Why Join the Challenge?
By day, I currently work in a diabetes center; before that, I was in acute care often covering Emerg.
About 2.5 months ago, a typical day in Emerg, I had a referral to see someone for nutrition intervention. The physician’s physical assessment indicated patient X, with Type 1/2 Diabetes (latent autoimmune diabetes in adults- in short, like type 1 it precipitates from an autoimmune mechanism, however, similar to type 2, it has a slower onset and developed over time), had come in with ketoacidosis (a lack of insulin in the body to process glucose, resulting in the body burning fat to fuel itself; as a result, ketone bodies build up and turn the blood to be more acidic than it should be) as a result from the inability to pay for prescribed insulin. Of note, the doctor had flagged that the patient had overdosed on heroine as well. I make my way down to the E.R., running through possible questions to ask in my head…
I went through the basics: assessed anthropometrics (height, weight, BMI, and made a physical examination for malnutrition by looking at quadriceps, triceps, clavicles etc for signs of muscle wasting and subcutaneous fat loss), obtained a dietary recall for patient’s usual intake, asked about appetite and asked about changes in patient’s ability to attend to daily activities. An hour and a half later, I had missed half my routine questions. Motor vehicle accident – that’s when it all began to spiral downwards. No family physician, the patient had resorted to heroine as a source of pain management; the accident had left teeth damaged and gums eroded, making it difficult to chew without exacerbating pain; because the patient was on insulin, working in a kitchen was no longer a choice as the risks of having a hypoglycemic episode (low blood sugar) would endanger other’s in the kitchen. No work, no income, no family physician, minimal supports. How does one even begin to think about carbohydrate counting to adjust insulin when you are unsure of where your next meal will come from? The issue here wasn’t knowing how to prepare healthy meals to manage blood sugars, but trying to juggle the needs of paying rent, medications and food. I felt helpless as a healthcare professional, nutrition counselling was not what this patient needed, but food security. All I could do was review the basics of blood sugar management and how what we eat affects it, introduce nearby low-cost and free food resources such as community kitchens or food banks, recommend some low-cost protein sources and meal planning ideas – hope that some of it would be useful for when things have stabilized and returning home from hospital.
Nutrition has a downstream effect – you don’t feel the positive or negative consequences until months or years down the road – it’s a humble and silent like that. Usually that’s the argument for why nutrition is not usually placed as a priority. Even with diabetes where food has a much more imminent effect on health, it can still be a challenge. Patient X was one in a bunch. Every so often, someone similar to patient X walks into the clinic with their own story and challenges that it is not a question of “what to eat” but “when will I get to eat again”. At this point, I don’t even know where to begin but to be impressed and acknowledge their commitment for showing up at the appointment.
What I hope to get out of this?
The goal is to better understand the mindset of these economic challenges. Not only to build empathy, but also to experiment with different strategies to overcome these barriers to managing health and blood sugars so that I can become a better clinician in serving those who walk into the clinic. And of course, to raise awareness of the challenges our neighbours are facing and making a statement – a call for change.
Not exactly day 0, but not exaclty day 1 either. I say this because I came across this challenge a little short of notice. Due to the windstorms yesterday, I stayed in and did not purchase any groceries. Unlike everyone else, I’ll be starting the challenge on Monday and hoping to complete after Sunday. Honestly, I thought really hard about it before making the decision to post-pone my start by a day. I woke up late (it’s a Sunday), starved and highly irritable, my hunger migraines kicked in… I knew I wouldn’t be able to get to the grocery store and make mindful decisions around my purchases. $18 …. that’s all I get, I need to spend it smart. So I looked in the fridge and had an apple and a cheese sandwich, picked up my keys and head out to the store. Afterall, planning and shopping is 10% of the work eh?
Here’s my haul:
|Food Item||Quantity||Price ($)|
|Oats, Large Flake, Quaker||1kg||2.00|
|Eggs, Medium||1 dozen||2.68|
|Yogurt, Balkan Style, 6% MF, Astro||750g||1.98|
|Oriental Vegetables, Frozen||750g||2.27|
|Stone Milled Wheat, Country Harvest
|Crushed Tomatoes, Canned||796mL||0.98|
|Butternut Squash, Whole||0.800kg||1.55 (@1.94/kg)|
Total = 17.63
Some thoughts ….
As a registered dietitian working with the diabetes population, my job was to drill into people’s minds to “choose whole grains”, “half your plate vegetables”,”pair your carbohydrates with protein” and”don’t forget the dairy / alternatives”. As a consumer, I had to think “$ and satiety”. I walked through the perimeter of the grocery store as I attempt to choose healthy options the way I suggest my clients to. First stop: fresh produce. I picked up a bag of spinach at $2.97 and placed it back down, deciding to go for frozen or canned options instead. My thought? Once cooked, this bag won’t last 3 meals… and with the storm the last two days, it’s too cold for salads. Two voices in my head battled between an in-house-baked white loaf of bread for 98cents vs. whole grain bread with a 30% discount (total of 40cents more). Plain, 0% MF Greek yogurt is a staple in my fridge (I usually get the 1.75kg for $9.99, and have it for breakfast topped with fruits and homemade granola), but the price difference was too big – the decision was easy, I settled for the cheapest dairy option available to ensure I have a source of calcium in my day. Of course, I stuck with plain flavour for versatility. I cheaped out on seasoning and stuck with an already seasoned vegetable oil, which would be healtheir and more affordable than butter – margarine, 0 trans fat. Then for statiety purposes and to stabilize the blood sugars, I tried to include a few sources of protein – eggs, legumes, tofu, tuna (I wish I could afford peanut butter). Thinking about which carbohydrate I could get the most bang for my buck (15 slices of bread would only make 7 sandwiches and I have 21 meals to sustain). Finally, I decided to go with oats: an affordable, low GI, high fiber carbohydrate choice. Since I got home, I couldn’t stop thinking about the lack of peanut butter and fruit! Let’s see how many meals I can stretch this for and how creative I can get, shall we?