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Dealing with diabetes

October 27, 2011
By KELLY FOSNESS - DMG writer ( , The Daily Mining Gazette

LAURIUM - Elaine Parks has a general rule of thumb for her diabetes patients to follow.

"I always tell them they should know their feet like they know the back of their hands," she said. "We want to teach them early in the disease process about foot care."

Parks, who is a registered nurse and certified diabetes educator for Aspirus Keweenaw Hospital, said patient education is important in helping individuals with diabetes to achieve the best possible quality of life. Equally important, she said, is encouraging patients to follow through with prevention measures that will decrease the risk of developing diabetes complications.

Article Photos

Kelly Fosness/Daily Mining Gazette
Using an artificial belly device, Family Nurse Practitioner Deborah Gruver demonstrates how to inject an insulin needle into the abdomen at Aspirus Keweenaw Hospital’s Diabetes Clinic Wednesday. Keeping the needle on a 90-degree angle, she said, decreases the amount of bruising and bleeding.

Family Nurse Practitioner Deborah Gruver, medical assistant Cathy Taskila, and Parks provide a wide range of services through Aspirus Keweenaw's Diabetes Clinic. Visits cover medication management, foot examinations and assistance with developing self-management goals.

Gruver said the most important thing patients at risk for diabetes should monitor is their blood sugar levels (or blood glucose levels).

"If they don't have blood sugars that are under good control, it increases their risk for complications," Gruver said. "If their blood sugars are under good control, some people never get to this."

Parks said diabetes increases a patient's risk for developing foot complications, which makes daily foot checks for wounds and other abnormal conditions important because small problems can lead to severe consequences such as amputation in extreme cases.

While diabetes shows a strong hereditary connection, Gruver said studies show obesity is a contributing factor as well.

"We've been seeing a lot of kids who are overweight who are developing type 2 diabetes," she said. "(Type 2) is really a type of diabetes (elderly) people get from being overweight and inactive."

The most common types of diabetes are type 1 and type 2, Gruver explained.

With type 1, she said the body makes little or no insulin, requiring daily insulin injections.

Type 1 diabetes is more common in children and teens, Gruver said, however, it can appear in older adults.

With type 2 diabetes, Gruver said the body prevents the insulin it does make from working properly.

"The body might produce enough insulin but it doesn't get into the cell to be used for energy," she said.

For patients with pre-diabetes, a condition in which blood glucose levels are higher than normal but not in the diabetic range, Gruver said they provide them with a blood glucose meter.

"We look to see if they have a hemoglobin A1C - it's a 3-month sugar average," she said. "It gives us an idea if their (blood sugars) are under good control or not."

Gruver said pre-diabetes is when a patient's A1C is between 5.7 and 6.4 percent. Diabetes is 6.5 percent and above.

"That gives us an idea of what they're running on an average for their three months but, it doesn't tell us what they're running before they eat, after they eat and bedtime," she said. "We use this meter to check their blood sugars before meals, two hours after meals and bedtime."

From those results, she said they come up with a treatment plan whether it involves medication or lifestyle changes.

One way medical professionals can catch diabetes at the pre-diabetes stage, Gruver said, is if the patient's blood sugar numbers are greater than 100 mg/dL fasting but less than 126 mg/dL.

"You know their body is having to produce more insulin from their pancreas to make their blood sugars normal and it's losing because the numbers are kind of creeping up a little bit," she said. "With these people we can actually stop diabetes, but the problem is they're not always referred to us right away or we don't always catch them in the blood work."

Patients who are diagnosed with Metabolic Syndrome, also known as "Syndrome X," are also at risk for developing type 2 diabetes, Gruver said.

"(Metabolic Syndrome) is basically a category of risk factors," she said, listing excess weight around the waist, high levels of triglycerides, low levels of HDL or "good" cholesterol, high blood pressure and high fasting blood glucose levels, as the conditions. "If you have abnormalities in any three of those five then you're probably at risk for developing heart disease, diabetes or stroke."

A diagnosis of diabetes is oftentimes hard for many patients to digest, Gruver said, which makes finding out where they stand emotionally, important.

"A big part of diabetes is anger and denial," Gruver said.

Some patients experience guilt, Parks added.

"They think they caused it," she said. "What I like to do is just sit down with them and figure out, out of all of these tools I have in my toolbox, what are they most interested in and we'll start from there."

As additional means of support, Parks said they try to encourage patients to participate in Aspirus Keweenaw's diabetes self-management training classes, which are held the fourth Monday of each month in the hospital's conference room. A diabetes support group is held the first Wednesday of each month.

"We also encourage most of our patients to see the dietician for individualized meal planning," she said.

For more information about Aspirus Keweenaw's Diabetes Clinic, call 337-6598 or visit



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