Divabetic

We’re excited to announce our December edition of Diabetes Late Nite. Kathleen Gold, RN, MSN, CDE, will stop by the studio to share her experience working with homeless people and Kelly Clarkson will provide musical inspiration from her holiday album, Wrapped in Red.  Join us here on Tuesday, December 4, 2018  from 6 – 7:30 PM.

One of the Diabetes Late Nite featured songs this month is Kelly Clarkson’s “I’ll be Home for Christmas.” This is a poignant inspiration song to gain perspective from Kathy prior to our podcast interview on the biggest obstacles homeless people face who are living with diabetes.

As a diabetes advocate for over 20 years at Unity Health Care Clinic at the Community for Creative Nonviolence, a shelter in Washington, D.C., Kathy helped homeless people check blood glucose logs, made referrals to specialists, and discussed ways to best manage their health. “What I try to do is spend as much time with them as they need,” Gold said in an interview for Diabetes Forecast. “We touch on other issues, not just diabetes: food, food stamps, depression. … They really are very motivated, and they try to make good choices.”

Q: I would think that for homeless people with diabetes the stress of living with so much uncertainty every day must play a big factor in managing their diabetes. What do you advise?

Kathy Gold RN, MSN, CDE: Yes, this is a major problem. They frequently don’t know when or if they will get their next meal or where they may be sleeping that night. I first try to address their living situation. Locating a shelter and a place to receive meals on a consistent basis is the main priority. Until these needs are met you can’t address their diabetes or their healthcare needs.

Q: What type of meal planning advice do you give to homeless people with diabetes who are relying on food stamps, the kindness of others, and prepackaged foods to carry them through the day?

Kathy Gold RN, MSN, CDE: I connect them with various food kitchens and food banks, so they know where to access food. Also, we discuss options for how to spend their food stamp dollars wisely. I help them create a shopping list of non-perishable items they could always have available. We also discuss portion control. I encourage them always to choose vegetables, whole grains and fruit if available. In DC the primary food bank offers a “diabetes meal” which provided an extra serving of vegetables.

Q: How do you advise homeless people with diabetes to create and/or adhere to a daily diabetes management routine if they don’t have a set schedule? 

Kathy Gold RN, MSN, CDE: This is a big struggle as the timing of meals is such a difficult thing to predict. It is important to use medications cautiously if the individual does not have access to meals at a predictable time. Oatmeal is always a lifesaver because all they need is a cup of hot water and they have instant nourishment. Educating the homeless about how and when their medications work to avoid a low blood sugar reaction is very important and ties in with the appropriate use of food stamps. The newer insulins make a huge difference in controlling blood glucose levels as they can be taken with meals. It is much more difficult if individuals are forced to use the older insulins where there is little flexibility.

Q: What kind of medical services and supplies are available to homeless people with diabetes?

Kathy Gold RN, MSN, CDE: A lot depends on where they live and if and how they are covered under Medicaid. Not all Medicaid plans cover the newer medications. In DC we are fortunate that all patients could have a meter and strips to test their blood glucose and our medication formulary was quite extensive. This is not the case in all states. Education is key. I found that if patients were educated, their expenses dropped, and the risk of complications greatly decreased. At the Homeless Shelter we saw significant savings and complication reductions but not everyone has access and that’s sad.

Q: Do you feel homeless people with diabetes are more likely to develop health-related complications? If so, can you share some insight into the types of health complications homeless people with diabetes are more likely to develop.

Kathy Gold RN, MSN, CDE: Many homeless individuals have a history of alcohol or drug abuse which places them at risk of many health issues besides diabetes. Kidney disease is a major complication, since many individuals also suffer from hypertension. Mental illness is widespread, and it is difficult to manage these individuals because they frequently don’t take their medications. Diabetic neuropathy, depression and feeling overwhelmed are very prevalent in this population. Hypoglycemia is also a frequent complication because of their inability to eat on time, which can cause them to be unresponsive, confused and/or disoriented. Severe hyperglycemia, if they stop taking their medications, can lead to ketoacidosis or a very elevated blood glucose level. It is necessary to deal with these health issues first, so they can manage their diabetes.

I found that people who overcame with addictions were very successful in managing their diabetes because they had the tools to make behavior change.

Q: I have read that homeless people with diabetes may sell their supplies in order to afford basic living needs. What’s your experience? 

Kathy Gold RN, MSN, CDE: There is a black market for strips and meters. In DC these supplies were provided, so we didn’t see as much of it. But there were some people who constantly “lost” their meters and they may have been selling them. People get desperate.

Q: How can our Diabetes Late Nite listeners help?

Kathy Gold RN, MSN, CDE: If you donate food, please stick to healthy foods such as vegetables and fresh fruit. Volunteer at a homeless shelter and prepare healthy meals. Whole grain cereals, oatmeal, peanut butter for protein and nuts for a good snack are good options. Avoid sugared cereals, processed foods that are high in salt, sugar, and fat.  Arrange with local restaurants or farmers markets to donate their foods to a homeless shelter. Offer to teach a simple cooking class at a food bank or a shelter. Donate brown rice instead of white rice and include some recipes that use foods you donated. Donate to the National Health Care for the Homeless Council https://www.nhchc.org/

Don’t miss December’s Diabetes Late Nite podcast featuring music from Kelly Clarkson’s Wrapped In Red album courtesy of SONY Music on Tuesday, December 4, 2018, 6 PM, EST.

Kelly Clarkson’s inspiring us to lend our ‘voice’ to  topics such as the link between HIV medications and type 2 diabetes, how the homeless manage diabetes, great gift ideas for loved ones with diabetes, and how you can lose weight during holidays (!). Plus, one lucky listener tries their luck during Mr. Divabetic’s ‘Wrapped In Red’ Health Game challenge. Guests include Poet Lorraine Brooks, Kathy Gold  RN, MSN, CDE, FAADE, Glucose Delivery Necklace co-creator Kris Maynard, Dr. Sara (Mandy) Reece, PharmD, CDE, BC=ADM, BCACP, FAADE, Maria Sakowitz, MS, RDN, LDN, CLT, Mama Rose Marie and the Charlie’s Angels of Outreach.

Diabetes Late Nite is a fast-paced, full-filled hour of diabetes education and wellness advice that encourages listeners to “laugh a little, learn a  lot.”