Danielle Dimengo grew up with an interest in diabetes because her brother is a Type I diabetic.
“Seeing all the things he had to go through piqued my interest in working with kids with diabetes,” the registered dietitian said.
Today, Dimengo spends most days seeing patients in Akron Children’s center for diabetes and endocrinology, where she assesses annual labs, medications and growth, and reviews proper carb counting and general nutrition in the context of her patients’ lives.
“I like the education part of my job because I like to see the light bulb click on in the kids when they learn about what they need to do to stay healthy,” said Dimengo, a nutrition educator for kids with diabetes.
A pump is a delivery method of insulin some patients with Type 1 diabetes use to allow for greater flexibility at mealtime and tighter control of blood sugar management.
Insulin pumps, or self-administered injections of insulin, are needed to keep a Type I diabetic’s blood sugar levels in check. Uncontrolled diabetes can affect multiple organ systems, which can ultimately lead to serious health complications.
Brooke acknowledged she has not been as compliant with carbohydrate counting as she should be when measuring out food portions. She reported sometimes “guessing” the numbers she’s entering into her pump.
After Dimengo asks Brooke about her typical breakfast, lunch and dinner, it becomes apparent that Brooke’s diet is heavy on granola bars, frozen pancakes and Go-Gurt.
“I think we need to work on doing a better job increasing protein, pairing the right foods together, and measuring our food portions out,” she explains to Brooke.
Dimengo prescribes fewer prepackaged foods and more whole foods.
“I think she fudges her numbers because she’s always in a hurry,” he says.
“Maybe if we make some changes, you can get Dad off your back,” Dimengo teases.
“What about hard boiled eggs and fresh fruit?” Dimengo asks. “I want you to pair a protein with a carb.”
Brooke seems amenable.
Dimengo explains how high-fiber foods, such as 100% whole grains, are good options to regulate blood sugar and feel full longer.
After spending nearly an hour brainstorming foods that Brooke can add to her diet, Dimengo introduces Brooke to one of her favorite carb-counting apps for her iPhone called CalorieKing.
“You always have your phone with you, so now you have a handy way to look up accurate carb counts,” she says. “Another good app for when you’re eating out is called MyFitnessPal.”
Dimengo explains that sometimes you have to go backwards a little in order to move forward.
“If you can go back to measuring foods for at least one meal a day, it will reinforce what portions look like and how many carbs are in certain portions sizes.”
The next patient of the morning is 10-year old Taylor, whose Type I diabetes is well controlled.
Since there are no major concerns related to Taylor’s health, Dimengo goes over labs, when and what he eats, and brainstorms ideas for how he could add more vegetables to his diet.
“Vegetable soups, casseroles that incorporate veggies, and even raw veggies with ranch dip are good choices,” Dimengo says.
Mom mentions that Taylor is pretty open to trying new things.
“If you cut a zucchini into circle-size chips, you can bake them in the oven with some olive oil, salt and pepper and a sprinkle of parmesan cheese,” says Dimengo. “They are yummy.”
Taylor looks skeptical, but agrees to try.
Increasing demand for registered dietitians
Many of the patients Dimengo sees suffer from failure to thrive, short stature and poor growth.
“Generally the doctors prefer we try nutritional interventions first before they move on to more invasive and expensive growth stimulation tests,” she said. “We, as dietitians, are an important piece of the puzzle. It’s nice to be needed and valued.”
Things have become so busy in diabetes and endocrinology that Children’s recently hired another dietitian to help Dimengo with the increased patient load.
“This is the first time we’ve ever had 2 dietitians working with diabetes patients,” she said.
After lunch she’ll see 2 teen patients who’ve been hospitalized because they haven’t been compliant with their treatment plans.
She’ll need to go over balanced eating, portion control, exercise and the USDA’s MyPlate model that replaced the old food guide pyramid.
“One of these kids is switching foster families, so I need to spend between 1 to 2 hours with her new family doing carb counting education.”
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