SHERIDAN — According to the Wyoming Department of Health, in little more than a decade the adult diabetes rate has almost doubled in Wyoming — rising from 4.5 percent in 2001 to 8.6 percent in 2013 — leading to new efforts to help limit the disease.
WDH is teaming up with WYhealth, a group that offers a variety of free services to all Wyoming Medicaid clients, to offer a new yearlong program called “Choice Rewards.”
The program will offer diabetes focused education, one-on-one support for living with diabetes and tools to help clients learn how to self-manage the disease.
Participants will be eligible to receive a $25 incentive card for every three months of the program they complete.
Locally, the diabetes education department at Sheridan Memorial Hospital already offers similar help navigating the process of preventing, managing or living with any form of diabetes.
November is National Diabetes Month, but registered dietitian and certified diabetes educator at SMH Sarah Houghton said diabetes awareness needs to be an ongoing effort.
“A lot of times we have patients just put ‘diabetes’ in a Google search and a lot of stuff can come up that’s not true, so we are a local resource for them if they have questions,” Houghton said.
The department sees patients with any type of diabetes including pregnant women with gestational diabetes, patients with pre- or borderline diabetes, kids and adults with Type 1 or Type 2 diabetes and patients on insulin pumps. Dietitians and educators offer individual appointments as well as group classes, teaching everything you need to know to manage diabetes.
The class is taught on an as-requested basis but is typically offered quarterly, meeting for two hours a week for four weeks.
Most insurances, including Medicare, cover 10 hours of diabetes education upon diagnosis and three hours each year after as a refresher.
Houghton said staying educated and active with your treatment is key to managing the disease for which there is no cure.
“Once you have any form of diabetes, with the exception of gestational diabetes that occurs during pregnancy, there is no reversing that diagnosis,” Houghton said. “That’s a misconception that floats around. They have said, for example, that bariatric surgery cures diabetes and that’s not true, it’s just in serious remission.”
The course discusses things like diet, exercise and medication options for those managing diabetes.
One class focuses solely on the timing, portion and balance of meals using food models and discussion to clear up misconceptions about how and what to eat with diabetes.
“I think people have misconceptions that there are all these foods that are off limits with diabetes, and I clear up that there is really nothing off the table, it’s more about portions and consistent eating patterns so you get steady, consistent blood sugars,” Houghton said. “Exercise also substantially lowers blood sugars, not just right then and there, but you can actually have lower blood sugar for 10 to 12 hours just because you took a 30-minute walk. It’s better than any medication we can prescribe, quite honestly.”
But if a patient does need medication, fellow CDE at the department Alyssa Wright is a registered nurse who works with patients where Houghton leaves off.
“Lots of times when people are diagnosed we have the pillars of diet and exercise but many people will still need medications, and there are several on the market with more and more coming all the time,” Wright said. “Some people are controlled on oral medications alone, there are some injectable medications that aren’t insulin and then there is insulin, which often gets a bad rep, but it is the most effective way to get those sugars back down because we are simply replacing a hormone that our bodies are not making enough of.”
Proper individualized treatment is essential because having diabetes increases your risk for heart disease and other complications that can affect most systems in the body including eyes, kidneys and nerve endings, particularly in the feet with neuropathy.
Though management is key after diagnosis, early detection of risk factors and steps toward prevention can reduce or eliminate your chance of diagnosis.
“One of my biggest passions is working with a patient with pre-diabetes as it is absolutely preventable in most cases,” Houghton said. “Research shows if you lose even 7 percent of your body weight it can have a significant impact on preventing diabetes. A lot of people assume they need to lose 40 to 50 pounds to help it but it’s really just 7 percent.”
Houghton encourages everyone to have annual health screenings and blood work, and anyone with risk factors for diabetes to get the diabetic management lab panel which includes the hemoglobin A1C test used to diagnose diabetes.
The lab panel can be ordered at the hospital’s outpatient lab for $35 year-round or by contacting your personal physician.
“Anyone experiencing classic symptoms of undiagnosed high blood sugars — increased urination, dry mouth, chronic fatigue, insatiable thirst — anyone experiencing those over a couple weeks time, that may be a red flag as someone wanting to go in and get screened,” Wright said. “But not everyone experiences those symptoms and that is why we suggest those with risk factors get the screening regardless.”
Risk factors for diabetes:
• family history
• high blood pressure
• abnormal cholesterol
Steps to help prevent diabetes and its complications:
• Be aware of personal risk factors.
• Be physically active — aim for at least 30 minutes per day.
• Eat more fruits and vegetables.
• Eat more complex carbohydrates such as whole grain bread and pasta, and less refined grains like white and enriched bread and pasta.
• Work with your doctor on preventive measures.
• Manage blood pressure and cholesterol.
• Quit or don’t start using tobacco — see quitwyo.org or call 800-QUIT-NOW for help.
Type 1 vs. Type 2
There are two main types of diabetes, as well as gestational diabetes and a condition known as pre-diabetes.
Type 1, formerly called juvenile-onset or insulin-dependent diabetes, accounts for 5 to 10 percent of people diagnosed with the disease. It is most often diagnosed in children and adolescents.
In this form of the disease, the body’s immune system destroys the cells in the pancreas that release insulin, eventually causing all insulin production by the pancreas to cease. Insulin is a hormone that helps regulate how the body converts sugar, or glucose, into energy.
Type 1 diabetes is not caused by eating too much sugar, and it is not preventable. It is an auto-immune disorder that can be inherited genetically but not always.
Type 2 diabetes, formerly called adult-onset, can develop at any age but most commonly becomes apparent in adults. Cases of children with Type 2 diabetes are increasing.
This form of the disease accounts for 90-95 percent of diabetes diagnoses. In Type 2 diabetes, the body is unable to use insulin properly, called insulin resistance. As the disease worsens, the pancreas may make less insulin or be unable to produce enough insulin to meet the body’s needs, which is called insulin deficiency.
Type 2 diabetes can be prevented or delayed by maintaining a healthy weight, eating well and getting regular exercise. Weight, family history, diet, age and other health measures like blood pressure and cholesterol are all risk factors for Type 2 diabetes.