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Johns Hopkins Medicine Suburban - Living with Diabetes: A Marathon, Not a Sprint

New Directions Winter 2017

Living with Diabetes: A Marathon, Not a Sprint

Date: January 10, 2017

Paula Miller-Knipple, Dr. Mihail Zilbermint and nurse Rebecca Taff.
Paula Miller-Knipple, Dr. Mihail Zilbermint and nurse Rebecca Taff.

Paula Miller-Knipple, of Hagerstown, Maryland, solves technical problems for laboratory customers at her job as a senior scientist for an international biotech company.

Despite being trained in scientific methods, even she couldn’t manage the intricacies of living with diabetes without the help of Suburban’s expert Inpatient Diabetes Management Service (IMDS) team. The program is directed by Mihail Zilbermint, M.D., a board-certified endocrinologist, who serves as director of Endocrinology, Diabetes and Metabolism Care.

About 26 percent of Suburban Hospital patients have diabetes. Suburban Hospital created the IDMS to help them control their high blood-sugar levels and reduce the incidence of hypoglycemia (low blood sugar) no matter the reason they were admitted.

“People come to Suburban because of many different medical issues,” says Dr. Zilbermint. “If they have diabetes, we have a system in place to manage their condition and teach them proper care. We think of it as providing them with a ‘safety net’ to help them when they leave here. Thanks to the commitment of our team of physicians, physician assistants, nurses, pharmacists, patient care techs and educators, we are seeing positive results. We hope fewer patients will return to us with complications from diabetes.”

For 38-year-old Miller-Knipple, the reason she originally came to Suburban was a badly infected pressure ulcer on her foot. Admitted by Andre Gazdag, M.D., an orthopaedic foot and ankle specialist, Miller-Knipple was seen by Dr. Zilbermint on her first day in the hospital because she wore an insulin pump. Over the course of several months, she had eight separate surgeries, including a toe amputation, and a prolonged hospital stay, all while under the watchful eye of Dr. Zilbermint and a nursing staff trained in monitoring her glucose levels.

“I had no idea that diabetes could be this serious,” she says. “I am a busy working single mother of three young children and I wasn’t taking proper care of myself. Dr. Zilbermint understood how difficult managing diabetes can be. He even shared with me that during his sub-specialty fellowship he wore an insulin pump and checked it regularly—just like a diabetes patient would—so that he could understand how time consuming it is.”

“With the help of Dr. Zilbermint and Suburban’s caring staff, now I have the confidence to manage my diabetes. They took my lifestyle into consideration and put a plan together with achievable goals.”

Education is a major component of the diabetes program at Suburban Hospital, and it extends to clinical staff as well as patients. An active group of “diabetes champions” provides one-on-one and group education sessions for nurses. All nursing units are stocked with diabetes kits containing the tools needed for teaching patients how to monitor and track their blood sugar readings. Thanks to the generosity of several donors, iPads preloaded with diabetes information are available for patients to use while in the hospital.

Diabetes care doesn’t stop when patients leave the hospital. Before they are discharged, they are referred to the “Diabetes Fine-Tuning” program, a series of small-group sessions for patients and their care partners. Hospital staff “prescribe” the class and patients are strongly encouraged to attend. During these sessions, diabetes educator nurses and pharmacists discuss important components of diabetes care like nutrition, exercise and emotional and physical concerns. They also work individually with each patient to set goals and properly track their glucose levels.

Ann Black of Rockville, Maryland, was thrilled to be back at the hospital for her Diabetes Fine-Tuning class. She states, “The program is fantastic. With the help of Suburban’s physicians, nurses and pharmacists, I feel like my head is no longer in the sand when it comes to my diabetes management. I’m learning to advocate for myself and take control of my health. I’m so grateful to Suburban’s team for the diabetes education I’ve received and I’m very encouraged about the future.”

Members of the community are also welcome to take advantage of Diabetes LITE classes, including the Pre-Diabetes Action Class, diabetes support groups and hospital-sponsored Heartwell clinics located in senior centers in Montgomery County as well as community-based diabetes self-management classes.

Adds Miller-Knipple, “Diabetes is a marathon, not a sprint. Thanks to Dr. Zilbermint and Suburban Hospital, I’m in control of my health for the first time in many years. I used to be afraid of my glucometer, but now I’m encouraged by the numbers I’m seeing.”

What Is diabetes?

People with diabetes cannot maintain healthy levels of blood sugar (glucose) unless they carefully monitor their food intake and, in many cases, take medication. Abnormally high blood glucose levels that persist over time can lead to a number of serious complications.

Type 1: A small fraction — as few as 5-10 percent — of people with diabetes are unable to make any insulin at all, a hormone produced by the pancreas that helps the body process carbohydrates from meals. This condition is known as type 1 diabetes, an autoimmune disease in which the body’s immune system mistakenly attacks and destroys the body’s own pancreas. The damaged pancreas can no longer produce insulin, so people with type 1 diabetes need insulin therapy to survive.

Type 2: For those who have type 2 diabetes, insulin is no longer effective at lowering blood glucose. Sometimes people with diabetes can keep their blood glucose at healthy levels by controlling the amount of carbohydrates in their diet. In most cases, medication is needed in the form of pills. Many people with type 2 diabetes will have to use insulin as well.

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