You've developed diabetes and you've always had trouble controlling your weight. Or maybe your weight is okay, but you're really not sure what, as a person with diabetes, you can eat, should eat—and maybe, more importantly, shouldn't eat—in an effort to control other important factors such as blood glucose, blood pressure and cholesterol. So, as they said in Ghostbusters, who ya gonna call? How about a registered dietitian?

An RD is a food-and-nutrition expert who has at least a bachelor's degree, and maybe a master's degree, in a course of study that's been approved by the Commission on Accreditation for Dietetics Education (CADE) of the American Dietetic Association. An RD also needs six to 12 months of CADE-approved experience at a healthcare facility, community agency or food-service corporation, and must pass an exam administered by the Commission on Dietetic Registration. This health professional could also be a Certified Diabetes Educator (CDE) or an Advanced Practitioner in Diabetes Management (BC-ADM). In short, this is a person who can tell you if what you're eating is good for you, what you might want to eat instead, and how you can best adjust your diet for better health.

"RD/CDEs provide medical nutritional counseling," says Joy Pape, RN, BSN, CDE, WOCN, CFCN, and president of EnJOY Life Health Consulting, LLC, in New York City. "Most doctors do not have the education, training or time to provide this service." As a result, Pape notes, "the doctor usually refers the patient to a diabetes-education program that has an RD/CDE or directly to an RD/CDE who will maintain an open avenue of communication with the doctor on your progress."

"A registered dietitian is an integral member of the diabetes healthcare team," explains Gillian Grant, RN, LDN, CDE, a nutrition-and-diabetes educator in the Nutrition Services department of the Joslin Diabetes Center in Boston. "She can provide education on how foods affect blood glucose and help patients develop individual meal plans."

Whatcha Gonna Eat?
So, is it the RD's job to provide you with menus, recipes and shopping lists to get your diet where it needs to be? Not necessarily. An RD or CDE will, after meeting with you, develop an individualized meal plan, which is an overview of what would be best for you to eat based on your own factors.

"What we've found," adds Pape, "is that, if you were to give a patient a menu and say this is what you're supposed to eat, most people won't follow that. Instead, we set up an individualized meal plan based on discussions with the person and influenced by financial situation, food likes and dislikes, and particularly blood glucose levels, cholesterol, blood pressure, their weight and more."

"The RD can then, through follow-up, help patients modify their meal plans as needed," says Grant. "He or she can further help adjust insulin doses and make medication recommendations depending on blood glucose results. RDs can give valuable feedback to the doctor regarding a patient's eating lifestyle and how it might be affecting the blood glucose levels."

Remember, it's not just what you eat that counts but when you eat. Are you a binger? Do you skip meals? Do you eat heavily at certain parts of the day and lightly in others? Are you an all-day nosher? The RD considers all of these nutritional-lifestyle factors when developing a plan that is right for you, and then offers advice to help you make healthful modifications.

But isn't all this what you would expect to do with your doctor, especially if he or she is a diabetes specialist? "A dietitian is critical because he or she has more time with the patient than the doctor to explore what is going on in the patient's life and how it has impacted food choices, food portions and other eating behaviors," says Grant. "This can directly correlate to a patient's current blood glucose management."

How Ya Gonna Stay on Track?
As either a caregiver or the person with diabetes working directly with the RD, what can you do to help make progress or maintain already achieved goals? Certainly, just following the individualized meal plan you and the RD create is essential. But Grant adds another crucial factor. "Record-keeping is excellent, but even without records, regular follow-up and coming to appointments is critical." And how long might you expect meetings with the RD to continue? "It is possible [you] may only work with the RD over three visits, over three to six months," says Grant. "Some patients keep an ongoing relationship with the RD and have longer times in between follow-up appointments."

So how do you know if a particular RD is right for you? "It takes sitting down and having a relationship with the person," says Pape. "It takes a visit to see if you can relate to the person. Some people have to go through several RDs. They're going to evaluate you, but sometimes the personality matches and sometimes it doesn't. Maybe you need more support, or maybe you don't need that support. So it really takes meeting with the RD, because many times you don't know which you need until you meet that person."

Grant adds that you might want to consider some other specific factors. "One can ask what types of meal-plan options, menu options or other resources the RD has available. How often can the RD meet for follow-up appointments? What are the RD's expectations for progress [as regards] weight loss and change in blood glucose?" Depending on your comfort with the answers, you can tell if this is the right RD for you or your loved one.