Continuing Education Event Review 

 

Review - Coast to Coast Speaker Series by Dietitians of Canada: A Diabetes Conversation 

by Kelly Whalen, BScAHN RD Clinical Dietitian in Long Term Care, and Owner of Balanced Proportions Nutrition

 

 

In February 2015 I e-attended the amazing Dietitians of Canada coast to coast learning event: A Diabetes Conversation, by Michelle Corcran, BSc BScN RD CDE. Due to the poor weather, Michelle managed to deliver an incredibly informative and interesting presentation via online services. Absolutely worth every penny, would certainly recommend to any dietitian.

 

Presentation Agenda
  • The role of clinicians in diabetes care (do dietitians matter?)

  • Overview of insulin therapies and diabetes medications

  • Complication management

  • Special Populations: Gestational Diabetes, Chronic Kidney Disease, Diabetes in the Elderly

 
Key Presentation Points
 

RD Roles         

  • Impact of RD’s: Nutrition education can help lower A1c by 1-2%, along with other DSME components can improve other clinical outcomes

  • Healthcare Teams get to spend 0.02% of the time with the patient, the other 99.98% of the time the patient is alone - self-management is key

  • Using behavior change techniques can be an effective way to have a conversation toward meaningful change - overall targets for diabetes management need to be individualized

  • Complication risk from diabetes reduces for each 1% drop in A1c

 

Management

  • Injection technique is important – 21% of patients inject insulin into the same site each day.

    • Can lead to lipohypertrophy (changes that develop in the fat tissue from injecting insulin)

  • Absolute risk of MI is higher in patients with diabetes

  • Neat Fact: Star fruit can be deadly for patients with Chronic Kidney Disease

  • Avoid herbal therapies in Kidney Disease & individualize treatment for patients

  • Low GI foods  should be used based on interest and patients ability to manage

  • Carbohydrate counting can improve A1c, BG, quality of life, and decrease need for insulin

  • Vegetarians: overall studies show similar results when following a vegan or vegetarian diet vs a conventional diabetes diet

 

Pregnancy

  • Nutrition needs to be individualized in pregnancy, ideal preconception A1c of 7.0%

  • Placenta delivery reduces insulin resistance, increased insulin sensitivity 24-48 hours after delivery, and risk for hypoglycemia

 

Elderly

  • Key is to avoid acute complications of poor glycemic control including hypoglycemia and prolonged, severe hyperglycemia.

  • Dementia risk increases with severe hypoglycemia

  • Different FPG or A1c targets for elderly and long term care residents than younger population

  • Multiple medications and kidney or liver impairment, may lead to changes in breakdown of medications (and the risk of hypoglycemia)

 

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