Diabetes can be managed and prevented with food choices. It sounds simple, but old habits are hard to change and people often don’t know the right choices for their specific requirements. Fortunately, diabetes is one of two conditions for which nutritional counseling is covered by Medicare and most major medical insurance.
Desert Health® sat down with Libby Quigley to understand how nutritional counseling can help those with diabetes.
First of all, Libby, please clarify what is covered by Medicare and insurance.
If you have Medicare and your blood sugar is 126 or over, you qualify to see a registered dietitian for 3 hours the first year and 2 hours every year after. The practitioner has to be an RD and registered with Medicare (possessing an NPI, national provider identification number). Most major insurance providers offer similar programs.
Three hours isn’t much. How do you work within that timeframe?
No, it’s not, but it’s a good place to start. I usually recommend a 1 hour initial visit and four 30-minute follow up visits. It requires motivation, but can be very educational and beneficial.
Tell us what someone could expect from nutritional counseling.
How people eat is cultural, medical, and social. When someone first comes to me, I sit down and ask them what role food plays in their life. Do they go out to eat 3 times a week? Do they enjoy a glass of wine each night or only once in awhile? What other medical conditions need to be taken into consideration? We figure out how many calories need to be consumed based on ideal weight goals (not all diabetics need to lose weight). After analyzing all this, I try to prioritize what changes will make the biggest impact on blood sugar levels. You can’t change it all. It’s too hard to do that.
Are your recommendations individualized?
Absolutely. Type II diabetes can occur for a multitude of reasons. The pancreas might not make enough insulin. Or a client may have a magnitude of fat cells, which does not allow their body to make enough insulin to handle the fat cells, and they become insulin resistant. It may be that your liver is overproducing glucose. Each diabetic is treated differently based on these factors.
I have clients track their blood sugar levels which can give us an idea as to where the broken part is. If it’s high in the morning, it means that their liver is producing more glucose overnight. If it’s high after a meal, it means that they have insulin resistance and the type of foods eaten needs to be considered. If someone is 50 lbs overweight and their blood sugar levels are high, chances are that if we can get them to lose weight, they won’t have to go on medication, so that would be a priority.
It’s like a jigsaw puzzle, so we put all the pieces together and then prioritize what we need to do, tackling one thing at a time and setting goals based on what is important to them. If they only eat one meal a day, it’s getting them to eat 3. If it’s having 3 cocktails a night, its asking them to consider only having 1.
What are the biggest challenges people face?
Most people know what good food is and what a balanced diet looks like, they just don’t know how much. I help them determine what a portion size is. We discuss how to read labels. I don’t do meal plans because I think they are too restrictive. The idea is to understand that you can have 4 oz of a protein and a cup of starch and the difference between good starch and bad starch such as whole grains versus white bread.
A lot of time, I have to ‘unwind’ education because people have been told by their neighbor that they can no longer eat carbs and other information that is not correct. My goal is to educate patients so they no longer need me.
What do you consider to be the most important?
To establish realistic goals and life changes. We do not have to be perfect; we only have to be good.
Elizabeth Quigley is a Registered Dietician and was formerly Eisenhower Medical Center’s Chief Dietician for 23 years. She is now a nutritional consultant with EQ Consulting and can be reached at 760.773.1796 or www.ElizabethQuigleyRD.com