Diabetes 12 Week Program

Participant will be able to state personal reasons for pursuing reduced A1C.

Participant will be able to verbalize health benefits from achieving reduced A1C and blood sugar management.

Participant will set a personal, initial health goal to achieve within 4- 6 months.

Participant will set one behavior change goal with a confidence of 7 or greater to work on before session 2.

Ask patient what their main goal is: lower A1C? Reduce diabetes symptoms? Lose weight to help improve blood sugar? Get off diabetes medications? There may be a variety of answers.

Validate their goal and give them confidence it can be done! It takes an individualized approach, but we can use the steps outlined in this program to touch on all the components that impact blood sugar.

Complete nutrition assessment and health history. Document current weight, height, A1C levels within the past year, and fasting and/or non-fasting blood sugars. Review any medications or supplements they are taking (metformin, insulin). Document any symptoms that may occur related to diabetes:

Discuss benefits of reducing A1C and improving blood sugars. A few benefits include:

Discuss diabetes and give a brief education on what it is. Discuss how to manage diabetes and use this resource as a guide.

Review handout with patient about basic nutrition for managing diabetes/blood sugar. Discuss in the upcoming lessons you will dive into more specific carb counting strategies. For now, the focus is a visual plate method - ¼ or less of complex carbs, 3-4 oz lean protein, and ½ plate non-starchy veggies.

Ask the patient how their current intake of meals compares to this basic plate method. Help them identify one behavior change they can work on between now and the next visit related to their diet.

Once the patient has identified one change they would like to commit to, help the patient make this a specific and measurable goal. Assess their confidence in their ability to make the change, and help the patient readjust the goal as needed. For example, if the patient identifies they want to decrease their sugary beverage intake, ask them to commit to how much they want to decrease.

Example: “It looks like you are eating more complex carbs than veggies at dinner every day. How much would you like to cut back? For example, can you add 1 extra non-starchy veggie serving to dinner? Can you do this every day, or do you want to start with making this change for a few days of the week?”

Let the patient make the decision on what they can do. Once they make a commitment, assess their confidence in their ability to make the change.

Example: “On a scale of 1 to 10, with 1 being absolutely no confidence, and 10 being fully confident, how confident are you that you can decrease your sweet-tea intake to 1 glass per day, 3 days per week?”

If the patient answers with a number between 7 and 10, let them know it sounds like they are pretty confident, and ask them how they will accomplish and track their goal to stay accountable. (They can use the provided worksheet or track in a journal or on a calendar).

If the patient answers with a number of 6 or less, ask what could be changed to increase their confidence (it may be decreasing to 2 glasses instead of 1, or it may be 2 days a week instead of 3 days per week). Explain to the patient that you want them to be successful in achieving the goal, and the goal can be adjusted and expanded upon at the next meeting.

Wrap up session by again congratulating patient on decision to improve their A1C. Ask patient to start weekly blood sugar checks, if applicable. If the patient takes insulin to manage type 2 diabetes, testing is usually recommended before meals and at bedtime if they are taking multiple daily injections. If they haven’t done so already have the patient take the nutriquiz before session 2 to assess intake. Schedule session 2 appointment at a one-week interval.

Participant will be able to identify carbohydrates and how they impact blood sugar.

Participant will be able to understand how to count carbs.

Participant will be able to set a goal to focus on their specific carb count recommendation in the next week.

Review patient’s previous goal and how it went last week. Identify any barriers that could have occurred and congratulate them for completing their first task!

Introduce the topic for today: carb counting basics.

Discuss the basics of carbohydrates using this handout on pages 4-7.

Use this handout to discuss what a net carbohydrate is. (reminder net carbs = total carb - total fiber).

Create a carbohydrate recommendation and discuss changes that can be made with their current diet to reach those goals. Options may include:

Review any questions the patient may have and discuss a carbohydrate-specific goal to focus on between now and their next visit.

Participant will be able to identify the many different types of sugar and how they impact blood sugar.

Participant will be able to identify the different types of sugar sweeteners and whether they impact blood sugar or not.

Participant will be able to set a goal to focus on their sugar intake and continue their carbohydrate counting goal.

Review carbohydrate counting goal from previous visit. Identify any barriers that may have occurred and congratulate them again on their efforts this week.

Introduce the topic of sugar and how it impacts blood sugar spikes. Use this handout from the American Heart Association to discuss added sugars and how much to consume each day.

Identify potential areas in their current diet where added sugars are prevalent. Assess their current intake and compare to the AHA guidelines.

Use the avoid the sugar spike handout in the Foodsmart handouts share drive to discuss ways to reduce sugar intake.

Discuss artificial sweeteners and identify if they are appropriate for the patient to utilize. Use this article to discuss current research on artificial sweeteners and recommendations.

Discuss the benefits of reducing sugar intake to avoid the blood sugar spike. Create a goal around sugar today, along with their carbohydrate counting goal.

Patient will be able to identify the benefits of adding lean protein to their diet to help manage blood sugar.

Patient will be able to identify types of lean protein.

Discuss goals from previous visit: cutting back on sugar and carb counting. Identify any barriers that may have occurred and congratulate client for the changes they have made so far.

Discuss the topic for today: adding lean protein, and how it benefits blood sugar balance. Use this handout.

Identify areas where protein might be lacking in the diet. Ask “where do you feel you struggle with protein the most?” Ideas for increasing protein include:

Come up with one goal to increase protein intake. If protein intake is adequate, provide ideas to help with variety.

Patient will be able to identify the benefits of adding healthy fats to their diet to help manage blood sugar.

Patient will be able to identify the difference between healthy and unhealthy fats.

Benefits:

Side Effects:

Patient will understand the importance of dietary fiber to prevent blood sugar spikes and manage diabetes.

Patient will be able to identify sources of dietary fiber and how to increase their intake.

Discuss goals from previous visit: healthy fats, lean protein, cutting back on sugar, and carb counting. Identify any barriers that may have occurred and congratulate client for the changes they have made so far.

Start the discussion about fiber and how it can help improve blood sugar. Use this article for a reference.

Discuss foods high in fiber using the Fiber First handout in the Foodsmart shared drive.

Review client’s diet and nutriquiz results to identify areas where fiber can be included if applicable.

Easiest way to increase fiber - fill ½ plate of veggies, ¼ with complex carbs, choose plant-based proteins, add nuts/seeds and avocados. Use Foodsmart plate method for demonstration.

Review net carbs from week two for questions about counting carbs.

Set a goal after today’s session on how to increase fiber intake and continue to focus on healthy fats, lean protein, less added sugar, and carb counting.

Patient will understand what a fed state is and the importance of giving the body a break from eating.

Patient will be able to create a realistic goal to create an overnight fasting routine.

Review goals from previous weeks and check-in. How are they doing? Any struggles or barriers to chat through?

Introduce today’s topic not as intermittent fasting, but as the overnight meal break.

Ask patient about their current eating routine. How late are they eating? How early? What is a realistic goal they can achieve to give the body rest from being in the “fed” state?

Set a goal for the visit and discuss any struggles/barriers - congratulate client on their efforts!

Patient will understand how stress can impact blood sugar.

Patient will be able to set some goals to manage stress when it occurs.

Review goals from previous weeks and check-in. How are they doing? Any struggles or barriers to chat through?

Introduce today’s topic - stress management. How does stress affect blood sugar?

Ask patient about their average stress levels. 1 being very low most days to 10 being extremely stressed.

Set a goal for the visit and discuss any struggles/barriers - congratulate client on their efforts!

Patient will understand the importance of movement in managing blood sugar.

Patient will be able to set a realistic goal to get in more movement and exercise.

Review goals so far - how is everything going? Any barriers or challenges to discuss? Check in with the patient and congratulate them on their efforts.

Introduce topic - adding in movement and exercise. Explain why exercise is important for managing blood sugar:

Emphasize: All movement is good movement! Choose an exercise that fits your needs best.

Rule of thumb:

Set some goals for today - how will they incorporate more movement?

Patient will be able to plan diabetes-friendly meals using the Foodsmart app.

Review goals so far - how is everything going? Any barriers or challenges to discuss? Check in with the patient and congratulate them on their efforts.

Discuss the importance of meal planning and how it can help improve long-term success of managing diabetes.

Discuss progress with goals so far. Congratulate them on their efforts. Determine when they can draw their A1C again (if they haven’t already done so) to assess progress.

Patient will be able to identify additional nutrients to consider if they are taking diabetes medications.

Congratulate client on their efforts so far! Discuss any challenges or barriers the patient is experiencing with their goals.

Introduce today’s topic - additional nutrients for diabetes.

A well balanced diet with non-starchy veggies, lean protein, healthy fats, and fiber-rich carbs is the key to getting in enough nutrients to balance blood sugar.

Set a goal for today.

Patient will be able to identify positive outcomes with their goals and identify their next steps to continue improving their health.

Congratulate client on their success!

Schedule patient for accountability follow-ups, or enroll them in another program.