6/1/2018 College of Agricultural, Consumer and Environmental Sciences All About Discovery! TM All About Discovery! TM New Mexico State University New Mexico State University aces.nmsu.edu aces.nmsu.edu All About Discovery! TM The College of Agricultural, Consumer and Environmental Sciences is an engine for economic and community development New Mexico State University in New Mexico, improving the lives of New Mexicans through academic, research, and Extension programs. aces.nmsu.edu Disclosure Financial relationships: 1 Employee of New Mexico State University Coordinator of the Kitchen Creations program, which receives 1a funding from the NMDOH Diabetes Prevention & Control Program I have no relevant financial relationship with any commercial interests that create a conflict of interest to affect CME content about products or services. 1
6/1/2018 Objectives At the conclusion of this presentation, participants will be able to: Discuss strategies used in managing 1 diabetes in pregnancy Develop a list of resources to use with 2 women who have diabetes in pregnancy Lifestyle management 1 MNT 70‐85% of women with gestational diabetes (GDM) can control it with Physical lifestyle modification alone activity Weight management 2
6/1/2018 Medical Nutrition Therapy 1,2 Fasting: <95 mg/dL 1st MNT visit: 60‐90 min 2nd MNT visit within one week: 30‐45 min 1 hr postprandial: <140 mg/dL 3rd MNT visit within 2‐3 weeks: 15‐45 min GWG 2 hr postprandial: <120 mg/dL Additional visits every 2‐3 weeks or Glycemic as needed for duration of pregnancy goals • ≥175g carbohydrate • ≥71g protein Adequate calories • 28g fiber Nutrition assessment (DRI) GWG Recommendations 3,4 Twins 50‐62 lb 5 16.8‐24.5 kg (37‐54 lb) 14.1‐22.7 kg (31‐50 lb) 2.7‐6.4 6‐14 11.3‐19.1 kg (25‐42 lb) 3
6/1/2018 GWG Recommendations 6 GWG Recommendations 4
6/1/2018 Physical activity 7 PAGA: ≥150 minutes/week moderate‐intensity aerobic activity • Walking • Contact sports Safe • Swimming • Activities with a high risk of falling • Stationary cycling • Scuba diving • Low‐impact aerobics • Sky diving • Yoga, modified • Hot yoga Unsafe • Pilates, modified • Hot pilates If done regularly before pregnancy and provider approves: • Running or jogging • Strength training Insulin Management 1 1 2 3 • insulin • insulin sensitivity • insulin • daily insulin resistance resistance • Leveling off/small requirements • insulin dose decrease of insulin • hypoglycemia weekly/biweekly requirements late • frequent blood • <50% basal insulin in trimester • >50% prandial glucose self‐ • Referral to monitoring insulin specialized center 5
6/1/2018 Mark Twain “Habit is habit, and not to be flung out of the window, but coaxed downstairs a step at a time.” 2 3 1 How does your patient feel? 8 6
6/1/2018 What can/can’t they change? Increasing adherence Self‐ Stress Reflective Goal setting monitoring management statements Stimulus Social Open‐ended Summary control support questions points Importance Cognitive Contingency Affirmations & confidence restructuring management rulers 7
6/1/2018 Successful counseling Cognitive Behavioral Therapy (CBT) Motivational Interviewing (MI) Counselor Example Text Successful counseling 8
6/1/2018 Praise • Positive reinforcement • Promote change talk • Must be genuine • What does she value? What motivates her? Praise Reinforce Reinforce Avoid Avoid efforts efforts outcomes outcomes Diet Weight Activity Glycemic #s Monitoring Showing up 9
6/1/2018 Praise Tina has GDM and is in the second trimester of her pregnancy. She has not been prescribed medication but was asked to test her blood glucose levels in the morning (fasting) and two hours after each meal and to bring her log to each appointment. She did not bring her log to her first appointment and confessed that she often forgets to test anyway. Praise 2 hours after Your turn! 2 hours after 2 hours after Fasting Notes breakfast lunch dinner 109 122 115 Monday Speaker: Tell someone next to you about a recent 106 152 Missed walk after dinner Tuesday accomplishment that made you happy or proud. 126 121 131 120 Wednesday 113 128 179 247 Sick Thursday Listener: Listen for behaviors and motivators that 159 150 Sick Friday led to the accomplishment, and offer praise. 127 Saturday 119 121 140 Sunday 10
6/1/2018 OARS Resist the righting reflex! O Open-ended questions A Affirmations R Reflective listening S Summary points OARS When asked what concerns she wanted to add to the agenda, Tina said she wants to talk about how to control her blood sugars. You begin addressing her concern with: “What do you think will help you achieve the blood sugars you want?” Tina: “I don’t know. Walking seems to work pretty well, but sometimes my sugars are still high. I know you taught me about how to eat healthy, but it feels like too much to take on. Taking time to walk is already a challenge. I don’t know how to fit in the meal changes.” 11
6/1/2018 OARS Counselor reflects: “I think what you are saying is that you can’t see a way to find time to address the changes needed to improve your eating. Is that correct?” Tina: “Yes, I guess it is, but I know it’s important for my baby. I just feel overwhelmed by all that I have to do.” OARS Counselor: “What are the things that you would like to see change with your eating?” Tina: “Well, I know I need to watch my carbs, but the foods I’m used to eating are usually high in carbs. I need to plan meals that have low‐carb foods, too. I would also like to eat out less. 12
6/1/2018 OARS Counselor: “Here is what I’ve heard so far. You have made positive changes in your physical activity and think eating healthier is the next step you should take. On one hand, you’re concerned about the time that will take, but on the other hand, it’s important to you because you want the best for your baby. You want to plan low‐carb foods into your meals and eat out less. Is there anything you want to add or correct? Shops with Shops with Stops for Stops for Browses Browses her child after her child after samples samples aisles aisles work work Buys high Buys high Plans dinners Plans dinners Checks out Checks out carb snack carb snack while while foods foods shopping shopping No meals for No meals for Buys fast food Buys fast food Skips her walk Skips her walk Sat‐Mon Sat‐Mon 13
6/1/2018 Stimulus control • Identify triggers associated with non‐adherence • Help her address the issue before it happens • People don’t live in isolation • Create safe spaces Goal setting & MI rulers • SMART goals “Why a 7, and not a 5?” • Importance ruler Promotes change talk Super • Confidence ruler important/ confident 1 2 3 4 5 6 7 8 9 10 Not at all important/ confident “Why a 7, and not a 10?” Identifies barriers 14
6/1/2018 ADA Diabetes Food Hub: https://www.diabetesfoodhub.org/ University of Nebraska‐Lincoln food and nutrition resources: https://food.unl.edu/free‐food‐nutrition‐fitness‐and‐food‐ safety‐educational‐powerpoints‐and‐handouts 15
6/1/2018 06/ 01/ 2018 Pre pa ring F re e ze r Me a ls At Ho me 1. Sa ve s mo ne y 2. I nc o rpo ra te s fa mily fa vo rite s 3. Allo ws c o ntro l o ve r ing re die nts 4. Allo ws c o ntro l the a mo unt a nd po rtio n size s 5. Pro vide s kno wle dg e o f nutritio na l info 6. Sa ve s time 06/ 01/ 2018 Do n’ t Be I ntimida te d Sta rt sma ll Ge t c o mfo rta b le with the ide a Co o k thing s yo u kno w yo ur fa mily like s T ry a fe w dishe s Build o n yo ur skills No t e ve rything ha s to b e a c a sse ro le 16
6/1/2018 06/ 01/ 2018 Wha t Ca n Yo u F re e ze ? Answe r: a lmo st a nything Be wa re o f c re a m sa uc e s, ma yo Ra w me a t vs. c o o ke d me a t Qua lity ing re die nts Ba ke d Go o ds https:/ / www.fsis.usda .g o v/ wps/ po rta l/ fsis/ to pic s/ fo o d-sa fe ty-e d uc a tio n 06/ 01/ 2018 Ha ve I c o nvinc e d yo u ye t? Pre pa re to diffe re nt sta g e s o f c o mple tio n Bro wn la rg e b a tc h o f g ro und b e e f a nd fre e ze in o ne po und se rving s fo r q uic k me a ls Cho p se ve ra l o nio ns a nd fre e ze in o ne c up se rving s Ma king me a tlo a f? Ma ke a n e xtra a nd fre e ze it. Do ub le a fa vo rite re c ipe a nd fre e ze o ne 17
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