Friday, Jun. 27, 2008
Food matters
By Chuck Newcomb
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AIM
ReprintOnly about 10 percent of diabetic patients see an endocrinologist who specializes in diabetes care. The remainder are followed by a family physician or clinic. Family physicians don't get paid for counseling patients on diabetes management so many patients get very little education. Physicians are also so busy that they often don't refer patients for education and health insurance policies don't allow patients to self-refer for education.
In the meantime, patients are encouraged to learn as much as they can about managing their own diabetes. The best care model is when the patient is actively taking part as a team member in charge of what they are doing and how they do it. The American Association of Diabetes Educators (AADE) is promoting a plan for diabetes self-care called AADE-7:
1. MAKING HEALTHY CHOICES - Patients need to learn about carbohydrates and fats so they can be comfortable reading nutrition labels and knowing what they mean. Patients should choose healthy foods at the table and grocery store and watch portion sizes. Keep a diary-make note of what you eat, how much you eat, when you eat and how it makes you feel.
2. BEING ACTIVE - Physical activity is necessary for diabetes self-care since it can help keep blood glucose levels closer to normal. Everyone's physical abilities are different, so you should work with the care team to find out what's best.
3. MONITORING - Reduce the risk of complications by consistently monitoring or checking blood glucose levels. As you get comfortable doing this, you can identify what is "normal" for your body. If you don't routinely check and record your levels, work with your care team to create a self-monitoring schedule.
4. TAKING MEDICATION - Diabetes medications come with specific instructions for use. These drugs can affect the body differently depending on when and how you take them. Know the names of medications and the reasons they were prescribed for you. Learn to recognize changes in how you feel and work with your care team to make any necessary changes.
5. PROBLEM SOLVING - Understanding how diabetes affects your body can help you identify problems and learn how to take care of them. Problem solving skills can help you prepare for the unexpected. Some of the most important problem-solving skills for diabetes self-care are learning how to recognize and react to high and low blood glucose levels and learning how to manage sick days.
6. REDUCING RISKS - Understanding the potential complications associated with diabetes will help you prevent them. Your care team can teach you about complications such as kidney damage, nerve damage and vision loss. No one knows your body better than you, so you need to play an active role in reducing your risk.
7. HEALTHY COPING - Living with diabetes every day can make you feel discouraged, stressed or even depressed. But people living with diabetes can learn healthy coping methods that help them recognize and manage their physical and emotional problems. Develop and nurture partnerships in your personal life with your spouse, loved ones and friends. Go to group educational sessions where you can meet and relate to other people going through the same experiences. Build healthy relationships-and remember that you're not alone.
What is needed are more nurses, dietitians, pharmacists, physicians, physician assistants and nurse practitioners to become trained to meet the special needs of those patients with diabetes. Spring 2009 the California Central Valley American Association of Diabetes Educators will be having a workshop to teach health care professionals about diabetes management. Encourage members of your health care team to find out how they can get specialized training in diabetes management.
Chuck Newcomb, MS, RD, CDE is a consulting Registered Dietitian currently providing medical nutrition therapy services for Memorial Hospital Los Baños. He has a Masters of Science in Clinical Nutrition from New York University. E-mail questions to the Attention of ChuckRD at: MHALosBanos@SutterHealth.org.