Margaret J. Wilkman, RN, CDE, is a clinical nurse specialist at Duke University Medical Center in Durham, North Carolina. She is part of a consulting team, consisting of an endocrine specialist, a dietitian, and a clinical nurse specialist, that sees patients with diabetes who were admitted to the hospital for reasons other than diabetes.
DIABETES HEALTH: How long have you been involved with diabetes care?
Margaret Wilkman: I’ve been a nurse for 30 years. I started with the Visiting Nurse Service of New York, one of the first in home nursing services in America. I did some diabetes education there; boiling glass syringes and stainless steel needles, which tells you how long ago that was. Then, as a nurse practitioner, I was diagnosing people with diabetes and even prescribing medication. This was all before home blood glucose monitoring.
From 1978 to 1987 I was the Coordinater of Credentials at Duke University’s 1000 bed hospital. It’s a major tertiary care, heart service, and cancer care center, with an upstanding Endocrine department; we trained people like James Gavin, Jay Skyler, Harold Leibowitz….
DI: So where do you work now? What patients do you see?
MW: I work on a consulting team with an endocrinologist and a dietitian. We see people who don’t come into the hospital for diabetes, but who have it. I end up working with everybody involved with diabetes, except children. I work mainly with people 18 and up.
DI: What do you dislike about working with diabetes?
MW: I hate hyperglycemia. I don’t like giving up on people: I think it’s mean to leave someone with sugars in the 200 to 300 range.
DI: Oh? Do you recommend the pump?
MW: Sometimes. I wore one for a while, with saline solution in it, as part of my pump trainer’s training, and it didn’t take long before I just wanted to step on it. For some people, it’s a constant reminder of diabetes, for others it means more freedom. It’s a lot more work, but the results can be amazing. There were two women who kept to their diets religiously and still had blood sugars in the 200’s, but when they went on the pump they got normal sugar levels.
DI: What’s your favorite part of being a certified diabetes educator (CDE)?
MW: Trying to find a way to help people take charge of their diabetes, to help them take control. Trying to find the “on” switch, to get people started. Part of it is knowledge, and part of it is believing you can make a difference. Diabetes is a great finger-pointing disease. I try to have my patients recognize when their blood sugars are a result of something they did, like overeating, etc., and take responsibility for that, but also to remember that if it’s not your fault, you shouldn’t beat yourself up over it.
Diabetes is not a perfectly understood disease, there are dozens of things that change blood sugars that we have no control over. You can’t expect to do everything perfectly and have perfect blood sugars. Even if you do treat your diabetes perfectly, your sugars still won’t be perfect.
DI: On a lighter note, what’s your favorite diabetes book?
MW: For my patients, I recommend “Learning to Live Well” from the IDC (International Diabetes Center), which is available from Chronimed. For myself, I read the journals, like Diabetes Educator, Diabetes Spectrum, Diabetes Care, etc.
DI: What tips do you have for nurses or people with diabetes to help them gain better control?
MW: That’s really a two-part question. The more people with diabetes learn how their body responds to blood sugar changes, the better they will be able to take control of their diabetes. Diabetes isn’t a disease you want to forget about, but it’s surprisingly easy to do. Most people can’t tell when their blood glucose is really high, over 200.
Nurses should listen to their patients and try to understand the difficulty of living with diabetes. They should be less ready to call people “non-compliant.” In my experience, most “non-compliant” people simply don’t know what to do.
Margaret’s name (and the idea for this diabetes educator feature) was submitted to us by Peter Lordi of Ulster Scientific. Peter selceted Margaret for her outstanding committment to the field of diabetes education and patient care.
“Her academic excellence combined with her clinical skills marked by humanitarian qualities serve as an example for all, regardless of profession, to emulate,” said Lordi. “Margaret has been an inspiration to my staff. Her constant concern for the needy serves as a constant reminder to all of us to maximize efficiency and minimize costs by designing cost-conservative, quality products that will contribute to the well-being of all.”