Diabetes Alert Day is just around the corner, and to get a jump start on raising awareness for this chronic condition, we recently caught up with Melinda Maryniuk. She’s the Director of Clinical Education Programs for the Joslin Health Solutions division within Joslin Diabetes Center. Her areas of special interest include nutrition, patient education, behavior change, and increasing access to quality diabetes education services. (Check out her full bio at the end of this post.) Melinda spoke with us about how she got her start in diabetes education, what she wished more patients knew and her philosophy behind behavioral changes.
Can you tell us a little about how you became interested in dietetic education?
Growing up, I had always seen myself as a schoolteacher. But when it came to choosing a major in college, my dad pushed me to be some kind of scientist (I don’t remember why) even though I was not particularly interested (or good at) the subject! After changing majors multiple times (medical technology…biology…) and feeling completely without direction – my mom asked me a really important question. What do you like to do most? When I answered “eat” – she suggested I consider being a dietitian. Taking a nutrition class in college for the fun of it got me hooked. It was a perfect blend of science (which turns out I really did enjoy when it came to food chemistry) and teaching.
During my dietetic internship, where about a year is spent in a medical center before taking the exam to become a “registered dietitian” (RD), I quickly learned I was not comfortable working with sick patients in inpatient settings. I wanted to keep people OUT of the hospital. Once I started working in the field of diabetes education 35 years ago, I knew this was the right path for me. I never thought of people with diabetes as “sick” – but just having to be a little more intentional about making healthy food choices.
Looks like you’re also a believer in behavioral change. Can share what that means for the patients you work with?
We are all responsible for our day-to-day health care. We make hundreds of decisions each day that may affect our health. We choose to smoke or not smoke. Brush and floss our teeth. Choose healthy foods. Wear seat belts. Keep our weight in check. Be physically active. Have annual check-ups with our doctor. Take or not take the medicines (or vitamins or whatever) are prescribed to us. Much of what we do becomes automatic and we don’t even think about it. If you are generally “healthy” – you can make what might be considered poor choices without any immediate consequences.
When diagnosed with a chronic condition like diabetes, there are some behaviors that must be done (like taking insulin) in order to survive. There are some behaviors that should be done (like checking blood glucose) in order to reduce risks of serious problems. And there are some behaviors (like choosing healthy foods and being more active) that can lead to living a longer and healthier life. Thus, while adopting healthy behaviors is important for everyone, it is truly a matter of survival or at least greatly improved quality and length of life for people living with a health condition like diabetes.
When I first started out as a diabetes dietitian – I thought I had all the answers. I believed that if I could just tell people what to eat…they would stop eating the foods they loved that were not good for them and eat what I told them. I made up dozens and dozens of sample menus, lists of “dos and dont’s,” fancy handouts persuading people how to build-a-better-breakfast. I was recognized as a very creative and entertaining “teacher.” But while my “students” (patients) may have been “learning” something – they were not necessarily doing it.
So I changed my approach. I found that I became more effective when I followed the “ask-don’t-tell” philosophy of behavior change. Not telling the patient what to do…but asking them what they would like to do, how they think they can do it, how I could be of help and working with them to create reasonable action steps to actually do it. I believe for people to be successful in making changes in their behavior, they have to settle into an understanding of why that change is personally important for them to make. And then break it down into small steps. Having a healthcare provider, diabetes educator, coach or just a supportive family member or friend (even within an online community) can help see that intention to change – become a lasting behavior change.
I’ve long been a big fan of this quote (directed to doctors) from physician and philosopher, Albert Schweitzer, which also reflects this thinking: “Each patient carries his own doctor inside him. They come to us knowing this truth. We are at our best when we give the doctor who resides within each patient a chance to go to work.”
How do you see online communities like PatientsLikeMe contributing to patient education?
Online communities are a tremendous resource for people living with a wide variety of different health conditions. Research has shown you’re more likely to stick with the healthy behavior changes you make if you receive some kind of ongoing support. An online community is a perfect way to both offer and receive that kind of support. I love to see how these communities are growing to share ideas, tips, suggestions, practical advice and real-world experience. I think peer-to-peer support can be as valuable as reaching out to your healthcare team. That said, and while I’m very open to new therapies and sharing information, it’s still essential to have your primary care provider be part of your decision team for products and new paths you want to try.
There’s probably a lot you wish more people that are living with diabetes knew, but what would be your top three?
#1. Know Your Numbers. By that I mean, know the results of important lab tests and exams done for diabetes. Firstly, know what your A1C is, what it should be.. and if it is not where it needs to be, know what to do to get it there. Know what your blood pressure is…and what it should be. Other important lab test numbers to be aware of are your LDL cholesterol and a protein test to check kidney function. Have an annual dilated eye exam and make sure your feet are checked by your doctor to pick up any potential problems early. Being proactive in knowing your test results and making sure you and your healthcare team is taking action towards reaching target results helps you to live a long and healthy life with diabetes.
#2. If you’re not getting answers you understand, change up your healthcare team. If you feel frustrated with your physician, an important first step is to tell him or her what you’re looking for and how they could be more helpful. Sometimes people leave their doctor when what could have helped is just having the conversation of how to improve the relationship! Ideally, it is great to have more members on your healthcare team – like a diabetes nurse educator or dietitian – but that may not always be possible. However, you may be able to form a connection with a community pharmacist who is interested in diabetes that can also serve as a support and answer questions. Also, because diabetes CAN be hard…there may be times when it will be helpful talking with a professional psychologist or mental health counselor to help you navigate the stresses and challenges of living with a chronic disease. And surround yourself with people who are positive and supportive. Sometimes those closest to us don’t provide the support we need (or are misguided in how they are trying to “help”). Make sure you point out HOW they can be more helpful. And…this is a great place for online community support systems like PatientsLikeMe!
#3. Your diabetes treatment plan will change over time. Whether you have type 1 or type 2 diabetes, be prepared that the doses and types of medicine you take will change. That does not mean your doctor can’t figure out what is going on…or that your diabetes is getting “worse” – but your body can change and how it responds to different medicines can change. People with type 2 diabetes are often not prepared in their understanding that over time they will likely need to take insulin by injection. No matter what the medication regimen you follow, a healthy meal plan and regular program of physical activity is critical to helping the medicines work best. You need all three- diet, activity, medicines.
What do you wish patients knew that we haven’t asked you about?
Learning about diabetes is a lifelong process. You may have had it for quite some time and attended a class years ago. Know that there are always new things being learned. New discoveries. New medicines. New approaches to meal planning. Never stop learning and asking questions. Subscribe to a magazine like Diabetes Forecast (from the American Diabetes Association) or take annual diabetes refresher classes at your local diabetes education program. As Dr. Elliott P. Joslin, the founder of the Joslin Diabetes Center, said way back in 1934, “the diabetic who knows the most, lives the longest.”
And we just can’t pass up the opportunity to ask you about this one – Last October a donation was made by CheeseBoy in your name to the Greater Boston Food Bank. Can you share what that was all about?
Ha! How did you hear about that?!? My sister picked up a flyer for a contest that Cheeseboy, a fast food chain was running in honor of their millionth grilled cheese sandwich being sold. She challenged everyone in our family to enter the contest – which was to write a (very) short essay stating to what group Cheeseboy should make a $10,000 donation – and why. I’d been thinking a lot about food insecurities and how (surprisingly) not having access to enough food in the poorer populations of our nation (and the world) is being increasingly linked with a higher risk of obesity and diabetes. It stands to reason. When a person has very little income the food that tends to be purchased tends to be low quality and high calorie (buying a super size soda can be cheaper than buying a bottle of water!) So, I wrote a 250 word essay to recommend a donation go to Feeding America – the nation’s leading domestic hunger relief charity. I didn’t realize at the time Cheeseboy is a Boston-based company so they asked if I minded for the donation to make an even bigger impact by giving it all to the Greater Boston Foodbank – that is part of the Feeding America network of charities. What a thrill it was to feel responsible for a donation of $10,000 to such an important organization that ultimately provides increased comfort and security for people who are at high risk for many health problems – including diabetes. And, as a bonus, I received a special card allowing me grilled cheese sandwiches for life! The ultimate in comfort foods!
About the PatientsLikeMe diabetes community
There are more than 14,000 PatientsLikeMe members currently living with diabetes, and many of them have been sharing their experiences and contributing to real-world research that could benefit their fellow diabetes patients. If you’re living with type 1 or type 2 diabetes, you can find others just like you on PatientsLikeMe. Track your own experience with a personal health profile, or share your story in the community forums to start living better together.
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More about Melinda Maryniuk, MEd, RD, CDE, FADA
As Director of Clinical Education Programs for the Joslin Health Solutions division within Joslin Diabetes Center Ms. Maryniuk oversees the clinical, educational and quality improvement activities for the 40 Joslin Affiliates and outreach programs. She also coordinates the education activities for the HealthCare Services Department, including several national diabetes education initiatives. Her areas of special interest include nutrition, patient education, behavior change, and increasing access to quality diabetes education services.
Ms Maryniuk has worked in the field of diabetes education for over 30 years and has lectured and published extensively for both patient and professional audiences around the country and internationally. She is active within the American Diabetes Association, having served on the Board of Directors, as chair of the Education Recognition Program Committee and is currently an Associate Editor for Clinical Diabetes. Within the American Dietetic Association, Ms. Maryniuk served as Chair of the Diabetes Care and Education Practice Group as well as Chair of the Division of Clinical Dietetics and Research of the Council on Practice. She is the recipient of the 2005 Outstanding Educator in Diabetes from the American Diabetes Association as well as the 2010 Medallion Award from the American Dietetic Association. She recently served as a Co-Chair for the task force to review and revise the National Standards for Diabetes Self-Management Education.
Melinda has a BS from the University of Tennessee-Knoxville and a MEd from Tufts University. She completed a dietetic internship at the Frances Stern Nutrition Center in Boston.