Education, lifestyle key to managing diabetes

August 3, 2023

Contact: Carrie Burkett - / 603-356-5461 x2264
or Tim Kershner - Timothy.Kershner@MaineHealth.org603-356-5461 x2198

According to the Centers for Disease Control, more than 37 million American adults have diabetes, and only 1 in 5 of those know they have it.

For Brian Day, the increasing amount of water he was drinking could have been the first sign he had diabetes.

At age 41, Day was drinking a lot more water than usual, but neither he nor those around him took notice. A lifelong athlete, Day was involved in playing sports, officiating, and coaching three teams at Kennett High School.

A test confirmed the diabetes diagnosis, which was not unexpected but still a surprise. Diabetes ran in Day’s family with both parents and a number of aunts and uncles with the disease.

“It’s one of those things when you’re young and you know that diabetes is hereditary, but you don’t think about it. I was forty-one years old and still active playing and coaching sports.

Jennifer Golkowski, a nurse practitioner and diabetes specialist with Memorial Hospital says by the time people notice symptoms, diabetes “has probably been around for a while.” She also acknowledges living with diabetes takes effort and patience. “As serious as diabetes can become in a person, it is often easily managed and people living with diabetes can live healthy lives.”

Diabetes occurs when the pancreas does not properly regulate sugar in the blood stream. The most common form, Golkowski says, is Type 2 Diabetes where the patient needs some help keeping blood sugar levels normal. Major Type 2 risk factors are obesity, a sedentary lifestyle and family history. “Type 2 diabetes has more to do with insulin resistance. The body is producing enough insulin but not using it properly.” Type 2 diabetes is typically found in adults, though now more frequently in children and teenagers. With no noticeable symptoms at first, a blood test is required to see if a patient has Type 2 diabetes.

Type 1 diabetes starts with the autoimmune destruction of the pancreas, preventing the body from producing enough insulin. Type 1 diabetes is often found early in life but can also appear later in life. Golkowski notes patients with either Type 1 or Type 2 diabetes could experience “an increased risk of cardiovascular disease, heart attack and stroke, damage to blood vessels in extremities, damage to nerves in your extremities, numbness and pain, kidney disease, and problems with vision.”

While Type 1 diabetes can only be treated with insulin, Type 2 diabetes has more options. Golkowski recommends, “focusing on healthy lifestyle, maintaining healthy weight, eating well, exercising. Together these actions “are the mainstay of diabetes treatments.”

a woman wearing a lab coat, glasses, and stethoscope sitting at a clinical work computer station
Jennifer Golkowski, APRN-AGACNP, sees patients with diabetes at Memorial Hospital's Mount Washington Valley Rural Health Primary Care.

Diabetes symptoms often go unnoticed, so screening labs are important. Golkowski says, “Feeling thirsty, urinating a lot, waking up multiple times overnight to urinate, fatigue, unexplained weight loss, blurry vision” are all reasons to see a doctor right away.

Golkowski also warns that high blood sugar damages blood vessels, leading to damaged organs. Diabetes is consistently among the top ten causes of death and is the number one cause of kidney failure, lower-limb amputations and blindness in adults.

Now 68, Brian Day manages his diabetes with a combination of medication, diet, and lifestyle, though it has not always been easy. Or fun. Or successful. His schedule as a three-season coach at Kennett High School made a regular diet and exercise program a challenge. Testing was not always convenient, and he frequently had his dinner late at night while returning from games. “When you’re first diagnosed it scares you. I got onto a good diet, took my medication and lost some weight.” Frequently in the first years after the diagnosis, he admits, “I went off the wagon.”

Eventually, Day found a routine that worked for him. With the help of his providers at Memorial Hospital, Day is controlling his diabetes. “If I had to do it again I’d start easy. Just work at it lightly. Once you start losing weight and feeling better then you can get into it.”

Golkowski adds, “Ideally, we like to treat Type 2 with a goal of putting diabetes into remission. You can’t cure it, but you can put it into remission.”

In addition to preventive measures, Golkowski says testing is especially important for those with a family history of diabetes, one or more risk factors, or over the age of 45. Given the role family history plays in diabetes, diabetes is very common. “People who have a family history of diabetes should be sure to have a hemoglobin A1C screening regularly as recommended by their primary care provider.”

People with diabetes need a regular retinal eye exam to check for signs of diabetic retinopathy. Diabetic retinopathy can occur in both Type 1 and Type 2 diabetics and can lead to vision loss of blindness. The simple exam can detect signs early and is usually part of a regular diabetes treatment and monitoring plan.

a man putting a golf ball towards the hole
68 year old Brian Day manages his diabetes with a combination of medication, diet, and lifestyle adjustments. Here he enjoys golf at the North Conway Country Club.

Golkowski was a dietitian before becoming a nurse practitioner and certified diabetes educator. She uses her knowledge of food and nutrition to help patients navigate planning healthy diets and lifestyles. “I want people to enjoy life and have a good quality of life. So rather than saying, ‘you can’t have this or the other,’ we talk about things that are healthy and taste good and making replacement. Like replacing your white bread with a whole grain bread and finding something you like.” She will emphasize that lifestyle changes are not about denial but about “trying new things, finding things that you like. Finding ways of eating out at restaurants and socializing.” However, she is the first to admit, “Holidays are always hard.”

“Diabetes can be a progressive disease. There are times when you are doing everything well but over time you still need more treatment,” which can be frustrating for some people. “We try to be as proactive as we can. Educating people is one of the strongest tools we have.”

Golkowski also works with families since managing a chronic condition takes teamwork. “I love when families come in for the visit. It’s good to have the family be educated with the patient.”

Improvements in diabetes treatment and monitoring in the last ten years have helped patients “find the right balance between healthy eating, exercise, and education.” She advises diabetes patients to manage medication, monitor blood sugar (A1C) monitor for long-term complication. She also encourages others to get tested regularly especially if they are in a high-risk category or are having symptoms.


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, imaging services, cardiopulmonary care, family birthing center, oncology, chemotherapy and infusion services. Practices include primary care and family medicine, diabetes care, behavioral health, women's health, podiatry, orthopedics and physical therapy. Memorial Hospital is also home to The Merriman House nursing home, which provides senior care services in a comfortable, home-like setting. For more information,  or call 603-356-5461.