Page 16 - Today's Dietitian (February 2020)

Diabetes

Weiner and Setnick, as well as Brown
during her presentation, offer the fol-
lowing practice pointers for RDs, which,
while they may not all directly relate to
eating disorders or disordered eating,
can help young patients feel empowered
and enable RDs to provide care when
emotional challenges arise:
• Look for clinical and behavioral
signs of eating disorders and disordered
eating. Certain red flags may pop up
throughout treatment that could indi-
cate an eating disorder or disordered • Listen carefully to the answers. other health care professionals. She also
eating. Unexplained high A1c, episodes Weiner says RDs sometimes are pro- recommends asking whether a person has
of DKA, and hypoglycemia can be clini- grammed as “fixers”—they know they “checked,” not “tested,” his or her blood
cal indicators of ED-DMT1. Patients have answers for clients and they want glucose. “‘Test’ implies pass-fail,” she says.
reporting traditional eating disorder to help, especially in the face of a lifelong Weiner views the terms “control,”
symptoms regardless of diabetes status condition that requires daily, dedicated “compliance,” and “adherence” as
such as excessive exercise, discomfort management. This isn’t necessarily a judgmental and points RDs to the 2017
with eating or taking insulin in front of fault, she says, but it doesn’t always rep- consensus report “The Use of Language
friends and family, and hoarding food resent what people with diabetes need in in Diabetes Care and Education” by
1,8
also may be at risk. Changes in weight a given moment, which is perhaps simply the American Diabetes Association
may or may not be present, so RDs an ear for their feelings to be validated. and AADE (available at https://care.
shouldn’t use this factor alone as evi- Setnick agrees: “Sometimes what diabetesjournals.org/content/diacare/
dence of an eating disorder. someone needs isn’t information but early/2017/09/26/dci17-0041.full.pdf),
Some common warning signs Weiner affirmation. Don’t try to use informa- which argues these terms connote
has seen in her practice include clients tion as a solution for feelings,” she says. laziness, carelessness, and a lack of
canceling appointments, claiming they For example, “if [a young patient] says, motivation on the patient’s part.
can’t upload tracked blood glucose infor- ‘I’m really afraid that if I inject my insu- This stigmatizing language can lead
mation onto data sharing software, and lin incorrectly, I’ll die,’ the answer is to poor psychological outcomes such as
not running out of test strips, lancets, or not, ‘Well, I will help teach you how to depression and anxiety and discourage
other supplies for checking blood glucose. do it correctly.’ Of course [the patient] self-care behaviors. Instead, state
• Ask questions. Setnick emphasizes needs to be taught how to do it correctly, what the patient does or doesn’t do in
the importance of asking patients but someone has to address the fear.” objective terms, such as “He takes his
questions—as many as possible, but Furthermore, Setnick says, RDs medication about half the time.” The
“kindly and curiously” without giving off shouldn’t assign feelings to patients or consensus report offers other language
an air of suspicion by asking too many. assume how they feel, such as saying to substitutions when speaking with
She suggests: “What are you worried a patient, “You’re so lucky that we have patients, such as “manage” instead of
about?”; “How can I support you?”; insulin.” The appropriate action is to ask “control,” and providing suggestions (eg,
“What is your understanding so far of questions about how the patient is feel- “Have you tried …”) vs imperatives (eg,
10
the nutrition needs of your condition?”; ing instead of assuming. Setnick sug- “You shouldn’t …”).
and “How has your eating changed since gests queries such as, “How are you Another instance in which Setnick
your diagnosis?” coping with this?”; “Do you ever get would be sure to use language carefully
Asking questions provides “a golden down about this new diagnosis?”; and is in discussing meeting with a mental
opportunity for the dietitian to offer to “When you get down, what do you do health professional. She believes patients
clear up any misconceptions, address about it?” If the patient is struggling to with type 1 diabetes and their families
any fears, and then give the individual cope, Setnick suggests adding a mental often can benefit from mental health
confidence that the dietitian is there health professional to the diabetes care counseling to cope with the stresses
and willing to answer questions that team to help them develop healthful of managing a chronic condition but
come up, even between appointments,” coping strategies. avoids saying they “need to see a psy-
Setnick says. • Avoid stigmatizing language. This rec- chologist” or “need to go to counseling.”
However, Setnick says, asking too ommendation is obvious to most if not “In my experience, teens (and some-
many questions can give patients the all RDs, but it may not be obvious what times parents) can misinterpret that
impression that you don’t trust them— that language looks like when speaking as, ‘This person must think I’m really
they may shut down and feel accused or with young people with type 1 diabetes. screwed up,’” she says. Her suggestions:
defensive. Be sure these questions are Weiner stresses using person-first lan- “I’d like us to bring a counselor onto our
“open-ended and nonjudgmental,” Weiner guage (ie, someone is a “person with dia- team,” or “Let’s get some advice from
adds. In other words, listen more than you betes,” not a “diabetic”), a trend that’s someone who is a specialist in this type
speak, and let the patient have the floor. starting to catch on with many RDs and of situation.”

16 TODAY’S DIETITIAN • FEBRUARY 2020