Common CGM Misconceptions That Dietitians Can Help Clarify for Their Patients, Pt. 3
In part three of this four-part series, Lisa Jones, MA, RDN, LDN, FAND and Grace A. Derocha, MBA, RD, CDCES, a certified diabetes care and education specialist and health coach in Detroit, Michigan, discuss the most common misconceptions about continuous glucose monitoring and how dietitians should approach clarifying these misconceptions with their patients.
Listen to part one of this four-part series here.
Listen to part two of this four-part series here.
Listen to part four of this four-part series here.
Transcription:
Moderator: Hello, and welcome to Nutrition 411, the podcast, a special podcast series led by registered dietitian and nutritionist Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions for Consultant 360.
Lisa Jones, MA, RDN, LDN, FAND: All right. Well, welcome to episode three, overcoming common client misconceptions about CGM. And we are lucky to have Grace back with us today to talk all about CGM. Welcome, Grace.
Grace A. Derocha, MBA, RD, CDCES: Hi, Lisa. Thanks so much for having me again.
Lisa Jones: Yes. And I know in our past episode, I just wanted to kind of circle back to that. We were talking about the data. Is there any like a a way that you want to talk about from that episode?
Grace A. Derocha: Yeah. What I would say is let the data be another part of the CGN tool that you are using to help your client in the most effective way, but understand that there is ebb and flow to what that looks like because that's literally what's happening with our blood trigger levels as we go throughout the day. So It's not always going to be perfect, but it can be a helpful way to help your client make some tweaks in their lifestyle habits.
Lisa Jones: Yes. And that sounds like progress over perfection to me, which I'm a big fan of. So thank you.
Grace A. Derocha: So I, I love that too. I say that to myself. I say that to my kids. I say that to my clients and patients and anyone who'll listen.
Lisa Jones: Yes. It's posted behind my computer right now. So there you go, Grace.
Grace A. Derocha: Oh, I love it.
Lisa Jones: All right, let's dive right in. So what are some typical client misconceptions about CGM? And then how can dieticians clarify these?
Grace A. Derocha: Yeah, I think the number one misconception that I always hear from my clients is glucose should always stay within like this narrow, perfect range. You know, and that is that is not true because there is the ups and downs that are naturally going to happen when we eat so trying to explain that to them and Trying to explain that there may be you know, some spikes or some dips and that's that's okay, but Understanding what is the good range to try to stay within most of the time.
Lisa Jones: Yeah, that's, I think that's helpful too, 'cause a lot of times with those ranges, it's like even if you're a couple points over, like I've had patients in the past that would be like really upset about that. And it's like, it's only a couple of points. Like it's only like don't, try not to, you're trying to get them not to worry as much. That's really helpful advice.
Grace A. Derocha: Yeah, and I think another one, it kind of ties to that, right? Like, if I have a spike, I've failed. And like, no, you haven't, you know, there are so many things that can make your blood sugar go up. And it's also moving, right? So I think with the CGM too, that only being able to see that blood glucose value at that moment. But then there's also trend arrows that showing. Is the blood sugar going up from there or is it starting to come down? I think that's helpful, Insight 2, to remind them of that.
Lisa Jones: Yeah, and I'm sure it reassures the patient as well. And this leads really nicely into the next question I was going to ask you, and that's, "How can dieticians help clients understand that the data is a tool for Insight, not the strict set of rules that you were kind of talking about before with those guidelines?"
Grace A. Derocha: I love this question because I think it reminds us that it doesn't have to be, I can only have this or I, gosh, how many times have you heard people say or feel like carbs are bad or carbs? Yes, carbs.
Lisa Jones: It’s all over social media.
Grace A. Derocha: Yeah. I mean, don't get me started. So that's why I'm glad we're having this conversation because it is not, that is not the case. So I think we can really guide our clients to feel empowered by having that CGM data as a tool rather than a super strict or rigid framework. And then taking that again, back into fostering some understanding and some self -awareness and then what can you tweak on your end, right? So, kind of framing it as a learning tool, that research tool that I've talked about in other episodes, and highlighting patterns, again, like the progress, not perfection, to kind of look at where we're at, normalizing some of the variability, right? We know that carbs are the food that tends to bring blood sugar higher, faster, but then kind of trying to find balance with that to remind them that fiber is a helpful way to help decrease the spike. Having some lean proteins, some heart -healthy fats at the same meal or at the same snack can also be a helpful tool to... And it's funny, I've had patients do this where they will eat just an apple and kind of watch over diligently probably just because I kind of want to see like, is she right? Is she telling me the truth? And then seeing it and then having it with, you know, an apple with their favorite nut butter. And they've come to me and they're like, Oh my gosh, you're right. And then they also think about and they're like, you know, you are right, because I love an apple, and I'll eat it before my workout. But then I will feel like, oh, I think that, you know, if you don't feel as our healthy habits and our foods that we're choosing at one time to help.
Lisa Jones: Yes. And that is great. That is such a great example of empowering your clients to allow them to do that. And then the kind of seeing let them come back to you and say, "Yes, I was missing the protein."
Grace A. Derocha: Yeah. Yeah. And protein's having its heyday too. Everyone wants more protein. So being able to like to incorporate all of those macronutrients at once instead of just one and seeing how it can be impactful.
Lisa Jones: Yes, that's such a good strategy. And speaking of strategies, what other strategies can be used to help clients view their CGM as support for sustainable lifestyle changes?
Grace A. Derocha: Yeah, so I think when someone first gets a CGM on. I think it's tricky because like we have talked about as well, it's a lot of data and a lot of information. So being able to take a deep breath through that. And then kind of emphasizing your CGM is your personalized feedback tool. And you are an individual, right? Not everyone is the same. So really kind of looking at that, diving in again, encouraging that curiosity as they're experimenting with the different foods or timing or ways that activity fits into their day, their sleep patterns, how they manage their stress, and then tweaking that, progressing as we've talked about, and then fostering some real sustainable change that makes the most sense for that client and how their life works.
And then the flip side of this really is that your CGM becomes somewhat of a positive reinforcement tool, right? So you are starting with your CGM, you're seeing things that you like, seeing things that you don't as the client, and then making some tweaks based on your life. And then later getting to use the CGM to be like, wow, this is working, and it is some positive reinforcement. So frame it up that way too can be great.
Lisa Jones: Yeah, and that's an easy framework for dietitians to remember too, because you've got the two P's, the personalized and then the positive.
Grace A. Derocha: Yeah. Yeah. Yeah.
Lisa Jones: So then how can dietitians, we talked a little bit about, you mentioned reassuring clients, but how can dietitians reassure clients who feel overwhelmed? And I know we talked about the overwhelmed with data in a previous episode, but they're overwhelmed by tracking the glucose data continuously.
Grace A. Derocha: Gosh, I love this question because, right, food is more than fuel, right? It is a lot. It's traditions, it’s a culture, it’s a celebration, it's fun. And I also think that part of food is emotional. So, normalizing how your client might be feeling, you get people at different ages and stages and different places of how they're feeling about having to wear a CGM. So, you know, being there for them too, in that aspect of normalizing how they're feeling about this, it is a change. Change can be hard for some people or harder for some people in the process. And again, coming back to, I mentioned this in a different episode, but not feeling like shamed or judged in their process, I think is important. So being able to do that as thoughtfully as possible. I feel like dietitians are like such amazing souls. So being able to give that to them in the process as well as educating them about food and nutrition and the science behind it becomes important too.
Lisa Jones: Yeah. And that's so it's almost like a gift to them, right? That they're getting.
Grace A. Derocha: Yeah. And we can be flexible. I would say if you, if we need to be flexible, because if you don't bend, you break. And I think that's important for us as the dietitian, but also to remind our clients in the process and our interactions with them as they're working through things. And like, I think framing to that the CGM isn’t a tool, but is also like a supportive tool, hopefully, right? And not a stressor tool.
Lisa Jones: Yeah, it's almost like your supportive tool, like your friend or your sidekick or...
Grace A. Derocha: Yeah, and it's giving you lots, I always tell people, you know, your CGM can be your chatty best friend that's giving you a lot of information that you might not always want, but you know that they're there for you?
Lisa Jones: Yes, your chatty best friend, because it's, what is the number? 280 times a day?
Grace A. Derocha: Yes.
Lisa Jones: Definitely chatty. I'd be like, stop. Just text me the information. No, I'm just kidding.
Grace A. Derocha: And I think you'd, depending on the person, like when they're using their CGM, you can, you know, not have it ping you every five minutes. You can decide like the key days of when you want to hear to hear from your chatty best friend, the CGM.
Lisa Jones: Well, that would be kind of distracting if you're working and being chatted 280 times out of your day. So that's a great point. And thank you so much for being on this episode. I learned a lot. And I just want to ask, is there any final takeaway with client misconceptions that you want to say?
Grace A. Derocha: Yeah, I would say to, well, I like to use this analogy because it's my name, but to for clients to offer themselves grace in the process. And then as the dietitian working with a client, the same kind of thing, you know, allowing there to be the learning curve as they're trying to manage through things. And remembering that the CGM is your chatty bestie that is supposed to be there for support in that stress.
Lisa Jones: Your chatty bestie, I love it and mentioning Grace. Yes, and thank you, Grace, for that.
Grace A. Derocha: Yes, thanks, Lisa. I'll see you in a future episode.
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