A DAY IN THE LIFE OF . . .
A DIABETES DIETITIAN
My day begins, just like other busy working mums, getting up at 5.45am, walking Poppy the dog, preparing breakfast, making packed lunches and dropping my son at nursery. Ruth BarclayPaterson NHS Ayrshire and Arran Ruth has been a Diabetes Dietitian for five years, with previous experience in Community and Acute. Ruth is currently completing a Masters in Health and Wellbeing.
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I arrive at work for 8.30am. Over a coffee, I check my emails, diary, print off my clinic list and plan my commitments for the day around appointments, triage, new referrals, team meetings, phone calls, liaising with other healthcare professionals and clinical supervision. In addition to ongoing professional education updates for patients, staff and students, I also try to plan time for ongoing service development projects. My aims as a diabetes dietitian are to help patients understand their diabetes and provide education on how different foods eaten can affect their bodies and impact on their diabetic control, quality of life and general health. I also want to highlight the importance of integrating diet, lifestyle and medications successfully, to help prevent micro and macro vascular complications. My day with NHS Ayrshire and Arran begins with either a clinic or group session. The clinic session plan allows for a variety of joint working with diabetes specialist nurses and consultants, as well as 1:1 dietetic-only sessions. Today starts off with a joint clinic in collaboration with the Diabetes Specialist Nurses. Typically, these clinics have four complex patients, where the multidisciplinary-team approach is key to encouraging selfmanagement and acknowledgement of the emotional distress these patients are often experiencing as a result of living with their diabetes. Actively listening is paramount. Hearing the patient’s story and having an open mind about how this affects their ability to make dietary and lifestyle
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choices that then impact on their blood glucose control, is vital. A patient’s life with diabetes is still as busy as everyone else’s, with the addition of a long-term condition to manage. A case example is that of a 28-year-old patient not taking insulin as a result of their fear of hypos. This patient consistently runs with blood glucose levels in the hyperglycaemic range and has had multiple Diabetic Ketoacidosis (DKA) admissions in the past. Treatment involves the whole MDT team with input from psychology services. All clinical interventions are documented onto our electronic system, SCI Diabetes, and recorded in patient contact statistics. I often have to be creative and adapt my solution-focused approach by using evidenced-based diabetes nutritional information and applying it to clinical practice. A technique I use is agreeing a goal plan in collaboration with the patient, tailored to diet, lifestyle and diabetes management goals. DIETETIC-LED CLINICS
Afternoon clinics tend to be dietetic led. Weight management and carbohydrate awareness/counting are the most common clinical themes. An interesting patient I saw recently had a diagnosis of Type 2 diabetes and was desperate to lose weight. Her mobility was significantly reduced due to a knee complaint and associated pain. Her BMI was over 35kg/m2 and she wished to use a liquid meal replacement for breakfast, but was unsure how to manage her twice-a-day insulin regime. After assessment of her current and
A DAY IN THE LIFE OF . . .
My day with NHS Ayrshire and Arran begins with either a clinic or group session. . . . . . . As a diabetes dietitian, seeing patients achieve long-term personal goals is truly rewarding
planned carbohydrate intake, insulin titration advice was provided to minimise the risk of hypoglycaemia. Furthermore, this dietary education helped the patient understand the role of carbohydrate in her diet and associated insulin requirements, as well as the insulin mode of action. Over a six-week period with regular telehealth reviews, the patient lost over 7kg. She was so happy that she could touch her toes for the first time in years! As a diabetes dietitian, seeing patients achieve long-term personal goals is truly rewarding. CARBOHYDRATE COUNTING
Teaching carbohydrate counting is undoubtedly my favourite intervention. Practical sessions are offered on a 1:1 basis and also as part of the oneday structured education programme, ‘Better Regulation Using Carbohydrate and Insulin Education’ (BRUCIE). Patients are given the tools to manage the multiple factors (activity, alcohol intake, working patterns and mealtimes) that can affect blood glucose control and overall insulin requirements. The practical sessions involve weighing out foods, calculating the carbohydrate content based on the portion served and matching insulin doses based on insulin-tocarbohydrate ratios. We continually get feedback from our patients that they feel empowered
by learning how to do this, as it gives them flexibility with food and dietary choices. One patient commented on Care Opinion referring to BRUCIE: “The course revolutionised my blood sugar monitoring.” TELEHEALTH ON DIET AND DIABETES
My role includes other duties too, including keeping up to date with latest guidelines – In March 2018, new evidence-based guidelines were published by Diabetes UK for the treatment of diet and diabetes. I’m also progressing phase 2 of a telehealth project: ‘Telehealth on Diet and Diabetes’ (TODD), designed to facilitate diabetes and dietary self-management and dietary behaviour change (in order to create increased dietetic review capacity) within the diabetes dietetic service. The TODD project aims to improve patient lifestyle outcomes and patient contact on a more regular basis with diabetes specialist dietitian. Additionaly, I normally input into Practice Placement C for student dietitians. I’m a dietetic representative on the Area Allied Health Professions Professional Committee and my other key areas of interest include behavioural change techniques, capturing patient outcome measures and dispelling the pseudoscience and myths associated with diet and diabetes. It’s usually a busy day in the life of for me! www.NHDmag.com May 2019 - Issue 144
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