If you’ve got diabetes, whether you’re prescribed medication or not, your doctor may well give you a daunting to-do list with items such as “lose weight”…“cut back on carbs”…“lower your blood sugar”…and “get more exercise.”
The challenging part is that you are on your own in reaching those goals! Most doctors don’t have time to give patients the support they need in managing the self-care of their disease. But help is available.
Many people now depend on health coaches. A coach—ideally a “certified diabetes educator” (CDE), a health-care professional, such as a registered nurse, pharmacist or registered dietitian, with specialized training (see below)—can help people with diabetes navigate the intricate day-to-day details that determine how effectively they will control their disease.
With diabetes coaching, patients usually meet their coaches in person (the frequency and number of visits often depend on insurance coverage). The meetings can be private or in group settings at a doctor’s office or medical center. In some cases, coaches also stay in touch with patients with phone calls, e-mail or Skype. What kind of help will you get? It depends entirely on what you need. Examples…
• Exercise for nonexercisers. Regular exercise is among the best ways to lower blood sugar, improve insulin sensitivity and reduce diabetes-related complications.
However, the reality is that many people with diabetes have never exercised, and you can’t expect someone to go from being totally sedentary to athletic just by saying that he/she should.
A coach looks for ways to ease people into exercise. For example, you might take a 10-minute walk after each meal—but even that might be too much, particularly for someone who’s obese or has other health issues. How about standing up during TV commercials? Even this small step can make a difference. Marching in place is even better. Don’t feel like standing? Try tapping your feet while you sit. From a health coach’s perspective, any activity is better than none.
• Investigating blood sugar spikes. Let’s say you take diabetes medication and check your blood sugar every day. The readings have generally been good, but lately your glucose has been consistently testing high. What changed?
It could be many things. For example, have you had a recent illness? A bacterial infection may raise glucose levels. Maybe you’ve gotten careless with your diet because you’re not testing often enough.
Your coach can help you figure it out. He will look at all of the factors that affect blood sugar—not in general terms, but those that affect you personally.
• Help with carb counting. It’s among the most effective ways to manage after-meal glucose levels. Counting carbohydrates is particularly important for people taking insulin—they often need a higher dose for a carbohydrate-rich meal.
But carb counting can be tricky. Carb plans are individualized, but generally patients are advised to have between nine and 13 carbohydrate choices a day, with each “choice” equaling 15 g of carbohydrate. A coach can help you finetune your carb plan when your glucose is running high.
Example: Many people depend on “eyeball estimates”—they look at the size of an apple or another food and make a quick mental calculation about the carbohydrates. You might be great at estimating…or not so great. If there’s been an unexpected change in your readings, inaccurate carb counting could be to blame. Your coach might recommend that you take a more scientific approach, such as using a scale or measuring cups.
• Real-life monitoring. Many people don’t realize that their glucose is high because they’re not checking their blood sugar levels often enough (the full cost of test strips isn’t always covered by insurance). A diabetes coach will always ask how often and when you’re checking your glucose—and help you find a solution if cost is an issue.
Example: Maybe you should be checking your glucose level more than four times a day but can’t afford it. A coach might advise you to check your glucose around breakfast time one day…around lunchtime another day…and at bedtime on a third day. After a few weeks, the coach will have enough information to identify, in general terms, your blood sugar trends. He can then recommend certain changes—such as eating more or less carbohydrates (see above)—to bring your readings into your target range.
• Strategic eating. To help keep your blood sugar levels under control, a coach may give advice not only on the foods you eat but also on the order in which they are consumed. That’s because research shows that eating protein-rich foods first and saving carbs for the end of meals helps blunt blood sugar spikes. Using this strategy, a person with diabetes having a meal of, say, grilled chicken, broccoli and potatoes should consume those foods in that order to minimize the impact on his blood sugar.
If you have diabetes, a certified diabetes educator (CDE) can give you the kind of attention you need to really get control of your disease. A CDE is a health-care professional, such as a nurse, pharmacist or dietitian, who has met the requirements of the National Certification Board for Diabetes Educators (NCBDE). This certification, which requires 1,000 hours of diabetes-management training, passing an exam and undergoing continuing education, greatly increases your chances of getting reimbursed for the cost of diabetes coaching services. Check with your insurer.
If the coaching is not covered by insurance, depending on where you live, you can expect to pay $30 (for a group) to $200 (one-on-one) for an initial consultation with a coach/diabetes educator, with an additional charge for a “service plan” that includes a certain number of visits, phone calls and/or e-mails. To find a certified diabetes educator near you, go to NCBDE.org.
