Ep. 43 | Norma Brown, RN, Diabetes Educator, SGMC Health

Transcript

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- Welcome to another episode of What Brings You in Today?

- I'm Erika Bennett.

- And I'm Taylor Fisher.

- And we just wanna thank everyone for tuning in. If you haven't already, please like and subscribe so you can be sure to get the latest episodes as they come out.

- And if you have any topics or questions you'd like us to answer, you can do, you can submit those at sgmc.org/podcast.

- Yep. And today we are here with Norma Brown, who is a registered nurse at SGMC Health, but is also a big proponent of our diabetes education program. So Norma, what brings you in today?

- Yeah. So I wanted to talk a little bit about how SGMC Health works with the patients with diabetes in our community. SGMC has been a big proponent and of diabetes education. And it's, diabetes is a huge problem in our country, but certainly in the south where we like to fry everything. And so we like sweet tea. But I just wanted to touch base and just let people know that our program is out here and kind of what's involved in that.

- Okay. Well first off, let's talk a little bit about you and how you got into diabetes education. So tell us a little bit about your background and what kind of, how you became so passionate about diabetes.

- Okay. So I've been a nurse for 38 years, which blows my mind, but I often introduce myself as you know, I'm, I'm Norma Brown and I've been a nurse since God was young and in diabetes since Adam was a lad. So I started out in critical care, did that for 12 or 13 years. And then kind of just segue, I did went, you know, PRN and just went to different areas and I fell into the diabetes realm and I just, I just really, really enjoyed that and have just stayed for, for one reason or another. I've just managed to continue to stay in that area. And I think it's good to have a specialization as you get older. But yeah, so that's kind of my background.

- Gotcha. Well let's just, for all the people that don't know what diabetes is, if you're not aware, we're kind of aware because it is so prevalent in our area. But tell us just what is diabetes?

- So diabetes can is is when the body is not able to either produce insulin or the body does not use the insulin correctly. So with type one diabetes, which is about 10% of our population, it's the pancreas where the insulin is made in the body just basically stops making the insulin. They think that it's autoimmune in nature. It tends to be diagnosed with people that are younger. You hear a lot of times of children, but usually before age 30. But that being said, there is no black and white hard line. Yeah. As far as that goes. 'cause we see people that are 40 and 50 that wind up with type one now type two, which is our largest body, pardon the pun, of patients that's like the other 90% they, their body stops using the insulin correctly. So a lot of times it's somewhat weight related over time having diabetes. It is a progressive disease state and so sometimes people can manage it with diet and exercise, use a little bit, shed some weight and just kind of pick up healthier habits. And then because it is a progressive state, sometimes you have to take pills and sometimes you have to take insulin because your body just is not making the amount. But it doesn't mean that you've turned into type one, it just means that your insulin requiring in type two, is

- That like insulin resistant? I hear that a lot, but

- Like yes, insulin resistance

- Is, that's the type two. Yes. Okay. And it gets worse over time. It can. So is there a huge benefit, which I'm assuming there is in early diagnosis?

- Absolutely. So a lot of times people don't realize that well, and they, and especially with type two, a lot of people, it's kind of a gradual thing and they'll have increased thirst. Well, it's hot outside and I've been working outside, so I'm drinking and drinking and drinking and then increased urination. So, well I've been drinking so much, so it's, you know, I'm going to the bathroom more. And then insatiable hunger, like right after you eat that burger, I'm still hungry. So those are kind of classic red flag signs of, of diabetes. Now, the earlier you can be diagnosed, the faster that we can work on some of the easy things. I say easy, but diet and exercise. I don't expect people to go run a marathon. And I don't think that you have to live a really hardcore, strict life as far as food goes, but you have to adapt a little bit. If you're drinking a six pack of Coke, we gonna have to talk. Yeah. So, but the earlier that we can get on it, the quicker we can kind of turn that ship around and keep the, the bad things, the hardcore complications from happening.

- So you educate patients in the hospital. Can you tell us a little bit about your role and how that works?

- Yeah, so there's three educators. There's myself and then Leanne and Stacy. And we do both inpatient and outpatient. Okay. Education. So there's kind of like two roads. So inpatient we see folks who might be newly diagnosed, people who maybe are starting, they came in kind of sick and they're gonna start on insulin. We see from, from pediatrics to gestational, you know, the pregnant mamas or, and all the way to geriatrics. So we see the spectrum of patients. Other things, like if they've come in for something, it could be kind of a focused education when it's inpatient. So maybe they came in really sick and didn't know what to do with their selves and they have diabetes. We go over kind of a sick day guideline or we go over foot care. So it's, it can be stuff like that. The outpatient aspect is three very intense classes. And we have them in the morning, the afternoon and the evening every month when we want in December. 'cause it's Christmas and nobody comes, but they're

- Too busy eating that food. They're too busy. Exactly.

- I wanna big guilt trip my Thanksgiving too. That's kind of a sketchy job. I'll pick back up in January. Yeah. But the classes are two and a half and three hours long and everyone who comes to them goes, why didn't I know this? Yeah. Why have, you know, and we'll get people that have had diabetes for 20 and 30 years and they come and they're like, but it's not information that you're born with.

- You know? Right. Yeah.

- You have to actually seek it out.

- Yeah.

- And you know, you do what you do until you know better and we try to help, you know, better, you know. Yeah.

- And you know, I feel like you don't really see a lot of education even out in just like social, any kind of, I don't, I don't see anything about it, but maybe it's 'cause I don't have diabetes and it's not targeting me and my feed, but I, you know, you see like weight loss stuff and how to, how to lose weight. Different nutritional fads and stuff. But you don't really see anything about like, Hey, do you have this diabetes? Let me help you be, you know, more better at that.

- Right, right. Well now that you've talked about it, it will come up on your feet.

- Yeah, we'll see. Yeah. Yeah. We'll see. I

- I'll test around. You're always listening. Okay. Yeah. So the outpatient, we also have classes for people who are Medicare eligible. They can come for two hours of education each year and just kind of like, like I shot my arm juice up. He, yeah, this is the latest, the greatest, the newest. And you know, try to help him out with that. And we have gestational classes and we also have classes for people who are gearing up for insulin pump. So we have intense intensive insulin and carbohydrate counting. So that kind of gets people started towards that path of wearing an insulin pump.

- How do you combat, like lifestyle change? What are your tips for that? Yeah. Because I feel like that could be very hard when there, it

- Can be

- Having to make dramatic changes maybe. Or maybe they're just starting with little

- Ones, but, well, you know, that's the thing. It's, you kind of wanna try to meet you halfway and like I said, if you're drinking a six pack of Coke, we gotta cut that way, way back, you know, cut down to two a day, you know, and then eventually one a day. The the biggest thing that I could tell a patient or anyone who's newly diagnosed is get the sugar out of your drinks. And I really, in within the diabetes educator world, they really want you to get away from diet sodas as well.

- Yeah.

- So, you know, water, I drink crystalite. So there's other options out there. It's just sometimes, you know that sweet tea, it's not familiar. Yeah. You know, let's do half and half for a while and then let's peel it back to unsweetened and you can sweeten it with artificial sweeten oil.

- Yeah.

- That's why

- I don't, I don't think people realize how much sugar they're drinking

- Is I gonna say. Oh, they don't. We had Dr. Ula on that time, that was one of his major like tips for not, you know, keeping your caloric intake down was pay attention to what's in those drinks because that's Austin juice. Juice hidden in in

- There.

- Juice is good for

- You thinks, but it's healthy. But I'd rather you eat the apple than drink the juice. Yeah. Because that's like mainlining, you know? Yeah. When you drink juice. Yeah. So, you know, eat the orange or the tangerine but don't, don't eat

- Juice. You still can get like a little bit of that, taste that, a little bit of that.

- Yeah.

- Sugar rush.

- Someone who's like hardcore wanting to get like, I'm drinking my, you know, you can now get sugar free.

- Right.

- Which is pretty cool options. And then, you know, I'll say, well you know what, ha put so much in and then fill the rest up with water and ice and you're still getting that flavor and that satisfaction, but you're not getting that big jolt. Yeah.

- It is very addictive. It is. I like a coke every now and then.

- Yeah. I haven't drank sodas in 15 years. I tried one about, about, I don't know, seven or eight years ago and I was like, oh my God, I can't believe, I mean, I mean I was like a diet coke fiend, but

- Well the fact that they use Coca-Cola to like clean your, the corrosion underneath the hood of your car, that means it stuff. But it's really good. I still drink going every

- That means it's good for you. Yeah. It's cleaning out your insides. Yeah. Yeah. It is. So we've talked about, you know, the, the drinking, the sugar and the, the diet. What are some easy kind of exercises you kinda recommend them to start off with?

- Okay. So if you've lived a, a sedentary lifestyle, you know, if you're sitting there at the, at the tv in front of the tv, if you have TV that gives you commercials. 'cause now you don't even get commercials. You don't even have to get up, find yourself a little break. But at the commercial break, you know, stand up and either walk in place, walk, if you have like a circle in the house, like your living room, dining and kitchen, living room, dining, kitchen, walk that while the commercials are on, you know, when you would normally maybe get up and go and get something to drink. That's a really great time to do that. Other exercises, probably the best one that I can think of is being in the pool, you can either swim because you still get that resistance from the, the water on you, but it's so easy on the joints.

- Yeah.

- And you know, people would be like, well I don't swim. I said, well get in the shallow wind and go back and forth. Just walk back and forth, you know. And then resistant bands, you know, you can find those pretty much anywhere and they're really cheap. But the resistance bands, and then I'll tell people to get two cans of, you know, corn or whatever

- That Coca-Cola.

- Yeah. Coca-Cola. Something with a little bit of weight on it and you know, just do some, what I call armchair exercises where you're just lifting and that kind of thing. Yeah. Chair exercise. Yeah. Alternative. So that's usually just starting off. I don't, you

- Know. Yeah.

- Don't run a marathon, my God, I don't expect you to do that. You know, if you have access to, I don't even know what those things are called. The little pedal things. Yeah. Those are great also. So anything like that. Okay. So, you know, anything that's an improvement on what you have Yeah. Have been doing, which is usually sitting.

- Yeah.

- So,

- Okay.

- Like I take the stairs here.

- Yeah,

- Yeah. You know, and that's

- It. I I, I could be up to the fifth floor yesterday on the stairs and I was a little out of breath when I got out there. I was a little embarrassed, but,

- Okay. Well if I tried, I'm eight months pregnant, if I tried to take the stairs to the fifth floor, y'all would have to call a code blue on me.

- Oh, I know what I was gonna say. Now the don't do that. What role does the primary care provider play in diabetes? Like what is the most common way that people realize they have diabetes? And then what would you say is the I importance of primary care provider?

- The, usually they'll have those symptoms that I talked about. Or I'll tell you one that a lot of people come in with is numbs and tingling in their feet. And they're like, why are my feet feeling weird like that? What is that about? And eventually they'll go to find out or they'll find out through their, you know, primary care and they'll be like, oh, you, you have diabetes. So that's often one of the things that is again, a red flag. But as, as the primary care, unfortunately we do have people who like never go to the doctor and Oh, usually at least once a week, twice a week, we have people that come in chest pain, then they go and have a heart cath, then they go and have bypass surgery. And it's found incidentally that their blood sugars are really high and have been, 'cause we draw something called an A1C and that A1C is like a three month average blood sugar for someone with diabetes, seven or less is what our target is. And we'll find these folks that come in that haven't been really following up with a provider and they're, you know, 11, 12, 14 and that's like a blood sugar around 2 50, 300. So, so you've been sitting there for a minute, you know if your blood sugar is, is running that high over the last three months. So you probably had it for quite some time.

- Yeah, I've seen those commercials about lowering your A ones they

- Picked the

- Pharmaceuticals. Yeah. The dance was jardi

- A ones.

- Yes.

- Yeah.

- Okay. How do you encourage these patients? Because it sounds like, you know, a lot of it is lifestyle change, so I know that's probably one of the hardest things for them to do if they've been living this way their whole life. How do you kind of

- Right

- Motivate them? Are they

- Encourage 'em to keep

- Being

- Compliant and the

- Right?

- Yeah.

- Well I will say that Leanne and Stacey are awesome. They are very passionate. I am too. But they bring just a ray of sunshine into the room, you know, and it's never judgmental. And I think that that's really important because sometimes people can be, so of course you're, you know, I had a lady say to me, I would never have thought that you had diabetes. I said, we don't have horns. Yeah. You know, so, so I guess you just wanna be encouraging the ones that do come to class love it. And they always wind up coming. We do a three month follow up with them and they are just like so excited to come to that three month follow up because they've been in class with 2, 3, 5 other people and they're like, how have you done? Don't, gosh, you look like you've lost weight. You know, it's like that community,

- Like they kind of get

- Connected support group and we used to have a really active support group and we're actually gonna fire that back up in January. So we will be probably trying to advertise that a little bit more and, and get that going. I mean we, we had a really great support group and I think that it's very important to go

- Yeah.

- And, you know, learn something. Yeah. And be with folks that are like-minded.

- Yep. - Yep. I think that adds a lot of value. Absolutely. And then there's a lot of support out there on social media. You just wanna Sure, yeah. Choose what it is that you're listening to because sometimes it can be, you know, crazy town.

- Right.

- So, but just to kind of get that support, we can do that.

- Yeah. I think I would think that the encouraging way would be the better is, you know, instead of the hard line, kind of more stern, you know, because I'm sure that anyone that has someone kind of pointing their finger at 'em, they don't wanna listen to

- Them. Oh yeah. And, and those, Lynn and Stacy have a way of making people talk. And you know, Stacy was in with a patient recently, this is kind of an aside, but she was in with a patient probably a couple of months ago and she was talking with the patient and the more she talked, she was just like, have you got food at your house? And she's like, oh yeah. And she looked at her and she goes, have you got food in your house? And she started crying. She goes, no. And so these are the people that when you say that to 'em, when they're asked on, you know, we asked all that when they're coming in there, people are embarrassed or ashamed. Right. But there's no reason to be embarrassed or ashamed if you are going hungry, we need to solve that. So

- Absolutely.

- You've been trying to work with Second Harvest and helping them move patients towards where the food pantries are and that kind of thing. And we got her some food, you know, so I say that's little things like

- That. Yeah. I mean, I've heard several stories of that from different, it's things that people don't realize that we do, like in, or the, the medical field, the people that are taking care and, and, and learning more about these patients and seeing other needs outside of the hospital. Absolutely. That can be met. And then kind of going the extra mile to help make sure, because you're right. If she doesn't have access to, if whoever it was doesn't have access to food, then how can we help them make the right choices in their food? Right. And then they're gonna end up just sick again. So it is about like that connecting them to the important, important resources that can help them be healthy outside of the hospital.

- Absolutely. Absolutely. I mean, she's gonna go home from the hospital and she's gonna have to try to scare up some food from somewhere. Yeah. But you know, if she has that going home, at least she can make some soups. She can get some, you know, usually they have like some kind of potted meat, canned meat, something like that. It's not perfect, but you know what, when you're hungry and you

- Need, yeah. I mean,

- Yeah,

- It's better to be, have access to resources for sure. I mean, and that just speaks so much to the type of people that are working on your team and that they are like truly caring about the patient. Oh, truly. You know, more than just a job. Yeah, absolutely. Absolutely. Definitely. That makes me feel good. That's sweet.

- And healthy food is

- Hard to

- Get ahold

- Of

- If you, that's a whole national

- Issue. Restricted, if you ever want to get a real shock about fast food, watch Supersize Me, you can see it on Netflix. And that is shocking what this guy goes through. He challenges himself and it's fascinating. But

- Yeah, I think I watched like a half of that and then I was like, I can't, I can't, I can't watch, I can't watch the rest of it. Yeah. Yeah. That's fascinating. But it's the hard reality. I mean, and the, and it is the hard reality of what our people are facing out there. And so

- You can get four for four, you know what I mean? Versus whatever, you know, if you have to go and buy meat, which is really expensive, you know. So one of the things we do in support group, or we did in support group, we take it back up, is we went to Winn-Dixie one night and we walked around and looked at labels and talked about meats and meat choices. And it was fantastic. I mean we, I don't know how many people we had. I bet we had 30 head of people. It was a lot. It was grocery store

- Tour kind of thing.

- Yeah. We kind of toured the grocery store and talked about label reading and that kind of thing, and looked at something that said, oh, I'm sugar free. Yeah. And then, you know, because that's a misnomer. Well they can fall

- Victim. Yeah.

- Does it's, it is so

- Well, and if no one's ever taught you

- Yeah.

- That Exactly. If no one has ever had, you know, a discussion about it, I, I know what it's like to, to kind of grow up and not really think about that. And then you start looking at it and you as an adult, you're learning, oh my gosh, well I've been eating all the wrong things and I had no idea. 'cause that education is just not there.

- It's not there.

- So I you're, I

- We're, that's what you're here for. We're bustling on through and doing our little part and we are moving our education classes out to our sister hospitals in Ion and Lanier.

- Very nice.

- So we're really excited about that expansion.

- That is good. I know that's one of the things that also comes up on our community health needs assessment. Every time we do that for a low and Baron and Lanier is just awareness for diabetes and things like that. I mean, that's a common issue that is out

- There. So Yeah. I've think going and seeing the healthcare providers in those areas, you know, and just kind of beating the door down, letting 'em know we're here and we're gonna be locally and, 'cause it could be a chore for people to get into Veta. It's, you know, it costs money for gas, sometimes you have to wait on a ride and that kind of thing. So it's a lot. It let's you know, the elderly, let's go to the mountain. The elderly

- Are not driving

- Exactly

- That far. My, my family and my grandmother, they live in Ray City and my granny does not drive. So it would be a trek for her

- To

- Come over here

- If she didn't have a ride. Exactly. Exactly. So

- I think that's really good.

- Yeah, it is. We're really excited about that growth.

- What role does the patients, you know, family and support system play in all of this?

- That's a real good question. So I think it's really important not to be judgmental and I'd be like, you can't have, get that outta your, yeah, okay. Alright. You know, you don't wanna be shameful.

- Yeah.

- I think some of the best ways that you can support is if they're gonna start walking. You know what, get up and walk too. You know, and gonna hurt you. Right, right.

- Yep. - If you're able, you know, if you're in a scooter, well scoot along slowly next to, you know, I mean that's And just chitchat. Yeah. You know, I think other things like trying to follow that same kind of meal plan. You know, you don't wanna make fried chicken and baked chicken, you know.

- Yeah. That makes it hard. Adapt. Yeah.

- Adapt. And other things. Like, I was thinking about this, if we're gonna encourage them to stop smoking and so it's really hard to stop smoking if other people in the house are smoking. Yeah. So stop smoking with them. It's probably one of the better things you could do for your life.

- Yeah, absolutely.

- Yeah. So just that kind of support, you know. Yeah. And I think it's really important not to, to shame them. Now our classes can bring one support person with them. So you know, if you have someone who's diagnosed, you know, a husband's diagnosed with diabetes, a wife wants to come and you sometimes they're, you know, the chief cook bottle washer, you know. Yeah. Yeah. So just whoever that is, that's your support person in your life to come along 'cause it's information. That's good to know. Right. So yeah,

- I think that's good. Yeah. It would be very difficult to break a bad habit if you know your support, your spouse. Spouse is

- Exactly.

- Just still doing that right there

- For sure.

- They probably don't need to be smoking either, so. Exactly.

- You're right. Think of the money you'd save because I think cigarette, like a pack of cigarettes is very expensive. I don't know. Never smoke. So, but they're like super expensive.

- Yeah. I don't, I don't know, but I'm sure with how expensive everything else is that, that I also wanna things that Exactly. It's up there, but, well that's awesome. I'm just glad to know that this resource is here for our community, so

- Absolutely.

- Yeah. Definitely do our part to help

- Yeah. Share

- The good news.

- Yeah. If the, if the provider is an affiliate of SGMC, they can go on Epic and just order ambulatory diabetes education.

- Okay. - And if they're not, they can really, honestly, they could just call the hospital operator, say, put me through to a diabetes educator and we'll fax the paper order for them to fill out at their provider's office. So there's lots of ways.

- Very good. Do you have any success stories that stick out in your mind of people that you've educated or?

- I do. I had this fellow, this is when I was working at the clinic, at the diabetes clinic, and he wanted a pump by God. And so I worked with him and he came in and he came in and we had to learn how to carb count. And then within the pump, this is a minute ago, 'cause pumps work a little bit differently now, but within the, the pump, you had to know how to give your insulin if the pump failed, could it 'cause it is just a machine. Yeah. So if you had that pump failure, how much you would give to correct your blood sugar, how much insulin you would give to cover your food. And so there's these practice things and it was, it's like homework, you know? And blood is hard. He didn't even know how to round up or round down.

- Yeah.

- So I wrote it out for him, you know, and I worked with him and worked with him and worked with him. He come in, miss Norma, it's like, Hey, you know, and by God, he still is on his pump and doing great. Yeah. That's awesome. So that to me is just like a little, yeah. You know, but like, like I was saying, you know, we have a three month follow up and we'll see those people that have those A one Cs coming in, they're 11% and they'll be seven or less, you know? And you're like, yes. Yeah. And they're so proud of

- Themselves.

- Yeah. Because it's not been that hard, you know, they're just like, I just didn't know.

- Right. Yeah.

- Yeah. So we, you

- Can't fix what you don't know, you

- Know? Exactly. Exactly.

- That's awesome though.

- Yeah, it is. It really is. Yeah.

- That's great. I bet that feels really,

- It does. Rewarding. Rewarding. It does. It's, it's fantastic. And a lot of 'em are like, well we just didn't know. Yeah. I just didn't know. Why wasn't I told about this class before,

- You know? Yeah, yeah.

- You know, so it doesn't help to just say eat less and move more. That's, that's not

- Yeah.

- A plan.

- Yeah.

- Yep.

- Okay. Well we really appreciate you being here. Yes. Thank you

- For having me.

- This has been a really great, I think this is a really good, relevant conversation, especially for the area that we live in. Absolutely. Like you said,

- And we can put information, we'll connect it with this podcast episode about the support group and the classes and

- Stuff like

- That. That's definitely, that's

- Great. Yeah.

- So, you know, we've been talking about food this whole time, so now we're gonna have a little test. What is your favorite? I got the answer meal to eat

- Here. Okay. So I like to get a small breakfast and a cup with Turkey sausage. Oh, you sure that was coming? Is that your That's my GoTo. Yeah. I knew that was coming. You can't say fried chicken at this point. No. Well I mean you can, but you're kinda like goy. But that's what, that's what I like to get. And if I get that in the morning, I just usually don't. Right. Need much of anything. It's solid. It can at lunch, it keeps you going. That sticks to your ribs, right? Yeah. Okay. Breakfast as a king,

- I like the Turkey sausage

- Too.

- Okay. - So it's a little bit, a little bit healthier, but just a small one. Just a small,

- Yeah. Yeah. Alright. You heard it here first. If you Yeah. Want to get a relatively decent breakfast that is going to stick to your rib and keep you full till after lunch, you can go for the Turkey sausage instead.

- Yep. Okay. Thank you everyone for tuning in today and if you have any questions you would like us to answer or topics you'd like to hear us discuss, you can submit those at sgmc.org/podcast.