Wanda Rushton, a family nurse practitioner who specializes in diabetes medical management.
Wanda Rushton, FNP

About 1 in 10 Americans is living with diabetes, statistics show, and up to 20% of people don’t know they have it. Managing this chronic health condition can be a challenge for even the most disciplined people, but it’s essential to a long, healthy life.

Diabetes affects how your body turns food into energy and, if left unmanaged, can cause serious health problems. It’s the seventh leading cause of death among U.S. adults, according to the Centers for Disease Control and Prevention (CDC), and the No. 1 cause of kidney failure, adult blindness and lower-limb amputations.

The good news: Diabetes complications are often preventable, said Wanda Rushton, a family nurse practitioner at Novant Health Diabetes Management - Winston-Salem.

"We take the time to roll up our sleeves and help people identify where they're falling short. Once we figure out 'the why,' we can get them on a regimen that works for them. And we've found it doesn't matter if we're working with Type 1 or Type 2 diabetes patients, they get better,"

Rushton said.

Type 1 vs Type 2 diabetes

Of the 34 million Americans with diabetes, 90 to 95% have Type 2 diabetes, according to the CDC. It often develops over many years and is usually diagnosed in adults, the CDC said, but more and more children, teens and young adults are also developing it. Type 2 diabetes can often be prevented or delayed with healthy lifestyle changes.

Currently, it’s not known how to prevent Type 1 diabetes. It is thought to be caused by an autoimmune reaction where the body attacks itself by mistake. Symptoms often develop quickly with Type 1 diabetes patients, and the CDC said it’s most often diagnosed in children, teens and young adults.

Diabetes medical management

Selby Rouch, a Novant Health physician assistant.
Selby Rouch, PA-C

Rushton works alongside Selby Rouch, a Novant Health physician assistant, to assess each individual and find the right puzzle pieces for diabetes management. They often coordinate with a patient’s physician and are supervised by an internal medicine physician, but their skill levels allow them to work independently. This means patients don’t need a physician referral to make an appointment, keeping co-pays to a minimum.

For people with Type 1 diabetes, Rushton and Rouch focus on proper insulin replacement since the patient’s pancreas no longer makes it. This typically centers on getting the right amount of insulin for food intake and blood sugar fluctuations. In Type 2 diabetes patients, the focus is on enhancing the insulin their body produces and establishing a better diet and exercise regimen, along with oral medication or other non-insulin injections.

Calling on three decades of experience, Rushton explained the top reasons diabetes goes unmanaged, along with advice to get back on track.


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Waiting to see a specialist

Some patients, especially those with Type 1 diabetes, may be on a waiting list to see an endocrinologist (a physician who specializes in treating diabetes and other hormone disorders). Rather than let diabetes go uncontrolled for two or three months, we encourage them to schedule an appointment at our clinic. Even if we determine that they’ll be better served by someone at a specialty clinic, we have the skills and the time to get these patients on a safe treatment plan as they wait.

We can also forward notes to their doctor, whether that’s an endocrinologist or a primary care physician, on things to be aware of or follow up on. And we do a lot of that to ensure continuity in care.

Medication adjustments

When I look at a patient’s medical chart, I might say, “Back in 2020, your blood sugar levels were closer to targets. What happened in 2021?” It’s not a punitive thing. No one’s in trouble. We just want to figure out why they fell off their pattern of management.

I often hear, “Well, I stopped taking my medication,” and there are a few reasons for that. Maybe it was discontinued, or their body couldn’t tolerate the drug anymore. This gives us an opportunity to say, “Let’s pursue a new therapy or combination of drugs that might be more beneficial, convenient or affordable.”

Affordability assistance

Others stop taking medication not because it isn’t helping, but because it’s no longer affordable. Maybe their insurance stopped covering it, or they got a new job and it’s too expensive under their new health plan. We understand this completely, but we can work around it, so I would encourage someone to make an appointment at the clinic when something like this happens.

We have people – I like to call them little elves – who can determine what’s covered under their health insurance plan. We’ll run through all the available options and estimate how much it might cost someone. Thankfully, we have numerous instances where we help people get back on a therapy that was working for them when it was affordable.

Simplifying medication options

Another thing I hear from patients is that their current regimen isn’t practical. Maybe it doesn’t work with their lifestyle, when they wake up or go to bed, their work or school routine. In these cases, we help people modify their plan to make it more doable. I’ll give you an example.

We see a lot of folks in the Medicare population who have tried multiple insulin therapies. Eventually, they’re up to four injections a day. As you can imagine, that’s really overbearing, especially for older adults. They may even start to doubt their memory and can’t remember when they took their last insulin shot.

My partner and I have had a lot of success in moving these patients to a once-a-day combination injection. Essentially, “Let’s see if you tolerate this medicine instead. If you do, we’re going from four injections a day to one. From two co-payments a month to one.” It’s been amazing. We saw so many people improve last year because of this. And most of them were able to lose a little weight, too, because the medication reduces appetite.

Comprehensive education

Sometimes we realize it's just an educational thing. Maybe they didn’t have access to comprehensive diabetes education 15 or 20 years ago. Others may not have the right tools because “it felt like information overload.” Hearing that you have diabetes can be overwhelming and it’s hard to digest everything at once.

Another thing we see is that people can’t focus very well while in the hospital. Or their memories are impaired somewhat just because of the acute illness and how that sets them back. If this sounds familiar, remember that Novant Health has programs, classes and other educational resources to teach people ways to manage their diabetes. Medicare pays for two hours of counseling with a dietitian annually, and we highly encourage folks to take advantage of this.

Get your A1C tested in addition to – not instead of – regular blood sugar testing

The A1C test, also known as a hemoglobin A1C test, is a simple blood test that measures someone’s average blood sugar levels over the last three months. Think of this number as the best indication of how well someone is (or isn’t) managing their diabetes. It’s done quarterly and is measured at the clinic with a finger prick test.

But it’s important for patients to understand that we don’t treat your A1C. We treat your blood sugar glucose readings in relation to your diet, exercise regimen, medication or lifestyle.

Blood sugar goes up and down throughout the day and night, which isn’t captured by an A1C test. Two people can have the same A1C, one with steady blood sugar levels and the other with high and low swings. If you’re reaching your A1C goal, but are experiencing these highs or lows, I tell patients to check their blood sugar more often – and at different times of day.

Here's why: Swinging glucose levels will require a get-well plan, such as medication dose changes or timing of medications in relation to meal intake, or possibly an alternative therapy. No matter the solution, the diabetes experts at Novant Health will help people find one that’s right for them.