Hard Cover, Soft Skills

One of the emphasis points of phone behavior in a call center is soft skills; i.e., words, phrases, and vocal turns to put an agitated or irate customer at ease and receptive to assistance. Address the customer by name (either given name or title/surname, as appropriate); show immediate empathy; listen to the customer; do not use negative words (or if you do, follow them up immediately with positives); use “normal” words instead of “technobabble”… the list goes on and on (which is why there is a whole industry of people hired to teach other people “soft skills”)…

When we find this behavior in our medical care team, we call it “bedside manner”.

In call centers, customer support agents are graded and coached on their soft skills as well as upon their ability to resolve a customer’s issue. An agent’s pay, shift, even tenure is dependent upon the soft skills he presents to his customers.

In most cases, the catch phrases and techniques I associate with the checklist of gradable “soft skills” are phrases I find in speech rather than in writing, unless I am reading something on improving one’s “soft skills”.

Imagine my surprise when I found these same techniques in a simulated interview between diabetes patients and their dietitians, in a book aimed at people with diabetes and those who care about them!

That, friends and readers, is exactly what I found at the beginning of each chapter of 16 Myths of a Diabetic Diet. This book takes a number of the “eschew all, or your care will be as nothing” attitudes towards eating if you have diabetes and breaks them down into their origins, the reasoning behind them, and how modern standards of care and modern research have shown how almost any food can be incorporated into one’s diet, given care, moderation, and a view towards how it fits into one’s overall food plan.

This volume is well-written, with doctor-patient interviews exposing the belief (“myth”), why the patient and/or his family might have come to that belief, and how current medical-nutrition-therapy runs counter to (or at least at some angle of departure from) that myth. The remainder of each chapter explains the history of the myth, the current state of the art, and how one can adjust one’s food behaviors. While the authors – both registered dietitians and CDEs – do not shy away from technical information, they present it in a manner that is understandable by anyone.

If your diet has not changed since the first anniversary of your diagnosis – or if you have been told you can never eat fresh apples again – or if your personal Diabetes Police Force insists that there is nothing you can safely eat – get this book.

Chalmers, Karen Hanson, and Amy Peterson Campbell. 16 Myths of a Diabetic Diet, Second Edition (2007, American Diabetes Association). ISBN-10: 1-58-040287-9. ISBN-13: 978-1-58-040287-9. Paperback, $14.95. ADA order number 4829-02.

Just remember that the biggest myth is that the ADA’s advice for people with diabetes is accurate or effective. It isn’t.

The ADA’s suggested post-meal blood sugar targets–180 mg/dl after meals and the 7% A1c are extremely dangerous for Type 2s who develop a lot of retinopathy at that level and who almost ALL get neuropathy at that level.

Their dietary guidelines promote the low fat high carb diet which has been completely discredited as a way of preventing heart disease and which is known to raise blood sugar and cholesterol to levels that make it almost impossible for a Type 2 to control with diet.

The book does not address the ADA’s guidelines. It shows how thinking about a healthy diet for people with diabetes has changed over time, and provides reasoning for the current thinking. It does not replace the advice of a CDE or nutritionist, but may in some cases provide grist for discussion and thereby, a healthier diet for the patient.

In my experience, the healthiest diet for people with diabetes is the same as for most people without: moderate to low fat, moderate protein… about 15-55-30 protein-carb-fat for most people, with slightly more protein (20-50-30) if you are doing a lot of weight-bearing exercise and have no kidney damage, or slightly less fat (15-60-25) if you have cholesterol issues.

The real keys, IMO, are (1) caloric restriction; (2) reliance on whole foods (fresh fruits and veggies rather than frozen or canned, whole grains instead of white flour, etc.), lowered consumption of animal products, and maximum practical avoidance of chemical processing and preservatives. Unfortunately, there is still a bit of an attitude of “eek – a health food freak!” towards many who prefer whole foods to processed ones, and a lot of, “it doesn’t sell as well as the processed stuff” from the supermarkets and grocery stores.

The issue that we ignore is that of the quality of the food we do eat. It’s not the embrace or eschewal of fat in general, but the embrace of unhealthy fats (butter, fatty cuts of meat) instead of healthy ones (olive oil, flaxseed oil, high-omega-3 fishes), and the embrace of unhealthy carbs (such as refined sugar and high-fructose corn syrup) instead of healthy ones. And the acceptance of a lifestyle that leaves us little time (or little incentive, or both) to eat healthy foods, cooked from scratch, at a leisurely pace.

And of course, the acceptance of a lifestyle in which our most common soft-tissue injuries are Carpal Tunnel Syndrome and Beer Drinker’s Elbow…

Interesting: Joslin’s 2007 guidelines for blood glucose management are a lot more lenient than the ones my doctor said they had published in 2002!
I have been working on numbers of, fasting: non-diabetic, under 100; diabetic, under 110. Two-hour post-prandial: non-diabetic, under 120; diabetic, under 130. Before bed: diabetic, 100-130. A1C depends on the lab; previous labs counted above 5.0 as diabetic with diabetes control goals under 8%; current seems to be under 6.0 is “normal”, with diabetes control goals under 7%. Most medical professionals I know treat to as close to “non-diabetic” goals as possible, given the patient’s overall health and willingness to comply. (Some patients have too many spikes and dangerous dips for doctors to be comfortable treating to under 7%. I believe these are either the minority or Those Who Don’t Care.)