Thrown In

(01/17-01/29) Community

Community Site

I have begun the daunting dietetic internship through the University of Kentucky. I am currently getting my feet wet in the community rotation at Lexington Clinic in the endocrinology department. My preceptors are at two different locations which allows me to get a variety of experience and see a multitude of patients. I begin my week at the main Lexington Clinic building, and then go to Lexington Clinic East to end my week. Most of our patients are referred for prediabetes/diabetes, but we also have consults for other conditions like weight loss, kidney disease, GI problems, and fatty liver disease.

Day to Day

For the most part, my days look pretty similar. I arrive at 8am and start prepping notes in the EMR. We see approximately 3-4 patients in the morning, have a 30-minute lunch break, then see approximately 3-4 more patients in the afternoon, and finish with any notes we need to complete. Majority of the appointments are one-on-one nutrition counseling; however, we do have group diabetes education classes on Tuesdays.

My Expectations

I walked into this rotation trying my best not to have any expectations as I did not want to be disappointed. Of course, naturally I had an idea of what it was going to be like. The one thing I did expect was to feel as if I was starting from scratch. I expected all that I learned in my undergrad to be of a slight benefit to me because I had been told there is nothing you can do to prepare. And that is correct. You cannot study enough, you cannot shadow enough, you cannot work enough to know what you’re doing. Obviously, all of these are great things that will keep you on the right track, but they will not prepare you for the internship. Before getting my hands dirty and leading an MNT session, I really didn’t know much at all. Yes, I did counsel a patient the second week of my rotation… talk about being thrown in. But actually, doing it is how we learn. And, if I can do it, you can do it.

That being said, I expected to learn a lot, and I can confidently say that after only two weeks, I have learned a WHOLE lot. Since the first day, my knowledge about diabetes, carb counting, plate demos, and Mifflin-St. Jeor equations has all increased significantly. Now you’re probably thinking, “I know all of that stuff. We learned that in undergrad.” Well, let me tell you, this is another level. I knew the basics coming in, but I never would have been able to learn the things I know now outside of the internship.

Like the Backs of Our Hands

Because majority of our patients have diabetes, the interventions and diet recommendations for diabetes make up our daily language. We speak it every day at almost every appointment; we know it like the backs of our hands. The following is a list of specific nutritional recommendations we give all diabetic patients to manage their blood glucose levels:

· Consistent carbohydrate meal plan for glycemic control.

· 3 meals per day.

· Avoid missing meals.

· 45-60 grams carbohydrate per meal.

· Improve balance of meals by incorporating protein, carbohydrate, and non-starchy vegetables.

The main goal for individuals with diabetes is to keep their blood sugar levels stable. In order to do this, they must have a consistent intake of carbohydrates throughout the day. This looks like similar size meals with the same components. What is meant by this is that patients treating diabetes should be eating three meals a day that each include 45-60 grams of carbohydrates, some protein, and non-starchy vegetables. Giving a range for the amount of carbohydrates that can be eaten will avoid eating too little or too many carbohydrates resulting in a fluctuated blood glucose. Adding the protein will slow down the reaction time it takes for blood glucose to rise and making sure they eat non-starchy vegetables will make certain that they are getting vitamins and minerals (“Get smart on carbs”, (n.d.)).

This is only a glimpse at the nutrition intervention for our diabetic patients, but it is the most important in managing diabetes and reducing risks for related complications.

Meeting Competency

We had an assignment due in which I evaluated the education handouts at my sites and gave suggestions on how they can better meet the needs of the population. I was able to meet CRDN 1.1 as I measured the quality of these handouts and their effectiveness.

It’s Not That Daunting

I can say, after just two weeks of my community rotation, I am enjoying it. I have more confidence, I look forward to future days of internship, and to be honest, it’s not that daunting.

Written by Brianna Starr, UK Dietetic Intern

References

1. Get smart on carbs. (n.d.). American Diabetes Association. Retrieved January 26, 2023, from https://diabetes.org/healthy-living/recipes-nutrition/understanding-carbs