Dietitian Archives - Diabetes Counselling Online

Summary of a seminar by Dr Rosemary Stanton on plant based eating

February 23, 2015 by Sally Leave a Comment

Last week I went to a presentation called Paleo versus Plant based diets. I really wanted to share some of the information I was reminded of there with you. Upfront I’d like to make clear that I’m not sharing these to make you feel bad or guilty, so please don’t go there! Just to help you to reconsider and be mindful of what you put in your mouth due to the effect on your overall wellbeing as well as your diabetes management.

There were three key speakers. Dr Kate Marsh (a member of the Diabetes Counselling Online board) who is passionate about plant-based diets, Dr Rosemary Stanton who is probably the most well-known dietitian in Australia and Brenda Davis, a Canadian Registered Dietitian. The day wasn’t about diabetes, but they made several key points that I thought worth sharing with you related to improving your wellbeing by eating more plants. This doesn’t necessarily mean going vegetarian or vegan, but just cutting down on the animal-based foods.

Dr Kate Marsh showed us the evidence of how plant-based eating can improve diabetes management, and help people to avoid chronic disease in general.

Brenda Davis made direct nutrient comparisons between the Paleo and plant based diets, in many cases demonstrating how close the modern Paleo diet was to a vegan diet. But in this blog, I don’t want to discuss the Paleo diet as a ‘diet’ is not sustainable and although it has some strengths it’s not suitable to recommend on a population based level such as this blog. If you’re interested in this for your own health, I recommend a personalised consultation with your Accredited Practising Dietitian as some aspects of it may be dangerous for people with diabetes, especially in the longer term.

Instead I want to focus on Dr Rosemary Stanton’s presentation which was entitled ‘Why so many controversies?’ because it’s really a common sense (and of course evidence-based) approach to healthy eating. The changes she suggests are not too hard to try and really make sense when you think about.

Dr Stanton is a great advocate of the Australian Dietary Guidelines due to the enormous amount of research (over 55,000 pieces of peer reviewed published scientific research) and work by a committee of leading experts in the field of nutrition, public health, industry and consumer issues, and overseen by the Council of NHMRC that went into it to ensure that the Australian population would have not only the right amount of energy (calories/kilojoules) to maintain a healthy weight, but also would have the vitamins and minerals needed to keep us well and to help prevent chronic disease.

She began by explaining how we get so many mixed messages through the media and how important it is to check on advice that you read, as many of the people who talk about nutrition aren’t university trained experts in the field even though they may have passion on their side. Then she got to the part that I really wanted to share with you about own diets.

Dr Stanton explained that in comparison with Australian consumption patterns when the guidelines were being reviewed, the evidence suggests that we need to eat more:

Vegetables and legumes/beans – a variety of different coloured vegetables
Fruits
Whole grain (cereal) foods such as wholegrain breakfast cereals and wholemeal bread
Milk, yoghurt, cheese – preferably reduced fat varieties (except for children under 2 years)
Fish, seafood, poultry, eggs, nuts and seeds, and legumes/beans
Red meat (young women only)

There were also many areas as population that we could do with eating less of, and most of these related to our diabetes health such as:

Refined grain (cereal) foods such as white bread and low fibre cereals (these will spike our BGLs without providing our nutrient requirements)
High and medium fat milk, yoghurt and cheese (let’s stick with low fat to avoid the saturated fats and extra energy that we don’t need)
Red meats (adult males only)
Energy-dense and/or nutrient-poor foods and drinks which are high in saturated fat, added sugars, added salt and/or alcohol, such as sugar sweetened drinks, fried foods, hot chips, many take-away foods, cakes and biscuits, chocolate and confectionery and crisps.

Dr Stanton made the point quite strongly that although the foods in that last bullet point are referred to as ‘discretionary’ items in the guidelines, really it’s just ‘junk’ food and we’re better off without it and taking any extra energy needed from the main food groups of the guidelines themselves. This idea was explained further in the Diabetes Counselling Online blog I wrote on Snacking.

She talked about how our Modern Western diets currently emphasis:

foods and drink high in added fat, sugar, and salt
highly processed grains
meat dominates dinner
vegetables are only an accompaniment (often chips)
fruit juice preferred to fruit
full and medium fat milk, cheese, sweet yogurt , ice cream
alcohol (with or without food)

And if you think about this it’s just so true! For those of us who are not vegetarian, if you ask us what we’re having for dinner, the answer is ALWAYS a meat-based one. It’s just the way we’ve learned to think about our meals – maybe it’s time to consider this, recognise that it’s not doing us any good, and try to improve what we’ve in the past.

Dr Stanton suggested that the main changes needed are:

much more vegetables and legumes
more fruit
include nuts and seeds
far less junk (currently 36% of adult’s and >40% of children’s calorie/kJ intake)

Do many of you try to include ‘Meat Free Monday’? Here’s a link to a website dedicated to this idea with recipes from some of the top chefs that you might like to take a look at.

If you start to enjoy some of these, you might see how you can move closer to a plant-based diet without comprising on your enjoyment of the meals you’re eating. It doesn’t mean you have to give up your favourite steak – just try cutting down the size of it and increase the vegetable sides, or your pizza night – make it at home with healthier toppings, or even your night off cooking nights – by having frozen pre-prepared meals that you’ve made a batch of earlier.

Have you read my Diabetes Counselling Online blog called ‘Learning to Love Legumes’? It’s full of some great ideas and those legumes will provide you with more than enough protein to keep your tummy satisfied hunger-wise and those tastebuds happy too.

Dr Stanton’s ‘Take Home’ messages were a great reminder to us all when there is just so much conflicting information available via the internet. She says:

education is important and ongoing
get information from trusted sources (NHMRC), without a conflict of interest
don’t trust Dr Google
be sceptical of those with something to sell
with scientific papers, read the whole paper, not just the newspaper headlines or blog comments

And what sensible advice that is!!

I’d like to finish up this blog by sharing one of Brenda Davis’s presentation slides. She finished her talk on Paleo vs Plant-based diets by explaining about the longest living people in the world, those that live in the Blue Zone, and a quick rundown on what keeps them so healthy. Could you adopt some of these ideas into your own life?

Paleo vs Vegan diets Blue Zones Longevity Diet 1 Brenda Davis 2015 — Blue Zones Longevity Diet – Brenda Davis 2015 – Please click on the image to make it larger

Hoping this has helped you to consider some positive changes you can make to your own diet. Sally

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a linked list of all Sally’s Diabetes Counselling Online blogs here.

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D-thoughts on bread

February 9, 2015 by Sally 5 Comments

Bread has become a staple food in our modern diet but can be problematic for those of us with diabetes, especially if it has a high glycemic index, we eat too much of it, or it contains too much of nutrients such as sodium and saturated fat which can affect our heart health and longer term insulin resistance. Today’s blog aims to help to you make better choices by understanding where it fits in the Australian Dietary Guidelines and find a bread that you can enjoy while maximising your glycemic control.

And for those of us who avoid wheat/rye bread due to the gluten content (coeliac disease, wheat intolerance or a FODMAP intolerance) we can take a look at some of those options too.

Probably a good place to start is a look at where bread fits in the Australian Dietary Guidelines, then we’ll go on to a reminder on label reading, which will lead in nicely to a look at some of the better bread choices on the market for people with diabetes based on a comparison table put together by student dietitian Stacey Beech for Dietitian Connection.

Australian Dietary Guidelines

Of course bread fits into the grains and cereals food group in the Australian Dietary Guidelines, and we encourage breads that are full of whole grains which provide extra nutrients and fibre in the bread you’re choosing. This is beneficial for your general health, as well as your diabetes health. And the more whole grains there are, the lower the glycemic index will be to help you avoid those spikes which can be associated with breads for some people.

Click on the image if you need it to be larger

You can read more about grains in this blog on grains prepared earlier for Diabetes Counselling Online. And the recent blog on snacks highlights that a piece of grainy bread can work well as a snack (with a topping) if you haven’t used your suggested serves for the day.

Label reading on bread packs

It’s important not just to think about the amount of carbohydrate in the bread you’re choosing, because often if the carb is low they’ve had to manipulate fat and sodium to make up for it.

As with most products we should be aiming for lower total fat (breads are usually quite low at around 2-6g/100g), lower saturated fat (well under 2g/100g) and lower sodium (less than 400mg/100g). Fibre should be as high as possible, and protein can be higher too (to contribute to lowering the GI).

We discussed this comparison a while ago in the Diabetes and Food – let’s celebrate it! closed Facebook group and the main point made was that although the Helgas low carb seeded loaf is indeed lower in carb with 27.7g/100g compared with 44.5g/100g in the ‘usual’ one, there’s over 10% more energy (kilojoules) meaning it won’t help with weight management because the fat is 10.9g/100g in the low carb version, compared with 2.8 in the grainy one. If you’re not trying to lose weight then it’ll be fine, but it’s worth bearing this in mind as we know that extra body weight contributes to poorer glycemic control.

It’s also worth checking comparison tables (summary of one below) as I noticed there’s a bread called ‘Well Being Lower Carb Bread’ that actually has the same level of carbs as many of the wholegrain varieties – just a reminder to not always believe what it says on the pack!

Helgas low carb 5 seeds bread NIP — Helga’s low carb 5 seeds bread NIP

Helgas mixed grain bread NIP — Helga’s mixed grain bread NIP

Good bread options from the Dietitian Connection bread comparison table by Stacey Beech

This is a mini-table with content taken from Stacey’s more comprehensive table, to show you some of the better bread choices on the market. All values are per 100g.

By no means am I suggesting these are the best breads, but by showing you this comparison I hope to help you to recognise which breads will be better choices for you. I’ve only chosen the ‘mainline’ brands to compare. And I’ve only covered wheat breads here, where rye breads are also a good option.

Bread	Energy (kJ)	Protein (g)	Fat (total) (g)	Fat (sat) (g)	Carb (g)	Dietary Fibre (g)	Sodium (mg)
Burgen Wholegrain & Oats Bread	964	10.7	9.1	0.6	31.9	6.4	280
Helga’s Traditional Wholemeal Grain Bread	1010	9.9	4.0	<1.0	38.0	7.3	400
Coles Smart Buy Multigrain Sandwich	990	8.8	2.4	0.4	47.0	4.3	400
Well Being Lower Carb Bread	952	10.4	2.1	0.6	36.8	8.8	349
Tip Top 9 Grain Wholemeal	1040	12.4	6.4	0.7	30.6	8.7	370

And here are some of the gluten free comparisons if you have an interest here.

Bread	Energy (kJ)	Protein (g)	Fat (total) (g)	Fat (sat) (g)	Carb (g)	Dietary Fibre (g)	Sodium (mg)
Helga’s Sunflower and Red Quinoa GF Bread	1100	6.3	8.0	<1.0	40.1	4.2	400
Coles GF Chia & Seed Bread	1130	7.3	7.5	1.5	41.2	3.7	280
Country Life Gluten & Dairy Free Lower GI	1030	6.0	7.2	<1.0	37.2	4.2	400
Pure Bred Multigrain Farmhouse (added Iron)	717	5.1	2.3	0.3	32.6	9.7	534
Burgen GF Sunflower and Chia Bread	1190	7.0	9.7	1.4	39.7	4.2	400

I included a variety of breads here for you consider what type of bread will suit your personal needs, but of course you should consider how you personally enjoy the taste of the bread you’ve chosen. Trying a few different varieties is often a good idea in that respect to find what works for you, for taste, glycemic control and long term health.

Sourdough and Wraps

These types of breads can be beneficial for people with diabetes, especially for those who really don’t like the grainer options.

With sourdough it’s important to check that it is ‘real’ sourdough as the term ‘sourdough’ is often misused as a marketing word on some breads. If it’s real sourdough, then the glycemic index should be lower (due to the fermentation process involved).

Wraps

There are a few good wraps around, although there aren’t many actually listed in the Low GI Shoppers Guide 2014 with a low-GI. The only one I could spot was the Diego’s low-carb wraps which have 11.g carb per serve. But I’d be checking the fat and sodium levels on that label before buying them…

One of our often discussed favourites in the Diabetes and Food – Let’s celebrate it! Facebook group is the Goodness SuperFoods Barley Max wrap which does tick all the boxes, so is a great one to try if you haven’t already.

I don’t want bread!

Of course no-one is suggesting that we *have to* eat bread. Many people I know choose to avoid it for various reasons, and that’s what suits you, then it’s easy to meet your grain serve guidelines in other foods.

It’s also worth mentioning that everyone is different as to how different carbs affect your BGLs, so a little self-experimenting with testing your BGLs before and 2 hours after meals can go a long way with various foods so you can have a better feel as to how those foods effect you personally.

I hope you’ve found this blog on bread helpful in making your choices best for your diabetes and general wellbeing. Sally

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D-thoughts on snacking

January 26, 2015 by Sally Leave a Comment

Happy Australia Day! And what good timing for a blog on snacking! It must be the ‘most asked’ question I get as a dietitian: “What are the best snacks for people with diabetes?”

It’s not really a black and white question as the answer depends on your personal diabetes requirements, your personal tastes, your ability to be mindful in your choices and your knowledge of healthy eating in general. So this blog aims to help you to be mindful in making snacking decisions.

We encourage you to choose foods that are higher in nutrients to add to your overall wellbeing, rather than ‘discretionary choices’ which everybody, diabetic or not, is encouraged to limit. It’s especially the case for us with diabetes… but it doesn’t mean missing out on delicious flavours!

Priority One

Your first priority needs to be your overall diabetes goals. Are you getting all the nutrients from your diet that you need for wellbeing? Are you needing to watch your weight? Is matching your food intake to your body’s ability to process carbs an issue for you?

A perfect segue to our Australian Dietary Guidelines… Are you actually meeting the quantities recommended in the 5 main food groups across your day?

In an ideal world we would choose snacks that are included in the foods that we are recommended to enjoy each day. In these examples I’m referring to the ‘Healthy Eating for Adults’ brochure, but there’s also a Healthy Eating for Children brochure for those thinking about their children with diabetes. In both cases, the actual food group listings are on page 2.

Each of the food groups has snacking potential, so there’s always plenty to choose from.

In the ‘Vegetables and legumes/beans’ group you can always find a low-carb snack if that’s what you’re after. Whether it’s raw veg to nibble on, celery with nut butter, blanched asparagus spears when they’re in season, tasty tiny tomatoes that burst with flavour in your mouth, hummous dip with veggie sticks, or even leftover cold roasted non-starchies or ratatouille (recipe in the files section of the closed ‘Diabetes and Food – let’s celebrate it!’ Facebook group). There are always options in this group of foods if one of them will meet what you’re looking for…

Next group down and a great one for those wanting something to satisfy a sweetness craving is the ‘Fruit’ group. With diabetes we are recommended to aim for about 2 serves per day, eaten at different times. However, some fruits are really low in carbohydrate, so we can have more of these without upsetting our glycemic control. Some of those include berries, passionfruit and kiwifruit. But still watch your quantities. If you want to know how much fruit will contain 15g of carbohydrate, take a look at www.calorieking.com.au , search for the fruit you are looking at, and adjust quantities to get to the 1 carb serve number.

In the ‘Grain (cereal) foods’ group, it’s easy to calculate whether you’re going to meet your daily recommended amount. Often for people with diabetes this is a group that people actually tend to be low in. Instead of choosing a ‘discretionary item’, swapping in a low-GI high fibre grain snack such a piece of heavily grained toast with a topping to suit your taste can be a great option to satisfy your hunger and keep your BGLs stable. Or even a small bowl of your high-fibre cereal. Of course these options all contain carbs, but they are all much more nutritious than a cracker or sweet biscuit.

In the ‘Protein’ group, snacking options are easy to find, but it’s important to remember to try not to exceed the guidelines in terms of serve sizes and number of serves recommendations. This is because protein contains energy (or calories/kilojoules) that will cause weight gain if you have too much, although they shouldn’t upset your glycemic control. I recommend having a read of this blog on Protein : written earlier, if you’d like more info. The perfect snack from within this group for us with diabetes is really a handful of nuts, as the evidence behind inclusion of nuts in our diet is quite outstanding. Read more about nuts in this blog.

And last, but not least, is the ‘Dairy and/or alternatives’ group. I wrote a couple of blogs about dairy and diabetes as it’s such an important food group for us with diabetes. Here’s a link to the first one and the second one that contain more great ideas for snacking. My favourite snacking recommendations to help meet the nutritional guidelines are a low-fat yogurt (low sugar too if you’re watching your carb intake closely) or plain low-fat greek yogurt with berries mixed in. Or a low-fat milk based smoothie made on frozen berries, with a couple of teaspoons of chia seeds added for extra fibre. Even a cup of milk based coffee can do the trick… These should work well to satisfy hunger and provide you with the nutrients this group is known for.

Priority Two

Your second priority, also a very important one, is to ask yourself what do you actually feel like eating and why? Sometimes snacking can become a habit. People say “I have a sweet tooth and NEED a biscuit or cake”. (or whatever) This is important too, because if you deprive yourself of what you really want (or feel you need) all the time, then your craving will only grow bigger and you’ll end up overdoing it and regretting it later. Not a good thing, but happens all too often. If you can enjoy a small amount of what you feel you “need”, being mindful of enjoying every mouthful, savouring the textures and flavours that you’ve wanted so badly, then you’re in a better place to return to your ‘healthier’ options on a regular basis.

Do I really need to snack?

If you’re medicated for your diabetes, and are putting yourself at risk of a hypo if you don’t snack, then you should snack as you’ve been advised by your medical diabetes team. If in this case you’d rather not be snacking as you’re just not hungry, then you should talk to your d-team and arrange to have the medication adjusted so that you don’t need to snack.

For those of you where snacking has just become a habit, it’s worth thinking twice to see if you really are hungry before you just head for a snack. Is it out of habit or because you’re bored? Sometimes a drink of water will satisfy that ‘hunger’ feeling, which may actually be your body telling you that you’re dehydrated. If you’re bored, take the opportunity to go for a walk, call a friend, do something off your household chores list, read a book, or engage in your hobby.

If you are constantly actually hungry, it may be worth your while to visit an Accredited Practising Dietitian to see how your meal plan can be adjusted to help avoid that happening. Being hungry is not good or necessary for you to manage your diabetes and weight well.

More ideas?

In the Diabetes Counselling Online closed Facebook groups ‘Diabetes and Food – let’s celebrate it!’ and ‘Diabetes Weight Matters’ we’ve asked the members what their favourite snacks are and have created a document up in the files section of the groups. I think I still need to finalise the weight matters file, but it’ll be there soon. These are member ideas, not necessarily dietitian approved, so please use this blog as a thought process in helping to make your snacking decisions right for you.

Also in the current issue (February 2015) of the Australian Healthy Food Guide they’re running a feature relevant to this blog that you may find helpful. It’s entitled “Your Treat Foods Toolkit” and explains “why those ‘naughty’ treat foods are discretionary, and how they can fit into a healthy diet.” It’s written by an Accredited Practicing Dietitian, Brooke Longfield and can be found on page 34. Although not related specifically to diabetes, you’ll find it helpful for portion sizes and understanding more about ‘discretionary’ foods.

Happy snacking! Sally

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Making Rice Nice for Diabetes

January 12, 2015 by Sally Leave a Comment

Rice is one of those grains that can be problematic for people with diabetes, so I thought it might help if we explain a little of why that is, why different rices have varying effects on our BGLs and ways to make rice more diabetes friendly.

You may know that, generally speaking, a quarter of a cup of cooked rice is one carb serve. You can see that in this snip from CalorieKing showing that half a cup of boiled rice = 28.8g carb (or 2 carb serves).

And this photo shows you what half a cup of cooked rice (2 carb serves) looks like on a plate.

You may also know that, particularly for us with diabetes, we’re better having rice that breaks down more slowly to glucose in our bloodstream, or low-GI rice. The main types in Australia of low GI rices are long grain rices including Basmati and Doongara. Even when choosing brown rice for the extra fibre, we’re best to choose brown Basmati or Doongara.

This mini-table gives you a feel for the glycemic indexes of various rice products.

Source: Low GI Diet Shoppers Guide 2014

Rice type	Glycemic Index	Glycemic Index rating
Aborio/risotto rice, boiled, SunRice	69	Medium
Basmati white rice, boiled, SunRice	59	Medium
Basmati white rice, SunRice, microwave pouch	52	Low
Calrose rice, brown, medium-grain, boiled	76	High
Calrose rice, white, medium-grain, boiled	87	High
Japanese style sushi rice, SunRice	89	High
Jasmine fragrant rice, SunRice	73	High
Long-grain rice, white, boiled 15 mins, Mahatma	50	Low
Low-GI Long-Grain rice, Brown, SunRice	54	Low

This is only a snapshot, but it indicates that there’s quite a difference in how quickly the different rice types break down to glucose in our bloodstream. It’s also worth bearing in mind that the longer you cook any rice the higher it’s GI rating will become, so try to keep it tender, not mushy.

What makes these rices different in GI is the type of starches they contain combined with the shape of the grains. The two main starches found in rice varieties are amylose and amylopectin. Wikipedia explains that high-amylose varieties of rice, the less sticky long-grain rice, have a much lower glycemic load. It’s to do with the chemical structure of the starches.

Nutritionally rice is mostly starch (80-90%). This snip from Wikipedia shows the nutritional content of Rice, white, long-grain, raw, and demonstrates that it doesn’t add a whole lot of nutrients to our meals other than carbohydrate.

By keeping your portion sizes reasonable, consuming protein foods and vegetables with your rice meal will add nutrients and lower the overall GI of the meal.

And dishes that you’ve previously always used rice in can be nutritionally enhanced by swapping in other forms of more nutritious grains such as barley, quinoa and cracked wheat. Why not do an experiment and try some swaps out for yourself? One of my dietitian colleagues makes her sushi with quinoa, and barley risotto is amazing! Here’s a recipe from Taste.com.au for it.

One trick with rice is to combine it with other grains for added fibre and nutrients and to further lower the glycemic index and improve that nutritional profile.

Fortunately more and more options are available to us.

The Australian company, SunRice, has a great range of ‘Health & Wellbeing’ rices and rice blends that you may like to consider trying.

And Coles also has recently launched some similar products that are all high in fibre and have a low glycemic index too. The varieties available are:

Brown Rice and Quinoa
Brown Rice and Chia seeds
7 Ancient Grains – a combination of brown rice, green lentils, millet, quinoa, sorghum, amaranth and chia seeds (the highest fibre variety).

These microwaveable packs usually contain 2 serves per pack. You should check the Total Carb per Serve column to check how many carb serves a ‘serve’ contains. It’s usually about two. They’re very convenient quality carb options to keep in your pantry.

Resistant starch

Just a reminder while we’re on the subject of starches, that cooked and cooled starches develop a crystalline structure which makes them resistant to digestion (hence their name) which lowers their glycemic index. So adding cooked and cooled rice to your salads is a great way of adding a serve or two of low-GI carbs to your meal to help manage your blood glucose levels and provide the many benefits associated with including low-GI carbs in each meal. The theory of resistant starch goes that if the starch resists digestion it will end up in the large bowel to feed the good bacteria which in turn improve our immunity and overall wellbeing. You can read more in the blog on fibre if you’re interested.

So I hope you learned how to make rice work better for you. Please let us know if you have any questions. Sally

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a linked list of all Sally’s Diabetes Counselling Online blogs here.

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Navigating the Australian Health System

December 18, 2014 by Imagine_David Leave a Comment

Navigating the Australian health care System

Health care in Australia is divided between Federal and State responsibility.

To make the most of the system it is wise to understand how to navigate these systems, so you can get the best ‘value’ to enable your diabetes self care plan to be most efficiently and affordably implemented.

The International Diabetes Foundation recognises that “People with diabetes have the right to understand their disease, make informed choices and receive care based on best practice. They must be part of the team that manages their condition.This can only be achieved if interdisciplinary teams and people with diabetes have the information and tools to make changes based on best practice and recognized improvement strategies are used to support meaningful system change.”

All too often people living with diabetes do not get the opportunity to have the specialist input from a diabetes educator or dietitian.

To make your diabetes self care plan most effective it is in your best interest to have an appropriate level of diabetes self management education.

A diabetes educator provides diabetes self-management education for people with diabetes. They play a major role in self-empowering the person with diabetes by focusing on an individual’s needs, providing knowledge, motivation and support to aid the prevention of diabetes related health complications.

Diabetes Educators have many years experience (some living with diabetes themselves) and can provide you with tailored education, upon the following:

Self blood glucose monitoring.
Oral hypoglycaemic agents.
Insulin initiation and titration.
Sick day guidelines.
Hypoglycaemia recognition and management.
Complication risk management.

Accredited Practising Dietitians can, in addition, provide you with a nutritional assessment and advice tailored to your individual needs, in addition to education upon the following:

Influence of nutrition on blood glucose control.
Carbohydrate counting and information.
Weight management.
Blood lipid management.
Related health issues.
Complication management.
Hypoglycaemia recognition and management.

State Health Systems:

State health systems often provide services such a diabetes self management education courses at community health centres or in public hospitals.

These courses may be a combination of individual and group self management education sessions, usually run by a diabetes educator and a dietitian. These diabetes self management programs are usually free.

Whatever type of diabetes you have been diagnosed with, this is a good place to start.

To find out more about what is available in your area make contact with your local hospital or community health service.

005 — **Navigating the System to Better Health**

Another way to find your local diabetes self management programs is via Diabetes Australia or ADEA.

What’s Next

By initially connecting with these state funded health care professionals, you can then navigate the Medicare system with your GP to connect in an affordable manner with other members of your health care team. e.g. podiatrist, exercise physiologist, psychologist/counsellor etc (ALL of whom are covered by the Medicare system).

Medicare – Federal Government Funding

Talk with your GP about the Medicare system, whats available to people with chronic health issues like diabetes.

The Chronic Disease Management (formerly Enhanced Primary Care or EPC) — GP services on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers.

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out in the MBS.

Patients who have a chronic medical condition and complex care needs and are being managed by their GP under a GP Management Plan (item 721) and Team Care Arrangements (item 723) are eligible for Medicare rebates for certain allied health services on referral from their GP.

In summary:

Maximum of five (5) services per patient each calendar year
Medicare rebate of $48.95 per service, with out-of-pocket costs counting towards the extended Medicare safety net
Patient must have an Enhanced Primary Care (EPC) plan prepared by their GP (your GP is paid to produce this for you)
GP refers to allied health professional (referral NOT required if that health care professionals happens to be available for free in the State health care system)
Allied health professional must report back to the referring GP

CAUTION: In creating the Chronic Disease Management Plan ensure YOU and your GP knows who is available in the State health system for you to enable the best use of this plan.

Team Care Arrangements (item 723)

Provides a rebate for a GP to coordinate the preparation of TCAs for a patient who has a chronic or terminal medical condition and also requires ongoing care from a multidisciplinary team of at least three health or care providers.
In most cases the patient will already have a GPMP in place (but this is not mandatory).
The minimum claiming period is once every twelve months, supported by regular review services.
Involves the GP collaborating with the other participating providers on required treatment/services, agreeing to arrangements with the patient, documenting the arrangements and a review date in the patient’s TCAs, and providing copies of the relevant document to the collaborating providers.

**With good self care knowledge everything is possible.**

A Diabetes Self-Management Plan Review form can be downloaded here Diabetes. This document shows a guide to the goals made in collaboration between the doctor and the person living with diabetes.

CAUTION: If you have more than one of these in place, e.g 2 different doctors making 2 different plans for you, your health care provider may end up out of pocket and may charge you the full fee for service – with no rebate owing to you.

Any questions? Please ask, even the smallest of questions.

Kind Regards,

David, Diabetes Educator @ Diabetes Counselling Online

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