Well, here we are. In the last place that many, me included, would expect me to be, the newest president of the Association of Diabetes Care and Education Specialists. I want to first start by saying “Thank you!” for selecting me to lead our association. Your show of confidence and trust in my leadership abilities means a lot to me.
So, what should I tell you about myself as we begin our journey through this next year? How did I get here? What is my connection to the specialty? What are my goals for the next year?
For starters, I am the second oldest of 9 children; therefore, leading and caring are second nature to me. I have 3 sisters and 5 brothers, and I am the “favorite” aunt to my 13 nieces and nephews.
I am an assistant professor at the University of Texas Cizik School of Nursing in Houston, Texas. My clinical practice at MD Anderson Cancer Center allows me to use my skills as a diabetes care and education specialist to positively influence diabetes-related outcomes for people with diabetes/hyperglycemia and cancer.
My journey to this stage of my career in diabetes care and education has been a thoughtprovoking one. During my childhood, I would often hear my grandmother talking about checking her blood sugar and taking her insulin. This was a woman who could bake the world’s best caramel cake (in my world at least), eat a healthy portion, and still have a blood glucose reading close to target. She was a firm believer in the “healing power of food,” so if you were not “a good eater,” she had a remedy for that—Father John.
Over the years, many of my family members were diagnosed with type 1 or type 2 diabetes: my aunt, my mother, my cousins. I watched how they were treated by those who were involved in their care. There were 2 incidents that were particularly striking to me. After having diabetes for about 20 years and injecting insulin for several years, my aunt passed out at home one day and was found to have blood glucose of <30 mg/dL. She was never the same. We have no idea how many episodes of hypoglycemia she had before that day, but following that event, she had significant memory loss and later dementia. Another situation that struck me was the death of my cousin at the age of 18 following an episode of severe hypoglycemia. His mother found him, but she did not have glucagon readily available to administer.
I wondered why these avoidable incidences occurred. For me, it came back to education and caring. Did the providers ask questions about prior episodes of hypoglycemia? Were they instructed on the treatment of hypoglycemia? Did they have access to a diabetes care and education specialist? Were they offered technology that could have alerted them to impeding hypoglycemia? These unfortunate and avoidable occurrences sparked my passion for the care of people living with and at risk for diabetes.
Now that wasn’t the only reason to begin this journey. I had other motivations. I completed my MSN in 1999, and after being a nurse practitioner for several years, I was invited to work in a large outpatient clinic in inner-city Detroit. I was informed by my boss that there were 15 000 people with “poorly controlled diabetes” and that we needed to come up with a plan to improve our HEDIS scores. I am all about a challenge!
Over the next several years, I would work closely with my physician colleague and a nurse and a dietitian who were “certified diabetes educators” to create a diabetes health enhancement clinic to allow one-stop shopping (physician, nurse, dietitian, podiatrist, and eye specialist) for people living with diabetes. Working with this patient population led to my taking and passing the certification exam, and the rest, as they say, is history.
Over the next year, it is my goal to draw attention to the impact of unconscious bias on the care that we provide to our patients/clients/customers and their families. Unconscious bias can impact all aspects of care for people with or at risk for diabetes, from dietary and physical activity recommendations to technology and health care referrals. For continuous glucose monitoring, underlying bias based on what we think we know about the person may lead us to believe that they can’t afford it or that they don’t have the skills to use it. It can also come into play when considering people with diabetes for automated insulin delivery devices. Our bias about what a pump candidate “looks like” can hinder people with diabetes from benefiting from the technology.
Many times, we think of bias as an aversion to things that we “just don’t like,” whether it be people, foods, climates, and so on. Unfortunately, bias runs deeper than that. Bias gets at the heart of thoughts and opinions that we formed early in our creative years, that have grown and flourished or died a natural death depending on how attentive we have been to them. Unconscious bias is the deep down (undercover) feeling that we have about things. I often share that I don’t like okra. This stems from my childhood when my mother placed that slimy, prickly green vegetable on my plate and expected me to eat it—not going to happen. Not then, not now! I am biased against okra.
Food aside, let’s talk about our deep-seated feelings and ideas about people, their background, their economic status, the color of their skin, the cadence of their speech, yada yada yada. You get the idea: how these things impact, how we react to them, and how we care for them. My goal and desire for us as diabetes care and education specialists is that we remove the lens through which we see the world to see clearly the person who is sitting in front of us. This will allow us to address “their needs” without “our bias” influencing the tools that we offer. My heart’s desire is that everyone in need of our service will have the opportunity to benefit from our care without concerns for how we see them.
In the words of my mother, “Anything worth doing is worth doing well.” By the grace of God and with your support, I endeavor to do this well. Let’s go to work!