My Diabetes Team—The Registered Dietitian
I’m singing praises for the Registered Dietitians (RD) today who support those of us dealing with diabetes. Some have special certifications like Certified Diabetic Educator (CDE) as part of their qualifications. They manage somehow to make extremely complicated information, understandable. These are amazing health care professionals. They can help make our journey through diabetes a bit easier, no, a lot easier. But we have to be willing to try some new things. Open-mindedness on our part is helpful. I’m not totally there yet. I am a work in progress.
After diagnosis, you take the first step in dealing with your diabetes. You're testing your blood sugars. Yay you! You have never been fond of needles but you have succeeded in testing, most days, the recommended number of times. So, what is the connection between your blood sugars and the food you eat? This is where visits to the Registered Dietitian (RD) comes in to help us weave through the overwhelming information.
How can a RD help you control blood glucose levels?
The Registered Dietitian helps you understand how the foods we eat especially carbohydrates, play a role in our diabetes (For the sake of ease, I refer to RDs as ‘she’. They are also ‘he’). She can teach you how to use an exchange method of calculating carbs or maybe she teaches you to count your carbs in grams. She teaches you to subtract the fibre from your carbs so that maybe you can have a little more carb that your body can tolerate. She can very effectively teach you how to read nutrition labels. She can give you suggestions on portion size. She can teach you what a portion size looks like with those really cute rubber models, you know, the ones that show how much 1 oz of hard cheese is or 4 oz of juice or 1 serving of pasta (That’s it? That’s a serving size??? No wonder my sugars are high after spaghetti night!). She has other tools in her tool box as well. She can teach you how to judge portions by the different parts of your hand. Now that's really cool. (I love fun ideas). She can give you all kinds of great ideas on how to eat more healthfully.
She may have asked you to keep a food diary prior to seeing her. Three typical days of your eating, two-week days and one weekend day. Write down everything you eat and drink for those three days. Pretty easy to do even when your lifestyle is very busy. She can analyze your food diary. She looks at the type of foods you are eating. Hmmm. There's some really good foods in your diary. She starts with the positives. Praises you for the good foods she sees in your diary. She tells you all the good things she wants you to keep doing (AKA, you’re already doing some really good stuff!).
How did I control my blood glucose levels?
Next up, my experience. Time to give suggestions on ways to tweak my current diet so my blood sugars are more in range.
RD: Eat more green leafy vegetables.
ME: Ok I can do that.
RD: Perhaps add in fruits that the body will absorb slower and are higher in fibre, like apples or pears.
Me: I like those fruits but how about grapes and cherries?
RD: Yes, but count them, 12-15 is a serving and is absorbed fast, raising blood sugars quickly.
ME: (Pouting) Ok.
RD: You can have that chocolate chip cookie but not every day. And only one.
ME: One? Ugh, but okaaaay. (Pouting again)
Note to self: I wasn’t told NOT to eat them, I was shown how to INCLUDE them.
RD: Maybe try oatmeal for breakfast instead of white toast and peanut butter. Oatmeal is wonderful. Full of whole grains and nutritious goodness.
ME: Except…I don't like oatmeal. Do RDs know it was called ‘gruel’ when I was a kid. Who eats gruel? Remember the story of Oliver Twist? "Please sir, I want some more." Omg! No. I don't think so. Well RD, you're pretty convincing. Ok I'll give it a try. I'll go buy some instant stuff that has apples and brown sugar in it. I could probably choke it down then.
RD: Only the real stuff.
ME: What...? Not the instant? Only the real stuff. Well I still don't know but I'll try. Turns out, they make an instant steel cut oatmeal that doesn’t raise my blood sugar two hours after eating and tastes great. (Smartie pants).
Next up, Tuna. (Now I'm heading for the door. The smell alone is obnoxious.)
It's also full of ‘goodness’ and is ‘easy to prepare’ which fits my lifestyle. After seeing many, (many) different RDs over the years, I now go in prepared and I take control of the appointment by stating: "Please don't recommend Tuna. It doesn't matter what you do to it, it's still Tuna. I really hate Tuna." Every RD I have seen over the years, to their credit, laughs and says, “Ok no Tuna”. They haven't got time to waste either. They want to help. (A second note on Tuna: I grew up with Charlie the Tuna, mascot for one of the tuna companies. How can I possibly eat Charlie? I mean, really!).
And lastly, beans and legumes, this always comes up. Even if I'm open to this, the rest of my family is not. The ‘meat-a-tarians’ in my house aren't going to go for that. I have to admit, even I’m not too enthusiastic about beans and legumes. I have hunted down recipes and I come up pretty empty handed on the ‘yum’ factor; they’re pretty much all ‘yuck’. I want recipes the whole family will eat. In terms of lifestyle, I don’t have time to cook two different meals (The RDs have never suggested I do that either). If you really want to feel like you’re out there alone with your diabetes, try cooking a separate meal for yourself than the rest of the family. So, my solution…I make homemade chili, a lot. The family loves it, me too. I have been swapping out half the dark red kidney beans for black beans and so far, so good. I may very slowly change my recipe again to include other beans. Although I lay blame on the family, it’s really about me. I am still a work in progress in this area. Things like edamame or soy beans just don’t turn my crank. (Right up there with tofu, shiver!)
Over the years, I have met with many RDs. We haven’t always been on the same page especially if they didn’t understand my lifestyle but like in every field, it’s not just the knowledge that is important to impart, it’s the application. If there’s no real-life application for me, then I will risk saying it out loud, the information may very well become useless. I must be a part of the plan, central to the plan. If I’m not, I'm going to go home thinking the visit was a waste of time. Thankfully, that has rarely been the case.
The RD and me, we are a team. We can be good together if I am open and they are skilled. They usually are. Me…not so much.
Were the financial costs of type 2 diabetes surprising to you?