Did you say, Casey?
Jillian Pate: There you go.
Natalie Tappe: Well, there we go.
Jillian Pate: Thank you.
Kasey Stevens | Quality Insights: Alrighty. We have a lot of content to cover today. So I'm gonna go ahead and get started.
Natalie Tappe: Okay.
Kasey Stevens | Quality Insights: so good afternoon and welcome to our webinar diabetes control for Chronic Kidney Disease Prevention. My name is Casey Stevens. And I'm communication, specialist, quality, insight.
Kasey Stevens | Quality Insights: Everyone has entered the webinar on mute. But we will have a discussion following the pre presentation, depending on time. You have any questions or comments, please submit them, using either the chat or the QA. Tool in your Zoom menu. You can also raise your hand to be unmuted and ask your question aloud. Today will be discussing diabetes control
Kasey Stevens | Quality Insights: for chronic kidney disease prevention. We're going to start with a pre knowledge kept check. So we can further evaluate what was learned here today.
Kasey Stevens | Quality Insights: So if you will take the time to scan the QR code on the screen, I'll also drop that link in the chat so you can answer those couple of questions. I think there's only 8, and a lot of them are simple. Just go ahead and start
Kasey Stevens | Quality Insights: filling those out
Kasey Stevens | Quality Insights: to the best of your ability before we get started today. Go ahead and drop that into the chat as well.
Kasey Stevens | Quality Insights: Alrighty.
Kasey Stevens | Quality Insights: And so this webinar is also eligible for continuing education credits today. For nursing as well as dietitian continuing professional education credits. You can see the details about those credits here. If you're interested in obtaining credit, you'll need to stay for the entire webinar. That is, 60 min and complete an evaluation and knowledge check. We'll share the link to the evaluation at the end of today's discussion. And now I'd like to introduce our presenter today. Renal dietitian nutritionist. Gillian Paig
Kasey Stevens | Quality Insights: as a renal dietician. Gillian has worked in the kidney world for over 7 years. During this time she realized the importance of preventative nutrition education for those with CKD.
Kasey Stevens | Quality Insights: Her vision for clients is to gain a better understanding of their own personal walk with CKD. And how she can provide the appropriate recommendations and resources to help them feel educated, encouraged, and empowered.
Kasey Stevens | Quality Insights: All right, and without further ado, I'll let jelly and take control from here.
Jillian Pate: Alright. Good afternoon, everyone. I'm gonna get control over it real quick, and then we will get started.
Jillian Pate: thank you, Casey, for my introduction. I kind of slide over that slide.
and it would help if it was like actually wanting to let me control it.
Jillian Pate: Okay, so while I'm getting it rolling just as
Jillian Pate: just as kind of another overview. I have been fortunate to be in the kidney world for the last 7 to almost 8 years. It was something that I didn't have a lot of education on in college in my undergrad and graduate school.
Jillian Pate: and I just really fell in love with
Jillian Pate: just kind of the subset of Reno, because you don't get a lot
of just really more detail with it
Jillian Pate: should be good.
Jillian Pate: Casey. It says I have control, but then it's okay. Here we go. Here we go.
I apologize. kept saying I had control, and then it wasn't doing much.
Jillian Pate: Okay.
Jillian Pate: alright. So part of our presentation. These are some of the objectives that I am going to review. Really. So that way you guys could walk away. I know you guys just took your pre test. But these are some things that I want you guys to walk away with today. Of course, understanding the mechanism of you know, really, how blood glucose
Jillian Pate: control can prevent Ckd progression. Really identifying the role that, as you know, as a dietician that we play in medical nutrition therapy to hold Ckd progression. But then also really kind of go further to explain really the difference between a registered dietician and a renal dietician, and how we can start implementing kidney nutrition.
Jillian Pate: Okay, so a little bit about, you know, with the kidneys. Obviously, we know the importance of our kidneys. But I always think it's a nice little refresher just to
Jillian Pate: just to kind of heads up. Because I'm gonna talk about some of these issues as I talk about the nutrition side of it. So, of course, with our kidneys, they are thankfully in charge of removing waste products, removing excess fluids. However, they also critically regulate our sodium potassium and protein levels.
Jillian Pate: And so a lot of times with chronic kidney disease. What we're gonna see is the most prevalent cases of that is gonna be if maybe you've already had another chronic disease state, such as diabetes. Maybe you have hypertension polycystic kidney disease as well as kidney stones.
Jillian Pate: So I wanted to put this in there. Many of you guys might have heard. You know, the National Kidney Foundation. They do a great job of really putting the awareness out there. About 37 37 is kind of their challenge. They use a lot as far as like walking 37 miles through a month, you know, really bringing awareness out. And the reason be behind. That is because we have right now 37 million Americans with chronic kidney disease
and the leading cause of kidney chronic kidney disease is diabetes. So I was really grateful for this opportunity today to talk a little bit more about how us, having more control over diabetes, and how that can further
Jillian Pate: halt further progression with chronic kidney disease. You can see right there. It says, 40% of individuals with diabetes end up having C kb.
Jillian Pate: and just to throw out there. I'm not gonna really touch much on hospitalizations, or really the costs so much. But I did wanna put that out there. This was something in my previous research. But an average hospitalization for someone with C. Kd is around $18,000 per hospitalization. So just like anything you know us getting out there and providing more prevention, you know, that's where. Not only were we gonna halt the progression. But we're also gonna help out with reducing the rising rates
Jillian Pate: of healthcare.
So how does blood glucose affect your kidney function? If you know if we're in the healthcare system, you know. One of the very first things that I learned is, even though there might be so many things that are in critical condition. As a dietician. One of the very first things we look at is what their blood sugar looks like, because that can affect so many things
Jillian Pate: with hypoglycemia. Really, the way it has an impact on our kidneys is that it goes right after the vascular system. You know, the higher our blood sugar stays it cont, and especially in a continuous state, it's gonna really wear and tear down our vascular system and the nephrons in our kidneys, which, of course, are filtering. You know our blood or fluid once again, and you know, really attacking all the things that our kidneys are known to take care of
Jillian Pate: it also is, you know, it's forcing the kidneys to work harder, due to the increased blood flow. So one of the ways that by us controlling blood sugar is that we're able to get that more into a stabilized state. It's gonna help lessen the workload of our kidneys, which overall is gonna help reduce the rate of them actually getting chronic kidney disease.
Jillian Pate: So looking at, you know, the difference really between type one and type 2 diabetes, you know, with type. One diabetes we often, you know, recommend within the first 10 to 15 years after onset of type, one diabetes. That is, sometimes when you're gonna see Ck to present itself.
Jillian Pate: it's a little different, though, with type 2, mainly because a lot of times, you know, individuals can have type 2 diabetes for a number of years before actually getting diagnosed. It's more common, of course, with type one to be diagnosed based on symptoms and have that taken care of a little bit more quickly and promptly. So typically your medical care team is, gonna be a little bit more hands on deck with your kidney health.
Jillian Pate: But with type 2, a lot of times you're not. You're almost gonna have Ckd. By the time your di type 2 diabetes presents itself due to the delay in diagnosing
Jillian Pate: something I wanna mention that was on that last slide. But I went ahead and just wanted to touch it now is, you know, protein and the urine. So a lot of times when we see that protein present in our ur analysis that commonly indicates kidney disease. So not only are we looking at some of the other markers, such as Creatine and their Gfr. And just different functions of their kidneys, but we're also looking in the Uranalysis to see how much protein spillage is actually in
Jillian Pate: in their urine.
Jillian Pate: So I wanted to quickly kind of identify some of the symptoms that we would see with someone with chronic kidney disease.
Jillian Pate: And as you can kind of read over these, they actually kind of cover a numerous amount of diagnoses. So you look at, you know, less energy trouble concentrating, you know, urinating more often than normal. You know some of those symptoms. Of course they mimic diabetes in general, so if you already have diabetes, you might not always think that it's related to your kidneys. Just more of your diabetes. State.
Jillian Pate: You know, if your feet ankles are staying swollen. That, of course, can also mimic. If you have a history of hypertension, and you're already dealing with fluid balance, so you wouldn't always necessarily think that that's your kidneys.
Jillian Pate: However, when you do start seeing your urine becoming more foamy, or you might have blood in your urine. That is something that kind of triggers for kidney disease as well as poor appetite.
Jillian Pate: So part of the diagnosing process of C. Kd, and this is one that I like to discuss is because if we are only seeing patients or individuals, you know, and
Jillian Pate: either you know, an emergent standing at the hospitals, or if we're getting a little bit of blood work here and there, it's really hard to identify what's going on right with any kind of disease. State a lot of times. We're looking at their routine lab work for over like a 3 month stance. If we're starting to see their kidney numbers being elevated. We're not just gonna automatically look at that and think, okay, they have chronic kidney disease. We're gonna take it a little bit further. Get a couple more trends to go off of before truly diagnosing them with C. Kd.
Jillian Pate: we look, of course, at their lifestyle here in the Appalachia area. Unfortunately, it's a little bit more common to have a secondary lifestyle which in turn tends to be more in our obese population
Jillian Pate: that we run into that genetics do play a marker in C Kd, especially if you have polycystic kidney disease. It's a little bit different polycystic kidney disease, and C Kd, we do take care of them a little differently, but at the end of the day we are looking at the decline of their kidneys.
Jillian Pate: And then, if they have another chronic kidney disease, state or another chronic disease state, such as diabetes. If you have a great care team. They're often going to jump on and start marking their kidney numbers as well as checking with their A one. C,
Jillian Pate: okay. So I wanted to kind of go over if you're not familiar with. But there are 5 stages of kidney disease. Oftentimes the first stage. You almost don't even know you have it, of course, because your Gfr is pretty much remaining above 90. This is pretty common. When you're in the hospital you might have an acute kidney injury.
Jillian Pate: Stage 2. That's often when you're gonna start seeing a little bit of decline, you can see the Gfrs between 60 and 89 typically minimal side effects. This is ideally when we want to catch it. But that's not always the case. Stage 3 is typically the most common of individuals that I work with.
Jillian Pate: mainly because this is when some of their symptoms are rise. A lot of times that they're hospitalized honestly to a different diagnosis. Then that's when some lab work will come out and they'll realize that they're already stage 3 chronic kidney disease
Jillian Pate: stage 4. You're gonna start seeing a drastic state. Drastic kinda decline, poor appetite. Very low energy like, I said. Some of these, you know, some of these side effects are challenging, because if we already have someone that's dealing with other disease states, you know, it's hard for them to really pinpoint that it might be their kidneys.
Jillian Pate: And then, of course, Stage 5 is when they get critical. If they're following the kidney doctor regularly, that's when they'll pretty much be recommended to start dialysis, however, some that might have really have been diagnosed with Stage 3, C. Kb, you know, about 10 years ago, and unfortunately stay kind of non-compliant with any kind of interventions, they might end up going to the hospital due to feeling so poor, due to the toxins billing up in their body.
and then at that time be started on dialysis in the hospital. So the way reason I wanted to kind of stack this out is because between Stage 3 and stage 4. We really have that opportunity to halt further progression. Especially with
Jillian Pate: with nutrition, but also making sure that we're identifying. If these are our diabetic patients. What we can do to continue to halt further decline. And one of the things I specifically target when I first talk to my patients is okay, are you diabetic? If they respond, yes, we identify. Okay, what is your blood sugar been running? What's your A one? C, I can say, hands down. I have a majority of my patients. I do not check
Jillian Pate: regularly. And so that's kind of where we start. We start with. Okay, let's start checking it. Let's make sure you have the supplies that you need, and then we're gonna be able to build off of that to get better control.
Jillian Pate: Okay? So as a dietician. what I provide is called medical nutrition therapy.
Jillian Pate: and part of that is, I am assessing. You know, I'm assessing their symptoms. I'm really kind of assessing the whole situation, because when I do things, I look at everything at a very individualized approach, which is one of the reasons I love. What I do is because
Jillian Pate: it's a pretty big stigma with dieticians that we pretty much take things away from. You know them the patients that we're working with. We take away everything that they're enjoying. We kind of. We put off all the things that really help them enjoy their life. And that's just not true. What we're doing is we're coming in and we're trying to kind of assess the whole situation. Meet them where they're at here in the Appalachian area always like to address that. There are plenty of options. We just have to get the right resources in their hands.
Jillian Pate: So we assess symptoms. We review lab work. We, of course, monitor their blood glucose labs as well as we encourage them to get their A one C. Check twice a year at least at the minimum.
Jillian Pate: Then we kind of dive right in as far as looking more at their sodium, the protein potassium. And I'm gonna talk a little bit about that in just a moment.
Jillian Pate: So often times you'll find us as dieticians in a couple of different settings in the hospital setting. You know, a lot of times we can get referred while they're in house when they're in acute the hardest part about this, though, is typically when we have a patient that's in the hospital setting, they're normally in there, due to some sort of element that has helped them enough to make them stay in in acute setting, which means this is not the ideal time for a dietician really to be able to provide all the expertise we have to give.
The best case scenario is that they have a great support system at cheerside, that we can kind of start going over some different
Jillian Pate: support systems as far as controlling their blood sugar. As well as you know, really kind of reviewing any of the most pertinent labs that we have right there in front of us. But ideally outpatient setting is where we're gonna get most of our impact working one on one with our patients.
Jillian Pate: So there, of course, with anything any kind of intervention working with providers? You know there's always going to be some barriers.
Jillian Pate: So I wanted to take the next couple of slides to go over some things that I personally have dealt with
Jillian Pate: with some of my patients that I work with. So this is a very common statement, but it says my doctor doesn't think a nutrition consult is needed at this time.
Jillian Pate: I do think a lot of times physicians or other providers, you know. Nowadays we are so quick to have to get through what we need to get through, to add another subset to add another topic to their conversation to make it go out further. It almost just seems like I can take care of this. Let's just do these very minimal steps, and you'll be fine.
Jillian Pate: But what I've ran into, though, is the patients that I do start working with, and oftentimes it's after they stop me out instead of the doctor referring is, they're completely overwhelmed with how much they have to change in their diet, that it's almost kind of baffling that we don't address it sooner.
Jillian Pate: And so that's what kinda goes into. This next one is, I was so concerned what I could and could not eat with diabetes, so I just stopped eating, and this is the same thing. So I've heard the same verbiage with diabetes, with C. Kd. Whenever you get a new medical diagnosis, and I'm sure I can relate to many of you is, you know, whenever we hear something, our first reaction, our first response is that we often wanna go online. We want to research. We want to figure out what's going on.
Jillian Pate: I will say this, it helps when you're an educated medical professional, because you can kind of essentially filter through a lot of the verbiage you can filter through recognizing things that are just appropriate and things that are just so off off canter. But with our patients and the people we're working with, if they start Googling and doing their own research, they're gonna get to a point that they are so overwhelmed that they are going to stop eating, or they're going to limit themselves so much.
Jillian Pate: That is, doesn't even pertain to them, because once again, everything that we work on from a nutrition standpoint, it has to be individualized, especially with their lab work. Just because you have chronic kidney disease does not mean that you have to stay away from all the other foods that someone else with chronic kidney disease would have.
Jillian Pate: So I'm sure that you might have heard this before. Diabetes has taken everything I love to eat away from me. You know a lot of times we have that stigma with diabetes as far as having to reduce our carbohydrate, having to take away all of our suites especially, you know, this time of the year we're going to holiday season and it gets very overwhelming, because if they have really been on target with their blood sugar, they're really nervous. They're very scared about things to
Jillian Pate: limit. They're nervous about things that they normally would have with their family members around this time of the year. So instead of actually understanding the importance of moderation and portion. And what we're really looking at.
Jillian Pate: You know, and it's easy when when we work in this, and we see the benefit of, you know, hey? If you're gonna have, you know pumpkin pie with your Thanksgiving dinner, just eat it a little bit closer to your meal time so that way your body doesn't shoot your blood sugar straight up, you know. It's small little interventions like that that really can help them enjoy the time that they are, you know, with family, and just to really walk out their life with their chronic disease diagnosis.
Jillian Pate: So some of the barriers I most commonly seen is that there really isn't enough dietitian support. Patients are not being referred to our services as well as we're looking at cost of services. You know, we once again we're looking at another provider. But at the same time, if we're looking at, you know, referring to another provider, sometimes the patients are, gonna look at. This is just another expense. This is just another bill, and I can't. I can't do that.
Jillian Pate: Transportation is also a barrier.
Jillian Pate: But what I always like to do, and it's just my personality is. I always like to spin it. I always like to stay optimistic with how we can make the situation better. I know the importance of building rapport with providers. I know the importance of us creating a better referral based system as well as how important it is for us to get credentialized as dieticians in the insurance field. So that way, we can actually build insurance companies and really reduce that that burden of our patients having to pay out of pocket.
Jillian Pate: Where I live. Telehealth is huge. I will say that is something that you know, unfortunately, came out of the pandemic, but it has really benefited our healthcare system by being able to provide telehealth services more regularly. And that's actually where I see the majority of my patients now.
Jillian Pate: So how can a dietician benefit your interdisciplinary team?
Jillian Pate: So what we're here for today, of course, is talking about blood glucose control. You know we are another person to be on the team to really help support that blood, glucose control. And the way we do. It is not just giving them a meal plan, but really sitting down, walking them through, educating them on what we're looking at. II don't feel like. It's beneficial to just have this handout in a in a doctor's office just a hand to them and say, these are the things that you should stay away from, or these are the things.
This is the meal plan followed exactly, because it's gonna look so different. And why not take a little extra time
Jillian Pate: to recognize like, hey? He doesn't like asparagus he doesn't like. He doesn't like drinking milk, he doesn't, you know, like a lot of things, not this meal planes, not gonna work. Well, guess what we can sit down. And we can. We can really kind of work through what this person likes and doesn't like to make sure that they are staying nourished. Make sure that they're enjoying what they're eating and at the same time getting control of their blood glucose level
Jillian Pate: with that we're helping to reduce hospitalizations.
Jillian Pate: because one thing that I've noticed is if we're not addressing their hyperglycemia, if we're not addressing you know their blood glucose that could honestly, the longer it goes on, could then stem down to C. Kd. Also it can go into other cardiovascular issues. So by us doing that. We're helping to reduce hospitalizations
Jillian Pate: by taking that little bit of extra time. We're also having the opportunity to address any kind of food insecurities. So if I'm talking with someone and they're they're pretty much being transparent with me and saying, You know what I can't afford some of these foods. II won't even know what some of these foods are. You know, it's our job that we can actually take a step back work with social workers in the area work with the food bank work, with other, you know, resources that are available to help them get some of these nourishments into their home.
And that is something that we've been working with. The facing Hunger Food Bank is they actually have a food is medicine program.
Jillian Pate: And I love that because we're not only providing these individuals with food, but we're actually giving them food that's going to benefit their chronic disease state.
Jillian Pate: And then something I like to touch on is that we also help improve their medication adherence. And really, the way we tie into that is because you gotta think if I have a patient that I'm working with.
Jillian Pate: Say, they're not eating like they should be. Their blood sugars all over the place. Say that. They just really limit to their intake. They're not drinking as much a lot of times if they keep taking their medication as prescribed, it could cause a lot of Gi. Distress which then in turn would actually make them want to stop taking their medics medication.
Jillian Pate: Also, if they've reduced their intake, they also might have reduced their body weight. So blood pressure, medication, different things like that. Even their you know, their medication they're on for their diabetes might not be appropriate due to the weight loss. So there's a lot of benefits by us coming in and helping them feel more confident with their intake. So that way when they're continuing with their medications, they're gonna continue to feel the best they can.
Jillian Pate: So did you know, there is actually a hundred 11,000 registered dieticians here in the United States. Out of that there is actually 570 that are renal dieticians. And here in West Virginia we have 2 renal dieticians myself and my friend that has worked with
Jillian Pate: the transplant center up at Camc. And I'm excited for her cause. She is continuing to move on to more endeavors with Cmc. But she is our other renal dietician here in West Virginia.
Jillian Pate: So as a dietician, I get asked pretty often, you know what's the difference between a dietician and a renal dietician, and it's just like any other professional in the healthcare system. Whenever we can take a little bit of time. Do a little bit more research and kinda make that our specialty. That's where I feel like we can provide the best support.
I'm still a dietician through and through. So I have several dieticians that reach out to me asking me questions about kidney nutrition. I love it because I'm able to share my expertise with them on things that we would normally look at.
Jillian Pate: So what we do, though, is we just take a closer look, and where we see kidney patients on a more consistent basis. it really opens up the opportunity for us to see other areas of where nutrition can play a big part. So once again, we're continuing to individualize the goals. You know, based on their current diagnoses, on their lab results.
Jillian Pate: We're, of course, addressing their blood glucose control. But something that I mentioned earlier is, we also review feuds high and potassium, phosphorus and sodium the fluid sodium balance in their body, you know, that is something that we talk about on a on a continuous basis, because once again, I don't want to just hand out
Jillian Pate: information that's just giving them just the simple basics of stay away from this and stay away from that. But I really want them to understand like, Hey, if you reduce your sodium intake. Or if you would choose this product over that product, you're gonna start seeing some swelling going down, and that is hands down when I'm working with someone with
Jillian Pate: swelling issues. You know one of the best things ever is when they message me and tell me that they can get their shoes on for that week. So really meeting them where they're at helping them have those nutritional interventions
Jillian Pate: in place so that way they can just feel confident. I think that's where it's at. We gotta be confident with what we're recommending to our patients. Because, of course, that intern is gonna help them stay confident. So protein is something that we talk about often.
Jillian Pate: with blood, glucose control. This is huge. Okay? So as a diabetic. If I'm just looking at someone that has diabetes. I am always talking about the consistency of protein. Protein, you know, is what's gonna help halt that blood sugar to really kinda spike up. It's gonna help. You have more of that gradual just steady blood glucose level during after your meal times.
Jillian Pate: With protein. It's gonna help. You know, promote wound healing, you know, in the diabetic setting we wanna make sure that any of these diabetic ulcers anything that's coming about where we know that blood having a higher blood sugar is really against that wound healing. We always wanna make sure we're incorporating enough protein with that.
Jillian Pate: So this is something that we always talk about and encourage on a consistent basis. But what happens is when you actually have chronic kidney disease. We have to kind of scale back on how much protein we're having a day.
Jillian Pate: This can be really challenging. Because if you're a diabetic and you find out and you're really trying to get blood glucose control. And you really start pushing that protein very hard with each meal. But you might not know that you have chronic kidney disease which you really could be doing in turn, is actually harming your kidneys more, your blood sugar might be seen a little bit of improvement there, but you're also making your kidneys have to work a lot harder.
Jillian Pate: So in turn, it's we're not really always getting the best benefit. So that's where, as a dietation. We come in. You can see some of the medical nutrition therapy parameters I have there on the screen. I look at really what stage of chronic kidney disease are at.
Jillian Pate: I assess if they have diabetes, because once again, like I said, that that does kind of determine how much protein I'm going to be recommending, and at the end of the day our body. What it does is it takes that protein, it breaks it down into waste in our body. So by us kind of pulling back on how much protein we're doing. It's making our kidneys work a little bit less and not be so strained all the time.
Jillian Pate: Real quick. I didn't put this in my slide, but I just, you know, think it's something good to bring up is a lot of times when we hear the diagnosis of C Kd. And pulling back on protein. It's very quick to want to pull back and do more of a vegetarian lifestyle. Pull away from all animal based products. And really, what I can say to that is
Jillian Pate: depending on your patient. If they truly rely on animal based protein for every single meal throughout the week. That's what they live on. I wouldn't go to a complete extreme. I mean, recognize the area. Recognize the clientele you're working with? Is it really feasible and start scaling back? Absolutely? I have seen vegetarian lifestyles work tremendously because vegetarian or plant based protein essentially isn't gonna be as harsh on your kidneys
Jillian Pate: as you know. It doesn't have much of a waste product like, you know, animal products do. But I just wanna say it's not one of those things that has to be one extreme or the other. I think it's essentially just starting to pull back some and and really explaining that to we're working with so that way they feel more comfortable with why, they are, you know
Jillian Pate: why, they're stubbing out their steak for a little bit more of like a a bean dish. You know things like that.
Jillian Pate: So potassium potassium is something that we look at. You know this is something that is promoting our heart to squeeze up blood through the body. You know it helps promote muscle movement, and also it filters blood through the kidney
Jillian Pate: a lot of times with potassium, you know. It's so important for our heart. But a lot of times we don't recognize the relationship that our kidneys and our heart have hand in hand with this potassium
Jillian Pate: there is a guide that I do use for this that has, like higher, lower potassium foods.
Jillian Pate: I have some people that have C Kd. And honestly, the way their their body is responding to this disease state. It sometimes can be really quickly that their kidneys are no longer filtering out that potassium.
But then there's some that their body is still having some of that filtration going, and potassium isn't much of an issue.
Jillian Pate: What I run into is someone that finds out they have chronic kidney disease and completely avoids potatoes and and bananas and orange juice and tomatoes, and all the things they love that are high potassium. And honestly, they might start out, and they actually have a lower potassium, and they could get themselves in trouble for reducing their potassium so significantly. So that's why we really have to encourage them not to always rely on their research, because once again, if they're filtering through at their own discretion.
they might not realize the importance of so keeping a moderate potassium intake
Jillian Pate: diet. And that's really where a lot of my patients stay. I have some, of course, that are on low potassium diets, but more so than none. They stay on a moderate potassium diet
mit ctl and phosphorus. So phosphorus is something I wanted you to address, because unless you're familiar with the kidney world, you don't often hear of phosphorus 150.
Jillian Pate: So phosphorus along with calcium, they work hand in hand to work up our bone health. So once again our kidneys not only help us get rid of the waste and the fluid, but they are really in charge of our bone. Health as well.
Phosphorus
Jillian Pate: is something that is normally able to be filtered through our kidneys on a regular basis. However, if we are not having that filtration like our kidneys normally provide for us then at times that phosphorus is not gonna rem be removed from. But our body. And what it's gonna do is it's just gonna stay in our system. And it's gonna essentially add, like another toxin in our body. It's gonna really be harsh on our vascular system. It's gonna help trying to keep in that calcium. It's gonna kind of resist that calcium a little bit and make our bones feel more brittle and weak.
Jillian Pate: So one of the best things we can do to help reduce that phosphorus level is, of course, address it with diet. It's honestly, most commonly found in more processed foods. Dark Colas. Lunch means dairy products, things like that. Honestly, things that a lot of my patients heavily rely on.
Jillian Pate: So we start just kinda really start sliding back on that a little bit. Really watch a portion, you know, if we're drinking, you know 6 Pepsi's a day. Can we move back to? You know? 3. We start where we're at and just kinda work there just to help, you know. See those numbers start coming down? There is also medication called a phosphate binder. Not many of my C. Kd patients are on phosphate binders, or more so on it when they get on dialysis. But that is another way to get that removed from their body.
Jillian Pate: Okay, so I wanted to show you guys as a provider what a referral model kind of looks like right now. So this is kind of kind of spinning down from like a hospital setting. Okay? So, as you can see, you know, when we are ready to discharge a patient from the hospital. We are making sure that we are having a lot of check marks off.
Jillian Pate: You know. We're looking at making sure they have a follow-up appointment with their Pcp. Any pertinent medications being called into their pharmacy. If home health consults are applicable, we're doing that. We're getting medical supplies ordered, and then I had to throw this one in there about the survey call, because I feel like that is a very consistent, consistent thing. After they leave the hospitals to get those survey calls
so. But with that you can kind of see that's like our frontline defense. We see someone we take care of these things, you know.
Jillian Pate: and then at that time, just looking over there at the PC. Follow up appointment, and then at that point steps down and you can see it refers to other disciplines based on like, why that patient was hospitalized. So, for example, you know, if we have a patient that has uncontrolled diabetes, goes into the hospital. With hyper, calci or hyper
Jillian Pate: glycaemia, or they're in the hospital like they're end up being dka things like that. They get them stable, they're ready to discharge. They make sure to take care of all these situations, especially if that patient may have been out of medications. And that's what caused some of these issues. And that's kind of where we take care. But we almost essentially kind of put a Band-aid on that situation.
Jillian Pate: but something that, and a very biased standpoint. I'm gonna honestly put that out. There is. This is where medical nutrition therapy can really make more of a difference. Okay? So I've just spent the last several moments talking to you guys about you know what C. Kd kind of looks like, what dietitians can do.
Jillian Pate: But here's the thing. At the end of the day we have to get our ourselves in there as been seen as a provider, so that way we can when this patient is getting discharged with high blood sugars? Maybe they honestly have found out that they now have chronic kidney disease due to their diabetes. We wanna be right there with our medical nutrition therapy able to help right there. Now, I'm not naive. I recognize that there are some patients that are not really going to want our services. Like I said, there is a very big stigma there
Jillian Pate: that
Jillian Pate: we're essentially gonna take away everything that they enjoy eating, that we're going to make things not really applicable for them, for their finances, for where they're at they honestly might be really overwhelmed if they are in the hospital. They're not feeling their best, you know we're going to. We're going to realize that, you know, this might not always be the best opportunity to catch them. But from a dietician standpoint, even if we can get their information referred to as dieticians.
Jillian Pate: and even reach out to them a week or so later to get that set up. That's really helping us set the opportunity for us to get in there, because with doing this, you can see up here on the front line. We're getting straight in versus down there, many steps down down the road. We might eventually get in touch with some of these patients.
Jillian Pate: Nope, it's not the one. Okay.
Thank you.
Jillian Pate: Okay, cost of services. So once again.
Jillian Pate: you know, there are a lot of medical nutrition therapy coverage now through insurance companies. Thankfully, Medicare has really kind of set the lead on that so as a dietician, we can provide up to 4 visits a year. However, if
Jillian Pate: you're diabetic, or you have Ckb or other chronic disease states, you know, all we have to do is reach out to the referring provider and get almost like another need for be seeing the dietician. And then at that point they actually get unlimited coverage
Jillian Pate: which is free to our patients now, if they have if they have like a secondary things like that, I'm not gonna go too much into that. But you know there's other ways that we can
Jillian Pate: provider services to that way. They're not is, I mean, I think the most I've had a patient have to pay out of pocket is, you know, a very small amount. But typically what we like to do is we like to be able to provide this through insurance that way. They can get the best help you know, paying out of pocket. It's not always feasible. I don't ever want our medical nutrition therapy services to be a barrier due to finances. So we try to make that as accessible as possible.
Jillian Pate: So I pulled out this statement because I felt like it was just really pertinent for kind of what we talked about today, but it says structured education is critical to engage people with diabetes and C. Kd. To self manage their chronic disease state. I know that's a lot of verbage. But essentially what I loved is that it says we want to promote more diabetes, self management programs.
Jillian Pate: This is where it's at. Not only do we wanna be there to educate and support. We wanna show them step by step, making them feel more comfortable in the process. There has been so many great resources through the year, and I don't ever wanna discredit the professionals before me that have really, you know, led the way. They have made so many things easier for us as providers. Now to get to these patients and to have the information we need to help
Jillian Pate: provide them. The nutrition education. But where we're at now is we are seeing such a rise in chronic kidney disease that we have to come to a point that if diabetes is the biggest
Jillian Pate: target area of chronic disease state, what we do is we have to scale back, and we have to recognize that those with diabetes, those with that diagnosis.
we gotta get them in for more preventative screenings, you know, getting them to feel more accountable and take initiative. And and like I said, I'm not naive. I've worked in the health care setting for a really long time, and we can say all these things, and we can have all of these agendas and and initiatives for things, and at the end of the day we can't make them do anything that they don't wanna do. But as far as I'm concerned, we can still be there to kinda stand in the gap for them. We can be there to be able to provide these resources.
Jillian Pate: hear them out, make them feel like they're not alone. Give them the support they need. And really, as providers lean on one another to recognize that it's not just a one person. Show that we need one another to be able to have that accountability, to be able to have the referrals to be able to have that support system really in our professional world. So that way we can then pour it out into
Jillian Pate: the people that we're working with.
Jillian Pate: So this is something that I kinda currently work on. And I just kinda wanted to show you what a flow would look like working with a dietician is, you know, once we get a referral we essentially work with it. We take these, we take these
Jillian Pate: these patients that we're working with. With my practice. What we do is whenever I get a referral from a doctor I look at them, I guess. Signed, you know, to them. We make sure that they are getting scheduled in a timely manner, because I know that if we wait too long after referral, it's so much harder to capture these patients. We wanna make sure
Jillian Pate: that they are being contacted. We wanna make sure that they know really what we provide know that the services are covered know pretty much. Try to really identify any barriers early on. So that way we can set up the most successful program for these patients. Once again, collaborations huge. I make collaborate with their physician. Whoever is there referring nurses, anything like that that we can talk to, to really make sure all hands are on deck.
Jillian Pate: I initiate a program that helps really, us just focus on what we're looking at a lot of times it's gonna start. It might start slow, because once again, if their blood sugar is not controlled, we always start there because I know hands down. If if they are already C. Kd. Stage 3 or stage 4. They're getting worrisome. They're they're pretty much grasping at straw, saying, Hey, what can I do to stop this kidney disease when I tell them, hey, do you have diabetes? And they say, Yes, and I say.
Jillian Pate: Okay, you know, what's your blood sugar running? Oh, I'm not sure. What was your last? A one? C, maybe 8. I don't know. It's been a while. Okay, then I'm like, okay. Well, then, let's focus on getting your blood sugar taken care of. Let's look at that a lot of times you're like, well, I mean, I'm taking metform, and I'm taking this. I'm taking that. And it's like that's great. But we have to. We have to take a step back, and we have to recognize until we can get their blood sugar in control.
Jillian Pate: We're truly not gonna be able to make that much of an impact with their chronic kidney disease until we get that blood sugar controlled. Get that vascular system to to be a little bit more supportive. So it's not so much wear and tear. I mean, it is truly, it is truly that simple that if we can just get more of their attention on what we need to look at, we're gonna be able to help help further progression.
Jillian Pate: And that's essentially with where we're at. We don't want to see more patients going on. Dialysis dialysis is booming and the C Kb. Rates are rising, and you know diabetes has been such a hot topic for so long.
Jillian Pate: and at the end of the day it's just going to continue to take.
Jillian Pate: you know, the providers and real dieticians and dieticians stepping in and really being seen as you know, as a provider, just like everyone else.
Jillian Pate: Alright, and that is a very winded conversation. But I really do wanna just say thank you for giving me the opportunity to just really kind of give you a little bit more insight to what it looks like being a renal dietician, and what we can do to help support. You know. Ckd. Prevention.
Kasey Stevens | Quality Insights: Thank you so much, Julian. We really appreciate you joining us today. I'll let anyone who has a question kind of start to filter those into the chat or the QA. And while we're waiting on those
Kasey Stevens | Quality Insights: I'd like to run over a few closing items first. I'd like to remind everyone wanting ces and cpees for today's webinar to stick around to the end. So we can direct you to the post Webinar evaluation
Kasey Stevens | Quality Insights: so we're going to advance the next couple of slides here. So here is a link to the evaluation and post knowledge check. I'll also drop a link to that in the chat so that way you can have it. But you can also scan the QR code on your screen as well in order to receive your free nursing cease or dietition cps and certificate of completion, you will need to complete the evaluation and post knowledge check. Once you have successfully completed both, you will be forwarded your certificate.
Kasey Stevens | Quality Insights: as you can see. Here, we've got a couple of ways for you to do that.
Kasey Stevens | Quality Insights: Or you can wait until in the webinar, you'll see a pop up window from Zoom and asking if you'd like a link to the evaluation, and then if you have any questions about Ce. Cpe's or the certificate you receive at the end of the evaluation. You can email Andrea Lefkay at a left K at quality insights.org, or if you have other questions, you can contact me at case Stevens at quality insights.org alrighty. So, Julian, it looks like we've got a couple of questions here in the chat.
Kasey Stevens | Quality Insights: one is, how do we get a copy of the recording? And that will be emailed to you? Later this week, and also be available on our website in case someone you know really missed this help for information today? We'll have that available and someone else just said, Thank you for the information. So I'm gonna go ahead and drop that link to the chat in the
Kasey Stevens | Quality Insights: or link to the
Kasey Stevens | Quality Insights: webin evaluation in the chat.
Kasey Stevens | Quality Insights: Joanna looks like we do have a question today. Do you have any recommendations on a broader, comprehensive kidney education program where patients have transitioned to stage 4 or 5 and heading towards dialysis.
Jillian Pate: Yes. So that is something that you know, I provide in my services. So that's something that if they're interested can provide information for them just to kinda help you get some further education there. It depends on like where your patients are at, but that's you know I am. You know
Jillian Pate: I'm licensed in Ohio, Kentucky, West Virginia, you know any opportunity that I can to help. If not, I can always help you with other dieticians to meet with. I will say we do have with quality insights with our renal network. We do have our kind of our kidney care advocates who work sometimes with like our stage, 4 stage 5 individuals preparing for dialysis. They are great help.
Jillian Pate: So a lot of times I'll even tag team with them a little bit if I have someone that stage 4 Stage 5. They're learning a little bit more about that. Alice's, but they're not at that point yet. I kind of step in and give my expertise, and you know nutritional help there, so that way, we can hopefully maybe hold that progression for a little while longer.
Kasey Stevens | Quality Insights: Fantastic. Thank you so much, Jillian. And if anyone else has any other questions feel free to reach out. But thank you so much for joining us today. And if you have a few moments after the webinar feel free to fill out that evaluation as well. Thank you all so much, and hope you have a great rest of your week.
Jillian Pate: Thank you.