As someone living with diabetes and being on social media, I hear many stories from other people living with diabetes. The kind of stories that only people with diabetes will ‘get’. We share the laughter and humour or irony, but more often than not, we shake our heads at the things we see or hear. Spending much of our time with specialists and our diabetes healthcare team, it’s unsurprising to hear stories around their diabetes healthcare professionals that just don’t get it. Being a dietitian specialising in diabetes myself and having gone through the training and study that other dietitians would have been required to undergo, this disappoints me more than people think. I think part of this breakdown is due to varied expectations from both people with diabetes and healthcare professionals. So I’ll try to share some advice from my experiences living on both sides of the fence.
There is more to low carb than vegetable sticks. A quick search on Google these days will provide you with an abundance of low carb substitutes and ideas for recipes for many dietary modifications. An adaptation to ‘paleo’ recipes are also a good starting point.
If you don’t know or understand something about your client’s diabetes management, ask your clients. Don’t be afraid to let them educate you. Not only is each person’s diabetes and management style different, but they are experts at this. Living with a chronic condition and dealing with it 24-7 will tend to do that to you. You may even learn a thing or two about diabetes that the textbook won’t tell you.
Remember that as health professionals, we are here to help them with their diabetes management and improve their health. Judgement has no room in clinical consults. If clients bring in material they got off the internet, don’t shut them down. Keep your poker face on and be patient with them. Engage in an open discussion and talk about what it means to them and the benefits and risks of following it. Any fool can follow a diet they find online. Be thankful they feel comfortable enough to discuss it with you before trying it and to get your expert opinion on it. It’s also a really good way of finding out what is currently popular among the diabetes community and it gives you an advantage for keeping up to date with emerging research.
Ask clients what they think they can do towards their goals. Clients will usually see suggestions they come up with as more achievable and have a higher chance of sticking with it. Remember to work with them around their lifestyle and what’s practical for them. Focus on the positives of what they are doing and reinforce those good habits and changes. No one likes feeling like a failure. Letting them decide how they are going to manage their diabetes through lifestyle changes is extremely empowering for them. The moment my endo gave me a choice between sticking out with tablets or moving on to insulin, I felt powerful. Living with a chronic condition as demanding as diabetes can make you feel powerless and even imprisoned by it. The least you can do is let them choose their own adventure and be prepared to support them along the way.
Dear People with Diabetes (PWDs),
Please stop bashing dietitians and calling them useless. Understand that dietitians can’t give you a magic pill to fix all problems. It takes time. Speak up if you disagree with something. If someone told me to stop eating cake, I would be narky too and tell them otherwise. Recipes can be modified and alternatives can and should be made to reach a compromise.
If dietitians have to leave their judgement at the door, you have to do the same as well. Entering a consult thinking that your dietitian will be terrible and you won’t gain anything from the visit, sets you both up for failure. Keep in mind that sometimes dietitians don’t know everything about diabetes. Be prepared to share information with them in a respectful manner rather than calling them ignorant. Keep an open mind and be prepared to ask questions. If you find something interesting online, bring it in. Sharing is caring and trust me, most dietitians will appreciate the effort. Think about what you want to get from your dietitian. Do you want information about managing carbs in your diet or even a refresher on carb counting? Let them know as it helps them to set up the consult to get you to where you want to be. I make it a point to ask clients what their health goals are and work from that.
Make sure you understand what your dietitian is telling you. When I first asked about carb counting many moons ago (before I became a dietitian) I was given a formula to use. By the time I got home, I had forgotten how the formula worked and was too embarrassed to ask because I didn’t want to look stupid. Dietitians and healthcare professionals appreciate questions and are more than happy to clarify anything you don’t are unclear of. It shows them that you are engaged in the consult and are ready to start making changes. And if they grumble every time you ask them something, find yourself another dietitian. I won’t deny that there are some dietitians out that are difficult to get along with, but don’t let negative experiences deter you. It is important that you find a dietitian you feel comfortable with, who is willing to work with you and respects you and your decisions. It is more than okay to say you are not ready to take the next step and move along at your own pace. This is your life, your diabetes, your decisions.
Dietitians would much prefer that you are upfront and honest to them. Being honest with them and more importantly, with yourself, is an important step towards change. It’s okay to say that you went to the pub and polished off the parma that was the size of both your palms and the chips but not the salad. I can assure you that many dietitians have done the same thing (at least I know I have…).
Underneath each person’s title be it health professional or person with diabetes, we are human. Treat each other with the mutual respect and please try not to kill each other. Working in partnerships with others are much more beneficial for everyone involved. Be patient with each other and leave the judgmental thoughts at the door.
Do you have any other tips or advice you would give from a health professional or PWD perspective?
6 thoughts on “Working with Dietitians and Diabetes”
What about RNs that are also CDEs? I had one say that I was not eating enough carbs and that I would have brain damage as a result. When I reminded her that carbohydrates were not an essential macronutrient, she laughed at me and said then she could not help me, gathered up her papers, and left. This was four years ago and before my gallbladder operation.
This post can be applied to working with any healthcare professionals. Ideally it would be nice to have the diabetes healthcare team working together and with you, as many of their roles are interwoven. CDEs should only really be giving general advice and referring to the dietitians in situations such as these. But laughing at you and leaving just seems very unprofessional! I’m sorry you had an experience like this. Hope you have found another CDE!
great advice, very insightful!
Thanks Maheeni 🙂
Just recently started following you, so am reading backwards,LOL.
I have a wonderful dietician who doesn’t always agree with me, nor I with her, but we agree to disagree. She wants me on 1200 calories a day, I eat between 900-1000 a day. She wants me on 120g carbs a day, I eat between 70-90g carbs a day. But, we agree that what I am doing is giving me energy, I am healthier than I’ve ever been, my A1c is better than it’s ever been, and my weight is dropping, so for now what I’m doing is working. When or if things change, we’ll re-evaluate things. She works for me, and I work with her. We are a team. Thanks for such a great post. Heidi from New Hampshire USA
Haha thanks for reading through! That’s really great to hear that you’re a team with your dietitian and that things are working well for you. That mutual respect both parties is so important but often forgotten. Well done! 🙂