Transcript: Reducing Risk of Diabetes Complications

HadleyReducing Risk of Diabetes ComplicationsPresented by Lisa GoldenGenie Benavides, RNDate August 15th, 2012

Shirley McCrackenGood morning. My name is Shirley McCracken. I’m the moderator for today’s seminar. Today we have Lisa Golden who is the diabetes field specialist for the Texas Department of Assistive and Rehabilitative Services. In Texas, they contract with diabetic educators across the state to provide diabetes self-management education to consumers.

Today, we have one of those educators joining Lisa. It’s Genie Benavides. She is a nurse who has been providing services for the Division of Blind

Hadley.edu | 800.323.4238 Page 1 of 58

Services since 2002. Lisa and Genie, I’m going to turn the microphone over to you now.

Hadley.edu | 800.323.4238 Page 2 of 58

Lisa GoldenThank you, Shirley. And thank you, Hadley, for this opportunity for Genie and I to come and speak about this topic. In my position with DARS, we deal with a lot of complications with diabetes. I know that complications can be frightening to a lot of people.

Often people bring up all the frightening things that can happen if you have diabetes. “You’re going to go blind, you’re going to lose a leg, or at least a few toes, and you’re going to go on dialysis.” The message that I like to bring to people is that complications are preventable.

There’s a lot that we can do to slow down or even stop the progression of complications. And the things that we as diabetes educators promote are things like healthy eating, being active, monitoring so you know what your blood sugar is, taking your medications, and healthy coping and problem solving when things go wrong.

These are the things that can help you prevent complications. One of the things that I find with

Hadley.edu | 800.323.4238 Page 3 of 58

people is that there’s nobody to cheer you on when you do things right. So, if you take a walk around the block, you eat your five servings of fruits and veggies, and you check your feet.

All those things are important in diabetes management but there’s nobody that gives you that gold star or tells you, “Hey, you did a good job.” It’s important that you remember that what you do every single day, the little healthy things that you do prevent the complications of diabetes, makes an enormous difference in your future.

Now, in a few minutes, we’re going to identify some of the complications that people with diabetes are at risk for. But first, I’d like to talk a little bit about complications and why they occur. For me, when I think of complications, I think of three things.

One is micro vascular damage. That’s what we call it in the medical field but it’s just basically damage to our small blood vessels. The other thing is inflammation and the third thing is stress. Stress

Hadley.edu | 800.323.4238 Page 4 of 58

has an enormous effect on our bodies so let’s talk about these a little bit.

Genie, can you help me talk about a little bit about what diabetes does to our small blood vessels?

Genie Benavides, RNWell, you can imagine having diabetes means that you’re learning to control your blood sugars and it’s very possible to control your blood sugars which, by the way effects any occurring complications.

When you have a large amount of blood sugars running around your body they come knocking at the door of the smaller blood vessels. Because they can’t enter, they begin to destroy that blood vessel and also begin to destroy the nerves that run alongside of those small or large blood vessels.

The nerves depend on those blood vessels to feed them to keep them healthy. So when you have blood sugars hitting those blood vessels, they

Hadley.edu | 800.323.4238 Page 5 of 58

cause the damage, the death, to those blood vessels ultimately also death to the nerves.

Lisa GoldenAnother thing that we try to do with diabetes is reduce the amount of inflammation in our bodies. Can you talk a little bit about why that’s important?

Genie Benavides, RNInflammation causes swelling and soreness anywhere on your body. Like if you have a back injury and nothing’s broken, more than likely your inflammation is what’s causing pain. It’s causing the swelling, the redness, and the soreness. Any time you have inflammation in your body it’s going to affect your blood sugars as a diabetic.

Hadley.edu | 800.323.4238 Page 6 of 58

Lisa GoldenSo what can we do to reduce that inflammation?

Genie Benavides, RNOne thing is, of course if it’s necessary; you need to talk to your physician. You need to be on an anti-inflammatory medicine. You need to be able to apply cold therapy or heat therapy to the area of the inflammation. If you have a sore in your leg, of course because you’re diabetic, you need to see a physician because it could start with inflammation but it could actually develop into a sore, ultimately maybe an ulcer.

So seeing your physician regularly on these issues is important and knowing your body and knowing when you need to see your physician for inflammation. And you know you can have inflammation of the heart. You can have inflammations of muscles which the heart is a muscle. You can have inflammation anywhere in your body that causes your blood sugars to elevate, and ultimately a problem with your diabetes.

Hadley.edu | 800.323.4238 Page 7 of 58

Lisa GoldenLet’s talk about the third thing which is stress. It is a huge part of all of our lives. There’s a lot of stress on us from work, family, and finances which for many dealing with a disability provides an even greater amount of stress. Diabetes itself makes a big difference in the stress management in your life because you’re always thinking about what was my blood sugar, was it high or low, and why it can’t it just be perfect.

Do I have enough supplies for what I want to do today? What if the pharmacy doesn’t have my medication ready? Do I have everything I need to make a healthy meal? Am I going to be able to get enough sleep? There are all these stressors that are affecting our bodies. Can you tell us a little bit about the effect stress has on our body?

Genie Benavides, RNWe could write a book on this Lisa. Stress is so very important to understand in regards to diabetes. Now when you think of diabetes management you’re going to think of diet of course, and in that diet including your medications. Next you would be

Hadley.edu | 800.323.4238 Page 8 of 58

thinking about your need for more mobility or an exercise program designed for you.

But few understand there’s a third component and that is called stress. The reason why stress is so important to you is that when your brain detects that your body is in stress, it will begin to shoot out a hormone through your pituitary gland in your brain. That hormone, like every hormone, has a particular job. And its job is to give you the ability to overcome the stress.

Let me say this, stress is not only worries, concerns, crises, fears, anxiety, and anger. But stress can also be flu or a surgery that you need to have done. Stress is a component of many things and unfortunately your brain doesn’t know how to put that stress in categories and treat accordingly.

It has one treatment for all stress in your body. That would be, again, the brain telling your pituitary gland to shoot out the hormone called cortisol. Cortisol then goes into your blood stream to help you fight the stress in your body and it

Hadley.edu | 800.323.4238 Page 9 of 58

turns into a self-body made steroid called corticosteroid.

Then that in turn causes blood sugars. It turns right into blood sugars and the idea is to give you the ability to fight or flight, giving you that adrenalin rush that we sometimes talk about, that super power, all designed to give you the ability to overcome that stress.

Unfortunately, again, all that ends up becoming and elevated blood sugar. So when people have elevated blood sugars, I’m not suspecting always that it’s their diet. I’m also expecting through their testimony and explaining to me their life most recent there’s a change in their life. Let me give you a little story.

I went to Saint Angelo, Texas a few years ago because the counselor there wanted me to see three consumers who all had very elevated, between 200 and 300, blood sugars. Her comment to me was, “These consumers are eating terribly. Come and teach them.”

Hadley.edu | 800.323.4238 Page 10 of 58

Well, I chuckled because I knew these three consumers and I didn’t feel it was their eating. But I had known that each of the three of these people were going through crisis in their life; one, recent blindness, another one, a recent divorce, and the third, a loss of employment. They all had extreme stress in their life and ultimately it was the cause for the elevated blood sugars.

Lisa GoldenThank you. So I think it helps to keep these three things in mind because the body is a complex machine. We sometimes get to blaming and there’s more going on. But there’re things that we can do to prevent the stresses, to handle stress a little bit better, or to handle the inflammation.

But before we get into that, I would like to talk about some of the complications of diabetes. Probably some of the first ones that always come up are cardio vascular issues and strokes that people with diabetes are at high risk for. When you have diabetes if you have high blood pressure, high cholesterol, or if you smoke, smoking has a huge effect on your body. Actually let’s talk about

Hadley.edu | 800.323.4238 Page 11 of 58

that for a second because I think that is an important point.

Genie Benavides, RNIt is not only important it’s crucial for people with diabetes to understand why smoking is not a beneficial vice for them. It’s very hard on your body and the reason is this. The drug nicotine in smoking constricts blood vessels.

You remember I talked earlier about when blood sugars are running around in your body and all your blood vessels and sometimes [blood sugars] have a hard time getting through the smaller vessels.

Well, if you are smoking, nicotine constricts, which means tightening your blood vessels. Here come these blood sugars wanting to pass through these constricted vessels, having a harder time to get through, causing a vessel slough off I call it. Meaning that the sugars passing through, and with the vessels tightening, it is more likely clots can develop causing a stroke. So smoking is really hard on you.

Hadley.edu | 800.323.4238 Page 12 of 58

I never put people down that smoke. It causes people to have that little relief of some stress in their life. But it is a habit and it can be broken. Now days there’re so many medical helps to get people off of the nicotine habit. So as a diabetic, you’re actually increasing your chances for a stroke many, many, many times.

Lisa GoldenI do think it’s important that we take advantage of those helps that are out there because I think people think that stopping smoking is just a will power issue. There are resources and things to help. The people that are successful at stopping smoking have usually tried many, many times. I think average is four to seven times that they’ve tried to quit. So even if you’ve tried in the past to stop smoking, I think it’s important that you continue to try because each time you will become more successful

Genie Benavides, RNThat’s right, Lisa. That’s why there’s a not a fix it for all. We are individuals with different characters,

Hadley.edu | 800.323.4238 Page 13 of 58

with different motivations, and with different everything. So what we need to do is keep trying to find the one thing that helps us to quit smoking.

You’ll knock into it. It’ll happen. You’ll either find a patch, a nicotine patch, that works for you or some of you are able just to stop cold turkey. There are many ways nowadays to help you to stop smoking. The thing to do is not give up. Like Lisa said, keep trying to find that one thing that fits you.

Lisa GoldenThat ties into something. We’re going to back up for a second because Cindy has brought up an excellent question in the chat. How do you recommend managing stress that is out of control, like life crisis? Do you recommend medications for diabetics?

Some people do turn to smoking as stress management and actually you can contribute to your issues instead. So let’s talk a little bit because I think this is one of those excellent questions.

Hadley.edu | 800.323.4238 Page 14 of 58

Genie Benavides, RNMm hmmm, it is. Good for you Cynthia, that’s an excellent question. It helps us to know your needs by you all asking these questions, so please don’t hesitate. Only you know your ability of the stress load you can bear that becomes dangerous. By dangerous I mean health wise.

So I would go see my physician, for one thing, if you think your stress load is so heavy that you need some therapeutic help. Then you need to speak out. Also another good thing that would help most of you tremendously is to find a good support group. When you find a support group and you attend these groups it helps to eliminate so much stress because you discover that you’re not the only person that’s going through these issues.

Now stress in our society is elevated so much more than our grandparents’ day. Our grandparents’ day had a good work day but they came home and they relaxed. The demands on our life in this day and age are so horrific, there’s no space for relaxation.

Hadley.edu | 800.323.4238 Page 15 of 58

I didn’t even know that I didn’t know how to relax until I went for my first massage. Lying on that table I realized I had never known how to relax before. So for some of you doing something different will help lower your stress, like go get a massage, or go for a long walk, or just turning on music and sitting there and listening to the music sing.

Some of you need to engage in prayer if that’s your belief system. Some of you need to be able to have a good friend to talk to, or for a season of time go see a counselor, psychologist, or some counselor that you trust, or maybe even a counselor at church. If that’s what you do and that would help you.

There are so many ways that you can learn to eliminate stress in your life. But remember this, limit the demands put on you. I’m learning that myself. You work all day, you get home and you still have so much to do at home, then if you have family you have to be with them listen to their days.

Hadley.edu | 800.323.4238 Page 16 of 58

Then maybe you have new technology so instead of you getting to go to bed early and relax, you have to go learn new technology. That’s a stressor, isn’t it? So there’s so many stresses in our life you learn to put them in limit mode and when you need help you need to learn to reach out and get help. Help is out there. Just look for it.

Lisa GoldenI think one of the biggest things is taking just a minute for yourself. And especially when you feel that tension in your body, sometimes even just closing your eyes, taking a few deep breaths, coming back into the moment, will help you do a lot to move on from that particular moment and relieve those issues.

Genie Benavides, RNAbsolutely, Lisa. One of the most important things is we want to control our diet, but what about the diet of our mind? Many of us don’t know that we need to alter some of our thought processes.

Hadley.edu | 800.323.4238 Page 17 of 58

Some of our thoughts that go through our mind, we just let them come in because we just think it’s normal and that’s natural. No, it’s not normal and natural. What you do is you don’t allow yourself the privilege of thinking negative or fear things. You stop that and every time a fear thought comes into your mind, it would benefit you to stop and, out loud, say a positive reversal of that fear.

When you hear yourself say positive things it actually is known to bring some healthy hormones into your body. So talk to yourself. Don’t let yourself just think any stressful thing, especially in the night, when you wake up in the middle of the night. How many of you have gone through that? I did last night.

You wake up in the night and every bad thing you can think of just comes crashing down on your mind. What you should do is stop, like Lisa said, stop take some good deep breaths, and begin to counter act each fear filled thought with a positive word coming out of your mouth. It changes your thinking and ultimately really changes your emotional health and your stress life.

Hadley.edu | 800.323.4238 Page 18 of 58

Lisa GoldenI also want to address the second part of her question which was, do you recommend medications for diabetics. I think it is important that you talk continually talk to your doctor about the medications and how they’re working in your body.

I think people feel a lot of stress and a lot of guilt when they go on medications. Why can’t I just manage my diabetes with my diet and exercise? So they feel guilty when they get put on medications, or heaven forbid they get put on insulin. They think, “I’m a failure because I got put on insulin.” But today there are so many good tools out there medication wise for the doctors to use.

Honestly, when you’re put on a medication, some medications work for some people and they don’t work for other people. So it’s important that you’re responsive, that you recognize what works for you, and talk to your doctor about what is and isn’t working for you. When that medication stops working for you, talk to the doctor again because

Hadley.edu | 800.323.4238 Page 19 of 58

another medication might need to be added, or it might need to be changed.

If the doctor doesn’t know, then he doesn’t’ know to adjust. One of the things for me about preventing complications is hopefully you’ll get put on a medication and your blood sugar goes down. Eventually it’s going to start rising again, and when that starts to happen if you talk to your doctor and he can get it back under control, then that’s one of the things about preventing complications.

I hate it when people feel guilty about being on insulin or taking medication at all. To me that is a very healthy behavior to have those conversations and figure out what works. It can also mean that sometimes it works too well and we need to back off medications. If you’re not having those conversations you won’t back off medications either.

Genie Benavides, RNVery good, Lisa. That is so true. Never feel guilty about the need for medication in your life. I hear consumers say frequently that life is over because

Hadley.edu | 800.323.4238 Page 20 of 58

they had to go on insulin. The old myth is that, if you go on insulin you failed and you’re doomed. That is not true at all.

As a matter of fact, insulin is becoming, in my thinking, a hero of the diabetic. Insulin goes into your blood stream and does a job that you need to be done in your body. I’ve read most recently a research done on insulin. It even helps maintain your muscle mass.

As you age, and believe me I understand that because I’m fighting for my muscles in my middle sixties you automatically lose muscle mass. But insulin is now known to help maintain your muscle mass, besides lowering your blood sugars more naturally than even an oral medication.

So never feel guilty about having to take medications such as insulin. Never feel guilty about if you are at a point in your life that you need some medication for depression or anxiety. Like I said earlier, we have a society of many stressors causing people to have anxiety.

Hadley.edu | 800.323.4238 Page 21 of 58

I want to encourage those of you who have anxiety attacks. I think this is for somebody out there that suffers with this. When you have anxiety attacks, you feel like you’re having a heart attack and that becomes so much more anxiety filled for you because you think you’re having a heart attack.

A simple checking of your blood pressure and your pulse will tell you whether you are having an anxiety attack or a heart problem. So always, when you’re entering into an anxiety situation where you feel your heart beating, you feel like you’re going to crawl out of your skin, and you think possibly it’s a problem with your heart, get your blood pressure monitor. Hopefully you have one, if not it’s a good investment.

Check your blood pressure and your pulse because if it is an anxiety attack, more than likely your blood pressure will not be hardly elevated at all, nor your pulse. If it’s a heart problem, you’re either going to have high blood pressure or low blood pressure. So it’s a good indicator of what you need to do.

Hadley.edu | 800.323.4238 Page 22 of 58

I know people have spent a lot of money going to emergency rooms thinking they’re having a heart attack when it was an anxiety attack. So, again, you are an individual don’t look at your neighbor necessarily at what that person does for them. Let you know you and that you learn to treat you or to best go to your doctor and look for something that fits you.

Lisa GoldenIt’s nice for me I see a friendly face in the chat room. Aura mentions about stress and she has three children, a two and a half year old, a six, and a nine year old and they’re always on a quick schedule. So she knows how to manage her own stress but it’s hard to build in, and I think one of the things that you mentioned earlier is support.

It’s nice to have a formal support group to go to but it’s also important that you have friends and family and people because just as you have stressors in your life, they will have stressors in their life. I think sometimes you just have to work out a plan and say you know, this is my time so

Hadley.edu | 800.323.4238 Page 23 of 58

can so and so watch my children. Can they help me with that?

Then another time it’s going to be their time to have some time to themselves to manage their stress. Maybe you can do something that would ease things for them. I think there’s also a lot to be said in relieving stress by doing for others. We all find a release in that so even though that sounds silly, you’re going to take on some task of somebody else’s. There’s something about that generosity that really helps you in your life.

Genie Benavides, RNThat’s a wonderful stress reliever when you are able to help other people. It takes you off of you for a while and it really does help and then you begin to feel productive. Now, there’s a balance in everything of course. You just can’t spend all of your time helping other people and not helping yourself. It’s a balance to help yourself and to help other people.

But you’re right, Lisa, that is so right on, to be able to look to helping other people. I want to say

Hadley.edu | 800.323.4238 Page 24 of 58

something here. There’re usually roots to stress in our life. I’ll tell you one of the big roots that people have that cause them stress is called guilt. You must learn to identify guilt in your life.

You feel bad if you do, you feel bad if you don’t. You feel threatened if you do and you shortchange your family if you don’t. But if you do too much then you get angry because you’ve done too much. See how guilt works? Guilt plays all of us.

Guilt is not a positive force for you. It’s a force that you must identify and eliminate from your thinking and from your life. Really you can do what you can do. That’s the way I live my life. If I didn’t live my life that way, I would probably have already gone stark raving crazy.

I have learned that I can do what I can do for me and I can do what I can do for others. I can’t go beyond what I can do because then it becomes impossible. When you begin to get into the realm of impossible, motivated by guilt, then you get defeated.

Hadley.edu | 800.323.4238 Page 25 of 58

That’s why it’s so much better that, when you’re going to manage your diabetes, you take on the little changes instead of these humongous huge things that are hard to attain. You learn to build yourself into being a healthy person, and a healthy diabetic, and believe me that is possible.

Lisa GoldenBut it takes planning and I think that’s the thing. If I could teach anybody about managing diabetes, it is that you have to have a plan. Managing stress and having the ability to have time for yourself, you have to have a plan for that. That’s what I would encourage people to do.

Now, Cindy brought us back to, let’s discuss a little bit about the complications. We were discussing cardio vascular disease but I also want to mention stroke because strokes are a huge issue.

Genie Benavides, RNYou know what’s really strange in our society? Once we get an idea of something it becomes a concrete mindset in our lives. Mindsets do not

Hadley.edu | 800.323.4238 Page 26 of 58

benefit us because it doesn’t allow for flexibility to happen. Thinking of a stroke, what’s the first thing you think of when you think of a stroke?

Lisa GoldenWell, I think of all the things you’re going to lose. I think of high blood pressure.

Genie Benavides, RNThe key words are high blood pressure. My husband had a stroke on July the 8th and I’m going to share a little bit about that because it’ll benefit you. When a friend of mine, a high school buddy, heard that my husband had a stroke, she called me.

The first words out of her mouth were “This is the perfect time for you to teach your husband how to gain control of his health, particularly his blood pressure.”

I said “What’s the problem. He doesn’t have high blood pressure.”

Hadley.edu | 800.323.4238 Page 27 of 58

“Oh, well he needs to get better control of his blood sugars.”

I said “He’s pre-diabetic and his blood sugars are less than a hundred.”

“Oh.”

See how people have these judgments, ideas, and mindsets about certain things? Let me tell you about strokes. Strokes are caused by alien particles in your body, be it blood clots, bacteria, cholesterol, fat embolisms, I could go on and on and on and on.

July 8th my husband had a stroke. It was fortunate that I didn’t work that day. I discovered him having a stroke, called EMS, went to the hospital, and they were amazed, the doctors, that my husband’s blood pressure was more low than high. His blood sugars were prefect, everything, but why did he have a stroke?

Hadley.edu | 800.323.4238 Page 28 of 58

Well, let me tell you where this is going. They discovered, through blood cultures and my husband having had a stroke called a shower stroke, his stroke was caused by bacteria in his heart. How did those bacteria get into my husband’s heart?

Well, questions from the doctors like, “Has he had any dental work recently?”

I said “Yes, he had a broken molar. It took a few weeks before he could get that tended to and when it was fixed, it was a temporary filling put in.” They figure that a bacteria that was in his mouth got into the hole in his tooth and began to set up shop. Did you know that bacteria set up shop in your mouth? And then from there it went down his throat and into his heart. They [bacteria] love the heart because it’s dark, moist, and terrific food hanging around called fresh blood. So these bacteria developed into what’s called, a vegetation.

You know I told my husband, “You’re always complaining I have so many plants in my back yard. Well, guess what? You have a plant in your

Hadley.edu | 800.323.4238 Page 29 of 58

heart and at least my plants don’t try to kill me.” That’s a funny little thing there we have between us, but I thought I’d share it with you.

So, he was on an anti-biotic with a pic line for four or five weeks. He may have to go on them again if it isn’t entirely gone when they test him again. And you know what, they couldn’t find that bug. They couldn’t find it because it didn’t show up on CAT scans, MRIs, Sonograms, ultrasounds, nothing showed. But finally what they had to do was go down with a camera down my husband’s throat, into his heart, and there they saw it.

Why am I telling you this? I’m telling you one of the most important things you do, or should do, and probably one of the least things that any of us do is take care of our mouth. Take care of our teeth. See a dentist regularly.

You know, none of us realize that that’s not a luxury, going to the dentist. It is actually a mandatory thing that should be in our lives. Now I’ve learned that from this situation with my husband and that he almost died. Not only did it

Hadley.edu | 800.323.4238 Page 30 of 58

cause the stroke, but it caused a heart infection. It caused pulmonary embolisms in the lungs, which you might know that that’s very dangerous, and a spleen infarction.

So, my husband had four things, any one of those could have killed him, all because of a bacteria that started in his mouth. So, should we be flossing and brushing and using mouth wash? And by the way, don’t get a mouthwash with alcohol. That can cause dry mouth.

So, there are new ones out there that don’t have alcohol, but do kill bacteria. Also, you do need to see a dentist. I know it’s expensive, but you shop around like you would for a TV.

We can afford TV’s. Shop around for a dentist. Find one that doesn’t cost maybe as much as other. Ask him about maybe a payment plan that you can afford to pay, twenty dollars, twenty five or so a month, but see a dentist. It could mean your life.

Lisa Golden

Hadley.edu | 800.323.4238 Page 31 of 58

I think gum disease is one of those complications of diabetes that people don’t often talk about. The amount of sugar that’s in your mouth, it impacts your teeth, it impacts your gums.

I also think it goes back to what I was saying earlier. The little self-care activities that you do every single day that you think, again nobody’s giving you a gold star for. Brushing your teeth, flossing, and calling and making your annual dentist appointment, those little things make a huge difference in your future.

Genie Benavides, RNThey say it’s the little foxes that spoil the vine. And it’s the same principle. What we said about doing the little things add up rather than trying to do great big old things that you can’t get to. And in turn feel like you’ve failed and you stop doing things.

Better you do little things every day. When when you do these good things on a day, and you forget the next day, are you going to allow guilt to lead you for the future? No. because today you’ve

Hadley.edu | 800.323.4238 Page 32 of 58

learned about guilt, right? Guilt is not a positive force so get rid of that guilt and remember every morning is new.

I get up every morning. I go out and look at the sky. I see the moon going down and the sun coming up. I hear the birds chirp I smell the skunks, unfortunately, and I think, “Oh wow, a new day.”

I can start over again and that’s the attitude you need to have to manage your health issues. Every day is a new day. A new opportunity to do the things that you know, and are learning, that you need to do for you.

Lisa GoldenNow, I want to move on to some of the other complications of diabetes. Hadley has some great courses on the eyes. They have a great course which I’ve taken myself. So, I’m going to skip some of the eye disease because I think there’s a lot of great information out there.

Hadley.edu | 800.323.4238 Page 33 of 58

So, let’s talk about kidney disease because one of the things for me is there is a correlation. They’re showing people who have the damage to back of the eye are also having damage to their kidneys. So to the same small blood vessel, going back to what I said in the very beginning. Kidney disease is a huge issue nowadays. So, can we talk a little bit about that?

Genie Benavides, RNI’m so glad that you brought that up Lisa because people don’t like to talk about kidney disease, especially when they have diabetes. But do you know what? You need to talk about this because talking about it is part of the answer to the solution.

The reason why it’s so important with kidney and eyes is because those two major organs in your body, the eyes and the kidney do so much for you. They are related in that they are the only two major organs in the body that have little blood vessels to them.

Hadley.edu | 800.323.4238 Page 34 of 58

You know, I’m saddened when I go sit with people like I did yesterday. I went and sat with a husband and a wife. Both of them had blood sugars in the 200s. I don’t just pounce on them. I wait for the little opportunity to encourage them and begin to teach them how important it is to bring down blood sugars.

Imagine you have blood flowing all over your body from the top of your head, with hair or without, to the bottom of your feet. You have blood moving all the time. When you have sugars that are above 100 or 110, there’re more of them, simply put, in your bloodstream. So when they go knocking on your eyes and they go knocking on your kidneys, they are causing damage simply because the vessels to both those organs are smaller and so therefore more vulnerable.

So when you have diabetic retinopathy, you’re more likely to have some at least beginning stage of kidney problems. You best know that so that you can begin to take care of your kidneys as you would your eyes. Know that and not fear kidney disease because so many times when we’re not comfortable with something we just want to tune it

Hadley.edu | 800.323.4238 Page 35 of 58

out of our lives. That is not the solution. Denial is never the solution. But facing your fears is always the solution because there’s remedy out there.

So kidney disease is unfortunately because of diabetes coming up on the increase. Now, let me say this one invitation to you to rid of one mind set. Diabetes is not your problem. It’s manageable. It is high blood sugars that is your problem and the cause of complications, so zero in on your blood sugars. Monitor them daily and keep a tab of what’s going on in your body in relation to your high blood sugar.

One year ago this last July I attended the Texas Renal Force. It was one of the best meetings I attended in my life because it opened up my understanding how to help consumers with kidney disease. You know kidney disease comes in five stages. Stage one is the beginning and stage five is when you are in kidney failure and have to go on dialysis.

There was a gentleman there at this meeting that had been on kidney dialysis for thirty three years

Hadley.edu | 800.323.4238 Page 36 of 58

and you would not have known it looking at him. If I did not see him introduced at this meeting, and I saw him in the crowd, I would have never known that this man was on dialysis, much less for thirty three years. And he what said makes so much sense and I’m passing this on to you.

The reason for his success in being on kidney dialysis for so many years was that he was an active, involved, assertive member of his own healthcare. Did you hear that, assertive. Being assertive is your friend. Not hiding or denying, but being assertive. Asking your doctor questions, asking your diabetes educator questions, asking and reading and searching, attending things like Hadley is presenting today, hat is the way you find answers and solutions.

Not everybody has to be on kidney dialysis for 33 years either though because kidney transplants are becoming more common. I want to tell you a little story of a lady I saw in New Braunfels about six years ago.

Hadley.edu | 800.323.4238 Page 37 of 58

She was my age, a young lady. No, I’m just kidding. In her 60s, like myself, and she had lost her eyesight, diabetic retinopathy, and here came the kidneys following that. So she went into kidney failure and, guess what, her heart decides to give her a problem as well.

So, I went to see her when she was in the hospital and they had done open heart surgery, fixed her heart, then the first thing I knew she had a kidney transplant. Her brother gave her one of his kidneys and she got her life back. Even her sight improved. So never, never think that there’s not a remedy for you out there. And look at her age, 68, hmmm. That’s not old to me. The older I get that’s pretty young.

But it’s a good story for you to hear because kidney dialysis and having kidney disease is not terminal in your thinking. So change your mind set on that. Change it about insulin, change it about having diabetes, and please change it about kidney disease. When you find out that you have kidney disease, and one of the first ways people find out that they have kidney disease is usually that they become anemic.

Hadley.edu | 800.323.4238 Page 38 of 58

Few people understand how the kidneys are instrumental in you having new blood cells created in you and active. You need blood cells. You need hemoglobin and all those healthy things running around in your blood stream and in your body. Well, the kidneys, that’s one of their functions. So when you have kidney disease, one of the first things you’ll know is anemic.

You’re anemic, you have anemia. Also your labs will reveal so is it important to get labs when your doctor asks you to, absolutely. And then, the five stages, your doctor will lead you through those, give you medicine, give you diets, and things even to prevent.

I saw a lady 39 years old in South San Antonio. She was in stage four kidney disease. With the help of medicine from her doctor, diet changes, and starting to exercise by walking, (walking doesn’t cost a thing), she walked every day after work, by the way.

Hadley.edu | 800.323.4238 Page 39 of 58

Doing those three things, her kidneys went back to stage three and stayed there. So there’s always hope and we want to have you to feel hope today. That’s why we’re bringing this message to you. There’s simple, every day, applicable, and common sensible things that you can do to better your health.

Lisa GoldenGenie, one of the things that I love that you brought out is monitoring. Sometimes we only think of monitoring as taking our blood sugar, maybe checking our blood pressure, and weighing ourselves. These are great things that you can do at home. Checking your feet, things that you can do at home, but it’s also important to monitor your lab tests.

Talk to your doctors about what the lab results mean because people don’t often. Everybody wants to know what the symptoms are of each of these complications and watch out for that. But you’re so far down the line and some people just don’t have symptoms.

Hadley.edu | 800.323.4238 Page 40 of 58

You hear of people having a heart attack and they didn’t really know. They just thought they had heart burn and then all of a sudden they’re in the ER. We can give you warning signs on a lot of these complications about what might happen, but if you’re not monitoring, and that includes talking to your doctor about all the different lab tests that are important.

And another thing that you brought out was dealing with the small blood vessels because one of the newer discussions about complications of diabetes is the hearing loss and diabetes. I don’t think people think of that. And really what we’re learning is that those same blood vessels that are in the back of the eye and in our kidneys, you also have tiny blood vessels in your ear, along with the nerves. So between the damage to the blood vessels and the damage to the nerves, people start to lose their hearing so that’s another big complication I wanted to mention.

Genie Benavides, RNYou’re right, Lisa, and you know it’s interesting. I don’t think that maybe some doctors would

Hadley.edu | 800.323.4238 Page 41 of 58

appreciate this, but I often say that diabetes is really a nerve disease. The reason why is because even though the blood sugars are running in your blood, remember your nerves run alongside your blood vessels, so when your blood vessels are affected by high blood sugars, they effect the nerves and cause damage. And absolutely we’re beginning to see more hearing loss in people because of diabetes.

I want to go back also and say something about monitoring. This is what people should do if you want to know your body. You can catch things at a start rather than when they become a huge problem. And that’s like Lisa said, by you monitoring every day.

You should get up and after you brush your teeth, remember brush your teeth, and go to the bathroom. You need to weigh. You should be weighing yourself daily. That is not just for you to know your weight, and remember no guilt. Guilt doesn’t make you lose weight, no.

Hadley.edu | 800.323.4238 Page 42 of 58

You just know your weight. And better than anything it’s about monitoring your weight. Weight monitoring is a tool to know a body change happening so that when something is changing in your body that needs attention by your physician, you will catch it early before it becomes a huge problem.

You also need to be keeping a journal. How do you do that? You can do it with a tape recorder. You can do it with large print, large calendars. You need to be monitoring your weight, your blood pressure, your blood sugars, and when you feel necessary, even your temperature.

Diabetics are prone to be people of infections, unfortunately. But you can easily solve those infections because of your monitoring, knowing your body, and keeping a journal. You will detect something of a change that’s happening. Now, I recommend you journal because I’ll tell you why.

Do you really remember everything you did yesterday that was important to your life? I don’t. Did I remember yesterday that I had corn bread so

Hadley.edu | 800.323.4238 Page 43 of 58

I shouldn’t probably have corn bread again today? I probably would not want to remember that because I love corn bread, right? But when you put things down of significance on a journal, you should be writing down all your monitoring stats that you’ve accumulated and the date and the time.

You should be writing down significant things that happen in your life like it was your birthday so you had a piece of cake. By the way, I recommend that’s about the best and only time you should have cake is on your birthday. But, then when you put all this down, you begin to see a picture of you and you begin to know you better.

It would be really beneficial if you took that journal with you to the doctor’s appointments because when they see you’re interest and your attempt to really try to keep yourself healthy, they’re going to want to join in with you a little better. It’s a lot easier to deal with people who are compliant than people who are not.

Hadley.edu | 800.323.4238 Page 44 of 58

So when you take that into your physician, he’s going to see how compliant you are and how you’re going the extra mile trying to keep yourself healthy. You should be putting down there your medications in your journal. You should be putting down guess what, stressors. Well I have to write down here yesterday I had a little spat with my next door neighbor. It caused stress in my life and my sugars were 20 points up more than normal.

See, when you do that, you are training yourself to know you and how to limit things in your life. So, monitoring, keeping a journal is so important. Now, what else am I leaving out?

Lisa GoldenNothing that I can think of. Cindy brings up a good question. She asks, “Could you experience hearing loss with no other complications in other areas like the eye or kidneys?”

Genie Benavides, RNAbsolutely, yes.

Hadley.edu | 800.323.4238 Page 45 of 58

Lisa GoldenI think people don’t recognize how individual our bodies are. We can’t pick and choose. It’s not like we can say if you have diabetes, and if your blood sugar is this, then you’re going to get in this order these complications. So, everybody’s different and so you need to just pay attention to what’s going on.

Hearing loss has a huge impact on people’s lives. So it’s important that if you do something small like that, just losing people’s voices and not being able to participate fully in conversations, or having to turn the TV up way loud, all those little signs. It could tell you that something else is going on inside your body.

Sometimes we go, “Oh boy, I’m just getting older.” Or, blame it on when you went out and it was really loud at the restaurant you went to earlier, and now that you’re home you think, “Oh, well that’s the issue.” Sometimes it’s your diabetes.

Genie Benavides, RN

Hadley.edu | 800.323.4238 Page 46 of 58

That’s really right and on that line, Lisa; I’d like to bring up one other complication from high blood sugars. And that is called gastro paresis, that’s your stomach disorder. More than ever in the last few years I’ve begun to see more consumers that are having problems with their stomach digestion.

Gastro is stomach; paresis is paralysis of the stomach, which means that when you eat food it should be starting to eliminate itself in your digestive system, your stomach, within six minutes. When you have gastro paresis, it’s hanging around as long as two hours, and what happens? It causes nausea and it causes a lack of appetite. It causes so much frustration.

I met with a girl last week, 47 years old, that has severe gastro paresis. They’re to the point where they’re even going to insert a pace maker in her stomach to regulate her digestive track, which is good because she needs relief. She cannot eat anything. It got to the point where she couldn’t; not only just solids, but she couldn’t even drink liquids.

Hadley.edu | 800.323.4238 Page 47 of 58

Now, should you fear this? No, but should you know this? Yes. Because is it important how you manage your diabetes or your blood sugars? Absolutely. You want to, like Lisa said, you want to surely have a plan and that means take some times to plan. I suggest to people that on Sundays you make your plan for your week.

Write it on a calendar or in a recorder, all the appointments you have or all the things you’d like to see happen that week. Then in your plan, you’re doing that preparation. You prepare everything. And that may include your food, by the way, because I have found if you prepare your week’s food, you’re going to save money and you’re going to eat healthier.

And third, planning and then preparing the plan will ultimately give you great prevention in your life and in your health. You can prevent these things that we’ve talked about and so many others we haven’t talked about.

Lisa Golden

Hadley.edu | 800.323.4238 Page 48 of 58

You know, gastro paresis is part of one of the complications of diabetes, neuropathy. Often, when you hear about nerve damage, you think about losing feelings in your hands and feet. You may think of losing a limb or something like that. But there are all these others things that are affecting the nerves on the inside of your body, just as much as it’s affecting the nerves on the outside.

Again, it’s one of those things we can’t predict. It’s not like all the sudden you’re going to have the pain of neuropathy and then you lose your feelings whatsoever. Often, even people that have painful neuropathy, they end up the pain’s not where the actual problem is and that can be an issue as well.

We only have a few minutes left, so let’s talk just a minute about neuropathy and get some final thoughts.

Genie Benavides, RNYou know one thing about neuropathy, people frequently tell me they feel like they’re walking on tacks or ants are biting them. The good news, neuropathy can be reversible. Not many people

Hadley.edu | 800.323.4238 Page 49 of 58

know that. So many times when you do get one of these complications, you want to give up and just accept it as is. Never, never, ever, never give up or stop doing the things that you can do.

I read this morning how vitamin B-6 is a great neuropathy healer, also walking. I tell my consumers, even if it hurts you, you’ve got to increase your circulatory system by walking which will help. Remember you are helping the blood vessels to administer to those nerves because neuropathy is nerve disease. So you want to increase circulation and good food coming to all the nerves in your body and it is reversible. Good news.

Lisa GoldenSince we’re coming to close, what I want to bring out is some of the things that you can do. We’ve talked a lot about them, to reduce your risk of complications. So, we talked about reducing your stress level, all the little techniques and tools, and really you have to find what works for you.

Hadley.edu | 800.323.4238 Page 50 of 58

To some people exercise is great and the more they exercise the less stressed they are. For some people it is about their belief system or and some people, like was mentioned earlier, just have responsibilities to other individuals. And we have to take that into account and find other techniques that work in your busy lifestyle.

We talked a lot about monitoring. I think that’s extremely important, to know where you’re at. I love the idea of you keeping a journal because you do forget all the things that affect your day to day life and why your blood sugar was. And like you mentioned, it’s not always about the food that you ate. A lot of times it’s about the stress that’s in your life or the medication that you were on at that time. So, being able to keep a journal and know exactly what’s going on is important.

Talking to your doctor, I cannot stress how important that is. To advocate for yourself, maintain a good relationship with your health professionals that come into your life. We try to get diabetes education for our consumers that are having issue with either diabetes, and we do that as much as we can, but it’s still kind of a short

Hadley.edu | 800.323.4238 Page 51 of 58

amount of that a medical professional is with a consumer.

It really is up to the individual 99% of the time to manage their diabetes and manage it well. I think it is a lot of responsibility, but I want everybody to know that all of those little self-care behaviors mean a lot in the long run. So, do you have some final thoughts, Genie?

Genie Benavides, RNIt is our goal today, Lisa’s goal and my goal, that we instill hope in you. So many times people have the mindset that this is just the worst thing in the world, for you to become a diabetic, and that’s not true.

Texas, through DARS and BDS, provides a Diabetes Management Training. Doesn’t that tell you that they believe diabetes is manageable? Well, we know it is and our goal for you is to help you be motivated. Again, with hope, knowing that the little changes you make are going to help you live a healthy, uneventful bad life. Thank you.

Hadley.edu | 800.323.4238 Page 52 of 58

Lisa GoldenThank you, Shirley and Hadley, for giving us this opportunity to come speak about something that we’re very passionate about. We hope that we’ve given you a little bit of hope that there is a light, and hopefully some good tools to be able to use. Thank you. I’m going to turn the microphone over to Shirley.

Shirley McCracken Thank you, Lisa and Genie. That was wonderful information. I think that we have most of the questions that were written in the chat room answered. I would like to remind you that anyone that, everyone rather, that this seminar will be archived on our past seminar site, and that will be available 24/7.

Also, I’d like to remind people that our seminars are now available in podcast which you can download to your mobile device. You can just log on to Hadley’s Web page and you can get more information about that. Also, I’d like to mention some courses that are available through Hadley.

Hadley.edu | 800.323.4238 Page 53 of 58

I believe that Lisa mentioned one of these herself, that she had taken it, Diabetes towards Health Management. Also, you might be interested in Health One and Two: a Guide to Wellness. Hadley has also produced seminars along this topic. One is, How Diabetes Saved My Life: Managing Diabetes with a Healthy Diet. And another seminar is Healthy Eating: Easy to Digest Information We Can All Use. Again, this is such valuable information that these ladies presented, Genie and Lisa. We thank you so much and I’m turning the microphone back over to you for just a minute for any last minute closing thoughts that you may have.

Lisa GoldenI guess my closing thoughts are to think about all the aspects of what taking care of yourself means. It is about healthy eating, and I think that’s the thing that everybody focuses on. But it’s also about being active, which includes the stress management.

Sometimes we think in order to be active you have to go to the gym and you have to participate in a

Hadley.edu | 800.323.4238 Page 54 of 58

formal class, but it’s important that you just get up and you live your life. The more you’re out there in the community, the more you’re up on your feet instead of sitting in front of the TV, you’re better off.

It’s about taking your medication and talking to our doctor about taking your medication. It’s about what works for you and what doesn’t. It’s about healthy coping. We talked a little bit about stress management, there’s also a tie between diabetes and depression.

We talked a little bit about support groups. Support groups are an important part of healthy coping. Getting the support of your family in a healthy way was as well. How they can help you, whether it’s helping take care of your kids so that you can go do what you need to do to manage your diabetes for a few minutes. That’s a way that they can support you.

We also talked a lot about monitoring. That’s in all the aspects of monitoring, not just your blood sugar, although, that’s very important. And that

Hadley.edu | 800.323.4238 Page 55 of 58

information is for you because the number itself is not good or bad. It’s not a reflection on you. The number is the number that it is.

And, when you start to recognize the numbers that you have, you can start to look at it and if it was something you ate, if you took your medicine when I was supposed to, or was it just a really stressful day that has affected. Sometimes it’s the opposite. Sometimes you have too much medication because you’re really enjoying your life. This is a good day and you’ve got the stress off of you so you didn’t need as much medication as usual. So, it’s about all the healthy behaviors that you do every single day of your life.

Genie, do you have any other thoughts?

Genie Benavides, RNI’d like to leave you with the word we talked about today and the word is assertive. Aggressive would be a stronger way of being assertive and not so good. Don’t be aggressive, but learn to be assertive. Speak up, whether it’s to your family, to yourself, or even to your doctor.

Hadley.edu | 800.323.4238 Page 56 of 58

You need to learn that you have a voice and that it’s important that you’re involved in your own personal care. You have assertion as a healthy way of being involved in your health care. Don’t be shy, speak up. Be assertive. Thank you.

Shirley McCracken Thank you so much for that valuable information. I know I learned a lot today, and from the comments I’ve read in the chat room, other people have learned a lot. I sure appreciate you sharing your knowledge with us.

I’d like to thank everyone for participating today. We value your feedback. Please let us know your thoughts on this seminar and suggestions for future seminar topics by sending an email to feedback@hadley.edu. Again, please send up your feedback and suggestions for upcoming topics. feedback@hadley.edu.

I’d also like to leave you with a comment that I wrote in the chat room and that I think goes along

Hadley.edu | 800.323.4238 Page 57 of 58

with what Genie and Lisa shared with us. I once read some place that the better care I take care of myself, the better care I’m able to give to the other people in my life. So consider that words to think about because we’ve got to take care of ourselves.

We thank you so much for joining us today, Lisa and Genie. Again please send us your feedback and suggestions for seminars at feedback@hadley.edu. This concludes our seminar for today. Thank you.

Hadley.edu | 800.323.4238 Page 58 of 58