Building Hope Helps Put a Positive Spin on Having Diabetes

An exclusive interview withVirginia Valentine, APRN, CDE

Virginia Valentine, APRN, BC-ADM, CDE, FAADE, named the American Diabetes Association’s 2019 Outstanding Educator in Diabetes, knows firsthand what it’s like to experience the struggle that comes with having diabetes. She has had type 2 diabetes (T2D) for 39 years, so she’s used to the reactions she gets when meeting someone new for the first time.

“There is often a huge amount of shame and blame,” Ms. Valentine says about those who do not really understand the condition. “There is a stigma attached to having type 2 diabetes because many people assume that you have diabetes simply because you are overweight. Case in point—I once overheard a woman who had type 1 diabetes telling her friend that she had the kind of diabetes that she didn’t cause herself.”

As a health professional with one of the most common diseases among adults in the United States, Ms. Valentine’s personal experience informed the theme for her presentation upon accepting her award at the American Dietetic Association 79th Scientific Sessions in San Francisco, California.

Shifting Focus of Diabetes to Caring and Away from Shaming

The topic of her presentation comes from personal and professional appreciation of the struggle faced by some many people with type 2 diabetes. Ms. Valentine’s address: “The Most Important Thing We Give to People Is Hope—Overcoming Stigma in Diabetes and Obesity,” was selected to recognize how important it is to help people reframe this condition “because the stigma gets in the way of caring for people with diabetes.”

First off, she says, it’s important to have a health care professional who acknowledges that having type 2 diabetes is not your fault. “There are now studies with the zillions of genes that have an impact on insulin resistance,” she says. “So, knowing that is important because it’s not that I am looking to give individuals with type 2 diabetes, including myself, a pass. I say, rather, this is not your fault, but it is your responsibility.”

Changing the way we think of ourselves is an important an necessary step forward, Ms. Valentine says. “Taking ‘diabetic’ out of the language helps, too,” she says. “I am not a diabetic. I am a person with diabetes; It’s not about being ‘diabetic’ or having a ‘diabetic foot.’”

Ms. Valentine, who just turned 70 years of age, is currently a certified diabetes educator and advanced practice nurse at Sage Specialty Care in Albuquerque, New Mexico, where she holds a faculty appointment with the University of New Mexico. In addition, she is co-author of Diabetes, the New Type 2—Your Complete Handbook to Living Healthfully with Diabetes Type 2.

The annual award is presented by the American Diabetes Association Board of Trustees to recognize a “distinguished health professional who has made outstanding educational efforts in the field of diabetes and has demonstrated significant contributions to the understanding of diabetes education.”

“As I said, earlier, there is definitely a genetic component to type 2 diabetes,” says Ms. Valentine. “Many people think type 1 diabetes is due to genetics but more than half of the time, there is no family history for these individuals. Yet, with type 2 diabetes, if your identical twin gets diabetes, there is a 90 percent chance that you will have it, too.”

She stresses that it’s critical that you stop blaming yourself for having type 2 diabetes. “It is important to recognize our own implicit biases but also to acknowledge the hard work it takes to manage our diabetes every day,” she says. And she advises doctors to reframe the conversation. “Say to your patients, wow, I am so proud of you.”

Beyond the Message of Weight Loss—4 Tips to Remain Hopeful and Positive

All too often, people with diabetes are told that if they “just lose 10 or 15 pounds, their diabetes will go away,” says Ms. Valentine. Many of us know that if you manage to lose 15 pounds, your blood sugar may stay in the normal range for a period of time, but it is just as likely to creep back up again. “Since we’ve all been there, it is important to remain positive” she says. “It may just mean that you’ll need to add an extra medication to get your blood sugar back down to where it should be.”

That said, she encourages her patients to do all they can to keep their diabetes in check in order to avoid the complications that commonly occur in people who have T2D for a long time. “We pretty much know what causes the complications— it is high blood sugar,” she says. “So I work with my patients to figure out who we are going to manage their blood sugar so they can avoid developing heart disease, neuropathy, vision loss, fatty liver disease, and such.”

Start Add Steps to Get Yourself Moving More. Her approach is to counsel every individual to literally start taking small steps. “Put on good walking shoes, look at your watch on the way out the door, and go out and walk for 5 minutes,” Ms. Valentine says. “When you turn around and walk back, you’ll have walked for 10 minutes. Then you can keep building up slowly to your goal walking time.” Aim for 10,000 to 15,000 steps most days.

Commit to Chewing Your Calories. She typically offers this common diet strategy, too: do not drink your calories. In particular, avoid beverages that are nothing more than “liquid sugar,” which is what she calls fruit juices and sweetened soft drinks. A better choice is to mix a splash of orange juice, lemon or lime into seltzer (sparkling water) or flavored infused unsweetened iced tea. “Gradually, keep cutting back on the sugary beverages to the point where you are replaced them with non-calorie beverages.”

Asking for Help is Necessary. If you are unsure about what you should be eating, it is best to speak with a certified diabetes educator (CDE), Ms. Valentine says. For most of us, it will take more than one visit to get a good handle on a good diabetes eating plan.  

Start by asking your doctor to recommend someone, and if the suggestion has already been made, follow through. You can also find someone you like in your area by visiting www.diabeteseducator.org. The American Association of Diabetes Educators website notes that, “Diabetes education is a recognized part of your diabetes care and is covered by Medicare and most health insurance plans when it is offered through an accredited diabetes education program, which has met vigorous criteria set by the U.S. Department of Health & Human Services.”

Take Your Medication Diligently. For individuals with diabetes who are taking medications, Ms. Valentine recommends that you invest in a pill box that has enough space for all your pills for the week. Fill them on Sunday, then put the box where you will remember to take each medicine at the right time.

When patients come to her office, Ms. Valentine always asks what issue is giving them the most trouble. “Often, it is not something that they are failing at, it’s just that we haven’t come up with the right treatment for them yet.”

 If a person’s hemoglobin A1c is rising, it may mean that a medication needs to be changed or another one added. However, this isn’t something that is the patient’s “fault,” she says, stressing that “type 2 diabetes is a progressive disease, so we need to support you in finding the right treatment plan. This usually involves making small shifts in your lifestyle and getting you on the right medication to get you to a near normal glucose level.”

Adjustments to your medication plan are expected over time, as circumstances change, and you age. So stay hopeful and keep at it—she knows since she’s been reminding herself to do this daily herself.

Mrs. Valentine has worked with the following companies: Abbott, AstraZeneca, Intarcia, Janssen, Lilly, PamLab, Boehringer Ingelheim, Lilly, and Roche.

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