After finishing my 10 week clinical rotation I interned at three outpatient diabetes and endocrinology centers. I rotated at the University of Maryland Medical Center (UMMC), Baltimore Washington Medical Center (BWMC), and Greater Baltimore Medical Center (GBMC). I observed Certified Diabetes Educators (CDEs) working with patients in group and one-on-one sessions. CDEs are health professionals that have advanced knowledge and skills working with pre-diabetes, and diabetes prevention and management. They work with patients to promote diabetes self-management education (DSME). While each educator had their own style of counseling and patients had their own set of challenges and needs; I found there was one common goal to empower patients to take control of their diabetes. Diabetes is a chronic illness with no cure, and can often wreak havoc on the body if not managed well. Nerve damage, kidney failure, and infections are only a few of the consequences of poorly controlled diabetes. CDEs work to teach patients how to take control before and even when some of these complications occur.
While observing a one-on-one education, a CDE perfectly described to her patients the importance of diabetes management. She said, "Manage your diabetes, or your diabetes will manage you." The CDEs I observed gave their clients the tools and developed support systems that would help their client achieve their goals. Blood glucose monitors were a main tool for clients. CDEs often taught patients how to properly use a monitor as well as set a schedule for taking blood sugar levels. Many patients did not understand the importance of regular monitoring, and the educators worked to show them how keeping logs of blood sugar levels can help you see what foods spike your blood sugar, as well as how well your medications are working.
Another tool used was different insulin delivery devices. These include vial and syringes, insulin pens, and insulin pumps. The CDEs I observed taught their patients how to properly use their syringe and vial or pen and used the actual devices to assure patients could do it once at home. This allowed patients to feel more comfortable using their insulin. Insulin pumps are used mostly with type I diabetes patients. These patients go through a lengthy process and training to assure they can properly monitor their blood sugar levels, carbohydrate intake, and insulin delivered.
|Many insulin pumps can be synced with smart|
phone apps and computers
The tool that I found to be universal was nutrition education. Each patient has different food preferences, living situations, carbohydrate sensitivities, and possible other health complications. All these must be taken into account to develop the best method for monitoring their intake. For type 1 diabetes and type 2 diabetes requiring insulin, carbohydrate counting is key to give the right amount of insulin for carbohydrates eaten. For other patients, carbohydrate can be used if patients are more comfortable with math and food label reading. Another method commonly used is the MyPlate method. It provides patients with a visual of how their meals should look. This limits how much carbohydrate intake they have while increasing fruit and vegetable intake.
My time working with these CDEs showed me different ways of counseling patients and working with them to manage their illness. Coming to my internship I was unsure the setting I wanted to work in as registered dietitian, but after two weeks I have found my passion. So, look out world for this future CDE to be!