Paul Szmal: Good morning, it's 816, it's the Friday Extravaganza on FLX Morning. It's our regular monthly visit with Finger Lakes Community Health and joining us this morning is Karla Jensen. Good morning.
Karissa Jensen: Hi, it's Carissa. I'm sorry, yes, of course it is. I can read. Carissa Jensen, you are an RN, an MSN, and a CDCES. What does that last one stand for?
Paul Szmal: Certified Diabetic Care and Education Specialist. And that's what we're going to talk about today. November is Eye Disease Month and there's one pretty serious one called Diabetic Retinopathy. So let's start with a basic rundown of what diabetes is and how it can affect the eyes.
Karissa Jensen: So diabetes is a disease that, you know, is caused by elevated blood sugars. Generally we have type 1, type 2, and then we have gestational diabetes that affects some of our pregnant women. The more serious ones that are affected by diabetic retinopathy are type 1 and type 2. In type 1 patients, our pancreas stops working and is no longer producing any insulin, whereas in type 2, it is still working and producing some insulin, but our body is more insulin resistant. Type 2 is generally the one that is diagnosed later in adulthood and is, you know, 90 plus percent of the population of diabetics is type 2 diabetics.
Paul Szmal: And of course, the lifelong battle for diabetics is regulating that blood sugar level, and when that gets too high, that's one of the things that can lead to these eye problems, right?
Karissa Jensen: Absolutely. It can lead to not only eye problems, but kidney problems, increased risk of stroke, heart attack, and nerve problems in our feet and our hands.
Paul Szmal: So what are some of the things to watch for? Because obviously this is something where if you see any sign of any symptoms at all, you better act quickly.
Karissa Jensen: So in regards to diabetic retinopathy, the unfortunate thing is sometimes it can go unnoticed. Patients will have no symptoms at all, which is why we encourage yearly exams to monitor for the development of it and monitor progression of it. But if you have any changes in vision, blurred visions, you're seeing dark spots, floaters, anything like that, definitely should see your primary care doctor, or if you're established with an eye doctor, get in to see them and let them know that you have diabetes so they can make sure that the appropriate tests are being performed.
Paul Szmal: Now those who are diagnosed with type 2 diabetes get this screening immediately. Tell us about the screening and how it works.
Karissa Jensen: Yes, so when you're diagnosed with type 2 diabetes, we encourage the screening to be almost immediately and then yearly thereafter. With type 1 diabetics, it's a slower progression, so they are screened usually within 5 to 10 years of diagnosis, depending on their age. So the screening process that we can perform right here at Finger Lakes Community Health is we come in and we take about six internal pictures of your eyes. It looks at your retina, your blood vessels, all the different parts of your eyes, and then two external pictures. Here at Finger Lakes Community Health, we send those pictures to an ophthalmologist who reviews them. We usually have those results within 24 to 48 hours, and if they need, if patients need a referral to an ophthalmologist for further evaluation, we'll do that right here in the office. Our machines allow us to do a lot of the exams without the need to dilate. Oftentimes in the ophthalmologist office, they do dilate, and that just relaxes the eye muscles and allows us to get better pictures and the pupil to open up more. So we can dilate here in the office if a patient needs the dilation, but it's not always required.
Paul Szmal: Interestingly enough, this sounds like just what I did yesterday. I had an annual eye exam, and I had a small retinal tear repaired with laser surgery a few years ago, so it's important I get that checked every year, and that's what they did was that photo thing. Well, we did both in my case, the drops for the dilation, and there's this relatively new machine that just, like you said, takes photos of the eyes.
Karissa Jensen: So what are the ways to try to prevent this? If you're a diabetic, beyond your normal daily regimen of care, is there something you can do to make sure this doesn't happen?
Paul Szmal: There's not really anything that you can do to make sure it doesn't happen. You know, we encourage the yearly screenings more frequently if you are diagnosed with retinopathy, so we can monitor things closer, but the best way to prevent diabetic retinopathy from developing is to just control those blood sugars as well as you can. You know, make sure you're taking your medications as prescribed, make sure you're monitoring your blood sugars at least twice a day, if not more frequently, and lifestyle changes such as following a healthy, low-carb, high-protein diet, and exercise are all good to not only protect our heart, but prevent those high blood sugars.
Karissa Jensen: And of course, we always talk about the effect of diet, and having a good diet affects a lot of things positively. So what does this diet look like in terms of what you should eat and how much of it?
Paul Szmal: So generally for our diabetic patients, we encourage a diet that's high in protein and high in fiber, so high in our lean proteins, which can be in meats, beans, nuts, legumes, or and a high-fiber diet, which is our fruits and vegetables. And we don't tell patients, we don't say that, you know, you shouldn't eat carbs, you know, because we do need carbs, that is a main energy source of our body. We just encourage more complex carbs versus, you know, the simple carbs that we find in, you know, our sweet treats.
Karissa Jensen: And a good thing to remember, whether you're a diabetic or not, when it comes to healthy eating, is eating your foods in order. So when we eat our proteins and our fibers first, so our meats and our veggies, or if you're a vegetarian, your other forms of proteins, when we eat those first, those act as a cushion in our body when we eat the carbs, and that just helps those blood sugars break down more slowly in our body, so we don't see the spikes. And that's good for both diabetics and non-diabetics, because oftentimes when we get those spikes in blood sugars from eating a lot of carbs, that's then followed up with the crash, which is why we feel tired and we run out of energy, you know, we kind of want to take that late afternoon nap.
Paul Szmal: Yeah, wow, I don't think I've ever heard that before, so remind us again, what order to eat these foods in? That's new information for me.
Karissa Jensen: So it's your proteins, followed by your fibers, and then your carbs. You know, so not only does it help manage those blood sugars, but it also, you know, if we're filling up on protein and fiber, then we're going to eat less of those carbs anyways. And the protein is what helps with muscle mass and just stabilizing those blood sugars long-term.
Paul Szmal: We're talking this morning with Carissa Jensen from Finger Lakes Community Health, which offers health centers all throughout our listening area. You're not far away from one if you're listening to this. We're talking about diabetic retinopathy, so if a patient of Finger Lakes Community Health is diagnosed with diabetic retinopathy, explain how you find them the care they need.
Karissa Jensen: So we, if a patient is diagnosed with diabetic retinopathy here in the health center, you know, we'll receive that notice from iPax, which is the company that reviews our images, and then we'll get them set up with an ophthalmologist or an eye specialist in the area, depending on where they're located. You know, here at Finger Lakes Community Health, we like to help patients with transportation and make sure all of their needs are being met so we can help them get set up for transportation. If there isn't a local eye center that accepts their insurance, they need to go further. But it's, it's really just generally making a phone call and saying, you know, we have this patient come in. They were diagnosed with diabetic retinopathy. Patient signs a form that says we can release that information. We send it over to them and we get them scheduled for an appointment.
Paul Szmal: And of course, in general, for diabetics, you have a diabetic care team at Finger Lakes Community Health that can help them find what they need and, like you said, take care of some of those logistics and things as well.
Karissa Jensen: Yes, absolutely. We developed the diabetes care team. I joined it about a year ago. We have a pharmacist and then a nutritionist that helps out with a couple of our health centers as well. And it seems to help our providers get more hands on the patients because, you know, our providers are seeing so many patients that, you know, and they're trying to manage so many things that by having the diabetes care team that can focus on, you know, the medication, the lifestyle changes, and the overall management of these patients, just allows these patients to have more support and care and hands on. You know, we also provide education that's recommended by the American Diabetes Association through this care team program at Finger Lakes.
Paul Szmal: Learn more about this topic and others at the website localcommunityhealth.com. And again, I keep losing track. Is it eight or nine health centers now?
Karissa Jensen: I believe it is eight. I'm pretty sure.
Paul Szmal: I always forget whether it's eight or nine. I'm pretty sure it's eight. They're all around our area, including one just about a mile away from where we sit here in Geneva. Carissa Jensen has been with us this morning talking about diabetic retinopathy. Thanks for the great information, especially that order of eating foods. I had never heard that before, so that's great for anybody.
Karissa Jensen: Thanks. Yes, thank you. Have a great day.
