Author: Gena Webb

You may have heard the phrase, Diabetes Self-Management Training, and wondered what that was referring to. Diabetes Self-Management Training, DSMT for short, describes Diabetes Education programs that focus on training persons with Diabetes with the skill set to make daily decisions that manage blood sugar. This education aims to prevent, delay, or lessen the severity of severe diabetes complications by self-care and self-management. Each individual responds to food, activity, stress, and other factors individually. These programs recognize the need to personalize education and goals to meet that person with Diabetes where they are in their journey with Diabetes. You are in the driver’s seat! You see your provider, educator, and other healthcare providers for a few hours each year. All the rest of the time, you make all the decisions. What you eat, staying on schedule with your medications, and how much time you exercise are all under your control. These classes are structured to help you develop behaviors to meet your goals and promote quality of life.

Seven behaviors are focused on during training.

• Healthy Eating
• Being Active
• Taking Medications as Prescribed
• Monitoring your blood sugar levels
• Reducing risks to lower the chances of diabetes-related complications
• Healthy coping with Diabetes and emotional well-being
• Problem-solving to find solutions and take action

The Diabetes Self-Management Training program at DRH Health is certified through the American Diabetes Association. Joy Galloway, MS, RD, LD, CDCES staff the outpatient program. She is our Quality Coordinator and is a Certified Diabetes Care and Education Specialist. Rachel Loyd, RN, is our inpatient diabetes educator, working with patients who are admitted to DRH Health with self-management of their diabetes care.

There are four specific times when a referral for Diabetes Self-Management is recommended:

• At initial diagnosis of any type of Diabetes
• Annually to review status and/or progress or when not meeting treatment targets
• When complicating factors develop
• When transitions in life and care occur

Contact your provider for a referral for outpatient services. They can then send that referral to our scheduling department, which will contact you to make an appointment. Medicare, Medicaid, and most commercial insurance plans cover Outpatient Diabetes Education Services. Self-pay options are available as well.

We have other opportunities to help develop your diabetes self-management skills:

• DRH Person with Diabetes Support Group:  We meet once a month on the first Thursday at 6:00. There is no charge for this meeting.   This is an excellent opportunity to have questions answered about Diabetes Self-Management and to interact with those following a similar journey with Diabetes. For more information, call our Diabetes Education number at 580-251-8461
• DRH Garden Fresh Program:  This program is designed to promote improvement in A1C values through education and an increased intake of fresh fruits and vegetables. Qualified individuals (with Diabetes) are placed on a program to receive fresh produce every week. Quarterly A1C testing and diabetes education are provided at our Garden Fresh meetings at the Think Ability Garden Hub or our DRH outpatient facilities. To see if you qualify, contact your healthcare provider.
• Diabetes Technology Focus: Various new technology is now available to help ease Diabetes Self-Management. We provide training on using a continuous glucose monitor to its fullest potential, employing various apps to simplify keeping track of blood glucose readings, medications, and meals consumed, and also with Omnipod Insulin Pumps. Medicare has now approved the use of Omnipod 5 in type 2 diabetes. The benefits of more consistent insulin dosing and saying goodbye to multiple daily injections are very attractive to many. Contact us for more information on how you might benefit from a CGM, insulin delivery devices, or various Diabetes Management technologies.

Joy Galloway, MS, RD, LD, CDCES
Diabetes Educator

I often get asked, “Why does the same meal affect my blood sugar differently each time?” The answer to that question is multifaceted. Food, of course, significantly affects blood sugar after a meal or snack. However, other things “at play” impact your post-meal results. The American Diabetes Association’s post-meal blood sugar goal is no more than 180. The College of Endocrinologist’s goal is tighter at 140. I always recommend that you establish a baseline for your average post-meal response. Then, identify the foods and combinations that increase blood sugar readings. Once you identify those meals, food items, or snacks, you can work on portion control, frequency of consuming those foods, what other foods are combined with your “trigger” foods, and eliminating certain foods from your diet. If you want to move from average control (under 180) to tighter control (140 or less), how you reshape your diet and lifestyle contributors can get you there!

Insulin made by your body or injected opens the door to your cells to allow sugar to enter and be used for energy. How well your cells respond to insulin is often one of the answers to why your blood sugar readings differ from meal to meal. Insulin resistance means your cells do not respond to insulin, keep your blood sugar circulating, and are not used for energy. Your degree of insulin resistance changes throughout the day. Here are some factors at play with post-meal readings that affect your degree of insulin resistance.

• Stress:  Stress plays a significant role in blood sugar. Did you know your liver stores sugar? When you are stressed, your body produces adrenaline that causes your liver to dump sugar. On a stressful day, you can have mealtime sugar and dumped liver sugar, affecting your post-meal reading. This makes a meal with which you usually have good results seem ineffective, making you feel that “nothing works.”  Those higher results were the combination of two sugar sources.
• Inactivity:   Changes in activity level can have a fairly rapid result on your post-meal readings. Just skipping routine exercise for 2-3 days can have an impact. Daily exercise improves how fast you can pull sugar into your cells, using it as energy.
• Lack of Sleep:  Consistently sleeping less than 7-8 hours a night or tossing and turning can significantly impact your sugar levels during the day. Hormone production during sleep helps regulate blood sugar. Poor sleep quality can make you start the day with higher fasting blood sugar, affecting your blood sugar all day.
• Weight Gain: Just gaining 5-10 pounds can affect your post-meal readings. A meal that once resulted in post-meal readings within the goal could now be less effective.
• Portion Control: Larger portions of food that usually work well in your diet can be easily overlooked when figuring out what caused your blood sugar to go higher than expected.
• Skipping Meals:  For many people with diabetes, skipping meals can lead to a higher post-meal reading after the next meal. While you may not feel hungry, your body still needs energy to work with. Your liver will be signaled to dump sugar out to cover your energy needs. You could go into your next meal with a higher blood sugar due to liver dumping, causing your post-meal reading of a trusted meal to be higher.

So, if you are seeing meals or snacks that used to be your go-to combinations that worked well with your blood sugar results start to change, think about the “affecters” listed above. It could be that it is not just the food you eat that is changing your testing results.

Joy Galloway, MS, RD, LD, CDCES
Diabetes Educator