Dietitian Certified Diabetes Educators in Long Term Care Added expertise for your residents

Diabetes is the leading cause of blindness, kidney failure and amputations in the world and is a major risk factor for high blood pressure and death due to heart disease.

Type 2 diabetes is a significant challenge for health care professionals in long-term care. The cornerstone of good health with diabetes is a combination of healthy diet, regular exercise, compliance with medications and regular follow up. Certified diabetes educators (CDEs) are skilled at working with clients with diabetes to control blood sugar and minimize the complications.

Dietitians in long term care have expertise in monitoring blood glucose records and understand the interactions of medications, food, and exercise that affect blood glucose levels. They recommend and monitor tests needed to follow the disease progression.

Dietitian CDEs provide added value in the home’s diabetes management to further help residents, their families, and staff understand the importance of both food choices and portion sizes. The overall goal of providing optimal care aims to keep residents as healthy as possible while enhancing their quality of life.

Development of diabetes

Diabetes is a serious chronic disease that develops when the pancreas cannot produce the hormone insulin, or when the body cannot properly use the insulin it produces. Insulin’s main role is to allow glucose to enter the cells, where it is converted to energy, to fuel the body and the brain.

Starches and sugars from the diet provide the body with necessary glucose. In the absence of insulin, the glucose cannot enter the cell and this causes glucose in the blood to rise to abnormal levels, causing many acute and chronic health concerns or conditions.

In 2007, approximately 2 million people in Canada had diagnosed diabetes and this number is expected increase to 2.8 million people by 2012.

Type 2 diabetes

Although there are several types of diabetes, Type 2 diabetes is most common and actually affects 90% of people diagnosed with diabetes in North America. This type of diabetes is most common in people as they age. Type 2 diabetes can be related to the slowing of insulin production and release from the pancreas, but also to the growing problem of obesity, which reduces the cells’ ability to allow insulin and glucose to enter

The initial recommended treatment is lifestyle change. This requires knowledge of how food can affect diabetes and how increased activity can promote better blood glucose control. Initially the family doctor provides some information and may send the patient to an endocrinologist or other specialized service including referral to a registered dietitian 3.

If lifestyle interventions are not successful, medications are the next step. There are different types of oral medications available to manage diabetes and each works in a different way.

Different medications may be taken at the same time in order to improve blood glucose control in several ways. In some cases, people with Type 2 diabetes need to use insulin injections to allow sugar to enter the cells and be converted to energy.

It is rare that seniors have diabetes without having other chronic health conditions. There is frequently a triad of diabetes, heart disease and hypertension that together has been termed “metabolic syndrome.” This necessitates the monitoring of saturated fat and salt, as well as starches and sugars. It is common for seniors to joke that without sugar, fat and salt in their diets, it is not worth eating at all!

Dietitian care for residents with diabetes

All registered dietitians in long term care work as an integral part of the interdisciplinary care team in order to provide a more comprehensive picture of the residents’ needs. Dietitians have the knowledge and expertise to provide individualized care so that residents stay as healthy as possible while dealing with their diabetes and other chronic illnesses.

Dietitians provide support to planning meal and snack menus that are both appealing and nutritious, while taking into account necessary food restrictions. There must be a balance between eating healthy food that provides all essential nutrients and controlling starch and sugar intake for best diabetes control as well as optimal nutritional status. Menus also must meet the residents’ needs and desires for personally satisfying meals and snacks.

Quality of life is of foremost importance in long term care and our residents greatly benefit from having this specialized nutrition care in their homes. This includes the opportunity to maintain freedom from unnecessary restrictions. Dietitians can evaluate which residents with diabetes require strict management of their food intake and which residents can be provided with a more liberalized diet. This is part of the individualized care that dietitians are able to provide.

Certified Diabetes Educators

Doctors, nurses, dietitians, pharmacists and other health care professionals all receive diabetes instruction as part of their education and usually quickly gain experience in helping their clients manage the disease. An interdisciplinary team approach in any health care environment greatly improves health outcomes for people with diabetes.

Health care professionals who are licensed by a Regulatory

Body in Canada may apply to write the certification exam to become Certified Diabetes Educators (CDE). Applicants must have accumulated 800 hours of diabetes education experience over the previous 3 years (4).

The Canadian Diabetes Educator Certification Board (CDECB) is responsible for the development and administration of the certification program for CDEs across Canada. CDEs must be re-certified every 5 years, through an examination or by using a specified credit portfolio to maintain education and activity records. CDEs find work in hospitals and other health care facilities, in community health centres and in specialized diabetes education clinics. Providing individualized counseling and care is the foundation of diabetes control.

Dietitian CDEs

A dietitian who is a CDE has a special interest in diabetes and has met the requirements for certification. Dietitian CDEs can take a leadership role in the overall comprehension and management of diabetes in the home. They can often be a resource to the home on overall diabetes management and policy direction.

Dietitian CDEs use counseling techniques that encourage residents to make necessary lifestyle changes and follow their meal plans. This “one-on-one” support greatly assists residents to understand their diagnosis and empowers and supports the residents’ right to participate fully in making any decision concerning any aspect of his or her care 5. Dietitian CDEs also ensure that the resident and their family are educated about their individual care plans and potential outcomes. This is part of counseling, which allows the client to have control of what they eat, and in long term care, respects each resident’s right to accept or refuse care in their own home.

Summary

Dietitians have a responsibility to provide the best nutrition care for residents with diabetes, to work with the interdisciplinary care team and to provide residents with information and support that meet their individual needs. Dietitians CDEs can play a leading role in diabetes management and enhance quality of life for residents in long term care. The diabetes counseling framework supports the resident as a member of his or her health care team.