True or False: Foods that People Think are Healthy

 

Salad

 

Gluten-Free, Fat-Free, Cholesterol-Free, Sugar Free foods

Why people think they’re healthy: “Free” implies that bad things are removed from foods, so it would seem these foods would then be healthy and therefore there is no need to limit portions.

Why that’s not necessarily so: People with celiac disease cannot process gluten (found in wheat, rye, barley, bulgur, graham, and spelt) however most people can. Someone may experience a benefit from cutting gluten from their diets only because they are cutting down on carbohydrates, but this often can go too far. Someone who goes “gluten free” has to become really conscious of including whole grains in the diet (such as rice [especially brown], corn, quinoa, millet, buckwheat, gluten-free oats) because of their nutritional contributions and importance to overall health. Carbohydrates should provide 45 – 65% of total calories daily per the Dietary Guidelines for Americans. Many foods made without fat or sugar will have more of the other in order to make them taste better, which still renders them to be unhealthful. The manufacturers are going to put something in to make sure people like their products! Calorie balance always comes into play with portions, as well.

 

Health Drinks and Health Bars

Why people think they’re healthy: Popular electrolyte-replacement drinks replace fluids and provide “energy”; protein bars are formulated to have protein and “energy”.

Why that’s not necessarily so: The “energy” from these foods is provided by carbohydrates (mostly sweeteners) and some vitamin-containing “waters”; plus they often provide caffeine. Electrolyte drinks provide fluids and energy for vigorous workouts, however they are not healthy for casual drinking when compared to plain water, 100% fruit juices, or milk. “Health bars” are often candy bars with added oatmeal or other grains, and nuts. Advise people to read labels to see the sugar and fat content of these heavily marketed products. Suggest they consider a switch to making smoothies which contain whole fruits, vegetables and milk or yogurt for a healthy drink or snack.

 

Vegetarianism

Why people think it’s healthy: Aren’t we supposed to eat more vegetables?

Why it’s not necessarily so: The problem for many people is that being a vegetarian is more about giving up “meat” and less about eating enough volume or variety of vegetables and fruits. A diet based on pasta and cheese or nuts and soy can be quite unhealthful due to its limited nature. Vegans in particular are at risk of not getting enough protein and calcium, and should take B-12 supplements because this nutrient can only be found in animal proteins such as meat, dairy, eggs, and fish. Further, vegetarians still need to focus on getting a balanced diet—fresh fruits, vegetables, and whole grains, and encouraged to consume low fat dairy as well.

 

Wine

Why people think it’s healthy: Many studies tout that wine is healthy and beneficial, showing that wine’s alcohol and polyphenols, especially resveratrol from grapes, appear to reduce LDL (“bad”) cholesterol and increase HDL (“good”) cholesterol. Wine also provides antioxidants which can be helpful in preventing some diseases.

Why it’s not necessarily so: Many of the studies on wine have been conducted on animals, or look at correlations, and are not necessarily true for humans. Plus, some of the benefits of wine can be found in grapes themselves, and in other fruits and vegetables. The recommended daily limit of one glass for a woman, two for a man is not often followed in real life. Moderation is the key. Other research has also demonstrated that wine is unhealthy. Too much can lead to high blood pressure, increased triglycerides, and cancer. Wine is also not recommended during pregnancy.

 

Foods People Often Think Are An Indulgence, But May Be Good For You:

 

Coffee

Why people think it’s an indulgence: It’s “addictive”, it interferes with sleep, and people love it so much it must be bad.

Why it’s pretty healthful: True, overindulgence can create problems for some such as affecting blood pressure or interfering with sleep. Current research continues to provide evidence for new ways that caffeine is beneficial to health. Contributing to the major reasons coffee was deemed unhealthy in past decades was that people who smoked, exercised little, ate unhealthy diets, and also drank coffee resulted in coffee being blamed for years for high cholesterol, obesity and other problems when in fact the accompanying habits were the culprits. Coffee seems to be protective against Parkinson’s disease, Type 2 diabetes, and liver disease including liver cancer (Mayo Clinic). Neurologists have determined that coffee has a role in improving cognitive function and decreasing the risk of depression. The key again is moderation, as well as moderating the added cream and sugar.

 

Eggs

Why people think they are an indulgence: Eggs contain cholesterol, and for many years cardiologists pinpointed eggs as being especially detrimental to heart health.

Why they’re pretty healthful: Eggs do contain cholesterol, however even people with high cholesterol do not have to avoid them completely or even limit themselves to the whites. Eggs are an excellent source of protein, and the yolks offer minerals (zinc, iron) as well as choline, vitamin A, and B-vitamins which are essential to normal cell processes in the body.

 

Chewing Gum and Mints

Why people think they are an indulgence: Aren’t they essentially candy?

Why they’re pretty healthful: The sugar alcohol Xylitol in some sugarless gums and mints is actually beneficial to the teeth. Xylitol prevents cavity-causing bacteria from adhering to teeth and can help build enamel. Xylitol should be listed in the first three ingredients for gum or mints. It can be beneficial to take the gum or mints after eating sugary or acidic foods at times when you don’t brush your teeth.

 

Emmie Olivas, RD, CDE

Fit4D CDE

 

Resources:

Academy of Nutrition and Dietetics. www.eatright.org.  Accessed December 3, 2015.

Managing Blood Sugars During the Holidays

With the holidays right around the corner, keeping blood sugars in control can be somewhat of a challenge. Whether you’ve “fallen off the bandwagon” in the past or done a relatively good job eating healthy, the following suggestions may help you get through the holidays without cramping your lifestyle.

  • Always take your medications. Be sure to stay on a schedule with your medications and don’t forget them if you are traveling away from home. Don’t be embarrassed about having to take medications in front of family or friends. You can always excuse yourself and go to another room to check blood sugars and take medications. Most people will understand or won’t even notice.

  • Keep checking blood sugars as instructed by your doctor. When eating different foods and doing different activities you may find that managing blood sugars can be a bit more challenging. Continuing to check blood sugars is critical to staying in control.

  • Carry glucose tabs or another form of fast-acting sugar with you. As mentioned above, by doing other activities you may be more likely to have unexplained high or low blood sugars. Have a form of fast-acting sugar on hand in case of a low (e.g., glucose tabs).

  • Get some form of physical activity every day. Go for a walk after dinner, play with the kids, go dancing, etc. The holidays can bring many opportunities for activity with loved ones.

  • Eat a healthy snack before going to a party to avoid overeating unhealthy foods. When you are hungry you are much more likely to make unhealthy food decisions and temptations can be harder to resist. If you show up not hungry you are much more likely to resist those yummy temptations.

  • Find out what will be served before going to a party to plan it into your meal plan. There is no need to feel shy about asking the host of a party what will be served before showing up. When you know what will be served you can decide beforehand what you will eat and won’t have to make a decision in the moment (as it may be harder to make a healthy one).

  • Bring a healthy dish to a party to share with others! You can always bring something you can eat, and others will most likely appreciate it as well. With 1 in 11 Americans having Type 2 diabetes, and more than 1 in 3 having Pre-Diabetes (2), you aren’t alone!

  • While socializing, go to a room where the food isn’t being served to avoid snacking. Get yourself out of temptation’s way. If after a while of being away from it for a while and you want to eat, you can go back and consciously eat.

  • Choose low or no carb drinks such as sparkling water, unsweetened tea, or diet beverages. An easy way to avoid too many carbs is by avoiding sugary drinks. High sugar drinks can quickly put you over your carb limit.

  • Make the focus of your festivities people and activities instead of food. The holidays aren’t just about food. Enjoy the relationships you have and don’t be scared to strengthen them during the holidays.

  • When eating, focus on vegetables and protein before carbs. When loading up your plate, be aware of what has carbs and what doesn’t, to avoid setting yourself up for failure.

  • Don’t overeat. You’ll thank yourself later

  • Plan ahead if you will be traveling. Keep in mind different time zones, availability of a refrigerator and medications. Talk to your health care provider with more specifics if you are concerned.

  • Be wary of treats brought over by friends and neighbors. The holidays can be a time for baked sweets and sharing them. Graciously thank others for their thoughtfulness but don’t allow yourself to lose control. Plan treats into your meal plan if possible, and give the rest to someone who may want them.

 

Remember, the holidays are for enjoying and growing closer to others and not just about the food. By having good control of your Diabetes during the holidays, you will feel better and have better BGs without any regret (3).

 

References:

 

1. “Managing Your Diabetes During the Holidays.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 17 Nov. 2014. Web. 14 Nov. 2015.

2. “2014 National Diabetes Statistics Report.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 15 May 2015. Web. 14 Nov. 2015.

3. “The Importance of Controlling Blood Sugar.” The Importance of Controlling Blood Sugar. N.p., n.d. Web. 14 Nov. 2015.

 

Annette Valle, RN, CDE

Fit4D CDE

Exercise and Diabetes

Everyone knows that getting regular physical activity is good for you, but it can be particularly beneficial for people with diabetes. Physical activity can help control blood sugar as well as relieve stress, improve heart health, strengthen the muscles and bones, and improve mood.  For a person with diabetes, activity helps the body become more sensitive to insulin to help improve a blood sugar control (1).

Despite these benefits, today’s world is full of barriers to actually doing exercise.  Time constraints, family obligations, a dislike for exercise, lack of gym funds, or not even knowing how to begin are some obstacles that can get in the way of starting an exercise routine.  While it can be easy to get stuck on the obstacles, thinking through and planning ahead can help you incorporate physical activity into your daily routine.

Here are some tips for making exercise part of your regular routine:

  • Schedule it in. Make exercise an appointment and stick to it!
  • Make it fun. If exercise is enjoyable, you are much more likely to do it. If you like to walk, try a beautiful park.  If you like to dance, turn on the radio and jam. If you like to be outside, join a community garden and sign up for gardening hours. If you like to be around others, join your local gym or city recreation center and take a class (any centers have free or low cost options). The opportunities are endless – find the ideal activity for you and mix it up!
  • Find a buddy to exercise with: Getting support for regular physical activity can help you to actually do it!
  • Sneaking in “incidental” activity: Take the stairs instead of the elevator or parking in the back of the parking lot instead of in front are additional ways to add activity into your daily routine.
  • Set up goals and rewards. You can’t get to where you are going if you don’t know your intended destination.  Try setting a time-oriented, realistic goal, and make it specific using the SMART acronym:
  • Specific: What will you do? Who will you do it with? When will you do it?
  • Measurable: How will you know when you achieve it? (e.g., walked a half a mile)
  • Achievable: Can you reasonably do it? (e.g., if you are just starting to exercise, setting a goal of running 10 miles isn’t realistic but starting with a half mile is)
  • Relevant: Is this something you can and want to do? (If you don’t like running choose another activity)
  • Timely: When will you do it?

Once you’ve set your SMART goal, find a buddy (friend or family member) to hold you to it and reward yourself when you reach your goal.  For example: “By Friday I will walk around the track 2 times after dinner on Monday, Wednesday, and Friday and then I will go see the new movie on Saturday as my reward.”

Before starting any new exercise program, it’s important to talk with your healthcare provider. People with conditions involving the heart, eyes, kidney, and nerves may have limitations in the type and intensity of exercises they do. For a person with diabetes, it’s also important to make sure to be prepared for a possible low blood sugar.

Here are some tips for exercising with diabetes:

  • Know what low blood sugar is. Hypoglycemia is when blood sugar drops below 70 mg/dl.
  • Know the symptoms of low blood sugar. These may include feeling dizzy, shaky, light headed, irritable, and less coordinated.
  • Prepare and prevent hypoglycemia. Check blood sugar before exercising. If it’s below 100 mg/dl, have a snack of 15 grams carbohydrate, such as a piece of fruit.
  • Carry your glucometer with you to measure your blood glucose as needed.
  • Bring glucose tabs or gel in a pocket as emergency quick carb.
  • Use caution with high blood sugar. If your blood sugar is 300 or higher, or 250 with ketones, exercise is not advisable and it is recommended to seek medical care. Stay hydrated with water. Consider testing blood sugar after exercise, especially if it was a long and/or intense session.
  • Check feet every day and wear comfortable shoes.
  • Consider wearing a medical ID and keeping a phone in your pocket.
  • Always carry water to stay adequately hydrated.

A simple rule of thumb: if you don’t feel well, don’t exercise. Once you feel better and you have talked to your doctor about exercise, incorporating more activity into your life can have numerous benefits- so get moving and enjoy!

 

SOURCES:

  1. Bartlett R, Gratton C, Rolf CG eds. Encyclopedia of International Sports Studies. New York, NY: Routledge; 2010:1367-1368.
  2. Coleman E. Diet, Exercise & Fitness. 8th Edition. Falls Church, VA: Nutrition Dimensions; 2011.

 

Nicole Anziani, RD, CDE

Fit4D Coach

Diabetes doesn’t take Vacation

Diabetes doesn’t take Vacation

Yeah, Vacation!!

In a recent TIME magazine I read that 96% of Americans recognize the importance of taking vacation, yet we are taking fewer days off than in the past and leaving unused vacation days at year’s end.

Vacation is a time to de-stress, to break away from our everyday life and daily grind whether it be through a ‘stay-cation’ or by exploring new surroundings or making an annual trek to our favorite location. Having time away can help with peace of mind, and help us reconnect with family or to interests not fully explored with the demands of work and everyday life. I know I focus better, perform more effectively and work harder when allowed time to break away and rejuvenate both physically and mentally.

This may come from a week-long vacation or simply a long weekend without work vying for my attention.

For those that need reminders I encourage you to do the same. Carve out some vacation time in any manner you will find pleasurable and doable.

Use the tips given by Gabrielle Kemble, Fit4D Health Coach, who recently wrote about how to plan for summer travel, and frankly, travel at any time of the year.

What I would like you to think about is this…while I extoll the virtues of vacation remember that diabetes doesn’t take a vacation. It goes where you go. Taking a break is vital, taking a break from the daily grind of diabetes self-management is also refreshing. However, to take a complete break from lifestyle habits or your medication regimen may impact your diabetes not only for the time away but into the days and weeks following your time off. It may be difficult to reign in the excess of vacation, just as it can be difficult after the holidays. Remember your A1C is a 2-3 month average of your blood sugar which includes what might be a weeklong break from healthy eating along with any change in activity level. So, to have it both ways, vacation with diabetes control I encourage you to plan ahead and get the best for your diabetes management and get the most out of your vacation.

Consider This

Consider how you may include occasional special treats while not over doing it. An increase in activity may help balance extra calories but we  don’t burn as much as our mind assumes. And excess calories and carbohydrates can cause the hyperglycemia you’re trying to avoid. Pack snacks, and easy foods to prepare when you have kitchen facilities to reduce frequency of dining out – and you’ll save money, too! Indulge with conscious thought to do so but in a controlled manner. Share a dessert and if you plan to do this, skip the appetizer. Or, if you plan to stop at the creamery for a frozen dessert, pick something light for dinner and not the pasta special. Enjoy the sights and take an additional walk after your meal. Manage alcoholic beverages and limit snacking. Why stock the camper, fridge or car with a multitude of snacks we wouldn’t ordinarily have at home? Don’t use vacation as an excuse to eat junk food, fast food or too much of any food. Keep snacks out of reach while driving so as not to eat out of boredom.

These are tips to manage food intake and reduce hyperglycemia. On the other hand, for those who are more active on vacation, you’ll want to plan ahead to prevent the hypoglycemia that can come with an increase in physical activity.

Medications

Everyone’s needs and desires are different just as medications are. So, think about how your medications work, and discuss with your Certified Diabetes Educator (CDE) or Health Care Provider (HCP) your vacation plans before leaving. They can help you learn how to make necessary adjustments with considerations for your medication regimen while on vacation to accommodate any change in sleep pattern, activity level, or food habits.

If you travel with a plan you are more apt to stick with it and be healthier for it, mind, body and spirit. Upon returning home you will feel better and ease into your routine more easily as well. I wish you all a fun, restful and healthy vacation!

 

Lori Muller RD, LD,

CDE Fit4D Diabetes Health Coach

Summer Travel & Diabetes

Summer is upon us, and for many people that means travel plans!  Diabetes shouldn’t hold anyone back from getting out and enjoying the fun!  The important thing to focus on, is taking your care routine with you.

 

The Essentials

Packing double the amount of medication and supplies you usually use is a great idea, incase of delays in traveling or other unexpected events.  Think about packing medication, test strips, lancets, batteries for your meter, and ketone strips.  Always take copies of prescriptions with you, should you need to get refills on the road.   Keep your health insurance card and emergency contacts in an easy to find place for emergencies; wear your medical ID bracelet or necklace.  If on insulin, be sure to bring a glucagon kit, as well as plenty of syringes or other insulin delivery devices.  It is also a good idea to check out where to get medical care near your travel destination as well.  Better to be prepared and not need it then want it and not have it.

Bring a note with you from your doctor explaining that you have diabetes and what medications you need.  If traveling to a location where a different language is spoken, consider having the note translated into the appropriate language(s).  Medications and other diabetic supplies should be packed in your carry on bag, rather than in checked luggage so that there is no risk of losing it.  Keep time zone changes in mind as you go, and be sure to take your medication at your usual times.

If you utilize an insulin pump, there are a few extra things to consider.  Request a private screening at the airport, rather than going through the body scanner.  Make sure you have extras of all your supplies – reservoirs, infusion sets, inserters if you need one, extra batteries for your pump, glucose tablets, non-perishable snacks and insulin.

 

Move!

With driving, or flying, there is always a risk of blood clots when you sit still for awhile.  Try to move around every hour or two if you are at risk for these.  Insulin that is open and in use, needs to be kept at room temperature.  If you will be in a hot car or other area, remember to pack your insulin with a cooling ice pack, putting a towel between the ice and medication to prevent it from accidentally freezing.  If you are in an area that will be excessively cold, keep your open insulin close to your body to keep it the appropriate temperature.   Unopened insulin should always be kept at refrigerator temperature, so this should be wrapped in a towel and placed with an ice pack as well.

 

Prepare for Lows

Pack plenty of pure sugar items that you can use in case of a low blood sugar.  Healthy snacks like fruit, raw veggies and bottled water are a good idea too as these are not always readily available on the road or in the air.  Make sure you have access to nutrition information.  If the places you will be eating at don’t have carbohydrate information readily available, download a nutrition database app such as Calorie King or Nutrition Data, or get a hard copy of their pocket guide versions.

Once you arrive at your travel destination, try to maintain your usual activity level to keep blood sugars in check.  And above all else, test your blood sugar!  Even more than usual, since changes in routine, eating and exercise habits can drastically affect blood sugar levels.  The more you check, the more chances you have to improve the results.  It can be difficult to balance your diabetes with changes in routine, but it if you plan ahead you can fully enjoy your summer vacation!

 

Gabrielle Kemble, RD, CDE

Fit4D CDE & Clinical Manager

 

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

5 Tips to Help Your Patients with Diabetes Stay on Track with Their Medication

Health care providers prescribe medications hundreds of times each week, but to a person newly diagnosed with Type 2 diabetes, hearing “I want you to take ____” is a public admission of failure. Failure to lose weight. Not making time for exercise. Inability to change habits like flavored coffee for breakfast or a favorite aunt’s cinnamon buns during family gatherings.

For many people with diabetes , a prescription for oral medication or even worse – insulin – is a sure signal that amputation, blindness, renal failure and death is just around the corner. Often too shocked, scared, or angry to ask questions, your patient leaves your office with prescription in hand but never fills it. Or they fill it, but decide they won’t take it because they hope to make the lifestyle changes that they’ve been putting off for months or years. Sometimes they fill the script but only take the medication when they remember, or when no one else is around so they don’t have to admit they have diabetes, or when they feel like their blood sugar is high.

Here are 5 important strategies we’ve found successful in empowering and motivating people with type 2 diabetes to take their meds as prescribed:
1. WIFM: What’s In It For Me. Explain why the medication is necessary both for short-term management of diabetes as well as prevention of long-term complications. Talk about how the med will address how the person feels on a daily basis, addressing any complaints they talked about during their examination.

2. Describe how the medication works in easily understandable language and provide clear, easy to understand written materials. Often newly diagnosed people with diabetes don’t know the difference between oral meds and insulin, or that oral meds work in a variety of ways. If you don’t provide written information, many people go home and do a Google search which may lead them to inaccurate information or promises of ‘natural’ cures.

3. Talk about possible side effects and how to minimize them. Ask what side effects they’ve heard about, or which ones concern them the most. Weight gain or inability to lose weight and fear of hypoglycemia are two of the most common fears.

4. Know the cost of the medication and if the insurance plan will cover it. People often don’t want to admit that they can’t afford a medication, and take it less often than prescribed or won’t refill the script.

5. Ask open-ended questions that show you are listening to their fears and that you’re working together to improve their health. Examples of questions to encourage an open discussion:
a. How will you manage taking this medication? What is your usual routine for taking medication and how will you add this med to your routine?
b. What have you heard from your family, friends or other people with diabetes about this medication?
c. What might get in the way of taking this med?

If you don’t have time to explain how the medication works and answer questions, assign this task to another member of your health care team. Tell your patient why you’re prescribing the medication and that you will have them meet with this professional to explain how to take the medication and answer all their questions.

We often label people with diabetes non-compliant when they don’t follow-through with prescribed medications. Non-compliance is like an onion: peel away the layers until you find the actual reason why your patient didn’t fill the script or ‘forgets’ to take the med. We can’t assume that people with diabetes take their meds as prescribed, and we also can’t assume that we know why they don’t take their medications. The only way to find out the truth is to have an open and honest discussion.

Written by:

Lynn Grieger, RD, CDE, CPT, CWC

lynn g

 

References:
Medication Adherence. Its Importance in Cardiovascular Outcomes. Ho PM, Bryson CL, Rumsfeld JS. Circulation. 2009; 119: 3028-3035.
Working With Patients to Enhance Medication Adherence. Lin EHB, Ciechanowski P. Clinical Diabetes January 2008 vol. 26 no. 1 17-19.

Helping Patients Find Their Voice: Too Much, Too Fast?

As healthcare providers we tend to give a large amount of information to our patients at one time. It’s not that we don’t care or that we don’t understand adult learning; sometimes there is just a lot of new information that’s important to know. Think about the patient that is new to monitoring their blood glucose and new to insulin. It’s not just learning two new skills (which can be frightening enough for some) but learning how to treat lows, figuring out how to fit testing and injections into their lifestyle, what to do if they miss a dose and on and on. Those “two things” come with a lot of other little things to learn.

Here’s a few of things we’ve learned at Fit4D to make a difference in the complex world of diabetes, where there is frequently too much information that’s too fast!

  • Frequent check-ins are a must.  You might be thinking, but that’s not scalable—it’s expensive and certainly not realistic. But wait…check-ins come through online live events like webinars and support groups, texting their Fit4D coach, interacting on CDE led twitter groups, and phone calls when really needed.
  • Most of the questions come after the appointment.  We’ve all heard the stats that patients only retain 50% of the information given once out the door. Once they get home that’s when the questions start.  Sure, some people will call the office, but some people won’t.  Maybe they just called but then thought of another question or they’re embarrassed to call in the first place because they think they should already know the answer.  Having a place to go about “what‘s bugging them the most about their diabetes” is crucial. I’m not talking about a pile of handouts or even a website. What I mean is technology that is smart enough to individualize and yet escalate to their coach when needed.
  • Create a trusted relationship.  It’s important to get patients honest concerns and create an environment to help them feel like it’s OK to ask, in their mind, the “silly” questions. You may be thinking, how can just one question or one small piece of information make a difference?  Timing of medication is one very common mistake patients make.  Depending on type of medication simply helping them simply understand when  (and why) they are taking their medication can make a big difference in blood sugars and increase medication adherence.

I’d love to hear how you make a difference for patients and conquer the “too much, too fast” dilemma. 

Written by:

Sherri Isaak, MS,RD,CDE, BC-ADM

Just ask…

Just ask…..

What are you eating? Are you exercising? How often are you testing your blood sugar? What are your blood sugar results? Are you taking your medications? How is your stress level? Are you doing foot exams? Are you setting goals? Do you smoke? Are you ready to change—today, tomorrow, next week? The list of questions and topics for patients really is exhausting. They’re frequently bombarded with information they may or may not want to hear. Instead, how about focusing on what the patient’s needs are right now. Actually…the one need that’s “bugging them most about their diabetes.”

It’s hard because we as clinicians think to help our patients; we need to cover every topic—now.  Maybe we have a checklist of information we’re supposed to run through. But, is that really what’s best for the patient?  Nope. Helping them focus what’s on the top of their mind, “what’s bugging them” about their diabetes is far more impactful.

One of my patients went through my hospital-based diabetes education course a few years back. It really was a great series of classes with excellent educators. We even made it fun with hands on activities, healthy snacks, and included a multidisciplinary team of nurses, an exercise physiologist and dietitians. A year later she came back into my office and said, “I loved your course but I really didn’t pay much attention to what you said.  There was a lot of information I wasn’t ready for. I was really stressed out and needed to deal with that first. Now I’d like to focus getting on track with my eating.”  Yep—ready to focus on what’s bugging her most.

We have multiple drugs for diabetes, amazing technology, and well trained healthcare providers but if we seek out our plan, not what’s on the forefront of the patient’s mind, all of that really doesn’t matter quite as much.   Think about the patient, smiling and nodding in the office (pretending to listen about the importance of taking medication twice per day), but they are so focused on their only social event out, pizza night, that they think you just took away.  Now that’s something we could easy clear up, if we would have just started with that one question….what’s bugging you?  By doing that, now you have a relieved (and much happier) patient, who learned how to fit pizza into their meal plan!

Other than working on the challenges the patient wants to address first, why does it matter?    It matters because a step-by-step approach can help patients be more adherent to their diabetes care plan. Deal with their initial concerns, gain their trust and weave in the care plan challenges at just the right time for them. That’s what we’ve found that works best anyway

Helping patients focus on what’s on their mind and their top priorities gets better results and a bigger impact. It’s a simple question, “what bugs you most about your diabetes?”.…and let the patient lead from there.

 

Written by:

Sherri Isaak, MS, RD, CDE, BC-ADM