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Memorial Hospital’s Miranda Center a Resource for Diabetics in the Community

November 03, 2016

NORTH CONWAY, NH – Carol Edwards’ retirement to the North Conway area was long anticipated but did not go quite as planned. Relocating from Seacoast New Hampshire to Intervale last April with her husband Barry, she starting dealing with rapidly worsening diabetes symptoms after the move. She consulted with her new primary care doctor, Angus Badger, MD, when she wasn’t feeling well and he referred her to Miranda Center for Diabetes at Memorial Hospital. And that’s where her journey with diabetes began.

Carol is just one of the many Americans with diabetes, a number that increases every year. In fact, every 23 seconds, another person will be confronted with the reality that they are now a member of a club they did not intend to join.

It all starts with a set of symptoms. The common symptoms of diabetes are:

  • Urinating often
  • Feeling very thirsty
  • Feeling very hungry - even though you are eating
  • Extreme fatigue
  • Blurry vision
  • Cuts/bruises that are slow to heal
  • Weight loss - even though you are eating more (type 1)
  • Tingling, pain, or numbness in the hands/feet (type 2) 

Carol had been previously diagnosed with diabetes, but as she put it, her symptoms “exploded” after her move.  “My blood sugars had been borderline and they tipped over when I got here. I knew I was feeling poorly so I went to Dr. Badger who recommended the Miranda Center. There’s where I met Justine and the crew.

”Memorial’s Miranda Center for Diabetes and Endocrinology is lead by diabetes nurse practitioner Justine Fierman, FNP-BC, BC-ADM, MSN, CDE. Justine is an experienced provider and administrator who sees patients with diabetes as well as those with endocrinology issues.  

Her passion for treating diabetes comes from a very personal place. Her father had Type 1 diabetes but was in denial about his condition. He died from complications of diabetes at the age of 56, an age she recalls as being far too young. His memory is what motivates Justine to help meet patients where they are at to help improve their condition. “It’s Diabetes detective work. I ask a lot of questions, looking for patterns contributing to blood sugar problems.  I suggest small changes and ask the patients what changes they feel they can maintain for the lifelong journey.  We work together to create a plan and keep revising that plan as the journey continues.” It’s her personal approach that is already resonating with patients at her new practice at Memorial.  

Justine is part of a multi-disciplinary team including a board-certified endocrinologist, dietitian, nurse practitioner, nurse and other clinical support staff – all with a mission to help people with diabetes manage their disease with evidence-based treatment provided in a cost-effective manner. In addition to her office at Memorial Hospital, Justine also sees patients at a satellite location in Berlin, NH at Androscoggin Valley Hospital.

Justine believes diabetes as a life-long trip with different paths you can go down. She sees her team’s role as helping guide patients to the best outcomes with the least obstacles. The team provides the patient with the tools they need for their journey, whether that be nutritional counseling, education on use of equipment such as a meter or education on how to manage the day to day fluctuations in blood sugars. Providers at the practice can adjust diabetes medication along the way.

Carol feels the support she received from the Miranda Center made all the difference in the world. “I had a big turnaround. My blood sugars are under control. My eating has changed. I adhere to my diet and I eat much better. I’m in much better physical shape and saw a good weight loss.”

But managing blood sugars and diet isn’t the only challenge for those battling diabetes. The financial impact can be staggering – especially for those on a fixed income, like retirees, or those with high-deductible health insurance plans.

According to the American Diabetes Association, the total estimated cost of diagnosed diabetes is $176 billion annually in direct medical costs. And people diagnosed with diabetes incur average medical expenditures attributable to diabetes of $7,900 per year. That makes understanding options and their financial impacts critical, as some patients forgo the treatment they need when the costs become too burdensome.

Carol credits the Center’s staff with helping her find the right treatment plan and prescriptions that worked not only for her condition but also for her financial needs. The Center’s staff helps match patients with discount coupons from drug manufacturers, refers patients to financial aid programs for income-eligible patients; referring them to the lower cost pharmacies and stores around town for meters and testing strips; and prescribing lower-cost drugs when appropriate.

“Initially it cost me $600 for 5 injectable pens in a month! If you use up those 5– what do you do? That’s your money! It was an eye opener – it was an unexpected expense on a retirement income. They found medication that had coupons that got me down to $15 for a set of pens. She prescribed a medication that was less expensive too.”

Justine agrees. “Patients come in who have purchased insurance with only catastrophic coverage with a high deductible. They may see several hundred dollars a month in prescription costs. This can lead patients who can’t afford their medication to defer treatment, resulting in poor blood sugar control and complications from diabetes.  For example, Shannon, our medical assistant helps determine the least expensive blood glucose meters out there and identifies RX co-pay cards for discounts too. If a patient can’t afford a medication, they won’t take the medication. It’s crucial we prescribe the right medication and diabetes supplies that the patient is able to afford long-term. ”

November is Diabetes Awareness Month, but it’s also an open enrollment period for many insurance plans. Justine advises, “Patients need to choose insurance wisely. Open enrollment time is the time to research it. Some plans have add-ons to help reduce exposure for out of pocket expenses.”

Thanks to the Miranda Center for Diabetes, Carol is starting down the right path, and still with a ways to go. “With a diagnosis, it’s like you’ve been hit by a truck. You don’t know what you’re doing. (Justine’s) level of competence and her calmness was very reassuring. She kept saying ‘everything will be fine; we’ll work on this together and everything will be great.’”

For more information or to make an appointment, call 356-0796, Ext. 3353 or talk with your primary care provider. You can also find more information online at

Sidebar article

Memorial Hospital and Cranmore Fitness Team Up for Diabetes Awareness
Monday, November 14th is not only World Diabetes Day, it’s also the day when Cranmore Fitness, North Conway’s largest fitness facility, will hold their annual Open House & Membership Drive with a special visit from staff from the Miranda Center for Diabetes from 9am – 12pm.

Visitors can join Memorial Hospital’s Miranda Center for Diabetes nurse practitioner Justine Fierman, FNP-BC and medical assistant Shannon Forand for free health screenings, including blood pressure check and a diabetes risk test.

Cranmore Fitness will be offering complimentary classes offered throughout the open house including Yoga, Les Mills BODYCOMBAT, Strength in Motion, Spinning and MOVE. Personal trainers will also be available at the club for 15 minute consultations with guests.

Additionally, to help support diabetes resources, awareness and education in the community, Cranmore Fitness will host a membership drive in conjunction with Memorial Hospital from November 7-21. Cranmore Fitness will donate a portion of proceeds from the drive to the hospital’s Miranda Leavitt Diabetes Fund. Brenda Leavitt, mother of Miranda Leavitt after whom the Center and the Fund are named, will be at the Open House to share information on the program, which serves to support the needs of patients with diabetes in the community.

About Memorial Hospital
Memorial Hospital is a not-for-profit 25-bed Critical Access Hospital located in North Conway, NH, and is a member of the MaineHealth family. Its hospital services include a 24-hour emergency department, surgery center, clinical laboratory, heart health & wellness programs, family birthing center, sleep center, wound care and hyperbaric medicine center, oncology, chemotherapy and infusion services and the Miranda Center for Diabetes. Physician practices include primary care and family medicine, women's health, orthopedics and sports medicine. The Merriman House, a 45-bed nursing home specializing in Alzheimer's and other memory disorders, is also located on the hospital campus. Together, our staff and providers are committed to meeting the health needs of the Mt. Washington Valley and surrounding communities by collaborating with community partners in the delivery of accessible, comprehensive, compassionate, and quality health care.

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