By: Barbara Ross
Self-management is the key to healthy living with diabetes, but there are always challenges to maintaining optimum blood glucose levels. Lagging motivation and focus can be obstacles, and adjusting diet and medications to meet changing conditions is challenging. If you have ever wished for a person to help you improve your skills, someone who could offer informed guidance between appointments with your doctor – you may have been wishing for a diabetes coach. Diabetes coaches are personal trainers for individuals with insulin-dependent diabetes. This unique branch of diabetes education delivers ongoing, one-on-one consulting from a trained certified diabetes educator.
A leader in this field is Gary Scheiner, MS, CDE. Over the past 15 years, Gary has developed advanced self-management techniques for individuals with insulin-dependent diabetes. His consulting company, Integrated Diabetes Services, helps people master the skills that can help them meet their personal goals. Coaching is done in person, by phone, by email, through private chats, and by video conferencing, with the goal of making a supportive, personal connection between the educator and the person with diabetes. “Patients come to us through referrals, our website, and through our continuous networking efforts,” said Gary.
Daily self-management of diabetes can feel like a lonely “grind.” A diabetes coach provides ongoing feedback and motivation that can improve results. “I was an exercise physiologist at the Joslin Diabetes Centers in Philadelphia for three years before I started Integrated Diabetes Services in 1995,” said Gary. The Joslin Diabetes Centers are teaching and research affiliates of Harvard Medical School. The institution was a pioneer in including exercise physiology staff as members of the diabetes team. “It was there,” Gary went on, “that I learned about comprehensive insulin care – treating the whole body – covering the emotional, physical, and mental components of living with diabetes.”
Gary shared the philosophy that exercise is an essential part of diabetes self-management and that exercise professionals can help people with diabetes enjoy the benefits of physical fitness through a balance of diet, medication, and exercise. But from his own experiences as a diabetes educator and a person living with type 1 diabetes (he was diagnosed in 1985), Gary also felt strongly that many people with insulin-dependent diabetes needed more guidance, training, and support than was possible at a diabetes clinic. Integrated Diabetes Services was founded on this belief that more could be done.
Gary developed his educator-based, private-pay practice to work cooperatively with the client’s healthcare team and supplement the services provided by the physician. To date, Gary and his fellow coaches have helped nearly 4,000 clients from 45 states and 20 countries to integrate all aspects of diabetes self-management. “Our clients are motivated people seeking out the best and latest information about diabetes. Many are underserved by their current healthcare providers,” Gary commented. “Diabetes coaches fill the ‘gap’ with information and education that diabetes healthcare providers need to give patients with diabetes.”
From his Philadelphia area office, Gary directs a core team of certified diabetes educators, most of whom have diabetes themselves. The practice specializes in intensive blood glucose control for both children and adults with insulin-dependent diabetes. Diabetes management and education services are offered to anyone with diabetes, but they put special emphasis on insulin pump and CGM usage, particularly in children and adolescents with type 1 diabetes. “As diabetes coaches, we provide advanced education as well as insight into how to tweak insulin doses and medications for optimal health.”
What might a diabetes coaching session include? The coach might work with the insulin-dependent individual on practical skills for matching insulin to carbohydrate intake and physical activity. The session might also include strategies for managing the impact of emotions, stress, illness, and aging. Each consultation is built around addressing the individual’s current concerns. The coach may also help the individual prepare questions for the next visit with the doctor.
Gary’s whole approach to diabetes coaching is based on his desire to train individuals to live full, healthy lives with diabetes. His books and educational outreach are one method, and diabetes coaching is another. Gary is happiest when his clients are able to successfully manage their diabetes. “A small percentage of our clients stay on continuously,” he says. “But about half will work with us for about a year and then be able to perform the techniques on their own. Remote coaching is very effective, so we are able to do follow up whenever and wherever it is needed.”
Gary likes to share the techniques he has developed with the larger community of diabetes educators. Recently, he led a webinar for diabetes educators through the American Association of Diabetes Educators (AADE) on the benefits of exercise in glucose control – particularly during the holidays, when festive food and family stress can send glucose levels soaring. While it is not difficult for diabetes educators to teach their patients about the relationship between physical activity and glucose control, keeping patients inspired is more of a challenge. During the online presentation, Gary shared his strategies for motivating individuals with diabetes to begin and continue regular physical activity and exercise.
Webinars are only one way that Gary uses technology to offer his services. Because many of his clients do not live near his office, all of the diabetes coaching services are available remotely over the phone or through the Internet, using email, private chat, or video conferencing. For those who want to learn the latest diabetes management strategies but don’t feel the need for one-on-one coaching, Gary is starting an online webinar program called “Type 1 University.” This program allows people with diabetes to participate in live web-based courses on topics ranging from use of advanced pump features to prevention of hypoglycemia. Pre-recorded courses will also be made available.
In addition to his diabetes coaching practice, Gary Scheiner serves on the board of directors of the Diabetes Exercise and Sports Association and volunteers for the Juvenile Diabetes Research Foundation and American Diabetes Association. He has also written of dozens of articles on fitness and diabetes and is the author of four highly regarded books on living with diabetes: Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin; The Ultimate Guide to Accurate Carb Counting: Featuring the Tools and Techniques Used by the Experts; Get Control of Your Blood Sugar; and You Can Control Diabetes. Think Like a Pancreas has become a popular classic in the area of diabetes education. The book offers practical techniques for successfully matching insulin dose to the body’s ever-changing needs. The book covers Gary’s approach to day-to-day blood glucose control and monitoring, which focuses on identifying an individual’s lifestyle as the basis for designing an insulin program. Gary shares methods for measuring insulin to carbohydrate intake and physical activity and ways to avoid and treat hypoglycemia. Gary also brings his 25 years of personal experience living with type 1 diabetes to a discussion of the pluses and minuses of the various insulin-delivery methods.