An important message for nurses to share with diabetic patients is their diet is not about deprivation. That?s one of many nuggets of nutritional truth Virginia Peragallo-Dittko, MA, APRN, BC-ADM, CDE, shares with clients at the Diabetic and Obesity Institute at Winthrop-University Hospital in Mineola, N.Y.
Peragallo-Dittko, the center?s executive director, said myths and misunderstandings often lead patients to make wrong nutritional choices. ?The foods that are important to a patient culturally can be included in a meal plan,? she said. ?It?s all about portions.?
Marlene Bedrich, MS, RN, BC-ADM, CDE, agrees. ?Many patients have a distorted idea about portion sizes and don?t know what a balanced diet is,? she said. Bedrich is program coordinator for the University of California, San Francisco?s Diabetes Teaching Center. She said patients should know diabetes can be controlled and requires lifestyle changes.
Bedrich often needs to correct patients? faulty information, such as the belief that a diabetic can?t eat carbohydrates. If a person loses some weight, the diabetes will improve, she said. She often counsels patients to take it one day at a time and learn what makes a balanced diet.
Diabetes nurse educator Marianne Chojnicki, RN, CDE, at the Joslin Diabetes Center in Boston, teaches to eat a healthy diet, patients must put the right combinations of food on the plate. Each meal should have carbohydrates?particularly whole grains?proteins and fats. Vegetables should take up half the plate, with carbohydrates (potatoes, rice, pasta, for example) and protein each as one-fourth of the meal.
Chojnicki starts teaching a patient about nutrition by taking a food history, discovering what the person is eating. Then she helps the patient take baby steps to make needed changes. A common mistake, she said, is not eating three meals a day. ?It?s very important to eat breakfast within an hour of waking up,? Chojnicki said. ?The body has been running on empty all night long.
?Look at food as the fuel you put in the car. Put the right combination of food in, and it will last four to five hours. Then you need more fuel.?
As patients become accustomed to a lifestyle conducive to blood glucose control, they need ongoing assessment, Peragallo-Dittko said. ?Patients may be acting on information from 10-20 years ago. Find out what they?re doing now and how their life has changed. They might have retired, or have less structure in their day,? all of which affect eating habits and nutritional needs. She said teaching nutrition isn?t a static, one-time-only intervention; patients need regular support with their food choices. ?It?s also about honoring what they?re doing right,? Bedrich said.
She added as patients age, they need less food, so portion sizes should be a little smaller.
Nurses need to assess whether patients are falling back into old habits, Bedrich said. They might have good intentions in a diabetic education class, but don?t have a good plan to implement them. She said nurses should learn about the patient?s peer and family pressures.
A common pitfall of diabetic patients is snacking. Bedrich said patients should try to stick to three meals a day and avoid snacking.
The only time a snack is needed, Chojnicki said, is when the patient can?t get a healthy meal.
She recommends healthy grab-and-go foods. For example, a truck driver in her diabetic clinic regularly ate two doughnuts at 10 a.m. She suggested he change to peanut butter sandwiches on whole grain bread. As they worked together over time, the patient increased what he ate for breakfast, then needed less of a snack later on.
Pergallo-Dittko cautions patients about consuming sugar-free food products. ?People think ?sugar-free? means ?eat all you want,? but they don?t understand that the food is still caloric and often higher in fat.?
While patient education by nurses is a bedrock of diabetic management, a recommendation that all three diabetic educators offered is to connect patients with a registered dietitian. Chojnicki said an ongoing relationship with a dietitian can increase the patient?s knowledge and bring lasting health results.
