Leslie Lee is interviewed by Roberta Ruggiero, HSF Founder
Leslie Lee is on the Advisory Board of the HSF and talented Registered Dietitian at Swedish Hospital in Seattle, Washington. She was instrumental, with Wolfram Alderson and Roberta Ruggiero, in designing and implementing the current HSF Hypoglycemia Questionnaire and evaluated the results which will be featured in the new 5th Edition of Roberta’s book, “The Do’s and Don’ts of Hypoglycemia: An Everyday guide to Low Blood Sugar” that will be released September 12, 2017. For a sneak preview, don’t miss this interview!
Leslie, I felt such a connection to you the first time we spoke. It felt like we were old friends just catching up. However, it was much deeper than that, we bonded, as Wolfram would say, on a soul level!! How did you feel after our first conversation?
Oh, I felt exactly the same way! We had an instant connection. I thought “this woman gets me.” One common theme among those of us who have struggled with hypoglycemia is feeling like we are not understood or taken seriously by the medical community. When you find someone who not only understands what you’ve been through, but has been through it herself, risen above it, and is helping others through it, it feels like a god-send!
I also can’t believe that after sharing our desire to educate and advocate for suffering hypoglycemic on a global level, we immediately started putting our ideas together about how we could join the “eliminate sugar revolution. Very slowly, and despite my time and energy being at an all-time low, our working and friendship relations blossomed. When I causally mentioned I would like to repeat the Hypoglycemia questionnaire from 1989, both you and Wolfram eagerly said, “Let’s do it!”
Both of you were responsible for taking our past Hypoglycemia Questionnaire to another level. You re-evaluated, designed and implemented a new version…more medical and technical.
Why were you so drawn (and eager) to join me and the HSF and then to take on the enormous task of the hypoglycemia questionnaire, it’s new design, evaluation and writing of the results?
I always felt like hypoglycemia was the rate-limiting factor on my quality of my life. It was something I had to understand better and overcome in order to live the life I wanted to live. When I was a young adult searching for information on why I might be experiencing hypoglycemia, how I should manage it, and, most importantly, how I could prevent it from happening, I found a literal void of information out there. Everything I read was basic and targeted to people with diabetes who were taking insulin. I was not that person, so their advice wasn’t useful. I didn’t find any answers in the doctors I saw either, so I decided to become a dietitian specifically to learn how to “fix” myself.
In nutrition graduate school, I saw another example of the void of information. Our community nutrition lab provided diet education to new diabetics, and nowhere in the curriculum was any mentioning of hypoglycemia. I told my advisor there was a hypoglycemia education need that our program wasn’t meeting, and she encouraged me to test it. So, I wrote a questionnaire (much like ours!), administered it to new diabetics enrolled in the program, and found a treasure trove of information. About 97% of our respondents had newly diagnosed type 2 diabetes, and two-thirds had serious concerns about their experience of hypoglycemia. When I realized that basically none were taking insulin, I realized hypoglycemia is happening in diabetics without being triggered by insulin administration. That’s when I realized that perhaps reactive hypoglycemia precedes the development of type 2 diabetes.
I hadn’t had many opportunities to explore this hunch further until our conversation. Thankfully, my boss at the time, Wolfram, was supportive of my spending time working on it, and the questionnaire was born.
What was the most startling conclusion of the new questionnaire?
There were many interesting conclusions. The most important result to me was what we learned about reactive hypoglycemia preceding the development of type 2 diabetes. Two-thirds of our respondents who have been diagnosed with type 2 diabetes or pre-diabetes reported they experienced hypoglycemia before their diabetes diagnosis. Most of them (85%) experienced hypoglycemia for two or more years before their diabetes diagnosis, which to me presents a very clear window of opportunity for education and diet improvement.
I believe the same metabolic dysfunction that presents as reactive hypoglycemia now can develop into insulin resistance and type 2 diabetes later, if diet is not modified. That was always my hunch and my greatest fear. It’s a simple observation, but I think it’s highly significant in that we can now interpret reactive hypoglycemia as a red flag or a call-to-action to intervene with diet modification and prevent diabetes from developing.
What would you like to see us (HSF) do with the results?
I’m a big believer in influencing the influencers. Physicians, nurses, dietitians need this information, because they are the touchstones to every patient. They need to know that it’s reckless to say “just eat more sugar” to a person on the verge of developing diabetes. Believe it or not, that’s common advice for the treatment of hypoglycemia! We need to stop the influx of misinformation out there, improve clinicians’ understanding, inform patients that what they’re experiencing could lead to diabetes, and then we need to empower them to change.
I’d love to see the HSF develop the gold standard in diet education for patients who experience reactive hypoglycemia. I think we can equip clinicians to better educate their patients on treating hypoglycemia strategically so that the treatment doesn’t trigger another episode of hypoglycemia, and, most importantly, eating in such a way that it’s prevented all together.
Do you think/believe the medical profession will accept and use our news/views and recommendations?
I do, but unfortunately, it’s going to require patient advocacy and the demand for better care. There’s nothing sexy about what we’re talking about. There’s little opportunity for a drug or medical device to fix the problem, so corporations will not be sending sales forces in to educate your physician. It will require a grassroots effort; both patient self-advocacy and the HSF will be critical.
Other than the medical profession and the HSF (hypoglycemia community), who will profit most from our results?
Those suffering from hypoglycemia, just like you and I, Roberta! That’s what we’re all here for—you, me, and every physician, nurse, and dietitian in practice today are striving to help those who are suffering. Fortunately, this isn’t a complicated matter—it’s simply a confused one. Opportunities to help abound, and I think that’s exactly what our questionnaire demonstrates.