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Abstract:
Gaps in diabetes care don’t just slow outcomes – they compound risk. In this interview, Registered Dietitian Faith Nacional shares frontline insights from working across type 1, type 2, and gestational diabetes (GDM) in adults, children, and pregnancy. Faith explains the recurring pattern she sees: an over-reliance on medication, minimal follow-up, and widespread misinformation (from “quick remission” myths to confusion around GDM) that leaves clients without a practical plan.
She outlines what effective support looks like – a personalised self-management care plan with clear checklists, ongoing reviews, and a multidisciplinary team (nutrition, medical, and exercise professionals) that aligns lifestyle, monitoring, and medical therapy. Faith also highlights prevention opportunities, how to correct myths compassionately by linking advice to pathophysiology, and why continued professional education matters.
If you work with clients at risk or already diagnosed, this conversation shows how to close the gaps in diabetes care with structured follow-up, tailored nutrition, and coordinated support.
Below is the full interview transcript for you:
Dr Michelle de la Vega
PhD, Research Scientist, VP of Science Education at The Health Sciences Academy
Faith Nacional
Registered Dietitian-Nutritionist, with specialisation in Diabetes, Weight Management, and Nutrition Education
Dr Michelle de la Vega:
Michelle de la Vega here from The Health Sciences Academy. Faith is a Registered Dietitian working with clients for quite a few years now. I’ve known Faith for a while, and she has actually shared with me some of her experiences working with clients as a nutritional professional and Registered Dietitian, where some of the cases shocked me.
So today I wanted to talk with her a little bit more about these topics, especially around the area of diabetes health, which I know you have a lot of experience in. So let’s dive right in and let’s get started.
Faith Nacional:
As I move along with my career, I move on to my interest, which is weight management. And then I discovered that alongside that, there are a lot of cases that revolve around how to manage their blood sugars, or they started off with diabetes, and then they have issues with weight or vice versa.
So it became like a small step for me to learn how to navigate diabetes mellitus problems. And then it expanded from adult care to child care because of the different types of diabetes that have been around. And at the same time, I’ve also had my fair share of experience with pregnant women who are also dealing with the same issues during their pregnancy journey. So that’s mostly how it built up.
- What patterns do you see in how patients with type 1, type 2, and gestational diabetes manage their condition?
Michelle:
So you talked with clients who have type 2 diabetes, type 1 diabetes, and gestational diabetes. So what patterns have you really noticed in how these individuals are managing or not managing, in many cases, their diagnosis or even like a pre-diabetes diagnosis?
Faith:
Right. It’s not that it’s not important, but it’s not the focus. Let’s say, following up, or focusing on nutrition, their physical activity, and their behaviours. It’s more of a straight cut, like here’s the problem, here’s the medication, that’s what we have to do, and follow up with me if there are some concerns or anything. So I think that’s the biggest gap that I’ve experienced from the past, and when I transition in terms of my own private practice. So those are the things that were not really a focus before.
- Have you seen cases in diabetes care where you thought: It shouldn’t have to be this way?
Michelle:
And were there situations where you were with a client and heard the stories, and you were just like, It shouldn’t have to be this way?
Faith:
Yeah, it’s a lot. Like even now, I still experience seeing clients who have the same issues that I’ve encountered in the past. And I’m really surprised, like even though there’s a lot of training available or webinars available that talk about diabetes mellitus, it’s still a recurring problem that I see. So the main highlight or focus of having that balance of medications with their lifestyle, with their nutrition, there are still some things that need to be better, I must say. So it’s quite a bit in the cycle right now.
- How do approaches to medication and follow-up differ between type 1 and type 2 diabetes?
Michelle:
So let’s dive into that a little bit more because I’m curious about the medicine bit, especially in the follow-up afterwards. Let’s separate the two types of diabetes, right? So there’s type 1 diabetes, for which insulin is a requirement. There’s no ands, ifs, or buts about that. You have to take insulin with type 1 diabetes. Can we just dive in a little bit more about: like the difference between the two and not just the reliance on medication, but what have you seen about clients that sort of see losing weight and type 2 or you know what, why do I need to pay attention to the carbs that I’m eating if I’m taking insulin with type 1?
Faith:
I have limited resources. I can rely only on insulin and that’s the problem when you have that kind of mindset or the client have that kind of mindset you don’t need to just like resort to one solution which is like relying on medications alone like what you said because the thing is as we know insulin is like the key to help our body unlock the energy from the glucose that are coming from our food. Because as we know, if we have left diabetes mellitus unmanaged, the life expectancy of an individual decreases, and inevitable things happen, if you can see it. When they are diagnosed, they are so scared. I must say that this is the only way that I can grow.
Because as we know, if we have left diabetes mellitus unmanaged, the life expectancy of an individual decreases, and inevitable things happen, if you can see it. When they are diagnosed, they are so scared. I must say that this is the only way that I can grow.
I would maximise or sacrifice a healthy weight management. So I would go extremely low, very low calories, having to try different diet trends that are not specific or designed for managing diabetes. And in turn, they lose weight in an unhealthy way, but then they don’t realise the complications it’ll bring, in the future if they go the same path. Because if you’re in the stage of prediabetes, for example, you have a higher chance of preventing it from transitioning to diabetes.
- What happens when patients rely only on medication or ignore diabetes management altogether?
Michelle:
Have you seen lots of individuals come to you where they were perhaps diagnosed years ago, and they were just relying on that medication, and now they have those complications. Or they weren’t relying on medication for type 2, and they were just like whatever… I’m not going to do anything. I’m going to try these different diets, or if nothing worked and then ended up getting complications.
Faith:
I have no time to change like this. The initial thing is that here are the medications that you can follow. If you have high blood sugar, then take this more or let’s recalibrate the medications. until such time that it becomes like a habit for him. It’s not like an overnight thing that, okay, I wanted more. And it’s like different from addiction though, because he can control it. But the thing is that’s the first line of defence that he has.
I have heard, “Oh, my blood test after three months has gone higher than before, so I have to go back to the doctor and recalibrate the medication” to the point that it becomes the maximum dosage for him, and there’s no other way but to add insulin, because he was diagnosed as type 2, not type 1. And he discovered it, thinking it was acute. And when I was explaining to him that, no, this happens for a long while, it doesn’t fall into the acute category, but the chronic kidney failure stage already. And that’s a wake-up call for him, like, I should have done this now. The doctors are telling him, we need to do dialysis for you. And that’s the thing that he doesn’t want to do because it’s highly invasive.
We were able to prolong the time before he did the dialysis, and he then appreciates how important that is because that six months’ time he was supposed to have the dialysis. We were able to cut back a lot and change a lot with her blood sugar patterns. However, since it’s too late for him to have that kind of recovery because we’re already on stage four, he said that although it’s late, I still understood what my case is.
Michelle:
Yeah, it’s a really challenging situation, and I can’t imagine how difficult it is for them to realise that all of a sudden clicked that oh my god, I should have done this 15 years ago. I wouldn’t be in the situation if I did these different things.
Faith:
And you know that client Michelle, it’s very rewarding for you to learn from them. Like, see, he realised at that point in time that I could manage this myself. Had I known this, had I been referred to the right people who are very informative, who can discern what the misinformations are that I read on the internet or shared on social media. Had I known this all, I would have been taking care of it better and independently as I can. Having that constant increase of medications can put a lot of pressure on any of her or his system.
So that alone, when he shared with me, had I met you before, like 10 years, 15 years ago, I would have understood my case better.
- What does a personalised self-management care plan for diabetes look like?
Michelle:
Yeah. So you talked a bit about a self-management plan, right? What does that actually mean? Like for someone with diabetes, for example, this individual has type 2 diabetes, so what might a self-management care plan look like?
Faith:
Right, so a self-management care plan doesn’t talk about independently managing it, but as a healthcare provider, as a nutrition professional, you would be able to help the client decide what course of action they should take in the best interest of the patient. Of course, for example, like in my case, I have a lot of colleagues, even I myself have fallen on that pitfall wherein like someone have consulted to me and I just calculated the calories, nothing major, nothing, everything like I would calculate them, give them a menu, but that’s the pitfall that you have to like really be aware of – because the client would always have this one like, okay, what will I do with it afterwards?
So having that self-care management plan is having those guidelines, a checklist that you can give them. Okay, here’s what we’re going to talk about right now. Here’s what we’re going to deal with. You have to come back to me. I always say to my clients that this is not a one consultation. solution for you. You have to follow me through and this is the target that you need to achieve on that, let’s say, first two weeks. So I think having that self-care management is the key to making sure that you are always well synced in with your clients as well.
- How important is teamwork between dietitians, doctors, and other health professionals in diabetes care?
Michelle:
Yeah, and as you mentioned too, that fits within the larger team. So they have the endocrinologist or the medical practitioner that they go to for those HbA1c tests or other exams, or to see how their kidney function is, in that example or the complications. We all have our little specialities, right? We all have our areas.
So to have that care plan but with a care team, almost like a healthcare team, I feel like it’s really necessary, especially for diabetes health, because it’s such a complicated condition. It has all these different complexities, all these different factors that go into it that we sort of need to have – okay, these are the things that you do at home with that self-care plan, here is the checklist that you mentioned, how did you do this week, how are you doing over the first couple of weeks.
But you also have the medical practitioner who’s looking at the molecular side of things, and how the numbers are going in the body.
Faith:
And you know, diabetes mellitus has been emerging in recent studies, and it’s too overwhelming for the client to fully understand everything else. And it’s a multifaceted approach. It’s not like you’re replacing everything. Nutrition professional or one healthcare professional to the other because I’m imparting something different. This is just one part of the information that I’m sharing with you with my expertise.
And I’m not an expert in exercise, or I’m not an expert in molecular science to handle those things. You have to make sure that once you achieve that remission part, which is very rare, to be honest. And I’ve seen it on Type 2 only; I haven’t seen it in Type 1 yet. You still have to go through consultations, follow up, a team of support and everything.
Because the moment you drop it, because they feel that, oh, I am in remission, I’m fine, I’m happy.
- Why is diabetes remission so misunderstood – and what should patients know?
Michelle:
I feel like that’s a big, important point of misinformation about this idea of a quick remission. It’s okay. I went to my doctor. I was just diagnosed with type 2 diabetes, which means that yesterday I didn’t have type 2 diabetes. Today I have diabetes, which means that tomorrow I can go back and not have diabetes.
No, no, no. With type 2, the changes in your body have been happening for probably five to 10 years, and you just haven’t noticed symptoms, for example.
Faith:
You know what? It’s funny, Michelle. I am reminded of this client. She has a very misinformed definition of reversal of diabetes because during her first pregnancy, she was diagnosed with preeclampsia and gestational diabetes. We managed that.
And then she comes back to me for her second pregnancy.
“Oh, I wonder why I had diabetes again, she said.”
I said, “Why?” “I reversed it before when I was with you.”
I said, “What do you mean you reversed it before when you’re with me?” We corrected it.
“Oh, I wonder why I had diabetes again, she said.”
I said, “Why?” “I reversed it before when I was with you.”
I said, “What do you mean you reversed it before when you’re with me?” We corrected it.
“Before I deliver my baby, I have my normal blood sugar. And then the doctor said, I don’t have any diabetes anymore and my baby is okay. My baby doesn’t have diabetes anymore.”
So I said, it’s not reversal. It’s because at that point in time, so again, the definition of diabetes, type 1, type 2, gestational, some people would surprise you that they don’t even understand, like, why they are diagnosed with gestational diabetes. So if a nutrition professional wouldn’t be able to cover those misinformations in their consultations or follow-up, not necessarily on the first one, because it wouldn’t appear.
You would very likely know your client is invested in learning if, on the next follow-up, they would question you about something. That’s what I learned, like some new questions. And then when you ask them, “Where did you hear this from?” “Oh, there’s this guy or there’s this girl who talks about this. And he said with this, you would be able to do this. So you have to make them understand that their situation, even though they present a specific evidence, it doesn’t apply to you because you have this, this, this, this, this.
Oh, so I have to be careful during my next pregnancy now. Because before, she was identified as GDM at a later stage. Now, on her second pregnancy, it was evident that it was the first leading to the second trimester. So what happens with that? So if you are not careful and if you’re not following up with specific nutrition professionals or healthcare providers, there would still be signs or risks that you are actually increasing as you move along in your life. It’s more like giving appropriate information for them to take with them and see that, okay, this doesn’t apply to me.
Even though I hear it or even though it’s a trend, I cannot benefit on this one because I understand fully now what my situation is.
- With so much misinformation online, how do you guide clients to evidence-based diabetes care?
Michelle:
So in addition to misinformation and fighting these billions of myths that are out there, diabetes, health, healthcare and nutrition in general.
Faith:
I’ve been in my practice, and if you are sharing ideas with the other colleagues, with the other dietitians that I have, with the other doctors, the most constant or common answers whenever like this problem arises, like what would you do if a client would ask you this? Oh, just let them know that either they can try and see if it works for them or like it’s not true, plain and simple. But the idea of having to explain to them why it’s not effective for them or why it’s not appropriate for them is still missing. Having them understand, like the pathophysiology of diabetes, would make a huge difference.
So that’s primarily my hope that other nutrition professionals would follow, even healthcare professionals.
- How can health professionals close the gaps and redefine diabetes care?
Michelle:
So you’ve seen a lot of the gaps that are there, right? But also possibilities and positive changes that you can see from working with clients.
How do you believe that we could redefine diabetes care as health professionals?
Faith:
There is no clear-cut solution for diabetes care. It’s a matter of having that kind of cohesive team with the client that will support the concept or the principles behind the diabetes care plan. That is not a problem. And we are still on that reactive part of the healthcare process. In my personal experience, my mother had undergone surgery because of the diagnosis of cancer.
And this actually gave a certain imbalance in the gut and in her diabetes, blood sugar metabolism. It doesn’t have to be from the clinical point of view. It can also start from a preventive part of this one, and if you look at even the different healthcare organisations, the Academy of Nutrition and Dietetics position statement is having that preventive management can really lower the risk of any type of lifestyle issues. And it’s really evident because there’s a study that is saying this, like if we target it in a way that it is more preventive, the life preservation and life expectancy would be higher. I realised that I have more clients coming in when I do that kind of strategy because then word of mouth happens, like I have this dietitian who can help you.
I have a fitness trainer who can help you. So vice versa, we will all benefit. But there is some hesitancy because there is no follow-up that happens. And it’s not about you referring it to the client. It’s about establishing that kind of checklist for you to have a follow-up. So there’s a missing point because sometimes professionals would say, if I refer the client to you, how can I assure that they will come back to me? But that’s not the problem itself.
- What makes the Diabetes Health Continuing Education Diploma different – and why is it so timely?
Michelle:
So, the Diabetes Health Continuing Education Diploma – let’s talk about that a little bit. What do you feel makes this different from other courses that you’ve seen about diabetes health that are out there? And why do you feel like this certification on diabetes health is so needed right now?
Faith:
Apart from the recent studies that diabetes has a complex type right now that we haven’t known for quite some time. I was surprised when we were like going over this type of diabetes alone in a particular module that how many types already are emerging, have been proposed, have been approved in terms of the type and where can you get it, how can you get it, how can you be diagnosed with it, even though they don’t know anything scientifically related to diabetes mellitus, they would be able to like fully understand their case, their conditions, their family member’s conditions when learning this course because it’s more not really in general, but in simple terms, we were able to like really have all the information in place. And what are the materials that we are going to use? Like, of course, we have had months and months of revisions of this course.
And that actually inspires me because even I myself will have my share of experience in diabetes mellitus. I’m really excited about going through the course and seeing like, am I an expert on this? And I’m not confident anymore. When we were preparing the courses, I had so many things like, I never knew this one. This one would make perfect sense for my client, so and so. So that is, rather than attending training and then afterwards, whatever you learn of carb counting, for example, from the last five years, it’s the same.
Wherever the site of insulin injection is, it’s still the same, like this. Because 90% of the professionals don’t have that much time to sit down and go over abstract papers, studies, and revisions of studies in terms of certain principles. So that’s what I’m excited about with the course.
Michelle:
So for those professionals who do want to step up, who want to take their practice to the next level, but really don’t know where to start, right? That’s always a problem. What’s the first step?
What’s one shift that you think could have a more meaningful impact on those who are diabetic?
Faith:
They don’t need to rush it. I have been in their place, wherein I was so excited to be an expert in a particular focus area that I cut corners. And it’s not good. It’s not very beneficial in the long term. I can practice it with my clients or with my family members first.
Don’t think about like, oh, after this, I have to earn more, or I have to do this because you have to make sure that you’re confident enough to really take on clients. And if your focus is diabetes, public health, or those who are at risk for diabetes, such as your client, having that assessment would benefit them because they would realise, like, oh, I have to work on this. I have to have this checklist in place first, and then that would have that snowball effect.
Michelle:
And I really don’t want to take my insulin. Do I have to take my insulin? I have a cold, and I just don’t feel good, and I’m too lazy. What do you do? What is an athlete or a physical trainer who has an athlete on their team who has diabetes?
What do they do if the athlete starts to not feel well in the middle of a training?
So these different aspects of not just, okay, here’s all the information, but here are some of the practical things that you can potentially do as well with that misinformation that you said is so common as well.
So thank you so much, Faith, for sharing all of this very pertinent, very important information from the role of a nutrition professional or a Registered Dietitian that’s been working with clients with diabetes and seeing firsthand all of the different issues that can sort of arise and go forward with. Thank you.
Faith:
I’m very happy that I’ve been part of the creation of this course. It really helped me gauge myself as a nutrition professional. Despite my years of experience, there is always room for improvement to become better with this course. So it doesn’t mean that even though you’re practising for 10 -15 years that you have to stop. There are innovations, there are always updates that we need to learn, constantly learn.
And I’m pretty much very excited to see this course launch because I feel that a lot of professionals and clients alike would really benefit from this. And I’m excited about the upcoming webinar. Anything that can help me support my professional community, the client community, I would be happy to be involved in.
Faith has shown us where diabetes care falls short. On 10 October (Friday), you’ll see exactly how to bridge those gaps with smarter tools and evidence-based strategies. Be part of our upcoming Diabetes Health launch webinar to deliver better outcomes for your clients and patients.
