NUTRITION411: THE PODCAST, EP. 27

Becoming Familiar With Continuous Glucose Monitors, Insulin Pumps

Lisa Jones, MA, RDN, LDN, FAND

This podcast series aims to highlight the science, psychology, and strategies behind the practice of dietetics. Moderator, Lisa Jones, MA, RDN, LDN, FAND, interviews prominent dietitians and health professionals to help our community think differently about food and nutrition.

In this episode, Lisa Jones interviews Jennifer Smith, RD, LD, CDCES, and Susan Weiner, MS, RDN, CDN, CDCES, FADCES, about ways to become familiar with diabetes technology, including continuous glucose monitors, insulin pumps, and smartphone applications. This is episode 4 of a 4-part series.

Additional Resources:

Listen to part 3 of this 4-part podcast series here. 

 

TRANSCRIPTION:

Narrator:

Hello, and welcome to Nutrition 411, the podcast. A special podcast series led by registered dietician and nutritionist, Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant360.

Lisa Jones:

Hello, and welcome to Nutrition 411, the podcast where we recommunicate the information that you need to know now about the science, psychology, and strategies behind the practice of dietetics. Today's podcast is part of a series of short episodes on diabetes technology, featuring a Q and A with Jennifer Smith and Susan Wiener. I want to introduce Jennifer first. Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin Green Bay. She's a registered and licensed dietician, certified diabetes educator, and certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's an active member of the American Diabetes Association, and American Association of Diabetes Educators, and was an active member and educator for Team WILD, which means we inspire life with diabetes. She's also a contributing author for the Diabetes Sister's website. For the past 10 years, Jennifer has been the Director of Lifestyle and Nutrition with Integrated Diabetes Services. Jennifer has also lived with type one diabetes since she was a child, so she has firsthand knowledge of the day-to-day events that affect diabetes management. Welcome, Jennifer.

Jennifer Smith:

Thank you. It's wonderful to be here.

Lisa Jones:

Yeah, thank you for being here.

Jennifer Smith:

Of course.

Lisa Jones:

And now I want to introduce Susan. Susan is an award-winning nutrition, health, and diabetes expert and the owner of Susan Wiener Nutrition. Susan served as the 2015 ADCES Diabetes Educator of the Year and is an ADCES fellow. Susan is diabetes and real-life columnist for Endocrine Today and is the on-air host for video interviews and content for healio.com. She's the co-author of the Complete Diabetes Organizer, Your Guide To Less Stressful and More Manageable Diabetes Life, and Diabetes: 365 Tips for Living Well. She has extensive TV, radio, podcast, and video experience and is well-versed in media communications. Welcome, Susan.

Susan Weiner:

Thank you so much, Lisa. It's great to be here.

Lisa Jones:

All right, well welcome to episode four, where we're going to be talking about practical insights on optimal nutrition strategies. If you had to sum up the conversation that we had from our last episode where we talked about debates and dietetics, was it a game changer or a double-edged sword, what do you think your one or two-sentence key takeaway would be for the audience? I'll go to Jennifer first.

Jennifer Smith:

I think the key takeaway is that it is absolutely more of a benefit, but you do have to be very careful in recommendations, as we've said in all of this discussion, to really meet the need of the person that you are working with and trying to help. So making it more of a benefit, remembering that on the backend too much could be the sharp side of that sword.

Lisa Jones:

Yes. I like how you weave the sword in there. I finally put it down because Susan was like, you don't need the sword. And anyway, Susan, what's your takeaway?

Susan Weiner:

Technology is a benefit for most people as they can communicate better with the healthcare team and they can make decisions any time of the day they have a lot of the data that they need to make those decisions, as long as they feel comfortable with it and it doesn't become an additional overwhelming burden. I would quote the late great Richard Rubin who came up with the term "diabetes overwhelmness" to define the overwhelming to-dos that one must do every single day when you live with diabetes without having a break. And if using apps and if technology, to a very advanced extent, does make that burden even more challenging, then as dieticians and as clinicians, let's take a little bit of a step back and see if we can introduce the technology just at a little bit of a slower pace and still get benefits and build our way up to more technology over time if that's what is a benefit to the patient.

Lisa Jones:

Yes, and I love that quote, diabetes, that you quoted. Never heard that before. So thank you for sharing.

Susan Weiner:

Of course.

Lisa Jones:

And great takeaways from both of you, Jennifer and Susan. Thank you so much.

Jennifer Smith:

Absolutely.

Lisa Jones:

Moving into our fourth segment is practical insights. So my question today is how can dieticians leverage tools to enhance optimal nutrition strategies for diabetes management? So how can they leverage this technology? Susan, what are your thoughts on this?

Susan Weiner:

I believe that dieticians who are not always familiar with diabetes technology should become more familiar with being able to understand insulin pumps and CGMs, continuous glucose monitors because it will make a world of difference in how your patients are adopting and adapting to certain healthier behaviors. And if they do decide to eat something that's a little bit different, out of the ordinary, they can visually see on these reports, on their CGM reports, how what they're eating, how they're exercising, how they're taking their medications, can be of benefit to their outcomes. So many of the dieticians that I work with who are not familiar with this are nervous about learning about it.

But again, if you turn to a site like Danatech or DiabetesWise or a lot of the other resources that are available through the American Diabetes Association or the Association of Diabetes Care and Education Specialists and become more familiar with what people with diabetes are doing, these tools can be enormously beneficial, official rather than repeating the same things over and over and over again to the people you work with and you are wondering why you're not getting a different result. So become more familiar with the technology, what the reports mean, what the graphs mean, and how to interpret them, and then you'll be able to have a much better input and outcome with the people that you're working with.

Lisa Jones:

Yes, that is so true. Making sure that you're staying on top of it too. And again, I know I said in a previous episode it sounds like it's a full-time job, so if you were to give one piece of advice to make it easier to keep up with everything, what would you say, Susan?

Susan Weiner:

My one piece of advice is to become familiar with some of these tools, like a CGM or what insulin pumps are out there, and you can read reports. For example, I write a column called Diabetes in Real Life for Healio Endocrine Today, which is free to get a print copy or online, which gives a lot of great information about all different aspects of nutritional care, technology, mental health, diversity, and so if you subscribe to any of these publications where you can get for free just a kind of digest of everything going on, that's a great idea. Or again, check out Danatech to just find different aspects of diabetes technology in a digest form to become familiar with it.

Lisa Jones:

Wonderful. And we will put that in the show notes so that listeners can go and they can read it, subscribe, and then that's something that comes right to your inbox so then they can read it and become immersed with it, learn it. So thank you for that, Susan. And then Jennifer, what are your thoughts on how registered dieticians can leverage these tools?

Jennifer Smith:

Well, I love how Susan went from the standpoint of a dietician to using technology that works with seeing how food impacts things for people with diabetes. I love that you went right to learn about CGMs or even blood glucose monitors that link with an app potentially. CGMs especially, continuous glucose monitors, I think are the best technology to make a recommendation to use. I mean, if somebody were to ask me whether or not I wanted to keep my insulin pump or I wanted to keep my continuous monitor, I would 100% say, "Please don't take my continuous glucose monitor." 100%. And the reason is, I can see the impact of all the variables in my day-to-day life because I have used a CGM that shows me a trend. I can see the impact of the typical foods that I like to eat. I can see the impact of the regular exercise or activities that I do. I can see the impact of a workday versus a day off.

So if you are going to use any technology and learn to use it in order to recommend, it would absolutely be CGMs. Leveraging with that another piece of technology, and I think both Susan and I mentioned the app before, Undermyfork is a lovely app that combines what we know very well as dieticians, is food and nutrition. And it pulls together with that your CGM trend. So as I mentioned before, if you take a picture of this breakfast that you eat all the time and you've never used a CGM before and now you've got one and you can see, wow, I didn't realize that this is what this type of breakfast was doing. I knew I felt this way after eating it, but look at the reason that I feel this way. So pulling all of these pieces together, for many people, it's an aha moment. And from the standpoint of your recommendation then, if you've brought that aha moment to them, you now have much more leverage from teaching points.

Lisa Jones:

Yes. And the other thing I was thinking too is like, wow, as you were talking, this is such powerful information to have right at your fingertips.

Jennifer Smith:

It is.

Lisa Jones:

So who wouldn't want to take advantage of that? So thank you.

Jennifer Smith:

Absolutely. And it crosses all types of diabetes. I think it really, whether you have type one, or type two gestational diabetes, I think the use of a continuous glucose monitor is so valuable.

Lisa Jones:

Yes. Well, definitely. You just made the case. Fantastic information. Any closing comments for this? And I appreciate both of you for being on all these episodes. We've had an amazing discussion. I've learned so much from both of you. But if you want to provide a quick takeaway for the listeners for this segment, and then if there are any closing comments about any of the discussions we've had, I would love to hear what your thoughts are.

Jennifer Smith:

Yeah, I would... Oh, go ahead, Susan. Go ahead.

Susan Weiner:

I'm sorry. I have one quick follow-up on this segment is that people, I believe, on Medicare who are taking insulin with type two diabetes are now covered for CGMs, but they have to be taking insulin.

Jennifer Smith:

Correct.

Susan Weiner:

Right, Jen?

Jennifer Smith:

Correct.

Susan Weiner:

But if someone is not prescribed insulin on Medicare, they are not covered for CGM. I just want part of the takeaway to be very sure that there is insurance coverage before we recommend any technology so that a person doesn't get their hopes up and then they're not going to have insurance coverage and then they can't afford it. Some people, of course, can afford it out of pocket, but most people cannot. So I wanted to make sure that that point was also in our discussion.

Jennifer Smith:

Absolutely.

Lisa Jones:

Great point too. That's stressful in itself, hearing that it's not covered. How about you, Jennifer? Any additional thoughts?

Jennifer Smith:

I think the best takeaway, and I'm glad that Susan brought it up again earlier, is as a clinician, as a professional, to do the homework ahead of time. And sometimes that means playing with apps and looking for apps that are being recommended. Susan brought up using Danatech and DiabetesWise, both are just excellent, excellent places to start your search. If you have no idea where to start, that is where to go. Some of the new apps also have simulator apps to be able to use. So from an emerging technology use of many of the pumps and the CGMs as a practitioner, you can actually go to the sites and utilize a type of simulated app and get an idea of how it works and what it looks like and what kind of data you're going to be able to see once the people that you're recommending it to are using it. So I think that as a takeaway, be willing to play with and try many of the apps that you think you may want to recommend.

Lisa Jones:

Yes, yeah. And then the other thing too, as I was listening is the conference, the diabetes conference is probably a great place for dieticians that are wanting, I'm sure. I haven't been to that type of conference in a really long time, but I'm sure now there are probably all kinds of exhibitors that are exhibiting new apps for you to check out, right?

Jennifer Smith:

Oh, absolutely. I think all of the exhibitors, outside of maybe the ones that have a new food to try, I think they all have some type of app to remain connected, especially on a professional level, to be able to stay connected and learn more and see updates and whatever is going to be coming out that isn't available quite yet. So yes.

Lisa Jones:

Oh, so good. So that's another place, and we will put all the information you provided and resources, and links in the show notes for everyone to reference as well. There's a lot to get in there, a lot of great content. So again, thank you so much for being on Nutrition 411. It's been a pleasure.

Jennifer Smith:

Thank you so much for having us.

Narrator:

For more diabetes technology content, visit Consultant360.com