November is National Diabetes Month
By Donna Varamo, WRDA Student Volunteer
Hunter College Graduate Student, MS 2021
November 1, 2020
November is National Diabetes Month, which intends to increase the public’s awareness of the risk factors, symptoms, and types of diabetes.1 This year, National Diabetes Month is raising awareness for the diabetic youth population.1
Diabetes is one of the major health epidemics in America, and the prevalence is continuing to increase. The 2020 National Diabetes Statistics Report states that there are roughly 34 million Americans that are currently living with diabetes and roughly 88 million adults that are living with prediabetes.2 As of 2018, approximately 210,000 children and youth under the age of 20 years old had diagnosed diabetes, including 187,000 diagnosed with type 1 diabetes .2 In children ages 10-19, the incidence of type 2 diabetes has significantly increased in Non-Hispanic black, non-Hispanic Asian Pacific Islander, and Hispanic youth populatons compared to non-Hispanic whites. 2 Variations in diet and lifestyle factors, genetics, and access to healthcare can contribute to the rise of diabetes diagnoses among these populations and increase the risk of developing diabetes-related complications in the future.
What is Diabetes?
Diabetes can be differentiated into two types: type 1 and type 2.
● Type 1 diabetes is typically diagnosed in children and young adults. It is an autoimmune condition that develops when the body’s immune system begins attacking and destroying pancreatic beta cells, resulting in the decreased production of insulin.3 If there is a lack of insulin production, sugar cannot be transported into cells and converted to energy, resulting in elevated blood sugar levels. Type 1 diabetes is managed with synthetic insulin injections that allow cells to utilize glucose and create energy.
● Type 2 diabetes is attributed to lifestyle and genetic factors including low levels of exercise, dietary habits, age, history of prediabetes, and family history of diabetes.3 Type 2 diabetes was once commonly referred to as “adult-onset diabetes” due to its high prevalence in the adult population, although this type is increasingly being diagnosed in children. In people with type 2 diabetes, pancreatic beta cells make insulin, however the body’s cells are unable to respond to the insulin and cannot take up glucose, resulting in hyperglycemia. Type 2 diabetes is typically managed using a combination of medications, diet, exercise, and insulin.3
The increased blood sugar levels associated with both types of diabetes can lead to long term complications, such as neuropathy, retinopathy, nephropathy and cardiovascular complications.3 Blood circulation to extremities may become impaired, leading to nerve damage, poor wound healing, and possibly to amputations.3
Controlling Diabetes with Diet
Diabetic diets are intended to maintain stable blood glucose levels and prevent complications from diabetes.4 Meals should be consistently spread throughout the day and include healthy carbohydrates, fiber-rich foods, and heart healthy fats. Foods high in saturated fats, trans fats, and sodium should be avoided. There are different approaches clients can use to creating well balanced meals that keep blood sugar levels within an optimal range, including the plate method, carb counting, and tracking the glycemic index of foods.
An Interview with a Dietitian who Specializes in Diabetes:
I was fortunate to have the opportunity to interview Dr. Diana Malkin-Washeim, PhD, MPH, RDN, CDCES, CD-N. Dr. Malkin-Washeim has been working with youth and adults diagnosed with diabetes for roughly 25 years. She is currently the director of the Nutrition and Diabetes Program at the BronxCare System’s Health and Wellness Program. She continues to find tremendous joy, passion and endurance working with patients with diabetes because the scope of practice is so broad.
As an RDN and CDCES, she believes that encouraging dietary changes in patients can be very challenging. In her program, she frequently utilizes a multidisciplinary approach that includes the RDN/CDCES, pharmacists, social workers, primary care physicians, adult and pediatric endocrinologists, and OB/GYNs. This team approach optimizes patient care and allows the patient to receive education from each of these disciplines.
Behavior modification can also be more successful when the practitioner meets the patient where they are and understands their point of view. Asking questions regarding access to food and cooking equipment, literacy, and physical ability ensure that the practitioner and their patient are on the same page. It also serves to establish realistic goals that are achievable for the patient. She believes that fulfilling patient expectations, being transparent, and being sincere are keys to successful sessions for both the patient and dietitian.
Dr. Malkin-Washeim frequently works with individuals who are illiterate, impoverished, and food insecure. Attempting to secure necessary medications and equipment for these patients can be a frustrating process that sometimes ends in failure. Access to technology, such as continuous glucose monitoring systems, insulin pumps, and blood sugar test strips, is necessary for monitoring and controlling both type 1 and type 2 diabetes. Some patients have difficulty accessing these materials.
During the COVID-19 pandemic, services and programs that are available to patients with DM include one-on-one counseling, shared medical visits (PCP and RDN/CDCES), and telephone/telehealth visits. Patients have also demonstrated decreased food security and increased need for services due to the pandemic. Demand for telehealth has increased dramatically, but its use is limited by the amount of time available for training and staffing of the platform. It is also more difficult to perform a thorough physical examination remotely, as the practitioner is limited to only sight. Still, Dr. Malkin-Washeim expertly manages her resources to ensure that her patients will always receive quality care, which includes making telehealth and in-office patients both a priority.
She finds that working with each patient individually, being present and actively listening during their sessions, and having empathy are some of the most beneficial approaches when educating and collaborating with her patients. It is also important to be understanding and supportive of cultural diversity within her population. Her advice for dietitians is to expand their breadth of knowledge to include more diverse technology and medications. Also, dietitians should not be afraid to ask each other questions.
References
1. NATIONAL DIABETES MONTH - November 2020. National Today. Accessed October 20, 2020. https://nationaltoday.com/national-diabetes-month/
2. CDC. National Diabetes Statistics Report, 2020. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed October 20, 2020. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html
3. Differences Between Type 1 and Type 2 Diabetes. Diabetes Research Connection. Published July 11, 2016. Accessed October 20, 2020. https://diabetesresearchconnection.org/differences-type-1-type-2-diabetes/
4. Diabetes diet: Create your healthy-eating plan. Mayo Clinic. Accessed October 20, 2020. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295
