Last week I had an opportunity to interview Amy Nainstein, RN, NDTR, CDE from Aventura Hospital and Medical Center. Here is what she had to share.
What made you decide to get into the career path of a CDE?
I was working in a wound healing center as an RN. At the same time, I was going to school for another degree in Dietetics. The out-patient Diabetes department is part of the wound healing center. When the previous CDE left, my director asked if I would like to train to be the Diabetes educator and I can also work on becoming a CDE. I happily took the position being able to use my Dietetics education with the position.
Are you connected to diabetes personally, via a family member or yourself?
No, I don’t have a family or personal history of Diabetes.
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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?
I would explain that Type 2 Diabetes is influenced by lifestyle. A large percentage of people with Type 2 Diabetes are able to control it with diet and exercise. It is very likely that if the person improves his/her lifestyle with a healthy diet; exercise and weight loss if needed, that he/she will probably need less medications and some people are able to stop using medications and manage it with diet and exercise completely. There are other causes of diabetes which are not modifiable such as genetics.
What would you tell a patient with type 1 diabetes about adjusting insulin for higher fat meals?
I would explain that a higher fat meal slows digestion and therefore requires somewhat less insulin. But, insulin needs to be adjusted by their doctor. I would recommend blood glucose testing before and 2 hours after low fat meals and high fat meals to determine if insulin should be adjusted by the doctor.
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?
Prediabetes means that the fasting blood glucose is between 101-120. The A1C test is between 5.7 and 6.4%. These readings are in-between normal diabetes readings. When someone has a prediabetes diagnosis, it is very important to improve lifestyle to prevent the onset of diabetes. The recommendation would be to follow a diabetes diet; weight loss if needed and exercise for 30 minutes 5x/week minimum. Following these recommendations would hopefully prevent the onset of diabetes and return the readings to a normal level.
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 would explain that expired test strips would not even work with a meter. I would recommend generic meters and strips from well-known large pharmacies. There are also reduced rates on diabetes supplies provided from well-known diabetes supply companies. I would provide information on these discounts.
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 explain that a vegan diet can be very healthy. Although it’s healthy, it does not always help people lose weight. I would discuss why they want to go on a vegan diet and what their typical diet consists of. Then we could develop a well-balanced vegan meal plan for them to follow.
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?
I believe that a type 1 and a type 2 diabetic can use the GI Index on a general basis to pick preferable foods which are lower in the GI index. Although these low GI index foods are better choices, counting carbohydrates is a more accurate way to determine the amount of insulin and carbohydrates one needs.
Are there any supplements/ vitamins you recommend for both type 1 and type 2 diabetes patients to take?
There are many supplements and vitamins which some health care professionals recommend for diabetics. I am not familiar with these. I would recommend researching them prior to taking them and asking your doctor.
Could you please explain to our readers the importance in protein in blood glucose control?
Meals which contain protein slow down digestion causing a slower rise of blood glucose. This therefore gives better blood glucose reading managing diabetes better.
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?
People with diabetes are at a higher risk of gum and tooth decay. The reason for the higher risk is the high level of glucose in the blood. It is recommended that diabetics visit their dentist at least twice a year and take extra special care of their teeth for prevention.
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?
I would discuss with the child and parent together and separately the reasons why their diabetes management is not being done properly. Determine the reason together. Try to improve diabetes management. The parent may need more care and have difficulty caring for themselves.
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 would explain that an insulin treatment regime is used when the blood glucose levels are not managed with diet, exercise and oral medications. High blood glucose levels lead to multiple complications which are very important to prevent because they damage the body. Insulin is a pure medication which has fewer side effects than oral medications. It may be possible to prevent the need for insulin if one is diligent with diet, exercise and compliance with oral medications.
For more information and to contact Amy Nainstein visit http://aventurahospital.com/service/diabetes
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