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Joy Pape, MSN, FNP-C, CDE, WOCN, CFCN, FAADE

Joy Pape, MSN, FNP-C, CDE, WOCN, CFCN, FAADE
(Associate Medical Editor Diabetes In Control) Clinical Nurse Practitioner, CDE, Comprehensive Weight Control Center, Weill Cornell Medical College; President of EnJoy Life! Health Consulting, New York City, NY; co-author of the Real-Life Guide to Diabetes; Immediate Past President for the Metropolitan New York Association of the American Diabetes Association of Diabetes Educators (MNYADE). As an internationally known family nurse practitioner (FNP) and certified diabetes educator (CDE), Joy Pape specializes in diabetes, weight management, home blood pressure monitoring, sleep, and foot care. She is the co-author of the Real-Life Guide to Diabetes (The American Diabetes Association). She writes for several national magazines, is a dynamic national motivational presenter for both health-care professionals and the general public, and is a partner of Laugh it Off! a health edutainment team. Joy says, “Most important is that I still see patients. That is my passion…to connect with my patients so that together we can help them reach their optimum health.

Prevent Disasters By Using CGM

Man, 69 years of age, of Italian descent, “a numbers guy,” has type 2 diabetes, A1C 8.9%, taking a GLP-1 daily, and metformin 1,000mg twice daily. Blood pressure was managed, in target range of ~110-120/70-80, HR 76-82, weight-BMI 25.3. Had been on an SGLT-2, but developed DKA, so he can no longer take SGLT-2’s nor did he want to. Checked fasting glucose some mornings a week but not every day because he did not like to stick his finger. He really didn’t want to deal with his diabetes. Due to his recent illness, he was willing to try something new and different, especially since I told him it’s about numbers and he would not have to regularly stick his fingers.

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When Treating Obesity, Discuss the Holidays — Before, During and After

It’s not unusual for people who have excess weight or obesity to have many barriers to overcome in managing their weight. In my experience, the holiday season can be a big barrier. For much of the world, holidays are associated with food; not just food but an overabundance of food. And for many, the weather is cold at this time of the year, which doesn’t help with being active.

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What Not to Trust

I received a call and glucose numbers from patient who has type 2 diabetes, usually with hyperglycemia, never hypoglycemia. I noticed there was at least a 12-hour span since the last glucose reading. His glucose levels after the over-12-hour lag showed hypoglycemia during the  night when the numbers start showing. His glucose averaged 53 during that time, but it has been running 150 and over, and we have been slowly increasing his insulin.

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Take a Second Look at Surgery Recommendations

Patient is male, 48 years of age, type 2 diabetes with hyperglycemia for eight years, class III obesity,  and very symptomatic GERD. Patient planned to have laparoscopic sleeve gastrectomy. I asked him why he chose that particular surgery. He said, "Because it's less invasive." I asked if his surgeon told him the sleeve gastrectomy could increase his GERD, and is not as effective for the treatment of type 2 diabetes nor for weight loss as is a bypass. He said, "No, the surgeon just left it to my choice. I said I wanted the sleeve and he was good with that."

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