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Education, not moderation: Assault on diabetes focuses on lifestyle

By Bob Buckel | Published Saturday, June 21, 2014

”Moderation in all things, and all things in moderation.”

That may be a good philosophy in some ways – but it is not Dr. Brad Faglie’s motto.

Dr. Faglie, a board-certified family physician, does not recommend moderation when it comes to attacking diabetes – a disease that is attacking Wise County residents in increasing numbers.

Teaming Up

TEAMING UP – Chris McKown (left) with Renew Home Health and Dr. Brad Faglie discuss a case earlier this week. Diabetes is the seventh-leading cause of death in the United States and the sixth-leading cause of death in Texas. It’s estimated that 10.6 percent of Wise County’s population has diabetes, and that number is projected to rise to 17.1 percent by 2020. Messenger photo by Joe Duty

“It all boils down to diet,” he said Monday as he waited for the monthly diabetes support group members to arrive at the classroom on the second floor of Wise Regional Hospital. “When all else is said, it’s what we eat.”

What Americans eat is killing them. Dr. Faglie should know – he used to weigh 290 pounds.

He also used to have diabetes. He no longer has it, and today he approaches diabetic education with a zeal that borders on evangelistic.

“I run into a lot of misconceptions,” he said. “That unhealthy food is OK in moderation – they’ve been told that.

“That’s being overturned slowly. The research is out there, but the interpretation of the research is just now coming out into the mainstream. Unhealthy food is not healthy in any amount. It’s not OK.”

The support group, sponsored by Wise Regional, Renew Home Health and the Wise and Montague County Medical Society, has been meeting since January at 6:30 p.m. the third Monday of each month – but it’s not the only way the local medical community is attacking diabetes.

Dick Gilley, R.N., a board-certified critical care nurse, works in the ICU at Wise Regional and Baylor. He’s also diabetic and a certified diabetes educator.

“I work with people individually and as a group,” he said. “I teach a group class on Thursday nights – I had eight people for the spring, and I’ve got 25 for the summer.”

The monthly support group is open to all, but a doctor’s referral is required to get into Gilley’s class.

“When we get our program certified, it will be billable to Medicare, Medicaid and private insurance – and it bills at 100 percent because it’s preventive care,” he said. “Right now, we’re working with grant money, and it’s free.”

The program’s application for national certification went in the mail last Friday.

“To be where you can be certified in six months, I’m very proud of that,” Gilley said. “We started with nothing.”

Nothing but need, according to the statistics.

A GROWING MENACE

Diabetes is the seventh-leading cause of death in the United States and the sixth-leading cause of death in Texas. It’s estimated that 10.6 percent of Wise County’s population has diabetes, and that number is projected to rise to 17.1 percent by 2020.

“It is truly an epidemic of the worst proportion,” Dr. Faglie said, citing a sharp uptick in cases in just the six years he’s been practicing medicine. “I’ve actually seen the rise in diabetes and its associated symptoms – obesity, hypertension, hyperlipidemia, heart disease – at younger ages.

“I have 13-year-olds who are getting diagnosed with type II or adult onset diabetes. It’s crazy,” he said.

Diabetes is a serious illness that can and does kill. It’s the primary cause of death for 71,382 Americans every year and contributes to the death of another 231,404.

“Diabetes affects every system,” Dr. Faglie said. “Chronically elevated blood sugar affects the small blood vessels in all systems, so diabetics typically experience chronic kidney disease, peripheral neuropathy, leg swelling and therefore ulcers and subsequently, amputations.

“Their vision goes because the blood vessels in the eye are affected,” he said. “Heart disease, the small blood vessels around the heart, and then, dementia. It’s a difficult illness to treat, and it’s become more and more serious.”

Many of the folks in the support group have just been diagnosed. Faglie’s goal is to get them to make immediate and drastic changes in their lifestyle.

He recommends a “paleo” diet that takes humans back about 10,000 years, before food began to be processed.

“What I tell people is, if you can’t pick it, peel it or kill it, it’s probably not healthy,” he said. “If it’s got any sort of processing that takes place in the preparation of that food – such as bread, the milling of grains – it’s not ideal.”

Processed and refined carbohydrates – not just sugar, but bread, rice, pasta, cookies, chips – are the big offenders.

“Essentially, that’s why people are diabetic,” he said.

“Honestly, the patients who are diebetic aren’t bad about eating cherry pie every day. They’ve largely cut out the obvious. It’s the things they’re told they can have in moderation, like bread, that are hard to cut from the diet.

“But that perpetuates it, keeps the diabetes going and even worsens it.”

EDUCATION, BLOOD TESTING THE KEYS

Community-wide education and regular blood testing are making a difference, Dr. Faglie said. He enjoys the classes, where there is a lot of question-and-answer time, because they allow him to teach when he’s not trying to also keep up with a schedule of patient appointments.

Chris McKown of Renew Home Health said some people come straight to the group within days or hours of their diagnosis.

“Most of the people, if they are coming under home health, they have us to teach them,” he said. “But somebody who’s not, the only real education they get is with their physician, in the office – so they run into a time constraint.

“With this program, they can come in, ask questions – it’s been really great. The first one we had was seven people, then 15, then 20, then 28. Every month, it’s grown.”

For most, the diabetes diagnosis comes as a result of a routine physical that involves a blood test. The key number is the hemoglobin A1c.

For people without diabetes, the normal range is between 4 and 5.6 percent. Hemoglobin A1c levels between 5.7 and 6.4 percent indicate an increased risk of diabetes, and levels of 6.5 percent or higher indicate diabetes.

“A lot of people feel normal, but the blood work shows an elevated A1c,” Dr. Faglie said. “Some people come to me for neuropathy – that’s tingling in the legs – or a lot of times they have fatigue, they just don’t feel like they felt 10 years ago.

“And then a lot of times they have spouses who bring them in,” he said. “They see how they eat, and they just know something’s wrong.”

The ultimate goal is to prevent diabetes.

“We want to try to catch the younger crowd,” Dr. Faglie said. “Unfortunately, diabetes doesn’t just hit – it grows over the course of years and decades.

“It grows out of a lifestyle, and lifestyle modification is the only true treatment for diabetes.”

CLASS TIME

That’s why a class, a support group – education – is such a key element of the attack.

“A lot of people were coming to the diabetic education classes, and they expect to learn how to use their pump, how to use their insulin, how to take more medicine,” McKown said. “This is completely different. They come and start learning how to eat, how to do even better, and some of them do that very well.”

As Dr. Faglie starts Monday evening’s class, he asks the group, “What is diabetes?”

“Something you don’t want,” says one woman, drawing nervous laughter.

“The inability to make insulin,” says another, and the doctor says yes, but he still wants more.

“The inability to process sugar,” comes the answer.

“That’s right,” he says. “Adult-onset diabetes is the inability to process sugar – or more specifically, carbohydrates.”

And although carbohydrates are the fuel your body needs to produce energy, research is showing that processed, refined carbohydrates are the culprit in diabetes and possibly other diseases.

He draws a modified “food pyramid” on the whiteboard.

“This is what I recommend my patients eat: meat, veggies, beans, nuts, dairy – minus milk – then fruit,” he says. “The carbohydrates in these groups are not bad.”

He said that after years – decades – of processed carbohydrates, the body becomes less able to process that, and the result is chronically elevated blood sugar.

“Basically what happens is, your cells get inundated with too much blood sugar for too long,” he said. “They start pulling those sugar receptors out of the cell walls, and you become insulin-resistant. That’s hard.”

He recommends cutting those carbs out completely.

“If food is unhealthy, it’s unhealthy,” he says. “This food group is really not OK in moderation.”

And when you think about it, that sounds right.

Attacking a killer is no time for moderation.

For information about the Diabetes Support Group at Wise Regional Helath System, call Chris McKown of Renew Home Health at 940-395-7205.

DIABETES AT A GLANCE

  • Nearly 26 million children and adults in the United States have diabetes.
  • 79 million Americans have prediabetes
  • 1.9 Million Americans are diagnosed with diabetes annually
  • Nearly 10 percent of the U.S. population has diabetes, including more than 25 percent of seniors.
  • As many as 1 in 3 American adults will have diabetes in 2050 if present trends continue.
  • The economic cost of diagnosed diabetes in the U.S. is $245 billion annually.

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