On the frontline of change
Let's go back in time to 1980 when I first started working at St. Joseph's Hospital. My orientation included spending time at the Diabetes Education Centre so that what I taught to inpatients would be consistent with what the centre was teaching. I had the opportunity to see Dorothy Gibson's passion for teaching in action. Dorothy was the centre's first coordinator.
There were two main oral diabetes medications - glyburide and metformin. A typical insulin regimen was regular and NPH taken by syringe. Urine testing was the norm which only told you if your blood sugar was over 10 mmol hours ago. Most of my teaching took place in the smoking lounges at the end of each ward - 50 per cent of the adult population smoked at that time.
The diet teaching tool was the 'blue book' of food exchanges. There were no nutrition information labels. The best advice we could give was to avoid foods with sugar listed in the first few ingredients. We had no information on the fibre content of foods.
Soon after I started, saccharin was taken out of commercial food products. The diet drink available at that time was ginger ale with no sweetening. Patients had to add their own saccharin. Unfortunately this would result in a chemical reaction that caused the mixture to foam up and the patient would be left with very little to drink.
Today diabetes management is much more sophisticated. There has been much research and advancement in care. Many people at St. Joseph's and in London had a role in this work.
There are now five different classes of medications which include 18 different pills and two injectable glucose lowering medications. Insulin has had many advances with three rapid analogs and two long-acting preparations. The insulin is more predictable and consistent in its action. It is most often taken using an insulin pen or a pump. Patients can test their blood sugar using glucose monitors that require very little blood and give results within seconds. We have the A1C blood test that helps assess the patient's glucose control for the last three months.
Diet teaching focuses on carbohydrate counting skills and using insulin to carbohydrate ratios. We rely on food labels, nutrient composition books and the internet for carbohydrate and fibre information.
Looking back I see a fundamental change in my practice. When we had limited information and tools the teaching was very rigid and I was telling patients what they couldn't do. Today most often I am teaching them how to manage diabetes so they can do the things they want to do.
Dietitian and diabetes educator,
Diabetes Education Centre