I Have Diabetes, Now What?

Editor's note: This piece was authored by D&A board member Valentine Reed-Johnson, RN

As a Registered Dietitian, working with diabetes almost every day can desensitize me to the real challenges that this serious condition brings. I am thrilled to get a chance to speak on behalf of so many out there struggling, and shed a light on what someone with diabetes goes through post diagnosis.

Diabetes is a metabolic disease which develops in those with genetic predispositions. The organ most responsible is the pancreas and the hormone is insulin. Without insulin functioning the way it should, the sugar we consume cannot feed our cells. People often forget this can be life threatening if not taken seriously, and the management of this condition is certainly no walk in the park.

Initially, when a patient of mine is diagnosed, I have to keep in mind the freshness of the diagnosis. Sometimes it just isn’t the right time to talk about all the new changes they will need to make to their diet. As a health care provider, we should never forget that we are talking to real people, with real emotions. I have learned on the job that a delicate approach is necessary to get a patient on board with improving their health.

There are many types of diabetes, but to make this simple, we are going to be talking about the most commonly seen: type 2.  While newly diagnosed individuals typically don’t have to check their fingersticks, without lifestyle changes, they could face a lifetime of pricking their fingers and injecting themselves with insulin daily.  Insulin certainly has a scary connotation, which health providers have to break down if the patient requires this more invasive measure.  Patients on insulin have to determine the amount of insulin they need to cover the carbohydrates of in a given meal. The health care provider’s role is often both prevention and control of the disease. The best scenario would be to educate the patient on how to change their lifestyles early on, so as to hopefully prevent the progression of the disease. Of course we also work with those who are already on insulin, with poor disease control, who are facing difficult consequent conditions. 

The diabetic diet is a carbohydrate controlled diet. This doesn’t mean the elimination of this food group, but instead “control,” of carbohydrate intake. Most patients see this as a sacrifice and a burden. Carbohydrates can include grains, such as bread, pasta, cereal, and starchy vegetables such as potatoes, beans, corn, peas; they also include yogurt and milk, and even fruit! Basically this diet is restrictive in the food types we are so used to eating, except for proteins and fats. The idea that so many foods affect their blood sugar can be overwhelming to patients and resistance is common. I have to explain that they actually need carbohydrates for energy and other processes in the body, but they must be portion controlled, and spread out evenly throughout the day. I need to tread lightly during these early stages of learning, because the patient could become demotivated and angry, which in turn would affect their desire to follow my advice.

An example of a portion controlled carbohydrate meal would be grilled chicken with roasted broccoli, a side salad with avocado, and one cup of brown rice. One cup of brown rice is 3 servings of carbohydrates. This is quite a small serving of rice, for those of you who don’t bake, or who aren’t familiar with measuring cups! Adding cheese and eating more protein and vegetables can be a way to prevent hunger, but for many of us this is a strange and new distribution of food groups on the plate. There is some good news though: newer diet research advice includes incorporating some concentrated sweets if the patient so desires. So, if a patient wants a candy bar now and then, it is now acceptable in moderation. One consideration would be to promote the consumption of candy bars with more fat and protein, such as a Snickers bar, versus a product with only sugar, such as Sour Patch Kids. This calculated intake of sweets can prevent blood sugar spikes.  

Physical activity should also be encouraged, and since the majority of patients do minimal exercise, the encouragement of gradual increases in exercise, with goals that they set themselves, is the best way to promote actual change. An example would be starting with a brisk walk, thirty minutes, three days a week. This alongside reducing carbohydrate intake is when we see results, and as little as a 5% weight change can have tremendous preventative benefits, and reduce risks for developing cardiovascular and peripheral conditions later in life.

Overall, if the patient with diabetes chooses, and is able, to make these lifestyle changes, they can lead a healthy life through collaboration with their doctor and dietitian.

I am fulfilled every day in my job, and know that I am providing the tools to prevent these patients from developing conditions in the future. 

For more information on diabetes, visit: American Diabetes Association

For more information or to contact Valentine, visit: Valentine Nutrition