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Educator Battles Diabetes For Choctaws

Lee Ann Griffin is a warrior for the Choctaw nation. Not the kind of warrior you'd imagine, Griffin RN, CDE (certified diabetes educator) battles diabetes, a disease whose numbers are growing. Her weapons are education, medical supplies such as glucometers and test strips to check blood sugar levels, medicine and lots of determination.

Oklahoma ranks second in the number of Native Americans or American Indians. People of Native American heritage have a higher risk of developing diabetes. According to the Centers for Disease Control, the largest ethnic group of diabetics in Oklahoma, 2000-2001, was the Native American population; 10.1% were diabetics. Also, in 2000 Oklahoma ranked 15th in the nation in deaths from diabetes.

Griffin, a member of the Choctaw Tribe, is a Community Diabetes Educator based out of the Choctaw Nation clinic in McAlester, Oklahoma. She is part of the Choctaw Diabetes Wellness Center, which is located in Talihina, Oklahoma. The Diabetes Wellness Center offers complete services for diabetics. The staff includes a physician who is board certified in Endocrinology, Diabetes and Metabolism, a physician's assistant, and a master's level Nurse Practitioner. The Center also houses a fitness center with trainers who help participants with an individualized fitness program. Besides Griffin, the Diabetes Wellness Center employs four other Community Diabetes Educators.

Griffin has individual appointments with patients on Mondays at the McAlester clinic. She sees patients of all ages who have a CDIB (certificate of degree of Indian blood) card that shows membership in any recognized American Indian tribe. She also sees employees who make appointments.
"I'm proud that our employees get good care. In Talihina there is good attendance in the Employee Wellness Group."

Griffin is delighted with the new, modern Choctaw Health Clinic, which replaced the old one in McAlester. "This clinic opened in July, 2007. We also have clinics in Stigler, Poteau, Broken Bow, Idabel Hugo, and a clinic opened in Atoka in 2008. Talihina is home to the hospital and the specialty clinics."
Griffin has worked for the Choctaw Nation since 2001.

"One day I was handed a blank piece of paper and was told to plan a Diabetes Wellness Program. The program is funded by a federal grant and a matching grant from the Choctaw Nation." Designing the program happened by trial and error. She saw diabetic patients and tried out different ideas to see which ones worked best. "We tried doing group sessions, but we had poor attendance, and the individual sessions worked better."

Griffin took a national exam and received her credentials from the National Certification Board For Diabetes Educators to become a certified diabetes educator (CDE) in 2005. In order to take the exam, medical professionals such as doctors, registered nurses, clinical psychologists, optometrists, and certified dieticians must be employed in diabetes self-management for two years, have a minimum of 1,000 hours in diabetes self-management experience, and have current employment as a diabetes educator a minimum of four hours per week.

Griffin sees 2-6 patients per day. "We discuss nutrition, exercise, medications and complications in our sessions," Griffin stated. Physicians refer most of her patients, but some patients make their own appointments.

"The Choctaw Nation is fortunate to have an Endocrinologist (a specialist in diabetes) at the Wellness Center in Talihina. I work with the doctors and do their lab work. We use a lab test, the hemoglobin A1C, to see how the patient is doing. This blood test measures blood sugar levels for approximately 90 days. We want the A1C levels to be between 6.5-6." (Recently the American Diabetes Association changed their recommended A1C levels for diabetics from >7 to 6.5-6.) Most doctors want their diabetic patients to have an A1C every 3-6 months.

Griffin gives her patient's glucometers and test strips. She teaches them how to use the glucometers and makes them demonstrate they can use them correctly before the end of training. Patients can also get their diabetes medications and supplies at the clinic. Griffin admits that some of the newer medications for diabetes are not on the clinic's Drug Formulary.

She still sees a lot of complications from diabetes such as leg amputations. There are more young adults with Type 2 diabetes, which used to occur mostly in middle-aged people.

Griffin and the other diabetes educators will go wherever they're invited such as doing diabetes screening at health fairs, senior citizen's centers, and the Choctaw Nation Housing. The educators are also trying to reach the younger generation. "We have a wellness program in the Choctaw Head Start programs. We are trying to catch the parents of the students," Griffin said.

The Choctaw Nation sponsors a program to teach fifth graders about diabetes. The diabetes educators go to 36 different elementary schools. "We developed the program to teach 5th graders what diabetes is on their level. We discuss risk factors, and signs and symptoms of diabetes and also stress two healthy habits: exercise and nutrition."

The students are taught food portion sizes and how to read the nutrition labels on boxes and cans. "Food labels are one of the biggies," Griffin said. The educators emphasize portion control and teach easy visuals such as the palm of hand equals one serving of meat, and the thumb is equal to one ounce.

In Griffin's classes, she doesn't stress weight. "I try to stress serving sizes, slow weight loss, and increased exercise. Walking is a great way to exercise."

Additional health information is available on the Internet at the Choctaw Nation website, www.choctawnation.com, then click the link for the Health Services Authority.

When asked about the future of diabetes treatment, Griffin responded, "The future of diabetes is that treatment will become more aggressive. It comes down to lifestyle, prevention, and wellness."

Mary J McCauley, a native of Oklahoma, holds two bachelor's degrees from the University of Tulsa. She took additional classwork from the University of Oklahoma, Oklahoma State University, Tulsa Junior College and Northeastern State University. She has a BS in Education and worked as a substitute teacher in the Tulsa area for several years, and McCauley taught two years in the Prue, Oklahoma school system, teaching social studies classes, yearbook and creative writing. McCauley went back to school at the University of Tulsa in 1990 and received a BS in Nursing in 1993. She worked in different hospitals and medical clinics in Tulsa. McCauley is now a fulltime writer in McAlester, Oklahoma with her husband and three dogs and one cat. She still has her nursing license and is working on a book about diabetes. Her first book came out in July, 2008 a romantic, suspense entitled Oklahoma Hearts Online.com. McCauley's website is [http://www.marymccauley.com]

By Mary J McCauley

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