Dietetic Internship - Community Rotation with a Diabetes Educator
My second rotation was spent in the town I live in right around the corner at Wentworth Douglass Professional Center with Dover Family Practice and Internal Medicine with their diabetes educators.
I was really excited for this rotation because this is ideally the environment which I could see myself working in. Working in the outpatient setting allows me to see progress in my patients over time whereas in the hospital it tends to be more acute. I am still open to all environments, though until I finish the internship. Who knows, I may complete a different rotation and absolutely love it!
The first week was a lot of ironing out details. There were 100 hours to spread out over the 5 weeks and projects and presentations to be sprinkled throughout. I loved some of the quotes and funny quips they put on the wall like the one pictured above. It’s not easy knowing that you have a chronic condition like diabetes, but it can be managed, and humor helps.
This recipe above was in a book for gestational diabetes but is great for anyone (and has coconut 😍). My preceptor adds this to her plain Greek or Icelandic yogurt with fruit like raspberries or apple.
Within the 5 weeks I was there I had seen a variety of patients with different backgrounds and at different points in their lives. I saw patients throughout the lifespan including patients with gestational diabetes (during pregnancy), pediatrics (a 12 year old), adults with insulin pumps and sensors, and seniors in their 80’s. For interns coming into their community rotation and would probably be useful for other rotations; look more in depth into motivational interviewing. The approach is less black and white and directive and more open-ended questions and guidance. It allows you to gain so much more insight about a person and gives you the ability to be able to help even more at a deeper level.
We talked about what I could potentially do for my hour long presentation before the rotation started and it included talking about fad diets and if they could work for diabetes. I did my research on a number of diets, namely, the ketogenic diet, intermittent fasting (including 5:2), circadian rhythm, and paleo. All of these diets require the body to cut a lot of carbs and essentially go into ketosis, which is typically pathological for people with diabetes but can happen for people with out it when they limit their carb intake. I was pleasantly surprised when at the end every single person evaluated me at 5’s (being the highest score) across the board! I was heavily anticipating it and it was great to hear feedback from the audience that it was helpful.
The bottom line is that while these diets are great for recipe inspiration and they may help blood sugar control initially, they are really hard to follow long term and there really isn’t a whole lot of research to back them up. Plus, people with diabetes need to watch their blood sugar because decreasing carbs that drastically and if they are also amping up their physical activity without consulting their health care team that could put them at risk for hypoglycemia, or very low blood sugars which can lead to a variety of symptoms and issues. It is great that people are focusing on their health, but it is also a good idea to make sure that it also fits with your lifestyle as there is so much more to diabetes than just diet. It’s important to also look at the big picture. Taking the time to eat your meal at the dinner table with family and appreciate your food and where it comes from. Savor the taste instead of rushing around and grabbing convenience items on the go that tend to be loaded with carbs, unhealty fats, and salt. It’s important to look at the potential impacts to mental health when it may come to an over focus on food. Balance and quality are the key.
I was also able to be a part of a board meeting where WDH may have the CDC come and do a clinical trial for a diabetic prevention program. Cool! I also attended their staff meetings and marketing meetings.
I also wrote a couple blog posts, one on meal planning and another on focusing on carbs. These will be linked to some podcasts WDH is putting out soon and I’ll share them if I can in the near future!
When it comes to food, it is more about nourishing yourself than restricting. Are you eating a balanced plate of mostly vegetables, then about a quarter protein, and starch? (Maybe an occasional glass of wine?) So many people have the mentality that there are good and bad foods and then they have the subsequent guilt that follows when they have something they label as “bad.” Stop it 🛑. Ask yourself why you think it is bad. (Unless you have an allergy). Health At Every Size (HAES) focuses more on the behavior around the individuals relationship with food and though weight isn’t part of the equation, weight loss tends to follow behavior change. There are many practices that are taking weight out of the equation and having a weight neutral approach. Some don’t even have a scale in their office. They may pull that information from prior visits from the doctor. When there’s a scale involved it can put a negative air to counseling when the focus should really center on the individual person as a whole and how they approach nutrition.
I will certainly miss the diabetes educators I worked with for the past month and I am looking forward to coming back to Wentworth Douglass Hospital for my last rotation in critical care. My next rotation will be part of my nutrition communications and marketing rotation with Seacoast Eat Local where I’ll get to host food demos at farmers markets, write blog posts, create educational materials, and more. Then it’s onto my clinical rotation. Next post won’t be until March. Stay tuned!
Chocolate and flowers for my birthday!
One of my preceptors wrote a couple books that she gave to me on my last day!