Here is the Michelle Dart Interview we conducted. Michelle has a wealth of diabetes knowledge, as a Nurse Practitioner, CDE and mother to a child with diabetes. She is an active author and diabetes coach. If you ever wanted to learn what a CDE does or thought you might like a diabetes coach, please enjoy our interview by listening to the podcast or read through the transcript below.
CDE and Author
DWB: Well, welcome everyone. Today, we are excited to have Michelle Dart with our program. Michelle is a nurse practitioner and a certified diabetes educator in upstate New York. In 2012, she was voted Woman of the Year by the National Association of Professional Women. She’s authored several books, including Motivational Interviewing in Nursing Practice, and more recently she has written two books on diabetes, Diabetes Your Way and Danny, the Diabetes Dynamo. Michelle, thank you for taking the time to speak with us today. We are pleased to have you on our program.
GUEST: Thank you for inviting me.
DWB: Great. Well, first off, I was wondering if, you could please tell us a little about yourself and how you became interested in diabetes.
GUEST: Well, I’d like to say that I’ve always known that this is what I wanted to focus my career on but that isn’t exactly how it worked. I believe everything happens for a reason. When I went to college I had no intention of being a nurse, even. And I just kind of explored different things and found that I felt most comfortable with the nursing. And so I ended up loving the nursing program and set out knowing that I kind of wanted to focus most of my career on children. And, you know, I loved the way I was doing, wanted to keep going further and continue on to get a Master’s Degree in nursing and became a pediatric nurse practitioner.
I became really interested in the teaching part, you know, the educator role, while I was in my graduate program. But right after graduation this position opened up and our local children’s diabetes program, and honestly, diabetes was very scary to me. I wasn’t very comfortable. I didn’t really feel like that was my niche, but I was able to educate and work directly with the children, and all of that was important to me. So I thought I would take a chance. And I learned so much during that time.
It was during my time in this position that my father was diagnosed with type 2 diabetes, so having that little bit of knowledge ahead of time was really helpful. I also got married and became a mom to a teenager with diabetes. And so I was so lucky to have that experience. I had to be able to support both of them as they started facing life with diabetes. My drive to be involved and make a difference in the diabetes community really comes from being deeply affected personally, and in the relationships that I formed with all the children, families and adults that I work with. So, I wanted to see an increased awareness because there are so many misconceptions about diabetes, and so that’s how I became interested in diabetes, a life that led me here.
CERTIFIED DIABETIC EDUCATOR
DWB: Well, that’s great. Could you explain for some people who aren’t aware of what a certified diabetes educator is, what they do, how you become certified?
GUEST: So after we become certified and take a large exam, we have to continue to actually maintain that education and learning how best to help the people with diabetes. So we have to maintain continuing education, which is a lot of different conferences where we can learn things, different journals. We have to take tests to gain some of this continuing education. And sometimes that’s enough to keep up our certification, but if we haven’t had enough of that continued, then we need to also retake the test. So it’s a big process but it’s well worth it.
DWB: You know, I think it’s important to know that it isn’t one of those things where you just take sort of a couple of classes online, and you walk right in as being a certified diabetes educator. I think it’s important for people to know that it is very involved. You do have to have a threshold level of education in the healthcare field, prior to even, being able to begin the process of becoming a certified diabetes educator.
GUEST: Oh, definitely. And any time you start in your position, like if I went from being a nurse in another area and went to go into an area where I would be a diabetes educator, I would have to go through an intense orientation program to learn how best to do my job. So it’s a lot of learning on the job, and it’s gaining a lot of experience before you can even take the certification exam.
DWB: What do you think is the most common thing that you do as a CDE? Is it helping people put together a meal plan? Is it helping them understand, the medication they’re taking? Is it a physical education program? How do you bring all-, how do you approach this? And what do you see doing-, what are you doing most often when you are talking with patients?
GUEST: Well, what I find works best is-, I mean, I can speak on every one of those topics, but I find that works when I walk in and I’m meeting with somebody is really getting idea where they’re at right now, how much do they already know, how much education do they need, and what areas really need to be worked on? I mean, there are some people that are doing an excellent job with eating a healthy nutrition, you know, meal, they have their meal plan all figured out. Exercise – maybe one of their bigger challenges. So we’re going to focus on that.
And as an educator, we all just… It’s hard to explain. We don’t just say, ‘Well, this is what diabetes is. This is what your meal plans should be. This is what your activity plan should be.’ Because everybody is different, and what might work for one person isn’t necessary they’ll work for another. So it really has to be a relationship that we form that I can get honest feedback for what’s working, what’s not working. And I help to kind of guide them. It’s like kind of just walking with them as they face their challenges for the diabetes, and helping them to figure things out and make decisions that are going to impact their life and their diabetes.
They know their own body best, so I have to put trust in that, and I trust that they do know how things have worked with them in the past and kind of get an idea how much education do they want or do they need. I don’t just assume they need to be educated on every aspect of diabetes, so it really is more talking and more of a coaching kind of style that I use.
But we can help answer any questions and explain every aspect of the diabetes because we really do have to have that well rounded education about diabetes, it’s complications and everything involved in order to be able to do the job.
DIABETES YOUR WAY
DWB: That’s great. I’d like to switch gears, if I could, here a little bit, and talk about your most recent book entitled Diabetes Your Way. Can you tell us a little bit about the book and how you got the idea to write about this particular subject?
GUEST: Well, I’m really excited about Diabetes Your Way. You know, in my experience, a lot of people that have been diagnosed with diabetes have been educated in some form about diabetes management, although there are, you know, a bunch of people that say they never learned anything or didn’t really realize that they had diabetes. But a lot of people have some basic understanding in that, you know, they know what to do, they aren’t always looking to find the answers. And there are a lot of resources out there that have the answers to what diabetes is.
And so I don’t see my role as one of telling somebody what to do or forcing education on people that aren’t at that point of needing or want an education. I see my role as exploring where they’re at, what holds them back and what goals they have for themselves. And it’s to help them create a way to manage diabetes successfully, you know, based on their lifestyle. And that’s what this book does. There are so many factors to consider when managing diabetes, that there’s not a set guideline for everyone to follow.
The guidelines really are just a starting point. And we have to make adjustments from those that you can follow through with, that can suit our lifestyle in order to be successful. And there’s really always more than one way to accomplish a goal. That’s what this book really is setting that message out to people, that you don’t have to follow, search guidelines. It is okay to sometimes waiver, as long as you’re finding a way to make it work.
There is always more than one way. And so that’s what kind of inspired me is I meet with people and they do know. You know, those that even tell me they know they should be eating healthy low balanced meals, and then, on the other hand they’ll say, ‘But I’m not really doing that.’ Okay, so you have an understanding but there’s something that gets in the way. So it’s really exploring those barriers, those things that get in our way.
And the book also provides different resources that we might not always think about. You know, local resources that are often kept a big secret. You know, a lot of people don’t realize what’s available in their own communities. So give them some ideas of where to look within their own communities, offer contact information with pharmaceutical companies, different websites that can be helpful. So it has a little bit of resources to get more of that education, if that’s a piece that they’re missing. But it also just really is a journey, it’s an exploration of where they’ve been and where do they really want to go, and how can we take the diabetes with us, without the diabetes guiding the way.
DWB: Uh-hm. It’s a fascinating book and, you know, it sounds like anybody along the journey, can benefit from the book, whether they are newly diagnosed or they’ve been dealing with it for a number of years or months or years. Depending on where you are, you can get something out of the book.
GUEST: I think you could. You know, there are different places, and I think that almost everybody is kind of in the middle. You know, some people are ready to make changes, they already have a plan in their mind and they’re ready to get started. And then we have people that are, you know, I don’t know. I’m not interested in making changes. I want to keep eating ice-cream every day. And I don’t want to hear about anything. So they’ve already shut us off.’ I don’t give up on that group because the goal is to help them get to the middle, where we are more ambivalent and, ‘Yes, I know I should, but…’ And looking at those things that get in the way. So we all go through those stages at different points. And really anybody affected with diabetes, regardless of type… You know, there’s a difference in type 1 and type 2 diabetes, definitely but in managing it, we all have some similar struggles. And the approach to lifestyle changes can be effective for all types of diabetes. And there’s a section for parents and caregivers. So, you know, even if you don’t personally have diabetes, this may help you to understand where they’re coming from.
DANNY THE DIABETES DYNAMO
DWB: I think it’s an excellent resource. Let’s take a look at the book you wrote before this. It’s a children’s book on type 1 diabetes entitled Danny, the Diabetes Dynamo. That’s a great title. Where did you find the inspiration for this particular book?
GUEST: And so it’s especially challenging to talk with children about diabetes. And they think so literally, and can easily misunderstand what’s said. So it’s not easy to use some of the terms like ‘diabetes’ and ‘ketoacidosis’ but these children are hearing these words from their parents, their healthcare providers. And so we have to try to keep this on a reading level that’s appropriate for the developmental stage.
But often the teaching focus is really on the parents and the children need to be involved when appropriate, and this is often dictated by the parents’ perception of the child’s abilities, their own comfort levels. They’re allowing children to participate, and it’s difficult for parents to give up some of that control, and with good reason. It’s scary to let anybody else calculate out in insulin dosage or decide how to react with particular like glucose readings.
I really wanted to start a series of books that will focus on helping these children grow right along with Danny and some other friends that he’ll need along the way. So school being another place where kids spend a lot of their time, I’m looking for Danny to be going to school soon. So that will be the next book for Danny.
DWB: Oh, great. As you were talking I was thinking about my own son who has several food allergies and the challenge is to explain to someone as young as five or six years old, why they can’t eat certain things and why these things happen. It seems that type 1 diabetes, the stakes are even much greater. And as you said, it’s such an ongoing process. Maybe if you could talk a little bit more about, what are the biggest difficulties that you’ve seen with talking with children about how to, about how to, take responsibility and be responsible about their diabetes?
GUEST: Well, each child is a little bit different. You know, some kids are right there, understanding, wanting to learn more about what they need to do. And then some children are going to be more reluctant, and especially if they were not as healthy of an eater prior to being diagnosed. Because now, with all this focus on healthy eating and, well, why can’t I have that anymore? So I think if we’ll have to be making a big change from where they previously were at, it means a lot more education. And, you know, sitting down even looking at food labels together. I had some that liked to sit there and look at the food labels and see, now which is the healthier one? And they aren’t even the ones with diabetes.
So just getting them involved and letting them help makes them take responsibility. Give them some ideas and let them create what their plate would look like, and help them decide on a family activity. And it really needs to be a family thing that they’re learning together, they’re active together, they eat together. All of that makes a big difference because then they all feel like they’re involved. And little by little these, you know, children will learn, if they have type 1 diabetes, how to deal with the insulin with the food. So there’s a lot involved and all will take time and different steps, depending on the child’s readiness to learn about that.
Otherwise, there are sometimes some battles, and it’s hard to say no to your child when they want something that we know is not good for them. So sometimes we need to make sure those things are not there to be tempting. We need to provide other options. Sometimes we need to find a way to distract them until we can get them to, you know, understand what’s going on. Distraction a lot of times works if they really are focused on wanting some things that they can’t have. Find a way to refocus them is often what we need to do when they’re little.
HOW TO FIND LOCAL RESOURCES
DWB: Yeah, it certainly must be a great challenge, particularly with children. I know how challenging adults can be sometimes. The next thing I want to cover is support groups. My understanding is that you’re often leading local support groups in your area. I think a lot of diabetics aren’t even aware that these groups exist. Can you tell a little bit about, you know, about these types of groups such as the topics that are covered and the format of the group meetings?
GUEST: Yeah, I mean, support groups can be an amazing resource. And not everyone realizes what is involved or how they get involved. Support groups can be run in different ways. For the support groups that I facilitate I don’t always go in there with an agenda or a plan or what. I think we need to talk about. If there’s a topic that keeps coming up within the group, we will reach out to other resources and provide additional information or another perspective. But primarily we focus on whatever is important to the group at that time. And the members of the support group offer advice to each other, they share stories about positive and negative experiences. And I tend to use a coaching sale even in that group to promote exploration of these issues. And we try to make it fun and informal.
Even with advertising throughout the community, I still find a lot of people weren’t aware that there is a group. But people can find out about these groups by asking their primary doctor if they see a specialist, like an endocrinologist for their diabetes. They would know if some resources, local diabetes-related organizations, like the American Diabetes Association, or The Juvenile Diabetes Research Foundation, community health organizations and hospitals – all of those places to probably point in the right direction if you were looking for a support group. And if there isn’t a support group readily available, I really encourage people to create one locally because it helps so much for the people that are coming to the groups and attending. They tell me often how much they gained from being there. And they keep coming back.
DWB: Great. You also provide some coaching services for people with diabetes. Who would be a good candidate for your coaching services? How does this process work if someone was interested?
GUEST: Well, you know, there are a lot of things that I can do through my coaching that it really… I see the person with the diabetes as the expert, like I said. They know themselves best and what’s worked, what hasn’t worked. They know how their body reacts to different foods and activities better than I possibly could. So I actually learn a lot by interacting with the people with diabetes about them. You know, I wanted to spend that time to get to know them and their diabetes. And it’s unpredictable. And all the planning that we do to manage diabetes doesn’t always keep things under control.
So, you know, every interaction’s going to be individual, and it’s guided kind of by what that person needs at that time. If they’re looking for just some information, I’m always more than happy to provide that. But I often spend more time helping people find solutions, and a solution within their own lifestyle. And my goal really is to empower people, let them define what success means to them and guide them to those solutions to be successful and create a life that they love despite living with diabetes.
Really a good candidate for my service would be anyone affected by diabetes that, you know, needs an objective perspective to help explore those challenges of living with diabetes. It’s hard to really look at yourself from a different perspective when you’re working, you know, talking with a family member, because that influences our top process, too. So having an objective person is very helpful. You know, anyone that is ready to make a change in their lifestyles to improve their weight or their diabetes management would benefit from coaching, parents struggling with the basics of raising a child with diabetes. And, you know, we add diabetes or weight issues to the mix of just basic parenting and it just becomes even more challenging.
So if somebody was interested in learning more about my services, I have a website and it is www.darthealthcc.com. I can be emailed at mdart[at]darthealthcc.com, and my phone number is 315-730-4597. We would do an initial free consult, work together to determine the program that would work best for them individually, and the coaching can be conducted by the phone, email, texting and sometimes I can even do locally in person.
DWB: Michelle, thank you very much for speaking with us today. We’re excited by the work you do, and we certainly look forward to hearing about your future projects, including future books. Thank you very much.
GUEST: Oh, you are welcome. Thank you for having me.