Keep it Simple for Practical Nutrition

Are your patients having trouble sticking to their diet? Do they struggle to make sense of all of the nutrition information they see on TV, in magazines, books and from friends? There is so much nutrition information around us that it is a challenge to stay on top of the latest recommendations. It is understandable that many patients feel overwhelmed with it all and give up.

My philosophy regarding nutrition is to keep it simple. I don’t believe that eating needs to be confusing and a constant challenge. If something comes from the ground, a tree or an animal and is not processed or minimally processed it is good for you. The idea that a banana might be bad for you or a potato is just confusing and not based on science. All whole foods like fruits, vegetables, grains, meats are inherently healthy for you. They have natural vitamins and minerals and are full of nutrients important for your body. Of course the portion size of any food is still important and something almost everyone can work on.

When I work with people who have diabetes, I start with finding out what their current eating patterns are like, and then we move towards some areas they are willing to work on. Typically, people think that I am going to tell them that they must eliminate all of their favorite foods and never eat things like bread, pasta, potatoes and sweets again. This is definitely not the case, and so it is exciting to see them brighten up as they learn all foods can fit into a healthy diet. I emphasize instead the importance of portion size, balance and variety. I also encourage patients to try and incorporate some healthy carbohydrates that maybe they haven’t tried before such as quinoa, faro, barley, beans, lentils, and Greek yogurt to name a few. I also drive home the value of vegetables as a low carbohydrate, high fiber and nutrient dense food group. When they see a portion of pasta compared to the equivalent vegetable portion they are usually amazed. With the patient, we collaboratively discuss ways they can include more whole grains and vegetables into their diet and plan ahead for meals and snacks so they have healthy and tasty foods available.

Recently, a patient told me she had never been able to stick to the “diabetic diet” after having diabetes for many years. She had given up on the diet because she didn’t understand it and wasn’t sure what a “carb choice” was. We reviewed carbohydrate foods and their effect on blood sugar as compared to fats and protein. We then discussed her current eating habits and she suggested that she could work on eating a few more vegetables and less crackers and pasta. At her next visit she was able to say with confidence that she had been able to follow what we discussed much of the time and was noticing a change in her blood sugars.

I really believe that no matter your diagnosis, eating should be fun and enjoyable and doesn’t have to be confusing. Eating plans can be flexible and should be something that makes sense for your lifestyle most of the time. Our patients will have much better success sticking with lifestyle changes if we can keep the messages related to nutrition simple and practical.  I’d love to hear how you are able to keep nutrition simple as an educator or a patient.

Written by:

Laura Russell, RD, CDE

Fit4D CDE

Pump Therapy, Is It Right For You?

There’s a lot to think about when you make the decision on whether or not to transition from injections to pump therapy.

  • Less injections. Most people with diabetes would say the biggest advantage to using an insulin pump is the elimination of multiple daily injections of insulin.  Instead of being “poked” two to four times a day or more, you are able to change your pump infusion site once every two to three days – drastically decreasing the number of times a needle must pierce your skin.  This could be enticing as you deal with the day-to-day tasks necessary to properly manage your diabetes.
  • Flexibility.  Pump therapy also allows you more flexibility in what you eat and what times you are able to eat.
  • Precision. Your dosing can be more precise with custom basal rate settings as well as having the ability to adjust how quickly your insulin is delivered.  This usually helps cut back on the variability of your blood sugar numbers on a daily basis and can also decrease your frequency of low blood sugars.

On the flip side, there can be some disadvantages.

  • You still need to test.  Pump therapy does not eliminate the need for close monitoring of blood sugar levels, and if you struggle to remember to check your number you could still struggle even with adding pump therapy.  It can actually be more dangerous for you to skip blood sugar checks while using a pump because if there is a malfunction with the pump – such as a kink in the tube – you have no long acting insulin in your system and you can develop dangerously high blood sugar levels rapidly.
  • Cost.  Pump therapy can also be expensive depending on insurance coverage.  You will want to investigate the cost before making the decision to get a pump.
  • You’re attached.  Also, you may not like the idea of having a medical device attached to you twenty-four hours a day, seven days a week.

Type 1 or Type 2?

While pump therapy is mostly used for people with type 1 diabetes, more physicians and diabetes teams are recommending pump therapy for those with type 2 diabetes.  The results have been positive.  One study* showed a decrease in A1c of 1.1% with pump therapy compared to just a 0.4% decrease in people with diabetes using multiple daily injections.  This decrease was also achieved without episodes of hypoglycemia.  They were also able to decrease their total daily dose of insulin by over 20%. This is not surprising as insulin infused continuously has been found to be more efficient than periodic injections.

Advancements in technology have brought many new and exciting options to people with diabetes.  Pump therapy can be a great option, and there are several different types of pumps with a variety of features available.  Before deciding what kind of pump features best suit you, first decide if pump therapy itself will work for your lifestyle and personality.  Talking to an endocrinologist or certified diabetes educator is a great way to find out more information and make the best decision possible!

 

Written by:

Gabrielle Kemble, RD, CDE

Fit4D CDE

*http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61037-0/abstract