Whether you’ve recently been diagnosed with diabetes and don’t know where to start in changing your food habits, or you’ve been living with diabetes for a while but want more support, you may consider speaking to a nutrition professional. In the US you have two choices, you can use the services of a dietitian or a nutritionist. Although they can be similar and have similar training, they are not interchangeable terms.
In the United States and many other countries, a dietitian is a board-certified food and nutrition expert. They are highly educated in the field of nutrition and dietetics — the science of food, nutrition, and their impact on human health. To earn the credentials of Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN), a person needs to complete the criteria set forth by governing bodies like the Academy of Nutrition and Dietetics (AND) in the United States.
Beginning January 1, 2024, all US dietetics students must also hold a master’s degree to qualify for their RD board examination.
Additionally, thirteen states require that dietitians be licensed in order to practice. The remaining states either don’t regulate this profession or provide state certification or optional licensing.
The dietitian must also continue their professional development by completing continuing education credits, which helps them keep up with the ever-evolving field.
Dietitians are qualified to manage nutrition therapy across a span of acute and chronic conditions. The type of conditions they treat depends most on the setting of their practice. This means that they can treat nutrition problems that may arise from cancer or its treatment, as well as work with clients to manage or prevent the onset of diabetes. Dietitians also treat people undergoing bariatric (weight loss) surgery or those with kidney issues, as these individuals can have many nutritional restrictions and benefit from individualized care to fully meet their bodies’ needs.
In the United States, the title “nutritionist” may encompass individuals with a broad range of credentials and training in nutrition. In over a dozen states, certain qualifications must be met before an individual can call themselves a nutritionist. Additionally, accredited certifications grant titles like Certified Nutrition Specialist (CNS).
In many states, such as Alaska, Florida, Illinois, Maryland, Massachusetts, and Pennsylvania, Registered Dietitians and Certified Nutrition Specialists are granted the same state license, usually called a Licensed Dietitian Nutritionist (LDN) license. In states that do mandate licensure, the CNS or RD credential may be required.
In the U.S. states that don’t regulate the term nutritionist, no degrees or credentials are required. You simply need an interest in the field. Anyone with an interest in diet or nutrition may call themselves a nutritionist. These individuals may apply their interest in nutrition to anything from running a food blog to working with clients. Those without credentials or licensure may pursue approaches to nutrition that are outside the scope of traditional medicine and while some of these approaches may have robust scientific backing, others may not and following their advice could be harmful.
Before consulting a nutritionist, you may want to check whether your state regulates who may use this title.
In an ideal world, patients would be referred to a registered dietitian as soon as they’re diagnosed with diabetes so they can get guidance right away about what to eat — and when — for better blood sugar control.
There is much confusion on what makes a “balanced diet” and with diabetes it can be even more misunderstood. Your diabetes journey can be supported by seeking the advice of a nutrition professional experienced in diabetes. This support and guidance can be invaluable, helping you navigate any dietary changes you need to make, especially if you have been recently diagnosed.
Medical nutrition therapy (MNT), the fancy term for the services a dietitian provides, includes a nutrition diagnosis as well as therapeutic and counseling services to help you manage diabetes. Many private insurance plans cover these services. Medicare Part B covers MNT for diabetes and kidney disease. If you have private insurance, check with your individual plan for specific coverage details.
Not all insurance plans cover MNT if you have been diagnosed with pre-diabetes. Because working with an RDN/CNS may prevent you from going from pre-diabetes to full-blown Type 2 diabetes, it may be worth paying for the visit yourself. The cost for a visit with a dietitian will vary depending on where you live and what type of facility you go to — a private practice, a hospital, or a diabetes center. You can expect to pay between $100 and $200 for the initial visit and about $50 to $150 for shorter follow-up visits.
A Registered Dietician Nutritionist (RDN) or Certified Nutrition Specialist (CNS) can discuss a variety of nutrition approaches to help you manage diabetes. For example, carbohydrate counting, My Plate, simplified meal plans, healthy food choices, exchange lists and behavior strategies.
They can help you figure out what therapy is best for you and will work with you on short- and long-term plans. People with diabetes need to understand how foods and nutrition affect their bodies to successfully manage the disease.
An RDN/CNS can provide detailed information about how to eat and practical tips for addressing daily challenges. He or she can help you to develop a daily meal plan that considers your individual food preferences, level of physical activity and lifestyle choices.
Learning to manage diabetes is complicated so you may need three to five visits spread across three to six months. You may have the option of having one-to-one appointments or joining a group run for people with your type of diabetes (Type 1 or Type 2) that meets regularly. You will learn to read food labels and decide if the food fits your plan. You may be asked to keep a food diary, if you are not already, which will help you see where you need to improve and where you are doing well.
An RDN/CNS can help you set goals and then plan meals to meet them. Your diabetes and nutrition goals might include goals for losing weight, lowering your cholesterol and blood pressure along with maintaining good blood glucose levels.
To get the most out of your first visit, plan to bring with you:
- A food diary. Record everything you eat and when you eat it for at least two or three days in a notebook or using one of the many smartphone apps available. At least one of those days should be a weekend because people tend to eat differently on weekends and to have different activity schedules than during the workweek. Be sure to thoroughly log everything you consume, including snacks, beverages, and between-meal nibbles. In order to help you make improvements, your dietitian will need to get an accurate picture of what you’re currently eating.
- A list of your activities. Exercise is an important part of living well with diabetes. Knowing how often you exercise and what you like to do, whether it’s walking, swimming, biking, or dancing, can help a nutritionist develop your eating plan.
- A list of your medications. Write down the names of your medications, the dosages, and the times you take each one. If it’s easier, just bring your pill bottles with you.
- Your blood sugar levels record. If you have started using a blood glucose meter, bring your meter and logbook to your appointment. If you haven’t been testing your blood sugar levels, they may be able to teach you how to check your blood sugar and guide you on how often you should test.
- Your questions. If you write down your questions in advance, you won’t forget to ask them. List all questions you may have, whether it’s about something you heard on TV, or from a church member, or from a cousin, so they can be addressed and you can be sure you know the facts about managing your diabetes.
At your first visit, your CDN/CNS will also ask you a series of questions to help customize an eating plan for you. She’ll need your height, and weight to calculate your body mass index, or BMI. This information is important to determine whether you need to lose weight. If you do, your dietitian can help you plan menus for dining at home and at restaurants. He or she may also suggest good sources for recipes and healthy substitutions to lower fat and calories in meals.
She’ll also want the details on all other health conditions you have, such as high cholesterol or high blood pressure, arthritis, or allergies, that will affect your nutrition needs, as well as any cultural influences on what you eat. This information will help her to tailor a healthy eating plan for you while taking your preferences into account. Together the two of you will develop a plan that will keep your blood sugar in control but will also be appealing enough so that you will stick to it.
Your dietitian will cover a lot of information during your first session, so it may help to take notes. You can bring along a family member who can help you remember the recommendations. This is particularly helpful if it's the person in your household who does most of the shopping and cooking.
Ideally you should make several visits to the dietitian and follow up about every six months to make adjustments. If you monitor your blood sugar after meals, bring your records so the dietitian can see how your meals and snacks affect your blood sugar. Also bring in a three-day food diary so your dietitian can see what types of foods you consume, and what kind of eating schedule you follow. Make sure at least one day is a weekend day because people typically eat differently on the weekends than they do during the week.
Besides good advice on how to eat healthily, a good CDN/CNS will also offer something more: A sense that you're not dealing with your diabetes alone. If you call your CDN/CNS to ask a food-related question, you can expect to hear an encouraging voice on the other end of the line that's telling you, 'It sounds like you're doing a great job,' and giving you a verbal pat on the shoulder and encouragement that things are going to be okay.
Family Update: I just wanted to let everyone know what is going on with my mom. Early this year my mom was told she was diabetic. Since I got after her and sent her a care package of diabetic friendly products, she has been watching her diet more closely. She finally got in to see the endocrinologist (after a February appointment was cancelled due to snow) and because her original blood work was almost six months old and she had altered her diet, they repeated the blood work. The results came back last week and my mother and the endocrinologist were quite happy. Her A1c went from 10.8 to 7.2. Since my mom is 82 years old, has had her gall bladder removed, and is a cancer survivor, the endocrinologist was pleased with that level and told her they did not recommend any medication at this time. They told her just to keep doing what she’s doing and come back in three months. This made my mother very happy because she did not want to take any medications. The only thing she takes now is a pill for her blood pressure and it’s the lowest dosage available. I will definitely be after her to keep up the good work and continue to watch what she’s eating so she can continue to manage her diabetes without medication.