I’ve been fortunate to have Nicole Brent as been my dietitian. She has worked closely with me while training for my competitions to manage my diabetes through proper diet and exercise regimen. Since I’ve known her, I’ve become much more knowledgeable and successful with regulating my blood sugars. She has always been helpful with diabetic issues that have arisen. It is such a treat that she has agreed to be interviewed on diabetes, her area of expertise.
Alissa: Please tell me a little bit about your credentials and how you got involved consulting diabetic clients?
Nicole: I'm a registered dietitian. I have a bachelor's degree then did an internship; Diabetes is very nutritional-related. Medication, exercise, and diabetes all go together and it's something that I was very interested in and felt that I could be helpful. You need 1000 hours working with patients to be able to become a certified diabetes educator. I attained that goal and became a Certified Diabetes Educator All of this education and experience has provided me with the skills needed to help my patients.
Alissa: What would be the best way to find a dietitian who specializes in treating diabetics?
Nicole: The National Certification Board for Diabetes Educators website is http://www.ncbde.org . Your zip code will give you a list of all the Certified Diabetes educators in your area. Also, if you talk to your endocrinologist, then he/she may have a dietitian that they work closely with. We work very closely with Texas Diabetes and many other physicians and endocrinologists in Austin.
Alissa: Cost is always a factor when making medical decision. There are so many expenses that diabetics incur that create financial difficulties. If somebody needs to see a dietitian and they can't afford it for some reason, how do you advise somebody to be able to get that dietary care?
Nicole: Usually, your insurance covers it if you have diabetes, but it just depends on your insurance.
Alissa: Are there alternative methods of coverage if insurance doesn't pay for it?
Nicole: I don't know about that. That would be up to your employer.
Alissa: Where can I find a dietitian who works with diabetic patients? Are there special certifications needed for this?
Nicole: There is a certification, which is not just for dietitians, but for practitioners who works with diabetics. It is called a Certified Diabetes Educator or CDE. You can go to their website, http://www.ncbde.org, to find a CDE. Practitioners working with diabetic clients, including nurse practitioners, physician's assistants, and dietitians should be a Certified Diabetes Educator or CDE.
Alissa: Are there specializations or certifications for dietitians to work with children with diabetes?
Nicole: There's not a certification for a diabetes educator to just work with children, however, there’s a Certified Specialist in Pediatrics or CSP. You can find board certified specialists in pediatric nutrition at The Commission on Dietetic Registration website, www.cdrnet.org.
Alissa: Craving sugar is a symptom of diabetics, but could something else cause this?
Nicole: I don't know that craving sugar is necessarily a symptom of diabetes. It depends on the person. Sometimes, it will come from the fact that someone knows they shouldn't be eating a lot of sugar causing them to want it more. That’s just human nature. One thing that will cause craving more sugar is if we are getting inadequate carbohydrate in our diet.
Alissa: What are the biggest differences between diets for diabetics verse non-diabetics?
Nicole: If I’m working with a diabetic patient and their goal is weight loss, we would be focusing on carbohydrates, so the emphasis would be carbohydrate counting and making sure that their carbohydrates are under control. Not only does carbohydrate counting help with weight loss, but it also helps to reduce calories because the carbohydrates have the largest percentage of our calories. If diabetes is not a factor, I will still teach carbohydrate counting because it is extremely helpful in weight loss. For non-diabetics total calorie intake and getting adequate exercise are priorities.
Alissa: What tips do you recommend for measuring carbohydrates?
Nicole: There are many great apps available to help figure out the carbohydrate content of while eating out. It is also helpful for foods that don't have labels on them like apples.
Alissa: The size of apples can vary greatly. How do you carbohydrate in an accurate way? Do you need to weigh it with a scale? Do you need to measure with cups? What are your suggestions?
Nicole: Either way.
Alissa: Is there a rule of thumb, 15 carbs for certain vegetables or fruits?
Nicole: No, because there are so many different amounts. The best way to learn is to measure your foods for a little while. You will learn from practice and experience. If you measure a cup of rice several times then you are able to eyeball it down the road.
Alissa: Are there any danger foods or unsafe foods for people with diabetes? What are good treats and desserts for diabetics?
Nicole: There is no list of food that is off limits because you are diabetic. Certainly there are foods that are better choices. I know that there are certain triggers for me which can be danger foods if you are diabetic. Same thing with safe foods.
I teach my diabetics to try to keep their snack to around 15, and for sure less than 20 grams.
Alissa: What would you recommend if somebody with diabetes wanted to have a dessert?
Nicole: Sugar-free Jell-O is carbohydrate free. Sugar-free pudding has only 15 grams. A granola bar that is high protein is a good choice. Desserts and snacks that range @ 15 grams of carbohydrates are wonderful options.
Alissa: What if somebody wanted to have a piece of cake or cookie - what would you recommend?
Nicole: Keep it small, and then if you're on insulin, you have to cover it. You need to be mindful about checking your sugar and making adjustments with insulin.
Alissa: Is NutraSweet or saccharin? Which would you recommend?
Nicole: According to the Food and Drug Administration, they are all safe, so that's something that I leave to the client. Some people feel more comfortable with Splenda because it's made from sugar. Some people feel more comfortable with TruVia, green leaf, or SweetLeaf because they are from a leaf, so they feel it is more natural. Be aware of the amount of these sugar substitutes that are being used, so they are not overused.
Alissa: Is there a limit on how much sweetener you can use per day? Do they have carbs?
Nicole: They do not have carbohydrates in them. Some of them are equivalent to 20 to 22 diet sodas a day, so be aware.
Alissa: Do sweeteners have long term side effects?
Nicole: Everything in life is about moderation. That's the key. If you're not comfortable with it, then don't use them.
Alissa: I really, really appreciate you, Nicole, as my dietitian and how much you've helped me through my competition season. I have learned so much from working with you. I thank you so much for giving me your time and helping me so that I can help others.
Nicole: You are very welcome, my pleasure Alissa.