visit.
Response to the shared group visits has been very positive. The opportunity to talk about living with diabetes and learn tips from peers for overcoming every day challenges is a highlight for many. Much of the success of this visit model is the emphasis on team-based care. One of the reasons for offering shared visits was providing better access to nutrition education. Since a registered dietitian is there for the visit, participants do not need to schedule a separate appointment. The group setting also helps reduce anxiety some feel about seeing a dietitian. In addition to clinical outcomes (improved A1C, reduced weight), scheduling a follow up visit with a dietitian is considered a mark of success for this visit model.
More shared group medical visits have been planned for the fall. Given how well visits have gone so far, the practice is considering offering shared group visits for other chronic conditions such as hypertension