Amy Freeman, certified diabetes educator and registered dietitian from Sodexo at Ocala Health talks about her work and how she enjoys working with folks who are living with diabetes.
What made you decide to get into the career path of a CDE?
My story is perhaps different from others. I was a critical care dietician, working in the ICU and NICU as well as being an administrative dietician. When our CDE left the practice, I was given the new responsibility of teaching the nutrition sessions of the diabetes self-management training classes. What was initially another task on my to-do list, turned into the high point of my work week. I looked forward to working with the folks in the diabetes class, I enjoyed the time we spent brain-storming on ways to improve their life-style habits through eating patterns and movement patterns. The dynamic of the group atmosphere, each contributing to the betterment of others was, and is, an extraordinary experience to be part of.
Are you connected to diabetes personally, via a family member or yourself?
Nope, just enjoy working with folks who are living with diabetes.
You have a newly diagnosed patient with Type 2 diabetes, they are feeling a bit overwhelmed with everything and want to know what they can do to reverse it or get rid of it. How do you answer them?
Have the person develop a SMART goal, a goal that is specific, measurable, attainable, relevant to them, and is time bound. This step starts with a simple question, such as “what one thing is important to you in your efforts to out-smart diabetes and how can we get there?”
To me, making a SMART goal is imperative. It allows the person to work on one thing, a very specific thing. When they meet this goal, they typically experience a sense of accomplishment, which may motivate them to pursue another goal, linking small successes together to build toward a greater success.
I love what Dave Ramsey says: “If you aim at nothing, you will hit it every time”. In this quote, Dave is talking about personal finances, but doesn’t it apply to life-style goals as well? Of course it does.
What would you tell a patient with type 1 diabetes about adjusting insulin for higher fat meals?
Making acute adjustments to insulin dosing is based primarily on experience. My thoughts and response would be different for one newly diagnosed verses someone who has been using insulin for some time. A rule of thumb that I learned from a friend, Joan, who has been living with type 1 diabetes for some time, she was diagnosed in the 1940s, is that “we can always correct a high blood sugar, but we cannot always correct a low blow sugar.” (Thanks Joan for your wisdom).
Therefore, when using a correction dose, start on a low dose of insulin, and check blood sugars more frequently in the initial stages of experimenting.
Could you explain to our readers more about being prediabetic, what this means, and what they should do if their doctor tells them they are prediabetic?
The terms prediabetes and diabetes are based on blood sugar or A1C levels. The cut off values for prediabetes and diabetes is the difference of only 1 mg/dl. In my mind, prediabetes is as serious as diabetes, but the boon is that research informs us that prediabetes is more responsive to life-style changes than diabetes. If the doc diagnoses pre-diabetes, I would tell the person to seek out a CDE or dietician and make a SMART life-style goal.
You have a patient who isn’t able to afford their testing strips. They are given some expired ones from a family member and ask you about using these and their accuracy. How do you answer them and how would you guide them for getting the supplies they need?
I typically advise against using expired test strips. I have worked with numerous folks who have difficulties affording test strips, whether by choice or by force.
If the client does in fact want to monitor blood sugars and is motivated to pay for them, most of the retail pharmacies have their own brand of meters and test strips that offer a financial advantage. The client can purchase the meter when they are “on-sale”.
As I write this, a major pharmacy retailer is offering a free meter and 50 test strips for under $20.00 and another major pharmacy is offering 50 test strips for under $13.00.
Your patient has been working to lose weight unsuccessfully, they have type 2 diabetes and come to you asking for advice and approval on starting a vegan diet. How do you answer?
I would ask them:
- What does the term “vegan” mean to them?
- What is their expected benefit from using a vegan diet? and
- Do they really want to be a vegan?
Based on their answers, we can then start to brainstorm on adding some vegan meals, or other healthful options, to their life, if they are willing.
Many diabetes patients both type 1 and type 2 use carbohydrate counting in their diabetes management. What about the GI Index and would this benefit both types of patients if introduced into their diabetes management plan? If so, how?
What benefit is there in following the GI? Does the client really want one more mealtime restriction to consider? If so, then we could discuss the possible pros and cons of attempting to use the GI. However, I would add that there is no convincing pool of evidence in the literature that highly promotes the individualized use of GI to improve overall A1C or long-term weight loss.
Are there any supplements/ vitamins you recommend for both type 1 and type 2 diabetes patients to take?
I tend to recommend supplementations only if there is a deficiency or in high risk groups (such as post metabolic surgery or those eating a restrictive meal plan).
Could you please explain to our readers the importance in protein in blood glucose control?
Protein has a unique role in how it effects appetite. Protein’s application in managing weight is due to its potential for increasing satiety and thermogenesis. There is a line of research that supports the positive effect of protein on satiety, where those who consume approximately 30% of total calories as protein – the higher end of the 2015 US Dietary Guidelines – report less feelings of hunger and consuming less calories throughout the day. Combine this with the nature of protein and its smaller role in postprandial hyperglycemia – the fact that it does not have the same impact on blood sugar that a carbohydrate food has – makes protein an attractive anchor for meals and snacks.
Are people with diabetes at a higher risk for oral problems such as gum disease and tooth decay? If so why is this and what can they do to reduce their chances of developing it?
It seems that folks with diabetes are at a higher risk for everything, and yes, this does include the gum disease and tooth decay. To reduce the risk for infections in the oral cavity, blood sugar control is imperative. In addition to blood sugar control, regular visits to the dentist for cleanings, about every 6 months, is encouraged. For overall risk reduction, I recommend 150 minutes of physical activity per week, blood pressure under control, stress management, and naturally, tobacco abstinence.
A patient’s adult child comes to you with concern that their parent isn’t taking their medications properly or testing as much as recommended. How would you handle this situation?
My gut response is to find out why the mom or dad is not managing diabetes to the level they did in the past. Could it be depression or memory loss? Could it be burnout? Finding out the why behind the issue is the first step.
A patient with type 2 diabetes has asked you how they can avoid being put on an insulin treatment regime. How do you respond?
I am in this situation countless times per week. The reality is that there is no guarantee that if you just do THIS (fill in the blank) the use of insulin can be avoided. The reality of type 2 diabetes is that it is a progressive illness, the natural trajectory of type 2 diabetes is the slow death of beta cells, diminishing insulin levels. We may be able to slow down this process and impede the need for insulin by managing weight, healthful eating, stress management and taking diabetes medications, however there is no guarantee that insulin can be 100% avoided.
To learn more about Amy Freeman please visit http://ocalahealthsystem.com/service/diabetes-program.