Diabetes · Dietetic Internship · Life · Weekly Recap

Week 31 Recap

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This week was so long and so crammed full of stuff I’m having a hard time remembering all of it!

I started in outpatient nutrition at the hospital this week and as soon as I met my preceptor on Monday morning I knew it was going to be a crazy day! We had 6 appointments all crammed in and every single one of them showed up…which is something that rarely happens in the outpatient world!

Four of those six required interpreters, which just added to how exhausting the day was, especially since one of them needed an ASL interpreter.

I left that first day feeling completely overwhelmed and exhausted and somehow managed to drag myself to the gym before coming home.

On Tuesday I got to start participating in my Diabetes Self-Management Therapy classes that the hospital offers to those who are newly diagnoses with diabetes.  That day was much more laid back because there weren’t a million appointments and I got to sit in a two hour class and soak up a lot of information that I already knew.

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It’s been an interesting experience so far.  Before the class participants start the class, they have a 1:1 appointment with RN who is a Certified Diabetes Educator (CDE), who gives them the basics about the disease and sets them up with a meter and all that fun stuff.  Then they participate in 4 2-hour classes and then finish off by having an 1:1 with on of the RD’s in outpatient to start using the skills they learned in class by planning some meals.

On Tuesday I was given a meter and told that I needed to test my blood glucose for a week and keep a food log.  Sounds easy enough, right? Well, I can tell you, that is a lot to ask of a person.  I’ve accidentally skipped checking my blood glucose a few times and my food logs are mostly from memory so I’m sure I’m missing things.

I feel for the people who are newly diagnosed and thrown into this class…it’s overwhelming!

The rest of the week was all over the place…literally!  I’m working on a project that requires me to understand scheduling, insurance verification, and billing, and the people I had to interview are not actually located on the hospital campus.  I had to make a few trips to a different location to talk to them and I learned how complex the process of getting someone in to see a dietitian actually is.

One of the outpatient dietitians also does appointments for cancer patients so for the first time in the 2 months I’ve been at the hospital I got the chance to go into the cancer institute building.  It is SO NICE inside!  Such a soothing and welcoming environment and all the staff are exceptionally friendly and helpful.  I got the chance to sit in on a few outpatient sessions with some cancer patients and it was an interesting experience.

They also opened up a new dining concept in the cancer institute that is really focused on meeting the needs of the cancer patients.  Their menu features a lot of items, like smoothies, that are appealing for those receiving chemotherapy.  My preceptor was kind enough to buy me a smoothie because she wanted me to try one and tell her what I thought.  It was strawberry, peach, watermelon and only had the fruit and a splash of orange juice.  The entire 16 oz cup was under 200 calories, which amazed me.  It was definitely very refreshing and not overly sweet, but after I finished it I felt like I didn’t want to eat any fruit for the rest of the day!

After a long week I did something crazy yesterday….

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I cut nearly a foot off my hair!

Her’s how long it was before I got it cut:

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As much as I’ve always loved having long hair, it feels good to have something new.  I cut my hair fairly short right before I graduated high school but looking back it wasn’t this short.  I think the last time I had it this short was when I was 14-15, so this is the first time in a decade I’ve had short hair!

I’m donating my braid of hair to Pantene Beautiful Lengths and they make wigs specifically for cancer patients, which is really exciting.

I actually have no idea how to style my hair now and I think it’ll be a learning experience to see what I can still do to it now that it’s so short!

It’s supposed to be sunny and warm today so I have a run planned for this afternoon and then I have a ton of work to get done for my internship.

Happy Mother’s Day to all the moms out there!

Diabetes · Dietetic Internship · Topic of the Week

Topic of the Week: Diabetes-The Disease

My week is already over…what? Well, that’s a lie, my rotations for the week area already over.  Tomorrow is a “didactic day” as we are calling them.  That basically means all 7 of us interns are all together for the day doing various activities.  I’m hoping it goes fast, I’m ready for the weekend! 2 Towns Ciderhouse Harvest Party anyone? That’s where you’ll find me on Saturday evening 🙂

Anyways, on to nutrition.

Diabetes is a VAST subject.  It’s a complicated disease and while many people have a firm grasp on the basics of the disease, I’ve realized lately that it’s not so clear to those who haven’t studied it for the last few years like I have.  On Tuesday night I had the opportunity to attend a diabetes education class with my preceptor and become an emergency glucagon provider.  Basically that just mean that in the case of a diabetic becoming severely hypoglycemic I am trained to administer glucagon using a glucagon pen.

I realize that was probably as clear as Greek to a number of people out there…it’s okay. I will explain.

In the training I was the only person minus my preceptor with a nutrition degree and strong nutrition background.  Our instructor was very well qualified to teach the course and was extremely knowledgeable on the subject of administering glucagon safely and properly, but it was obvious that the biochemistry background that would have allowed her to clearly explain things was missing.  That is totally fine because it wasn’t really her job, but my preceptor had to step in with some of the fundamentals.  Mostly, what is the difference between Type 1 and Type 2?

Although I know quite a bit about the differences between Type 1 and Type 2, I decided to bust out one of my old text books to reference just to make sure I got things right.

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Can we just talk about how long it’s been since I’ve opened this book?  I still remembered to find “Endocrine Diseases” so not all my nutrition knowledge has slipped away…but it has been a while.  Like 15 or 16 months.  Sheesh!

Also, I am proud to say I DID do something productive in college, my highlighting proves it!

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Not a total slacker, I obviously did my reading sometimes…

Basically, I love nutrition, I hate textbooks.  End of story.

So diabetes…

Type 1 Diabetes Mellitus

That would be the official name of the disease…  Simply put, in Type 1 Diabetes, the body loses the ability to produce insulin.  Insulin is produced in the pancreas and a diabetic’s pancreas becomes unable to do so.  This change doesn’t happen overnight, it’s gradual, but it causes a noticeable effect early in life.  Type 1 diabetics are usually diagnosed in childhood or early adulthood and from that point they will be dependent on receiving insulin, either through a shot or a pump, for the rest of their life.  Those with Type 1 diabetes typically lead very normal lives and are very in tune with their body.

Type 2 Diabetes Mellitus 

Unlike Type 1 diabetes that is caused by the body not producing insulin, Type 2 diabetes is caused by your body becoming resistant to the insulin it is producing.  The insulin loses it’s ability to do it’s job properly.  For that reason, a Type 2 diabetic has to utilize diet, exercise, and antidiabetes medication to manage their disease.  This is the more common type that accounts for 90% of all diabetes cases.

Insulin and Glucagon 

The last fundamental piece to understanding the basics of diabetes is understanding what insulin and glucagon are.  They are both hormones that are produced by the body and used to control blood sugar.  Insulin is responsible for taking the sugar in the blood and taking it up into the tissues to be used by the cells.  Glucagon does the opposite of that.  Glucagon allows glycogen, the body’s stored for of sugar, to be broken down into glucose (sugar) and released into the blood stream to be used where the body needs it.  If these two hormones are unable to work together then the body can either have high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia).

So to tie this back to my training on Tuesday night!  There is an individual at the preschool who is a Type 1 diabetic.  In the event that they becomes hypoglycemic (has low blood sugar) and it gets to an severely low level, they could lose consciousness, become unresponsive, or have a seizure.  This is an EXTREMELY dangerous state for anyone to be in and requires immediate attention.  If this were to ever happen to them, they have a kit with a glucagon pen in it that someone like myself could administer.  This would give their body a rush of glucagon to breakdown the glycogen and raise their blood sugar, bringing them out of a dangerous state.

Our body is pretty cool, isn’t it?

Source: Nutrition and Diagnosis-Related Care.  Escott-Stump, Sylvia.  7th edition.