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!
References:http://www.ncbde.org/certification_info/what-is-a-cde/