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The ADA recommends that dietary management of diabetes be handled by a registered dietician and that the plan be tailored to the individual patient. As a student provider, you probably do not have the training to fill this role.

On the other hand, you are able to ask the patient in a general way about diet and particularly any recent changes. Questions like, “Describe a typical day for you in terms of diet,” can elicit some information without getting bogged down. 

The following are the specific dietary recommendations of the ADA and are presented for your education. Again, you are not expected to obtain all this information from the patient.

• Low carbohydrate diets are not recommended for diabetic patients
• Saturated fats should be <7 percent of calories
• Protein intake should be <= 0.8mg/kg for patients with any degree of kidney disease
• Minimize intake of trans fat
• Weight loss is recommended for any patient with diabetes type 2 with BMI >25
• Routine supplementation with antioxidants is not recommended

Also ask the patient about any weight changes recently, any digestive problems, and note any dietary questions that you can pass along to your attending physician.

While you may not have the skills to assess the fat and carbohydrate content of a person’s diet, you often can assess behaviors that may lead to obesity and worsened glucose control. For example, skipping breakfast has been associated with weight gain so you can ask them if they eat breakfast or not and to consider starting if they don’t. Substituting noncalorie drinks for regular pop can quickly lead to a reduction in calories and successful weight loss.

You can also ask the person to assess their own behaviors by asking questions like these:

• “Do you think you have made any improvements in your diet since last visit, and if so, what kinds?”
• “Do you think you have more problems limiting the quantities of food you eat, or do you struggle with choosing healthy kinds of foods?”
• “What do you think would be a diet goal you can work on before next visit?”