As the chief of endocrinology of the Hospital of Central Connecticut in Southington, Dr. Manmeet Kaur said that comprehensive diabetes treatment “takes a village.”
Diabetes treatment is divided into four pillars of care: lifestyle modifications, diabetes education, glycemic management and medication management. She explained that the ultimate goal of care is to provide education and personalized support. By working on creating specific goals and changes, Kaur said that patients can get accustomed to their new life with a chronic condition.
"You have the clinician, but the model should be not only the clinician," she said. "There should be a clinician, a social worker and a psychologist to put all this care in this comprehensive model."
For Maritza Hernandez, her village came in the form of Meriden’s Community Health Center community health worker and diabetes educator, Leo Ortiz.
When she was diagnosed with diabetes during her pregnancy 18 years ago, Hernandez said she immediately went to the library to learn more about the disease. However, Hernandez said that her in-depth Google searches were bare compared to the education she received from working with Ortiz for the past four years.
Hernandez explained that Ortiz helped her understand how different foods are broken down in her system, potential complications, and how to administer insulin. They also developed sustainable exercise habits.
Within six months, Hernandez said she lowered her A1C levels from 14.8 to 6.3 and lost over 40 pounds.
"I had to be taught how to be a diabetic because for me, I didn't know," she said. Statistics and care
Elizabeth Caffrey, a diabetes educator for the Hartford HealthCare Medical Group, said that when someone comes into her office with high blood sugar levels, the patient typically says they feel "totally fine.”
Caffrey said that her patients would then begin describing symptoms they don't realize are caused by their diabetes, such as constant thirst, changing vision and waking up to use the bathroom throughout the night. However, it isn't until after they've lowered their blood sugar for the first time did they realize the impact that untreated diabetes has had on them.
An estimated 11% of Connecticut residents were diagnosed with diabetes in 2021, according to the Centers for Disease Control and Prevention.
In addition, the state Department of Public Health found that in 2018, 35% of residents were pre-diabetic, but only 10% knew.
"A lot of people just assume that they're more tired because they're older, or they're working harder, not that their glucose levels are more elevated," Caffrey said. "So as we get them back into a good range, they have more energy, they get better sleep, everything starts to go a little bit better for them."Knowledge is power
Learning to live with diabetes takes time, money and effort and newly diagnosed diabetes patients often don't know where to start. Still, once patients have the foundations of diabetes care, they can make significant positive changes for their health, said Jennifer Morales, a community health worker for the Hispanic Health Council based in Hartford.
In 2015, the Hispanic Health Council partnered with Wheeler Clinic to study community health workers' impact when working with low-income, Latino diabetic patients in Connecticut.
Morales explained that the study aimed to bring personalized diabetes education and resources to their clients as they work to understand their disease.
"Knowledge is power, and a lot of people don't know the necessary things that they need to do," she continued.
Over 17 home visits, each session focused on a different aspect of type two diabetes and disease management, such as complications, healthy food choices, medication adherence and blood glucose self-monitoring, according to the study's final report.
Morales said that she would help her clients clean out their pantries, set manageable physical goals and practice properly administering diabetes medications. In addition, they would take the education outside the home by grocery shopping with her client to learn how to read nutrition labels and find healthier alternatives to their favorite foods.
Morales said the visits also allowed the community health workers to better understand their client's social determinants and find creative ways to address them. For example, if her client didn't have food at home, she would connect them with nearby food pantries with healthy options.
The study concluded that the community health workers positively impacted clients' adherence to medication and helped lower the severity of the disease among their clients.
"The more they know about what they needed to do, they will make those changes," Morales said. Food and exercise
As a certified chef and Puerto Rican, Hernandez said changing her diet was one of her biggest challenges. However, she has found ways to compromise.
From soaking rice to investing in an air fryer, Hernandez changed her relationship with food through discipline and dedication.
Hernandez said she spends almost an hour and a half in the grocery store whenever she goes. She takes a low-sodium food list and reads every nutrition label for their sodium and sugar content. Then, she ensures her shopping cart is full of organic fresh fruits, vegetables, and veggie chips.
"I have to learn how to stop putting poison into my body," she said. "I don't eat McDonald's. I do not eat at Burger King... I don't eat anything that is not healthy for me anymore."
She also substitutes typical ingredients for healthier alternatives and finds new ways to prepare classic foods. For example, Hernandez uses raw cane sugar instead of white table sugar when making her daughter's favorite strawberry cheesecake.
"I can make your cake and you swear you think I put sugar in it and there's nothing in it," Hernandez said.
When she's in the mood for pollo frito, Hernandez turns to her air fryer or oven rather than a pot full of boiling oil. She said her friends are often shocked when they eat her food and realize it wasn't fried, even though it has the same texture and crispiness.
However, she said that she doesn't deprive herself of the foods she enjoys, but somewhat limits the portion and fills the rest of her plate with healthy food.
"You can have rice but put more salad on your plate -- less rice and less meat. That's it," she said.
Regarding exercise, Hernandez said that she often walks to Farmington from her New Britain apartment and back.
At the beginning of her health journey, Hernandez said that she was going to the gym three times every day to use the treadmill and lift weights with Ortiz. However, when the pandemic shut down the gyms, Hernandez said she turned to long walks and hiking trails as her primary source of exercise. Medication, outside factors
Diet and exercise are not the only treatment paths as there are often external factors that affect a patient’s ability to live with diabetes.
Chief Executive Officer of CT Health Foundation, Tiffany Donelson, explained that the racial disparities among diabetes diagnoses are driven by numerous social determinants that affect the health outcomes of communities of color throughout the state, such as unstable housing and food insecurity.
The DPH also reported that Black and Latino residents are almost twice as likely to be diagnosed with diabetes in 2018.
"People of color are less likely to have access to healthy food… [and] they are less likely to have a regular source of healthcare," Donelson said. "Oftentimes communities of color are in places where folks may not feel safe to walk outside."
In addition, since treatment for type two diabetes typically centers on lifestyle changes in regard to diet and exercise, a patient's personal financial and social situation will impact their ability to manage their disease.
Stephanie Parmlee was diagnosed with type two diabetes in 2015 after suffering a severe heart attack. She is a long-time Meriden resident and Ortiz's former client, as well as a self-proclaimed coffee head and avid snacker.
She said she struggled with remembering everything she needed to do to be healthy, like counting carbs and checking her insulin levels before eating. However, she said that her new insulin pump has helped her manage her disease and bring it under control for the first time.
Parmlee said switching her diet was relatively painless since she already liked fruits and vegetables, but struggled with accessing healthy food.
She explained that she lost her apartment to a fire in 2019 and has been living in hotels with her daughter and granddaughter. She said they only had a mini fridge to store healthy foods and no place to cook.
Despite the limited space, Parmlee said that they would try to cook to have healthier meals and save money on takeout. So they invested in a skillet, a rice cooker, a slow cooker and plates.
Parmlee said they also bought two mini fridges to increase their storage space. She estimated they would cook three times a week.
Since money was tight, Parmlee said that they would often need to get canned foods for the kids and she'd have cucumber pieces and cheese to at least eat something healthier that isn't full of sodium and sugars.
"Because we are in a hotel and the refrigerators are so small, it's harder to keep [fresh fruits and vegetables] in stock as opposed to having a real kitchen," she said.
Since her diet was in constant flux, Parmlee relied on her insulin pump to help her manage her diabetes. She explained that the pump continuously monitors her sugar level and vibrates whenever it is abnormally high or low. Parmlee can then see the numbers, which can help her pinpoint what she needs to do to stabilize the levels.
Parmlee said that her A1C went from 13 to six in less than a year with the pump.
"You look at the pump, it gives you the numbers, you put in your carbs that you're going to eat or drink and it does the insulin for you," she said. "So it's not like you have to figure out numbers and figure out what to do. It just made my life so much easier."Find support
Diabetes also affects mental health, said Caffrey, diabetes educator for Hartford HealthCare Medical Group.
Known as diabetes distress, she explained that individuals living with diabetes may feel overwhelmed by the drastic lifestyle, diet and medication changes.
From calculating how many carbs you need to eat to balance out sugar levels to committing to a workout routine, it takes a lot of work to manage diabetes. Caffrey said that people with diabetes might constantly worry about the disease's impact on their body and how their next meal may affect them.
"The mere fact that someone has to get up on a daily basis and really think about what they're eating, especially if they are on medication where they're matching up the medication to what they're eating. It is a lot of work," she said.
Parmlee said that she has never been a person that asks for help until her diabetes forced her to accept help.
Parmlee said she was overwhelmed by her disease the time she met Ortiz and was on the verge of giving up. She had just lost her job of 11 years, was experiencing homelessness and was severely depressed.
Although initially hesitant to accept Ortiz's help she ultimately did so for the sake of her children and grandchildren. Parmlee said that her conversations with Ortiz helped her understand what was going on and never felt judged for her emotions.
"[Ortiz said] 'I understand you don't really want help Stephanie and you're a little embarrassed, but it's okay to need help…and have somebody hold your hand while you're going through this,'" Parmlee said. "So the first time in my life, somebody made me that comfortable. To where I gave her everything I had in my heart and in my soul to get back on my feet."
Parmlee also turns to her family for support and motivation. She said that her daughter has been involved in her diabetes treatment from the start. For example, Parmlee said her daughter would often call her as a daily reminder to check her sugar levels. Similarly, her granddaughter knows how to check Parmlee's sugar levels and knows how to react if the levels are abnormal.
Although she still struggles with her mental health and diabetes maintenance, Parmlee said she finds the strength to keep pushing through and watch her grandkids grow up.
“I want to be around for them,” she said. “I want to be there for them when they graduate or when they make big life changes when they get married. I'm just trying to be there.”
Health Equity reporter Cris Villalonga-Vivoni is a corps member with Report for America, a national service program that places journalists in local newsrooms. Support RFA reporters at the Record-Journal through a donation at https://bit.ly/3Pdb0re. To learn more about RFA, visit www.reportforamerica.org.