Janis Roszler RN, CDE

Janis Roszler was named the 2008 American Association of Diabetes Educators (AADE) Diabetes Educator of the year and is particularly enthusiastic about bringing worldwide awareness and education to people living with diabetes. She’s the author of the “Dear Janis” column in Diabetes Positive!, a columnist on dLife.com, and contributor to many other diabetes publications. She has published several books about diabetes awareness, including “Sex and Diabetes” and “Diabetes on your OWN Terms.” You can find her diabetes information website at www.dearjanis.com.

diaTribe: This is a really big honor for us to be able to speak with you, Janis, so thank you so much for taking the time this morning. To start our conversation, could you give us some background on how you got involved in diabetes?

Janis: I didn’t begin my career in diabetes. I started out as a registered dietitian and home economist. At that time, I had no particular opinion about working in the world of diabetes, but when I started doing it, I fell in love with the fact that a patient’s behavior makes a difference, which isn’t the case with most medical conditions.

diaTribe: Could you talk more about the behavioral end or issues with adherence? How do you reach out and touch patients to encourage them to change their behaviors?

Janis: As diabetes educators, we ask patients to engage in self-care behaviors that are necessary to improve their health. In order to do them successfully, most people need the support of family and friends. This is the piece that I focus on: relationships. If there is tension between a partner, a friend, or a spouse, it makes it more difficult to implement important self-care behaviors.

diaTribe: What about if the patients do not even know about the educators? Accessibility to educators is still difficult, so can you discuss access to education and what can be done to improve it?

Janis: I believe that is where the mass media comes in. I do a lot of work with dLife. They have a television show and educational website for people with diabetes. We need to have the information floating around in as many forms as possible. We need to get it into the American conversation. Knowing how to become healthier should be as important as knowing not to drink and drive. Everyone needs to become aware of the importance of regular physical activity, sleep, healthy food choices, and portion control. We need to get these lessons out to the general population as taking care of their health will ward off a lot of diseases, especially type 2 diabetes. If they already have diabetes, these behaviors can improve their condition.

diaTribe: Is the bigger problem that people actually do not have the information or that they don’t understand how to put it into practice? I sense a frustration in people starting diabetes treatment, and they question why things are not moving faster.

Janis: One reason that I wrote my second book, “Diabetes on Your OWN Terms,” is because I think that patients receive the wrong messages. Many believe that there is only one way to care for diabetes. A lot of those messages come from lessons we have learned from clinical trials - that patients must employ a certain type of behavior to have the best outcome. Patients need to understand that they have many different behavior options to choose from. They can start with small steps and implement new health practices at a personal pace. For example, in the book I list what AACE and the ADA have as their target goals for blood glucose. The targets are significantly different, so I say, “Look at the range between the two. You could go somewhere in between if you wish and still enjoy a significant improvement in your control. It depends on where you want to start.”

diaTribe: Can you discuss prevention of complications and your thoughts on how best to achieve this?

Janis: I believe that there is a lack of recognition of the power of education as a way to prevent complications. For example, to prevent amputations, a patient should learn how to inspect his or her feet each day. Unfortunately, we do not have enough time to discuss every single topic. It is sad, but that is the way the system works; it is not prevention focused.

diaTribe: Historically, there have been many side effects with diabetes medicine such as weight gain or hypoglycemia. Is there anything that you can say about what makes it easier for people to stay on drugs or new technology?

Janis: The greatest thing that has really made all the difference in the world is the glucose monitor. People are checking their blood sugar, and they are making decisions based on the patterns that they see. Once they know how to use the results, they have the opportunity to become their own physician and can guide themselves. My favorite is the post-prandial test because people get very excited when they realize that they can look back at a meal and see what their food choices may have done to their glucose level. As far as staying on medication, information is power. The glucose meter helps show people the role that medication is playing in their diabetes health. They also need to know that there are many medication options to choose from. If one drug doesn’t work well, they should share their concern with their healthcare provider and ask if they can try something else.

diaTribe: Lastly, I’d like to ask you about women’s issues and diabetes, a subject I know you’re passionate about. How did you bring sex out of the closet in diabetes care? Should women get more attention in this realm in future years in your opinion?

Janis: I just started talking and writing about it and didn’t care that it made others uncomfortable. Sexual issues are too important to ignore. Women’s sexual issues definitely need much more attention. The research for women has lagged way behind men. We didn’t see any reliable studies on women until 2002! We recently discovered a connection between sexual complications in women with type 1 and the menstrual cycle. Who knows what else we can uncover? Will women get more attention? I hope so. More health care providers are now aware that a diabetes/sexual connection exists for women. Women are starting to ask about it as well.

diaTribe: Janis, thank you again for your time, and we look forward to hearing more from you in the future.