Interpreting CGM Data For Improved Dietary Planning, Pt. 2
In part two of this four-part series, Lisa Jones, MA, RDN, LDN, FAND, interviews Grace A. Derocha, MBA, RD, CDCES, a certified diabetes care and education specialist and health coach in Detroit, Michigan, about the best practices for interpreting continuous glucose monitoring (CGM) data in a way that's useful for dietary planning. They also discuss the challenges dietitians can potentially face when working with CGM data, and the approaches to addressing those challenges with their clients.
Listen to part one of this four-part series here.
Listen to part three 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 or consult at 360.
Lisa Jones, MA, RDN, LDN, FAND: All right, well, welcome back, Grace. We're excited to have you for episode two. Today we're going to be talking about analyzing CGM data for better nutrition guidance. So thank you for coming back.
Grace A. Derocha, MBA, RD, CDCES: Thanks so much for having me.
Lisa Jones: And during our last episode, we did talk about understanding CGM and its role in lifestyle change. So what would you say if you just had to say one key takeaway from that episode, what would it be?
Grace A. Derocha: I would say let the CGM be a tool that can be helpful for you for data about research and observations on yourself.
Lisa Jones: Yes. All right. We all can learn more about ourselves, so that is great advice. And diving into our conversations today, What would you say are the best practices for interpreting CGM data in a way that's useful for dietary planning?
Grace A. Derocha: Oh, that's such a good question. So when we're interpreting the actual numbers now, right, that we're getting from the CGM as this tool to help us tailor how we eat and how we can plan accordingly. There's a few things that we want to think about. So understanding kind of what your baseline trends are, so like, what is your fasting glucose in the morning? What is happening after meals? Are there patterns that you might see? Are there certain times of the day that your blood sugar runs higher or lower based on, you know, work or if you do a regular walk with your dog at a certain time, being able to make some of those baseline understandings of those trends. And then really assessing kind of your meal response to what you're eating and what that postprandial blood sugar is, which that is really like one to two hours after you eat, how impactful was that food to your blood sugar levels. And then based on that, kind of looking at what is the macronutrient effect, so from the carbohydrates and the protein and those fat ratios, what does that look like and how did that kind of affect that blood sugar reading after you ate? So those are a couple of things that you can think about when we're really looking at planning for someone's diet.
Lisa Jones: I think that it makes it more, I don't want to use the word easier, but in a sense that's kind of what it sounds like. It's easier to kind of, because you have like those three compartments that you can put in the trends, the patterns, and then the macronutrient impact, and that kind of makes it easier for dietitians or more useful, I should say, when trying to tweak those dietary plantings. Because you remember back in the day, like we didn't have access to this. And it was kind of like, let's throw a dart here.
Grace A. Derocha: Yeah. Let's try this today. You know what I mean? And we didn't have that data and understanding of what was happening at that time unless they told us how they felt or they poked their finger and checked their blood sugar. I guess another thing I would add to that too, once you summarized it, thank you for that, is the timing, right? The timing of when you're eating as well.
Lisa Jones: Yeah, definitely timing would be important too. So then how can dietitians identify, like now that we have these dietary patterns, and how can it impact blood glucose fluctuations?
Grace A. Derocha: Yeah, so being able to kind of take that all in, right, and see how is that impacting a client's blood glucose fluctuations and making adjustments accordingly. This could involve a little bit more work for the client or patient by kind of keeping a food journal so we actually know what they ate that caused that. There's so many different ways that you can do that now, but then also integrating some of that CGM data to look at those food records and really learning, you know, that caused a spike that made me drop low fast right after this meal. I didn't have any protein and this happened, you know, so being really able to take a step back to look at impactfully what is happening with the meals, with the timing to then make adjustments. I think it's so cool because at the end of the day, the data that we receive can really help be that force to help someone understand that making some lifestyle changes is a key.
Lisa Jones: Yes, and it just sounds so amazing because, and I'm gonna age myself here talking about this, but like, you know, back in the day when you had a patient fill out the 24 -hour recall and then sometimes they wouldn't fill it out so you were kind of flying blind, if you will, right? And now you have these real-time patterns and data that you can look at and kind of say, "Here I can see it and this is why this is impacting your blood sugar and your fluctuations are happening like this. Let's add a snack or let's add more protein here." So I think this is amazing.
Grace A. Derocha: Yeah, and I think, to, it allows the dietitian and the client to build rapport and allow a judge free zone. You know what I mean? Because I think a lot of that, sometimes I remember those 24 hour recalls too, Lisa, was that someone would feel judged based on what they ate. And then it doesn't allow you as their dietitian to provide them the guidance they need without them feeling some kind of judgment or shame in the process. So I think reminding them of that as well really leads to effective growth and change for that client.
Lisa Jones: Yes. Yes. So true. And you said kind of the shame and the guilt that they feel. So that brings, begs another question. What challenges might dietitians then face when working with this data and how can they address it with with their clients?
Grace A. Derocha: Yeah and I think I might have mentioned this in our first episode together but sometimes the data overload and then it's a lot of information right for for the not only the client but even us as as the dietitian kind of looking at it and figuring it all out so just trying trying to knock it overwhelmed with that. And then the interpretation challenges, right? And how there is ebb and flow to how someone might eat based on how their day works. And then again, coming back to those patterns, that timing. And sometimes the client themselves might see something and misinterpret that and kind of be thrown off and then feel like, oh, I'm not ever allowed to have, I don't know, a bagel, just to pick on something. You know what I mean? So then them making sure that they know that it is a space to have that conversation so that there isn't confusion or misconceptions that lead know, them feeling like they can't have something or them feeling like, "Oh, I'm quote -unquote bad for doing this or eating this," or not doing something. So I think, again, being able to work with them and make them feel like it's a safe space so that they can not feel stressed about wearing the CGM and the data overload and reminding them that it's going to be a useful tool in the long run.
Lisa Jones: Yes. And I'm sure like in the conversations that dieticians have with patients are probably telling them when they do first start wearing one, like these things can come up. Like the example you gave about the patient kind of misconstruing the data and thinking it means something when it really doesn't type thing. So they probably pre -held them ahead of time, right? Yeah, best practices to have that conversation.
Grace A. Derocha: Yes, I, I was just going to say, yeah, best practice always to kind of bring up some of the things that might make them feel weary or challenged in the process, because something new, there's always an adjustment in how you feel about what you're learning. And, and, you know, in this day and age with all of our technology, even the data coming in all the time about your blood sugar level can be like, "Oh, well, why is it doing that?" You know, and then feeling overwhelmed. So definitely setting it up for them in a way that allows them to be successful and show curiosity in the process instead of misunderstanding.
Lisa Jones: Yes. I love that. Success and curiosity. Two good words. Thank you for that. How can dieticians translate the data that they're getting into actionable dietary recommendations for clients?
Grace A. Derocha: Yeah, this is a great question. So, you know, us as dieticians kind of looking at all of that CGM data and figuring out what is the best way to go from here, right? Looking at some of those, the timing of eating, the glucose patterns, specific food or lifestyle behaviors that your client might have. So things that you can look for is, you know, is there a fasting glucose trends? Are there times when there are those postprandial, which is like the after meal glucose spikes? Is there any like glycemic variability? So peaks or lows throughout the day, like are they rollercoastering at any point of the day? And then taking that and trying to give them some actionable recommendations in the process, right? Because that is what we're trying to do is learn, you know, observe and learn, and then trying to make adjustments to do better so then your client feels better too.
Lisa Jones: Yes, which is the most important thing and the goal, like to make your client feel better. But that's really helpful. So what about dieticians that are, say they're like second career dieticians or dieticians that are new to this particular area, do you have any advice for them? Because it sounds a little overwhelming. If I was going to go and start doing this, I was so much, to your point, data overload. So is there any like a tip that you can give them to kind of make it be more streamlined.
Grace A. Derocha: Yeah, I would say a couple things. One, and you know this, right? As dietitians, I think dietitians are always like lifelong learners, so tap into some of that and allow yourself to, again, wonder and stay open to what this could be and how impactful it could be for someone. And then do you listen to this podcast. Do some of the research and kind of hone in and if even if you have colleagues that might be More experienced or had just had more time working in this field tapping into them asking them questions I think can be really helpful some of the CGM companies Offer a lot on their different websites to to be able to soak it in, learn a little bit more about how they work and how they could be helpful for clients.
Lisa Jones: Yes. Great advice. And also too, it's probably just like with anything, right? Like the more you practice it, the more efficient you become with it. So.
Grace A. Derocha: Yeah. And it's not going away. So I think, you know, being able to learn more and be ready for the questions that your clients might have. And I think too, sometimes we learn from the clients all the time, I know I do, being able to hone in on what they're asking so that you continue to learn and then are able to provide some insightful feedback as they're trying to dive into what a CGM might be and how it might be useful for them.
Lisa Jones: Yeah, so good. And thank you so much for being on this episode. Is there any final takeaways that that you wanna say about analyzing the data for better nutrition guidance?
Grace A. Derocha: Yeah, what I would say in general, with the CGM in analyzing data, is that the data is constantly, it's a moving thing, right? So to try to, when you're helping your client, remind them of that and remind yourself of that, so that there is takeaways of being able to make healthy habit lifestyle changes, but also knowing that it is a moving target and there might be ebb and flow there and knowing that that is okay too, you know?
Lisa Jones: Yes. - Yes, it is okay. Well, thank you so much, Grace, for being on this episode and I look forward to seeing you in a future episode.
Grace A. Derocha: Thanks, Lisa.
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