‍Introduction

Welcome back to MEDS eNews! This month we spend some time with Metabolic and Endocrine Disease Summit Fall faculty Donna Jornsay, a nurse practitioner and diabetes educator who has lived well with T1DM for 54 years and is going strong!  She discusses the role and importance of physical activity in maintaining glucose control in both T1D& T2D, whether CGM and/or frequent blood glucose monitoring more clinically significant than A1C alone, recent studies that have shown increased incidence and prevalence of youth-onset T2DM, and regarding diabetes and pregnancy, is there an ideal screening criteria that should be the standard? What about a standard for glucose targets? Following the interview is our Rapid Fire segment with Donna as well! 

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Thank you to Donna Jornsay for her time here today and as faculty. Please contact me at colleen@cmhadvisors.com with comments or suggestions. Thanks for reading! —Colleen Hutchinson

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5 Minutes With: Donna Jornsay

Diabetes Program Manager/Clinical Specialist, Mills-Peninsula Medical Center, Sutter Health

Burlingame, California.

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Are CGM and/or frequent blood glucose monitoring more clinically significant than A1C alone?  

Donna Jornsay: A1c is only an average. If your patient has an even number of blood glucose values of 270 mg/dL and 30 mg/dL, 270 + 30 = 300 divided by 2 would be 150mg/dL and equal an A1c of 7 %. BUT meanwhile the patient could be in an emergency room with DKA or have driven their car into a tree. A single blood glucose value is a snapshot, but CGM is a real-time video with alert.

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How would you characterize the role and importance of physical activity in maintaining glucose control in both T1D& T2D? Do you feel the general population understands the importance?

Donna Jornsay: Physical activity allows glucose to enter the body’s cells without requiring insulin to open those cell doors. It not only helps overall health and cardiovascular health in particular if the activity is aerobic, it also helps maintain good glucose control by facilitating the movement of glucose out of the bloodstream and into the cells where it’s needed for energy. Physical activity is particularly useful in the management of diabetes when it is performed after meals. But many people living with diabetes are fearful of exercise because it can result in hypoglycemia hours after the activity. Gary Schneiner’s book Think like a Pancreas is particularly helpful for those of us living with diabetes and trying to manage physical activity without hypoglycemia.

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Recent studies have shown increased incidence and prevalence of youth-onset T2DM, as well as a significant clinical burden, complications burden, and socioeconomic cost burden. We know some of the main drivers. Is it an epidemic? What needs to be done? 

Donna Jornsay: The incidence of T2DM in youth has increased dramatically in direct proportion to the increased incidence of overweight and obesity. With this, we have seen increased rates of complications in children and adolescents with T2, and these are occurring at younger ages and with shorter durations of diabetes—and progressing more rapidly as well. Our neighborhoods are often less safe than they were years ago, school systems have cut physical education programs, and too many children are spending hours in front of a screen. All of these factors have contributed to less regular physical activity in kids.

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With regard to diabetes and pregnancy, is there an ideal screening criteria that should be the standard? What about a standard for glucose targets?

Donna Jornsay: Given the increased rates of obesity, all women of childbearing age should be screened PRIOR to conception with an A1c. Then if this is normal, the women should be screened again at 24 to 28 weeks for gestational diabetes with a 50 gram glucose challenge test or a 75 gram 2 hour oral glucose tolerance test.

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You have presented on the topic of GDM diagnosis and management for many years. How would you characterize the evolution of the science and research on the topic over these years?

Donna Jornsay: Surprisingly, not much has changed in the last 30 years since the recommendation for universal glucose screening during pregnancy. That said, there remains controversy on many aspects of GDM screening and glucose targets. One more recent evolution is that the FreeStyle Libre3 glucose sensor is now FDA-approved for use in pregnancy with diabetes and gestational diabetes. 

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Rapid Fire:

Most critical new advance in my area of medicine: Glucose monitoring

Where I go for continuing education: American Diabetes Association’s Scientific Sessions

My mentor: Dr. Daniel Lorber, a brilliant, compassionate endocrinologist

Advice that has helped in my career: Write like you’d speak to someone in their living room.

Best tool in my clinical arsenal: Glucose wands 

What I wish the patient would remember: YOU have the ability to impact the course of your diabetes journey.

Biggest challenge for me and my colleagues: Helping patients accept the responsibility for impacting the course of their diabetes.

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