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

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.

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

 

Reaching the Unreachable: A Personal Approach to Diabetes

As published by Huffington Post 1/15/14; http://www.huffingtonpost.com/david-weingard/post_6474_b_4466725.html

 

By David Weingard
Shock — is how I felt when I was first diagnosed with diabetes.

I had been training for an eight stage survival race and was in great physical shape. Suddenly I felt weak and lethargic and knew a visit to my physician was necessary. Even getting to the doctor”s office was a physical challenge. It was here where I learned that my drastic weight loss was not a result of athletic training, but instead my body failing to produce insulin. My body was starving itself and I was unaware!

I was in disbelief and looked for resources to help me understand. While there is plenty of information online, I found that it was very basic and didn”t explain to me how to live my own life with the disease. I also couldn”t find the personalized support I needed to manage my health, engage with my family and meet professional demands while living with diabetes.

As I rebuilt my life collecting information and support from wherever I could find it. I made a commitment to find a way to help the diabetes community, so I began racing Ironman triathlons to raise money for diabetes charities. What happened after that was incredible. People started emailing and calling me for advice. I only know about my diabetes and really don”t have the knowledge to help someone else with theirs! This is when I realized that I can assist others by making this a personal journey. By leveraging many positive professional relationships along the way, I began to personalize diabetes management by engaging diabetes educators countrywide with diabetes patients via technology. The ultimate goal is to help people lead rich and fulfilling lives with diabetes.

We are in a state of crisis, people need help, there are almost 26 million people with diabetes in the U.S. and another 79 million adults in the U.S. with pre-diabetes. The financial impact was $245 billion to employers, government and the individual with diabetes in 2012

We”re in this predicament for many reasons and it continues to escalate because diabetes is so complex and difficult to manage. Over 40 percent of patients prescribed a new diabetes medication stop taking it within the first few months. While there are helpful resources online and within communities, it is often challenging to find the relevant information. Also, the people who look for this information and support are the ones motivated to take care of their diabetes. Solving to effectively engage the unmotivated patients is where the big problem lies.

People with diabetes have different experiences, contributing to the People who stopped using buy-detox.com can still feel strong cravings for the drug, sometimes even years later. complexity of managing an already multidimensional disease. I saw these differences in real-time as I had the rare opportunity to participate in focus groups comprised of people with diabetes of varying socio-economic and cultural groups. Interestingly enough I found myself relating to them. We had the same emotion when diagnosed: shock! There were so many beautiful and human moments as people shared their individual challenges and successes living with diabetes. There was also pain and a sense of resignation that diabetes was not going away and that they would need to find ways of coping with it… forever.

Additionally, I had the opportunity to learn from thought leaders who added to this pool of valuable guidance. Each mentor had incomparable perspectives on how to improve our business model and presentation. I look forward to their continued mentorship and the relationships I”ve gained from this experience.

David is founder and CEO of Fit4D, a company whose mission is to improve the lives of people with diabetes and other chronic conditions, worldwide. In his journey as someone with diabetes, David has been fortunate to meet many incredible people with diabetes and their families. It is David”s personal passion to share his experiences, knowledge and positive energy with the diabetes community. With over 20 years of experience in the technology sector at startup and public companies, David decided to devote his energies to helping people with diabetes. David can be reached via e-mail at dweingard@fit4d.com.

Fit4D is one of five semi-finalists in The Merck | Heritage Provider Network Innovation Challenge. The sponsors have called on entrepreneurs, data scientists, designers, health care providers, and big thinkers to create the products or services that will support patients with diabetes and/or heart disease in adhering to their care plans and ultimately improving health. Semi-finalists will be presenting their solutions at Demo Day on January 23rd in NYC. Check out their progress, watch their Demo Day presentations, and find additional open innovation challenges by visiting Health Data Challenges.

This blog series is produced in partnership with Health Data Challenges, creators of The Health Data Challenge Series, a formal initiative of the Health Data Consortium, powered by Luminary Labs. The platform seeks to foster the use of data to drive innovation that will ultimately transform health and healthcare through high-stakes innovation challenges. Learn more at www.healthdatachallenges.com.

Follow David Weingard on Twitter: www.twitter.com/Fit4D