Title/Topic: Counseling and education session in type II diabetes
Time Frame: 45 minutes
Facility: In an outpatient clinic of a General Hospital, patients referred by their specialists will be counseled on ways to improve their lifestyle and general nutrition. These patients have usually little to no information about managing type II diabetes. The other type of visitors will include those already living with diabetes and looking for ways to improve their diets and eating behavior.
Objectives
- Patients will learn to identify food groups and the notion of calories.
- Patients will be aware of the changes needed to improve their diet.
- Patients will be educated about the glycemic index and its effect on their blood sugar
- Patients will learn to count their carbohydrates.
- Patients will set up their goal and the timeframe to achieve it.
- Patients will have an increase in knowledge about meal planning.
Materials/Equipment
- Handouts listing carbohydrate-containing food
- Handouts listing fiber-containing food
- Food models reflecting portion sizes of food groups
- Logbook used to keep track of all foods consumed during the day
Procedures/Learning Activities with Timeline
- Establishing Rapport (5 minutes)
- Educating (25 minutes)
- Negotiating (5 minutes)
- Summarizing the plan (3 minutes)
- Scheduling (2 minutes)
- Evaluating (5 minutes)
Evaluation
The patient’s ability to summarize the plan is to be assessed after the session, and a progression checklist for the follow-up visit is to be created.
To make this session successful, objectives shall be set, making them attainable and tailored according to the patient’s preferences. The proposed list of objectives to follow within the time frame is provided below:
Establishing Rapport
The patient is to be made comfortable upon starting the session. The first 5 minutes are crucial – the dietitian has to introduce themselves and make the patient aware that the dietician’s role is not to restrict their food choices, but to educate the patient about the ways to manage diabetes. Afterward, the patient is asked about their knowledge of diet and exercise in type 2 Diabetes. The dietitian includes the questions such as “What has he/she been implementing?”, “What difficulties have they faced?” The purpose of this rapport is to get an idea about the patient’s habits and history. After the information has been gathered, general advice will be provided while stressing the importance of healthy eating, physical activity, taking medications and reducing health risks.
Educating
Now that the patient is acquainted with his dietitian, it is time to increase the patient’s awareness regarding the subject matter and the methods of managing the patient’s diet. In the course of the education process, an overview of all food groups will be given, and the points listed below will be emphasized.
Decreasing Caloric Intake
By improving food choices, the dietitian will be able to reduce the number of unnecessary calories to induce a drop in the patient’s weight (if needed). Moreover, for overweight or obese people, the specified stage of intervention will improve blood sugar control (Ajala et al. 505). Food exchanges and low-calorie options are to be explained to the patient. The notion of calories ingested vs. calories burned (through resting metabolic rate or physical activity) serves as an example of caloric manipulation.
Decreasing Saturated Fat
Higher intake of saturated fat (animal fat) is associated with greater insulin resistance. The reason for this is that a surplus of fatty acids is stored and processed to various molecules, thus, hindering normal cellular signaling, especially insulin. When fatty deposits block or alter the cellular insulin receptor, sensitivity to insulin is reduced. This is one of the essential areas to be tackled when explaining the relationship between diet and Diabetes. Full fat dairy products are to be replaced with low or skimmed ones. Lean meat (skinless chicken breast, turkey breast, fish and seafood) are the exclusive choice for animal proteins.
Increasing Fiber Intake
Fiber does not cause a spur in insulin production. As a result, consuming high fibrous foods can help a person stay healthy, reduce body fat, and control blood sugar (Silva et al. 791). A recommended amount of fiber is 25-30 grams per day (“Nutrition in Cancer Care (PDQ®)” para. 16). The key sources of fiber include whole wheat grains, legumes, vegetables and fruits. Some cereal manufacturers also produce food enhanced with fiber, which is an excellent alternative to regular or sweetened cereals. Fresh vegetables (carrots, celery, and cucumbers) are recommended as healthy snack options instead of fast foods or sweets.
Glycemic Index
Carbohydrates are the food group that alters blood sugar levels like no other nutrient does. The following food includes rather large amounts of carbohydrates: simple refined sugars, sweets, breads, cereals, milk, fruit, rice and pasta, as well as certain vegetables like peas, corn, beans and potatoes. When a high carb meal is consumed, the carbs will eventually be broken down into glucose and released into the bloodstream, increasing blood sugar levels. It should be noted, though, that the effect of carbohydrates on human body differs depending on the source of carbs. The usage of the Glycemic Index (GI) is a convenient way to classify carbohydrates. GI is a classification technique based on the influence of certain food on blood glucose levels. Foods high in fiber, which are absorbed slowly, have a low GI rating, while foods that are absorbed quickly have a higher rating (“Be GI Smart” para. 2). Absorption can help even out blood glucose levels. Pure refined glucose is picked as a reference point with a GI score of 100 and other foods are compared against it.
Averting a rise in blood sugar rates can be achieved by consuming the correct type of carbohydrate. High fiber food, such as whole grains, legumes (e.g. beans, chickpeas, etc.) fruits and vegetables, should make a major part of the diet. When implementing the glycemic index as a basis for food choices, one must take “glycemic load” in consideration; as it is affected by not only carbohydrates, but other nutrients in the meal. For example, bread is rich in carbohydrate, while beef contains virtually none. In the case of eating beef with pita bread, calculating the glycemic load will require a combined result of both indexes, with the weight of each food item in mind (Understanding Glycemic Index and Diabetes para. 1).
How to Count Carbs
The table of amount of carbohydrate per gram of a certain product, such as the one suggested by the American Diabetes Association (para. 4) can be considered the key tool for counting carbs. Known as the CHO counting, or the ratio of insulin per carbohydrate, the specified approach requires calculating the total carbohydrate content, the factors affecting the blood glucose response, and the insulin required. Afterwards, the pre-meal blood glucose level must be evaluated and the appropriate exercises must be designed. The latter are followed by an insulin bolus, and the record of the blood glucose response concludes the procedure (Imperial Center for Endocrinology para. 3). It should be born in mind that ‘1 CP (10 g carbohydrate) can raise blood sugars by 2-3mmol/l” (Imperial Center for Endocrinology para. 5). Using the 100 rule, one needs to divide 100 by the daily insulin dose, therefore, retrieving the CP ratio. One must also bear in mind that starch products, as well as lactose and sucrose rich meals are traditionally considered the best sources of CHO.
Negotiating
After the patient has received their educational session, it is time for negotiations to take place. From a realistic perspective, it will be almost impossible for a patient to follow all the tips and requirements previously mentioned, so a middle ground must be found for the patient to comply with the diet requirements.
Negotiable items may involve the following points:
- Limiting sweets and sugary foods and swapping them with natural fruits;
- Consuming whole grain food instead of refined products;
- Using calorie free/reduced calories condiments like mustard and low fat mayo;
- Increasing water intake and reducing eliminating soft drinks from the diet list;
- Consuming lean meats and reduced fat dairy products (Mahan et al. 549).
Summarizing the Plan
Before wrapping up the session, the patient has to repeat and summarize what they have learned in the course of the session with the dietitian. The latter will listen to what the patient has gathered and rectify any false info.
Scheduling
The patient’s progress can be assessed by setting up mini-goals and making sure that they are achieved. Whether it is reducing fasting blood glucose levels or reducing body weight, both the dietitian and the patient shall define the reasons for their next encounter and specify the goal that shall be reached in a specific time frame.
Evaluating
After setting up the goal for the next session, an evaluation of the efficiency of the counseling should be done. The evaluation is dependent on the success or failure of reaching the target. In case a patient has not achieved a 100% success but is still making improvements, it still counts as progress. For evaluation purposes, the patient is to be asked to keep a food log or diary where they list all the food eaten during the day, medications taken or simply the mood that accompanied their meals. This might help identify bad habits in the future and find the ways to dispose of them permanently.
Works Cited
Ajala, Olubukola, Patrick English, and Jonathan Pinkney.”Systematic Review And Meta-Analysis Of Different Dietary Approaches To The Management Of Type 2 Diabetes.” The American Journal Of Clinical Nutrition, 97.3 (2013), 505-516.
American Diabetes Association. “Carbohydrate Counting.” 2015. Web.
“Be GI Smart.” MV Hospital. 2015. Web.
Imperial Center for Endocrinology. CHO counting. 2015. Web.
Mahan, L. Kathleen, Sylvia Escott-Stump, Janice L. Raymond and Marie V. Krause. Krause’s Food and the Nutrition Care Process. St. Louis, MO: Elsevier Health Sciences, 2012. Print.
“Nutrition in Cancer Care (PDQ®).” National Cancer Institute. 2014. Web.
Silva, Flávia M; Kramer, Caroline K; Almeida, Jussara C; Steemburgo, Thais; Gross, Jorge Luiz; Azevedo, Mirela J. “Fiber Intake And Glycemic Control In Patients With Type 2 Diabetes Mellitus: A Systematic Review With Meta-Analysis Of Randomized Controlled Trials.” Nutrition Reviews, 71.12 (2013), 790-801.
“Understanding Glycemic Index and Diabetes.” American Diabetes Organization. 2014. Web.