Confusing Carbs
Aug 17, 2017, 17:10 PM
It is always interesting to me that there is such a wide diversity of professionals and their concerns involved in diabetes education. Last week I participated in a conference call to discuss topics of concern to diabetes educators. I did not know any of the other five participants. One CDE discussed her concerns regarding the vast amount of information available now with the hybrid insulin pumps. Because the sensor measures a glucose value every five minutes, there are 288 values per day and over 8,600 values per month. If your patient on a hybrid pump comes to see you every three months, you have an incredible amount of glucose values to review. Luckily, the software helps by providing percentages of times in glucose range, as well as those values above and below range. The glucose values are all neatly graphed in a variety of formats, depending on how the healthcare professional would like to assess the information.
Another participant voiced concerns over the vast amounts of information on the internet. Some patients have stated that they do not need to attend class because they can get whatever information they need there. Unfortunately, as we all know, the quality of information on the internet may be lacking. There are all types of “cure your diabetes” advertisements and it is difficult for patients to determine what information may apply to their particular medical condition(s).
Yet another participant shared the problems encountered with DIY – do-it-yourself-ers. Apparently, there are groups of parents out there developing their own insulin pumps and/or software which they use to manage their children’s blood sugars. In a profession that is extremely “evidenced based,” this sort of rogue care is quite disconcerting to many health professionals.
I sat quietly during the discussion, as I found their concerns fascinating. I had joined the discussion a bit late, as the patient I saw immediately preceding the conference call took an extra 20 minutes. This was our third meeting to discuss carbohydrates. My patient was a well-educated 72 year-old woman who runs her own business but she had trouble learning which foods contain carbohydrates.
I spent time at our first meeting reviewing food labels, both a printed copy and actual actual food boxes because she informed me she did not cook. She ate out rarely, but bought prepared frozen meals. Wonderful— I told her – that will make it very easy because all the information you need is written right on the box. I sent her home after the first meeting with instructions to start looking at labels in her pantry, as well as when she went shopping. At our next meeting, she still had a few questions, so I pulled out my food models. We discussed portion sizes and I had her group the food models into the correct nutritional categories. She did well on that exercise. At the third meeting, she was full of questions: “What fruits do not contain carbs?” - “What if I only drink fresh squeezed juice?” – “I heard that if you toast the bread…?” Unfortunately, she is not the only one that finds carbs confusing – it keeps the day interesting.
I hope you had a wonderful summer. I am looking forward to some cooler weather. Take care.
About the Author
Barbara Walz is an RN, BSN and has been a certified diabetes educator since 1986. Since 2000, Barbara has coordinated a multi-site diabetes study examining the macro-vascular effects of diabetes at the South Texas Veterans’ Healthcare System under the supervision of Dr. Ralph DeFronzo.