On this episode of The Huddle, we're joined by Lucille Hughes, DNP, MSN/Ed, CDCES, BC-ADM, FADCES, Director of Scientific Communication, Information, and Education at Embecta. Lucille discusses some of the unique care needs to consider when working with people with Type 2 diabetes who take insulin, how the DCES and other members of the diabetes care team can help to address their specific diabetes burdens and struggles, and how care for people with Type 2 diabetes differs from that of Type 1 diabetes. This episode is sponsored by Embecta. Find up-to-date diabetes technology product information, device training, professional education and more on danatech: Diabetes technology for healthcare professionals | Danatech (adces.org) Learn more about Embecta here: Discover Our Diabetes Care Products & Learn About EMBECTA
On this episode of The Huddle, we're joined by Lucille Hughes, DNP, MSN/Ed, CDCES, BC-ADM, FADCES, Director of Scientific Communication, Information, and Education at Embecta. Lucille discusses some of the unique care needs to consider when working with people with Type 2 diabetes who take insulin, how the DCES and other members of the diabetes care team can help to address their specific diabetes burdens and struggles, and how care for people with Type 2 diabetes differs from that of Type 1 diabetes.
This episode is sponsored by Embecta.
Find up-to-date diabetes technology product information, device training, professional education and more on danatech: Diabetes technology for healthcare professionals | Danatech (adces.org)
Learn more about Embecta here: Discover Our Diabetes Care Products & Learn About EMBECTA
Jodi Lavin-Tompkins
Hello and welcome to ADCES' podcast, The Huddle: Conversations with the diabetes care team. In each episode, we speak with guests from across the diabetes care space to bring you perspectives, issues, and updates that elevate your role, inform your practice, and ignite your passion. I'm Jodi Lavin-Tompkins, Director of Accreditation and Content Development at the Association of Diabetes Care & Education Specialists. And I want to thank Embecta for their support of this episode.
My guest today is Lucille Hughes. She's the Director of Scientific Communication, Information, and Education at Embecta. We're going to discuss personalizing care to meet the needs of people with type 2 diabetes who take insulin. Lucille, welcome to The Huddle.
Lucille Hughes
Thank you so much for having me today, Jodi.
Jodi
Yes, nice to have you today. And before we dive into today's topic, I was wondering if you could tell us more about your background and experience as it relates to today's topic.
Lucille
Certainly. First and foremost, I am a registered nurse by profession. I have my doctorate in nursing practice, my master's degree in nursing and a nursing education, and I'm a certified diabetes care and education specialist, board certified in advanced diabetes management, and a fellow of ADCES. I'm also the immediate past president and had the privilege and honor of serving as president of ADCES in 2023. I've been very lucky and blessed to have been also able to work in the field of diabetes as a DCES for over 37 years. And during this time, I've been responsible for starting and overseeing diabetes education programs and helping to assist many people with all types of diabetes, but especially those living with type 2 diabetes.
So this topic is very dear and near to my heart, and I'm so happy to be here today to raise awareness of this important topic and hopefully change the landscape of care for all who live with type 2 diabetes.
Jodi
We know that people with type 2 diabetes tend to be middle-aged or older and as a result may have other health conditions in addition to diabetes. So their care really needs to be individualized, and that's actually what the guidelines say. So can you describe some unique care needs that people with type 2 diabetes who take insulin might have?
Lucille
Certainly. As a diabetes care and education specialist, I believe that all individuals at risk for and living with diabetes are important to have individual needs. And that's why we approach each person with the goal of providing individualized care and creating those patient-centered goals. However, the type of diabetes is important. It’s an important consideration for everyone, the practitioner and the person with diabetes. And as practitioners, we recognize there's a difference between type 1 and type 2 diabetes and the care that each type of diabetes then requires. We have to be very mindful to keep these specific requirements at the forefront of our care for each person living with diabetes. In particular, for type 2 diabetes, many people struggle, as we know, to lose weight and often have other comorbidities besides diabetes that are unique to them. You know, it may be digestive issues, balancing other medications they need to take for other diseases and conditions that they might have, or maybe having to think about normal screenings and testing that we often have to add to our medical care list of things to do when we reach middle age and, Jodi, I'm at that age right now, so I know pretty well what they are. For example, I recently had a colonoscopy. Dealing with the screening, the day of, the prep, it's a lot. It's challenging for somebody without diabetes. Imagine adding diabetes into the mix. It can be extremely challenging. And people with type 2 diabetes need us and the guidance we can provide to keep them safe. When we are caring for a person with type 2 diabetes, the first thing we want to know is, you know, what is of the utmost concern to them at that time? And that's where we start, always keeping the person and their care needs and learning needs and concerns at the top of our list to cover with them at each interaction.
Jodi
Oh yes, that is critical because how can you individualize care if you don't know those things? So, when it comes to insulin delivery in the context of type 2 diabetes, what factors do you think we should consider to truly personalize their care?
Lucille
That's a great question, Jodi You know, we often get many questions about insulin, especially in the context of its use in type 2 diabetes. I always like to remind people living with type 2 diabetes that it is the disease of insulin resistance and keeping that in mind. That means that for many, they may eventually require insulin. And they may need more insulin to either lower their blood sugars or maintain their blood sugars compared to someone that may look like them, however though living with type 1 diabetes. So, because of this fact, we need to think about insulin delivery devices that meet this need for greater insulin requirement throughout the day. This could be different insulins, insulin delivery devices that can accommodate for a larger amount of insulin, such as maybe a larger insulin reservoir in an insulin pump. These specific accommodations for the increased need and requirement for insulin allow for the better quality of life for individuals with type 2 diabetes because it lessens the time they have to interact with that device. And anything we can do to lessen the burden of living with diabetes is always going to be our goal and our mission.
Jodi
So it's interesting how you put into context the difference between type 1 and type 2. I like how you put that in perspective. It helps us think about this topic in a different way. And I'm wondering if you could tell our listeners a bit more about the burdens of diabetes in this context.
Lucille
Oh sure. You know, Jodi, this is such an important topic. And I'm happy to say that we're beginning to see more articles and just basically more information in general being published on this topic. Practitioners and caregivers are learning that patient satisfaction, patient reported outcomes, such as how a person feels about living with their diabetes or what they need to do during the day to be successful living with their diabetes is truly as important to them as the type of medication or device that they are prescribed.
When we talk about the burden of living with diabetes, I would say, for a few examples, let's say, looking at a person and trying to ease or lessen the daily tasks they need to do each day to live successfully with their diabetes. And this could be seeing their practitioners, filling prescriptions, checking their blood sugars, planning their meals. How about planning their activities in their day, their work schedule around their diabetes tasks. Being prepared for highs and lows, I can go on and on. There are just too many to name. However, when we as practitioners and caregivers understand that there are many burdens and being able to have these conversations with our patients, we can begin to empathize. Sometimes it means thinking outside the box to make life with diabetes easier, such as offering an insulin pump with a larger reservoir to increase the number of days somebody can go between pump changes. Or I remember going back many years, I remember when the first pump clothing came on the market and how that really eased the burden of somebody sleeping at night, having to be able to put it into their nightgown for adults and for children. So, so much can be done in this area.
Jodi
Yeah, those are really good examples. Thanks for bringing those to our attention. Now I wanted to turn to the current landscape of technology use among people with type 2 diabetes because I feel like that also puts things in perspective around this topic.
Lucille
Oh it certainly does. I'm so glad you asked this, Jodi. Because this is another interesting subject to talk about because believe it or not, a recent survey showed that less than 28% of practitioners today actually prescribe diabetes technology to individuals living with type 2 diabetes.
Jodi
What's that percent again?
Lucille
Less than 28%. And I know that sounds surprising, but it's true. However, I believe we are starting to see a positive change. And I always like to talk about the more positive things. That might be a fact, but it is changing. You know, unfortunately, some practitioners do make decisions based on biases such as, well, the patient may not have the latest cell phone. So by looking at that, sometimes it's an assumption. Well, they're not going to be interested in technology or they can't use technology because, you know, they have an old cell phone. When in fact, some pumps and sensors don't even need a cell phone to operate it. So the good news is, is that again, staying on the positive. We are seeing a concerted effort to reach out to primary care and family practice physicians to assist them to learn more about diabetes technology, to help them embrace this technology and ultimately prescribe it. We are turning the tide that diabetes technology can be for all people living with diabetes. And each person should have access instead of maybe just one group or one type of diabetes. We understand that some people may not want to wear a device or may not be able to afford some of the diabetes technology that's available on the market today. However, we must, must at least offer it to everyone. This decision to use or not to use diabetes technology should be the person's decision, right? Our role as healthcare professionals is not to determine who can or cannot use diabetes technology, but yet our role is to ensure everyone sees them, learns about the benefits, and then gets to decide for themselves if it's right for them. Make sense?
Jodi
Oh my gosh, does it ever. This is such an important point, and I'm so glad you brought it up. I mean, this is in the health equity realm. We need to pay attention to this. It's very, very important. I'm wondering what you think the role of the diabetes care and education specialist can play in impacting access to diabetes technology for people with type 2 diabetes. So how can we help?
Lucille
I love this question because as a DCES, I'm very passionate about our role. It's very important first that all DCESs and practitioners first recognize that the landscape is not equal right now for people living with type 2 diabetes.
Jodi
That's unfortunate, yes.
Lucille
But once we acknowledge it, Jodi, we can then act on it. And the action part is simple. Don't assume anything about a person, such as they can't use technology or that their insurance won't cover it, or they can't afford it. Don't assume. Yet instead, educate and inform. Tell and show every person what's on the market available to them. They choose to take part. That's great. If not, respect their decision. Now though, if they do decide to engage with technology, then it's back in our hands to ensure we provide education and training that is tailored to them, the individual. The time that we take to train and educate and the way we train and educate may or should look differently for everyone. The end goal is for the person with diabetes to be successful, whether we're talking about their care, their medications, or their technology, the more confident they feel in managing their diabetes, I believe the more successful they will be.
Jodi
I agree wholeheartedly. I think that's very important. And you know, Lucille, technology is great, but there are still important educational needs around the use of technology, as you mentioned. And of course, we try to meet the individual where they are, but for example, I used to see people who did not rotate their insulin delivery sites and they developed lipohypertrophy. And this challenge to insulin delivery is not often spoken about, but it is so important. I know that in my previous practice, it made a huge difference when I discovered it and corrected it. So how do you see diabetes technology impacting the development of lipohypertrophy in people using insulin? And you may need to give our audience a little review on what that is and what it means.
Lucille
Sure, absolutely. So, lipohypertrophy is a lump of fatty tissue under the skin caused by repeated injections in the same place. It's common with people with diabetes, and lipohypertrophy can affect the body's ability to absorb insulin and can cause serious complications. We see this often in individuals who have what they may refer to as their favorite spot on their body where they inject insulin or maybe place their insulin pump sites, right? Unfortunately, when this fatty tissue develops under the skin, the body cannot absorb all the insulin properly and often creates the need for higher insulin doses. The risk here is when the person does move that injection site or that pump site to, let's say, a new spot, they can experience hypoglycemia or low blood sugar. Both practitioners and people living with diabetes can check their skin for this. It is critical to feel the skin. I used to do this for all of my patients when they came in. Feel their skin, look at their sites, take your fingers, put it on their skin and feel for lumps and bumps. If you notice these, then you'll want to inform that patient and educate the patient to avoid injecting into this area until this resolves, which could take months to happen, but it can go away. We don't want to keep using that spot. If the patient is not sure if they have lipohypertrophy, we always recommend, when in doubt, ask your practitioner, ask your diabetes specialist to look at your skin and to assess that for you. And that's the role that we can play to provide education and guidance to them if we do notice this, but also teach them how to also feel their own body, right? Because the best way to prevent lipohypertrophy, Jodi, is to make sure we remind our patients to rotate injections and pump sites between changes. Move them around, give each prior location a rest, and try not to come back to that spot or within two inches of that spot for a few days. I hope that helps.
Jodi
Absolutely. I love talking about this topic because it's more important than people realize.
Lucille
Yes,
Jodi
I'm glad we were able to include it. So Lucille, we've talked about offering technology and not assuming that someone can't take advantage of that, you know, in personalizing care for people with type 2 diabetes. We've talked about the factors that we should be considering. We've talked about the burden of diabetes for these folks, the current landscape of technology use, and many more things in this conversation, which has been great. So now I wonder if you have any closing thoughts you'd like to share?
Lucille
Oh Jodi, this was so wonderful to spend time with you today and discussing the needs for people living with type 2 diabetes, because as we mentioned throughout the whole podcast, it's such an important topic and we really want to bring to the forefront their unique needs. We need to keep empowering people with diabetes to have these conversations with their healthcare practitioners and encourage practitioners to have these conversations with their patients living with diabetes. And podcasts like these are yet another way to spread the word and raise awareness. This is another reason why, Jodi, I'm so grateful for ADCES for making this podcast possible and for talking about this important subject.
Jodi
And Lucille, thank you for taking the time to join us for this episode of The Huddle and for sharing your knowledge and experience with our audience. As a diabetes care and education specialist myself, I know how useful this information is for practice. So, I'm sure our listeners really appreciate hearing your perspectives on this topic. Thank you so much, Jodi.
Well, thank you again to Embecta for their support of this episode and thank you for tuning in to this week's episode of The Huddle. Make sure to download the resources discussed in today's episode. You can find them linked in the show notes at adces.org/podcast. And remember, ADCES membership gets you free access to resources, education, and networking that improve your practice and optimize outcomes for your clients.
Learn more about what ADCES can do for you at adces.org/join. The information in this podcast is for informational purposes only and may not be appropriate or applicable to your individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a healthcare professional. Please consult your health care professional for any medical questions.