Diabetes
Evaluate
Page Contents
Evaluating the Nutrition Care Plan
After you have implemented the plan, you want to follow-up and evaluate it to see if it has been effective in addressing your nutrition concerns. This can help you to decide on appropriate changes to make to the nutrition care plan moving forward. To evaluate your plan in an outpatient setting, you will need to set up a follow-up appointment or phone call with your client to gather updated information.
In populations with diabetes, the 5 main areas to commonly re-assess in a follow-up are glycemic control, medication and insulin, diet or carb intake, abnormal lipids, and physical activity. These may or may not be a part of the SMART goals you set, so you’ll want to ask the client how they are doing in terms of meeting the SMART goals you set together last appointment.
| Common Nutrition Issues | Evaluate Effectiveness of NCP |
|---|---|
| Glycemic Control |
|
| Medication and Insulin Adherence |
|
| Diet/Carbohydrate Intake |
|
| Abnormal Lipids |
|
| Physical Activity |
|
Evaluating Penelope’s Nutrition Care Plan
| Common Nutrition Issues | Evaluate Effectiveness of NCP | Outcome |
|---|---|---|
| Glycemic Control |
|
|
| Medication and Insulin Adherence | – | – |
| Diet/Carbohydrate Intake |
|
|
| Abnormal Lipids |
|
N/A |
| Physical Activity |
|
N/A |
Since hypoglycemia was a concern for Penelope, you booked a follow-up appointment with her for 5 days later to ensure she is not in danger of injury from frequent hypoglycemic events.
When assessing Penelope’s status after the implementation of the nutrition care plan, you want to see if the BG’s are better controlled and if she is still experiencing highs or lows. During your follow-up you discover that Penelope has been able to use the Plate Method to plan most meals and snacks, and is including more CHO in her breakfast and lunch, so she is no longer experiencing shakiness and hunger before lunch. Her logbook also shows her blood sugars are around 5-7 in the evening, and her FBG is above 4.
The changes Penelope has made are working well to manage her diabetes and prevent hypoglycemia. Penelope is pleased with these changes and will follow up with you in 3 months.
The Nutrition Care Process Model
As you use the Nutrition Care Process Model and the learning from this case study as a guide throughout your patient care in practicum, please keep in mind that the process is dynamic, and not step-by-step, as all cases are different. You are encouraged to complete the recommended readings for this module and continue to expand your learning in this clinical area of practice.
PART 4: EVALUATE COMPLETE. Pause to reflect on the evaluation strategies discussed, and review the readings and resources in the following section for your information.
You’ve now completed the nutrition for Diabetes module. Please consider providing feedback through the embedded form in the next section.
Summary
Here is a summary of everything covered in this module:
ASSESS
Setting the Agenda
- Greet and introduce yourself, explain the role of a registered dietitian in diabetes care, engage the patient in the conversation to build rapport, ask about their reasons for the visit and how you can assist in supporting their diabetes management.
Gathering Data for an Assessment
- Medical History: Diagnosis, past medical history, family history, symptoms, interdisciplinary team, and medications.
- Social History: Housing, income, insurance, substance use, food security, and physical activity.
- Anthropometric Data: Weight, weight history, waist circumference, height, and BMI. NOTE: Let the patient guide the discussion towards or away from their weight. If they are not comfortable talking about their weight or do not want to be weighed that is ok.
- Biochemical Data: Diagnostic criteria (OGTT, FBG, RBG, A1C), target ranges for diabetes management, lipid levels, urinalysis, and renal function.
- Dietary Data: Eating behaviors, food access and skills, diet history.
PLAN
ABCDES of Diabetes Management
- A1C Targets: Optimal glucose control.
- BP Targets: Optimal blood pressure control.
- Cholesterol Targets: LDL-C management.
- Drugs: Medication for heart protection.
- Exercise/Eating: Regular physical activity, healthy eating, weight maintenance.
- Smoking Cessation/Self-Management: Encourage quitting smoking and addressing barriers to achieving goals (stress, finances, social supports).
Creating a Nutrition Care Plan
- Review 8 key areas: hypoglycemia, hyperglycemia, medication and insulin, carbohydrate intake, macronutrient distribution, meal timing, cholesterol, and physical activity.
- Develop PES statements to identify nutrition concerns.
Recommendations Summary
- Hypoglycemia: Treat with the 15:15 rule, ensure sufficient carbohydrate intake, suggest to PCP to adjust medication. .
- Hyperglycemia: Adjust diet, increase physical activity, suggest to PCP to adjust medication.
- Medication and Insulin Adherence: Check medication adherence, consult with PCP.
- Carbohydrate Intake: Choose low GI, high fiber carbs, consider carb counting.
- Macronutrient Distribution: Use the plate method, include high fiber carbs at meals and snacks.
- Meal Timing: Eat regular meals and snacks, no more than 6 hours apart.
- Cholesterol: Choose unsaturated fats, high fiber foods, limit saturated and trans fats.
- Physical Activity: 150 minutes of moderate exercise weekly, resistance exercises 2-3 times a week.
IMPLEMENT
Interdisciplinary Team
- Liaise with healthcare team members (endocrinologist, PCP, diabetes nurse educator, social worker, physiotherapist, chiropodist) for medication adjustments, cholesterol management, and updated bloodwork.
Education
- Individualize education, discuss high-risk topics, connect client’s goals to the plan.
- Check previous education, focus on key messages, use visuals and analogies (insulin as a “key”).
- Support change with motivational interviewing, SMART goal setting, and referrals to other interdisciplinary team members if needed.
EVALUATE
Evaluating the Nutrition Care Plan
Follow-up to gather updated information on the 5 common areas to reassess:
- Mental Health – How are they coping with living with diabetes? Are they experiencing diabetes burnout? What supports do they have? Any additional supports to suggest?
- Glycemic Control: Are BGs better controlled? Are they experiencing hypo- or hyperglycemia? Using the 15:15 rule to treat hypoglycemia?
- Medication and Insulin Adherence: Are they taking medication as directed? Any improvements after a medication change?
- Diet/Carbohydrate Intake: Have they made suggested changes? Any barriers? Distributing carbohydrate intake throughout the day?
- Abnormal Lipids: Any improvements to lipid profile?
- Physical Activity: Have they made suggested changes? Any barriers?
Book follow-up appointments to reassess and adjust the plan as needed.
Acknowledgements
Katie Brunke, RD, CDE, PHEc
Jess Wiles, RD, MHSc(c)
