Emilee Shelton is Registered Licensed Dietitian, and a certified diabetes educator. In this short interview she talks about diabetes life and work.
What made you decide to get into the career path of a CDE?
I have always been interested in health and fitness. I spent my first year of college going to school to be a marine biologist. While in my first year of college my mom was diagnosed with Type 2 DM. I will never forget that phone call and the fear that I heard in my mom’s voice. She was fearful of all of the long term complications that could arise and the way the MD explained it to her made it seem that those would all happen to her within a short amount of time, even though we know those are preventable with will managed diabetes care. After that phone call I knew that there had to be a better way to help and support people with diabetes so that no one will ever feel the fear my mom felt. I wanted to provide hope, support, encouragement, and positivity.
Are you connected to diabetes personally, via a family member or yourself?
Yes, my mother as mentioned above.
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?
Unfortunately, we cannot reverse it or get rid of it but with good diabetes care we can definitely manage it and lead a very healthy life. I am here to support you and provide with you the tools and resources you need to do that! Here are a few things that you can do……….
What would you tell a patient with type 1 diabetes about adjusting insulin for higher fat meals?
In my organization we do not support this practice yet as there is not enough literature out there to support strict recommendations.
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?
Being prediabetic means that your doctor has identified numerous risk factors towards becoming diabetic. He may have run an A1c and it is higher than normal but not quite high enough to diagnose you with diabetes. In coordination with an elevated A1c he may also be looking at your weight, exercise patterns, and other blood values such as triglycerides and cholesterol.
Prediabetic is a really awesome thing. It is a chance to recognize a problem before it happens and with some life changes hopefully diabetes can be prevented. This does come with a warning label though that diabetes cannot be 100% avoidable in some circumstances because genetics may be a bigger influence than we can control.
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 advise them not to use them since they may not have the best accuracy being out of date. I would direct them to local support services in their area that may have funding or discount programs for purchasing test strips.
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?
If you are interested in starting a vegan diet I will support you. Although a vegan diet is not necessary for people with Type 2 diabetes to lose weight but it is an optional diet. Let’s take a look at the vegan diet and your food preferences to see if it is a lifestyle change that is best for you at this time. To get started we need to make sure you get all the nutrients you need.
I would then go into food preferences with the patient and discuss meal ideas to make sure they are getting adequate protein in.
This is my main concern with vegan diets is making sure they get adequate quality protein since that is limited with a vegan diet.
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 am aware of the glycemic index but do not support it. I think that there is not enough valid research out there for a person to fully implement it into their lifestyle. People can get adequate control of their diabetes by following a carbohydrate-controlled diet, exercising regularly, and maintaining a healthy weight.
Are there any supplements/ vitamins you recommend for both type 1 and type 2 diabetes patients to take?
I always recommend that my patients take a multivitamin. Life is busy and hectic and sometimes we don’t always get in the fruits and vegetables that we need to. I think that a multivitamin is a great backup.
Also for my women over 30 I recommend that they take a Vitamin D and Calcium supplement.
Could you please explain to our readers the importance in protein in blood glucose control?
Protein has numerous benefits. It is slower digesting so in combination with carbohydrates and fats the body is going to have work slower to break down that meal than if we just sat down and ate nothing carbohydrates; which take about 2-3 hours to digest vs. protein that takes 3-4 hours to digest, and fats that take 6-8 hours to digest.
Also because protein is slower digesting it helps to keep us fuller longer. So it is really important that people have adequate protein. For example, my pediatric patients all eat cereal and milk for breakfast. Most kids don’t drink 1 full cup of milk that has one serving of protein. This is not really sufficient enough vs. the high carbohydrate intake they are eating with the cereal. This will not get them sufficient energy to make it to lunch. I really encourage that my kids have at least 14-21g of protein at breakfast, which is about 2-3 protein servings.
Also if carbohydrates are restricted then protein can be used as a “filler” where patients don’t feel so restricted and can get a little more to eat, although always considering within moderation.
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 risk for oral problems if they don’t have good oral hygiene patterns. This is mainly related to people who don’t have good diabetes control. It is a vicious cycle if you already have gum disease because it is an infection, which may increase your blood sugars and make them harder to control.
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 parent that every child is going through times when they “don’t want” diabetes anymore. Be patient with them, don’t yell or scream at them for not doing their diabetes care, and don’t “nag” them (as my pediatric patients always say). Continue to encourage and support them. I even suggest counseling to some of my patients as an outlet for them to discuss their feelings towards having diabetes and to learn from the counselor on ways they can move forward to continue with their diabetes care.
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 honest with them that in some cases insulin may not be avoidable but they can do their best to prevent it or delay it. I would explain the natural progression of the disease along with how some people are diagnosed at different times in the disease progression so insulin is not always preventable. I encourage that they get started or back on track with their diabetes regimen and that to feel good about their diabetes care giving it 100%.