Sunday, February 19, 2017

Takeaways from my time in Outpatient Diabetes

While many associate type 2 diabetes with obesity, eating a poor diet can lead to type 2 diabetes regardless of weight status. During my outpatient diabetes rotation, I counseled patients to practice mindful eating and get regular physical activity to prevent or delay Type 2 diabetes.  My training taught me also to explain how the body reacts to the food we eat.
At the clinical sites where I completed my diabetes rotations, I had the opportunity to learn techniques on how to counsel and educate people with pre-diabetes and diabetes. I learned that diabetes affects 1 in 14 people, and once it is diagnosed it becomes a chronic condition. It cannot be cured, although it can be managed with diet, exercise, and in some instances, with medicine. The good news is that preventive screening can identify people at risk, and with proper intervention, those people can prevent or delay a diabetes diagnosis.
One of the most important things I learned is that, in addition to educating people on what to do or what steps to take towards changing their lifestyle, it is also important to explain how the body reacts every time we eat food. Keeping the explanation simple and to the point was the best way to convey the message and to educate the patients.  The following is an example of a simple explanation to patients about glucose metabolism:
Everything we eat gets converted into glucose, body’s main source of energy. In people without diabetes, glucose stays in a healthy range, because insulin is released at the right time and in the right amount to help glucose enter the cells (I think of insulin as “the door man.”) In diabetes, blood glucose build-up occurs for several possible reasons:
  • Too little insulin is made
  • The liver releases too much glucose
  • Cells can’t use insulin well = insulin resistance
Of particular importance is the last bullet – insulin resistance – and helping patients to understand how they can help themselves improve their body’s ability to use insulin:
  • Exercise: This is the biggest one! If lack of time is an issue, try to exercise first thing in the morning or schedule it as part of your daily routine. Be active in any way you can: take stairs, take a brisk walk, cut your lunch time in half and go for a walk the remaining time.
  • Lose some central body fat: Fat deposition around the waist and the mid-portion of the body is a risk factor for type 2 diabetes.
  • Healthy eating: Choose foods high in fiber (non-starchy vegetables and whole grains), which are more complicated for our bodies to break down, and thus, are more satisfying.  Eat vegetables first, and then protein so you will not be as hungry when eating starchy foods.
  • Portion size control: your plate should look like this:             
½ of your plate filled with vegetables, ¼ with starch and ¼ with protein.

After taking part in the counseling sessions, I realized how overwhelming this new diagnosis must be for patients. They need to change their eating habits, add exercise into their daily routine, and test their blood glucose after their meals.  I also learned that what often worked best for patients is to help them set two or three manageable goals at a time, then help them to think through any challenges that might prevent them for reaching these goals. It is important also to convey to them the importance of flexibility and consistency – it’s OK if one of the goals can’t be reached initially. They can keep that goal on their longer range plan and, in the short term, move on to the next goal to try to reach it. The most important piece of guidance is to help them recognize that taking charge of their health is a work in progress and a lifestyle change. Rome wasn’t built in one day, and, it’s important to help patients remember that.
It would be good for most of us, those diagnosed with diabetes or not, to make healthier choices. We can really make a positive impact  on our health if we set attainable goals and incorporate reasonable changes into our way of living.

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