Frank Samson: Welcome to Boomers Today, I'm your host, Frank Samson. Each week on Boomers Today, we bring you important useful information on issues facing baby boomers, their parents, and other loved ones. We’re really grateful for all our listeners, and we’re so lucky to have such great guests with us on every podcast. And today's going to be no different. We have with us Patricia Daiker, who's a registered nurse, board certified nurse coach, specializing in diabetes burnout, and author of the online e-course, Better Diabetes Life. She has been an RN for 35 years, practicing bedside at Baylor University Medical Center in Dallas for 15 years, primarily in the emergency department and credentialed as a certified emergency nurse.
She currently is the CEO and founder of Better Diabetes Life, a company whose mission is to deliver support and services to people with diabetes and other chronic illnesses who are experiencing the psychosocial burden we know as burnout. So, Patricia, thank you so much for joining us on Boomers Today, I really appreciate it.
Patricia Daiker: Well, Frank, you're welcome. I'm excited to be here and I'm excited to share this information with your listeners.
Frank: Thank you. I know we're going to talk about diabetes burnout and what that is all about, but before we do, I think it would be a good idea just to talk about, listen, there probably isn't an adult on this, certainly in this country and maybe even around the world that hasn't heard of diabetes. However, maybe not everybody really understands what it is. So maybe you could explain what diabetes is. And I know in our discussions earlier that you yourself have diabetes and maybe you could talk about that and how you got diabetes and how do people get it or how do they prevent it? I mean, I know that's really a loaded question there, but I'll let you take it from there.
Patricia: That is a lot, that's a big topic but we can get through it, it's actually quite simple. So, diabetes is a condition where you have problems with glucose regulation, and glucose is derived from the food you eat, mostly sugars and carbohydrates. So when you eat those foods, when you digest the food, they end up in your bloodstream as glucose. For the human body to function, we need insulin to get that glucose from the bloodstream inside the cell. And it acts as fuel for the individual cells in your muscles and different parts of your body.
When diabetes happens, it means there’s a problem with the insulin and insulin is what lets it get inside. There's several different types and I'll touch briefly on the three that are most common. Type one is a lack of insulin, and that's what I have. Type one is typically caused by a viral infection or something that sets off your immune system and your own immune system attacks the cells in your pancreas that makes insulin. And so, if you have type one, you have to take insulin for the rest of your life, you don't make any. Type two is more common and it's where you have insulin resistance. And so, you actually have a lot of insulin, your body just doesn't recognize it or use it very efficiently. And so, in either case you don't have enough insulin to get sugar into your cells or you have too much insulin that doesn't work. In both situations, you end up with too much glucose in your blood causing problems.
And the third type I'll touch on is gestational diabetes. And that's similar to type two in that it's mostly related to insulin resistance caused by hormones, typically in the placenta, and basically means you're not regulating sugar well. At the end of the day, all that extra sugar in your blood causes damage and the complications and that thing. So, the treatment is all about trying to get your blood sugar levels normal. There's many different ways we can do that, but in a nutshell, that's what it's about. It's about this glucose regulation gone awry.
Frank: Quite some time ago I was diagnosed as being a "pre-diabetic,” but I made some changes in my diet and exercise, and now things are to back to normal. Can you explain what the ‘pre-diabetic’ term means?
Patricia: Absolutely. This doesn’t happen right away, it’s something that builds up gradually over time. Pre-diabetes is when you're becoming insulin resistant, but your body starts making more insulin and it's keeping the blood sugars normal. You might be a little bit high, but not high all the time and it's not acutely a problem.
People can correct that by several different factors, one of which is diet. So, if we reduce the carbohydrates we eat, then we don't need to make as much insulin and therefore we decrease the demand on our body. And two, exercises are a good activity because it actually makes you more insulin sensitive. So, if we're reducing the carbohydrates, we're exercising, moving about, then some of the factors that were leading us to become insulin resistant are limited.
And so, you have the propensity to get diabetes if you would have continued with those behaviors that were leading you in that direction. But there’s a genetic component to it as well. You may exercise well and eat right, but still be pre-diabetic or develop diabetes.
Frank: Got it. Would you mind sharing your own experience with diabetes, and how you handle it in your personal life?
Patricia: Absolutely. So, I'm a boomer right now - I was born in '64. But back when I was 26, that's when I was working in the emergency department at Baylor and I started losing a lot of weight. And honestly, as a girl in my 20s, I was thrilled. I could eat whatever I want, my waistline was dropping. I worked nights, I worked in a very busy emergency department. And for me, I really just was tired a lot. I just was so tired and it wasn't sleepy like I worked nights tired. It was a bone weary, just, I've never been that tired before in my life.
Then something happened that changed my perspective. When you work in the ER, there's a phone that rings to alert you to an incoming ambulance. When the phone rang one night, I had this brief thought in my head, and this is horrible, but I thought, I hope it's a gunshot wound to the head because it won't take very long to care for them. That's horrible because they don't survive very often, but I thought that because I was so bone weary and tired, I didn’t know if I had the attention or strength to care for someone for hours at a time.
As a nurse, the fact that that thought even floated through my consciousness bothered me. It just wasn't okay. And that’s what prompted me to see my doctor about my weariness. I went and saw him and my fasting blood sugar was 140, which isn't that high. It's not crazy, crazy, but a fasting should be under 100. And so he's like, "Well, I don't know. Maybe you're just stressed." He said, "So when you're back at work, when you're in the ER working, check your blood sugar.” I checked it after I had eaten a meal, and it was around 300, which was very, very high.
After that, lab tests revealed that I had insulin antibodies. That meant that I had type one diabetes. My own immune system was attacking my pancreas, and at that time I was in the honeymoon stage, I caught it pretty early. It was shocking, though, because no one in my family or extended family had any type of diabetes. I was a fluke. I did remember getting a rash a few months prior to this, however, which I thought was chicken pox. It never turned into chicken pox, it just went away, but it was such an unusual rash. The theory is that I got a virus, some unusual virus likely from one of the patients that I cared for and that virus set off an immune response and my body attacked my own pancreas.
Frank: How did you get involved in educating people on diabetes?
Patricia: I'm actually a coach, and I think I’ll answer your question in two parts. First, I struggled with diabetes. I had all the clinical training, I had worked in ICU for several years prior to the ER. So, when I was diagnosed, I knew how to take care of patients in diabetic ketoacidosis. I had seen patients on dialysis, I had seen patients with strokes and heart attacks. I was very intimately familiar with this disease, I knew how to care for it.
The interesting part was I didn't want to do it. I was so mentally burnt out, it was hard to do anything. I didn’t feel motivated. During that time, what I found out was that diabetes wasn't my problem, it was how I coped with hard things. My go to strategy prior to this was avoidance. If something was bad or difficult, I didn't want to deal with it. What I learned is that clinical knowledge and understanding what to do was not enough. I had to build resilience towards this if I wanted to work on it and potentially make a difference in people’s lives.
The second piece comes about eight or nine years after my diagnosis. I was diagnosed in '91, and in 2000 I went to work for a software company and I was in the software industry for about 17 years. I had so much fun, but there was time when I was responsible for acclimating emergency department doctors with a software that they were very resistant to. It wasn’t enough to just tell them why they should use it, which had been my strategy prior to this.
I had to rethink my approach, and try to understand this from their perspective. Why would they want to use the technology? How could I present it in a way that would be more palatable to them?
These two experiences in human understanding eventually started to click and gel with each other. During that time as well, I was frustrated with the medical system. I felt as though I was never doing enough, and that there was always another issue that needed solving. It’s a daunting process, and I finally realized that there was a way I could help make at least one component of the medical industry easier for people to understand and interact with.
I don’t think anyone would disagree that proper diet and exercise is necessary to help manage diabetes, but what my course does is help make these changes to your life more manageable and easier to integrate. It also looks at these habits from a nursing perspective.
Frank: Got it. Thanks for correcting me on that. The difference between a nurse coach and a diabetes educator. Now, Patricia, let everybody know how they can learn more about your organization and learn more about your course, you have an online course and how they can get in touch with you.
Patricia: Absolutely. So, my website is betterdiabeteslife.com. You can access my course there as well. I also post frequently on Facebook, Twitter, and Instagram, and those handles are @Better Diabetes Life, so if you like those social platforms.
Frank: Great, great. So, diabetes burnout, what exactly is it? What's the cause of it? Who gets it? Tell us more about diabetes burnout.
Patricia: Burnout may look like a number of things. A person with diabetes who doesn’t want to get tested may avoid their symptoms in other ways too. They might decide to eat whatever they want, and hide other behaviors from people. Oftentimes, people concealing their symptoms are caring sadness and shame around with them too. It has many different nuances, but the end result is that they just abandon their care. You can think about burnout in the context of a job too. If you're in a job that you don't like, you can get to a point where you're phoning it in and you're doing the bare minimum. You can be burned out in a relationship.
Burnout with diabetes is especially difficult because if you don’t do what you need to do, then we have blood sugars that are out of control, and then you develop complications and such.
There’s a term for patients who don’t do what the doctors recommends. We call them noncompliant. My belief is that they're doing the best with what they have, they may just be at a point where they can't go on anymore. It may feel too hard or be overwhelming. I feel like noncompliance within the medical vernacular is judgmental. It implies that the patient is being ‘bad,’ when I don’t think that that’s true.
Frank: Got it. It appears that diabetes is easily detectable from a medical standpoint, if you can run all the right tests. Is it normal when someone just goes in for a physical or a normal checkup, could it be missed if the patient is not expressing certain symptoms to the doctor? Is it a normal course of action for a physical to check, to see if certain levels are high or is that something that somebody needs to always ask?
Patricia: So, it depends. There is no one way to practice medicine. Typically when you go see a doctor for an annual physical, especially at our age, they're going to draw some lab work. And that lab work includes at least a blood sugar level. Also, whether or not you’ve fasted before could impact your interpretation of the outcome.
But to your point, typically doctors are going to check your blood sugar. If you think you may have a history of diabetes, or if something's not feeling right. You're not feeling great, you're feeling tired. You have sores that aren't healing, different things like that, your doctor will want to do an A1C. And an A1C is a test that measures your average blood sugar over three months. If there’s an issue it's going to show up over the three months. So, the A1C is how you can even find the prediabetes like you're talking about.
Frank: Got it, got it. Well, I could talk too much longer in this subject matter, it's so important. And I really appreciate so much you taking the time to join us today on Boomers Today.
Patricia: Well, Frank, it was my pleasure. Happy to share this with everyone.
Frank: Thank you. Thank you so much. And thank you everybody for joining us on Boomers Today. Please, please be safe out there, we'll talk to everybody real soon.