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FOCUS ON DIABETES

Well coached

For those new to diabetes or facing complications, one-on-one advice and monitoring can be life-changing.

November 07, 2011|Jessica Pauline Ogilvie
  • Alex Picker, left, talks to his coach Gary Scheiner about his diet.
Alex Picker, left, talks to his coach Gary Scheiner about his diet. (Carolyn Cole, Los Angeles…)

Dan Belisario, 47, first met Gary Scheiner more than 10 years ago. Belisario had just been given an insulin pump for his Type 1 diabetes, and he worked with Scheiner, a diabetes coach, to incorporate the new device into his life.

After he became comfortable with the pump, his visits with Scheiner tapered off; he'd skip a few months, or even a year.

But that changed last September, when Belisario, a sales manager from New Jersey, met with an ophthalmologist.

"There's a vessel in the back of my eye that's swollen," he says; it's a complication of diabetes that results from continued high blood sugar. If the problem continues, Belisario could lose his sight.

So he's begun seeing Scheiner in person every six weeks, at the coach's suburban Philadelphia office. They review Belisario's workouts, meals, snacks and blood sugar readings in great detail. A self-described "constant eater" -- a habit that can keep his blood sugar dangerously elevated -- Belisario also emails Scheiner between appointments with questions and pictures of his food.

For The Record
Los Angeles Times Friday, November 11, 2011 Home Edition Main News Part A Page 4 News Desk 1 inches; 46 words Type of Material: Correction
Diabetes coach: A Nov. 7 Health section article about coaches for people with diabetes said that a study published in 2002 on lifestyle interventions for people with diabetes was conducted by the National Diabetes Education Program. The study was conducted by the National Institutes of Health.
For The Record
Los Angeles Times Monday, November 14, 2011 Home Edition Health & Wellness Part E Page 2 Features Desk 1 inches; 46 words Type of Material: Correction
Diabetes coach: A Nov. 7 Health section article about coaches for people with diabetes said that a study published in 2002 on lifestyle interventions for people with diabetes was conducted by the National Diabetes Education Program. The study was conducted by the National Institutes of Health.

And he has seen the results.

"My blood sugar numbers are the lowest they've been in a long time," he says. He's developed a meal plan to reduce snacking, and counts carbs to within inches of their lives. If his blood sugar stays low, he says, "the swelling in the back of my eye will go down."

For more and more Americans, diabetes is becoming a reality. Rates of the disorder are steadily climbing, and the Centers for Disease Control and Prevention estimates that 25.8 million people in the United States -- 8.3% of the population -- have either the Type 2 or Type 1 version of the disease. Among those born in 2000, the CDC estimates that 1 in 3 will eventually be affected.

Diabetes causes health problems by impeding the body's ability to process glucose, which leads to unregulated blood sugar. Those with Type 1 produce little to no insulin, a protein that controls blood glucose. Those with Type 2, which generally develops in adulthood and is more common among older and overweight people, do produce insulin, but their body has become resistant to it.

Over time, both types can lead to nerve damage, amputations, blindness, kidney failure and cardiac arrest.

In order to mitigate these risks, people with diabetes have to constantly monitor their health. A Type 1 diagnosis means testing blood sugar multiple times a day, and often taking insulin in step with meals and physical activities. Those with Type 2 might also need insulin, along with other medications that lower glucose levels. Nearly all of those with diabetes must make significant changes in the way they eat and exercise.

"For a lot of people, it's almost as if they have a second job," says Nora Saul, nutrition services manager at Joslin Diabetes Center in Boston.

That's how it's felt for Alex Picker, 37, who's had Type 1 diabetes since age 14 but decided to drop some extra pounds this year. "My blood sugars have always been under control, but I've taken my job of managing my diabetes more seriously."

After changing his eating habits and introducing daily exercise, the mortgage banker from the Philadelphia area says he noticed changes: "For whatever reason,"my insulin doesn't work as well."

That's where specialists like Scheiner, who now sees Picker once a week, come in. Though patients with diabetes often have many specialists they can visit -- endocrinologists, dietitians and ophthalmologists, in addition to a primary care physician -- daily management of the disease can feel overwhelming.

"We have done a good job in diabetes care of telling people what to do to manage diabetes -- but we haven't told them how to do it," says Martha M. Funnell, a diabetes researcher at the University of Michigan in Ann Arbor.

The field of diabetes coaching is in its infancy -- no official registry exists, and some diabetes experts aren't familiar with the profession. But many agree that the services coaches provide are an important part of the future of diabetes care, as long as the coaches are reputable.

"You just want to make sure that whoever you're hooking up with has experience in doing this," says Geralyn Spollett, a nurse practitioner and president-elect of healthcare and education at the American Diabetes Assn.

There is no formal required training to earn the title "coach" -- and because of that, those in the profession have varied levels of qualifications and expertise. Many, like Scheiner, are certified diabetes educators: healthcare professionals who are trained to work specifically with people with diabetes. Others are registered nutritionists, exercise physiologists, nurses or certified life coaches.

What they all should offer, though, is consistent help in navigating the daily choices that can mean the difference between good health and the onset of complications, things like preparing three meals a day, taking a walk instead of tuning in to "Law & Order" or bidding adieu to a beloved bedtime snack.

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