This content originally appeared on diaTribe. Republished with permission.
By Jennifer Alvey
Managing diabetes can feel like a full-time job, yet people with diabetes typically spend only 1-2 hours per year discussing management strategies with their provider. Diabetes coaching might help you find more continuous support.
Diabetes requires dozens of decisions daily about how to live—what foods to eat (or avoid), whether exercise and activity are a good idea that day, and the optimal timing for a slew of medications. And let’s not forget checking glucose levels frequently.
It’s a daunting list, and as many people with diabetes observe, managing their diabetes is like having another full-time job. Even with the latest technology, diabetes is high-maintenance.
On top of that, fewer than 5 percent of Medicare beneficiaries and 6.8 percent of people with private insurance use diabetes education services in their first year of diagnosis. With such low rates of initial diabetes education, it’s not surprising that people with diabetes often aren’t comfortable with the basics of diabetes management. Yet it’s far from the whole story.
People with diabetes often rely on their physicians for management tips and new diabetes information. Yet, people with diabetes typically spend 80 to 120 minutes per year, in total, with their endocrinologist or primary care doctor discussing their diabetes management. At least 10 hours of diabetes education every year is recommended to help manage glucose levels and reduce complications of diabetes.
A different path
In the current healthcare system, it’s unlikely that insurance companies will start reimbursing physicians for additional office visits or phone calls with patients, chronic illness or not. Even if diabetes education were easily and widely available at little to no cost, it’s not clear that the majority of people with diabetes would rush to attend.
Many of the struggles faced daily aren’t covered in enough detail in diabetes classes to help with specific dilemmas, such as:
How do I adjust my medication for exercising?
I don’t understand why my glucose is elevated, when I’ve barely eaten anything today.
Why am I not losing weight if I’m exercising daily?
These are, though, the types of questions that many diabetes coaches are equipped to answer.
What is a diabetes coach?
Diabetes coaching is a relatively new field. There is no national training or certification program specifically for it. Many coaches were already certified as a diabetes educator, a nurse, a dietician, or a fitness and exercise expert when they decided to start coaching.
Diabetes coaches are frequently people with diabetes who got involved in coaching so that they could help others like them who faced dilemmas about managing some aspect of their diabetes.
That was true for Christel Oerum. Always interested in fitness, Oerum looked for information on exercising while taking insulin, and found little. Over several years, she dug through medical journals and pieced together information. Ultimately, she started the Diabetes Strong website and wrote Fit With Diabetes, a book about managing fitness and diabetes together.
Oerum is a certified personal trainer who opened her coaching practice to work one-on-one with people who needed detailed, highly personalized information to live the life they want while living with diabetes.
When she works with someone who has diabetes, Oerum reviews CGM records and fitness/food app information, discussing the relationship between certain foods or activities and glucose numbers, and making suggestions.
“People often come with preconceptions,” about what is, or isn’t, possible when living with diabetes, she said. “For example, they’ll say ‘I can’t eat that.’ So I’ll ask them whether that’s a choice they want to make, and why they want to.”
Oerum says she sees her job as supporting her clients outside of the doctor’s office: “I help them think about how to be in control of their diabetes.”
For Marianne McCormick, a diabetes coach, nurse and diabetes educator in New Jersey, the move into coaching was motivated by wanting to repair damage that people with diabetes had internalized over the years from both healthcare professionals and from the culture at large. The constant focus on weight, particularly for many people with type 2 diabetes, results in anger at themselves for not losing weight, McCormick says. Her clients often come to her blaming themselves for their diabetes.
“We know that dieting and food restriction are not producing long-term results for weight loss. We also know that long-term dieting can cause distress and disordered eating behaviors,” McCormick points out.
Her focus with many clients is to help them tune in to the needs of their bodies, rather than viewing their bodies as misbehaving. Focusing on behaviors, such as lowering stress, eating consistent amounts of carbohydrates, and taking medication, is more successful for managing diabetes than focusing solely on the scale, she says.
Meeting people where they are
“There are so many layers behind the numbers,” observed Dr. David Ahn, an endocrinologist and the program director for the Mary and Dick Allen Diabetes Center in Newport Beach, California.
Diabetes increases the mental burden of people who live with it, he says, and that shows up in the increased rates of depression and disordered eating among people with diabetes.
What can help different mental and emotional burdens of diabetes from becoming overwhelming?
According to Ahn, one really important approach is “meet people with diabetes where they are,” and to better understand the personal challenges and goals of each person.
“For example, I had stepped out of the room to get my patient’s A1C,” he said. “It was 9.8, and I thought we would be having a conversation about how upset she was over that. But she was happy. She told me that it was her best A1C in five years.”
While some providers might have criticized that A1C reading, he said he praised her and asked about what she thought had helped her achieve that number.
“It’s important to help people in a way that they can then help themselves,” Ahn said.
Game-changing shifts with coaching
Even those who know what they need to do for diabetes management can struggle. That was the situation that Violet Dutcher, a writing instructor at Eastern Mennonite University, found herself in during the pandemic.
After 15 or so years living with type 2 and keeping her glucose down, the pandemic and lingering grief over the death of her husband several years before led Dutcher to seek comfort in food. “I tried to get a grip on my eating,” she said, “but the strategies I used before weren’t working any more.”
Through her son, who lives with type 1, Dutcher found Oerum, the diabetes coach. “It was a total game-changer,” Dutcher said.
She was ashamed of her eating, her weight, and her A1C, and mentioned that to Oerum. Oerum helped Dutcher shift her propensity to feel ashamed about eating cake or other enticing, if not nourishing, foods. Dutcher said, “She taught me to accept that it had happened, but instead of wallowing, to say ‘OK, time to move on.’
Now, Dutcher says she decides what she eats based on her blood glucose. If there’s something tempting at an event, she checks her CGM. If she’s close to 100, she might indulge, but not if her glucose is elevated. She reports that her A1C is now back in range, and that she has nearly reached her weight goal.
Overall, Dutcher likes the accountability that comes with working with a coach. Her stress level has decreased noticeably—so much so that her coach noticed the difference. Oerum told her she was “a textbook case of low stress affecting blood sugar,”
Looking for a Coach?
Most diabetes coaches maintain an online presence. A simple search for “diabetes coach” will turn up dozens of possibilities to pursue. Because many diabetes coaches work virtually, you may find a better match than if you were limited to local resources in an area without robust healthcare options.
Also, ask your medical team, friends, and other people with diabetes if they know of a good diabetes coach. Quite often, nurses and diabetes educators hear about good coaches, and will happily pass on their information.
The fees for diabetes coaches vary widely. Brief visits might be less than $100, while hour-long visits combined with analysis of CGM and insulin pump information could easily exceed $200. Many coaches will offer package rates for committing to a minimum number of sessions. Ask about rates for the coaches you are particularly interested in.
In general, insurance does not cover diabetes coaching. But if your coach is certified in diabetes education, nutrition, or similar areas, you may get coverage for coaching on those subjects. Be sure to ask your coach or your insurance company.
A person with certification in some aspect of diabetes. A person who has taken a single class in nutrition does not have the depth of knowledge that a registered dietician does.
A person you connect with. Many coaches offer introductory sessions for free or reduced rates. Consider talking with a few before deciding.
A person who will work with you on your priorities, and honor your choices.
A person who does not guarantee a specific weight loss or A1C improvement.
Good, experienced coaches know that their clients move at different speeds through life and through change, and won’t insist on a pace that will send you back into burnout.
Know What You Want
Before setting up any introductory chats, know what you want help with. Maybe it’s understanding more about CGM, or how to avoid low blood sugars after working out. Possibly you need a person who understands living with diabetes and can offer different, more positive ways to deal with the stress of life with a chronic disease.
Countless coaches offer specific programs to get clients to a particular goal. For example, there are numerous diabetes coaches who promote precise diets, exercise regimens, or programs designed to manage type 2 diabetes without medication.
Be wary of coaching that is not consistent with advice from your medical team. Discuss suggestions from a coach with your team before deciding to follow them. There might be pitfalls that you aren’t aware of.
Reputable coaches see their role as supporting your goals. They fill the gap between knowledge and achieving a specific health goal with practical suggestions. They also work with mental and emotional hurdles you may have getting there.
Hiring a coach may be just what you need to lower your diabetes distress and reach your treatment and other health goals.