SUMMER 1995 ISSUE

continued from page 1

betes, the end result is the same —
high blood sugar. The Diabetes Out-
patient Education Program at Sinai
Hospital works with people with
diabetes and their families to
help them learn about diabetes and
make the lifestyle changes that are
important for them. Many times, the
person who is newly diagnosed with
diabetes feels overwhelmed. "The
program helps people make lifestyle
changes in a way that they can suc-
ceed," states Micki Juip, R.N., pro-
gram coordinator.
The complications from diabetes
are many, and are related to high
blood sugar over a long period of
time. They include greater risk for
blindness, heart disease, impotence,
and vascular problems in the feet
that may lead to amputations, neu-

they first meet with a registered di-
etitian and a registered nurse who
is certified in diabetes education. At
this appointment, learning needs are
identified and an individual meal
plan is given. "This appointment is
important because it allows us to
tailor the education that is needed
for that person. The help they need
will be received through this pro-
gram," according to Micki Juip. Ed-
ucation can then be done individually
or in a class format of four 2-hour
classes. At the completion of the pro-
gram, three behavior changes are
planned to help the person achieve
diabetes control.
The program fee is based on the
services received and only covers pro-
gram costs. A physician consulta-
tion is available, but requires a
referral. Currently, Medi-
care, Medicaid, Health
Alliance Plan, and several
other insurance companies
"Meal planning
cover the Diabetes Outpa-
tient Education Program
at Sinai.
"Our program is one of
is the backbone
the most progressive in the
state," Dr. Rabinowe ex-
plains. "All the teaching
in the principles
materials have been ap-
proved by the Michigan De-
partment of Public Health
of treatment
and an interdisciplinary,
hospital based-committee
of 15 people." The curricu-
lum was developed by corn-
of diabetes."
mittee members, some of
whom are patients, along
with the usual complement
of cardiovascular special-
ropathy or nerve damage. Physi- ists, dietitian, pharmacists, nurses,
cians estimate that 30% of all kidney social workers, and physicians.
failure is due to diabetes, and recent
"Some patients may not need the
hospital statistics indicate that 25%
entire diabetes education program,"
of all inpatients at any given time Dr. Rabinowe adds. "The individual
have diabetes. The Diabetes Out-
assessment determines what is
patient Education Program helps
needed."
participants learn about the impor-
While diabetes cannot be cured, it
tance of keeping their blood sugars can be controlled. Insulin is anoth-
at their target range.
er important component of control
"Meal planning is the backbone in for persons with diabetes. There is
the principles of treatment of dia- a popular misconception — that a di-
betes," says Hershel Sandberg, M.D.,
agnosis of diabetes means a lifetime
chief of Endocrinology at Sinai. "As of daily insulin injections. Not nec-
physicians, our understanding about essarily, according to endocrinolo-
meal planning has changed enor-
gists. Not all persons with diabetes
mously over the past ten years. You
are dependent upon insulin injec-
cannot simply give a patient a sheet tions, and Sinai's Diabetes Outpa-
of instructions. You need time to dis-
tient Education Program addresses
cuss these issues." It is extremely the needs of persons who require in-
important for a dietitian to work with sulin and persons who do not.
a person with diabetes and establish
Diabetes that occurs in mid-life is
a meal plan based on their individ- known as Type II diabetes; it is the
ual needs.
most common form of the disease.
Sinai's not-for-profit education pro-
Persons with Type II diabetes often
gram has the time, expertise, and in-
are overweight, may have inherited
formational materials to address
the disease, show variable insulin
these issues. When a person with di- levels, and tend to live a sedentary
abetes enters the education program,
lifestyle. They usually are not de-

pendent on insulin injections. Oral
medication may be appropriate for
some, careful monitoring of meal
plan and exercise, and lifestyle ac-
tivities may be enough for others.
Persons with Type I diabetes are
usually younger at the onset of the
disease, and lean in build. Type I
diabetes does not tend to be inherit-
ed. They are prone to diabetic ke-
toacidosis, which can lead to coma,
and are dependent on insulin injec-
tions to live. About 90% of all per-
sons with diabetes are Type II, 10%
are Type I.
Dr. Sandberg notes that portable
blood sugar meters are available for
home use for persons with diabetes.
This advance in biotechnology has
had an enormous impact upon the
management of this disease for those
who are insulin dependent. "Persons
with diabetes can take a blood sam-
ple from a finger prick, test it with a
portable blood sugar meter, and ad-
just the insulin dose accordingly. But
Type I patients must be knowledge-
able. They need to know how to give
themselves insulin and understand
how to use self-monitoring tech-
niques," Dr. Sandberg explains.

SINAI HOSPITAL

Exercise is another management
issue that has been evolving in the
past ten years. By increasing their
activity, many endocrinologists and
researchers believe that persons with
diabetes can reduce the complica-
tions of cardiovascular disease that
are associated with diabetes. Exer-
cise also helps maintain or lose
weight, and it makes insulin work
more effectively. Therefore, exercise
is important in diabetes manage-
ment to help achieve target blood
sugar levels.
For the future, physicians expect
the prevalence of diabetes to rise in
the U.S. because it is an age-related
disease.
Micki Juip sees another benefit of
outpatient education programs such
as Sinai's: "When you get ten or
twelve people together in a class like
this, you break through the sense of
isolation associated with this disease.
Group education helps the person
with diabetes to have a forum to
share thoughts and concerns relat-
ed to diabetes and receive support
from each other."

HealthNews Briefs

continued from page 1

skin looking younger and results that last longer than facepeels of the past.
Tattoos can be removed by laser, thus leaving the patient scarless.
For referral to a physician or for more information, call SinaiSource at
1-800-248-3627.

Free Prostate Screening
Planned for September

A

pproximately 35,000 men will die from prostate cancer this year alone,
and another 165,000 men will be diagnosed with the disease. Prostate
cancer can be cured if detected early.
Two simple tests can help improve the chances of early detection and cure:
a prostate-specific antigen (PSA) blood test and a digital rectal examination
(DRE).
Plans are already underway at Sinai to offer the free annual prostate screen-
ing to men 50 years of age or older in September. This offer will be extend-
ed to men 40 years of age or older who have a family history of prostate
cancer. Last year, almost 100 men took advantage of this free screening.
For more information, call SinaiSource at 1-800-248-3627.

IlealthNews is published as a community service to provide up-to-date
information about Sinai Hospital, its physicians and services.

Founded in 1953, Sinai Hospital is a 598-bed tertiary care facility on a
36-acre campus centrally located in metropolitan Detroit. Michigan's only
Jewish-sponsored hospital, Sinai has numerous satellite locations through-
out the area.

Healthnews is produced by Sinai Hospital's Corporate Colmnunicationsi
Marketing Department For more information, please write Sinai Hospital
Corporate Communications/Marketing, 6767 W. Outer Drive, Detroit,

Michigan 48235.

Copyright 1995 by Sinai 1-lospital.

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Diabetes Outpatient Education

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