![\"Step](\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_3-implement-1024x132.png\")
\r\nLiaising with Penelope's Team<\/strong><\/h2>\r\n<\/header>\r\n\r\n\r\nIn this case, you have consulted with Penelope\u2019s physician regarding her current pharmacotherapy and concern over recurrent hypoglycemia with her medication regimen. The physician has considered this and has discontinued Diamicron and will replace it with either an SGLT2 inhibitor or a GLP-1 receptor agonist (depending on which one they can secure compassionate coverage for). You can refer to the Diabetes Medication Chart<\/a>\u00a0for a refresher on these medications.\r\n\r\n<\/div>\r\n<\/div>\r\nEducation<\/h1>\r\nWhen educating clients, try to:\r\n\r\n \t- Individualize the education as much as possible<\/strong>: Discuss high-risk topics (like hypoglycemia) first since they are priority, connect the client\u2019s goals to your plan, and focus on what they want to learn.<\/li>\r\n \t
- Find out if client has had previous education<\/strong>: Ask the client if any one else has talked to them about their diet and diabetes, and adjust your education accordingly.<\/li>\r\n \t
- Focus on a few key messages<\/strong>: If the client is newly diagnosed or doesn\u2019t know much about diabetes, try not to overwhelm them with too much information during your first couple of interactions. Use visuals, like props and resources, to convey your message whenever possible.<\/li>\r\n<\/ul>\r\n
How an RD would Counsel a Patient on Physical Activity<\/h1>\r\nPeople living with diabetes often face a number of barriers to participating in physical activity. RDs have the knowledge and skillset to suggest interventions targeted at addressing these barriers which can be effective at increasing participation in physical activity.\u00a0 Here are some ways RDs can counsel patients living with diabetes about physical activity:\r\n\r\n \t- Motivational Interviewing:<\/strong> RDs can use motivational interviewing techniques to explore a patient's ambivalence and increase their intrinsic motivation towards physical activity. This approach helps in recognizing barriers and enhancing the patient's confidence (self-efficacy) in their ability to engage in physical activity.<\/li>\r\n \t
- Goal Setting:<\/strong> Encouraging a patient to set SMART goals is key. Guiding the patient to set smaller, manageable goals such as short periods of walking or parking further from the store entrance can gradually increase their physical activity levels. . Anticipating challenges and adjusting goals to help overcome them can help the patient address barriers to exercise.<\/li>\r\n \t
- Tailored Exercise Plan:<\/strong> Based on a patient's preferences and health status, RDs with the knowledge and skills can recommend specific types of exercises such as aerobic activities (walking, swimming), resistance training (weightlifting), and stretching . Exercise plans should be individualized, considering the patient's current fitness level and any limitations. The patient should always consult with their primary health care provider to ensure they are ready to increase their activity level.<\/li>\r\n \t
- Breaking up Sedentary Time:<\/strong> Emphasizing the importance of reducing prolonged sitting and interrupting sedentary time with brief activity breaks is a helpful way to add more activity into their day. This helps manage blood glucose levels and improves overall health outcomes.<\/li>\r\n<\/ul>\r\nBy combining motivational strategies, personalized exercise plans, and goal setting, RDs can empower patients to adopt and maintain a physically active lifestyle, improving their physical health and diabetes management outcomes. For more information, please see: Physical Activity and Diabetes<\/a>.\r\n\r\n \r\n\r\nPause here and think of some key messages you might want to speak to Penelope about when providing education. Continue when you are ready.\r\n\r\n \r\n
\r\nPenelope's Education - Key Messages<\/strong><\/h2>\r\n<\/header>\r\n\r\n\r\nBased on your assessment Penelope has a basic understanding of diabetes pathophysiology, but she does not know how to properly treat hypoglycemia. It is important to start your education by reviewing hypoglycemia treatment and then moving on to the key dietary changes that will improve her diabetes management.\r\n\r\nPenelope tells you that she gets confused sometimes when trying to plan a meal and thought she was spreading her carbs out throughout the day. She doesn\u2019t understand why her BGs are low in the morning and high in the evening. To keep it simple you\u00a0 can focus on a these 3 key messages, asking questions throughout:\r\n\r\n \t- Carbohydrates come from plants (found in grains, legumes, starchy vegetables, fruit, milk, nuts, seeds) and give us energy by being digested into sugar\/glucose for use by our cells. Can Penelope identify the carbs she currently includes in her diet?<\/li>\r\n \t
- Hypoglycemia (or low BG) is dangerous because it can lead to fainting and falling. If you feel low, check your BG and follow the 15:15 rule if it is below 4.0 mmol\/L.<\/li>\r\n \t
- Penelope's breakfast contains mostly protein and fat (from the eggs, bacon, and mayo) with very little carbs - this may have caused a low BG and made her feel shaky and hungry before lunch. Her dinner contained mostly carbs (from the potatoes, corn, and apple juice) which may have caused a high BG reading after dinner.\u00a0 Review the Plate Method with Penelope to portion carbs at each meal by filling her plate with \u00bd vegetables, \u00bc starch, and \u00bc protein.<\/li>\r\n<\/ol>\r\nIt\u2019s also important to ask your client questions throughout. For example, when helping Penelope understand why her blood sugars were low in the morning, ask Penelope to put her breakfast foods on the plate and see if it is balanced. What is she missing? What could she add next time to make sure she is getting enough carbs in the morning?\r\n\r\nPause here and practice explaining the key messages above in plain language.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n
Using analogies<\/h2>\r\nIt can also be helpful to use simple analogies. For example, insulin is like a \"key\" that unlocks the \"door\" to our cells, allowing sugar in to provide us energy.\u00a0 In using this analogy to help educate a client about diabetes, you could say:\r\n\u201cOur bodies need insulin in order for sugar to go from our blood into our cells. Insulin is like a 'key,' and the cell receptor is like the 'lock.' Without insulin, the 'door' to our cells cannot be unlocked and sugar cannot get into our cells to provide us energy, so it\u2019s stuck in our blood.\"<\/div>\r\n\r\n[caption id=\"attachment_1095\" align=\"aligncenter\" width=\"657\"]![\"A](\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/key-g2a0272f40_1920-300x169.jpg\")
From Qimono<\/a> on Pixabay[\/caption]\r\nSupporting Change<\/h1>\r\nOngoing management of a chronic disease can lead to burnout, and making dietary changes may be difficult for some patients. To help support them in making these changes, you may want to try:\r\n\r\n \t- Motivational interviewing:\u00a0<\/span><\/strong>collect their story, listen reflectively, collaborate rather than convince.<\/li>\r\n \t
- [pb_glossary id=\"1443\"]SMART goal[\/pb_glossary] setting:\u00a0<\/span><\/strong>help to identify barriers to change as part of creating a nutrition care plan with the client.<\/li>\r\n \t
- Referral to social worker:<\/strong>\u00a0<\/span>consider referring them to a social worker if they need someone to talk to about coping with the burden of managing a chronic disease.<\/li>\r\n<\/ul>\r\nPause here and think about some SMART goals that you could set in collaboration with Penelope. Continue when you are ready.\r\n\r\n \r\n
\r\nPenelope's SMART Goals<\/h2>\r\n<\/header>\r\n\r\n\r\nHere are some SMART goals Penelope could work on based on her diet history and our nutrition care plan. As a part of making the goals SMART, you can discuss with her when she plans on making these changes and come up with ways to support her if or when she encounters barriers.\r\n\r\n \t- Use the 15:15 rule to treat hypoglycemia<\/li>\r\n \t
- Use the Plate Method to create balanced meals, with high fibre CHO at each snack and meal, such as whole grain bread or brown rice<\/li>\r\n \t
- Choose a no-sugar beverage instead of apple juice at dinner time<\/li>\r\n \t
- Include CHO and protein at HS snack if BGs below 7 mmol\/L<\/li>\r\n \t
- Continue to test BGs twice per day (FBG in the morning and BG at HS) using a glucometer<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\nPART 3: IMPLEMENT COMPLETE. Pause to reflect on the implementation strategies discussed. When you\u2019re ready, move on to Part 4: Evaluate.<\/div>","rendered":"\n
Page Contents<\/p>\n
Education<\/h1>\r\nWhen educating clients, try to:\r\n\r\n \t- Individualize the education as much as possible<\/strong>: Discuss high-risk topics (like hypoglycemia) first since they are priority, connect the client\u2019s goals to your plan, and focus on what they want to learn.<\/li>\r\n \t
- Find out if client has had previous education<\/strong>: Ask the client if any one else has talked to them about their diet and diabetes, and adjust your education accordingly.<\/li>\r\n \t
- Focus on a few key messages<\/strong>: If the client is newly diagnosed or doesn\u2019t know much about diabetes, try not to overwhelm them with too much information during your first couple of interactions. Use visuals, like props and resources, to convey your message whenever possible.<\/li>\r\n<\/ul>\r\n
How an RD would Counsel a Patient on Physical Activity<\/h1>\r\nPeople living with diabetes often face a number of barriers to participating in physical activity. RDs have the knowledge and skillset to suggest interventions targeted at addressing these barriers which can be effective at increasing participation in physical activity.\u00a0 Here are some ways RDs can counsel patients living with diabetes about physical activity:\r\n\r\n \t- Motivational Interviewing:<\/strong> RDs can use motivational interviewing techniques to explore a patient's ambivalence and increase their intrinsic motivation towards physical activity. This approach helps in recognizing barriers and enhancing the patient's confidence (self-efficacy) in their ability to engage in physical activity.<\/li>\r\n \t
- Goal Setting:<\/strong> Encouraging a patient to set SMART goals is key. Guiding the patient to set smaller, manageable goals such as short periods of walking or parking further from the store entrance can gradually increase their physical activity levels. . Anticipating challenges and adjusting goals to help overcome them can help the patient address barriers to exercise.<\/li>\r\n \t
- Tailored Exercise Plan:<\/strong> Based on a patient's preferences and health status, RDs with the knowledge and skills can recommend specific types of exercises such as aerobic activities (walking, swimming), resistance training (weightlifting), and stretching . Exercise plans should be individualized, considering the patient's current fitness level and any limitations. The patient should always consult with their primary health care provider to ensure they are ready to increase their activity level.<\/li>\r\n \t
- Breaking up Sedentary Time:<\/strong> Emphasizing the importance of reducing prolonged sitting and interrupting sedentary time with brief activity breaks is a helpful way to add more activity into their day. This helps manage blood glucose levels and improves overall health outcomes.<\/li>\r\n<\/ul>\r\nBy combining motivational strategies, personalized exercise plans, and goal setting, RDs can empower patients to adopt and maintain a physically active lifestyle, improving their physical health and diabetes management outcomes. For more information, please see: Physical Activity and Diabetes<\/a>.\r\n\r\n \r\n\r\nPause here and think of some key messages you might want to speak to Penelope about when providing education. Continue when you are ready.\r\n\r\n \r\n
\r\nPenelope's Education - Key Messages<\/strong><\/h2>\r\n<\/header>\r\n\r\n\r\nBased on your assessment Penelope has a basic understanding of diabetes pathophysiology, but she does not know how to properly treat hypoglycemia. It is important to start your education by reviewing hypoglycemia treatment and then moving on to the key dietary changes that will improve her diabetes management.\r\n\r\nPenelope tells you that she gets confused sometimes when trying to plan a meal and thought she was spreading her carbs out throughout the day. She doesn\u2019t understand why her BGs are low in the morning and high in the evening. To keep it simple you\u00a0 can focus on a these 3 key messages, asking questions throughout:\r\n\r\n \t- Carbohydrates come from plants (found in grains, legumes, starchy vegetables, fruit, milk, nuts, seeds) and give us energy by being digested into sugar\/glucose for use by our cells. Can Penelope identify the carbs she currently includes in her diet?<\/li>\r\n \t
- Hypoglycemia (or low BG) is dangerous because it can lead to fainting and falling. If you feel low, check your BG and follow the 15:15 rule if it is below 4.0 mmol\/L.<\/li>\r\n \t
- Penelope's breakfast contains mostly protein and fat (from the eggs, bacon, and mayo) with very little carbs - this may have caused a low BG and made her feel shaky and hungry before lunch. Her dinner contained mostly carbs (from the potatoes, corn, and apple juice) which may have caused a high BG reading after dinner.\u00a0 Review the Plate Method with Penelope to portion carbs at each meal by filling her plate with \u00bd vegetables, \u00bc starch, and \u00bc protein.<\/li>\r\n<\/ol>\r\nIt\u2019s also important to ask your client questions throughout. For example, when helping Penelope understand why her blood sugars were low in the morning, ask Penelope to put her breakfast foods on the plate and see if it is balanced. What is she missing? What could she add next time to make sure she is getting enough carbs in the morning?\r\n\r\nPause here and practice explaining the key messages above in plain language.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n
Using analogies<\/h2>\r\nIt can also be helpful to use simple analogies. For example, insulin is like a \"key\" that unlocks the \"door\" to our cells, allowing sugar in to provide us energy.\u00a0 In using this analogy to help educate a client about diabetes, you could say:\r\n\u201cOur bodies need insulin in order for sugar to go from our blood into our cells. Insulin is like a 'key,' and the cell receptor is like the 'lock.' Without insulin, the 'door' to our cells cannot be unlocked and sugar cannot get into our cells to provide us energy, so it\u2019s stuck in our blood.\"<\/div>\r\n\r\n[caption id=\"attachment_1095\" align=\"aligncenter\" width=\"657\"] From Qimono<\/a> on Pixabay[\/caption]\r\nSupporting Change<\/h1>\r\nOngoing management of a chronic disease can lead to burnout, and making dietary changes may be difficult for some patients. To help support them in making these changes, you may want to try:\r\n\r\n \t- Motivational interviewing:\u00a0<\/span><\/strong>collect their story, listen reflectively, collaborate rather than convince.<\/li>\r\n \t
- [pb_glossary id=\"1443\"]SMART goal[\/pb_glossary] setting:\u00a0<\/span><\/strong>help to identify barriers to change as part of creating a nutrition care plan with the client.<\/li>\r\n \t
- Referral to social worker:<\/strong>\u00a0<\/span>consider referring them to a social worker if they need someone to talk to about coping with the burden of managing a chronic disease.<\/li>\r\n<\/ul>\r\nPause here and think about some SMART goals that you could set in collaboration with Penelope. Continue when you are ready.\r\n\r\n \r\n
\r\nPenelope's SMART Goals<\/h2>\r\n<\/header>\r\n\r\n\r\nHere are some SMART goals Penelope could work on based on her diet history and our nutrition care plan. As a part of making the goals SMART, you can discuss with her when she plans on making these changes and come up with ways to support her if or when she encounters barriers.\r\n\r\n \t- Use the 15:15 rule to treat hypoglycemia<\/li>\r\n \t
- Use the Plate Method to create balanced meals, with high fibre CHO at each snack and meal, such as whole grain bread or brown rice<\/li>\r\n \t
- Choose a no-sugar beverage instead of apple juice at dinner time<\/li>\r\n \t
- Include CHO and protein at HS snack if BGs below 7 mmol\/L<\/li>\r\n \t
- Continue to test BGs twice per day (FBG in the morning and BG at HS) using a glucometer<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\nPART 3: IMPLEMENT COMPLETE. Pause to reflect on the implementation strategies discussed. When you\u2019re ready, move on to Part 4: Evaluate.<\/div>","rendered":"\n
Page Contents<\/p>\n
How an RD would Counsel a Patient on Physical Activity<\/h1>\r\nPeople living with diabetes often face a number of barriers to participating in physical activity. RDs have the knowledge and skillset to suggest interventions targeted at addressing these barriers which can be effective at increasing participation in physical activity.\u00a0 Here are some ways RDs can counsel patients living with diabetes about physical activity:\r\n\r\n \t- Motivational Interviewing:<\/strong> RDs can use motivational interviewing techniques to explore a patient's ambivalence and increase their intrinsic motivation towards physical activity. This approach helps in recognizing barriers and enhancing the patient's confidence (self-efficacy) in their ability to engage in physical activity.<\/li>\r\n \t
- Goal Setting:<\/strong> Encouraging a patient to set SMART goals is key. Guiding the patient to set smaller, manageable goals such as short periods of walking or parking further from the store entrance can gradually increase their physical activity levels. . Anticipating challenges and adjusting goals to help overcome them can help the patient address barriers to exercise.<\/li>\r\n \t
- Tailored Exercise Plan:<\/strong> Based on a patient's preferences and health status, RDs with the knowledge and skills can recommend specific types of exercises such as aerobic activities (walking, swimming), resistance training (weightlifting), and stretching . Exercise plans should be individualized, considering the patient's current fitness level and any limitations. The patient should always consult with their primary health care provider to ensure they are ready to increase their activity level.<\/li>\r\n \t
- Breaking up Sedentary Time:<\/strong> Emphasizing the importance of reducing prolonged sitting and interrupting sedentary time with brief activity breaks is a helpful way to add more activity into their day. This helps manage blood glucose levels and improves overall health outcomes.<\/li>\r\n<\/ul>\r\nBy combining motivational strategies, personalized exercise plans, and goal setting, RDs can empower patients to adopt and maintain a physically active lifestyle, improving their physical health and diabetes management outcomes. For more information, please see: Physical Activity and Diabetes<\/a>.\r\n\r\n \r\n\r\nPause here and think of some key messages you might want to speak to Penelope about when providing education. Continue when you are ready.\r\n\r\n \r\n
\r\nPenelope's Education - Key Messages<\/strong><\/h2>\r\n<\/header>\r\n\r\n\r\nBased on your assessment Penelope has a basic understanding of diabetes pathophysiology, but she does not know how to properly treat hypoglycemia. It is important to start your education by reviewing hypoglycemia treatment and then moving on to the key dietary changes that will improve her diabetes management.\r\n\r\nPenelope tells you that she gets confused sometimes when trying to plan a meal and thought she was spreading her carbs out throughout the day. She doesn\u2019t understand why her BGs are low in the morning and high in the evening. To keep it simple you\u00a0 can focus on a these 3 key messages, asking questions throughout:\r\n\r\n \t- Carbohydrates come from plants (found in grains, legumes, starchy vegetables, fruit, milk, nuts, seeds) and give us energy by being digested into sugar\/glucose for use by our cells. Can Penelope identify the carbs she currently includes in her diet?<\/li>\r\n \t
- Hypoglycemia (or low BG) is dangerous because it can lead to fainting and falling. If you feel low, check your BG and follow the 15:15 rule if it is below 4.0 mmol\/L.<\/li>\r\n \t
- Penelope's breakfast contains mostly protein and fat (from the eggs, bacon, and mayo) with very little carbs - this may have caused a low BG and made her feel shaky and hungry before lunch. Her dinner contained mostly carbs (from the potatoes, corn, and apple juice) which may have caused a high BG reading after dinner.\u00a0 Review the Plate Method with Penelope to portion carbs at each meal by filling her plate with \u00bd vegetables, \u00bc starch, and \u00bc protein.<\/li>\r\n<\/ol>\r\nIt\u2019s also important to ask your client questions throughout. For example, when helping Penelope understand why her blood sugars were low in the morning, ask Penelope to put her breakfast foods on the plate and see if it is balanced. What is she missing? What could she add next time to make sure she is getting enough carbs in the morning?\r\n\r\nPause here and practice explaining the key messages above in plain language.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n
Using analogies<\/h2>\r\nIt can also be helpful to use simple analogies. For example, insulin is like a \"key\" that unlocks the \"door\" to our cells, allowing sugar in to provide us energy.\u00a0 In using this analogy to help educate a client about diabetes, you could say:\r\n\u201cOur bodies need insulin in order for sugar to go from our blood into our cells. Insulin is like a 'key,' and the cell receptor is like the 'lock.' Without insulin, the 'door' to our cells cannot be unlocked and sugar cannot get into our cells to provide us energy, so it\u2019s stuck in our blood.\"<\/div>\r\n\r\n[caption id=\"attachment_1095\" align=\"aligncenter\" width=\"657\"] From Qimono<\/a> on Pixabay[\/caption]\r\nSupporting Change<\/h1>\r\nOngoing management of a chronic disease can lead to burnout, and making dietary changes may be difficult for some patients. To help support them in making these changes, you may want to try:\r\n\r\n \t- Motivational interviewing:\u00a0<\/span><\/strong>collect their story, listen reflectively, collaborate rather than convince.<\/li>\r\n \t
- [pb_glossary id=\"1443\"]SMART goal[\/pb_glossary] setting:\u00a0<\/span><\/strong>help to identify barriers to change as part of creating a nutrition care plan with the client.<\/li>\r\n \t
- Referral to social worker:<\/strong>\u00a0<\/span>consider referring them to a social worker if they need someone to talk to about coping with the burden of managing a chronic disease.<\/li>\r\n<\/ul>\r\nPause here and think about some SMART goals that you could set in collaboration with Penelope. Continue when you are ready.\r\n\r\n \r\n
\r\nPenelope's SMART Goals<\/h2>\r\n<\/header>\r\n\r\n\r\nHere are some SMART goals Penelope could work on based on her diet history and our nutrition care plan. As a part of making the goals SMART, you can discuss with her when she plans on making these changes and come up with ways to support her if or when she encounters barriers.\r\n\r\n \t- Use the 15:15 rule to treat hypoglycemia<\/li>\r\n \t
- Use the Plate Method to create balanced meals, with high fibre CHO at each snack and meal, such as whole grain bread or brown rice<\/li>\r\n \t
- Choose a no-sugar beverage instead of apple juice at dinner time<\/li>\r\n \t
- Include CHO and protein at HS snack if BGs below 7 mmol\/L<\/li>\r\n \t
- Continue to test BGs twice per day (FBG in the morning and BG at HS) using a glucometer<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\nPART 3: IMPLEMENT COMPLETE. Pause to reflect on the implementation strategies discussed. When you\u2019re ready, move on to Part 4: Evaluate.<\/div>","rendered":"\n
Page Contents<\/p>\n
Penelope's Education - Key Messages<\/strong><\/h2>\r\n<\/header>\r\n\r\n\r\nBased on your assessment Penelope has a basic understanding of diabetes pathophysiology, but she does not know how to properly treat hypoglycemia. It is important to start your education by reviewing hypoglycemia treatment and then moving on to the key dietary changes that will improve her diabetes management.\r\n\r\nPenelope tells you that she gets confused sometimes when trying to plan a meal and thought she was spreading her carbs out throughout the day. She doesn\u2019t understand why her BGs are low in the morning and high in the evening. To keep it simple you\u00a0 can focus on a these 3 key messages, asking questions throughout:\r\n\r\n \t- Carbohydrates come from plants (found in grains, legumes, starchy vegetables, fruit, milk, nuts, seeds) and give us energy by being digested into sugar\/glucose for use by our cells. Can Penelope identify the carbs she currently includes in her diet?<\/li>\r\n \t
- Hypoglycemia (or low BG) is dangerous because it can lead to fainting and falling. If you feel low, check your BG and follow the 15:15 rule if it is below 4.0 mmol\/L.<\/li>\r\n \t
- Penelope's breakfast contains mostly protein and fat (from the eggs, bacon, and mayo) with very little carbs - this may have caused a low BG and made her feel shaky and hungry before lunch. Her dinner contained mostly carbs (from the potatoes, corn, and apple juice) which may have caused a high BG reading after dinner.\u00a0 Review the Plate Method with Penelope to portion carbs at each meal by filling her plate with \u00bd vegetables, \u00bc starch, and \u00bc protein.<\/li>\r\n<\/ol>\r\nIt\u2019s also important to ask your client questions throughout. For example, when helping Penelope understand why her blood sugars were low in the morning, ask Penelope to put her breakfast foods on the plate and see if it is balanced. What is she missing? What could she add next time to make sure she is getting enough carbs in the morning?\r\n\r\nPause here and practice explaining the key messages above in plain language.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n
Using analogies<\/h2>\r\nIt can also be helpful to use simple analogies. For example, insulin is like a \"key\" that unlocks the \"door\" to our cells, allowing sugar in to provide us energy.\u00a0 In using this analogy to help educate a client about diabetes, you could say:\r\n\u201cOur bodies need insulin in order for sugar to go from our blood into our cells. Insulin is like a 'key,' and the cell receptor is like the 'lock.' Without insulin, the 'door' to our cells cannot be unlocked and sugar cannot get into our cells to provide us energy, so it\u2019s stuck in our blood.\"<\/div>\r\n\r\n[caption id=\"attachment_1095\" align=\"aligncenter\" width=\"657\"] From Qimono<\/a> on Pixabay[\/caption]\r\nSupporting Change<\/h1>\r\nOngoing management of a chronic disease can lead to burnout, and making dietary changes may be difficult for some patients. To help support them in making these changes, you may want to try:\r\n\r\n \t- Motivational interviewing:\u00a0<\/span><\/strong>collect their story, listen reflectively, collaborate rather than convince.<\/li>\r\n \t
- [pb_glossary id=\"1443\"]SMART goal[\/pb_glossary] setting:\u00a0<\/span><\/strong>help to identify barriers to change as part of creating a nutrition care plan with the client.<\/li>\r\n \t
- Referral to social worker:<\/strong>\u00a0<\/span>consider referring them to a social worker if they need someone to talk to about coping with the burden of managing a chronic disease.<\/li>\r\n<\/ul>\r\nPause here and think about some SMART goals that you could set in collaboration with Penelope. Continue when you are ready.\r\n\r\n \r\n
\r\nPenelope's SMART Goals<\/h2>\r\n<\/header>\r\n\r\n\r\nHere are some SMART goals Penelope could work on based on her diet history and our nutrition care plan. As a part of making the goals SMART, you can discuss with her when she plans on making these changes and come up with ways to support her if or when she encounters barriers.\r\n\r\n \t- Use the 15:15 rule to treat hypoglycemia<\/li>\r\n \t
- Use the Plate Method to create balanced meals, with high fibre CHO at each snack and meal, such as whole grain bread or brown rice<\/li>\r\n \t
- Choose a no-sugar beverage instead of apple juice at dinner time<\/li>\r\n \t
- Include CHO and protein at HS snack if BGs below 7 mmol\/L<\/li>\r\n \t
- Continue to test BGs twice per day (FBG in the morning and BG at HS) using a glucometer<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\nPART 3: IMPLEMENT COMPLETE. Pause to reflect on the implementation strategies discussed. When you\u2019re ready, move on to Part 4: Evaluate.<\/div>","rendered":"\n
Page Contents<\/p>\n
- \r\n \t
- Carbohydrates come from plants (found in grains, legumes, starchy vegetables, fruit, milk, nuts, seeds) and give us energy by being digested into sugar\/glucose for use by our cells. Can Penelope identify the carbs she currently includes in her diet?<\/li>\r\n \t
- Hypoglycemia (or low BG) is dangerous because it can lead to fainting and falling. If you feel low, check your BG and follow the 15:15 rule if it is below 4.0 mmol\/L.<\/li>\r\n \t
- Penelope's breakfast contains mostly protein and fat (from the eggs, bacon, and mayo) with very little carbs - this may have caused a low BG and made her feel shaky and hungry before lunch. Her dinner contained mostly carbs (from the potatoes, corn, and apple juice) which may have caused a high BG reading after dinner.\u00a0 Review the Plate Method with Penelope to portion carbs at each meal by filling her plate with \u00bd vegetables, \u00bc starch, and \u00bc protein.<\/li>\r\n<\/ol>\r\nIt\u2019s also important to ask your client questions throughout. For example, when helping Penelope understand why her blood sugars were low in the morning, ask Penelope to put her breakfast foods on the plate and see if it is balanced. What is she missing? What could she add next time to make sure she is getting enough carbs in the morning?\r\n\r\nPause here and practice explaining the key messages above in plain language.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n
Using analogies<\/h2>\r\nIt can also be helpful to use simple analogies. For example, insulin is like a \"key\" that unlocks the \"door\" to our cells, allowing sugar in to provide us energy.\u00a0 In using this analogy to help educate a client about diabetes, you could say:\r\n
\u201cOur bodies need insulin in order for sugar to go from our blood into our cells. Insulin is like a 'key,' and the cell receptor is like the 'lock.' Without insulin, the 'door' to our cells cannot be unlocked and sugar cannot get into our cells to provide us energy, so it\u2019s stuck in our blood.\"<\/div>\r\n\r\n[caption id=\"attachment_1095\" align=\"aligncenter\" width=\"657\"] From Qimono<\/a> on Pixabay[\/caption]\r\nSupporting Change<\/h1>\r\nOngoing management of a chronic disease can lead to burnout, and making dietary changes may be difficult for some patients. To help support them in making these changes, you may want to try:\r\n
- \r\n \t
- Motivational interviewing:\u00a0<\/span><\/strong>collect their story, listen reflectively, collaborate rather than convince.<\/li>\r\n \t
- [pb_glossary id=\"1443\"]SMART goal[\/pb_glossary] setting:\u00a0<\/span><\/strong>help to identify barriers to change as part of creating a nutrition care plan with the client.<\/li>\r\n \t
- Referral to social worker:<\/strong>\u00a0<\/span>consider referring them to a social worker if they need someone to talk to about coping with the burden of managing a chronic disease.<\/li>\r\n<\/ul>\r\nPause here and think about some SMART goals that you could set in collaboration with Penelope. Continue when you are ready.\r\n\r\n \r\n
\r\n Penelope's SMART Goals<\/h2>\r\n<\/header>\r\n
\r\n\r\nHere are some SMART goals Penelope could work on based on her diet history and our nutrition care plan. As a part of making the goals SMART, you can discuss with her when she plans on making these changes and come up with ways to support her if or when she encounters barriers.\r\n- \r\n \t
- Use the 15:15 rule to treat hypoglycemia<\/li>\r\n \t
- Use the Plate Method to create balanced meals, with high fibre CHO at each snack and meal, such as whole grain bread or brown rice<\/li>\r\n \t
- Choose a no-sugar beverage instead of apple juice at dinner time<\/li>\r\n \t
- Include CHO and protein at HS snack if BGs below 7 mmol\/L<\/li>\r\n \t
- Continue to test BGs twice per day (FBG in the morning and BG at HS) using a glucometer<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\nPART 3: IMPLEMENT COMPLETE. Pause to reflect on the implementation strategies discussed. When you\u2019re ready, move on to Part 4: Evaluate.<\/div>","rendered":"\n
Page Contents<\/p>\n
- [pb_glossary id=\"1443\"]SMART goal[\/pb_glossary] setting:\u00a0<\/span><\/strong>help to identify barriers to change as part of creating a nutrition care plan with the client.<\/li>\r\n \t
- Motivational interviewing:\u00a0<\/span><\/strong>collect their story, listen reflectively, collaborate rather than convince.<\/li>\r\n \t