I chose diabetes for my area of concentration, spending 6 weeks working in an outpatient setting with dietitians, many of whom were Certified Diabetes Educators (CDE). The experience helped me realize the complexity of both the mechanism and management of diabetes, much more so than what we learn in a DPD program.
I participated in and facilitated counseling sessions with Type 2 diabetic patients as well as women with gestational diabetes. Pregnant women are extremely compliant with the recommended treatment including checking blood sugars four times per day, counting carbohydrates for all meals and snacks and recording food intake and blood sugar readings. Because glucose crosses the placenta, uncontrolled diabetes during pregnancy increases risk of macrosomia, high- weight baby, which increases the chance of a cesarean section delivery. In addition, the baby may experience hypoglycemia until he or she is able to normalize blood sugar on his own. With so much at stake, it’s easy to see why pregnant women are generally compliant.
It’s not easy for all individuals living with diabetes to be so compliant. During this rotation, I spent 3 days living as if I had diabetes. This included counting carbohydrates, monitoring portion sizes, recording what and how much I ate, eating at regular times each day, and checking and recording blood glucose 4 times/day. It also involved dosing insulin appropriately based on blood sugar readings, which I did by injecting saline into an orange to simulate administering insulin into my body. I am not diabetic and only needed to cover carb content of the meal, not figure out how many units of insulin I needed to correct a high blood glucose reading before I could even start eating. I must admit that I purposely chose to eat individual foods for which I could easily determine carb content, as opposed to mixing foods. Eating individual foods to make it easy to count carbs day in and day out is unrealistic. Diabetics should not avoid carbohydrates; consuming 50-60% of total daily calories from carbs is important for maintaining blood sugar levels.
I wish I could tell every patient that self blood glucose monitoring (SBGM) is easy. For many patients, managing diabetes is easy only because they are motivated to do so, just like our gestational diabetic pregnant women. These patients focus on the goal of reducing their risk of neuropathy, retinopathy or heart disease that may follow years of uncontrolled blood sugar. Perhaps that patient whom we would like to improve SBGM is already hard at work trying to lose weight and is already taking on new health habits. Adding one more change might just turn them off completely. As dietitians working with Type 1 and Type 2 diabetic patients, we must realize that before patients can hear our recommendations for SBGM we have to address motivation and “meet them where they’re at”. There are many success stories of diabetic patients who have worked hard to lose weight, exercise and self monitor each day. They made the choice to learn and adapt new habits; and it has to be the patient’s choice. As registered dietitians, we must acknowledge and work with the barriers to effective SBGM and realize that every positive change is a monumental step in the right direction for the patient.
I participated in and facilitated counseling sessions with Type 2 diabetic patients as well as women with gestational diabetes. Pregnant women are extremely compliant with the recommended treatment including checking blood sugars four times per day, counting carbohydrates for all meals and snacks and recording food intake and blood sugar readings. Because glucose crosses the placenta, uncontrolled diabetes during pregnancy increases risk of macrosomia, high- weight baby, which increases the chance of a cesarean section delivery. In addition, the baby may experience hypoglycemia until he or she is able to normalize blood sugar on his own. With so much at stake, it’s easy to see why pregnant women are generally compliant.
It’s not easy for all individuals living with diabetes to be so compliant. During this rotation, I spent 3 days living as if I had diabetes. This included counting carbohydrates, monitoring portion sizes, recording what and how much I ate, eating at regular times each day, and checking and recording blood glucose 4 times/day. It also involved dosing insulin appropriately based on blood sugar readings, which I did by injecting saline into an orange to simulate administering insulin into my body. I am not diabetic and only needed to cover carb content of the meal, not figure out how many units of insulin I needed to correct a high blood glucose reading before I could even start eating. I must admit that I purposely chose to eat individual foods for which I could easily determine carb content, as opposed to mixing foods. Eating individual foods to make it easy to count carbs day in and day out is unrealistic. Diabetics should not avoid carbohydrates; consuming 50-60% of total daily calories from carbs is important for maintaining blood sugar levels.
I wish I could tell every patient that self blood glucose monitoring (SBGM) is easy. For many patients, managing diabetes is easy only because they are motivated to do so, just like our gestational diabetic pregnant women. These patients focus on the goal of reducing their risk of neuropathy, retinopathy or heart disease that may follow years of uncontrolled blood sugar. Perhaps that patient whom we would like to improve SBGM is already hard at work trying to lose weight and is already taking on new health habits. Adding one more change might just turn them off completely. As dietitians working with Type 1 and Type 2 diabetic patients, we must realize that before patients can hear our recommendations for SBGM we have to address motivation and “meet them where they’re at”. There are many success stories of diabetic patients who have worked hard to lose weight, exercise and self monitor each day. They made the choice to learn and adapt new habits; and it has to be the patient’s choice. As registered dietitians, we must acknowledge and work with the barriers to effective SBGM and realize that every positive change is a monumental step in the right direction for the patient.
